Rules of engagement: Journalists’ attitudes to industry influence in health news reporting

Abstract

Health-related industries use a variety of methods to influence health news, including the formation and maintenance of direct relationships with journalists. These interactions have the potential to subvert news reporting such that it comes to serve the interests of industry in promoting their products, rather than the public interest in critical and accurate news and information. Here, we report the findings of qualitative interviews conducted in Sydney, Australia, in which we examined journalists’ experiences of, and attitudes towards, their relationships with health-related industries. Participants’ belief in their ability to manage industry influence and their perceptions of what it means to be unduly influenced by industry raise important concerns relating to the psychology of influence and the realities of power relationships between industry and journalists. The analysis also indicates ways in which concerned academics and working journalists might establish more fruitful dialogue regarding the role of industry in health-related news and the extent to which increased regulation of journalist–industry relationships might be needed.

Keywords

Health news health-related industries journalists conflict of interest qualitative research

Introduction

Relationships between the ‘fourth estate’ of modern democracy – the news media – and their sources have long been considered an important focus for research and debate (Cottle, 2003; Hodgetts et al., 2008). Researchers have often characterised journalist–source relationships as a struggle for power – particularly definitional and agenda building power – and have sought to determine which party dominates (Blumler and Gurevitch, 1981; Carlston, 2009; Gandy, 1982; Reese, 1991; Schlesinger and Tumber, 1994; Schudson, 1989). In the political domain, Gans (1979) famously characterised the journalist–source relationship as a ‘tug of war’ or ‘tango dance’, since demonstrated to be most commonly led by sources, who frequently initiate stories and on whom journalists rely heavily for copy (Bennett, 2003; Davis, 2009; Fishman, 1980; Franklin, 1997; Gandy, 1982; Lewis et al., 2008; Reich, 2006; Stromback and Nord, 2006; Tiffen, 1989).

Concerns about journalistic independence and the quality of news reporting have been exacerbated by the post-war rise of the public relations (henceforth PR) industry and its exponential growth since the 1980s (Miller and Dinan, 2000). The PR industry has developed numerous strategies for public engagement, many of which make use of the news media (Schlesinger, 1990). These strategies blur the boundaries between marketing and other genres of communication and are therefore less transparent and more difficult to regulate. In this context, the role of expert journalists as professional ‘third parties’ – intermediaries between sources and their audiences (Greene, 2009) – is believed to be increasingly important. However, the ability of journalists to adequately fulfil this function has been questioned in light of a number of factors including the advent of the 24-hour newscycle and the reduction in resources to support news production, which promote increasing reliance on sources. These forces have arguably forced journalists into the role of ‘secondary’ rather than ‘primary’ definers of news stories – as reproducers of the perspectives of privileged sources (Benelli, 2003; Greene, 2009; Hall et al., 1978; Johnson, 1998; Len-Rios et al., 2009; Schwitzer, 1992).

Relationships between journalists and industry sources have recently been subject to particular scrutiny in the health domain because of concerns that health-related industries may be inappropriately influencing news content in ways that enhance their already extensive social power and threaten public well-being (Davis, 2003; Gandy, 1982; Gans, 2011; Greene, 2009; Johnson, 1998; Moore, 1989; Moynihan, 2003a; Moynihan and Sweet, 2000; Schneiderman, 2007; Schwitzer, 1992, 2005). There is no doubt that health-related industries use numerous strategies to engage with journalists, such as sponsoring awards for medical journalism, providing educational grants, sponsoring travel to medical conferences, providing media content in the form of press releases, including multimedia releases and video news releases (VNRs), and providing access to industry-sponsored medical ‘experts’, researchers and consumers (Goldacre, 2007; Greene, 2009; Helwig, 1989; Johnson, 1998; Len-Rios et al., 2009; Moynihan, 2003b, 2011; Moynihan and Sweet, 2000; Schwartz et al., 2008; Schwitzer, 1992; Sweet, 2001). The conflicts of interest that may arise from these forms of engagement are of particular concern given that many commercial products have a significant public health impact and account for considerable public and private expenditure. Pharmaceuticals, medical diagnostics and devices, complementary and alternative medicines (CAMs), food and beverages, for example, all have the potential to impact on public health. Furthermore, these relationships are significant because health-related news is a major source of health information for many people and has been shown to have significant public health effects, perhaps even beyond those of well-funded government public health initiatives (Grilli et al., 2002; Moynihan and Sweet, 2000; Schneiderman, 2007; Seale, 2003; Stevens, 1998).

Despite vociferous debate about the impact of industry interests on health news reporting, and the role that journalists play in mediating these impacts, to date, there has been little empirical research into the range of, attitudes towards and management of relationships between journalists and health-related commercial industries (Mebane, 2005; Moynihan and Sweet, 2000; Schwartz et al., 2008; Seale, 2003; Sweet, 2001). Although numerous studies have examined the frequency with which activities of PR representatives succeed in initiating, framing or appearing in news content (Bollinger, 2001; Lewis et al., 2008; Morton, 1998; O’Neill and O’Connor, 2008; Reich, 2010; Walters and Walters, 1992), only a few studies have specifically focused on the health domain (Cho, 2006; Dunwoody, 1978; Len-Rios et al., 2009). Furthermore, existing studies consist almost exclusively of content analyses of news products and so do not capture the social and subjective dimensions of industry–journalist relations, which could contribute to our understanding of industry influences on health news. Finally, data in this area has a significant North American bias, and no studies have been conducted in Australia. This is important because the role of health news as a source of publicity for health-related industries may differ significantly between countries that permit direct-to-consumer advertising of prescription pharmaceuticals (such as the United States) and those that do not (such as Australia). Here, we describe a qualitative study of engagement between journalists and health-related industries. The aim of this study was to inductively characterise the most salient social and subjective dimensions of this engagement with a view to understanding why, how and to what effect journalists reporting on health engage with representatives of health-related industries in Australia.¹

