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Rodgers, J.L.& Zapata Ramos M.L / Californian Journal of Health Promotion 2013, Volume 11, Issue 3, Pages 48-61. Is it Real? Qualitative Framing Analyses of the Depiction of Fibromyalgia in Newspapers and Health Websites Joy L. Rodgers1 and Mari L. Zapata Ramos2 Abstract
Purpose: This two-phase project employed qualitative framing analyses to explore how fibromyalgia has
been framed in some of the top sources of U.S. health information and how these sources address
treatments related to fibromyalgia. Methods: Phase 1 of the project examined 95 stories and articles
published between January 1, 2007, and October 15, 2010, in eight elite U.S. newspapers and five most-
trafficked health websites to determine the dominant framing of fibromyalgia in each source. Phase 2
analyzed 146 stories and articles published between January 1, 2007, and May 15, 2013, in 15 top-
circulation U.S. daily print and online newspapers and five popular health websites. Phase 2 was
conducted to examine changes in the dominant framing of fibromyalgia since Phase 1, and identify new
frames in the ongoing debate about whether fibromyalgia is a medical or mental condition. Results:
Project findings suggest a lessening in the debate insofar as the overall media representation shifted from
a depiction of fibromyalgia as a mental to a medical condition. Moreover, changes found between the two
phases in the identification of the frames demonstrate the evolving public discussion surrounding
fibromyalgia amid FDA approval of drugs specifically for the treatment of the condition. Conclusion:
Thus, the marketing of fibromyalgia-specific drugs may be a factor contributing to the legitimization of
the controversial condition.
2013 Californian Journal of Health Promotion. All rights reserved.
Keywords: : fibromyalgia, health, debate, framing theory, health communication

Introduction
diagnostic criteria (Wolfe, et al., 2010). The cause of fibromyalgia is unknown, and some Fibromyalgia is distinguished by chronic, widespread pain and pain sensitivity that by some estimates affects as many as 12.3 million combination of symptoms can be classified as a adults in the United States (“First Test,” 2013). disease (Chitale, 2008). The main question Women account for between 80% and 90% of those diagnosed (Centers for Disease Control undetermined physiological origin, leading some and Prevention, 2010; Glattacker, Opitz, & medical practitioners to suggest that pain associated with fibromyalgia is psychological. fibromyalgia include the presence of 11 out of 18 tender points (Wolfe, et al., 1990). However, Fibromyalgia in the Media
more recent guidelines suggest less emphasis on tender point counts (Wolfe, et al., 2010). Almost fibromyalgia has been long-standing (Wallace, all fibromyalgia patients further complain of 1997), the question seems to resurface in media poor sleep, fatigue, anxiety, and distress announcements of new treatments. The FDA (Anderson & Winkler, 2006; Dupree Jones, approval of three drugs for the treatment of Adams, Winters-Stone, & Burckhardt, 2006). fibromyalgia – Lyrica in 2007, Cymbalta in These additional characteristics have been 2008, and Savella in 2009 – and the subsequent included in preliminary 2010 fibromyalgia marketing of these drugs has fueled the debate. Rodgers, J.L.& Zapata Ramos M.L / Californian Journal of Health Promotion 2013, Volume 11, Issue 3, Pages 48-61. Indeed, the headline on a January 14, 2008, New commonly researched topics (Fox, 2011). Thus, York Times story by Alex Berensen read: “Drug health communicators have an opportunity to Approved. Is Disease Real?” and the headline on influence news frames by working to reframe a a January 16, 2008, online ABC News article by health issue to not only define a social problem Radha Chitale stated: “Like Chronic Pain, and attribute responsibility for the problem and Fibromyalgia Debate Persists.” Physician its solutions but also help establish a dominant treatment of patients is further exemplified in the headline “Fibromyalgia: Patients Say Many Doctors Don’t Take Them Seriously,” which The Present Study
appeared on a May 31, 2009, Sacramento Bee Given that fibromyalgia is viewed from two distinct perspectives, the aim of this project was to examine how fibromyalgia has been framed in Framing Theory and the Media
