Breaking News: Media Framing of “Female Viagra”
May 2016
In the last 60 years, the United States has witnessed a host of social movements, such as the women’s movement and the sexual revolution, that have profoundly affected the way our society thinks in terms of the role of women, gender equality, and sex. This article establishes that culture and media are undeniably entangled; therefore by examining the media framing of controversial topics, we can see how frames reflect broader societal issues and cultural trends. In a content analysis of 43 news articles from major U.S. publications, the author examines the presence, absence, and dominant frames in each article relating to the recent FDA approval of what the media deemed “Female Viagra” in order to gain a better understanding of how our society views’ toward sexuopharmaceuticals have evolved in relation to gender roles and equality. Despite the controversy, the researcher found that the drug was framed in a positive light, possibly highlighting the successes of the broader women’s movement in regard to greater gender equality.
In the last few decades, the United States has witnessed a host of political and social movements, such as the sexual revolution (Bailey 1997) and the women’s movement (Terkildsen & Schnell, 1997; Lind & Salo, 2002) that immensely affected our society as a whole in regards to gender equality and women’s rights. Such cultural movements subsequently play an influential role in how the media frames issues and events (Ki & Kim, 2008). As such, cultural norms are reflected in the press because culture influences the press and press frames interpret messages within shared cultural meanings (Haynes, 1984). However, even today the role of women in society remains contested and our society still grapples with the role of women. For example, a recent 2012 article published by The Atlantic titled “Women Can’t Have it All” detailed the struggles of a woman having a top career, while keeping up with the family and relationships, which generated controversy from both sides of the issue. Women’s roles in regard to gender equality and sexuality have been contested issues throughout the decades. Therefore, one way to understand the role of gender and sexuality in society today is to look at how these issues are discussed in the media. Exploring sexuopharmaceuticals offers a unique opportunity to do so as these topics have remained salient in news media coverage over recent decades (Ki & Kim, 2008; Kruvand, 2012) yet have been underexplored in the literature.
Recent research has shown that prevailing culture has had a salient effect on how the media frames pharmaceutical drugs, in particular the birth control pill and Viagra (Ki & Kim, 2008; Kruvand, 2012) and have found their role in society to be especially important, as these drugs were viewed as not just drugs, but as symbols of cultural change. To understand how the role of women in society has changed across time, we can look at a recently approved, highly controversial drug, generically named Flibanserin, which was developed to be the female equivalent of Viagra. Thus, how has the media framed this new pill in light of the continued evolution of gender equality, sex, and culture?
On August 18th, 2015, the FDA approved a controversial drug that aimed to boost a woman’s sexual desire and treat the disputed condition, Hypoactive Sexual Desire Disorder, or in other words, low libido, by targeting neurotransmitters in the brain. The drug, generically named Flibanserin, was rejected twice before in 2010 and 2013 after FDA committee members came to the conclusion that the drug’s risks outweighed the benefits. However, after Sprout Pharmaceutical’s lobbying attempts, a high-profile advocacy campaign, and numerous women willing to testify about their distressing low sex drive, the FDA approved the drug with its highest warning label attached. The FDA approval of Flibanserin generated wide media coverage, given its significance as the first drug aimed at treating female sexual dysfunction and the controversial nature of the drug. Cindy Whitehead, CEO of Sprout Pharmaceuticals, stated “There hasn’t been a whole lot of innovation in this category of women’s health since the birth-control pill [in 1960]. This is game-changing for women” (Schulte & Dennis, 2015, p.8). However, other critics expressed concern of potentially harmful side effects outweighing the “modest” benefit of the drug, as well as creating norms around women’s sexuality, specifically medicalizing female sexual problems. Adriane Fugh-Berman, a pharmacology professor at Georgetown University and director of PharmedOut, stated in an August, 18th 2015 Washington Post article “What has been learned since the last disapproval is that it has more risks than we thought and it doesn’t have any more benefits. The only thing that’s different is a clever, aggressive public relations campaign that Sprout Pharmaceuticals waged successfully” (Schulte & Dennis, 2015, p.12).
Although both the birth control pill and Viagra have both been studied in a media framing light, and how culture and news values have impacted the framing of those drugs, little is understood about how the media has portrayed Flibanserin, which is aimed at treating female sexual dysfunction, and the possible implications regarding what effect our society and culture has had on the framing of this drug. This is important because how the media represents sexual dysfunction drugs could have an impact on their adoption (Loe, 2004), as the way media frames content has been found to exert a powerful effect on judgment and choice, especially when the individual has no firsthand knowledge of the issue at hand (Andsager & Hust, 2003; Gitlin, 1980). Therefore amid the controversy, this study attempts to discover which frames the media applied to coverage of Flibanserin, in light of the broader women’s movement and sexual revolution in order to identify how the frames reflect changes in societal views and the relationship between culture and media frames in contemporary society.