Methods

In order to capture the social and subjective dimensions of journalist–industry interactions, we conducted in-depth, semi-structured interviews with journalists reporting on health in Sydney, Australia. Journalists reporting on health in television or print media were identified through searches of the Australian Health News Research Collaboration (Chapman et al., 2009) and Factiva databases. Purposive and snowball sampling were then used to ensure a broad range of perspectives were included. Sixteen journalists responded to our request for participation in the study, of whom 13 agreed to be interviewed. Participants included journalists working in television and print media, commercial and non-commercial news stations and publications and specialist and generalist journalists, as well as four ‘expert journalists’ (defined here as medical doctors or nutritionists who also write or present health-related news). All three major Sydney newspapers and four of the five free to air television stations in Sydney were represented in the sample.

Each participant was interviewed about their knowledge and experiences of industry attempts to influence health news reporting, their approach to managing industry advances and their views on the desirability or otherwise of industry involvement in the generation of health news. The interviews were digitally recorded, transcribed and deidentified.

Two researchers independently read interview transcripts and identified prominent themes in the data. The data were considered in relation to the literature referenced above and throughout the remainder of this article. The team worked towards interpretive consensus through discussion of results in team meetings and in the process of drafting this article.

The initial inductive phase of data analysis enabled the material to be organised into two distinct categories – how journalists viewed and managed direct attempts by health industries to influence their reporting, and how they approached industry influences mediated through academia. This article addresses the first of these areas of inquiry with a view to answering the following research questions:

How does industry seek to directly influence journalists’ reporting of health-related news?

What are journalists’ attitudes to relationships between journalists and industry?

To what extent, and in what ways, do journalists choose to engage with industry?

The study was approved by the University of Sydney’s Human Research Ethics Committee.

Results

Methods of industry influence

Participants described a range of ways in which industry sought to influence the reporting of health news (see Table 1). The most common of these were direct approaches by industry (generally via their PR officers) to journalists with press releases or material that they thought might be of public (or media) interest. This was usually followed up by an email and telephone call:

Table 1.

Methods for influencing health news reporting.

Getting involved in the news production process	Pitching stories and providing story content directly to journalists	Providing expert or patient ‘talent’
		Providing video news releases
		Organising photo shoots
		Organising press conferences
	Responding to negative stories	Threatening to take an alternative perspective to a competitor
		Withdrawing advertising
		Threatening to sue
Funding projects that might generate positive press	Research	Conducting in-house surveys/polls
	Patient programmes	Funding patient awareness campaigns
	New media campaigns	Setting up social media campaigns
	New media campaigns	Posting on blogs
	Events	Sponsoring disease awareness days/weeks
	Events	Sponsoring sports events
Establishing relationships with journalists and cultivating a positive perspective	Organising and funding education for journalists	Convening seminars/workshops
		Organising education trips, e.g., to factories or conferences
		Bringing a visiting scholar
		Providing research updates and information
	Offering inducements	Sponsoring journalism awards
		Providing gifts/product samples
		Funding travel
		Paying for meals
	Sending industry representatives
Promoting products and services	Sending promotional material
Direct employment	Commissioning news reports or advertorials

The most common strategy is a press release hitting your inbox, trying to alert you to something and then you’ll get called the same day to say, ‘Did you get our press release?’ At which point you’ll usually say, ‘Yes I got it and I’m not sure if I’m interested’, or ‘Yes I’m interested’ or ‘No I’m not interested’ and even if you say no you’re probably going to get a follow up call, at which point they might change tack and say, ‘Well have you thought about this, have you thought about that?’ [Journalist H]²

Industry representatives also contacted journalists in order to counter negative news coverage about their organisation or product:

If there are negative stories about particular products or companies generally the PR team will offer up interviews or send out statements challenging these negative things …. So they do tend to react and try to put their view out. [Journalist A]

Participants also explained that industry sometimes funded consumer groups, disease awareness campaigns, social media and public events, expecting that this would lead to favourable reports about their company or product:

They might do it through setting up an awareness day, that’s used quite a bit to try to get coverage …. They’ll get a PR company to send out a press release saying they’re holding an awareness day with a panel discussion and they’ll try to find a news [angle]. [Journalist D]

Pharmaceutical companies sometimes fund patient campaigns and advocacy groups. You occasionally find a suspiciously well funded new patient advocacy group and when you see that you don’t have to scrape far below the surface to find it’s a drug company thing …. There has been a history of them putting those groups together … [Journalist G]

In addition, participants described how gifts, sponsorship, travel or other inducements were offered in order to cultivate relationships and ‘curry favour’:

Now and again I do get emails from Nestle saying, ‘Would you like to come to Switzerland to see our factories?’ It’s not phrased like that, it’s always an educational tour or something … [Journalist C]

Furthermore, companies sometimes sought to promote their products by explicitly commissioning news reports or advertorials from journalists:

A couple of years ago a newspaper rang me up and asked me would I write a piece on [medical device] and I said yes because the year before I’d done a piece on [medical device] and I was very interested in the area and I had the information in my head, I had a few contacts. I didn’t realise this was going to be an advertorial when I agreed. [Journalist B]

Attitudes to industry involvement

Participants were generally distrustful of commercial motives and were sceptical of the merits of sources, events or products that were endorsed or produced by industry:

When I’m reading things I’m always on the look out for drug company funding and interests and motives and as soon as you see one it’s a big red light. [Journalist C]

All were wary of product placement or promotion disguised as news:

I get a lot of emails from drug companies and PR people saying, ‘Great news, new treatment for arthritis coming on the PBS next week’. They go straight in the recycle bin because it’s disguised advertising. [Journalist C]