prominent sources of health information. A key theory in the study of selection and Specifically, the project was conducted in two interpretation of news is framing (Borah, 2011; phases with each phase employing a qualitative Reese, 2001; Van Gorp, 2007). Goffman (1974) framing analysis of textual information found in introduced the notion of frames in referring to top-circulation print and online newspapers and “schemata of interpretation” that allow health websites to gain insight into how individuals to “locate, perceive, identify, and fibromyalgia was represented (Hertog & label” occurrences within their immediate McLeod, 2001, p.147). Framing analysis may experience as well as the world at large (p. 56). involve an inductive or deductive approach Similarly, Entman (1993) defined framing as “to (Semetko & Valkenburg, 2000). The goal of the select some aspects of a perceived reality and inductive approach is to identify all possible make them more salient in a communicating text” (p. 52). Cappella and Jamieson (1997) presuppositions of the frames (Semetko & further argued that framing refers to placing Valkenburg, 2000). In contrast, the deductive approach aims to examine the occurrence of phenomenon while minimizing other features. frames by predefining the frames, or using a strong set of presuppositions (Semetko & Framing has been used in studies on media Valkenburg, 2000). Thus, research questions for coverage on a wide range of issues, such as politics (Cappella & Jamieson, 1996; Scheufele, identification of the dominant framing of 2000), stem cell research (Nisbet, Brossard, & Kroepsch, 2003), and health (Pratt, Ha, & Pratt, newspapers and the relationship of the dominant 2002; Shih, Wijaya, & Brossard, 2008). Critical framing in the two sources of information. Phase to message production, framing may not only 2 of the project also examined how the dominant positively or negatively influence an argument framing of fibromyalgia has changed and sought but also help define social issues through the to identify new frames that may have occurred prominence or credibility given to the frame since the Phase 1 study. Specific research (Rothman, Bartels, Wlaschin, & Salovey, 2006). Research Center’s Project for Excellence in Journalism and the Pew Internet & American Life Project, newspapers tie with the Internet as the top source for news about housing, schools, and jobs, and with television as the main source 3. How do the frames in the newspaper stories for local political news. Pew Research Center surveys have found that 80% of Internet users – information provided by health websites? 59% of U.S. adults – look online for health information, with specific diseases or conditions and treatments or procedures among the most Rodgers, J.L.& Zapata Ramos M.L / Californian Journal of Health Promotion 2013, Volume 11, Issue 3, Pages 48-61. Times, USA Today, Los Angeles Times, The Washington Post, Denver Post, Chicago Each phase used a qualitative framing analysis Tribune, Houston Chronicle, Orange County to identify how fibromyalgia was represented in Register, Newark Star-Ledger, Tampa Bay newspapers and on health websites. While the Tribune, The Philadelphia Inquirer, San Diego protocols for both phases essentially were the Union-Tribune, St. Paul Pioneer Press, and Salt same, the newspapers and health websites Lake City Deseret News. The top five health examined and the time periods studied differed. websites chosen for review were selected using a ranking study of the 15 most-popular sites as measured by traffic (“Top 15”, 2013). From the News stories, features, and website content were ranking study, the top five sites with searchable identified for both phases using a keyword databases were chosen for review. They were: search for “fibromyalgia” in headlines and titles. NIH (National Institutes of Health), WebMD, The sample population in each phase comprised stand-alone news and feature stories published in the news, health, or science sections of the newspapers and press releases, research reports, Data Collection
and fact sheets to include frequently asked January 1, 2007, signifies the beginning time frame in each phase for the collection of news Opinion/editorials, letters to the editor, non- news stories (sports), book reviews, slide shows, fibromyalgia. Researchers chose this start date videos, obituaries, polls, comment pages, and because it represents a milestone period in the links to other online sites were excluded from treatment of fibromyalgia. With the FDA’s June both phases. Articles of 60 or fewer words to 2007 approval of Lyrica, discussions related to fibromyalgia have increased. October 15, 2010, appearing as part of a news roundup also were and May 15, 2013, reflected the end dates of Phase 1. The Phase 1 study entailed an analysis
Phase 1. The initial Phase 1 search for articles