A Review of Literature
Media Framing
Considering that the public depends on mass media to obtain their news and information, they are inadvertently exposed to editors’ decisions about what is constituted as newsworthy, what issues are considered more important over others, and how the information is delivered to the public (Terkildsen & Schnell, 1997). Although researchers originally found that the media’s influence is not so powerful and simply reinforces citizens’ political choices (Lazarsfeld, Berelson, & Gaudet, 1948), more recent schools of thought, such as research into agenda-setting, priming, and framing, have greatly influenced scholarly views of the media’s influential power. For example, several studies suggest that agenda setting and priming influence the public in two ways. First, the media sets the public agenda by deciding which particular issues to cover, which therefore influences the importance citizens attach to reported issues (Iyengar & Kinder, 1987; MacKuen & McCombs, 1981). Second, by promoting certain issues over others, or priming, the media influences voters’ evaluations of political actors and political judgments (Iyengar & Kinder, 1987; Krosnick & Brannon, 1993; Krosnick & Kinder, 1990).
Media framing is perhaps one of the most influential theories of the subtle yet powerful effects of how the news media represents events on how the public interprets them. Indicative of the popularity of media framing research, a recent meta-analysis of 15 leading communication journals between 1990 and 2005 analyzed over 131 articles on media framing (Matthes, 2009). Entman (1993) posited one of the most referenced definitions of framing: “to frame is to select some aspects of a perceived reality and make them more salient in a communicating text, in such a way as to promote a particular problem definition, causal interpretation, moral evaluation, and/or treatment recommendation for the item described” (p.52). In other words, framing augments issue salience by coupling a specific frame with issue coverage, subsequently affecting an individual’s considerations or perceptions when forming an opinion, which can result in a shift in support (Terkildsen & Schnell, 1997). Additionally, according to Scheufele (2000), framing is also based on the assumption that subtle changes in syntax or wording of the description may influence how audiences interpret the situation. Furthermore, framing influences how audiences think about issues, not by making aspects of issues more salient, but by invoking specific representations that affect audience interpretation. This may be intentional, or unintentional, but the effects can still be seen (Scheufele, 2000). The theory of media framing essentially declares that certain issues can be arranged or presented in multiple fashions and can therefore influence citizens’ considerations and levels of policy support (Terkildsen & Schnell, 1997).
The Women’s Movement
The theory of media framing has been applied to analyze and provide insights into the representation of a host of social movements, civil liberties issues, and protests (Eibach & Vaughns, 2010; Gitlin, 1987; Nelson, Oxley, & Clawson, 1997.) Considering media frames have been shown to affect levels of policy support and attitudes (Entman, 1993; Terkildsen & Schnell, 1997), it is thus important to understand how the women’s movement and feminism as social movements have been framed in the media in order to assess possible implications on public perceptions of these movements. Feminism and the women’s movement as a whole have undeniably played a large role in our society over the past several decades. Thus, with the theory of media framing in mind, and considering that the drug Flibanserin was an issue that a large majority of activists regarded as a furthering step for the women’s movement, the following section explores existing media framing research of the women’s movement and feminism.
Using content analysis of print media, news and public affairs, and magazine coverage, Terkildsen and Schnell (1997), Barnett (2006), and Lind and Salo (2002) assert that the media has placed feminism, and the women’s movement as a whole, into various frames over the past several decades. Before addressing the framing of feminists and women, Lind and Salo (2002) considered Rhode’s (1997) charge that women and women’s issues in general are neglected in the mass media. However, Lind and Salo (2002) found that feminists are portrayed in a remarkably different fashion than “regular” women are, yet not necessarily in a negative way. Feminists are less often framed in a personalized and trivialized fashion than are women, less often framed as victims, and more often framed as having agency. However, in terms of their presence in the media, feminists are absent from the news and public affairs programs analyzed in the study. Lind and Salo (2002) concluded that “feminism doesn’t seem, at least from what is presented in the media, to function within the private sphere, rather, it is more often found in the public sphere (media and the arts, politics, religion)” (p.224). This pattern discovered through analysis of the media may serve to reinforce the perception that feminism is neither relevant nor principally applicable to the bulk of daily life for the majority of citizens.
Furthermore, frames have been shown to affect attitudes and levels of policy support. Terkildsen and Schnell (1997) found that print media assisted in packaging the women’s movement and related gender issues by employing five unique frames over the duration of 45 years: political and economic rights, feminism, anti-feminism, and gender roles. The researchers went beyond discovering frames, however, and the second analysis in their research is a key point of interest for the current study. Economic rights and anti-feminism frames have been shown to have a strong, negative impact on attitudes toward gender equality, support for women’s rights, support for non-traditional gender roles and the frequency of “women’s issues” being mentioned as one of the most important issues facing the U.S. The feminism frame also had negative effects on attitudes; while the political rights frame had a positive influence on similar gender attitudes (Terkildsen & Schell, 1997). This is a crucial aspect for the current study, as it reinforces the notion that the media does indeed influence perception of topics related to feminism and women, and that media frames impact policy support. Terkildsen and Schnell (1997) assert that Bernard Cohen’s (1963) observation that, “the true power of the media lies not in telling voters what to think, but in telling them what to think about” needs correcting. “We propose that the true power of the media lies in telling the public what issues to think about, as well as how to think about those issues” ( Terkildsen & Schnell, 1997, p. 894).
