Looks can be deceiving: Ordinary citizens as sources in health news

Focusing on ordinary citizens in Belgian health news, this study complements a broad content analysis of news sources in print, broadcast and online news collected in February 2015 (N=1998) with a case study of pharmaceutical company Alexion's attempts to use media coverage of patient stories to place the reimbursement of Soliris, their most expensive medicine (approx. 265,000 USD per year per patient), on the political agenda. A literature review shows that in health news, citizen sources often occur as "exemplars" to complement expert interviews and dry statistical information (Hinnant, Len-Riós & Young, 2013). Exemplars are individual citizens' subjective accounts of health and illness, e.g. cancer patients talking about how they experienced chemotherapy. In fact, exemplars serve as a highly valued journalistic tool. Their use is widespread among health journalists because they are considered a very powerful persuasive strategy in conveying complex and abstract medical information that is meant to bring about behavioral changes (Zillmann, 2006). In other words, drawing the audience's attention through the use of exemplars seems a necessary prerequisite for effectively getting across public health messages to large proportions of the population. However, the increasingly commercial logic of many media companies could undermine the 'ideal' situation sketched above on two levels. Firstly, on an evaluative level, the use of emotional exemplars is often negatively associated with tabloidization (Gans, 2009). In order to reach wider audiences, journalists increasingly produce stories that hinge on news factors such as emotionality, exceptionality and drama (Verhoeven, 2008). According to some, this leads to a portrayal of health issues that is too sensational and over-simplified (Levi, 2001). Furthermore, the exploitation of emotional investment through exemplar-use may induce anxiety and incorrect assessments of actual health risks (Zillmann, 2006). Secondly, on a practical level, working conditions in the newsroom are under pressure because journalists are required to produce more content in less time. As a result, prevailing theories on journalistic sourcing practices suggest a greater reliance on elite sources, such as politicians, industrial elites and doctors or scientists (Franklin, 2011). However, while the use of elite sources saves time because it requires less journalistic effort than the use of citizen sources, the very same commercial logic encourages the use of citizen sources as exemplars in order to attract the attention of the widest possible audience through strong emotive appeals (Hinnant, Len-Riós & Young, 2013). Consequently, the reliance on elite sources combined with less time for fact-checking, may create circumstances in which orchestrated PR-strategies of resource-rich stakeholders directly find their way to news content. Health news is, therefore, a particularly interesting case in point for studying the appearance of citizen (and other types of) sources. The results of the content analysis confirm that – contrary to findings in other news beats (Reich, 2015; De Keyser & Raeymaeckers, 2012) – ordinary citizens are important sources in Belgian health news. In fact, ordinary citizens constitute the second largest source category in the sample (18.6%), only preceded by sources stemming from academia (20.5%). Yet this finding is a bit distorted as we have observed large differences across various media types, i.e. ordinary citizens are least frequent in online health news (2%) but are very dominant on the small screen (42.3%). Overwhelmingly, ordinary citizens are represented by patients or friends and family of patients who - due to their illness - cannot appear as source directly, e.g. someone in an advanced stage of Alzheimer's disease. A small minority is represented by vox pop-like contributions, e.g. opinionated tweets about a new health-policy measure, or man-on-the-street interviews to enliven televised news bulletins. Our case study approach, however, underlines that ordinary citizens in health news are not always what they seem. Mid 2013, the Belgian media unwittingly fell prey to the PR-strategy of pharmaceutical company Alexion. It came to light that, in order to get more leverage in negotiations with the Belgian Department of Health Care concerning the reimbursement of Soliris, Alexion had brought in the help of a PR-bureau (G+ Europe) to contact the parents of a young boy suffering from a rare disease (aHUS) that could only be effectively alleviated with a Soliris-treatment. Disguised as a Dutch patient organization, the PR-expert from G+ Europe hired by Alexion, encouraged the boy's parents to contact the media and to tell their story to the world for this would help them get the government to pay for the medicine their son so desperately needed. Not only, did Alexion deceive Viktor's parents, but also Belgian's leading national media outlets fell into the trap of Alexion's very proactive media strategy. Shortly after, through a fine example of investigative and collaborative journalism by two leading newspapers (De Standaard and Het Nieuwsblad), it came to light that the story of Viktor and his parents was not what it had seemed. In other words, while the content analysis of explicitly cited news sources demonstrates that industry sources are scarce (3.3%), our case study tells a different story. Very much aware of journalists' healthy skepsis toward information subsidies stemming from commercial organizations, Alexion indirectly put the reimbursement of Soliris on the political agenda through the use of one very mediagenic young patient and his parents. Although the selected case is linked to the Belgian national context, the media strategy of Alexion, a global pharmaceutical stakeholder, to market Soliris can be observed worldwide (e.g., Australia, Canada, and the UK). This shows that the role of ordinary citizens in health news deserves special attention, not only from a public health communication perspective, but also from a journalism studies perspective. While human exemplars may aid audience understanding of particular issues by raising awareness, the selection of exemplars may reveal the hidden agenda of proactive sources and thus negatively influence health reporting. References De Keyser, Jeroen & Karin Raeymaeckers. (2012). The Printed Rise of the Common Man: How Web 2.0 Has Changed the Representation of Ordinary People in Newspapers. Journalism Studies(13)5-6: 825 – 835. Franklin, Bob. (2011). Sources, Credibility and the continuing crisis of UK journalism. In: Franklin, Bob & Matt Carlson (eds.), Journalist, Sources and Credibility: New Perspectives. New York: Routledge. pp. 90-106. Gans, Herbert J. (2009). Can Popularization Help the News Media? In: Zelizer, B. (ed.), The Changing Faces of Journalism: Tabloidization, Technology and Truthiness. Oxon (UK): Routledge. pp. 17-28. Hallin, Daniel C. & Charles L. Briggs. (2015). Transcending the Medical/Media Opposition in Research on News Coverage of Health and Medicine. Media, Culture and Society(37)1: 85 - 100. Hinnant, Amanda, Len-Riós, María E. & Rachel Young. (2013). Journalistic Use of Exemplars to Humanize Health News. Journalism Studies(14)4: 539 – 554. Levi, Ragnar. (2001). Medical journalism: Exposing fact, fiction, fraud. Ames: Iowa State University Press. Reich, Zvi. (2015). Why Citizens Still Rarely Serve as News Sources: Validating a tripartite Model of Circumstantial, Logistical and Evaluative Barriers. International Journal of Communication 9: 773 – 795. Verhoeven, Piet. (2008) Where has the doctor gone? The mediazation of medicine on Dutch television, 1961-2000. Public Understanding of Science 17: 461-472. Zillmann, Dolf. (2006). Exemplification Effects in the Promotion of Safety and Health. Journal of Communication 56:221 – 237.

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