News coverage of drug development: implications for the conveyance of health information

Drug development promotes human health, and the number of newly launched drugs is negatively related to mortality [1]. According to data collected from 36 countries in 2015, the cancer disability-adjusted life-years (DALYs) for 19 types of cancers have reduced by almost 23% because of new drugs launched between 1982 and 2010 [2]. Estimated mortality also substantially reduced between 2015 and 2020 because of new drug development between 2011 and 2015 [2]. Drug development is, therefore, pivotal to public health promotion. However, immense investment in terms of technologies, resources, and time is required to develop just one drug [3]. In practice, the cost of developing a drug may exceed $800 million [4‐6]; the high failure rate of drug development accounts for such high cost. Approximately 11.8% of new drugs are approved for clinical use [7]. Furthermore, 10 years or more are usually required to complete the drug development and evaluation process [8, 9].

Drug development is time-consuming and labor-intensive. Additionally, information about the research and development of new drugs is sometimes esoteric for the general public [10]. Therefore, news media plays a key role in public health promotion by enhancing public comprehension of the development, effects, and performance of new drugs [11]. A previous study has shown that people who closely follow health news are more likely to acquire correct health-related knowledge [12]. Additionally, news coverage enables the general public to make informed decisions regarding health care [13]. In reality, drug development constitutes a professional “biomedicalization” sphere, yet news media can help break such sphere boundaries and move health-related information from the restricted sphere to public sphere [10]. However, it is noteworthy that, in reality, news media may not positively contribute to enhancing public comprehension of drug development. Instead, under different frames of news coverage, public opinion about health-related technologies and advances could be shaped differently [11]. Accurate, balanced, and complete coverage of new health products is indispensable for helping the general public make informed and correct health decisions [13].

Despite this, previous research on news coverage of drug development has found that news reports often lack important and basic information about the drugs developed [14]. The content analysis of coverage of the human papillomavirus (HPV) vaccines in newspapers in the US has also shown that even detailed information on newly developed drugs is frequently incomplete [15], with various types of essential information (including the experimental status, drug efficacy, and mechanism of drug action) missing. A recent study of 500 stories in the US media revealed that the incompleteness of information reported in news articles was mainly associated with the risks and cost of the product and treatment [13]—more than 50% of news coverage omitted the potential treatment risks, and 70% did not reveal the treatment cost [13]. This may have a negative effect on people’s medical decisions. Therefore, quality evaluation of news coverage of health-related technologies and medicines is important.

Currently, the majority of studies on news coverage of drug development and its public health implications are conducted in the US [10, 13] and other high-income countries [16]; few such studies are, or have been, conducted in developing countries. However, the transferability of findings from the US and other high-income countries to developing countries is a worthwhile concern. This is partially supported by the fact that claims and frames in news coverage of drug development can be affected by cultural factors. In the case of Kalydeco (a drug for cystic fibrosis), a Canadian newspaper emphasized the availability of the drug under the public funding program for patients, whereas news coverage in the US framed the drug as an economic story [17]. Similarly, in the case of trastuzumab (a drug for breast cancer), news coverage in both Canada and the UK presented it in a positive light, but the tone of the Canadian newspapers was more neutral [18]. Thus, diverse narratives can be constructed around the same drug through different styles of news coverage.

Examining news coverage in developing countries is important because: (1) they generally have a poor system of regulating the quality and accuracy of science news, and (2) the comparatively low educational level of people in these countries makes them susceptible to misleading or scientifically inaccurate information. Therefore, the objective of this study is to analyze the news coverage of drug development in the main health newspapers in China. Strict regulations regarding the accuracy of new drug information (as well as the professional qualification of health reporters) in news coverage are lacking in China. Consequently, it is a good sample country that offers a suitable environment to study implications of improving the quality of news coverage of drug development to enhance public comprehension of advances in drug development for public health promotion. In order to achieve this goal, the following research questions are answered:

