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Limits on Autonomy: Political Meta-Narratives andHealth Stories in the MediaSharon Batt aa Dalhousie University ,Published online: 16 Aug 2007.

To cite this article: Sharon Batt (2007) Limits on Autonomy: Political Meta-Narratives and Health Stories in the Media, TheAmerican Journal of Bioethics, 7:8, 23-25, DOI: 10.1080/15265160701462335

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Imperatives of Narrative

REFERENCES

Braun, J. 2007. The imperatives of narrative: Health interest groupsand morality in network news. American Journal of Bioethics 7(8):6–14.

Bergson, H. 1896 [1963]. Matiere et memoire. Œuvres. Paris, France:Presses Universitaires de France.

Bergson, H. 1932 [1963]. Ch. II, La religion statique. Les deux sourcesde la morale et de la religion.Œuvres. Paris, France: Presses Universi-taires de France.

Deleuze, G. 1986. Cinema 1: The movement image. Minneapolis, MN:University of Minnesota Press.

Deleuze, G. 1989. Cinema 2: The time image. Minneapolis, MN: Uni-versity of Minnesota Press.

Deleuze, G. 1992. Expressionism in philosophy: Spinoza. Cambridge,UK: Zone Books.

Flaxman, G., ed. 2000. The brain is the screen: Deleuze and thephilosophy of cinema. Minneapolis, MN: University of MinnesotaPress.

Kierkegaard, S. 1843 [1983]. Fear and trembling/repetition, trans. H.V.Hong and E. H. Hong. Princeton, NJ: Princeton University Press.

Morin, E. 2005. The stars. Minneapolis, MN: University of MinnesotaPress.

Nietzsche, F. 1997. Beyond Good and Evil. Mineola, NY: Dover Pub-lications.

Whitehead, A. 1967. Science and the modern world. New York, NY:Free Press.

Limits on Autonomy: PoliticalMeta-Narratives and Health Stories

in the MediaSharon Batt, Dalhousie University

Joshua Braun’s (2007) analysis of narrative conventions inthe media brings a much-needed gaze to a neglected areaof scholarship in bioethics. Bioethicists often invoke publicdebate of contentious issues as a beneficial means of pro-moting the healthy discussion on which democracies de-pend. Yet the problems inherent in the main vehicle forsuch discussion—the media—have remained outside mostbioethicists’ gaze.

I agree with many of Braun’s claims, however, I ques-tion his assertion that journalists and interest groups canfreely chose to either use or abuse the narrative norms ofbroadcast media (Braun 2007). This conclusion engages aclassic narrative trope—the hopeful ending—and offers abioethicist’s escape hatch: the appeal to personal autonomy.Social, political and economic forces constrain our ability touse narrative conventions in the media for the ethical good.If ethicists aspire to understand and journalists hope to im-prove media coverage of health issues, we need to appreci-ate these constraints, which are largely outside individualcontrol. In this commentary, I look at three structural lev-els: broad cultural beliefs; the cultures of health, medicineand ethics; and the culture of health journalism. I take mostof my examples from media coverage of cancer and phar-

Address correspondence to Sharon Batt, Canadian Institutes of Health Research, Training Program in Ethics of Health Research and Policy,Department of Bioethics, Dalhousie University, 5849 University Avenue Halifax, NS, B3H 4H7, Canada. E-mail: sharon.batt@dal.ca

maceutical drugs although I suspect my concerns are notrestricted to health reporting in these areas.