and stories between January 2007 and October (Husselbee & Stempel, 1997) and five top health 2010 generated 150 newspaper stories and websites (Consumer Reports WebWatch, 2007) hundreds of website articles. However, the over a 3½- year period between early 2007 and sample was reduced to 43 newspaper stories and late 2010. The newspapers chosen for analysis 52 website articles after exclusions and were: the Atlanta Journal-Constitution, the duplications were eliminated. Therefore, the Boston Globe, the Chicago Tribune, the final sample consisted of 95 articles and stories. Christian Science Monitor, the Los Angeles Times, The New York Times, USA Today, and Phase 2. The Phase 2 search for articles and
The Washington Post. The health websites with stories for the January 2007 to May 2013 time searchable databases identified for review were: NIH (National Institutes of Health), WebMD, hundreds of website articles. The sample was reduced to 39 newspaper stories and 107 website articles after exclusions and duplications were Phase 2. In Phase 2, news and features stories
eliminated. Thus, the final sample consisted of published in the 15 highest-circulation online and print newspapers in the United States (Lulofs, 2013) and articles posted on the five Unit of Analysis
“Most Popular Health Sites” (“Top 15”, 2013) The unit of analysis for both phases was the over a 6½-year period from 2007 to 2013 were individual article or story, with an examination analyzed. The newspapers chosen for analysis of the text and headlines of all articles and were: The Wall Street Journal, The New York stories. In each phase, 10% of the articles were Rodgers, J.L.& Zapata Ramos M.L / Californian Journal of Health Promotion 2013, Volume 11, Issue 3, Pages 48-61. coded by both researchers to ensure inter-coder health websites (Table 1). The average length of reliability, which was calculated at 0.87 for Phase 1 and 0.95 for Phase 2 using Holsti’s method (Neuendorf, 2002). The articles and The majority of the stories and articles (n=47, stories for each phase were divided between two 49.5%) were written or reviewed in 2010, with coders, who read the stories and articles and then 26 (27.4%) in 2009 and 15 (15.8%) in 2008. The completed a detailed coding worksheet to fewest number of stories (n= 7, 7.4%) were from examine: publication type; publication name; 2007. Features (n=39, 4.1%) and news (n=32, publication date; story length (in words); section 33.7%) were the most frequent type of articles where article appeared; type of item (i.e., news, and stories found. Seventeen (17.9%) of the feature); title or headline; main idea; secondary stories and articles were informational items and idea; suggestion of fibromyalgia as a medical three (3.2%) were medical reference. Four items condition; suggestion of fibromyalgia as a comprised the “other” category, which mental condition; no suggestion of fibromyalgia as a medical or mental condition (neutral); primary treatment of fibromyalgia; other The Phase 1 study identified five dominant frames – emotion, debate, treatment, credibility, fibromyalgia (Table 2). For newspapers, the No. 1 frame was a tie between emotion and debate, Phase 1 Results
with 11 stories (25.6%) each. The No. 2 frame in Phase 1 served as a preliminary study to newspapers also was a tie, with 10 stories ascertain the dominant framing of fibromyalgia (23.3%) each for treatment and credibility. in newspapers and health websites. Frames Rounding out the newspaper frames for Phase 1 identified in Phase 1 were used in Phase 2 to was informative with four stories (9.3%). In contrast to newspapers, emotion was the No. 5 The final sample (N=95) comprised 43 stories frame identified in websites (n=10, 19.2%), with from U.S. newspapers and 52 articles from debate taking the No. 2 position (n=19, 36.5%). Description of Final Sample, Phase 1 (N=95) and Phase 2 (N=146)
Rodgers, J.L.& Zapata Ramos M.L / Californian Journal of Health Promotion 2013, Volume 11, Issue 3, Pages 48-61. The treatment frame placed No. 3 in websites (n=18, 34.6%) and credibility was No. 4 (n=23, developments related to the approval or recall of 25.0%). Finally, the informative frame, which drugs or criticisms of drugs suggested for the was the least-dominant in newspapers, took the treatment of fibromyalgia. One illustration of the No. 1 position in websites, with 26 (50%) of the informative frame in newspapers appeared in a articles reviewed exhibiting this frame. 2010 San Diego Union-Tribune story by Matthew Perrone headlined “Group Urges Recall of Drug for Fibromyalgia.” Another example of the informative frame was seen in a Dominant Newspaper and Website Frames