As heterogeneous information (ranging from topic-choosing to linguistic expression) exists in news coverage, a deep content analysis can help reveal the complexity of new drug information. In order to analyze the claims and frames in Chinese news coverage of drug development, four influential newspapers: Science and Technology Daily, Health News, Zhongguo Yiyao Bao, and Medicine Economic Reporter were included in this analysis. All of them are managed by national government agencies of China: Science and Technology Daily is managed by the Ministry of Science and Technology of the People’s Republic of China; Health News is managed by the National Health Commission of the People’s Republic of China; and Zhongguo Yiyao Bao and Medicine Economic Reporter are managed by the National Medical Products Administration. They are issued countrywide because of their special and nearly irreplaceable roles in reporting drug development. They report profusely on drug development and set the tone for relevant drug information, because of which they are acknowledged as mainstream news media by the China News of Drug Information Association and as major resources of health information in China [19]. The China Core Newspapers Full-text Database (CCND) of the China National Knowledge Infrastructure (CNKI) was used to search for relevant news reports [20, 21]. A database search for the period 2015–2020 with the Chinese equivalent of the keyword “new drug,” revealed that the number of news reports published in Science and Technology Daily, Health News, Zhongguo Yiyao Bao, and Medicine Economic Reporter was much higher than that published in other newspapers. As a result of the social interruption caused by COVID-19, news coverage of new drugs in 2020 was atypical and non-representative. Therefore, only news reports published between 2015 and 2019 were retrieved.

A total of 3029 news reports were retrieved, but only those that introduced the research, development, or approval of at least one new drug were further analyzed. The news reports were independently screened by both authors, and inter-rater reliability was assessed using Cohen’s kappa, which was calculated to be 0.82 and considered good agreement beyond chance. All disagreements encountered during the news report selection process were discussed until consensus was reached. A total of 128 news reports met the inclusion criteria and were used for further analysis (Fig. 1, Table 1). Among them, 37 reports were from Science and Technology Daily; 39 from Medicine Economic Reporter; 29 from Zhongguo Yiyao Bao, and 23 from Health News (Fig. 2). Each article was analyzed from three aspects. The first aspect was related to the characteristics of new drugs reported in mass media, and the function, development phase, and place of origin of the reported drug were analyzed. The second aspect was related to the features of news coverage, with special focus on the reporting style and the information source of the news report. The last aspect was related to the accuracy of the content in news reports, and the availability of information about new drug mechanisms and presence or absence of misleading information about the reported drug were examined.

Exploring how newly developed or tested drugs are reported by newspapers—as well as the textual features and factual accuracy of those reports—can help comprehend their possible impact on the public’s perception of the reported drugs. Earlier studies on health news coverage in developed countries have not only observed that reports on new drugs are often written based on a very limited variety of information sources [14], but have also found that many of the reports fail to disclose essential information (including the efficacy and mechanism of the reported drug [15]) and to offer a balanced account of the risk and benefit of using the drug [13]. This is consistent with the observation we made in this study. As shown by the results, more than half of the analyzed news reports employed adjectives such as “best,” “first,” and “only” to describe the performance and importance of the reported drugs. More than one-fifth (21.9%) of the reports directly quoted the information provided by pharmaceutical companies. News reports using information collected from independent experts and patients are highly scant. In addition, over 90% of the reports failed to present a balanced account and focused solely on the positive aspects of the reported drug without mentioning any risks or harm warnings; the rate was higher than that in Canadian newspapers (68%) [33] and the US media (53%) [35]. This may be attributed to the reporting principles established by China for media management, which requires the news media in China to report more positive aspects of social development so as to keep the people and the country “united,” “stable,” and “motivated” [39].

In order to ensure a more balanced and objective description of the reported drug-related information in mass media, the establishment of guidelines on areas to be reported may help improve the overall quality of reporting in health-related domains. Important aspects that may affect the standpoint and/or reveal personal interests of the news reporter (including the source of information), as well as basic information about the drug or related treatment (including the scope of usage, known and potential adverse effects, and the manufacturer’s name) should be specified. The availability of alternative treatment options, as well as the cost of the reported drug, should also be covered in a news report [40]. Additionally, miscomprehension of drug efficacy may impede accurate health decision-making [41]. Our results show that most of the diseases reported in the analyzed news reports included common chronic diseases prevalent among a large patient population. Extensive use of absolute adjectives such as “best,” “first,” and “only” without providing risks disclosure can have a negative public health impact. Therefore, the use of adjectives should be regulated through carefully created guidelines.

