An incongruent picture of direct-to-consumer advertising of genetic tests: Qualitative framing analysis on newspapers and 23andMe’s press releases

Abstract

Drawing upon framing theory, this exploratory study suggested that conservative newspaper (the Wall Street Journal) regarded direct-to-consumer advertising of genetic tests as a regulation issue whereas liberal newspaper (the New York Times) as a science issue. The company, 23andMe, communicated the topic with the purpose of reputation building. This research informs genetic testing scientists and professionals about how media and company may influence consumers’ perceptions, and allow them to strategize how to shape future communication.

Keywords

Direct-to-consumer advertising genetic testing framing qualitative analysis

Introduction

In the past decade, there has been an explosive growth of direct-to-consumer advertising for genetic tests. According to global industry analysts, the global DTC genetic testing market is projected to reach more than $230 million in sales by 2018.¹ With the growing importance of genetic tests in clinical medicine and public health, the control of disease and health outcomes are increasingly based on the findings of genetic variations in individuals, and therefore offer more personalized approaches to treatment.² Many companies started to engage in direct-to-consumer advertising (DTCA) to promote genetic tests for disease risk-testing and identity-seeking. Among them, 23andMe is the largest, privately held personal genomics and biotechnology company based in Mountain View, California. The company is named for the 23 pairs of chromosomes in a human cell. At the same time, this “explosion” comes with unstoppable debates among doctors, patients, ethicists, politicians and regulatory bodies, such as the Food and Drug Administration (FDA).^3,4 In 2013, the FDA ordered 23andMe to discontinue marketing its flagship product, the personal genome service kit, which the company had not yet obtained the regulatory approval from FDA and resulted in concerns about the potential consequences of customers receiving inaccurate health results.

Define “DTCA of genetic tests”

In the context of this paper, “direct-to-consumer advertising of genetic tests” refers to the promotion of genetic tests through various media platforms, such as broadcast and the Internet, directly targeted to consumers without the intervention of a health professional.² Direct-to-consumer advertising is often coupled with direct-to-consumer provision of tests, in which the consumer can directly order the test from a given company and receive genetic information without necessarily involving a doctor or insurance company in the process. Consumers who order such tests often receive a test kit by mail. Sample collection is typically in the form of a cheek swab that is mailed back to the company or to a suggested laboratory. Consumers are usually notified of their results by mail or over the phone, or the results are posted online. In some instances, a genetic counselor or other healthcare provider is available to respond to questions or explain results, sometimes at an extra cost. Decreasing costs of this service make it more accessible to the average consumer, with prices starting at $99.

DTCA has an extensive and well-documented history in pharmaceutical advertising.^5–10 The following historical background is drawn upon that body of literature to provide context to the issue of DTCA for genetic testing, as genetic tests are now one of many classes of health products advertised directly to consumers.

Historical background of DTCA

DTCA has a long history in the USA since the first documented patent medicine ad appeared in 1708.¹¹ However, not until 1980s did an increase in DTCA occur in response to the favorable political climate, the patient rights movement, and the trend in biomedical ethics toward considerations of patient autonomy.^2,12 It began to exponentially increase after 1997 when the FDA issued guidance on broadcast regulations that allowed DTCA in broadcast and electronic media.^10,13 The USA and New Zealand are currently the only industrialized countries that permit DTCA of prescription drugs. Between 1996 and 2005, the amount of annual expenditures of DTCA increased 330% to 4.2 billion, whereas direct-to-physician advertising has barely doubled within the same time frame.¹⁴

Controversies of DTCA of genetic tests

The value of such DTCA and marketing efforts of genetic testing products and services has been the subject of considerable debate. Some have suggested that DTCA promotes awareness of genetic diseases, provides earlier diagnosis of serious conditions, and offers a means for people to learn about their ancestral origins.² However, at-home genetic tests’ accuracy has been questioned. On the one hand, without the guidance from a healthcare provider, consumers do not possess the knowledge to accurately interpret the test results in order to make treatment or prevention decisions. On the other hand, the validity and accuracy of the test itself are questionable, which might result in incorrect, incomplete and misleading information about consumers’ health conditions.¹⁵

This study intends to provide a more comprehensive picture of these debates by analyzing how media portray and how companies strategize DTCA of genetic tests. It is important to study media coverage since media are a major source for gaining health information and improving health literacy.^16,17 Moreover, media coverage of certain health issues may also influence public policy making, also called “media advocacy”.¹⁸ Among different media, newspapers are one of the communication tools that can provide in-depth information and therefore can reflect the specific process of media framing. One central premise of this study is that conservative newspaper coverage will differ from liberal newspaper coverage.^19,20 Therefore, this study aims to examine how conservative versus liberal newspaper frames DTCA of genetic testing differently.

