Have you noticed that most sick characters on TV shows look pretty good and are coherent — often feisty — even when they are in the hospital?

Have you caught the number of ads for drugs and health plans showing happy, vigorous people that dominate the major consumer health websites and are common on TV?

Have you noted that websites of disease voluntary organizations (lung, cancer, Crohn’s disease, arthritis) tend to show healthy people participating in “fun runs” or other fundraising activities, in addition to robust, active people going about their daily lives?

Now, I know I don’t look great when I’m feeling sick. I generally don’t appear happy or vigorous either. But I rarely see anyone who actually looks sick online, in print or on TV. The appearance of illness and suffering is slightly more common in images of older people, but as a group they are vastly underrepresented in entertainment, news and advertising.

There is a big, diverse herd of us out here who are ill and who don’t see our experience realistically portrayed by the media. So what?

The inaccuracy of health information as it appears electronically and in print has long been a concern of advocates for specific groups and diseases, public health and some journalists. They are concerned that erroneous and imprecise information and commercial messages affect consumer behavior. Such messages decrease the urgency with which we act to prevent and detect disease and increase our appetite for unproven and/or expensive technologies and drugs.

While it is difficult to draw a clear causal link between inaccurate health information and advertising claims in the media and specific behavior of individuals, there is ample evidence that many of us have only a faint grasp of risk statistics and that we don’t cast a highly critical eye on news and advertising. Further, we are documented under-achievers at following preventive and clinical guidelines and our doctors’ recommendations. Surely, confusing and false media messages contribute somehow.

But what about the images that accompany health information and advertisements? Do these misleading pictures and the dearth of those that portray suffering or discomfort make a difference to us as individuals and as a population? Does the misrepresentation of our reality when we are sick influence our willingness to engage in our health and health care? Does it subtly encourage us to favor pharmaceutical and technological fixes as opposed to, say, making the effort to work out a better plan for managing multiple medications, go to physical therapy or get up and move around a little more?

Though I haven’t found any studies that have asked these questions, it’s worth considering some possible unintended consequences of this distortion of our experience:

• Might the not-so-hidden message communicated by those uber-healthy images in the media — i.e., that illness affects neither our mind nor body — subtly undermine our confidence that we are doing the best we can? Findings from studies of Facebook show that heavy users are less happy than non-users. The unhappiness is attributed to the upward social comparisons people make with their friends. So what happens when we compare the way we feel and look to the media images of people who are supposed to be sick? Do we likewise add to our discomfort? Are we failing if we can’t feel — or at least look — like those happy people?
• On the other hand, might these positive images fuel our optimism and willingness to act on our own behalf? In the collective picture portrayed by the media, the full continuum of health and illness is represented only by pictures of people just getting on with it, illustrating a sort of “pull yourself up by your bootstraps” American ideal. By implication, such images “present health as a permanent condition in which the body and mind should be, if one applies the right doctors, techniques and products, optimal. Cancer, broken bones, obesity, aging, a large nose, small breasts, everything can be fixed,” writes Ferdinand Protzman in his essay The Picture of Health. The media shows us a picture of a desired result, not a series of processes with a reliable failure rate. Protzman notes that it is critical for marketers (and advocates) to represent good health as attainable, since if it is not attainable, it is also not obtainable through purchasing the right drugs, consulting the right doctor, taking the experimental medicine or expending the effort to lose weight or stop smoking.
• Might the absence of realistic images of illness and disability lead the public to underestimate the size of the population that is ill and the impact of poor health on people’s abilities to work, for example? While I could find no studies documenting the effects of the positive depiction of illness by the media, there is no shortage of research and commentary on the effect of the inaccuracy of images of women,minorities and older people. In each case, the authors speculate that this inaccuracy allows the public to overlook both the contributions and the needs of these groups and adds to negative stereotypes and stigma.Does the dearth of accurate images of ill people encourage us to limit our concern only to our own experiences and of those we hold dear and to disregard illness’s impact on those in other neighborhoods and states? Does it contribute to a sense among the general public that people who are ill are fundamentally different or that we sick people simply aren’t trying hard enough to be healthy and that therefore we deserve our suffering?

At a time when highly politicized views on who should have access to what health care through what means are discussed at high volume, I find myself puzzling about how, as a nation, we are able to advocate diverse policies based on such radically different views of how we become ill and whether we need health care when we are. Perhaps the invisibility of our experience of illness in the media plays a role.

Jessie Gruman is the founder and president, Center for Advancing Health. She is the author of Aftershock: What to Do When You or Someone you Love is Diagnosed with a Devastating Diagnosis. She blogs regularly on the Prepared Patient blog.