After the establishment of guidelines, their implementation should be closely monitored by professional bodies related to science journalism so as to assure that their members adhere to the guidelines. In order to achieve this goal, regular assessment of news quality, as well as systems for reward and punishment, may be put into effect. Additionally, when new drugs and other medical treatments are reported, the voices of different stakeholders (including physicians, patients, and scientists) should be reflected as much as possible to ensure that the content of the news report is objective, comprehensive, accurate, and unbiased. Unsupported claims in some critical medical areas should be prohibited by law, just as claims on health and therapeutic benefits for foods and nutritional supplements are legally prohibited.

In order to promote accurate public perception of health-related information, school students should be trained to acquire critical analysis skills through the incorporation of assignments and assessment tools requiring critical thinking into the curriculum. From a broader perspective, public health promotion should be enhanced so that the mass media is no longer the only information source and voice. If the general public can access multiple sources of health information, they will judge the accuracy of the reported health-related advances based on information retrieved from diverse sources. This can help avoid the “illusion of knowing” [42]. In fact, improper reporting practices can easily promote the illusion of knowing [43], causing people to possess less factual knowledge than they may perceive. This is particularly true for those who make prospective judgments or possess a low level of academic achievement [44], and they are more susceptible to the illusion of knowing. Therefore, raising literacy among the general public will be an important step to promote accurate public comprehension of health-related advances and, hence, public health as a whole.

In addition to literacy among the general public, health reporters play an important role in enhancing the public’s understanding of health-related advances. Therefore, they could adopt a more public-oriented approach while drafting a news report. In this study, we found that the patient was not cited as an information source in any of the analyzed news reports. The responsibility of mass media is to disseminate useful information to the public; therefore, journalists are expected to report the news in ways that reflect and fulfill the needs of society [40]. As far as news reports on clinically tested health-related advances are concerned, they link inextricably to the needs of patients. Voices and experiences of patients should be presented when health-related messages are conveyed to the general public [45]. Furthermore, because public attention is limited and difficult to sustain, an over-detailed description of a new drug or treatment may cause readers to lose interest [46], but an oversimplified or even biased account may cause the illusion of knowing. Journalists are, therefore, required to seek a point of balance. Owing to the technical aspect of news reporting, it would be best if news reports on health-related advances are written by journalists with educational training in related health disciplines [47]. Qualified journalists should possess professional knowledge, access appropriate primary sources of health information, and exhibit the ability to analyze public health issues in a neutral manner [48]. Additionally, journalistic professionalism should be maintained via the continuing professional development (CPD) system, which has already been recognized as an integral part of career development for health professionals [49], teachers [50], and journalists [51]. The ever-changing public-health arena renders the CPD system indispensable for journalists to be able to fully perform their duties in promoting public comprehension of health-related advances.

News media plays an important role in promoting public comprehension of health-related advances, which, in this study, were constricted to the progress in drug development. Over the years, considerable effort has been devoted to examining the mass media in developed countries [10, 13‐15, 52, 53], but few such studies have been performed in the context of developing countries. This study addresses this gap using China as a sample and analyzing the claims and frames in news coverage to ascertain how advances in drug development are depicted in news reports in a developing country. It is noteworthy that all our findings are based entirely on our analysis of news reports from representative media agencies in China, where state-owned news media dominate the news dissemination space. In view of the cultural differences among countries, the conclusions and recommendations made in this study may not necessarily be directly translatable to other countries. Moreover, over the last several decades, the influence of news coverage on public health has been shaped by changes in the pattern of information access [54‐57]. Such changes are led by the increasing diversity of media technologies [58]. Apart from traditional news media, a growing number of people use social media to obtain information [59, 60]. National-level surveys reveal that 25.5% of people in China read newspapers [61] while 77.1% read news reports online [62]. The influence of social media on news reading habits increases the complexity of drug information communication [63]. However, the present study focused only on news media. The impact of social media on conveyance of drug information for public health promotion may be worth examining in future studies in order to attain a comprehensive picture of the influence of news coverage on public health. Nevertheless, news media in China serves as a “mouthpiece” of the nation and of the Communist Party of China [63], which constitute the dominant voices. Conversely, social media serves only as a side source of information. Therefore, examining the news coverage of drug development advances in Chinese mass media can suggest strategies to facilitate accurate public perception of health-related issues.