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Mass
media acts as a bridge between science, medicine and the public. The article
discusses the quality of press news, within the context of international
journalism and contributes to the understanding of media impact on the public
understanding of science and medicine as well as upon collective health. A text
analysis of recent stories in regenerative medicine within the two principal
elite newspapers of wide national circulation in Brazil, Folha de São Paulo
and O Globo, is carried
out. The theoretical approach to Science, Technology and Society is applied and
the qualitative sociological theory of frames/framings as initially formulated
by Entman. The work is based on a methodological matrix built to study textual
devices-metaphors, examples, catch or effect phrases and representations – and
reasoning elements – origins, causes/effects and appeal to principles. It
applies a modified version of the one developed by Gamson and Modigliani. Within a surprisingly general scarcity of
news on this pioneer topic at the local and global levels, two principal
framings stand out: the scientific and medical frame and the social one, with
the first as predominant. It tends to reflect an idea of linear scientific
progress, an exaggerated optimism within the stories, as well as, a strong
pride about the role of local discoveries and treatments in Brazil. The quality
of information appears deficient, with considerable biases and dependent on
international sources for its legitimation. This situation can contribute
towards the development of false expectations on collective health in the
present phase of cell- based therapy application, as well as, to a certain
extent, misguide public understanding of science.
Keywords: Regenerative medicine, Mass media,
Cell-based therapy, Collective health, Public understanding of science, Press
news
INTRODUCTION
The public accesses the media as a privileged
source of information in science and medicine [1]. Newspapers co-produce
information in culturally specific ways and these are processed within civic
epistemologies: patterns of meanings that the ‘publics’ use to verify data and
act upon it within society [2]. However, the effect of this information upon
the individuals’ scientific opinions depends, to a great extent, on the way it
is organized and presented in the news reports published.
The present study intends to evaluate the
quality of press reports and offer a contribution to the understanding of the
eventual impact of the press on collective health. It undertakes the analysis
of news in a pioneering scientific and medical area: regenerative medicine (RM) in Brazil. Some
concepts within the theoretical approach to Science, Technology and Society
(STS) are applied to research the following questions:
• What is the quality of information in RM
reported by the local press?
• Which the main framings used in the news
reports?
• What place is assigned to social topics
within press coverage?
Global
quality of scientific news coverage: The context
The content of the information presented to
the population impacts the way it visualizes the contributions of science and
the manner in which public understanding of science unfolds. Some of the
characteristics considered as pertaining to adequate scientific and medical
journalism include: the relevance of the news selected, the precision of the
information transmitted, the recognition of the limitations of reports and
journalists, as well as, the professionals’ capacity to critically assess data.
The global context in which journalistic practice develops can also influence
Another important factor intervenes in the
information accessed and transmitted by scientific journalism. The relationship
between science and journalism has been historically uncomfortable; a difficult
collaboration has been established between scientists, science communicators
and journalists [3]. The languages, work routines and data presentation of the
three social sectors are quite different and that makes their integration
difficult [4].
In New Zealand, for example, communication
consultants and scientists evaluate the quality of science coverage as poor.
Bauer et al. [5] found that two thirds of American scientific journalists
consider their colleagues as lacking a critical perspective regarding the
topics researched. In the United Kingdom, 71% of the public believes that the
media transmits a sensationalist perspective on science [6].
The language used also substantively affects
the quality of the articles published. A study on meta-cognition developed by
Bullock et al. [7], proved that the use of scientific jargon increases people’s
difficulties in knowledge processing. It hinders the public perception of the
risks involved in the discoveries and diminishes their support for new
treatments. Some authors have also found that lay publics tend to become
irritated when confronted with uncertain research results or adverse health
effects and risks derived from therapeutic applications [3]. This type of
public reaction can influence the way risk and uncertainties are reported in
the newspapers.