As Flibanserin fits into the broader context of women’s movement, more specifically women’s health, it is beneficial to examine what frames the media uses when discussing women’s health. Prior research has found that women’s health magazines apply a certain frame when discussing women’s health issues, specifically citing that health is considered “women’s work.” Barnett (2006) performed a content analysis on women’s health magazines, in order to observe the ways in which health magazines frame women’s health related issues to determine how messages reinforce or challenge stereotypes of femininity. While health magazines focused on many issues that were ignored by the mainstream media, articles framed health as women’s work, suggesting that women must be attentive to protect their families’ health (Barnett, 2006). Barnett (2006) found:
By framing health as women’s work, magazines characterized health, not as a state of well-being, but as a state of well-meaning, in which women must strive to be healthy, not necessarily for their own sakes, but in order to fulfill their traditional role as nurturers” (p. 8).
This demonstrates the notion that women are expected to take care of themselves for the benefit of their family, rather than the benefit of the woman. This view of women’s health, specifically sexual health, somewhat contradicts ideas and products further discussed in this piece: the sexual revolution and the birth control pill, which offered implications concerning furthered female control and empowerment. In terms of Flibanserin and sexuality, we can draw an interesting dynamic, as this drug can be viewed as either allowing a woman who feels sexually inadequate to empower herself through more sex, or conversely, simply allowing her to be more available to her partner to fulfill a traditional role.
The Sexual Revolution
The 1960s proved to be an era of dramatic change in attitudes, opinions, and beliefs in regards to sexuality. Some scholars believe this movement, commonly termed the sexual revolution, occurred due to the repression of sexual energies of the previous decades, the revolt of sexuality incarnated in youth and the struggle to control/educate children’s sexuality, the uprising of women due to greater independence, and the scientizing of the world of morals (Martin, 1996). Other scholars, through the examination of magazine coverage in the 1960s, also suggest that the sexual revolution was discovered by the mass media around the time of 1963 to 1964. According to Smith (1990), these changes in attitudes towards a more open sexual culture could be seen and tracked through print media in the early 1960s. In 1963 Time (March 22), America (April 20), and Mademoiselle (October) all referred to the “Sexual Revolution”. The attention of the sexual revolution garnered by the mass media culminated in Time’s cover story on January 24, 1964. Although the sexual revolution has received media attention throughout the years, the author could find no studies that have explored the media framing of the sexual revolution.
Some scholars claim, however, that the start of the sexual revolution can be traced back to the introduction of the birth control pill in 1960. For example, Bailey (1997) states that while there were widespread concerns over population growth and poverty, the pill, through federal initiatives, was made available to unmarried women and consequently played an important role in potentially encouraging more sex, which prompted what we call the sexual revolution. It gave women vastly increased control over their sexual-reproductive lives, and therefore helped to change not only the experience, but the meaning of sex both inside and outside a marriage. Historians who have written of the sexual changes of that era tend to agree that the birth control pill was central to the behavioral and cultural changes that constitute what we still call the sexual revolution today (Bailey, 1997).
“The Pill”
The controversy generated by the approval of Flibanserin mirrored the approval of another drug that was released to the market over fifty years ago: the birth control pill. The birth control pill was a cultural phenomenon for its time, considering the amount of choice and control it gave to women concerning pregnancies was socially groundbreaking. Many social conservatives deemed the pill as one of the starting factors in the sexual revolution (Bailey, 1997); and as a result, its use became constantly entangled with health and safety concerns, ethical choices, religious opposition, and political and legal battles (Kruvand, 2012). While the pill has been the subject of consistent media attention over the last 50 years, Kruvand (2012) states that how the media covered and framed the birth control pill has received scant attention.
Exploring media framing of birth control from the 1960s through 2010, Kruvand (2012) found that a progress frame was the most prevalent in the 1960s when the pill was first introduced; however, it was quickly eclipsed by the Pandora’s box frame, questioning the short and long-term risks of the pill. The Pandora’s box was the dominant frame in the greatest number of stories in the 60s and 70s, and then its predominance began to decline after that. Generally, the medical frame was the leading frame and appeared in about one fourth to one third of all stories during the study period. The positive progress frame, which stressed the pill as a medical and social breakthrough, was the dominant frame in only nine of the 315 stories analyzed (all but one during the 1960s). On the other hand, the cautionary Pandora’s box frame, which stressed actual and potential risks from the pill, was the dominant frame in 97 stories, or 30.7 percent. Media coverage of the pill aided in molding the public’s views of what was moderate and deviant in terms of gender roles, sexuality, and morality (Kruvand, 2012). A large amount of the coverage analyzed, according to Kruvand (2012), supports the assertion that the news media tend to frame news of science and medicine in the context of two terms: either as promising breakthroughs or as potential perils. While society has changed significantly since the introduction of the birth control pill, the frames uncovered by Kruvand (2012) provide a lens through which to explore and make comparison to contemporary media frames of Flibanserin. Both drugs are aimed at female sexuality, though each addresses very different aspects of that sexuality. Yet, both drugs were controversial upon their respective introduction to society. Further, comparing media framing of Flibanserin to framing of birth control has the potential to offer insights into whether and to what extent the women’s movement, the sexual revolution, and other societal changes relating to gender have engendered change to how women, female sexuality, and women’s health are discussed in media today.