Unlike the role of media in society, DTC genetic testing companies are profit-driven, which results in a different motivation for framing DTCA of genetic testing. In addition, many consumers of web-based information are aware to some extent that the information content available through the Internet should be treated as suspect unless acquired through a reliable source.² This makes it all the more crucial to ascertain if many of the companies offering genetic testing services may only provide or even overstate the benefits of genetic tests to attract consumers’ attention. By comparing these two arenas, this study acknowledges what Sniderman and Theriault suggest that, “Frames are themselves contestable,”²¹ and understands that consumers have multiple ways of receiving information. In this case, studying different newspapers along with the companies’ websites may offer diverse perspectives and insightful findings compared to analyzing a single source. In addition, this study is also interested in whether the frames used in company press releases influence and transfer to news media.

Research objectives

This study seeks to investigate the major frames and the information sources communicated in a conservative newspaper (i.e. The Wall Street Journal), a liberal newspaper (i.e. The New York Times), and the company’s (i.e. 23andMe) press releases of DTCA of genetic tests. These findings are expected to generate a comprehensive list of major frames used in different types of newspapers and on the company’s website, offer basic concepts to further study audience adoption of the framing, develop testable message framing in future experimental studies, and finally provide social, ethical, and policy implications of the commercialization of genetic testing for health related conditions. The frames identified in the current study may contribute to further developing websites and public resources that provide complete and balanced information and evidence about commonly promoted genetic tests.

Literature review

News framing and DTCA of genetic testing

News coverage has a strong impact on what issues the public and policy makers consider important and how they interpret and respond to those issues.^22–24 News media often select and focus on certain aspects of the issue and make them more salient, while leaving out other aspects.²⁵ The process of highlighting certain aspects of a social problem in public discourse is called framing.²⁵ Framing serves as “a central organizing idea” that provides meaning and weaves a connection among otherwise discrete pieces of information.^26–28 Therefore, framing has a heavy influence on interpretation and understanding and indicating how individuals should understand an issue.²⁶ It helps to determine how the public views the issues by leading the audience to a certain line of reasoning or interpretation.^25,29,30

By focusing on certain aspects of an issue, the media can influence the way the audience think about the essence of the issue, as well as what the controversy is about.^27,31 Especially for health issues, such as DTCA of genetic tests, framing is not only a message that informs the public about what is important, but also about what are health issues and social values.³² By framing pros and cons of the DTCA of genetic tests in a certain way, the media tell the audience what should be valued most when making a judgment on this important health issue. Previous studies have demonstrated that, by framing a health issue, media promote particular problem definitions and arguments to inform audiences which aspects of a health problem are the most important and how to evaluate different solutions.^16,17 Policymakers and interest groups use data, anecdotes, symbolic images, and emotional appeals to frame issues in terms of their preferred solutions, and the news media serve as important settings in which this competitive process unfolds.³³

Another way that media can influence public understanding is through framing effects caused by the publication’s own political leanings.^19,20,34 Take the example of climate change, the more liberal, political left, newspapers critique industrial modernity and capitalism and support federal interventions to ameliorate environmental problems, whereas conservative newspapers place higher regard for individual rights and absolute rights of private property and free enterprise without government intervention.^20,35,36 In light of the previous literature, this study not only investigates how newspapers frame DTCA of genetic testing but also examines how conservative versus liberal newspapers frame this topic differently.

Arguments on DTCA of genetic testing

According to previous academic studies, scholars have long argued DTCA’s effects on consumers’ healthcare and the public.

