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The media battle between celebrex and vioxx: influencing media coverage but not content.

William B. Anderson (*)

Abstract

This study examined newspaper coverage of the battle between two pharmaceutical companies in the arthritis painkiller market and the impact that the companies' public relations activities had on the way the story was presented. A framing analysis was used to determine the relationship between the companies' messages and press content. Frames consistent with the companies' objectives occurred, but most stories were rated as neutral, with an almost equal number of favorable and unfavorable stories. This suggested that the companies may have influenced the press on what to cover but not necessarily what to say. (c) 2001 Elsevier Science Inc. All rights reserved.

1. Introduction

In the days leading up to the 2000 Olympics, former gold medallists Bart Conner, Dorothy Hamill, and Bruce Jenner were talking more about their arthritis and how to relieve the pain the disease causes than about the games. Conner appeared on "Good Morning America" on May 8, 2000 to extol the virtues of Celebrex, one of the latest treatments for people who suffer from arthritis. (1) Hamill and Jenner appeared on Larry King on CNN on August 29, 2000 to promote Vioxx, a competitor of Celebrex. "My doctor prescribed Vioxx for me," Hamill said on the show, "and it's as if I've been given a new life. It's just -it's been amazing." (2)

Testimonials from the former gold medallists were part of one the most expensive battles waged in the pharmaceutical business: the war between Merck's Vioxx and Searle's Celebrex for the arthritis painkiller market. (3) Since 1999, Merck and Searle spent tens of millions of dollars a month to market new pain relievers called COX-2 specific inhibitors to those suffering from arthritis and their doctors. (4) The result has been a $7.2 billion market in the year 2000 for the new prescription arthritis drugs, with analysts predicting a market increase to $13 billion by 2005. (5) By the end of 2000, Celebrex had become the number one selling brand of prescription arthritis medication. In its first six months on the market (January -July 1999), Celebrex set pharmaceutical industry records -in total prescription volume and refills-making it the most successful U.S. pharmaceutical product introduction in history, even bigger than the anti-impotence drug Viagra. (6) In the 18 months following its launch, Celebrex gene rated 30 million prescriptions with nearly 10 million patients taking the drug. (7)

This study used a framing analysis to examine how Searle and Merck public relations framed the COX-2 specific inhibitors and how the media covered the drugs. This analysis suggested that news articles covering the COX-2 specific inhibitors reflected the priorities (frames) of the drug companies, but these stories were more likely to be neutral than pro-company. That is, the pharmaceutical companies initiated stories on topics of importance to them but could not guarantee that the story would slant entirely toward their points.

1.1. Framing

Many sociologists and communication researchers define framing as the organization of information. Gamson and Modigliani described frames as a "central organizing idea for making sense of relevant events and suggesting what is at issue." (8) Nelson, Oxley, and Clawson characterized framing as the "process by which a communication source... defines and constructs" an issue. (9) In sum, drawing a "portrait frame" around information "delimits the subject matter and, thus, focuses attention on key elements within." (10) This allows, according to Entman, a communication source to present a slanted perspective on an issue and manipulate salience -that is, direct the viewer to consider certain features and ignore others -in an attempt to influence subsequent judgment. (11)

For the journalist, the concept of framing means that in deciding how to present the story-based on news, news organizations and journalistic values -the writer has some impact on reader interpretations. By including and excluding words and messages, as well as emphasizing certain text, a journalist can establish a frame of reference through which the reader may consume a story. (12) In a sense, journalists can "fram[e] social reality and shap[e] the public consciousness" through the manner in which they depict a story. (13)

For the public relations professional, the concept of framing means positioning a story to the media in such a way that journalists will cover it in the desired manner. (14) Public relations practitioners can study the journalist's preferred manner of news construction to propose stories that follow the conventions of news making, improving the chances the story will be covered in a manner consistent with how a client would like to have its story told. (15)

A number of studies have found a relationship between press releases and news stories. One researcher found court decisions reported in press releases were more likely to show up in newspapers. (16) Another discovered that although journalists preferred using their own sources for stories, when they did use press releases their stories tended to reflect the priorities and agenda of the press release. Even so, these stories were much more likely to be neutral (95%) as opposed to pro-agency (5%). (17) Other researchers found that reporters relied more on physicians and scientists for medical information than on corporate officials or citizen groups. (18) Based on this literature, it is reasonable to expect reporters to cover the COX-2 inhibitor story in the manner desired by the drug companies (their frames) but to rely more on neutral or expert medical sources such as physicians than on pharmaceutical company officials for information.

