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Driven by the quest for power, a need for ego gratification, and a desperate
competition for dwindling dollars, medical re-searchers intensely promote their
causes and programs. They do so because they assume that publicity aids in
creating and maintaining goodwill and translates into secure financial support
and the implementation of public policies positive to the organization (Nelkin,
1987, p. 133; Walters & Walters, 1992, 1994a, 1994b; and Evans & Priest, 1995).
To assess the results of their proactive, sophisticated efforts look no further
than the pages newspapers of record, such as the Chicago Tribune, Los Angeles
Times, New York Times, and Washington Post. On the front pages and between the
covers, numerous "discovery" and "announcement" articles dutifully attest to the
success that medical groups have had in gaining access to the media.
Because of these successes, modeling the source-reporter relationship, examining
how that relationship builds the news, and determining how information is
funneled from source to reporter to audience helps in understanding how mediated
reality is created and defined (Weaver & Elliott, 1985; McCombs 1992; Walters &
Walters, 1995).
The Source-Reporter Symbiosis Helps Develop the News
These articles on medical research do not appear magically on their own. They
are the result of a complex, symbiotic relationship between journalist and
institutional information source. Each party needs the other. On one hand,
sources derive benefit from publicity through the mass media. They gain access
to target audiences and the ability to define reality through manipulating the
information stock (Nelkin, 1987; Donafed & Turk, 1985, 1986; Walters & Walters,
1992, 1994a, 1994b). Media placement brings attention to an individual
institution, program, product, service or cause. It may also add legitimacy to
the event covered. That third-party endorsement is due to the credence and
assumption of impartiality that the public attaches to items in the RnewsS
(Walters & Walters, 1992, 1994a, 1994b). On the other hand, journalists and
media organizations derive benefit, too. They receive a flow of cheap, regular,
reliable, and usable information about issues of public interest. (See Walters &
Walters, 1992, 1994a, 1994b for listings of these studies.)
Scholars have created colorful metaphors to describe the relationship between
source and reporter. Gans (1979) called it a "tango." Hess (1981) labeled it a
"personal affinity" that brought together (or kept apart) journalists and their
sources. And, Turk called it an Rinformation subsidyS (1985).
No matter how the relationship is described, the media and public relations
offices do work together. And, they must. For, whatever else is true, data have
shown consistently that media organizations have neither the economic resources
nor the time to cover the entire story of the day.
The relationship can be seen plainly in the medical news cycle. It begins with
academic papers that are often simultaneously published and announced to
reporters at orchestrated pseudo-events like press conferences. Then, the
reporter breathlessly RrevealsS the findings of the studies to the readers
(Walters, 1992).
Even in the midst of this cycle, reporters loudly assert editorial independence
from the RhighwaymenS who inhabit public relations office. At the same time,
they rationalize using public relations office output. Reporters say that
Rbalancing of opposing viewsS and Rsource attributionS neutralizes inherent
one-sideness in the coverage of this news.
While such might be true in a perfect world, lack of balance often occurs. It
can be because of economic necessity, lack of expertise, or just plain
ineptitude (Schoenfeld, Meier, & Griffin, 1979; Mazur, 1981; Dun-woody & Scott,
1982; Dunwoody & Ryan, 1983; and Walters & Walters, 1991).
That ineptitude is partly the result of the perspective from which many
reporters view science and medicine. Wishing for neat solutions, some cling to a
textbook view of science as a well-managed, orderly, and predicable field. In
reality, the acquisition of science is messy, filled with dead ends, and
cluttered with uncertainties (Moore, 1989).
Because many reporters look for simple solutions and are unable to follow
paradigms, translate statistics, or independently evaluate the merits of
conflicting assertions, they have become what has been de-scribed as incompetent
Renough to cover anythingS (Cohn, 1989).
Such incompetence makes many science reporters unusually dependent upon sources,
and creates the potential for a handful of Rarticulate star-qualityS scientists,
who gather the most attention, to impact profoundly news content (Moore, 1989;
Cohn, 1989; Turk, 1985; Walters & Walters, 1991; Walters & Walters, 1992, 1994a,
1994b; Kreighbaum, 1967; Goodell, 1975; Walters & Walters, 1991). This danger is
heightened since Rthe press tends to print the views and interpretations of
individual authorities rather than report the results of actual studiesS
(Shephard, p. 134).