The pros

Compared to traditional genetic testing offered by the health care system, DTC genetic testing is known for its accessibility and affordability.⁴ Decreasing genotyping costs have resulted in DTC genetic testing services becoming more accessible to the average consumer; for example, 23andMe, the leading company in the field, now offers its services for $99 (as compared to an original price of $999 in 2007).

Another primary argument in favor of DTC advertising for genetic tests is that information is empowering.³⁷ DTCA educates consumers about genetic diseases, allows them to take a more proactive role in managing their healthcare,^2,38 and results in better health outcomes.³⁹ Proponents have said that advertising might help patients better share their personal experiences and knowledge of health or illness with their physicians and therefore improve relations between patients and their physicians.³⁷ DTCA enhances consumers’ understanding of their health conditions and even promotes information seeking in the form of family discussion about hereditary illnesses that could facilitate treatment and prevention of disease.^2,4

The cons

However, at-home genetic tests also have significant risks and limitations. DTCA is often criticized by its oversimplified, misleading, and inaccurate statements, resulting in negative consequences for health care relationships and outcomes. DTCA tends to omit significant information, exaggerate benefits of the genetic testing, and minimize potential risks. Without adequate counseling support, on the one hand, consumers are vulnerable to being misled by the results of unproven or invalid tests⁴⁰; on the other hand, consumers are unable to access complete genetic information and therefore may make important decisions about treatment or prevention based only on inaccurate, incomplete or misunderstood information about their health.⁴¹ More importantly, genetic privacy may be at risk if testing companies use consumers’ genetic information in an unauthorized way.^2,4 In addition, the emotional cost of learning negative results may become a big issue as well. As patients learn about negative genetic testing results without guidance from a healthcare provider, they could potentially develop clinical depression, anxiety and suicidal thoughts.^4,42

Asymmetric information about genetic tests

Genetic tests offered directly to consumers on the Internet are examples of what economists call “credence goods”.² These are goods whose utility is difficult or impossible for the consumer to ascertain due to the levels of knowledge and expertise required in the evaluation of their utility. This is in contrast to “experience goods”; for example, a vacation package, where the consumer is in a position to assess such utility due to prior experience and familiarity within the category of products or services. Credence goods may create a situation of asymmetric information, in which the seller has the upper hand in terms of knowing the utility value of the good, and therefore the buyer has to rely on the information provided by the company or the media to assess the service itself.

Hence, the information and knowledge for a genetic test is not only characterized by uncertainty, it is also characterized by dependency. Consumers are uncertain about the benefits and risks of genetic testing, and therefore, they rely heavily on media and companies for information. All of these factors put the consumer in a position of vulnerability, highlighting the need for understanding the framing used by media and companies.

Research questions

RQ1: How do conservative newspaper articles, liberal newspaper articles, and company press releases frame direct-to-consumer genetic testing?

RQ2: How do frames used in conservative and liberal newspaper articles about DTC genetic testing differ from the content and framing of information provided by the DTC genetic testing companies’ press releases?

RQ3: What are the information sources used by the conservative newspaper, liberal newspaper, and company press releases?

Method

The goal of this study was to identify the frames used in liberal and conservative national newspapers as well as in online genetic testing companies’ press releases when discussing the issues of DTCA for genetic testing. Specifically, this study intended to identify the congruity and discrepancy between news coverage and 23andMe’s press releases. A qualitative approach is used when exploring and discovering the framing that may lie hidden in media coverage.⁴³ Qualitative research is an accepted approach to study controversial topics in an effort to understand the meaning and symbols translated to individuals.⁴⁴ Therefore, the qualitative method was chosen for this study to provide an understanding of how DTCA for genetic testing was covered in both news media and 23andMe’s press releases. This process allowed the researchers to identify language use in text and interpret meaning of the text, which provides richness and depth of the conversations.⁴⁵

