The silicone breast implant story came to light in 1990 when the media reported that women were having severe health-related problems with their implants. Since then, some researchers have indicated that the media were biased in favor of women who had received the implants, and the coverage consisted mainly of interviews of the horrors surrounding their circumstances. Others, however, have charged that reporters preferred "corporate hand-outs" to the reality of what was happening in courtrooms, or in the streets. For example, these critics claim that the media reported results of research that indicated no link between implants and disease existed but failed to emphasize that the studies were funded by implant manufacturers. Neither account supports the notion that the news media are charged with covering all sides of a controversy in a fair and balanced manner. The purpose of this project was to determine if some of the most-respected newspapers in the U.S. provided balanced coverage in the case of the breast implant controversy.

The implant controversy provides a unique opportunity to view how journalists covered an issue that evolved over several years and where hints of deceptions may have existed on each side of the controversy. Newspaper articles were studied to identify the type of sources used and the way that each side of the implant argument was presented. The study was important because it included how the media reported news that affected individual women, members of class action lawsuits, and wealthy corporations seeking refuge from litigation. With more people seeking damages from companies accused of wrongdoing, such as in the implant case and most recently the tobacco industry, the role of the media is critical in the dissemination of information. The way that information is presented in the form of story organization, headlines, leads and type of sources interviewed all impact perceptions of right or wrong and ultimately the outcome of such cases. The results of this research shed light not only on the media’s pivotal role in influencing public opinion but also on whether or not the media cover a women’s issue such as breast implant safety in a way that provides the public and its policy-makers with the type of information necessary for sound decision-making.

Literature Review

While this study does not cover the history of the breast implant controversy, some background is helpful in understanding the current issues. In 1992, the FDA ruled that silicone gel breast implants could not be used for cosmetic augmentation. Also, a record 25 million dollars in damages was awarded to a breast implant recipient. In 1993, a grand jury investigation of Dow Corning (the largest manufacturer) records was conducted uncovering a 1974 Dow Corning study which indicated silicone to be a strong irritant to the immune system. However, in 1993, Dow Corning attorneys contended there was no scientifically established link between the release of silicone and symptoms of autoimmune disorder and won its first lawsuit.

In 1994, Dow Corning, launched a major media campaign to "secure maximum exposure for key positive messages" including the points that breast implants were safe, that women needed and valued them, and that each woman had a right to make her own informed decision. Media targets specifically included the New York Times, the Wall Street Journal, the Chicago Tribune, and five other major national media organizations, as well as 41 regional newspapers in the top 10-15 markets.

Also in 1994, Dow Corning and other manufacturers agreed to settle a class action lawsuit. By the end of that year, the claims office had received 145,000 registrations in the class action lawsuit, and women were notified of a 4.25 billion dollar settlement. Also in 1994, a Mayo Clinic study, which received funding from Dow Corning, indicated no link between illness and implants.

Results of more studies appeared in newspapers in 1995, some of which had not yet gone through peer review, stating that implants did not cause disease. A prestigious medical journal editor and researcher was criticized for a conflict of interest because the researcher was also a consultant for a manufacturer and had rejected the publication of articles indicating that implants injured health. In 1995, Dow Corning placed a full-page ad in major newspapers which stated there was no link between implants and disease. Also in 1995, Dow Corning filed bankruptcy halting all claims. In 1996, a federal judge ruled that lawyers could not introduce evidence saying implants cause disease because of highly publicized studies which indicated no link between implants and disease.

Over-reliance on official sources and press releases, coupled with unbalanced reporting, is of particular importance when dealing with stories where one side in a controversy have the power to make public relations personnel and selective information easily accessible. In light of increasing criticisms of the media being out of touch with the issues that concern certain segments of society, including women, it is important to look at whether or not all sides of a controversy are being equally presented. The news media influence not only individual health behavior, but also public officials responsible for public health policy According to traditional agenda-setting models, the media autonomously set public agendas through independent gatekeeping news choices. However, Shoemaker and Mayfield believe that the news media are far from independent. Instead, their decisions on news content are influenced by social and institutional pressures both within and outside the news organization, by a desire to uphold the status quo, and by people or sources who hold power in society. According to Tuchman, the use of official sources and public relations efforts, such as the one conducted by Dow-Corning, help satisfy the requirements of balanced reporting. However, Swisher and Reese state that public relations workers exploit the objectivity routine by being "highly quotable and highly accessible." Too often sources are used to cite the facts without further investigation and to give credibility to what the reporter visualizes.