In his cultural history of cancer in America, James Pat-terson (1987) found two consistent themes the media cover-age of cancer from the 1880s to the 1980s: fear and cheer. Thefirst featured statistics about rising death rates and scare sto-ries in lurid language (cancer was “a living death”, a “ver-itable Frankenstein’s monster”); the second delivered theMessage of Hope, assurances that cancer could be cured,if only people would pay attention to its early warnings,trust their physicians, and ensure that research was wellfunded. Patterson also found that, by the mid-century, op-timism prevailed as the dominant theme. The turn to cheerwas not because the picture was improving. Rather, themood of post-war America was optimistic. Popular belief intechnology and scientific progress overwhelmed thoughtfulcounter-messages based in skepticism or caution. Againstthis backdrop, the American Cancer Society (ACS) (Atlanta,GA) became a charity with unprecedented wealth, powerand media savvy under the leadership of Mary Lasker.Lasker, who was married to a famous advertising tycoon, in-troduced increasingly sophisticated public relations strate-gies, including ACS-funded meetings in sunny resorts for

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reporters and science writers, the use of celebrity endorse-ments, and wide distribution to the media of pre-packagedstories and messages.

Much of Patterson’s (1987) analysis supports Braun’s(2007) thesis: the ACS is an interest group that effectivelyemploys narrative crisis structure (the “war on cancer”) toget its message of hope into the media. The faith that sci-ence will inevitably conquer cancer strikes a deep-seatedcultural chord that journalists can use to give their storiesresonance. Whether a more realistic counter-message canbe delivered with anything like equivalent success, how-ever, is doubtful, because the expense of modern medicinedemands that optimism be maintained. Daniel Greenberg,a Washington-based science policy analyst, reached thisconclusion in a 1975 study of cancer coverage publishedin the Columbia Journalism Review. No matter how dismalthe true story, Greenberg (1975) found that official reportsfrom the ACS and the National Cancer Institute (NCI)(Bethesda, MD) were so upbeat that cancer coverage had“curious and gruesome parallels” with reporting on the warin Vietnam. Greenberg’s interviews with scientists and ad-ministrators at both the ACS and the NCI convinced himthat:

. . . there is no conscious intention to mislead the public. Rather,there is a desire to sustain public support and federal appropri-ations by conveying a picture of an immensely difficult problemthat will slowly yield if we spend on it and work at it (1975, 44).

Greenberg’s analysis suggests two subtle ways in which cul-tural forces act on a health interest group. They can affirmits biases to such an extent that the group constructs (andthe media disseminates) a misleading narrative based ongood intentions; or, a set of false assumptions may be sowidespread that interest groups and the media promul-gate them without realizing that they are distorting thetruth.

The effect in either case is to skew media reporting onhealth in one direction. The balance ethic may receive lip ser-vice as a principle of news reporting, but medical news isremarkably unbalanced. Several recent examinations haveconcluded that an upbeat and promotional tone prevails inhealth and medical reporting today. Gary Schwitzer, a for-mer medical correspondent at CNN and now a professorof journalism, monitored health news stories on four tele-vision stations in Minneapolis (MN) between February andMay 2003. The result: “single source stories were the rule,not the exception” (Schwitzer 2004, 1352). From 840 healthnews stories Schwitzer gleaned “ten troublesome trends,”many of which were a form of positive spin. These include1) hyperbole, 2) a lack of data to support sensational claims,3) commercial statements from private companies with nobalancing statements from other sources, 4) baseless predic-tions from basic science, and 5) a reliance on news releasesand handouts. Health journalist Andre Picard, who reportsfor Canada’s The Globe and Mail newspaper and its networktelevision affiliate, CTV, asserts that his own experience sup-ports Schwitzer’s list (Picard 2005). He adds ten grievances

of his own, among them jingoism (promoting home-grownresearch), kowtowing to powerful interests, a faith in tech-nology, irresponsible use of the word “cure,” and lack ofskepticism.