2007 Bloomberg News article published in the Salt Lake City Deseret News headlined “Seizure Drug May Treat Fibromyalgia.” Articles that further characterized (“triaged”) fibromyalgia and its symptoms and “diagnosis” also exemplified the informative frame. Informative also was the most-frequent frame in health websites (n=91, 85.1%). Similar to newspapers, this frame included articles that addressed new research on fibromyalgia and developments in approvals as depicted in headlines from WebMD articles stating “FDA Panel Rejects Xyrem as Fibromyalgia Treatment” (McMillen, 2010) and “FDA OKs Cymbalta for Fibromyalgia” (Hitti, 2008). Articles that described fibromyalgia or Phase 2 Results
served to define fibromyalgia, its causes, who it The final sample (N=146) consisted of 39 stories affects, and other statistics also distinguished the from U.S. newspapers and 107 articles from health websites (Table 1). The average length of Additionally, the informative frame included the articles was 562 words. The majority of the frequently asked questions and tips and advice stories and articles (n=33, 22.6%) were written on such things as finding the right doctor and or reviewed in 2012, followed by 32 (21.9%) in 2010; 28 (19.2%) in 2011; 18 (12.3%) in 2009; characteristics of fibromyalgia such as “tender 15 (10.3%) in 2008; and 12 (8.2%) in 2013. The fewest number of stories (n=8, 5.5%) were from 2007 (Table 2). News (n=52, 35.6%) items were Treatment. In newspapers, treatment was the
the most frequent type of stories and articles second-most-frequent frame (n=29, 74.4%). The found. Feature articles accounted for 40 (27.4%) treatment frame was characterized by stories that of the total number of articles, with medical highlighted both pharmacological and non- pharmacological therapies designed to not only accounting for 27 (18.5% each) of the total. provide relief from fibromyalgia symptoms but also improve quality of life and cope with its Dominant Frames
symptoms. Frequent drug treatments mentioned The following sections describe the results of the in newspaper stories included the prescription Phase 2 study in the identification of the five medications Lyrica, Cymbalta, and Savella. Exercise was among the most frequent non- pharmacological treatments cited, specifically, tai chi, which “may raise pain thresholds and Informative. The most-frequent frame in
help break the ‘pain cycle,’” (Roan, 2010). newspapers was informative (n=35, 89.7%), Some other non-pharmacological treatments characterized by stories that provided basic mentioned less frequently included vitamin and Rodgers, J.L.& Zapata Ramos M.L / Californian Journal of Health Promotion 2013, Volume 11, Issue 3, Pages 48-61. other supplements, talk therapy, medical journals such as The Journal of Pain and The marijuana, meditation, biofeedback, water Journal of Clinical Sleep Medicine. therapy, and acupuncture. In health websites, the treatment frame also was the second-most Debate. The fourth-most-frequent frame in
frequent (n=67, 62.6%). The treatment frame in newspapers was debate (n=14, 35.9%). The health websites depicted much more diverse debate frame addressed questions surrounding treatments than newspapers, including drugs the existence of fibromyalgia and its causes, as such as Xyrem, Tramadol, Lyrica, Cymbalta, well as the difficulty in treating fibromyalgia Savella, Nabilone, Prozac, Effexor, Ultram, Ultracet, Naltrexone, Flexeril, Gabapentin, representing the debate frame in newspaper tricyclic antidepressants, selective serotonin stories include: “Say ‘chronic fatigue syndrome’ reuptake inhibitors, and non-steroidal anti- and ‘fibromyalgia,’ and many physicians just wince. They still don’t take the diagnoses treatments on the websites also included seriously, but it’s time they did” (Ondash, 2007); exercise (water aerobics, strength and weight “for many patients, the Pfizer drug is validation training; swimming; walking; yoga; and tai chi), that they have a real medical condition, an as well as alternative treatments such as acknowledgment they’ve long fought to obtain” cognitive behavioral therapy, physical therapy, (Dwass, 2008); and “two drugmakers spent acupuncture, meditation, massage, chiropractic, hundreds of millions of dollars last year to raise marijuana, vitamin supplements, and herbs. awareness of a murky illness, helping boost sales of pills recently approved as treatments and Credibility. The third-most-frequent frame in