Studies on fairness and balance have focused on journalistic responsibility and society’s perceptions of the press. Simon, Fico, and Lacy defined fairness as the inclusion of statements from principal sources representing all sides of a story. Balance was defined as the relative amount of coverage devoted to a particular side in a story. They found that large, prestigious papers were found to be better than smaller papers at providing space that reported all sides of an issue. They argued that circulation size and reputation provide the editorial resources for greater research and fair and balanced reporting. However, Powers and Fico found that despite the availability of numerous information sources and resources, journalists’ decisions to use them may be patterned by influences other than concerns for audience needs or adherence to professional norms. Results from a survey of journalists from the top 21 circulation newspapers indicated that news content was found to be most powerfully shaped by journalists’ bias of source qualities. The personal judgments of journalists assessed in the study had the most powerful and numerous influences on the selection of sources in both routine and conflict situations. Tuchman believes reporters consider official sources such as committee chairpersons to be in positions to know more than other people in the organization. According to Sigal, such beliefs have resulted in a lack of diversity in sources.

Concerning media’s shaping of public opinion on health issues, Branstrom and Linblad found that public officials and medical staff were the initiators (sources) of story origin almost equal to the news agencies themselves. They asserted that news coverage contained "actors" (medical personnel or people of authority) who have a strong voice (influence) in press coverage. Concerning balance, the study found that coverage tended to concentrate on health initiatives and information while neglecting women, children, and the elderly who were affected by the issue.

Molitor examined the accuracy of news coverage on health stories. He compared the top five national newspapers' coverage of The New England Journal of Medicine published report on aspirin and its relation to heart attacks. Molitor found that newspapers omitted important information, sensationalized results, and misquoted reports out of context. Assessing the inaccuracies in reporting, Molitor asserted that coverage creates inaccurate hopes and fears and may also influence behavior capable of causing serious health problems.

Early studies on media coverage of breast implants suggest that the media were biased against their use. Weimer, et.al., surveyed a group of women who had breast implants. Answering an open-ended questionnaire, the study emphasized concerns of women with breast implants and their experience with media information. Respondents perceived inadequacy in reporting by the media and described it as biased, sensational, and overgeneralized.

Anderson and Larson also examined patients’ reactions to media coverage of breast implants. Results from the survey indicated respondents perceived that media coverage prior to 1993 was strongly against the use of implants.

Using content and narrative analysis, Vanderford and Smith found that the media relied on dramatic narratives that exploited an audience's identification with the victim. Their study of 64 articles in the St. Petersburg Times and 60 national network television evening news segments found that in 1991-1992, the primary focus of media stories was on women experiencing problems from their implants. This coverage was significantly greater in the print media where "compelling narratives with full detail and human drama" generally depicted doctors and implant manufacturers in a bad light. The researchers concluded that sensational stories of the implant recipients portrayed dangers, trivialized the medical benefits, and highlighted rare problems that created negative perceptions of the silicone breast implants.

This present study, extends and broadens the Vanderford and Smith study by addressing three questions: (1) What were the key issues identified in newspaper coverage during the height of the controversy from 1994 through 1996? (2) Was the use of sources fair and balanced? (3) Did fairness and balance of stories vary with the type of newspaper in which they were covered?