In a Columbia Journalism Review article, Trudy Liebermanreports the same lack of balance and critical analysis in thecoverage of pharmaceuticals (Lieberman 2005). One jour-nalist Lieberman interviewed, CBC correspondent SharylAttkisson, described her attempt to conduct a balanced in-vestigation into the safety of the cholesterol-lowering drugCrestor (rosuvastatin calcium; AstraZeneca [Wilmington,DE]). By Attkisson’s account, the reach of the pharmaceu-tical industry’s public relations arm was extraordinary. Shewas lobbied hard by the drug’s manufacturer, AstraZeneca,by physicians with financial ties to the drug company, bytwo public relations firms, and by a crisis-managementfirm. “They worked me and pushed me and contacted theexecutive producer and the president of the news divi-sion,” Attkisson said (Lieberman 2005, 50). Attkisson foundthe United States Food and Drug Administration (FDA)(Rockville, MD) to be “as obstructionist as the drug compa-nies, if not more so” towards journalists who want to publishprobing articles on drug approvals (Lieberman 2005, 50–51).Lieberman attributes this attitude to a flourishing culturewithin the FDA that began in the early 1990s, in which theFDA regards the pharmaceutical industry as “clients” or aninformal partner. She points to the “American cultural be-lief in the inherent goodness of medicine” as one reason thatjournalists covering pharmaceuticals are so ready to swal-low (and regurgitate) a public relations line. Another factoris the enormous sums the top five American news networksreceive annually in advertising from the pharmaceutical in-dustry, $1.5 billion in 2004 (Lieberman, 2005, 51).

These powerful systemic influences ensure that the in-terest groups who “game the system” carry the messagesof the well-resourced establishment. Although, as Braun(2007) points out, HIV/AIDS activists have made effectiveuse of theatrics and crisis narratives to gain media cover-age (unprecedented for any group of organized patients),these tactics were most successful when the goals dove-tailed with those of the pharmaceutical industry, promotingthe promise of drugs and weakening the authority of theFDA to regulate safety. High-profile media campaigns arerarely mounted by fringe elements, although (as in the caseof climate-change obfuscators) their scientific views maybe on the fringe. The “hijacking of reality” is more likelyto be a product of what historian of science Robert Proc-tor terms “trade association science” (Proctor 1995,101–132),that is, the deployment of sophisticated methods by indus-try associations to create doubt about the health hazards oftheir products, from cigarettes to asbestos to lawn chem-icals. Using rhetorical strategies, these interest groups in-voke science to deflect attention from one problem (e.g., thehazards of cigarettes) to another (personal responsibility orthresholds of exposure). Working closely with public rela-tions firms, industry lobby groups flood media outlets withpaid experts and press kits designed to forestall regulations

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by establishing doubt and controversy in the public’smind.

The norms of the news media may, as Braun (2007) as-serts, be amoral tools; but the ability to wield them effec-tively is heavily influenced by economic and political power.The stories that resonate are those that support rather thanchallenge popular misconceptions. Health interest groupsand journalists who would exercise moral agency in shap-ing health narratives in the media have less maneuveringroom than we might wish. If bioethicists want to encour-age more fruitful public debates about health, Daniel Green-burg’s (1975) comparison of cancer coverage to the war oncancer to Vietnam may be a clue to the way forward. TheUnited States did, eventually, pull out of Vietnam, but notuntil a profound societal shift had taken place. That changewas the result of collective, not individual effort; a successfulchallenge to the troubling state of network news coverageof health will take no less. �

REFERENCES

Braun, J.A. 2007. The imperatives of narrative: health interestgroups and morality in network news. American Journal of Bioethics7(8): 6–14.

Greenberg, D.S. 1975. A critical look at cancer coverage. ColumbiaJournalism Review January/February: 40–44.

Lieberman, T. 2005. Bitter pill. Columbia Journalism Review July/August 4: 45–51.

Patterson, J.T. 1987. The dread disease: Cancer and modern Americanculture. Cambridge, MA: Harvard University Press.

Picard, A. 2005. How can we improve medical reporting? Let mecount the ways. International Journal of Health Services 35(3): 603–605.

Proctor, R.N. 1995. Cancer wars: How politics shapes what we know anddon’t know about cancer. New York, NY: Basic Books.

Schwitzer, G. 2004. Ten troublesome trends in TV health news.British Medical Journal 329: 1352.

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