Quality of news’ content is also
substantively influenced by the structure of work within journalism as a
profession: journalists’ training and specialization opportunities, as well as,
working conditions. In some developed countries, a professional crisis has been
reported by science journalists [5]. As significantly intervening factors, they
have emphasized that newspapers’ circulation has been affected by a global
decline in readership, due to an increase in television news programs and
online coverage. It has also been shown that many newspapers have opted for
online platforms to recover costs [8]. A well-known fact is that, at the
international level, newspapers have reduced employment [9].
Among the journalists that are still working
in their profession, there is then a higher pressure to develop articles in
shorter periods of time [5]. The growth of online platforms also demands from
them a variety of different versions of their articles. A research piece
published in Nature, that interviewed 493 journalists, found out that, 59%
believed that the number of products per week expected from them had grown in
the last five years [10].
Within this general context, scientific
journalists face specific challenges to develop their work effectively. For
example, the time required to check the veracity of facts has been
significantly reduced and partly, due to an increase in the amount of
scientific production [11]. Many of them have tended to choose just a small
number of influential and trustworthy sources to filter the news’ contents [4,
12]. For example, public relation professionals (PR) are increasingly becoming
the spokesmen for research institutions and journalists require them more
frequently as sources and filters of information [1]. These PRs are generally
communication professionals, instead of science specialists and function as
gatekeepers for the access to scientific institutions. This range of changes in
the profession and the market contributes to diminish the quality of the
articles published.
The Brazilian press is far from exempt from the
consequences of these global trends, as reflected in some of the studies by
local authors [13, 14]. Moreover, in Brazil, the lack of specialized training
in scientific journalism can further accentuate the scarce scrutiny of the
information published.
CONCEPTUAL AND METHODOLOGICAL
APPROACH
This article is indirectly based in
constructivist concepts central to the area of Science, Technology and Society
(STS), as those on the co-production of science in society and of the
definition of ‘civic epistemologies’: tacit and culturally-specific ‘forms of
knowing’, that citizens use in the public sphere to verify knowledge and demand
adequate public policies [2]. These approaches help in the understanding of how
the press contributes to mold public knowledge on science and medicine.
More specifically, this study is based on the
sociological approach to the study of frames/framing. Frames were initially
defined by Entman [15], and they entail
journalists’ selection of some aspects of reality to be emphasized in the
communicational text, as a way to promote a specific definition of a question,
a certain causal interpretation, an ethical or moral evaluation, as well as,
recommendations that can solve the
problem. Some aspects of the topic in question become salient and others are
relegated, hidden or made invisible. Specific attributes, judgements and
decisions within the report are being suggested. A framing is then an
organizational and structuring endeavor, that is, it becomes a topic in itself
within a news report.
A qualitative study of the main framings in
RM news in Brazil has been carried out. It is based on textual or discourse
analysis of various dimensions in the narratives found in the articles
selected. Representation styles or “interpretative packages” were depicted in
the articles and defined: as central organizational ideas that mold a theme and
create meaning [16].
The matrix developed by the authors mentioned
was used to study its interaction with different elements from the narratives.
In this matrix, two wider themes-to be later discussed-were analyzed in
relation to: a) the devices for the
construction of framings (metaphors, examples, visual icons, effect phrases and
representations); b) the reasoning categories applied (origins/roots, consequences
or type of specific effects, appeal to moral principles and demands; e.g.
rationality, faith, causes). Only two main framings were found during the
classification of the articles’ themes: the
scientific-medical frame–reports on conferences, research discoveries and
novelties-and the social frame-
articles that discuss socio-ethical controversies, public policy initiatives,
economic aspects and the humanistic or humanitarian perspective, that focuses
on the narratives of individuals who
could be potential RM beneficiaries.