drowning out unresolved questions – including newspapers was credibility (n=23, 59.0%). The whether it’s a real disease at all” (Perrone, 2009). In health websites, debate was the fifth- investigative research and the expertise of the most-frequent frame (n=17, 15.9%). As with sources quoted or paraphrased in stories. newspapers, content on the health websites Examples of expert sources included medical related to the debate frame underscored the practitioners (rheumatologists, psychologists, inherent uncertainty and mystery surrounding and neurologists), directors, and researchers at fibromyalgia and its causes and treatments, as medical centers and academic institutions (Mayo well as questions about its medical status. Clinic and Tufts Medical Center) and drug Examples of the debate frame found on websites companies (Eli Lilly and Pfizer); peer-reviewed included statements such as: “fibromyalgia research journals such as the New England remains a poorly understood and hard-to-treat Journal of Medicine; and associations devoted to disorder” (Boyles, 2009); “doctor insisted that it health (National Institutes of Health and Centers was ‘all in your head’” (Eglash, 2013); and “not every doctor understands fibromyalgia well” fibromyalgia (Arthritis Foundation and National (Davis, 2010). Further examples of the debate Fibromyalgia Association). The credibility about the existence of fibromyalgia and the frame also was the third-most-frequent frame effect on patients include: “One of my best (n=43, 40.2%) in health websites. Similar to the friends doesn’t believe I have it. His wife, who newspaper stories, credibility in website content is a doctor, told him men can’t get it, that it is in was characterized by the expertise of sources my head” (McMillen, 2011) and “the top and exemplified in quotes from university misconception is that people think fibromyalgia researchers, physicians, psychologists, and isn’t a real medical problem or that it is ‘all in clinical practitioners; association leaders and directors from the FDA, National Center for Complementary and Alternative Medicine, NIH, Emotion. In newspapers, the emotion frame was
National Women's Health Information Center, the fifth-most represented (n=13, 33.3%). The emotion frame included stories that related to the Clinic, American Pain Society, and American frustrations and misunderstandings patients and College of Rheumatology; and by references to their families face in dealing with fibromyalgia Rodgers, J.L.& Zapata Ramos M.L / Californian Journal of Health Promotion 2013, Volume 11, Issue 3, Pages 48-61. pain and associated symptoms and disorders, as credibility and treatment frames followed with well as social stigma. For example, a 2012 10 articles each, and the last frame was Chicago Tribune article by Terri Yablonsky Stat informative with four articles. However, in stated: “I didn’t understand fibromyalgia or what Phase 2, the informative frame moved from the my wife was going through. It’s a natural bottom to the top spot as the most-frequent reaction to say, ‘Come on, there’s no way you frame found in newspapers. In the Phase 1 feel as bad as you say you’re feeling.’” Unlike study, the treatment and credibility frames tied for the No. 2 position. Phase 2 revealed a frequent frame in health websites (n=24, separation of the frames, with the treatment frame ranking second and credibility, third. The difficulty of diagnosis of fibromyalgia and its top-ranked debate frame in Phase 1 moved down association with other illnesses. As a 2011 in Phase 2, to the fourth-most-frequent frame. MedicineNet story by Bill Hendrick stated, “It Finally, what had been considered Phase 1’s took two long, painful years and countless most widely used frame, emotion, was the least- doctor visits before I was diagnosed with fibromyalgia, but our survey respondents had an even lengthier process – their average time to In terms of health websites, the informative frame remained the most dominant, with 91 articles identified in Phase 2 and 26 stories in Economic. The Phase 2 study revealed one