2. Methodology

To test this assumption, this study analyzed how Searle (Celebrex) and Merck (Vioxx) used public relations to frame the COX-2 specific inhibitors in news coverage. Because news releases provide a primary means for organizations to present their products to the media, seven press releases from Searle and four releases from Merck were obtained from PR Newswire and analyzed. These releases were disseminated from December 31, 1998 to November 23, 1999, when the two companies were still explaining the significance of and the difference between their COX-2 specific inhibitors to the media. These releases, along with direct quotations attributed to company spokespersons found in news stories, provided insight into how the public relations departments attempted to frame the product category as well as the individual drugs. The author used an inductive analysis to determine the frames developed by the pharmaceutical companies; that is, the descriptive words and phrases used within the texts determined the frames, as opposed to fitting the text into predetermined categories.

Three frames emerged from the text: 1. painkiller without side effects; 2. cost issues: and 3. positioning. Once identified, the author examined how journalists responded to these frames in their coverage of the new drugs by analyzing five daily newspapers from January 1, 1999 (the day after the launch of Celebrex) to November 27, 2000, These newspapers--Chicago Sun Tunes, New York Times, St. Louis Post Dispatch. Wall Street Journal and Washington Post --were chosen because they wrote the largest number of articles on COX-2 specific inhibitors. (19)

The author found stories contained in the Chicago Sun Times, New York Times, St. Louis Post Dispatch, and Washington Post in the Lexis/Nexis Academic Universe service, using the search terms "Celebrex" and "Vioxx" (in two separate searches) from "1/1/1999 to 11/27/2000" in the "major newspapers" category. Stories in the Wall Street Journal were derived from a search of the Dow Jones interactive retrieval system using the same search parameters. Stories mentioning the COX-2 specific inhibitors as part of the company's product line and those dealing with the company's stock price or the product's sales were deleted. Editorials and opinion columns were not included. Forty-five articles were obtained. The author then categorized the stories according to newspaper, date, section (news, business, or health), number of words, and slant (favorable to COX-2 inhibitor category or individual brand, unfavorable, or neutral).

3. The frames

3.1. Frame one: painkiller without side effects

COX-2 specific inhibitors were developed in response to discoveries in the 1980s that cyclooxygenase, or COX, came in two forms: COX-1, which helped protect the stomach from ulcers, and COX-2, which was associated with pain and inflammation. Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as Tylenol and Ibuprofen inhibit both forms of COX, thus losing the protective COX-1 enzyme and raising the risk of ulcers. On the other hand, COX-2 specific inhibitors block only the COX-2 form of cyclooxygenase, and thus in theory reduce pain without eliminating the protective effects of COX-1 on the stomach. (20) In other words, COX-2 specific inhibitors can reduce pain while reducing the risk of ulcers.

Studies sponsored by both Searle and Merck -- no independent clinical studies had been conducted at the time of the author's analysis -- confirmed that patients taking COX-2 specific inhibitors such as Vioxx or Celebrex have a lower incidence of ulcers than those taking other pain relievers. With this in mind, Searle asked the U.S. Food & Drug Administration (FDA) to approve Celebrex as a painkiller without the side effects normally associated with traditional NSAIDs. Yet, when the agency approved Celebrex in December 1998, FDA officials said the label for the drug must contain the standard warning for all arthritis drugs, which stated that the drug could cause side effects such as ulcers and bleeding. The FDA added that Searle must conduct more tests on "many thousands of patients... to see whether Celebrex actually causes fewer serious gastrointestinal complications" before the company could label the drug as being less prone to cause side effects than NSAIDs. (21)