Three "prestige’ newspapers were chosen for analysis. All articles (excluding editorials) on silicone breast implants from the Chicago Tribune, the New York Times, and the Wall Street Journal from March 1994 through December 1996 were chosen for analysis. This time frame was selected since it marked the most controversial period from when manufacturers agreed to the terms of a class action lawsuit in 1994, to the time when lawyers were barred from introducing evidence in court that implants cause disease in 1996. These newspapers were chosen for analysis because they are prosperous news organizations with the reputation and resources to conduct fair and balanced reporting and to set journalistic standards. Each newspaper also targets slightly different audiences. The New York Times and the Wall Street Journal are both national newspapers; however, the Wall Street Journal heavily covers business news. The Chicago Tribune is a regional newspaper. A total of 204 articles was analyzed: 68 from the New York Times; 70 from the Chicago Tribune; and 66 from the Wall Street Journal.

Each story was analyzed in terms of its fairness and balance. To measure fairness, Lacy, Fico, and Simon’s method was used which counts the number and type of sources in each story. Type of sources fell into one of five categories which included implant recipients, manufacturers, attorneys, physicians, and other. Coder reliability on this measure after two pretests was 100 percent.

To measure balance, a method similar to Vanderford’s and Smith’s definitions for negative and positive coverage was used. If an item was constructed like an argument against implants, it was coded as negative. If an item was supportive of implants, it was coded as positive. Items included headlines, leads, sources, and the overall story. For example, if a lawyer source used in a story was against implants and supportive of implant recipients, the measure of balance for this type of source would be categorized as negative. Leads and headlines were similarly coded. The overall story balance score, however, was more of a qualitative measure based on coders’ perceptions of story balance. Coders looked at the story in its entirety and made a judgment of the overall balance, taking into consideration the space devoted to the story and the tone of the writing. Coders used a five-point Likert scale with 1 being the most negative (against implants) and 5 being the most positive (for implants and their manufacturers) and 3 being neutral (for both sides of the controversy being equally covered). Coder reliability after two pretests for both headline and lead were 93 percent. Coder reliability after three pretests for overall story balance was 88 percent.

Reporting of Relevant Sides of the Controversy. The first research question asked what were the key issues covered in the controversy. The six key issues identified in the coverage concerned the following: (1) defendant’s actions (manufacturers), (2) plaintiff’s actions (implant recipients), (3) rulings for the defendants, (4) rulings for the plaintiffs, (5) health risks, and (6) lack of health risks. Table 1 indicates that actions of the manufacturer were covered more than twice the number of times than were the actions of the implant recipients, 21.6 percent of the stories dealt with defendant’s actions, while 9.3 percent of the stories dealt with plaintiff’s actions. Concerning health issues, 14.7 percent of the stories dealt with the lack of health risks of the implants, while 7.8 discussed the health risks. Court rulings in favor of the plaintiff made up 16.7 percent of the stories, while rulings in favor of the defendant made up 11.8 percent of the stories.

Use of Sources. The second research question asked whether or not the use of sources was fair and balanced. Table 2 indicates for the fairness measure, the type of source used most often in the news stories was a spokesperson for the implant manufacturer, while the women who had received the implants were interviewed the least, although attorneys were the second largest group interviewed, many of whom had represented the interests of the implant recipients. Of the 459 sources used, 101 were spokespersons for the manufacturer, 94 were attorneys, 58 were research documents, 49 were court documents, 46 were physicians, 22 were implant recipients, and 89 were other sources including judges, FDA commissioners, advocacy group leaders, etc.

For the balance measure using a scale of 1 to 5, with 1 supportive of the implant recipients and 5 supportive of the implant manufacturers, the manufacturers spoke in favor of their side of the controversy with a mean score of 4.0. The mean score for attorneys was 2.5; research reports was 3.7; court documents was 2.9; physicians was 3.4; implant recipients was 2.4; and other was 3.0. The overall balance of headlines, using the same scale, was 3.4; leads was 3.3; and story was 3.5.

Differences in Coverage. The third research question concerned whether or not there were differences in coverage among newspapers. Table 3 indicates the mean number of sources used by the New York Times was 5.1; by the Chicago Tribune was 2.5 and by the Wall Street Journal was 3.7. The total number of sources used including research and court documents was 181 for the New York Times, 122 for the Chicago Tribune, and 154 for the Wall Street Journal. The mean balance score for the sources used at these newspapers was 3.2 for the New York Times, and 3.6 for both the Chicago Tribune and the Wall Street Journal. Analysis of variance indicated significant differences among newspapers were found for both the mean number and mean balance scores.