Besides obvious problems with errors and omissions, using information from a
small pool reinforces a narrowness of perspective. Each source may promote
selective perceptions. Therefore, a reporter's choice of sources becomes
critical, determining not just who, but what, will be given RstandingS as an
authoritative voice. This selectivity becomes critical because each source may
have a different philosophy, organizational background, or primary goal. And
because of this, each may focus on a different aspect of an event, discovery, or
development.
The tendency of newspapers to pull medical stories from the wire service
compounds the problem because a small number of reporters interpret science news
for each other and the public
For these reasons, the classical balancing of viewpoints does not occur when an
articulate claims maker dominates the information scene. When this happens, the
one who reaches the broadest audience first gains the upper hand in creating the
dominant scientific ideology. And, as Noelle-Neumann (1984) points out, RWhat
does not get reported does not exist, or ... its chances of becoming part of
ongoing, perceived reality are minimalS (p. 150).
It follows, then, that the ability of the media to give RstandingS (to include
or exclude information from sources) adds or detracts to the context in which a
health issue becomes defined, recognized, and considered as a social problem.
Purpose of this study
Life on the Edge of the Precipice: Information Subsidy and Rise of AIDS as a
Public Issue, 1983-1989 examines a source-media relationship in a nonelection,
nonpolitical context using quantitative methods to study the development of AIDS
as an issue. Using a concept known as Rinformation subsidy,S the study focuses
on sourcing patterns in the Chicago Tribune, Los Angeles Times, New York Times,
and Washington Post from 1983-1989 to see 1) if there was a subsidy, 2) the
source of that subsidy, and 3) what effect, if any, that subsidy had on short
and long-term issue development.
Methodology
To demonstrate how the process of information gathering and dissemination worked
with respect to the development of AIDS as an issue, a time-series analysis
using monthly counts from Readers Guide, Indicus Medicus (a medical index), and
those of the Chicago Tribune, Los Angeles Times, New York Times, and Washington
Post. was performed.
Samples were drawn from the four newspapers for the period from 1983 to 1989, a
time period in which the nature of AIDS as a potential epidemic was first
recognized. These were drawn using a computer program to develop constructed
months for each year. Using a computer program, samples were chosen from one
constructed month for each year. Data were gathered from each newspaper using
the same constructed month.
To develop a source-comment matrix from the articles sampled, all sources and
their messages were identified by two coders with the paragraph as the unit of
analysis. A second coder analyzed 25 percent of all data sets, and intercoder
reliability was .920.
Each source was categorized according to affiliation. The nine broad
institutional affiliations were: 1) Federal Elected Officials, including U.S.
Senators and Represen-tatives; 2) Federal Health Authorities, including the
Secretary of Health and Human Services and officials of the Centers for Disease
Control, Atlanta, among others; 3) State and Local Elected Officials, including
governors and mayors; 4) State and Local Health authorities, including city and
state boards of health; 5) Research Physicians; 6) Others (people with AIDS,
physicians, and religious leaders); 7) Private Organizations, including the Red
Cross and the National Hemophilia Society; 8) Gays and Gay Organizations; and 9)
Unattri-buted.
The two coders also examined each paragraph for issue comments. These fell into
14 broad categories defined by Walters and Walters (1991). The categories were:
1) Cause: What caused AIDS; 2) Cure: How AIDS might be cured; 3) Education:
Developing a public education program; 4) Funds: Who pays and how much; 5
Discrimination: Legal, medical and personal; 6) Policy: What public policy is
best; 7) Prevention: How AIDS might be prevented; 8) Risk Groups: Who is at
risk; 9) Statistics: How many had it or could be projected to get it and how
many have died; 10) Testing: Development and proposed use; 11) Transmission: How
it is spread; 12) Treatment: Drugs and other methods; 13) Symptoms: How to tell
if you have it; and 14) Others: All others.