Despite the label on the drugs, both Searle and Merck introduced their products with the implicit or explicit communications message: people who suffer from arthritis can take a COX-2 inhibitor to reduce joint pain without the fear of side effects. For instance, Philip Needleman, Ph.D., copresident, Searle, said, "Celebrex is an important new therapy that targets arthritis pain and inflammation, but limits certain serious GI side effects associated with existing prescription medications." (22) The Merck news release announcing FDA approval of Vioxx noted, "treatment with Vioxx ... was associated with a significantly lower percentage of patients with gastroduodenal ulcers ... than treatment with ibuprofen." (23)

The author coded newspaper articles analyzed for this study as "favorable" if the journalists used more pharmaceutical company spokespeople (such as company officials or doctors favorable to the drug) than FDA officials. The company spokespeople focused on tests that showed the COX-2 specific inhibitors caused fewer side effects than NSAIDs, while FDA officials typically noted that the allegation that the new drugs caused fewer side effects was unproven. The author coded an article as "unfavorable" if it cited more FDA officials than company spokespeople, and "neutral" if the article contained an equal number of quotes from the companies and the FDA or if the article contained no quotes or messages drawn from press materials.

3.2. Frame two: cost issues

After FDA approval of Celebrex in December 1998 and then Vioxx in May 1999, insurance companies tried to limit prescriptions of both drugs. The insurers set strict conditions for patients to meet before paying for each drug because a monthly prescription for Celebrex or Vioxx cost approximately $86--eight times the cost of treating someone with generic prescription pain relievers. "When you read the medical literature, maybe 5 to 6% of people are at risk" of developing a serious ulcer, said Robert Seidman, vice president for pharmacy for Wellpoint Health Networks, a California-based insurer. "The vast majority of people have been comfortable with other drugs." (24)

Some doctors added that the pharmaceutical companies may have overstated the benefits of the new drugs. Dr. Walter L. Peterson and Dr. Byron Cryer, who worked as consultants to the drug companies, said that while COX-2 specific inhibitors did appear to reduce the incidence of ulcers in some patients, it was not cost effective to prescribe the drugs to all people with arthritis. They also argued that only people who have a greater chance than others of developing a serious ulcer should use Cox 2's. "It is unclear whether all the hype is warranted," the two doctors wrote in an editorial in the Journal of the American Medical Association. (25)

The pharmaceutical companies countered that all patients should receive the drugs due to the high safety profile of the COX-2 specific inhibitors. "Some people have serious adverse effects very early on" when taking other pain relievers, said Dr. Roger M. Perlmutter, Merck's executive vice president for worldwide basic research. "On balance, you would prefer to take a drug that had fewer risks because it can happen to anyone." Dr. Steve Geis, Pharmacia's vice president for arthritis clinical research, echoed that view: "Even with short-term therapy, people can have serious ulcers and bleeding. You can be healthy and get a complication." (26) Company spokespeople also argued that the new painkillers actually cost less than the full cost of NSAIDs. Richard U. DeSchutter, chief executive of G.D. Searle & Co., the Monsanto drug subsidiary, added, "For every $1 spent for NSAIDs, you have $2.30 spent for side effects." (27)

The author coded a newspaper article as "favorable" if the journalists used more pharmaceutical company spokespeople than insurance company officials or physicians opposed to wholesale use of COX-2 specific inhibitors. The company spokespeople focused on the efficacy of the COX-2 specific inhibitors, while insurance company officials countered that the drug's expense prevented it from being viable for every patient. The author coded an article as "unfavorable" if it cited more insurance company officials than drug company spokespeople, and "neutral" if the article contained an equal number of quotes from the drug companies and the insurance company or if the article contained no quotes or public relations messages.