Viagra
The second, most radical drug thought to have furthered the sexual revolution and changed attitudes toward sexuality, specifically in terms of impotence, was the introduction of Viagra in 1998. President Bill Clinton’s affair with Monica Lewinsky was the most popular American news story of 1998. The second most dominant topic in the news that year was the introduction of Viagra (Loe, 2004). Following the launch of this new pharmaceutical drug, a mass of news stories sensationalized the drug and created an atmosphere in which even the mention of its name became a public joke (Loe, 2004). With time, the so-called blue pill became well known and generally well respected as an effective drug. Some studies have examined the framing of Viagra since its launch in 1998 by the media. For example, Ki and Kim (2008) identified two frames in Viagra related news stories in the United States and Korea: a medical news frame and an influencer frame. The medical news frame was an objective discussion surrounding what the drug is, how it works, and which men would be good candidates to take the drug. The influencer frame identified stories that discussed societal/legal/political/cultural implications of the drug. Korean newspapers often discussed Viagra as a medicine, while American newspapers tended to discuss the pill within larger social and cultural contexts; this finding implies that in the U.S., Viagra seems to be regarded not just as a medicine to cure patients’ erectile dysfunction, but also as an influencer on the patient’s social and sexual life (Ki & Kim, 2008). This research offers great insight for the current study because in light of the American media covering more issues with a sexual or cultural perspective; it positioned Viagra as not only a medicine, but also an influencer on patients’ lives (Ki & Kim, 2008). Considering the media framed Viagra in terms of a cultural context, this finding may have implications for the ways in which the media framed the recent drug, Flibanserin, as part of a broader cultural movement, more specifically the sexual revolution.
Flibanserin
The American media framed the stories of Viagra and the Pill in a broader cultural context, rather than simply as a medical drug (Ki and Kim, 2008; Kruvand, 2012). However, Hartley and Tiefer (2003) stated that in recent years, primarily since the FDA’s approval of Viagra, a period of medicalizing sexuality and sexual problems has gathered momentum, with important implications for the sexual lives of many individuals and couples. Not only has Viagra been an influencer on male patients’ lives, but it also created implications for the sexual lives of females as well. The success of the blockbuster drug, according to Hartley (2006), and the concomitant spread of a “Viagra culture” prompted the pharmaceutical industry to continue to develop drugs that treat erectile sexual dysfunction, and also served as an incentive to support a medical approach to women’s sexual problems, and consequently develop new drugs to treat those problems. Hartley (2006) asserts that the drug industry constantly cites that 4 out of 10 women (43%) suffer from sexual problems. The critiques of this statistic are widespread (Moynihan, 2003), yet mass media and professional literature consistently cite this figure. In light of this, some researchers have explained there has been a biological turn towards medicalizing sexual problems, rather than focusing on the socio-cultural contexts out of which they emerge (Hartley & Tiefer, 2003; Tiefer, 2000; 2001). The social and cultural contexts for this new phase of medicalization include changes in medical research funding, demographic changes, new profitability of lifestyle drugs, and dramatic deregulation of the FDA (Tiefer, 2000). Medicalization is in fact a process, which occurs due to heavy promotion by those who have economic and professional interests in increasing medical domains. Furthermore, researchers have heavily debated the phenomena of Female Sexual Dysfunction, and whether or not the problem truly exists, or if it’s simply a case of disease-mongering by pharmaceutical companies (Tiefer, 2006).
These factors and many more, led to the controversial debate that surrounded the FDA approval of Flibanserin. Hartley and Tiefer (2003) finally assert that by turning female sexual problems into something that can be medicalized, the social and cultural aspects to their problems are ignored by simply giving women a pill. Women who are in search of solutions to their sexual problems are often embarrassed to talk about solutions with their doctors, and have little to no sources for information. Thus, women have become more dependent on mass media resources to obtain their information (Hartley & Tiefer, 2003). Consequently the media that promotes sexuopharmaceuticals may play an influential role in shaping the public’s understanding of sexual problems and creating demand for new drugs as solutions (Hartley & Tiefer, 2003).
Research Questions
Considering the ways media frame content has been found to exert a powerful effect on judgment and choice (Andsager & Hust, 2003), the fact that women often rely on the mass media for information regarding sexual problems (Hartley & Tiefer, 2003), and because of the implications previously found regarding the effect of culture on the framing of the birth control pill and Viagra (Kruvand, 2012; Ki & Kim, 2008), it is important to explore and examine the intersection of media, changes in women’s roles in society, shifts in attitudes and openness about female sexuality, and the medicalization of sexual dysfunction. The current study will thus examine how the mainstream news media framed the recently approved drug, Flibanserin, in order to identify broader implications and potential trends. Based on the insights from the previous literature, the below research questions are proposed:
RQ1: How has the print media framed Flibanserin?
RQ2: How does the media framing of Flibanserin compare to media framing of the birth control pill?
RQ3: How does media framing of Flibanserin compare to media framing of Viagra?
Methods
In order to identify frames among print news stories of Flibanserin, the researcher conducted a content analysis of news stories primarily from June 2015 through December 2015, following the FDA hearing for Flibanserin which took place in June, and the approval which occurred in August. To capture news stories in the months following the approval of the drug in August, the researcher extended the search to the end of the year. Some stories analyzed, however, were written in the mid-2000s while drug companies were searching for a “Viagra for women.” A few other stories were written between 2010 and 2015, detailing the stages of rejection and the possible implications of the drug if it were approved. It is important to assess these additional stories because doing so offers a fuller view of how the media covered the drug through its development and roadblocks in addition to its introduction to society in the summer of 2015.