For some, this distrust of industry was the result of having been burned in the past:

I’ve been duped before. Several years ago there was a drug and I knew the PR person so we had quite a rapport …. He sent the press release through and it was quite a marketing job actually … and the company ended up getting fined tens of thousands of dollars because it was an advertising piece …. I think I actually have been burnt from that experience. It’s made me more wary about what they do, the techniques they deploy. [Journalist J]

Participants explained that underhanded tactics used by industry to get their message out sometimes even backfired or worked against the company:

It’s not often that you get suckered into an event where you think, ‘Oh crap, I didn’t realise company X is totally behind this’, and if that was the case you can either walk away, or you can turn around and write a story that exposes what you think is an underhanded tactic. [Journalist H]

Despite their scepticism of industry motives, all participants emphasised that when it came to self-interest and self-promotion, it could be difficult to distinguish between commercial and public sectors, each of which had their own interests:

There’s an agenda behind almost everything and it’s not limited to … commercial interests. There are many other potentially equally questionable interests shaping news stories such as professional bodies … and disentangling their motives is nigh on impossible, and possibly it’s not even fair to try … [Journalist C]

Others went further and suggested that industry were unfairly criticised at times:

We can’t criticise industry for not doing any research and then criticise them when they do fund research. [Expert journalist F]

Indeed, participants emphasised that industry support does not, in and of itself, invalidate a health message, a story, an award or the health benefits of a product:

Maybe it is a big pharmaceutical company that is doing it but at the same time it’s still a good news story. So don’t penalise someone because they’re trying to flog their drug. If it’s a breakthrough and it cuts diabetes by 50% then it is still a good news story. [Journalist I]

Consequently, journalists were prepared to engage with industry in limited ways and offered a range of justifications for doing so.

Justifications for engagement with industry

One justification for limited engagement with industry was greater concern about the quality of the ‘message’ than the motives of the ‘messenger’. Hence, journalists might attend a meal, lecture or conference if they felt they would get something worthwhile out of the interaction such as a good story, useful information or a relationship with an expert from whom they might later wish to seek comment:

If somebody’s putting on a conference that looks useful I’ll go to that. If they want to buy me a cup of coffee that’s fine, if I think it’s going to be useful. For me what simplifies this a lot is that I’m working for myself, I don’t have time to go schmoosing, I don’t have time to go out … so unless it’s something that I’m really interested in that I think will give me some really interesting, different information or I’ll make some very good contacts, I just haven’t got time. [Journalist B]

Other major factors in journalists’ decisions regarding engagement with industry were their views about the newsworthiness of the story and their perceptions of public interest:

You weigh everything up on a case-by-case basis. But I haven’t found it difficult to resist industry influence because you’ve got to think about what the viewers really need to hear about. [Journalist D]

Journalists might promote a health message that was supported by industry if they felt that the message aligned with the public interest:

At the end of the day you’d want to write stuff that educates the public on important health issues. Where you could be lending undue support to a monopoly you’d probably state that. But where companies are coming together to get a message out and ultimately you look at it and go, ‘Their interests in this do align with the public good’, you don’t have an issue with putting it out there. [Journalist H]

On occasion, an ‘expert-journalist’ might even act as a spokesperson for a product if it was one they believed had the potential to benefit the community:

I recently endorsed a product, but it’s a product I love. I like their packaging, I like their portions, I think it has a place. So there’s always a question mark – where am I drawing the line? But it’s a product that I think is a good thing for the consumer to have in their diet. [Expert journalist E]

Personal management of industry influence

All participants acknowledged that, while they saw both risks and benefits in interaction with industry, industry had a legitimate place in society and some degree of engagement was inevitable:

We’re very careful about who we allow ourselves to develop relationships with but I don’t hold this view that you put a Berlin Wall between media and industry. We live in a capitalist society. You can’t expect them to not be there …. So I’m always prepared to listen to anything anyone has to say. That’s what journalism is. Once you close your mind then you go nowhere really. [Journalist G]

Much of participants’ talk thus concerned how they managed these interactions. They maintained that it was possible for them to engage with industry to some degree without compromising their objectivity:

My primary perspective is that I’ll be true to my brand. …. I’m not going to say anything that’s wrong, I’m not going to say anything that’s in clear violation of my role and responsibility because I’m paid to by somebody else. I would never do that. I’ve got really clear boundaries and principles. [Expert Journalist K]

Participants believed that they were capable of recognising when something was commercially motivated and evaluating the impact of those motives:

You get to know the bodies involved, so it becomes pretty clear where you should worry. If it’s some amorphous thing you’ve never heard of before and it has pharma company brands all over their letterhead then it’s a red flag … [Journalist H]

In order to make these evaluations, journalists relied on a process of critical inquiry, which involved a series of questions or steps they used to ascertain whether a person, piece of information or product was commercially motivated:

When I’m rung up … as soon as they say they’re a PR company I’ll say, ‘Who hired you?’ and that’s crucial information. I would never not ask that. [Journalist C]

On the basis of these evaluations, journalists made decisions about the degree of engagement that would be appropriate and emphasised that they consciously avoided situations in which they might be unduly influenced:

I wouldn’t do anything that would put me in any position where I felt I was being coerced into promoting something, I just wouldn’t do it. [Journalist B]

A belief in their own agency and ability to control interactions dominated participants’ accounts of engagement with industry. They emphasised that should they consult an industry source, or produce a story that aligned with the interests of industry, this would be on the basis of their independent assessment of newsworthiness, credibility and public interest, not because they had succumbed to influence.

And will you ever need to talk to anybody in industry as part of your stories?