From this data a source-comment matrix was developed for individual newspapers,
for specific years, and for combined newspapers and years.
Results
A time-series analysis used monthly totals of articles in each newspaper as the
dependent variable and the monthly total of articles in Reader's Guide and
Indicus Medicus. The data showed a strong relationship between the number of
newspaper articles and the number of articles in ReaderUs Guide and Indicus
Medicus. (See Table 1.)
A sourcing check of the newspaper articles confirmed the time-order (direction)
of the information flow. More than 90% of the articles were the product of news
conferences or public relations activities such as findings, bureaucratic
meetings, or press releases previewing forthcoming academic papers or
presentations. Only about 10% were the result of investigative reporting.
The Quantitative Connection
A total of 8,210 paragraphs appeared in the cumulative sample drawn from all
newspapers in period from 1983 to 1989. Of this total, 413 appeared in 1983, 136
in 1984, 826 in 1985, 1,144 in 1986, 3,077 in 1987, 1,641 in 1988, and 964 in
1989.
Of the identified groups, Federal Health Authorities were the most used both in
1983 and cumulatively over the entire period. The cumulative top four sources
over the time period were in order: Federal Health Officials, State and Local
Health Officials, Private Groups, and Research Physicians. At the bottom of
those selected for use in these newspapers were, starting with those least used,
Private Physicians, Gays and Gay Groups, Federal Elected Officials, State and
Local Elected Officials.
Over the time period, the Private Groups and Research Physicians rose
dramatically as sources used. In 1983, Private Groups and Research Physicians
were about 9 and 5.7 percent respectively of sources used, while cumulatively
Private Groups and Research Physicians were about 14 and 13 percent respectively
of the sources used. Federal Health officials fell from the 1983 figure of about
33 percent of sources used to a cumulative 15 percent.
Despite these fluctuations in magnitude, a comparative chart based on SpearmanUs
Rho showed that the rank order pattern of source usage was relatively stable
from year to year during the entire time period and that 1983 set the pattern
for the cumulative period with respect to sources. (See Graph 1 and Table 2.)
Only 1985 and 1988, with Spearman's of .492 and .438, slipped below the .500
mark from the sourcing pattern set in 1983. In 1985, the top four sources were,
in order, State and Local Health Officials, State and Local Elected Officials,
Private Groups, and Research Physicians. In 1988, the top four sources were, in
order, Research Physicians, State and Local Health Officials, Federal Health
Officials, and Private Groups.
Differences in sourcing patterns also emerged between the newspapers over the
time period. (See Graph 2.) Examined as a percentage of total newspaper
paragraphs, Federal Elected Officials were more often used in the Washington
Post and the New York Times than in the Los Angeles Times and the Chicago
Tribune. The Chicago Tribune more often used Federal Health Officials than did
the other newspapers, while the New York Times used Private Groups more often
that did the other newspapers. The New York Times and the Washington Post used
Research Physicians less often than the other newspapers, while the New York
Times and the Chicago Tribune used State and Local Health Officials more often
that did the Washington Post and the Los Angeles Times.
These findings not only seemed consistent with respect to perceptions about the
newspapers as products of the media and geographical environment in which they
operate, they also were consistent with reporting traditions.
Less consistency existed between the topic pattern established in 1983 and the
cumulative totals for the period 1983-1989. (See Graph 3.) While the top two
topics for discussion in 1983 were Cure and Cause, the top two for the
cumulative period were Policy and Education.
Because of the consistent sourcing patterns, the change in topic of discussion
was not so much the product of changing sources as it was the result of charging
focus of the sources selected. Except for 1984 and 1986, the ranking of the
messages used in 1983 had little in common with later years. Conversely, 1987,
1988, and 1989 showed topic stability with respect to the cumulative message
stock. Used as the base year, 1987 had a Spearman's of .771 with 1989 and .703
with 1990 and the Cumulative Spearman's was .588 for 1985, .669 for 1986, .913
for 1987, .736 for 1988, and .690 for 1989.
The differences in the cumulative totals for categories of topics reflected the
changed messages of those sources with the most access to the media over the
time period, as well as the aberrant source patterns of 1985 and 1988.