To process the information gathered, firstly,
the selected texts were repeatedly read, classified and codified manually and
this process was checked by a second codifier. Secondly, the tones of the
reports were defined, using a modified version of the categories developed by
Yoon [17] for studies on stem cell research. Each article was classified as
optimistic, pessimistic or neutral/descriptive. Keywords such as, success,
confidence, help and benefit, were selected in the news reports, to define them
as optimistic; versus, fear, critique, preoccupation, doubt, risk/danger and
setback, to illustrate the pessimistic versions. When the article presented a
balance between optimistic and pessimistic attributes, it was considered as
neutral/ descriptive.
The case-study is based on 39 articles on RM
published in the period between January 2012 and May 2019 in the two main
newspapers: Folha de São Paulo and O
Globo [Three of them were subsequently discarded as irrelevant]. The search
in the newspapers’ websites:
The two newspapers selected are those of
widest national circulation and have an important impact upon Brazilian
society. They have specific sections and staff dedicated to scientific and
medical coverage. These elite newspapers contribute to agenda-setting for the
non-elite newspapers and tend to use a greater number of sources and amount of
resources. The keywords used and the time-period of the sample analyzed reflect
the present stage of the RM field at the local and global levels, as it focuses
upon the clinical phase of cell therapy, after having during previous decades
developed mainly basic and preclinical research.
RESULTS
AND DISCUSSION
Main framings: Scientific/medical and social
A total of 36 newspaper articles were
analyzed and distributed between two different main framings:
scientific/medical (22 cases, 61%) and social (14 cases). Among the
subcategories of the social framings, the majority of articles refer to public
policy (9 in total), three of them are economic reports and it is surprising
that only one of them presents a humanistic perspective and another one, an
ethical approach. This can be a problem when evaluating the public impact of
the RM press as, on the one hand, it can diminish public awareness on existing
ethical debates and, on the other hand, limit the identification of the readers
with other citizens or patients.
The scarcity of humanistic/humanitarian
perspective in the sample contrasts with trends documented in other RM contexts
[18] and can reflect the priority attributed within elite newspapers, to ‘hard’
news versus ‘soft’ news, that is, those that report difficulties faced by
patients [19]. But the lack of moral and ethical debates in the local reports
echoes similar trends at the global level, once regulatory controversies
regarding embryo status have been overcome by many countries [20].
Textual devices used
in the news reports
An optimistic evaluation predominates in more
than half the cases analyzed [19], while the rest of the reports are evenly
distributed between those of pessimistic and of neutral tones. In the scientific coverage, benefits
and successes are emphasized versus risk and uncertainties, with the use of
metaphors, such as: “key to the mystery”, “rebirthing” and “key that
reinitiates the computer”. In the description of scientific and medical
advances and discoveries, cell-based therapy is represented as: “very
promissory”; “renewing hope”; “bringing benefits throughout life”. In the
effect phrases, the idea that novelties “repair” or “intervene” in a “broken
piece” within the human body, or else, “fix an irreparable loss of health”, is
repeatedly found. The bluntest effect phrase applied by journalists describes
the transformations produced by cell-based therapy as: “propelling cancer cells
to commit suicide”, that is, a description of a radical extinction of cancer
cells and the injected stem cells symbolically becoming the main subject for
this transformation.
However, many of the scientists quoted in the
reports who express a basic optimism in the discoveries, are somewhat cautious
in the use of effect phrases. They explain: “nothing falls from the sky” (in
reference to the amount of research and effort required to develop cell-based
therapies). They also admit that they, “sometimes have more doubts than answers”
and that, as scientists, they must “be responsible” in the way scientific
progress is publicly announced.
The examples and cases mentioned, in general,
are accompanied by visual material of high social and cultural impact. Among
them, there are photographs of: the kick given to a ball by a patient using a
bionic skeleton, in order to open the World Football Cup of 2014 in Brazil; a
quadriplegic individual sitting on a wheel-chair is shown as able to move a
hand due to cell-based therapy; a patient recovered from Crone disease is
reported as the “only patient in the world”. Some of the other texts only
describe the positive results of the initial phases of clinical trials in
cell-based therapy.