Depends on the story. It depends. But if I do it’s because I decide I need to talk to them, not because somebody’s telling me that I need to talk to them. [Journalist B]

Participants also emphasised their willingness to report in a manner that was not favourable to industry, claiming they were unconcerned by negative industry reactions to their reporting. Indeed, some commented that raising the ire of industry indicated that they were doing something right:

You can be guaranteed if [industry] don’t like the inflection of the story … you’ll get a call saying …. ‘Maybe I should have a talk to your editor about this’ …. They’re just flexing their muscles …. But it’s almost like you realise you’re doing your job well, if despite all the bluster and threats you can write a story that accurately covers something and educates the public, that’s what you’re there to do. I think that’s what all journalists get up in the morning aiming to do. So if you piss someone off along the way usually you’re doing something right. [Journalist H]

Several participants noted that it was they who were needed by industry, and that this gave them the freedom to report on issues that did not serve industry’s interests:

You always go back to how important is it that the viewers hear a certain thing … and don’t be concerned about whether you’re going to be upsetting industry by not putting them in the story. …. [Because] they need us, it’s not like they’re never going to talk to us again. [Journalist D]

It’s not a symbiotic relationship. It’s more of a parasitic relationship in which the PR people need you more than you need them … [Journalist H]

Finally, journalists emphasised that they were able to remain free from undue influence because they were not motivated by money and perks that industry might offer:

The thing is that most of us have got families and lives. We’re not that cheap and desperate for a feed that we’re going to waste our time unless it’s a good lecture … [Expert journalist L]

Paramount was the desire to maintain their sense of independence and integrity and journalists frequently commented that they would not want to feel beholden to industry:

No serious journalist wants to feel that they’ve been bought or wants to be beholden to someone. Anyone with the merest sense would know that it would be career death to get a reputation for doing that. [Journalist C]

‘Expert-journalists’ in particular spoke about the importance of being true to their professional ‘brand’ above all else:

I’d never want to be completely aligned with one company. It’s much more important for me to maintain myself as the company and ultimately as a brand in itself so that long-term I have independence to do whatever I want with that brand. [Expert journalist F]

As a result of their perceptions of their own shrewdness, their sense of control and power and the value they placed on remaining independent, journalists saw themselves as effective mediators of industry influence, rather than conduits for industry messages:

It’s not as though we just become this empty cipher through which corporations push their message into the press. [Journalist H]

However, they did acknowledge that ‘others’ might not be so immune. They pointed out that journalists who were young and inexperienced might be unaware of the strategies and motives of industry, or might be intimidated by industry ‘belligerence’ and that a rarer few might be complacent about, or indifferent to, the role of industry interests in a news story:

Not all reporters might be aware of the way that those interests work. I’ve been working in this area for a long time so I’m very aware of it …. We’re one of the few organisations that still has specialist reporters in health. Usually you’ve got this revolving roster of people going through. Why would they spot those agendas? [Journalist G]

Overall, however, journalists were viewed as being similarly scrupulous in their approach to industry and, perhaps for this reason, some participants commented that external regulation of relationships between journalists and industry might be unnecessary:

Well in my experience the one time that I did accept pharma dollars to travel to a conference that turned me off. So I guess in my experience there is no need [to regulate], because you quickly learn to avoid that yourself. I’m pretty happy with the discerning nature of journalists to figure it out without the need for regulation. [Journalist H]

In this regard, it is noteworthy that spontaneous reference to regulations and codes of practice did not figure prominently in the interviews. Their decisions therefore appeared to stem from personal values and critical reasoning rather than reference to formal regulations or codes:

If Pfizer rang me up offering to fly me to London I wouldn’t rush over to the code to see if the code lets me do it. For my own reasons I can see that it’s not something I should touch with a barge pole. [Journalist C]

Organisational limits to autonomy

Despite their asserted independence, our participants acknowledged that because they worked for major media organisations it was not always easy for them to make their own decisions about industry engagement. The organisational factor most commonly referred to by participants as impacting upon the management of their relationships with their sources was the pressure of the 24-hour newscycle. Limited time to research and produce stories could work in industry’s favour, as journalists might not have sufficient time to check the validity of stories before going into production. This was particularly the case on ‘slow news days’ when material was needed and journalists were scrambling to find suitable copy in time:

I think that journalists are under increasing time pressure to come up with content driven by ever contracting deadlines and journalists are doing the best they can to produce compelling stories that don’t contain hidden commercial barbs that could snare the reader. But occasionally things do slip through. [Journalist H]

However, lack of time could also work against industry, as busy journalists simply deleted industry press releases or, sceptical of commercial motives, chose not to risk publishing a story that they did not have adequate time to check for validity:

I don’t have the time in my job to always double check and triple check for [credibility]. So I’d rather leave it alone. [Journalist J]

Space limitations had similar impact. In some instances, reporting of industry links might be cut from a story to save space:

I think ideally you always should [include industry links in a news report]. Has it ever happened that I haven’t? Yes. And yes, space is a limitation … [Journalist G]

Competition for consumers was also acknowledged by participants as having the capacity to work for or against industry. While the organisational drive for ratings could lead current affairs programmes to churn out sensationalist stories that sometimes worked in industry’s favour, it could also encourage journalists and networks to avoid stories that were duplicative and obviously commercially motivated:

I don’t think the public has an interest in reading stuff where they can interpret that there’s a hidden commercial imperative to a story. Their first response is to think, ‘That journalist is under the control of a commercial body and this story is tainted and not that interesting’. It’s not a successful business model to provide that type of content. [Journalist H]

Discussion

Health-related industries use a variety of methods to influence health news. These interactions have the potential to subvert news reporting such that it comes to serve the interests of industry in promoting products, rather than the public interest in critical and truthful news and information. It is essential, therefore, that interactions between health-related industries and the journalists they seek to influence are managed appropriately and that the principal function of journalism – to provide rigorous, independent reporting and critique – is left unimpaired.