The researcher analyzed stories from four major American news publications, including The Washington Post, The New York Times, USA Today, and The Guardian. The stories were procured from the LexisNexis Database by searching for the term “Female Viagra” and “Flibanserin”. A sample of 43 news was acquired: 21 from The Washington Post, 15 from The New York Times, 3 from USA Today, and 4 from The Guardian. The researcher chose The Washington Post, as it contained the greatest coverage of Flibanserin perhaps due to its proximity to the federal government. USA Today and The Guardian, as they are also often explored in framing research and both publications produced stories with high relevance, and The New York Times, as the prominence and authoritativeness of this publication also extends to science and medical reporting, and the newspaper is frequently used as a study population for analyses of science coverage (Kruvand, 2012.) Although circulation of The New York Times is smaller than that of USA Today, it is recognized as an agenda-setting source (Gitlin, 1980). Furthermore, articles in these major newspapers are often reprinted by regional media sources; therefore, investigating the patterns in coverage allows researchers to guesstimate coverage trends followed by other smaller media sources (Ki & Kim, 2008).
Data Analysis
The unit of analysis was the entire news story, including the headline. The story and main topics were identified, and trends in topics and themes were observed. The primary objective was to identify and the presence and absence of frames in each story as well as the dominant frame. After initially observing several stories in the data set, the researcher used a typology of five frames to aid in the analysis (Table 1). This study combined and utilized the primary frames used in the research conducted by Kruvand (2012) of the birth control pill, one primary frame used in Ki and Kim (2008) analysis of Viagra, and one frame that emerged through the constant comparison method (Glaser & Strauss, 1967) as a result of the researcher’s analysis of the data. Kruvand (2012) used 9 frames in her study of the birth control pill: Progress, Medical, Pandora’s Box, US Family Planning, Defusing the Population Bomb, Sexual Floodgates, Ethics and Religion, Public Accountability, and Other. The Progress, Medical Drug, and Pandora’s Box frame offered the most relevance to the current study, and offered the best lens for comparison. Through preliminary analysis of the data, the researcher found that the other frames did not apply to the current situation of Flibanserin; therefore the researcher chose not to use the US Family Planning, Defusing the Population Bomb, Sexual Floodgates, Ethics and Religion, Public Accountability and Other frames. In Ki and Kim (2008) study of Viagra, the authors used two frames: an Influencer frame and a Medical Drug frame. The researcher applied the Influencer frame to offer a comparison of Flibanserin to the introduction of Viagra, and the Medical Drug frame was already applied from the study of Kruvand (2012). Some of these frames, Progress, Medical Drug, and Pandora’s Box, originate from Gamson & Modigliani’s (1989) study of the risks and benefits of nuclear power. Their typology has been adapted and broadened by scholars who have studied the framing of other scientific and medical issues, such as ” stem cell research,” ” genetics,” and face transplants,” among others (Kruvand, 2012).
Table 1: Framing Typology
Results
RQ1 asks how Flibanserin was framed in print media; in a content analysis of 43 articles from The Washington Post, The New York Times, USA Today, and The Guardian, the researcher found that in most cases, more than one frame existed in one article. The first component of this study examined the presence or absence of frames in each article. Thirteen out of 43 articles (30.2%) portrayed the drug through a Medical Drug frame, providing insight as to what exactly the drug is, what condition it claims to help treat, and how the drug operates. Nineteen of the articles (44.2%) used a progress frame, depicting the drug as a medical and/or social breakthrough and an important innovation in society. Only eight articles out of 43 (18.6%) presented the drug through a Pandora’s box frame, primarily discussing the risks and potential harmful side effects associated with taking the drug and called for women to practice caution and restraint when presented with the drug as an option. Twenty-one news articles (48.8%) framed the drug as a symbol of female empowerment and a step toward sexual equality, discussing that women now have furthered choice and control over their sex lives, and there is now a medical treatment for women suffering from what many described as a distressing condition. And finally, 28 news articles (62.8%) framed the drug as a having societal/political/ legal/cultural influences, a large majority indicating that the drug has broad implications in regard to societal norms concerning sexuality, potentially setting precedents for the FDA, and further opening up the discussion surrounding sexuality in society. Furthermore, the second component of this study explored the dominant frame in each story, it was found that 7 stories had a dominant frame of progress, 6 stories had a dominant frame of Pandora’s box, 6 stories had primarily a medical drug frame, 10 stories applied an empowerment/equality frame, and finally 14 stories had an influencer frame as the dominant frame. Concerning RQ2, Kruvand (2012) found that only 9 articles out of 315 utilized a progress frame, while the Pandora’s Box frame was found in 97 articles. Yet while studying coverage of Flibanserin, the progress frame was found in 19 articles out of 43 and only 8 articles used a Pandora’s Box frame. Regarding RQ3, the influencer frame was found in 61% of the articles, in contrast to 39% of medical drug frames. In the present study, 28 out of 43 articles (62.8%) contained the influencer frame, and 14 out of 43 had this as a dominant frame.