This became clear after looking at a chart of the cumulative top four sources
and the main topic of discussion for 1983 and for the entire period, and an
analysis of 1985 and 1988.
The rank order of the top four sources remained constant over the time period,
However, the principal topics of those sources, except for Research Physician,
did not. The data also suggested that the evolution of AIDS as a public issue
had a compacted, and somewhat different, topic cycle when contrasted to earlier
epidemics of RsocialS diseases.
Those who have studied analogous problems, such as syphilis, have found a
consistent three-part pattern in the media coverage of the health issue.
Typically, in the first stage, mediated messages take on moral overtones. In the
second stage, the media begin educating the public and covering the legal
maneuvers aimed at containing the disease. In the third stage, the coverage
focuses on the attempts to find medical treatments for the illness, with less
emphasis on morality (Fuller & Myers, 1940; Tuchman, 1973; Strodthoff, Hawkins,
& Schoenfeld, 1978; Schoenfeld, Meier, & Griffin, 1979; and Walters & Walters,
1991).
Differences between the coverage of AIDS and previous epidemic,s such as
syphilis, were many. First, most AIDS topics in all phases were centered around
policy. Second, discussion of AIDS in moral overtones did not occur until Phase
2. Even so, this discussion was more connected with preventing discrimination
than in enforcing morality. Third, the final phase of AIDS coverage was more
concerned with policy than with treatment, as had been found by studies of
previous social diseases.
The cumulative matrix of topics demonstrated the changing dynamics of the debate
over the time period. (See Graph 3.) While Pre-vention, Symptoms, and Treatment
appeared to remain relatively constant over the time period, Cause, Cure, and
Discrimination diminished and Funding, Policy, and Risk groups increased.
Education, Statistics, Testing, and Transmission had cyclical patterns that rose
and fell like a sine, pulsing wave-like through the period.
The source pattern-aberrant years 1985 and 1988 also contributed to the
truncated topic development pattern. The selected sources helped push discussion
from moral to policy and funding issues. In 1985, the top four topics of the top
four sources were: State and Local Health Officials -- Policy, Transmission,
Treatment and Education; State and Local Elected Officials -- Policy,
Discrimination, Funds, and Transmission; Private Groups -- Discrimination,
Policy, Transmis-sion, and Symptoms; and Research Physicians -- Cause, Cure,
Policy, and Funds.
In 1988, the top four topics of the top four sources were: Research Physicians
-- Other, Cause, Risk Groups, and Discrimination; State and Local Health
Officials -- Policy, Funds, Statistics, and Testing; Federal Health Authorities
-- Statistics, Treatment, and Risk Groups; and Private Groups -- Policy,
Treatment, Funds, and Statistics.
If the periods were subdivided into phasic groups using Spearman's as the factor
by which to group the related years, 1993 and 1994 would be grouped together, as
would 1995 and 1996, and 1987, 1988, and 1989.
Examined in this manner, AIDS coverage was different than that of earlier
epidemics of social diseases. Instead of a initial discussion tinged with moral
overtones, the AIDS debate launched into policy-related problems, followed by a
concentration on discrimination, policy, and education
Discussion and Conclusions
During the period from 1983 to 1989, an information subsidy flowed from sources
to the four newspapers of record. While the sources of AIDS information remained
relatively stable, the topics considered did not.
As might have been expected, Federal and State and Local Health Officials played
a prominent role over the time period. But private groups, such as the Red Cross
and the National Hemophilia Society and Research Physicians also played a
considerable role. Health officials mostly discussed standard fare -- Cause,
Cure, and Policy. Risk Groups, Private Groups and Re-search Physicians advocated
their respective causes.
Research Physicians promoted efforts to look for the cause of the disease, while
demanding more money to find a cure.
Private Organizations stated their cases, cleaving along lines of risk
assessment. On one hand, the Red Cross and other blood banks defended policies
concerning donations and blood bank safety, protecting their vested economic
interest. On the other hand, private organizations, such as the National
Hemo-philia Society, demanded closer scrutiny of safety issues because their
members were infected with a fatal disease.