Sample

Newspapers were selected for analysis in this study since they are considered the most relied upon media source and offer enough detailed information for further interpretation.⁴⁶ Since this study investigated how conservative and liberal newspapers framed the issue differently, The Wall Street Journal was selected as a representative for a conservative newspaper, whereas The New York Times was selected to represent a liberal newspaper. Both are national newspapers since the topic of DTCA for genetic testing has national impact. More importantly, previous studies indicated that The Wall Street Journal is quite conservative and The New York Times is quite liberal.^47,48 In addition, 23andMe was selected to represent the company side in this study. 23andMe is the first and only genetic testing service available directly to consumers that includes reports that meet FDA standards, and it currently has the largest market share in the industry.⁴⁹ Since the company’s press releases are accessible and published since 2007, the selected time frame of the sample starts from 1 January 2007 to the time this study was conducted (i.e. 29 October 2015). Thus, news articles written after 2007 were included in this study for comparison. This nine-year time frame allows us to capture a comprehensive look at the changes that have occurred in the DTCA of genetic tests.

All 23andMe’s press releases analyzed for this study were retrieved from the company’s online media center. The total number of press releases was 90 between 2007 and 2015. All news articles were collected using the online ProQuest database. Key terms used to search for relevant articles included “direct-to-consumer,” “genetic,” “genetic test,” “online genetic test,” and “23andMe” appearing in the headline, lead paragraphs, or index terms. The search excluded letters to the editor and editorial content, and yielded a total of 187 news articles. Articles were excluded if they contained less than 200 words, irrelevant content, or were duplicates. By checking through the headline of each story, the researcher first sorted out duplicates and unrelated items. About 29.4% (n = 55, 23 from The New York Times, 32 from The Wall Street Journal) were duplicates and 26.2% (n = 49, 12 from The New York Times, 37 from The Wall Street Journal) were unrelated items and thus were eliminated in this first-round filtering. After carefully reading each news article, 19 more news articles were eliminated due to irrelevance. Therefore, a total of 64 out of 187 (34.2%) newspaper articles were included in the analysis.

Procedure

A coding sheet and a coding guide were developed by the researcher and reviewed by an expert in qualitative methods and framing analysis prior to data collection. The researcher evaluated and coded all the articles. For news articles, items recorded on the coding sheet included the newspaper name, date of publication, word counts and the headline. To further identify the frames used in the articles, the researcher recorded main and secondary topics, information themes used when covering DTCA for genetic testing, and the sources used for paraphrased or directly quoted information. For the company’s press releases, the date of publication, major frames, and information sources were coded.

To ensure reliability, a co-researcher confirmed the final themes for accuracy and trustworthiness.^50,51 Since no published studies yet have established coding frames for DTCA for genetic testing in newspapers, open coding was used via a grounded theory approach⁵² to show how this topic has been framed in both newspapers and in 23andMe’s press releases. The constant comparative method was used to analyze each news story. The unit of analysis was the frame. Only repeated themes were categorized and reported. The primary researcher was a graduate student studying mass communications, who had previously been trained in qualitative data collection and analysis. The co-researcher was a graduate student, who had experience with framing theory and conducting content analysis studies.

Results

Of the 154 news articles that were analyzed, 33 were from The Wall Street Journal and 31 from The New York Times. In addition, 90 press releases from the 23andMe official website were also analyzed. The examination of the information used to discuss the DTCA of genetic tests in the major national newspapers and company press releases revealed seven main themes. These themes included skepticism, debate, regulation, empowerment, impact, credibility and official update.

Research Question 1: Dominant Frames

Skepticism

Many of the news articles discussed the skepticism associated with the DTCA of genetic tests. However, as expected, the skepticism theme was not seen in the press releases. Skepticism was referenced as questioning the reliability and validity of the test results, and the articles categorized in the skepticism frame expressed negative attitudes toward the DTC genetic tests. Skepticism was also discussed as the potential risks of DTCA of genetic tests, such as emotional harm. The skepticism sub-themes included inaccurate results, psychological harms, and overstatement of the medical significance of test results. The lack of accuracy discussed often focused on the complexity and unpredictability of the results. An article in The Wall Street Journal provided the following:

The potential harms outweigh the potential benefits of such tests. They [experts of National Cancer Institute] explained that many genes have varying degrees of penetrance, meaning that the probability that they would be expressed in a given individual is unpredictable and can be influenced by environmental and lifestyle factors.