Many articles refer to international journals
of prestige, such as: Nature, Science, MIT Technological Review, and New
England Journal of Science, as a way to value the local novelties or
interventions and not only as sources of news reports. Also, in order to
legitimize the content of the articles, emphasis is placed on the role of
foreign institutions and/or professionals participating in local research, or
else, upon the fact that some of the therapies in experimentation in Brazil
have already been approved in developed countries.
Within predominantly scientific reports,
there are very few references to associated political or social themes.
Sometimes, novelties are presented as the only health solutions for patients:
“there was no more to offer them”; “we tried to draw luck”. Reflections and
analogies are made in relation to peripheral or subordinate science in an
emerging country, for example, “being towed by what is done in foreign
countries”; “a hard race”, (in reference to the existing competition to obtain
original research results and their publication).
In contrast, metaphoric language in the
social framings tends to be of an ontological and analogical type. Discoveries
are described as: “playing the role of the Creator”; “a gene with multiple
personalities” (in reference to gene capacity to change its expression);
“revealing the secret of life”, or else, as a novelty that “opens doors”.
Effect phrases, in many cases, reflect common concerns in global RM, for
example, the existence of an endless regulatory loop-“the reduction of
regulating times”- the illegal commercialization of therapies-“we are
volunteers and are not looking for profit”- risks in the use of experimental
products as if they were approved-“people need to know what they are paying
for” and , also, the need “to attract foreign investment”, as a way to progress
in science and medicine in an emerging country. Narratives’ representations
refer to “promises of rejuvenation”- a central aspect of RM- as well as an
opposite evaluation as, “deceitful propaganda”. The examples offered are mostly
based upon testimonies and photos from “the famous”, and they occupy a central
place in the reviews. For example, it is the case of the football player,
Neymar, with the perspective of curing his damaged foot through cell-based
therapy.
The social reports show big differences with
those published in initial periods in the field of stem cell research in
Brazil. In previous decades, relevant local academics had detected a tendency
to report differences in opinions in the news in terms of “wars” and “battles” between
opposite sides [21,22]. Instead, in only three cases in these recent articles,
there is any explicit reference to relevant political or ethical struggles.
These are mainly related to: Current contrasting positions on blood storage
held between the National Agency for Health Vigilance -ANVISA- and the public
cord blood banks, on the one side, and the private banks on the other.
However, social and political controversies
are salient in a large proportion of the social framing articles (71%, 10
cases). In these cases, journalists formulate only subtle suggestions and
veiled critiques. Even when they are able to report both sides of the debates,
they present only partially relevant arguments. This is the case of critical
commentaries on the delays in ethical committees’ approvals of clinical trials
attributed to an excess of bureaucracy, or else, to unsatisfactory regulation
for the accreditation of clinics and scientific activities.
Results from studies in developed countries,
show local journalists as highly attracted to focus upon scientific
controversies [23]. However, in our sample, this trend only appears in articles
classified within the social framing. Otherwise, few scientific reports
illustrate scientific debates frequent at the global level, for example,
controversies on the best types of stem cells for specific research projects -
e.g. induced pluripotent cells (iPS) versus embryonic stem cells (ESC)-, or
else, on medical choices to apply a new stem cell treatment to patients or
maintain the conventional therapy.
Examples and cases tend to be used more
extensively in the social than in the scientific and medical framings.
Quotations of individuals’ testimonies are intended to familiarize readers with
the present state of patients’ health. The subjects mainly reported are: the
processes of patients that were successfully treated with cell-based therapy,
or else, began to be hopeful about symptom alleviation through these
treatments, as well as, the opinions of famous individuals who, when confronted
with positive results of the new therapies, changed their mind in relation to
the RM field or offered donations.