All participants in this study were distrustful of commercial motives. However, they also acknowledged that given the important and pervasive role of commerce in society, complete disengagement from industry was neither practical nor desirable. Participants therefore engaged with industry provided they believed this would produce newsworthy copy that would serve the public good, or excluded industry-initiated reporting where the public might be misled or misinformed. All participants described having ‘rules of engagement’ which could advance or impede industry’s interests. Journalists sought to evaluate the quality of source material before deciding whether to use it. However, participants’ capacity to exercise their autonomy in relation to interactions with industry was limited by organisational factors, in particular the pressures of the newscycle. However, participants reported that these pressures did not work consistently against or in favour of industry’s interests.

These findings resonate with other qualitative studies examining journalist–source relationships which have found that journalists who report on health are both dependent on (Michelle, 2006), and critical of, their sources (Leask et al., 2010). They are also consistent with a recent study of journalists not specifically working in health, which found that journalists take a sceptical approach to contact with PR but are willing to publish material from these sources on occasion and see themselves as effective mediators of commercial interests (Larsson, 2009).

Our results are also consistent with studies exploring relationships between health-related industries and other professional groups including doctors, dentists, pharmacists and biomedical researchers, most of which have found that professionals are in favour of at least some degree of industry interaction and engage with industry themselves (Brett et al., 2003; Campbell et al., 2007; Carney et al., 2001; Chimonas et al., 2007; Doran et al., 2006; Glaser and Bero, 2005; Jutel and Menkes, 2009; Korenstein et al., 2010; Macneill et al., 2010; Morgan et al., 2006; Moubarak et al., 2011; Mueller et al., 2007; Quinn and O’Neill, 2002; Ross et al., 2009). In most cases, these professionals recognise the potential risks of industry engagement and see themselves as having effective ways of managing these relationships (Campbell et al., 2004; Doran et al., 2006). Interestingly, our findings differ somewhat from those of one of the few qualitative studies of doctor–industry relationships (Doran et al., 2006). Although Doran et al. identified a subgroup of doctors who behaved similarly to the journalists in this study – choosing to engage with industry but only under certain conditions and with protective processes in place – they also found two further subsets of practitioners – ‘avoiders’, who abstain from contact with industry as much as possible, and ‘confident engagers’, who are completely dismissive of ethical concerns about industry relationships and/or see themselves as immune to untoward influence (Doran et al., 2006). This latter group has also been observed in a number of other studies (Campbell et al., 2004, 2007; Chimonas et al., 2007; Gibbons et al., 1998; Jutel and Menkes, 2009; Morgan et al., 2006; Moubarak et al., 2011). In contrast, none of the journalists in our study took an entirely avoidant approach to relationships with industry, and none saw themselves as completely immune to untoward influence.

While this points to a relatively nuanced view of commercial interests in health that is somewhat reassuring, journalists’ comments regarding their ability to manage industry influence also raise concerns regarding the realities of power relationships and the psychology of influence. Participants positioned themselves as empowered, agentic and scrupulous in their dealings with industry, but did not seek to generalise this to the rest of their profession because they suggested that not all journalists might be so empowered. This comparison of their own qualities with the possible shortcomings of others suggests that, to them, to be unduly influenced means that one must be either blind to the presence of commercial interests in health news, intimidated by the power of industry, indifferent to the manipulation of news by industry or actively colluding in this manipulation. This understanding of influence is problematic in two ways. First, it rests on a uni-directional understanding of power relationships between journalists and industry, which acknowledges industry’s dependence on journalists while ignoring the ways in which journalists need their sources. Journalists argued that this power imbalance freed them from any obligation to act in industry’s interests and any repercussions should they not choose to do so. However, the precise nature of journalist–source relationships has been the subject of debate for some time. It has been variously characterised as symbiotic (Peters, 1995), as a ‘tug-of-war’ (Davis, 2009) and as a parasitic relationship in which the journalist is dependent on the source (Dunwoody and Ryan, 1986). In light of this debate, and given what we know about the extent to which journalists publish industry material (Larsson, 2009), one might question whether participants’ characterisation of their autonomy within industry relationships is in fact accurate, or whether it reflects either a normative, socially desirable account of how ethical journalism should operate or a naive account of their own capacity to resist influence.

Second, our participants’ understanding of what it means to be unduly influenced does not account for the possibility that journalists’ responses to industry are not always under their conscious control and that an intention to remain free from industry influence is not tantamount to doing so. Indeed, research has demonstrated that other professions are more influenced by industry interactions than they believe (Spurling et al., 2010; Wazana, 2000) and that journalists sometimes overestimate both their agency and their independence from their sources (O’Neill and O’Connor, 2008). This is important because it suggests that in spite of – perhaps even because of – their good intentions, journalists may be exposing themselves to a more insidious level of influence – one which could lead them to act in ways that are inconsistent with their own values and intentions.

Implications

Our data suggest that most journalists engage with health-related industries to some degree and we believe it is neither feasible nor desirable to prohibit these interactions altogether. It is important, therefore, that these interactions are as ethically sound as possible. This is important for the profession of journalism because journalists depend for their status and autonomy upon public trust, and we know that trust in the media can be adversely affected by the ways in which journalists are perceived to interact with their sources (Connolly-Ahern et al., 2010; Gronke and Cook, 2007). It is also important for the public because journalists play a major role in shaping the public’s understanding of health and illness and expectations about therapies and services. Given that journalists are highly reliant upon, and influenced by, their sources (Michelle, 2006; O’Neill and O’Connor, 2008; Peters, 1995; Steele, 1995; Yoon, 2005), it is crucial that they are able to provide their audiences with independent critique.

