Innovating the Path to Impact

The brilliance of the HBO medical drama, The Pitt, has more layers than an onion. It's certainly helped to illustrate many of the problems within the U.S. healthcare system which are disproportionately felt by those who staff the nation's emergency departments. However, this is merely the most obvious impact of The Pitt's brilliant storytelling.

The most recent data-driven revelation was the effect that the show has had on viewers in terms of getting them to reconsider (or perhaps truly consider for the first time) many important issues that the medical community has pleaded with patients to think about since the beginnings of the doctor-patient relationship. Planning for end-of-life and considering gifts of life (e.g., blood and organ donation) are both some of the most universally important topics and also subjects that patients (and to a certain extent healthcare workers as well) actively avoid discussing.

This phenomenon has led to many brilliant researchers and marketing experts developing intricate campaigns to affect this trend. Most of these efforts, however well conceived, have proven abject failures. The Pitt, after just one season, has succeeded where these other efforts have failed. Whether intentionally or not, new data suggest that the storylines depicted on the show have had a powerful impact on viewers. While not branded as a public health intervention, The Pitt may be one of the most impactful "treatments" the medical community has ever seen. But before I present the data, I want to discuss the importance of "impact" and how it is measured in healthcare.

Efficacy: How Much of a Difference Are We Really Making?

In medicine and society, we always seem to be chasing the allure of the "wonder drug"—the one pill that will solve whatever health issue we face. Unfortunately, this pursuit often amounts to the hunt for the fountain of youth: alluring yes, but usually fruitless. In medicine, we use the Number Needed to Treat (NNT) to measure the impact of our interventions. This is a wonderfully simple figure that tells us how many people need to receive an intervention (e.g., a procedure, medication, etc.) for one person to benefit.

The NNTs for many of the drugs the medical community considers to be standards-of-care and even "wonder drugs" are shockingly high. As a point of reference, a value of 10 or less for NNT is considered "highly effective." Most medications fall well short of this. For example, roughly 100 people with high cholesterol need to be treated with a statin to prevent a single, non-fatal heart attack. Put differently, 99 out of 100 people who diligently take their statin every day for 5 years will get no benefit from the medication. For baby aspirin, this number is even worse, with likely 200–300 patients taking the medicine with no measurable benefit to prevent just one patient from having a heart attack or stroke.

While hearing these figures may create some understandable disillusionment among those holding out hope that a miracle drug will fall from the heavens to cure what ails them, it serves as a useful reminder for the non-procedural, non-pharmacological interventions that are the most foundational aspects of good medical care—intensive smoking cessation, for example, has an NNT of about 8; exercise programming for low back pain has an NNT of 7. There are probably many more dietary and lifestyle interventions that show similar efficacy; unfortunately, with no drug company to fund the research, many of these questions are left unanswered.

Story as a Tool of Influence

Humans are wired for story. Think about how well you remember facts with a story that anchors it in your memory compared with random bits of floating data. If you can recall where the treaty ending the Civil War was signed, it's probably in some way attached to a life event or story, perhaps a school field trip to Appomattox. Even though the medical community has known this for years, we've consistently failed to harness the power of story for issues that matter most.

Statistics are valuable for communicating data within the medical community, yet we all too frequently try to use these same numbers to persuade patients about important decisions related to healthcare. This is fundamentally flawed as a strategy because decisions about the care of ourselves and our loved ones are necessarily highly emotional. Our rational brains may respond to facts and figures, but our emotional brains only care about stories. And with issues of life or death, people's rational brains are rarely part of the conversation.

An Innovative Strategy

Working in both emergency medicine and palliative care, I encounter patients and their families on a daily basis who are suffering. While physical suffering is usually part of the equation, the more bothersome and refractory form of suffering is the psychological suffering of facing the inevitability of their mortality—an issue they've avoided thinking about for most of their lives. This is a natural reflex that Ernest Becker famously outlined in his classic, The Denial of Death. In order to remain functional, our brains have developed a natural, psychologically protective mechanism that allows us to push aside thoughts of our finiteness, despite a clear understanding among all of us that we will someday die. This is why almost anyone, if asked how they want to die, will respond "in my sleep" (which is a very rare occurrence, for what it's worth).

While protective in our prime and healthy years, this habitual aversion and avoidance to plan for serious illness and death leads to many preventable crises that arise when patients are under my care due to their failure to prepare for the inevitable. This provides people comfort as they navigate the stresses of their quotidian existence, but kicking the can down the proverbial road highly exaggerates the amount of suffering they will experience at the end of life.

An analysis of survey data conducted by UCLA asked approximately 1,500 participants a simple question: were people who watched The Pitt—arguably the most realistic and compelling depiction of emergency medicine—different in their approach to serious, yet painfully neglected, considerations around the greatest and most universal existential issues: serious illness and death? (Full study summary here: https://learcenter.s3.us-west-1.amazonaws.com/ThePittStudy_LearCenter_ResearchBrief.pdf)

The researchers found that, compared to people who did not watch The Pitt, viewers of the show were more likely to seek information and talk to others about organ and blood donation as well as end-of-life care planning. Considering the NNT for most of the medications doctors prescribe, the impact of viewership of The Pitt was remarkable:

NNT for watching The Pitt (vs. not watching):

• Sought organ donation information: 6

• Shared organ donation information: 8

• Sought blood donation information: 6

• Shared blood donation information: 7

• Sought end-of-life planning information: 29

• Shared end-of-life planning information: 11

  
  

  

  (Image Credit: Lear Center. The Pitt Study. Los Angeles, CA: Norman Lear Center; October 2025.)

  
  

This underscores the importance of storytelling in how we educate both the patients who sit in front of us, as well as the public at large. Even if patients can understand factual or statistical reasoning when presented to them in the moment, the messaging rarely sticks and it's unlikely the patient will remember any of the details of the conversation even a few days later. In contrast, with communication through storytelling, this same study found that one in every six viewers were persuaded to take real-world actions on unpopular and routinely deprioritized issues, like end-of-life planning, even after watching a single episode.

If a pill did that, we'd call it a "miracle drug." Heck, it would be considered the medical breakthrough of a generation. Yet, like the fountain of youth or El Dorado, the allure of a "miracle drug" can distract our efforts toward futile hunts. This is especially tragic because, as The Pitt has illustrated, well-done, true-to-life storytelling about the realities of health, illness, and death not only resonates with people, but also compels long-desired (and seemingly impossible) behavior changes.

We spend billions developing drugs with modest effects. What would happen if we spent just a little more doing a better job of telling the human story? This UCLA study of The Pitt's audience is an amazingly simple proof-of-concept study that should lead to larger-scale investment in true-to-life, rather than sensationalized, versions of healthcare. The success of the HBO medical drama has also shown that not only are public audiences able to handle the truth about medical care more than Hollywood has given them credit for, they are craving it.

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So, do we need better evidence? Of course, there will forever remain more clinical questions left unanswered than not. However, what we need most are better-told stories that illustrate the harsh realities of life, death, and healthcare. Thankfully, this is a lower bar to clear than large, randomized controlled trials. We as a medical community simply need to make it a habit of sharing them.

© Josh Russell, MD, FACEP – November 2, 2025