Indicating a changed reporting perspective (and perhaps societal values as well)
on the connection between public health policy and morality, the topic patterns
relative to AIDS differed from those of historic models. Because of the changed
perspective, AIDS was addressed as less of a moral problem and more of a public
policy problem.
Despite the shift from morality to policy, the AIDS discussion suffered because
a RtechnologicalS view of medicine was emphasized over a Rhumanistic one.S The
discussion of solutions was framed in the wizardry of new science, rather than
in more mundane realm of human responsibility and compassion (Nelkin, 1989).
That technological frame of reference could have been produced by several
influences. But, certainly the prevalence of public-relations backed research
physicians to whom RstandingS as a source was conveyed was a major contributory
agent.
This emphasis was not novel to either the time period or the issue. It is deeply
ingrained in the mediated culture of America, dating at least to medical news
coverage of the researchers who produced such RwonderS cures as penicillin
(Walters & Walters, 1991; Moore, 1989; and Evans & Priest, 1995).
In the United States, as perhaps in no other country, the driving medical
ideology has focused
... on cure rather than prevention, and is driven by a view of the body as a
machine, hospitals as repair shops, and physicians as master mechanics. It is a
view that sees cost as no barrier, and to a certain extent, prefers to ignore
the common or mundane in pursuit of technical or engineering challenge. (Gandy,
1982, pp. 95-120)
Glorified on stage, screen, and in fiction, these depictions have become an
integral part of the culture. As Thomas Thompson (1976) described them, star
quality physicians exist in a world apart. They are
performers in a dazzling theater packed with assistants, nurses, paramedics,
and a battery of futuristic equipment which could seemingly lift the room into
outer space. These are men who relish drama, who live life on the edge of the
precipice. (p. 45)
Thus, in fact and fiction, the mass media have helped create, and reinforce, a
magic bullet message. Some scholars believe these messages contribute to a
willingness to support expanded government funding for medical research and a
demand for more high technology medicine (Gandy, 1982; Bennett, 1977; and
Wildavksy, 1977).
As one theory posits this self-fulfilling cycle, the public wants interesting
stories about struggles against disease or hopeful news about a cure just around
the corner. The physician-researcher needs publicity and prestige brought by
media coverage for power, money, and glamour. Therefore, the medical
institutionUs public relations office and the press work hand-in-glove to meet
the RperceivedS public need (Page, 1970; Moore, 1989; and Evans & Priest, 1995).
While public expectations may be contributory, the RGee WhizS news frame has
become less of an audience fashioned-problem and more of an editorial flaw
(Walters & Walters, 1996). As less and less knowledge is gained through
first-hand experience of science, the audience has become more and more
dependent upon mediated reports. Exacerbating the problem is the rise of
corporate medicine and reduced personal contact with physicians.
Questions that arise about which medical research from which source become facts
become more critical in a high-tech society in which information and control are
unevenly distributed (Evans & Priest, 1995). The sources given RstandingS as
outlets for information contribute mightily to the discussion.
This is an age in which all parties in the health debate must concentrate on an
equitable distribution of scarce resources. Therefore, editors and reporters
must rethink the process of how they gather, analyze, and distribute the news.
In doing so, they (and the people who train them) must address basic questions
about what Radequacy,S Raccuracy,S RbalanceS and the blending of fact and
fiction mean with respect to reporting of medical news (Evans & Priest, 1995).
Can adequacy be defined in terms of objectivity? Does such objectively mean
accuracy, or balance, or a multiplicity of sources? Does objectivity vary from
audience to audience? Or, are such concerns even relevant in examining coverage
of medical science?
How can the truth-claims of competing purveyors of RfactS be validated? And, how
can the needs of concerned citizens be reconciled with the blurring of the
boundaries between fact and fiction?
Because of such complex questions, newspapers and other media outlets (and those
who train the editors and reporters) should seriously weigh the consequences of
reporting practices as they seek to serve the public interest. This is important
today and will be all the more critical tomorrow as we move in an era of
diminished resources, managed care, strident public outcries over division of
available resources, intense media competition, and increasing generational
strife.
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