Discussion
Comparison to “The Pill”
After applying the medical drug frame, Pandora’s Box frame, and the progress frame from the Kruvand (2012) study as a lens to examine the coverage of Flibanserin, it can be argued that we’ve seen a cultural shift in regard to further openness in terms of female sexuality, or in this case specifically sexual dysfunction. The researcher noted that there was a greater presence of the progress frame in this study, compared with that of the medical drug frame, and the Pandora’s Box frame. Out of 43 stories, progress was seen in 19 news stories, compared to 13 medical drug frames, and only 8 Pandora’s Box frames. In comparison with the Kruvand (2012) study, the positive progress frame was the dominant frame in only nine of the 315 stories analyzed. However, the cautionary Pandora’s Box frame was the dominant frame in 97 stories.
While most stories covering Flibanserin were constructed around the controversy surrounding the pill, it was not often that the risks and potential harms from taking the pill was the dominant frame. Only 6 out of 43 articles called for women to use restraint against taking the pill. Instead, numerous stories packaged the coverage of the pink pill as a progress, or under another frame, the empowerment/equality frame, considering it as a channel for female empowerment and a step toward sexual equality. A large number of articles opened with a story about a woman suffering with low libido who had been a part of the clinical trial, had more fulfilling experiences while taking Flibanserin, and ended by noting how overjoyed she was when the pill received approval. One article’s last line stated “When the FDA approved the drug in August, she and her husband shared a bottle of champagne. ‘We’re really excited,’ she said, ‘like we just planned our honeymoon.’” These personal anecdotes were used in several of the articles to demonstrate this drug as progress and something that may very well help in empowering women across the nation. This could possibly highlight the fact that over the decades, our society has witnessed changing roles for women and has advanced in regard to a further openness in attitudes toward female sexuality.
Furthermore, Kruvand (2012) states headlines during the fifty-year study period included encouraging, but mostly worrisome news about the pill such as: “Birth Control Pills ‘Safe,’ Drug Agency Report Says?” “Birth Curb Pill is Deemed Risky?” “Study Shows Birth Control Pill Alone can Cause Stroke,” and “No Long-Term Risk is found between Pill and Breast Cancer.” According to Kruvand (2012), the newspaper reported in 1989 that it was no wonder many women were reluctant about the pill: “Ever since birth control pills were first marketed in 1960, many doctors and women have found themselves torn between enthusiasm for the liberating contraceptive and fears about possible dangers from long-term use” (Kruvand, 2012, p. 51). Meanwhile headlines surrounding Flibanserin identified in the present study were not as fear inducing. For example, “FDA approves controversial drug for women with low sex drives; But the agency’s backing of Flibanserin comes with a series of conditions reflecting concerns about side effects.”, “The fight for a ‘female Viagra’; Why are there no sex-enhancing drugs for women?”, “Widely varying views of ‘female Viagra’ emerge at FDA hearing; An FDA advisory panel considers the first-ever “female Viagra” and weighs its benefits against its side effects”, “Roses? Check. Candy? Check. Little pink pill? FDA checking.” Federal panel considers endorsement of drug that some call a Viagra for women”, or “The pink pill is here: Who wants it?”
One possible explanation contributing to this more positive coverage of Flibanserin has to do with the growing percent of women working in the news media. Kruvand (2012) stated that back when the birth control pill was introduced, the media was largely a male dominated field which may have impacted news representation. Kruvand (2012) found the following:
Norman P. Lewis asserts that newspaper editors engaged in systemic gender bias, which led to discrimination that was more entrenched in newsrooms than in society as a whole. Although news about the pill was presumably of most relevance and interest to women, the New York Times did not initially cover the pill as a story for women, about women, and by women. (p. 52)
But by 2010, 41 percent of the editors and supervisors were women, and in 2011 the New York Times appointed its first female executive editor (Kruvand, 2012). Flibanserin has been viewed in a less negative light compared with the birth control pill; a possible reason for this is the changing gender roles in our society, specifically within the media.
Also, the coverage of Flibanserin deviates from much of the studies focused on framing of women’s health, and of the women’s movement as a whole. Bailey (1997) found that women’s health magazines framed health as “women’s work” and of the benefit for the family rather than for the woman. However, the coverage of “female Viagra” seemed to take a step in a different direction. In many ways, this drug was framed as a way to empower females for themselves, and help them feel happier in their relationships. Twenty-one news articles had a presence of the Empowerment/Equality frame, and 10 had this as a dominant frame. Therefore, due to the large amount of coverage Flibanserin generated in the U.S. and worldwide, a greater presence of progress and empowerment/equality frames found in the coverage of the drug, and even more positive headlines, it could be argued that the media coverage surrounding Flibanserin was potentially aimed at counteracting previous negative coverage of women in light of the progressing women’s movement and sexual revolution.
Comparison to Viagra
By analyzing the comparison, it was found that cultural, societal, political, and legal influencers played a large role in how Flibanserin was framed as well. This influencer frame was applied to the coverage of Flibanserin, and one particular trend emerged. In the study of Viagra, the influencer frame was found in 61% of the articles, in contrast to 39% of medical drug frames. In this current study, the researcher found a presence of 28 out of 43 articles (62.8%) with the influencer frame, and 14 out of 43 had this as a dominant frame. The influencer frame was found more than any other frame in the current study of Flibanserin. Ki and Kim (2008) cited that cultural norms are reflected in the press, because culture influences the press, and press frames interpret messages within the context of shared cultural meaning (Haynes, 1984). In response to their primary research question regarding how the media covered Viagra in Korea and the United States, Korean newspapers adopted a medical drug frame rather than a social influencer frame in their coverage of the pill. This finding indicates that Korean newspapers were still hesitant to publish sexual discussions related to Viagra in the media. Additionally, Korean newspapers seemed more likely to consider Viagra a medicine in Korea, further implying that public discussion of sexuality is still discouraged. Korean newspapers were also more apt to cover functional and informational news about Viagra, including its effect, side effects, product information, etc., as compared with American newspapers; however, articles regarding the social and political impacts of the drug were found more frequently in American newspapers.