3.3. Frame three: positioning

Once the FDA approves a drug for a single use, doctors can still prescribe it for other ailments; but pharmaceutical companies can market drugs only for diseases listed on the label. This directly impacts how the two companies attempted to position their respective products. Searle had the advantage of bringing Celebrex to the market before Vioxx, but Merck focused on the two drugs' labels. Vioxx received an indication for acute pain as well as arthritis pain; Celebrex initially received an indication for rheumatoid arthritis and osteoarthritis only. This meant that the FDA approved Vioxx for a broader range of uses, such as for menstrual pain and dental surgery, than Celebrex. (28) Later, the FDA approved Celebrex as treatment for familial adenomatous polyposis (FAP), a disease that almost always leads to colorectal cancer, which increased that drug's range of uses. (29)

Another differentiating factor was that Vioxx could be taken in a single dose, while Celebrex was administered in a single or double dose. Merck executives contended that Vioxx's single dose provided an advantage over Celebrex since patients usually want to take as few pills as possible. "We have a real once-a-day drug," Ed Solnick, president of Merck Research Labs, said. "They (Searle) don't, and that will be clinically apparent to patients." (30) Searle countered that Celebrex gave patients more options. "About 90% of the people who use Celebrex for osteoarthritis take the 200 milligram pill once a day," said Joseph C. Papa, president of United States operations for Searle. "If someone wants the flexibility, they can take the 100 milligram pill twice a day." (31)

The author coded a newspaper article as "favorable to Celebrex" if the journalist focused more on Celebrex being first to market or its indication for FAP; stories were "favorable to Vioxx" if the journalists focused more on the drug's broader indications or its single dose position. The author coded an article as neutral if the journalist balanced the story with equal number of references to both drugs' respective position.

3.4. PR objectives and tactics

Both companies spent millions introducing the COX-2 specific inhibitors. Days after the FDA approved Celebrex, Searle started a public relations and marketing campaign to teach physicians about Celebrex. Searle salespeople placed more calls --more than 2.5 million --to doctors than any company had ever done for any other drug, said Joseph C. Papa, president of Pharmacia's North American sales operation. (32) The company sent 45,000 "patient-starter kits" to physicians and pharmacies. Each free kit contained ten bottles, each with a 25-day supply of Celebrex --more than the usual 7- to- 14-day supply that drug companies usually offer for free samples. Using a sophisticated database, Searle gave Celebrex samples to doctors who most often prescribed arthritis-related painkillers - rheumatologists, orthopedic surgeons and podiatrists. Searle also aimed the kits at physicians in large medical practices who prescribed large quantities of NSAIDs. (33)

To educate consumers, Searle enlisted members of the American Gastroenterological Association to encourage people with arthritis and other patients to take a quiz to see if they might be at risk for developing serious ulcers. Those found to be at risk were encouraged to talk to their doctor. Searle also ran print advertisements in 50 publications, including newspapers in the 20 largest markets as well as large magazines such as Time and News-week. (34)

Searle's marketing was so effective, in fact, that it gave its rival Vioxx a boost. By the time the FDA approved Vioxx in May 1999, doctors and consumers knew the benefits of COX-2 specific inhibitors. (35) During the first four months of 2000, Merck spent $67 million to advertise Vioxx to consumers, according to Scott-Levin, a consulting firm, more money than any company spent to advertise any other drug. (36) Also, both companies launched intensive media relations campaigns targeting top tier medical trade, science, and consumer reporters. This study concentrated on analyzing the results of the efforts focused on newspaper dailies.

4. Results

The results can be seen in the following analysis. All of the newspaper articles analyzed fit within one of the three frames generated by studying the drug companies' press releases. The "position" frame received the most attention with 23 stories (51.1%), followed by "no side effects" (13 stories = 28.9%) and "cost" (9 stories = 20%). Yet, despite the drug companies' success in getting the media to cover the story in the desired frame, the study found the news coverage to be remarkably balanced. Stories categorized as "neutral" appeared with the most frequency (24 stories = 53.3%), followed closely by "favorable" (11 stories = 24.4%) and "unfavorable" (10 stories = 22.2%).