Phase 1. However, the treatment frame (n=67) additional frame over Phase 1. An economic found in Phase 2 supplanted the debate frame frame characterizing business and financial (n=19) from Phase 1 to become the second- most-frequent. The treatment frame (n=18) in newspaper stories (28.2%) and one health Phase 1 occupied the No. 3 position, which in website article (0.9%). The economic frame Phase 2 was held by credibility (n=43). In the included stories that addressed monetary and Phase 2 study, the emotion frame (n=24) moved non-monetary expenses incurred by patients into the No. 4 position, a spot held by the such as time spent on doctor visits and costs of credibility frame (n=13) in Phase 1. The debate drug and non-drug treatments. Pharmaceutical frame, which was the second-most-dominant on companies’ stock prices for fibromyalgia drugs health websites in Phase 1 (n=19), moved down to the least-dominant frame in Phase 2 (n=17). Examples of the economic frame included these Thus, fewer health websites were framing statements from a 2009 San Diego Union- fibromyalgia from a debate standpoint in favor Tribune story written by Michael Kahn: of treatment options and an emotional point of “Fibromyalgia syndrome is also associated with view. Moreover, the additional economic frame high direct and indirect disease-related costs” identified in Phase 2 appeared more frequently and “effective treatment of fibromyalgia in newspapers than websites (n=11 and 1, syndrome is therefore necessary for medical and In addition to the identification of frames, the Differences Between Phases 1 and 2
suggestion of whether fibromyalgia was a Although the conceptualizations of the frames medical or mental condition also was examined. identified in Phase 1 were the same as the Variations in perceptions were noted between frames depicted in Phase 2, the framing of the two phases in both newspapers and health fibromyalgia changed somewhat between the websites (Table 3). In the Phase 1 study, two phases (Figure 1). For example, in Phase 1, newspapers showed a strong stance (by choosing the top-ranked frames for newspapers were one or the other) in whether fibromyalgia was emotion and debate, each with 11 articles. The considered a medical or mental condition.
Rodgers, J.L.& Zapata Ramos M.L / Californian Journal of Health Promotion 2013, Volume 11, Issue 3, Pages 48-61. Phases 1 and 2 percentage of articles per frame and source. This figure illustrates the dominant
framing of fibromyalgia in newspapers and health websites and the differences found between the
two phases.
considered fibromyalgia a medical condition and almost half that (n=17, 39.5%) considered fibromyalgia a mental condition. Six (14.0%) Classification as a Medical or Mental
newspaper articles positioned fibromyalgia Condition
neutrally, mentioning both medical and mental aspects of the condition. In contrast, some websites presented fibromyalgia as either both or neither a medical nor a mental condition. However, in general, websites positioned fibromyalgia as a mental condition (n=37, 71.2%) rather than a medical condition (n=14, 26.9%). Conversely, in the Phase 2 study, 23 *Percentages do not total 100 because some articles suggested fibromyalgia could be fibromyalgia was a medical condition, while 19 (48.7%) articles suggested fibromyalgia was a mental condition, and 11 (28.2%) articles remained neutral. In terms of health websites, 44 necessitates an understanding of the consistency (41.1%) articles implied fibromyalgia as a or variance of information sources. In terms of medical condition, while 35 (32.7%) articles the information on the debate that surrounds indicated fibromyalgia was a mental condition, fibromyalgia, this project was able to provide and 48 (44.9%) articles were neutral. These some insight. While the differing views on percentages do not add up to 100% because fibromyalgia and its status as a physical or some articles suggested fibromyalgia could be psychological condition are generally known, this project went beyond an exploration of those personal opinions to an examination of how top Discussion
health-information sources promulgate this debate. The project examined how fibromyalgia Rodgers, J.L.& Zapata Ramos M.L / Californian Journal of Health Promotion 2013, Volume 11, Issue 3, Pages 48-61. newspapers and on health websites and how high average yearly associated medical costs of these sources addressed treatments related to fibromyalgia, which range from $4,800 to fibromyalgia. The project sought to identify the $9,300 (“First Test,” 2013), fibromyalgia would dominant frames in newspapers and health seem to meet the criteria for a societal issue websites, and to compare and contrast the worthy of newspaper coverage. However, this frames found in each. On the whole, newspapers project revealed far fewer newspaper stories on tended to provide information that told a story in fibromyalgia have been published than have a trustworthy manner and represented current been posted on health websites. Forty-three aspects of the issue. Health websites tended to (45.3%) newspaper stories out of the total 95 for provide information that was more educational. newspapers and health websites were found in Phase 1 of the project and 39 (26.7%) of the Is Fibromyalgia Newsworthy?