Information sources used by the two countries’ newspapers for Viagra news were also examined. The American newspapers more frequently used drug manufacturers and patients as information sources. This finding reflects the trend of American newspapers covering more issues with a sexual or cultural perspective because Viagra is considered to be both a medicine as well as an influencer on patients’ lives. Although this aspect of the current study was not intentionally examined, a large number of the articles examined used sources such as representatives of the drug manufacturer, Sprout Pharmaceuticals, as well as the patients. These findings imply that culture indeed played a large role in how this drug was framed. A large reason behind this was possibly because Flibanserin was considered to be more than just a drug; the media framed it as having heavier societal and cultural implications. For example, of the articles that used an influencer frame, numerous articles cited the cultural and societal implications in terms of medicalizing sexual problems and subsequently creating norms surrounding sexuality. The Washington Post, in discussing what critics had said, stated on October 18th, 2015 “What is normal? Is it ‘natural’ for men to desire sex, but not women, or not as much? What sparks desire? If the spark dies, is it something that popping a pill can – or even should – reignite?” Another article from The Washington Post stated on June 1st, 2015 “‘This approach assumes that there’s a certain sexual drive that’s normal and that if a woman is interested in sex less than that, then that’s abnormal. It seems to me that that’s wrong,’ Barbara Mintzes, an assistant professor at the University of British Columbia, told BuzzFeed News.” From analyzing the coverage of this drug, we can see that culture and society was important in the framing of Flibanserin in that the drug was rarely covered in a simple medical drug frame, much like Viagra. One interesting point that can be noted as well is the increased openness surrounding sexuality potentially caused by what many deem a sexual revolution (Bailey, 1997), but also the counteracting increase in medicalizing sexual problems (Tiefer & Hartley, 2003). In other words, sex is more openly talked about in society today; however, it’s possible that from pills such as Flibanserin, the discussion could be stifled between people such as patients and doctors, if there is a supposed pill that solves all the problems. Therefore, many scholars are wondering if society is ushering out of a sexual revolution into a sexual pharmaceuticals era (Hartley & Tiefer, 2003).
In essence, media framing has been shown to have powerful effects on judgement and choice, as it not only tells the public what issues to think about, but how to think about those issues as well, through subtle changes in syntax or wording of the description (Andsager & Hust, 2003; Scheufele, 2000; Terkildsen & Schnell, 1997). The birth control pill, Viagra, and Flibanserin, as this and other research shows, were not seen or framed as just drugs; indeed these drugs were entangled in much larger societal implications and cultural movements. Therefore, through the analysis of coverage, this study uncovered interesting shifts in evolving attitudes toward the discussions surrounding sexuality that potentially had an influential impact on the media framing. Starting in the 1960s, the birth control pill was framed in a rather negative and concerned light, as sexuality was not something openly discussed in a public setting (Kruvand, 2012). Through the decades, we’ve seen how media has been impacted by the women’s movement and the sexual revolution and how the framing has reflected changes in society surrounding gender roles and sexuality (Bailey, 1997; Barnett, 2006; Lind & Salo, 2002; Terkildsen & Schnell, 1997). As discussed above, the framing of Viagra was shown to be more entangled in culture in American newspapers, as opposed to South Korean newspapers, as South Korea was less open about discussing sexuality in a cultural light (Ki & Kim, 2008). The current drug was considered to be very controversial; supporters argued the drug as an issue of equality and sexual freedom, and critics hailed that through a strategic marketing campaign that used the rhetoric of women’s rights, an ineffective drug passed through that had serious implications concerning societal norms. However, despite the controversy surrounding Flibanserin, evidence indicates that the media framed this drug as a progress, a step for empowerment and equality, and as an influencer of patients’ lives. This is potentially due to the fact that this drug speaks to larger cultural issues such as gender roles and equality, issues that are still prominent in our society today, and therefore was a powerful influence in how this drug was framed by the news media. The researcher finally asserts that how these drugs are portrayed in the media reflect larger cultural issues as well as societal stances on these issues; therefore as our culture progresses and attitudes shift in regard to gender roles and equality, it is important for further research to explore the relationships between sexuopharmaceuticals and culture to see changing trends in gender equality, sex, and the role of women in contemporary society.
Limitations
First, it is important to acknowledge limitations. First, a very small sample of articles was analyzed; therefore future research could examine a larger number of articles which could yield different results or give a better overall view of the framing. Second, a greater variation of results could also be determined if other media outlets such as news broadcasts or magazines were considered. Third, tone, positive versus negative, was not measured in this study; further research could be improved by examining positive and negative tones in the articles. Longitudinal study could assess if the drug Flibanserin continues to receive consistent media attention, much like the birth control pill and Viagra have.