Looking at type of sources used by each newspaper, 20 percent of the sources used by the New York Times were spokespersons for the manufacturer; 23 percent were attorneys; 12 percent were research documents; 12 percent were court documents; 10 percent were physicians; 5 percent were implant recipients; 18 percent were other. For the Chicago Tribune, 20 percent were spokespersons for the manufacturer; 20 percent were attorneys; 12 percent were research documents; 9 percent were court documents; 13 percent were physicians; 8 percent were implant recipients; and 18 percent were other. For the Wall Street Journal, 27 percent were spokespersons for the manufacturer; 19 percent were attorneys; 14 percent were research documents; 11 percent were court documents; 7 percent were physicians; 2 percent were implant recipients; 20 percent were other. No significant differences were evident in the type of sources used among newspapers.

Conclusion

Results from this study indicated that between 1994 and 1996 the views of the implant manufacturers were more often presented than were the views of the implant recipient. Also, story issues were more likely to concern the actions of the manufacturers and the people interviewed for these news stories were more likely to be spokespersons for the manufacturer rather than for implant recipients.

Looking at fairness of coverage, the findings suggest that since spokespersons for the manufacturer were interviewed most, stories favored their viewpoint. Also since research funded by the manufacturers or published by a consultant to the manufacturer was heavily reported as fact, the manufacturers’ viewpoint was further emphasized. As expected, different types of sources represented different sides of the controversy. However, the mean scores for all sources except the implant recipients and their attorneys favored the use and safety of breast implants.

When looking at differences in coverage among newspapers, a few were identified. The New York Times tended to present a better balance of all sides of the controversy. The New York Times was also found to include significantly more news sources in its stories. The Wall Street Journal was most likely to present the view of the manufacturer. However, overall coverage by all three newspapers was very similar in terms of the issues covered and the types of sources used.

These findings raise questions concerning the coverage of the breast implant controversy. Too many stories relied more on official sources and public relations officers and presented more of their viewpoints. One reason for this is that the official spokespersons for the manufacturers were most easily available for comment and may have influenced the judgments of reporters. The implant recipients’ viewpoint was noticeably absent. These women were part of a class action lawsuit and were not under the usual restrictions of commenting to the press. Had these women been sought out more often for comment, coverage might have been less one-sided.

The media also failed to question research findings funded by the manufacturers. Some of the studies reported as conclusive had not yet been submitted for peer review. Other studies used nurses (a few of whom had implants) rather than large numbers of implant recipients, and looked for very specific auto-immune diseases such as lupus, rather than more common symptoms such as rashes, joint pain, and fatigue and found no significant differences between the two groups. Flanders’ recent comments on these studies implied that the research had been designed to boost the manufacturers’ case and only the results that served their agenda were promoted to the press. This type of reporting undoubtedly influenced policy-makers, as well as public opinion, suggesting the ill-effects of silicone were fabricated by money-seeking implant recipients and their attorneys, a result the manufacturers had likely hoped for when such studies were funded. Although key patterns did emerge, more research is needed to identify issue placement within the story regardless of the number and type of sources used and whether or not space was equally allotted. For example, a story may have included that research was funded by a manufacturer; however, when it is placed near the end of the story, its significance is lost. Nevertheless, these findings do suggest that newspapers during this period were less likely to emphasize the plight of the implant recipient and the dangers surrounding usage than the trouble that manufacturers were facing in light of expensive lawsuits. For the most part, reporters highlighted information from the manufacturers’ public relations offices. According to Tuchman, balanced reporting serves as a defense for journalists who seldom have the time or expertise to verify the truth. However, if journalists have not the time nor the expertise to verify truth, and instead publish easily available material, is their portrayal balanced? This is an important question in the coverage of controversial issues that affect not only women, but the lives of many people because of the media’s power to construct reality by the selection, arrangement, and emphasis of their news accounts. This is an especially important finding in light of newspapers’ desire to increase readership among women.

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