The potential psychological harms were also discussed as a reason why experts are skeptical about the tests. The articles often stated the occurrence of “unnecessary fear” that leads healthy women to overreact about the results and therefore undergo “unnecessary medical procedures.” Additionally, the results may lead to “a false sense of security.”

Many of the articles also indicated that the testing companies over-hyped the medical significance of tests results, which results in a lack of practical use to consumers. The following description found in The Wall Street Journal included:

Besides questions about accuracy, there is also the issue of how useful the answers will be. There's no evidence, many physicians say, that people will act on such information to lead healthier lives. Little is known about the interplay of genetic and nongenetic factors such as diet, exercise, smoking and pollution that also affect a person's risk for disease. And few doctors are well-versed in how to interpret genetic tests or what to tell patients based on the results.

Debate

A large proportion of the articles from the conservative and liberal newspapers discussed the debate of the efficacy of DTC genetic tests. Many articles discussed the debate theme in four subthemes, including its pros and cons, its business model, the regulation decision and the target population that should receive the tests. The pros and cons debate was the most frequently used theme. An article in The Wall Street Journal read follow:

The warning to the Google Inc.-backed company from the Food and Drug Administration follows a debate that has grown as hundreds of thousands of people have turned to direct-to-consumer genetic tests for clues about disease risk and ancestry. Proponents say people have a right to direct access to their genetic data. But some public-health experts worry about inaccurate results or the misuse of data outside of the guidance of doctors and genetic counselors.

Another subtheme of the debate frame was discussion of the business model, especially 23andMe, which was inherently relevant to the regulatory issues. On the company side, they argued that the tests are solely information and simply provide consumer genome information. However, the FDA views them as medical tests, in that they might influence the choice of a drug or other important life decisions, such as marriage or pregnancy.

The newspapers also presented the debate about who should be tested. Take the example of breast cancer discussed in The New York Times. A 23andMe’s unpaid advisor suggested that all American women 30 and older should get the test. In contrast, other experts said only the target group who had a family history were exposed to the risk of cancer and should be tested.

The final subtheme within the debate frame dealt with regulation decision on the FDA’s crackdown on genetic testing. In The New York Times, an assistant professor at Duke University, Dr Angrist said that, “I find that disappointing and shortsighted and naïve.” Angrist said it was “borderline absurd” to think someone was going to get a mastectomy based on a $99 test, without follow-up. However, some doctors endorsed the FDA’s decision. Another example from The New York Times read as follow:

The FDA action is the latest salvo in a long-running debate about whether and how such tests should be regulated. On one side are some doctors, geneticists and state regulators who say the tests should be regulated because the results might be used to make medical decisions. … On the other side are those, especially 23andMe executives, who argue that the services merely provide information, not medical diagnosis, and that consumers have a right to the information contained in their genes. At a time when consumers are taking more control of their health care, denying them such information would be, as one director of 23andMe recently put it, “appallingly paternalistic.”

Regulation

The regulation theme was another frame found in the articles analyzed. These articles often included what the regulation decisions entail and how the relevant companies and other interested parties reacted to the regulation decision. One description of the DTCA of genetic tests regulation decision in The New York Times said:

The regulation of DNA tests and technology is complicated and in flux. … In 2013, the food and drug agency told a Silicon Valley company, 23andMe, to stop selling health information reports that interpreted a person's DNA. In February, it allowed the company to offer a direct-to-consumer test to help identify carriers of a gene linked to a specific rare disorder, Bloom syndrome. The food and drug agency, expecting a wave of new technology to analyze the human genome, helped finance the work of scientists and engineers at the standards institute in Gaithersburg, Md.

In terms of company reaction, the company indicated in their press releases that they would actively communicate with the FDA to address their concerns and assure consumers with appropriate refund instructions.

Empowerment

In addition to the skepticism of DTC of genetic tests, some news articles from the more liberal newspaper (The New York Times) and many of the press releases also discussed the empowerment benefits of these tests. The message of control and empowerment and the accessibility of the tests were consistently emphasized, as demonstrated by the following example from the company’s press release:

23andMe is focused on empowering individuals to access, explore, share and better understand their genetic information, making use of recent advances in DNA analysis technologies and proprietary web-based software tools. … “Our goal is to allow individuals to gain deeper insights into their ancestry, genealogy and inherited traits and, ultimately, the option to work together to advance the overall understanding of the human genome,” said Anne Wojcicki, co-founder.