Most specially within the social frame,
narratives show great differences between the way scientists and journalists
describe the new developments in RM. Journalists express themselves in more
optimistic tones and use effect phrases such as: “a radical change”; “it renews
hope”; while scientists are more cautious in their descriptions of scientific
and medical progress and use phrases like: “nothing is miraculous”; “one should
stay close to reality” and “a lot still needs to be evaluated”.
However, scientists tend to be ambiguous and
unspecific when they consider the moment when these therapies will be
definitively tested and approved. They apply phrases such as: “in the short
term”; “soon”, “in a brief period of time”, “in some time”. Only in very few
articles they explicitly mention a probable timespan for market release; e.g.
“between 5 and 10 years”; “almost in 15 years´ time”. The “hyped” promises of
cures that were predominant in the RM press coverage in the last two decades
seem to have been overcome, to some extent [24]. But journalists still make too
many optimistic predictions, partly based on the unclear time-periods informed
by scientists on when their discoveries might become products. This situation
may eventually induce a certain level of false expectations among readers.
Reasoning elements
within news reports
Reasoning elements found in the news reports
mainly appeal to scientific rationality and technological development,
especially in relation to local progress in RM. A secondary kind of appeal
involved–one of the types of cause and effect–responds to an interest in the
solution of human suffering, i.e., the acceptance of its existence and adequate
actions to transform it. Ethical and moral appeals are extremely limited within
the news. This section illustrates the reasoning elements prevalent in the
articles through a brief presentation of commented quotations from the
newspaper Folha de São Paulo.
In relation to the appeal to scientific
rationality, a review article dated April 6, 2018, expresses caution when it
describes a research project on the creation of bones and cartilage “à la carte”:
“The procedure being developed by Bonus is
still under experimentation. It involves ‘in
vivo’ culture of bone tissue from stem cells derived from the patient’s own
fat tissue and extracted through liposuction, that is, no artificial inserts [are being used]. Technology will allow any person to order, for example, the bone
he/she needs in case of trauma, infection or cancer (...) Tissue
engineering, researchers warn that it is important to be cautious during
experimentation. ‘Validation of this
type of research is very important. One
cannot accelerate clinical tests’.” (own emphasis).
The journalist’s optimism in stating that,
any person will be able to develop this type of treatment, contrasts with the
more cautious rhetoric used by the scientist quoted. The journalist judges the
consequences of the discovery from a viewpoint based upon a universal
logic.
An appeal to Brazil’s future technological
development in the field is transmitted, for example, by a review published on
January 23, 2019 and related to partnership building between the firm Novartis
and the prestigious private Institute Butantan in São Paulo. The report
specifies that Novartis has invested around 40 million US dollars in local
research during the last three years and it comments on a meeting that took
place between the São Paulo mayor, João Doria, and the President of the
Novartis Institute of Medical Research, James Bradner:
“(…) the objective declared by Doria in
Davos, is the attraction of foreign
investment to São Paulo. One of the aims is to form partnerships with the
private sector so that Butantan becomes
the main world producer of vaccines” (own emphasis).
The report is highly presumptuous regarding
the potential consequences of partnership building for Brazil’s future in
vaccine production; the aims established show a lack of reality criteria as
well as appealing to national identity and pride. This news report is the only
one among the 52.7% of articles (19 in total) on public/private strategic
partnerships in RM; a governmental strategy for health promotion that started
in the last decade.
In a review dated September 11, 2018, present
regulatory obstacles for the development of cell-based therapy are reported by
a top manager at a firm willing to invest in Brazil:
“ANVISA intends to reduce regulatory stages,
but we still have to bear longer waiting
times than those in other contexts. (...) the interval for a clinical trial
approval used to be of two years and has now been reduced to one year. (...) we could have more local research if we
operated more closely to European standards that allow for approvals in 4 to 5
months.” (Own emphasis)
The report offers an open critique of
inefficiencies in the present regulatory system. Its underlying motivation is
to propose regulatory flexibility and it indirectly promises major future
investments, if approval conditions emulated more closely those in European.