If we are correct in our understanding of what journalists took undue influence to mean, and if this is found to be true of the wider population of journalists, it could go a long way to explaining the challenges faced, to date, in establishing a constructive dialogue between academics, who are concerned about the growing role of industry in the production of health-related news, and journalists currently working in the field. Journalists may rightly be defensive when confronted with the suggestion that they may be influenced by interactions with industry given that, according to their understanding of influence, this is to suggest that they are naive, ignorant, submissive, lazy or corrupt. It may be productive, therefore, to preface these discussions with a clear articulation of what is meant by the term ‘influence’ and an acknowledgement of the ways in which the intentions and values of journalists align with those of concerned academics. This would more likely lead to considered dialogue regarding the possible threat that interactions with industry pose to those intentions and values.

A constructive dialogue around these issues might also facilitate discussion regarding the extent to which increased formal regulation of journalist–industry relationships might be needed. Although journalists in this study were confident in their ability to make individual judgements on the basis of personal values and critical reasoning, it is in the interests of neither the public nor the profession to individualise and relativise ethics in this way. Furthermore, participants’ lack of spontaneous reference to either professional regulation or codes of ethics when discussing decisions about industry engagement as well as their description of the organisational pressures they face suggest that professional codes of ethics and other mechanisms of self-regulation might not be enough to ensure ethical behaviour and that, if the ‘dark side’ of industry–journalist relationships is to be managed, other strategies such as formal regulation might be necessary.

Limitations and future directions

This was a small qualitative study and caution should be exercised in generalising the results. Further research is needed in order to corroborate our findings. Research examining the content of Australian health news stories for evidence of commercial influence would assist in determining the extent to which we can allow journalists to rely on their own critical faculties and/or informal codes of ethics when managing their interactions with industry. We also acknowledge that it is likely that, at least to some extent, participants rendered a socially desirable account of how ethical journalism should operate or a naive account of their own capacity to resist influence. However, it would be a mistake to entirely discount our findings because even espoused values can motivate behaviour change if people want to be seen to be true to their word.

Conclusion

Commercial organisations cultivate relationships with journalists and news organisations with the aim of influencing information that is communicated through the media. Given the significant influence of the media on the health of individuals and populations, we should be alert to the potential impact of industry–journalist relationships on health care, health policy and public health. Qualitative research provides us with an in-depth understanding of journalists’ attitudes towards, and ways of managing, their interactions with health-related industries. These findings suggest that such interactions are widespread, varied and probably inevitable. While journalists appear to have personally derived, ‘rules of engagement’ that guide their interactions with industry, we cannot be certain that self-regulation is adequate – particularly in the context of increasing organisational pressures upon journalists. Should subsequent research show that critical self-reflection is insufficient to guide interactions between journalists and health-related industries, other measures, such as external regulatory controls, might be necessary.

Footnotes

Declaration of conflicting interests

The authors have no conflict of interest to declare. The National Health and Medical Research Council played no role in study design; in the collection, analysis and interpretation of data; in the writing of results; or in the decision to submit the article for publication.

Funding

Funding for this project was awarded by the National Health and Medical Research Council, project grant 632840.

Notes

Author biographies

Bronwen Morrell is an National Health and Medical Research Council funded PhD candidate at the Centre for Values, Ethics and the Law in Medicine, University of Sydney and Managing Editor of the Journal of Bioethical Inquiry. Recent first-author publications include ‘Power and control in interactions between journalists and health-related industries - the view from industry’ forthcoming in the Journal of Bioethical Inquiry, ‘The perils of a vanishing cohort: A study of social comparisons by women with advanced ovarian cancer’ published in 2011 in Psychooncology (vol. 20) and ‘Cancer as rubbish: Donation of tumor tissue for research’ published in 2010 in the journal Qualitative Health Research (vol. 21).

Rowena Forsyth is a Postdoctoral Research Fellow with the Sydney School of Public Health and an Associate of the Centre for Values, Ethics and the Law in Medicine, University of Sydney. Recent first-author publications include ‘Decision making in a crowded room: The relational significance of social roles in decisions to proceed with allogeneic stem cell transplantation’ published in 2011 in the journal Qualitative Health Research (vol. 21) and ‘Health Journalists’ Perceptions of Their Professional Roles and Responsibilities for Ensuring the Veracity of Reports of Health Research’ published in 2012 in the Journal of Mass Media Ethics (vol. 27).

Wendy Lipworth is a National Health and Medical Research Council Career Development Fellow at the Centre for Values, Ethics and the Law in Medicine, University of Sydney. Recent first-author publications include ‘Views of health journalists, industry employees and news consumers about disclosure and regulation of industry-journalist relationships: An empirical ethical study’ published online in 2014 in Journal of Medical Ethics, and ‘Deriving and critiquing and empirically-based framework for pharmaceutical ethics’ in 2014 in American Journal of Bioethics (AJOB) Empirical Bioethics (vol. 5).

Ian Kerridge is an Associate Professor in Bioethics and Staff Haematologist/BMT Physician at Royal North Shore Hospital, Sydney. Recent first-author publications include ‘"Interests" and the inadequacy of disclosure’ published in 2012 in the Australian and New Zealand Journal of Psychiatry and ‘Pharmaceutical industry support for continuing medical education: Is it time to disengage?’ published in 2011 in Journal of Paediatrics and Child Health (vol. 47) and ‘Religious perspectives on embryo donation and research’ published in 2011 in Clinical Ethics (vol. 5).