In addition, The New York Times used some anecdotal evidence to illustrate the self-empowerment theme. The following article read as follow:

Genetics is going to be a ubiquitous part of health care. I [a young woman, consumer of 23andMe] think that everyone is going to get their genome. At some point, health care is going to reimburse for it. And you're going to hear stories of people really taking ownership of health prevention, directed by their genome, and hear less and less the fear of, “Oh, my grandmother died of Alzheimer's. It's a horrible disease I hope I never get.”

Official update

Another dominant frame of the articles and press releases was official update, with subthemes focusing on product launch and the new appointment of company officers. Official updates are frequently discussed in the press releases to inform the public about the most recent news of the company. For example, in a press release published in 2007, 23andMe announced that it would officially launch its first product to consumers on Monday, 19 November. Another important issue about the company was the new appointment of officers, often accompanied with important breakthroughs or significant business strategies. A New York Times article said:

23andMe Inc., the personal genetics company, has sold enough DNA spit kits to accumulate genetic information on 850,000 customers. Now it plans to mine that database for drug targets, and it has picked a star drug developer to lead the effort. The closely held Mountain View, Calif., company said Thursday that Richard Scheller, who retired in December as head of research and early development at Roche Holding AG, would become chief science officer next month and lead a new therapeutics group that will seek to discover drugs.

Impact

Despite the discussion of empowering benefits of the DTC genetic tests, many of the press releases argued 23andMe, as the leading personal genetics company, is making great impact on individuals’ lives and the society. Impact was referenced as the significant number of consumers the company served. For example, “It [23andMe] has genotyped more than one million people worldwide. By accessing their own DNA to learn more about themselves, 23andMe customers have helped push genetic testing into the mainstream, and helped power a new genetic research model.” Another account of impact stated the significance and innovativeness of the projects that 23andMe initiated:

23andMe, Inc., the industry leader in personal genetics, today announced that it is embarking on a world-wide effort to assemble the largest cohort of women whose lives have been impacted by breast cancer and to build an infrastructure, based on genetics, that will accelerate consumer-based research of the disease.

Credibility

A large proportion of the press releases discussed the credibility of the tests. In addition, these articles often included the following three subthemes: collaboration, awards, and advanced technology. The collaboration subtheme accounted for the majority of the presses under the credibility frame. By introducing a well-known expert or partner, the company intended to gain trust from the public about its products. One description of the collaboration in the press release indicated as follow:

23andMe, Inc., the industry leader in personal genetics, and Ancestry.com, the world’s largest online family history resource with nearly 3 million active users and 875,000 subscribers, have teamed up to provide improved genetic information to Ancestry.com’s DNA customers.

In terms of awards, the press releases focused on the significant contribution of the company and others’ acknowledgement. For instance, the following press release read as follow:

23andMe Inc., a privately-held personal genetics company, announced today that it has been selected as a 2008 Technology Pioneer by the World Economic Forum. The 2008 Technology Pioneers were nominated by the world’s leading technology experts, including venture capitalists, technology companies, academics and media. The final selection from 273 nominees was made by a panel of leading technology experts appointed by the World Economic Forum.

Research Question 2: Difference in Frames among Newspapers and Press Releases

In The Wall Street Journal, skepticism was the major frame that constituted 54.55% (n = 18) of the total articles. It followed with debate (21.21%, n = 7), regulation (18.18%, n = 6), and official update (6.06%, n = 2). However, no article used the frame of empowerment, impact, or credibility found only in the press releases. In The New York Times, empowerment (48.39%, n = 15) and debate (32.26%, n = 10) were the two most used frames. Regulation (12.90%, n = 4), skepticism (3.23%, n = 1), and impact (3.23%, n = 1) also appear. However, no article used the frame of official update or credibility.

In terms of company’s press releases, they focused more on impact (36.67%, n = 33), official update (23.33%, n = 21), credibility (18.89%, n = 17) and empowerment (16.67%, n = 15). Only 4.44% (n = 4) of the press releases discussed regulation, and none of the press release used the frame of skepticism or debate. The results of different frame distributions are illustrated in Figure 1.