References
Andsager, Julie and Stacey Hust. (2003). “Medicalization vs. Adaptive Models? Sense making in Magazine Framing of Menopause.” Women & health 38 (Sept): 101-122.
Bailey, B. (1997). “Prescribing the Pill: Politics, Culture, and the Sexual Revolution in America’s Heartland.” Journal of Social History 30 (July): 827-856.
Barnett, B. (2006). “Health as Women’s Work: A Pilot Study on how Women’s Health Magazines Frame Medical News and Femininity.” Women and Language 29 (October): 1-12.
Dennis, Brady and Brigid Schulte. (2015, August 18). The FDA just approved ‘female Viagra.’ What is it and why is it so controversial? The Washington Post. Retrieved from https://www.washingtonpost.com/regional/
Eibach, Richard and Valerie Purdie-Vaughns. (2011). “How to Keep on Keeping On: Framing Civil Rights Accomplishments to Bolster Support for Egalitarian Policies. Journal of Experimental Social Psychology 47 (Jan): 274-277.
Entman, R. M. (1993). “Framing: Toward Clarification of a Fractured Paradigm.” Journal of Communication 43 (Dec): 51-58.
Gitlin, T. (1980). The whole world is watching: Mass media in the making and unmaking of the New Left. Berkeley, CA: University of California Press.
Glaser, B.G., & Strauss, A.L. (1967). The discovery of grounded theory. Chicago, IL: Aldine.
Hartley, H. (2006). “The Pinking of Viagra Culture: Drug Industry Efforts to Create and Repackage Sex Drugs for Women.” Sexualities 9 (July): 363-378.
Hartley, Heather & Leonore Tiefer (2003). “Taking a Biological Turn: The Push for a “Female Viagra” and the Medicalization of Women’s Sexual Problems.” Women’s Studies Quarterly 31 (June): 42–54.
Haynes, R. (1984). “Test of Galtung’s theory of structural imperialism.” Foreign News and the New World Information Order 4 (Dec): 200-216.
Iyengar, S., and D. R. Kinder. News that matters. Chicago: Univ. (1987).
Ki, Eyun-Jung and Jangyul Robert Kim. (2008). “How Viagra Has Been Framed Since Its Launch: A Framing Analysis of Major Newspapers in South Korea and the USA.” The Open Communication Journal 2 (July): 108-116
Krosnick, Jon and Donald Kinder. (1990). “Altering the Foundations of Support for the President through Priming.” American Political Science Review 84 (June): 497-512.
Krosnick, Jon and Laura A. Brannon. (1993). “The Media and the Foundations of Presidential Support – Bush, George and the Persian Gulf Conflict.” Journal of Social Issues 49 (Jan): 167-82.
Kruvand, M. (2012). “The Pill at Fifty: How the New York Times Covered the Birth Control Pill, 1960-2010.” American Journalism 29 (Oct): 34-67.
Lazarsfeld, Paul, Bernard Berelson and Hazel Gaudet. (1948). “1968: The People’s Choice.” New York (1948).
Lind, Rebecca and Colleen Salo. (2002). “The Framing of Feminists and Feminism in News and Public Affairs Programs in US Electronic Media.” Journal of Communication 52 (Jan): 211-228.
Loe, M. (2004). The rise of Viagra: How the little blue pill changed sex in America. New York, NY:University Press.
MacKuen, Michael and Steven Coombs. (1981). “More than News: Media Power in Public Affairs” Journal of Politics 45 (Feb): 19-144.
Martin, John. (1996). “Structuring the Sexual Revolution.” Theory and Society 25 (Feb): 105-151.
Matthes, J. (2009). “What’s in a Frame? A Content Analysis of Media Framing Studies in the World’s Leading Communication Journals, 1990-2005.” Journalism & Mass Communication Quarterly 86 (June): 349-367.
Mazur, A. (1987). “Putting Radon on the Public’s Risk Agenda.” Science, Technology, & Human Values 12 (July): 86-93.
Moynihan, R. (2003). “The Making of a Disease: Female Sexual Dysfunction.” British Medical Journal 45 (Jan): 45-47.
Nelson, Thomas, Rosalee A. Clawson and Zoe M. Oxley. (1997). “Media Framing of a Civil Liberties Conflict and its Effect on Tolerance.” American Political Science Review 91 (Sept): 567-583.
Scheufele, D. (2000). “Agenda-setting, Priming, and Framing Revisited: Another Look at Cognitive Effects of Political Communication.” Mass Communication & Society 3 (Aug): 297-316.
Slaughter, A.M. (2012, July/August). Why women still can’t have it all. The Atlantic. Retrieved from http://www.theatlantic.com/
Rhode, D. (1997). Feminism, media and the law. New York, NY: Oxford University Press.
Terkildsen, Nadya and Frauke Schnell. (1997). “How Media Frames Move Public Opinion: An Analysis of the Women’s Movement.” Political Research Quarterly 50 (Dec): 879-900.
Tiefer, L. (2001). Arriving at a “new view” of women’s sexual problems: Background, theory, and activism. New York, NY: Haworth Press.
Tiefer, L. (2000). “Sexology and the Pharmaceutical Industry: The threat of Co-Optation.” The Journal of Sex Research 37 (Aug): 273-283.