Christopher FC Jordens is Associate Professor in Bioethics and Principal Research Fellow at the Centre for Values, Ethics and the Law in Medicine in the School of Public Health at the University of Sydney. Recent first-author publications include ‘The quality of Australian health journalism is important for public health’ published in 2013 in the Medical Journal of Australia (vol. 199) and ‘Trouble in the gap: a bioethical and sociological analysis of informed consent for high-risk medical procedures’ in 2013 in the Journal of Bioethical Inquiry (vol. 10).

References

Benelli

(2003) The role of media in steering public opinion on healthcare issues. Health Policy 63: 179–186.

Bennett

(2003) News: The Politics of Illusion, 5th edn. New York: Addison-Wesley; Longman.

Blumler

Gurevitch

(1981) Politicians and the press: An essay in role relationships. In: Nimmo

Sanders

(eds) Handbook of Political Communication. Beverly Hills, CA: SAGE, pp. 467–493.

Bollinger

(2001) A new scoring method for the press release. Public Relations Quarterly 46: 31–35.

Brett

Burr

Moloo

(2003) Are gifts from pharmaceutical companies ethically problematic? A survey of physicians. Archives of Internal Medicine 163: 2213–2218.

Campbell

Gruen

Mountford

. (2007) A national survey of physician-industry relationships. New England Journal of Medicine 356: 1742–1750.

Campbell

Moy

Feibelmann

. (2004) Institutional academic industry relationship: Results of interviews with university leaders. Accountability in Research 11: 103–118.

Carlston

(2009) Dueling, dancing or dominating? Journalists and their sources. Sociology Compass 3: 526–542.

Carney

Nair

Sales

. (2001) Pharmaceutical industry-sponsored meetings: Good value or just a free meal? Internal Medicine Journal 31: 488–491.

10.

Chapman

Holding

Ellerm

. (2009) The content and structure of Australian television reportage on health and medicine, 2005–2009: Parameters to guide health workers. Medical Journal of Australia 191: 620–624.

11.

Chimonas

Brennan

Rothman

(2007) Physicians and drug representatives: Exploring the dynamics of the relationship. Journal of General Internal Medicine 22: 184–190.

12.

Cho

(2006) The power of public relations in media relations: A national survey of health PR practitioners. Journalism & Mass Communication Quarterly 83: 563–580.

13.

Connolly-Ahern

Grantham

Cabrera-Baukus

(2010) The effects of attribution of VNRs and risk on news viewers’ assessments of credibility. Journal of Public Relations Research 22: 49–64.

14.

Cottle

(ed.) (2003) News, Public Relations and Power. London: SAGE.

15.

Davis

(2003) Whither mass media and power? Evidence for a critical elite theory alternative. Media, Culture & Society 25: 669–690.

16.

Davis

(2009) Journalist-source relations, mediated reflexivity and the politics of politics. Journalism Studies 10: 204–219.

17.

Doran

Kerridge

McNeill

. (2006) Empirical uncertainty and moral contest: A qualitative analysis of the relationship between medical specialists and the pharmaceutical industry in Australia. Social Science & Medicine 62: 1510–1519.

18.

Dunwoody

(1978) Science Journalists: A Study of Factors Affecting the Selection of News at a Scientific Meeting. Bloomington, IN: Indiana University.

19.

Dunwoody

Ryan

(1986) The credible scientific source. Journalism Quarterly 64: 21–27.

20.

Fishman

(1980) Manufacturing News. Austin, TX: The University of Texas at Austin.

21.

Franklin

(1997) Newzak and News Media. London: Arnold.

22.

Gandy

(1982) Beyond Agenda Setting: Information Subsidies and Public Policy. Norwood, NJ: Ablex.

23.

Gans

(1979) Deciding What’s News: A Study of CBS Evening News, NBC Nightly News, Newsweek and Time. New York: Vintage Books.

24.

Gans

(2011) Multiperspectival news revisited: Journalism and representative democracy. Journalism 12: 3–13.

25.

Gibbons

Landry

Blouch

. (1998) A comparison of physicians’ and patients’ attitudes toward pharmaceutical industry gifts. Journal of General Internal Medicine 13: 151–154.

26.

Glaser

Bero

(2005) Attitudes of academic and clinical researchers toward financial ties in research: A systematic review. Science and Engineering Ethics 11: 553–573.

27.

Goldacre

(2007) Journalists: Anything to declare? BMJ 335: 480.

28.

Greene

(2009) Pharma’s influence on the fourth estate: Health care journalists’ conflicts also scrutinized. Annals of Emergency Medicine 53: 18A–20A.

29.

Grilli

Ramsay

Minozzi

(2002) Mass media interventions: Effects on health services utilisation. Cochrane Database of Systematic Reviews 1: CD000389.

30.

Gronke

Cook

(2007) Disdaining the media: The American public’s changing attitudes toward the news. Political Communication 24: 259–281.

31.

Hall

Critcher

Jefferson

. (1978) Policing the Crisis: Mugging, the State, and Law and Order. London: Palgrave Macmillan.

32.

Helwig

(1989) There’s no room for freebies in medical journalism. Canadian Medical Association Journal 140: 542–543.

33.

Hodgetts

Chamberlain

Scammell

. (2008) Constructing health news: Possibilities for a civic-oriented journalism. Health 12: 43–66.

34.

Johnson

(1998) Shattuck lecture – Medicine and the media. New England Journal of Medicine 339: 87–92.

35.

Jutel

Menkes

(2009) ‘But doctors do it …’: Nurses’ views of gifts and information from the pharmaceutical industry. Annals of Pharmacotherapy 43: 1057–1063.

36.

Korenstein

Keyhani

Ross

(2010) Physician attitudes toward industry: A view across the specialties. Archives of Surgery 145: 570–577.

37.

Larsson

(2009) PR and the media. Nordicom Review 30: 131–147.

38.

Leask

Hooker

King

(2010) Media coverage of health issues and how to work more effectively with journalists: A qualitative study. BMC Public Health 10: 535–541.