Figure 1.

Percentage of frames in newspapers and press releases.

Research Question 3: Information Source

An examination of the information sources used to cite DTCA of genetic tests in the newspaper articles and press releases revealed five major categories: company officials, consumers, government officials, experts, and others (such as attorneys and members of advocacy groups).

The Wall Street Journal predominantly cited experts (42.53%, n = 37), company officials (27.59%, n = 24), government officials (21.84%, n = 19), and others (8.05%, n = 7). It did not refer to consumers as an information source in any of the articles. Experts (43.70%, n = 52) and company officials (33.61%, n = 40) are cited as two major information sources presented in The New York Times, followed by consumers (12.61%, n = 15), government officials (7.56%, n = 9), and others (2.52%, n = 3). When it came to company’s press releases, the majority of the releases cited company officials (81.94%, n = 127), experts (16.13%, n = 25), others (1.29%, n = 2) and consumers (0.65%, n = 1). None of the press releases cited government officials. The comparison of information sources among the newspapers and presses is presented in Figure 2.

Figure 2.

Percentage of information sources cited in newspapers and press releases.

Discussion

The purpose of this study was to analyze the content of conservative and liberal newspapers as well as 23andMe’s press releases and assess the inclusiveness of the frames of information they provide. Toward that end, this article focused on how these media outlets convey information about DTCA of genetic tests, how they frame this topic differently, and the types of information sources cited in the news articles and press releases.

According to framing theory, the ways in which newspapers and company press releases frame health and medical information are important to study, given that the manner in which information is presented may, in fact, influence consumers’ decisions and judgments toward products.⁵³ This study used framing theory to understand the ways in which information included in conservative newspapers, liberal newspapers, and company press releases selectively presented a view of reality that may ultimately influence consumer decision-making regarding the use of DTC genetic tests. Some of the frames summarized in this paper are contained in the health belief model, such as perceived susceptibility and perceived benefits.⁵⁴

The findings of the qualitative framing analysis indicated that the conservative newspaper considered DTCA of genetic testing as a regulation issue; therefore, it emphasized risks to a much greater extent than benefits and discussed more regulation-related frames to highlight the significance of government intervention. Specifically, the majority of the articles in The Wall Street Journal mainly discussed the risks and skepticism as well as regulation toward DTC genetic tests, which may serve to draw attention to the need of government involvement in regulation. In contrast, the liberal newspaper regarded it as a science issue, and therefore identified this issue more like a science debate and focused on its potential benefits for individuals. In particular, The New York Times offered a balanced picture by using more debate frames. Furthermore, this liberal newspaper presented the benefits of the personalized genetic test as outweighing the risks to consumers with the empowerment brought about by genetic science and technology. By comparing these two different newspapers, this paper revealed that the political leanings of news organizations (i.e. the view of the publishers) might affect which frame was selected to discuss the DTCA of genetic testing, however, in an unexpected and different way compared to the prior literature. According to previous studies that compared the frames adopted in conservative versus liberal newspapers, conservatives tend to be pro-business and stand for individual rights and absolute rights of private property and free enterprise without government intervention, while liberals tend to be skeptical about industrial modernity and capitalism and therefore suggests the necessity of federal interventions.³⁵ This is contradictory to the findings in the current study: the conservative newspaper supports for government regulation whereas the liberal newspaper stands for individual and business rights. Interestingly but surprisingly, the results of this study demonstrated that the overall political leanings of news organizations influenced the framing of DTCA of genetic testing but in an opposite way suggested in the previous framing literature. However, the reason why the findings are contradictory to previous studies is beyond the scope of this study. The researcher offers some possible but not complete explanations. First, it is likely that the political standing primarily affects parts of the editorial content but does not reflect on every single issue. Second, genetic testing is a quite complicated and growing field, which may blur the clear-cut political leaning of the newspapers. Third, there may be other factors influencing the selection of frames in both newspapers that have not yet been examined in the current study, such as the demographics of journalists and readership.