Otherwise, it follows, investment resources and periods will be limited and
conditioned to regulatory transformation.
Cause/effect appeals regarding patients’
suffering can be exemplified with the following quotation from a report
published on April 6, 2018, about new stem cell techniques for cartilage
regeneration. The patient in recovery explains:
“Two surgical procedures were necessary, as
well as, many physiotherapy and body-building sessions. The size of the scar in
my right knee-25 stitches in total-is not bigger than my relief. At present, I
cannot run, but I am able to return gradually to my normal life.”
However, the narrative mentions solely the
positive effects of the treatment. It also exemplifies the use of innovation to
provide a better quality of life versus to ensure a definite cure, the focus of
many cell-based therapies at the global level [20].
A review dated May 15, 2014, on the treatment
of a patient cured from Crone disease, develops a humanitarian perspective:
“The method used-technically a blood stem cell transplant-has not yet been
approved by Brazilian local authorities. (...) But it is being used for severe
cases in hospitals in Europe and the US”.
The therapy acquires legitimacy based on
international experience and it is applied in a humanitarian way, given the
severity of the disease and the lack of alternative solutions. The quotation
also illustrates the global trend towards the implementation of regulatory
flexibilities in RM, a practice much less frequent in Brazil.
Ethical appeals are quite absent from the
news reports. One exemption is that of an article dated August 2nd, 2019, on
the controversial technique CRISPR-Cas9, for gene-editing of human germinal
cell-lines (e.g. Ledford, 2015) [25]. Two antithetic ethical positions are
discussed by the review and then, the following explanation is provided: “In
March 2017, The American National Academy of Science considered that new
developments of the technique (...) ‘open up realistic possibilities that
deserve serious consideration’ ”.
A change in the recommendations of respected
international scientific associations is perceived as exclusively linked to the
progress achieved in technique development. Moreover, its future use appeals to
an ambiguous ethical principle: ‘to leave options open. This allows for the
potential application of the technique, until new considerations on risks and
uncertainties are clarified, instead of taking into consideration, for example,
the precautionary principle.
CONCLUSION
Beyond the situation described for journalism
in the international context and its potential influence upon the Brazilian
society, the news reports’ analysis reflects some local cultural
characteristics and the subordinate character of scientific journalism in an
emerging country. Substantial differences in the languages employed by
journalists and local scientists are found in the description of discoveries,
the way of making topics salient and evaluating them, as well as, imprecisions
in the journalists’ narratives and a scarce scrutiny of data veracity and
validity. The general adverse conditions of professional journalism in Brazil
vis-á-vis those in developed countries, can undoubtedly influence carelessness
within reporting and could become the subject of further research.
Research results reveal a deficient quality
of RM information in the press, presenting quite a lot of biases and dependent
on international sources for its legitimation. The total number of news reports
seems surprisingly small, considering that RM has become a pioneer scientific
and medical sector at the local and global levels.
The reports produced by journalists are too
optimistic in relation to successes and accomplishments of local medical
discoveries and hardly discuss scientific risks and uncertainties that, at the
global level, are portrayed as still very significant in RM [26]. This
situation can contribute to the shaping of exaggerated expectations among the
local public, even though, maybe to a lesser extent than in previous decades.
Narrative interpretations present a reasoning
that appeals principally to scientific rationality and progress of RM in
Brazil, in a linear fashion and from a universalistic perspective that
frequently boasts about national scientific and medical identity. Only in a
secondary sense, do texts appeal to collective health and the experiences of
the sick.
The constructivist method adopted by this
study-based on the Gamson and Modigliani [16] matrix-allows to reveal the
persistent interpretative patterns in the reports on RM and contributes to
understand the thinking processes involved in narrative building.
Interpretative methods are extremely useful to address the integration of
scientific meanings into the shaping of civic epistemologies and the
construction of the public understanding of science and medicine.
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