total 146 in Phase 2. This finding suggests an Newspaper editors and reporters have ground underrepresentation of the issue of fibromyalgia rules for what defines news that often represent an informal or unwritten code within news organizations (Harcup & O’Neill, 2001; O’Neill Is Conversation Shifting?
& Harcup, 2009). The rules stem from daily practice and knowledge gained on the job. fibromyalgia for patients is the long length of Several studies have looked at Galtung and time to diagnosis and the poor treatment from Ruge’s (1965) original delineation of the 12 doctors who may not be well-informed about factors of news values to further refine or fibromyalgia and, as a consequence, doubt the identify news values (Cohen & Young, 1973; legitimacy of fibromyalgia and patients alike Harcup & O’Neill, 2001; Herbert, 2000; O’Neill & Harcup, 2009). While traditional news values emotion frames identified in this project would such as conflict, emotion, impact, prominence, appear to bear this out, especially in Phase 1 in novelty, immediacy, and proximity (Harrower, which debate and emotion tied as the most- 2007; Itule & Anderson, 2003) continue to focus dominant frame in newspapers. However, in on events that raise awareness of societal Phase 2, the debate and emotion frames moved problems and their inherent consequences, a down in ranking to Nos. 4 and 5, respectively. 2012 study by Strömbäck, Karlsson, and The downgrading of these two frames could Hopmann found the most important properties spell good news for fibromyalgia sufferers, of what makes news are that the event is indicating increased awareness and acceptability “sensational and unexpected, dramatic and of fibromyalgia not only in mainstream media thrilling, (and) that it is an exclusive news story” (pp. 725-726). Additionally, in looking at news values in today’s digital environments, Journalistic objectivity is tied to organizational Strömbäck et al. (2012) further found no routines, whereby reporters strive to provide suggestion of differences between traditional balanced or alternative views by quoting a topic and online media, stating: “Despite all that has “expert” on both sides of an issue (Calder, been written about the impact of digital media Richter, Burns, & Mao, 2011). For example, if and online publishing on journalism, thus far such differences do not appear to translate into attention, a reporter might contrast their how journalists perceive the importance of statements with quotes from opponents that may various event properties when deciding what’s cast doubt on the advocates’ position. As seen in the high number of opposing expert sources and officials directly quoted or paraphrased in the articles, objectivity in the media corresponds Rheumatology estimates that fibromyalgia directly with the credibility frame identified in affects more than 12.3 million people in the this project. Furthermore, deadlines are United States, which is comparable to the number of people affected by cancer, and the moving online. Journalistic routines are Rodgers, J.L.& Zapata Ramos M.L / Californian Journal of Health Promotion 2013, Volume 11, Issue 3, Pages 48-61. intensifying, with reporters more apt to “go by fatigue, and cognitive difficulties that may lend the book” (Calder et al., 2011, p. 12). As such, support for the depiction of fibromyalgia as a the media’s reliance on official sources may account for the movement of the emotion frame Rodriguez, 2011; Salgueiro, Buesa, Bilbao, & from the top position in Phase 1 of this project to Azkue, 2012). Thus, this finding is cause for concern for fibromyalgia advocates, who may be looking to health websites as a tool for The main purpose people are driven toward health websites is to seek out information, especially as it relates to specific diseases, Limitations
conditions and treatments or procedures (Fox, This project is not without limitations. Further 2011; Rains & Donnerstein Karmikel, 2009). Therefore, the finding of the informative frame fibromyalgia is being framed or viewed in other as the most dominant in both phases of this health websites and blogs, specifically those project was not surprising. Health websites also related to fibromyalgia. Also, qualitative tend to provide health information as a means of research is inherently subjective, meaning education. For example, the health websites results may vary among different researchers. examined in this project contained sections Future research could expand on the findings within the news articles that were based on tips, presented here by looking for additional support basic information, and definitions, rather than of how fibromyalgia is considered by medical providing information about the state of the science journals versus personal health websites and by incorporating resources that weren’t fibromyalgia a medical or mental condition) or investigated in this project, such as blogs, feature stories about people living with videos, and slideshows. Also, future research could use this project as a model for a framing analysis on how fibromyalgia is viewed as a Medical or Mental Condition?