39.

Len-Rios

Hinnant

Park

. (2009) Health news agenda building: Journalists’ perceptions of the role of public relations. Journalism & Mass Communication Quarterly 86: 315–331.

40.

Lewis

Williams

Franklin

(2008) A compromised fourth estate? UK news journalism, public relations and news sources. Journalism Studies 9: 1–20.

41.

Macneill

Kerridge

Newby

. (2010) Attitudes of physicians and public to pharmaceutical industry ‘gifts’. Internal Medicine Journal 40: 335–341.

42.

Mebane

(2005) The importance of news media in pharmaceutical risk communication: Proceedings of a workshop. Pharmacoepidemiology and Drug Safety 14: 297–306.

43.

Michelle

(2006) Media(ted) fabrications: How the science-media symbiosis helped ‘sell’ cord banking. Communication and Medicine 3: 55–68.

44.

Miller

Dinan

(2000) The rise of the PR industry in Britain, 1979–98. European Journal of Communication 15: 5–35.

45.

Moore

(1989) Health Risks and the Press. Washington, DC: The Media Institute.

46.

Morgan

Dana

Loewenstein

. (2006) Interactions of doctors with the pharmaceutical industry. Journal of Medical Ethics 32: 559–563.

47.

Morton

(1998) Effectiveness of camera-ready copy in press releases. Public Relations Review 14: 45–49.

48.

Moubarak

Martins

Zuily

. (2011) Attitudes of cardiology residents toward interactions with the pharmaceutical industry. International Journal of Cardiology 146: 461–462.

49.

Moynihan

(2003a) Blurring the boundaries. BMJ 326: 1094.

50.

Moynihan

(2003b) Urologist recommends daily Viagra to prevent impotence. BMJ 326: 9.

51.

Moynihan

(2011) Is journalism the drug industry’s new dance partner? Exploring the new frontier in influence peddling. BMJ 343: d6978.

52.

Moynihan

Sweet

(2000) Medicine, the media and monetary interests: The need for transparency and professionalism. Medical Journal of Australia 173: 631–634.

53.

Mueller

Hook

Litin

(2007) Physician preferences and attitudes regarding industry support of CME programs. American Journal of Medicine 120: 281–285.

54.

O’Neill

O’Connor

(2008) The passive journalist: How sources dominate local news. Journalism Practice 2: 487–500.

55.

Peters

(1995) The interaction of journalists and scientific experts: Co-operation and conflict between two professional cultures. Media, Culture & Society 17: 31–48.

56.

Quinn

O’Neill

(2002) Attitudes of general practitioners to their interactions with pharmaceutical companies: A qualitative study. Irish Medical Journal 95: 199–202.

57.

Reese

(1991) Setting the media’s agenda: A power balance perspective. Communication Yearbook 14: 309–340.

58.

Reich

(2006) The process model of news initiative: Sources lead, reporters thereafter. Journalism Studies 7: 497–514.

59.

Reich

(2010) Measuring the impact of Pr on published news in increasingly fragmented news environments. Journalism Studies 11: 799–816.

60.

Ross

Keyhani

Korenstein

(2009) Appropriateness of collaborations between industry and the medical profession: Physicians’ perceptions. American Journal of Medicine 122: 955–960.

61.

Schlesinger

(1990) Rethinking the sociology of journalism: Source strategies and the limits of media centrism. In: Ferguson

(ed.) Public Communication: The New Imperatives: Future Directions for Media Research. London; Newbury Park, CA: SAGE, pp. 61–83.

62.

Schlesinger

Tumber

(1994) Reporting Crime: The Media Politics of Criminal Justice. Oxford: Clarendon Press.

63.

Schneiderman

(2007) The media and the medical market. Cambridge Quarterly of Healthcare Ethics 16: 420–424.

64.

Schudson

(1989) The sociology of news production, Media, Culture & Society 11: 263–282.

65.

Schwartz

Woloshin

Moynihan

(2008) Who’s watching the watchdogs? BMJ 337: 1202–1203.

66.

Schwitzer

(1992) The magical medical media tour. JAMA 267: 1969–1971.

67.

Schwitzer

(2005) TV medical reporters: Puppets and pros. Columbia Journalism Review, 28 June. Available at: www.cjr.org/behind_the_news/tv_medical_reporters_puppets_a.php

68.

Seale

(2003) Health and media: An overview. Sociology of Health & Illness 25: 513–531.

69.

Spurling

Mansfield

Montgomery

. (2010) Information from pharmaceutical companies and the quality, quantity, and cost of physicians’ prescribing: A systematic review. PLOS Medicine 7: e1000352.

70.

Steele

(1995) Experts and the operational bias of television news: The case of the Persian Gulf war. Journalism & Mass Communication Quarterly 72: 799–812.

71.

Stevens

(1998) Designing an effective counter advertising campaign – California. Cancer 83: 2736–2741.

72.

Stromback

Nord

(2006) Do politicians lead the Tango? A study of the relationship between Swedish journalists and their political sources in the context of election campaigns. European Journal of Communication 21: 147–164.

73.

Sweet

(2001) Sponsored journalism awards shocks Australian media. BMJ 323: 1258.

74.

Tiffen

(1989) News and Power. Sydney, NSW, Australia: Allen & Unwin.

75.

Walters

(1992) Environment of confidence: Daily newspaper use of press releases. Public Relations Review 18: 31–46.

76.

Wazana

(2000) Physicians and the pharmaceutical industry: Is a gift ever just a gift? JAMA 283: 373–380.

77.

Yoon

(2005) Examining journalists’ perceptions and news coverage of stem cell and cloning organizations. Journalism & Mass Communication Quarterly 82: 281–300.