When it comes to press releases, overall, 23andMe’s press releases focused only on the positive impacts of the tests, utilizing more frames of credibility, impact, and empowerment to emphasize the benefits of the tests. It is likely that these positive frames are adopted to build the company’s reputation and trust among consumers. Interestingly, according to the study results, the frames used by company releases failed to be picked up by The Wall Street Journal; only the empowerment frame was transferred to The New York Times, but not other positive frames such as credibility or impact. A possible explanation could be that the empowerment frame is more consumer-oriented, whereas credibility and impact frames are more company-oriented. The empowerment frame discussed how the DTC genetic tests advanced individuals’ understanding of their genetic information and motivated them to take control over health prevention behavior. The credibility and impact frame stated how 23andMe was devoted to providing accurate and scientific results and how 23andMe positively influenced individuals’ health decisions and contributed to the whole society. As such, considering a broader readership, it is not surprising that The New York Times was more likely to focus on a more personally relevant topic instead of the activities of one company. However, again, the frequent use of positive empowerment frame in a liberal newspaper is unexpected since, compared to a conservative newspaper, a liberal newspaper is less likely to place higher regard for consumer rights and benefits and should be skeptical about the credibility and authenticity of genetic tests.

In terms of different information sources cited in newspapers and press releases, the findings indicated that The Wall Street Journal often referred to the opinions of government officials and experts, The New York Times referred to experts and company officials, whereas 23andMe’s press releases mainly cited company officials. By examining the information sources used, the results again suggested that different newspapers treated the issue of DTC genetic tests differently. In particular, the conservative newspaper considered it as a regulation issue and demonstrated significant amount of the government involvement and policy development; therefore, the conservative newspaper referred to government officials as information sources much more than the liberal newspaper and the company. The liberal newspaper regarded it as a science issue, and the reliance on university-affiliated persons is greater than the conservative newspaper and the company. Past framing analysis studies have noted the lack of use of university and extension professionals.⁵⁵ Therefore, this study suggests that reporters may be relying upon university researchers and scientists more often in the case of DTCA of genetic testing. In addition, not surprisingly, the press releases mainly quoted company officials to promote the product, since the releases were considered as a major communication outlet between the company and the consumers. In terms of the tones, company officials cited throughout the news articles and press releases favored DTC genetic tests. Government officials often opposed DTC genetic tests since many of them were cited in the discussion of the necessity of regulations. The tone of experts was varied and more balanced; some of them supported but others opposed. In general, the information sources cited in different newspapers as well as press releases may also contribute to the distinctive tones presented in the news articles as well as press releases.

The overall purpose of this exploratory study was to describe the informational landscape of DTC genetic tests in the newspapers and company press releases. The investigation yielded some insights into how DTC genetic tests are being represented in the major media as well as by one DTC genetic testing company. However, there are several limitations to the present study. As with any content analysis, there is no way to determine if the content framed within newspapers or press releases will actually influence human behavior. Future research based on our findings needs to explore whether news framing can, in fact, influence the way the audience perceive DTC genetic tests. In addition, it is important to note that both the articles included in the sample as well the researchers’ interpretations of the articles limit this study. These limitations are both common with qualitative research.⁵⁶

It is also important to point out that our study is descriptive in nature and focused mostly on describing “how” the newspapers and company presented the issue of DTC genetic tests. What is largely missing is a theory-based explanation of “why” the media should present the issue in one way or another. What factors can affect the way the newspaper frame an issue? First, the political stances that are taken by the conservative and liberal newspapers are different. The political orientation of the publisher or the editorial board can influence not only the selection of stories but also the way issues are framed. Future research could explore internal and external factors of news organizations that may affect the media’s selective use of certain frames in presenting the issue of DTC genetic tests. Also, the communication purpose of newspapers and company press releases is considered to be different. Newspapers intend to build their credibility and increase their readership, whereas company press releases intend to inform the stakeholders about the company and build its reputation. Therefore, with different communication purposes, the selection of the frames is different.

Footnotes

Acknowledgement

This manuscript has not been published elsewhere and it has not been submitted simultaneously for publication elsewhere.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author biography

Jing (Taylor) Wen (M.S. Iowa State University) is a doctoral student at the Department of Advertising in the College of Journalism and Communications, University of Florida.

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