primarily women’s condition and how that is Finally, given the apparent difficulty in more closely associated with a mental condition. classifying fibromyalgia, treatment options also may become a challenge. In health website Conclusions and Implications
articles depicting fibromyalgia as a medical Findings from this project suggest the lack of condition, pharmacological treatments were consensus in the classification of fibromyalgia predominant among options listed. Conversely, as a condition is beginning to diminish. Phase 1 non-pharmacological options were predominant demonstrates that the two sources people refer to in articles characterizing fibromyalgia as a most frequently, online newspapers and websites mental condition. Many of these non-drug (Pew Research Center, 2011), do not agree on alternatives, such as acupuncture, herbs, and tai whether fibromyalgia is a medical condition chi, can be traced to Eastern medicine, which is (newspapers) or mental condition (websites). closely tied to mind-body-spirit treatments for Two years later, Phase 2 demonstrates that both sources of health information more frequently options were mentioned in articles suggesting classify fibromyalgia as a medical rather than a fibromyalgia as a mental condition, they tended to be antidepressants that treat psychological previously identified. This project also helps to aspects of the condition. Although this project’s further support the notion that frames function as Phase 1 characterization of fibromyalgia as a mental condition shifted to a more neutral stance (Gamson & Modigliani, 1987). Explicitly, the in Phase 2, more than one-third of the articles frames identified in this project highlight the still portrayed fibromyalgia from a mental standpoint. Besides the physical pain and fibromyalgia and the shifts that have taken place in two important information sources since FDA psychological stressors such as poor sleep, approvals of drugs specifically made for the Rodgers, J.L.& Zapata Ramos M.L / Californian Journal of Health Promotion 2013, Volume 11, Issue 3, Pages 48-61. treatment of a condition that has been steeped in fibromyalgia went from being characterized as debatable, viewed by some as a mental condition and by others as a medical condition, to being Cymbalta, and Savella for the treatment of considered medical by the most-sought-out fibromyalgia seems to be helping the shift of sources of health information: newspapers and fibromyalgia toward a legitimate medical health websites. Nevertheless, this suggestion condition. This project has shown how in a time References
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The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care and Research, 62(5), 600-610. Yablonsky Stat, T. (2010, June 2). Fibromyalgia symptoms can hurt patients, their marriages. Chicago Rodgers, J.L.& Zapata Ramos M.L / Californian Journal of Health Promotion 2013, Volume 11, Issue 3, Pages 48-61. Author Information * Joy L. Rodgers, Ph.D. College of Journalism and Communications University of Florida P.O. Box 118400 Gainesville, FL 32611-8400 352-682-8495 (cell) / 352-392-1794 (fax) rodgersj@ufl.edu Mari Luz Zapata Ramos, Ph.D. College of Business Administration University of Puerto Rico, Mayagüez Campus P.O. Box 9000 Mayagüez, PR 00681 787-832-4040 ext. 2095 *corresponding author

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