The St. Louis Post Dispatch had the largest number of stories on the COX-2 specific inhibitors during the studied time frame (20 stories = 44.4%), followed by the Wall Street Journal (10 stories 22.2%), New York Times (8 stories = 17.8%), Washington Post (6 stories = 13.3%), and the Chicago Sun Times (1 story = 2.2%).

COX-2 inhibitor stories appeared in almost equal amounts in three sections of the newspaper. The business section had the most stories (17 = 37.8%), followed by the health section (15 stories = 33.3%) and the news section (13 stories = 28.9%).

When studying the correlations among frame, paper, slant and section of the newspaper, the only significant correlation occurred between frame and paper (See Table #1). The most apparent example of this correlation was the St. Louis Post-Dispatch, which had 20 articles on the COX-2 inhibitor story (See Table #3). Of these articles, 11 were classified as neutral (55%), eight as favorable (40%) and only one as unfavorable (5%).

5. Discussion

Across all three frames, it appears that the media did not simply follow the public relations agenda established by the drug companies. Reporters contacted a variety of sources, including physicians, industry analysts and insurance company and HMO spokespersons. Although the drug companies successfully positioned the coverage of the story based on their desired frames, the use of independent sources prevented the companies from having totally favorable coverage. The remainder of this section will detail how reporters covered each frame.

5.1. Frame one

Most of the articles (47%) in the "no side effects" frame were neutral, with a similar number of favorable (23%) and unfavorable (30%) stories. The number of words in the favorable articles (5,787) outweighed the number of words in the neutral (4,283) and unfavorable (2,054) articles. Most of the articles were categorized as news (47%) and health (39%) stories, but some of the articles fell into the business category (14%).

The St. Louis Post Dispatch had more favorable stories (23%) on the "no side effects" issue than the other papers combined (1 article in the Washington Post). A Post-Dispatch reporter quoted doctors who sided with using COX-2 specific inhibitors, such as Dr. John Atkinson, professor of clinical medicine at the Washington University School of Medicine, who said, "Celebrex is a nice addition to the drugs that we have to treat arthritis." In the article, Dr. Atkinson expressed surprise that the FDA didn't approve the drug for general pain management "because pain and arthritis are so intermingled." The reporter noted that Atkinson said that the FDA's ruling "probably wouldn't affect" his prescribing the drug, especially for arthritis patients with a history of stomach ailments after having taken NSAIDs. (37)

On the other hand, the Chicago Sun-Times, New York Times, and Wall Street Journal all noted the FDA had problems with the drug companies' claims that the COX-2 specific inhibitors would cause fewer gastrointestinal problems. One Chicago Sun-Times writer noted, "Food and Drug Administration said there is no proof that it causes fewer stomach problems." (38) A New York Times reporter added, "The agency (FDA) declared that there was no proof that the new drug is ultimately easier on patients' stomachs than older competitors. Celebrex will bear the same warning about side effects as many of today's standard painkillers." (39)

5.2. Frame two

Most of the articles covering the "cost" frame were categorized as business (78%) stories, with a few classified as a health story (22%). An equal number (44%) of unfavorable and neutral stories appeared with only 12% fitting in the favorable designation. But, in terms of number of words, the number of words in the neutral (5,095) stories outweighed the number of words in the unfavorable (2,648) stories by an almost two-to-one margin.

The stories in the unfavorable category noted the lack of unbiased scientific studies justifying the higher cost of COX-2 specific inhibitors. For instance, a New York Times reporter wrote that a "pair of new studies has led The Journal of the American Medical' Association to conclude that while those risks are indeed lowered, they are not lowered enough to justify the extra cost of prescribing them for most people." (40)

The neutral articles also noted those who questioned the wholesale worth of the more expensive COX-2 specific inhibitors (as compared to NSAIDs), but offered a chance for the pharmaceutical spokespeople to respond. For instance, one St. Louis Post-Dispatch writer quoted the following spokespeople: "Just because the Food and Drug Administration approves a drug, that doesn't mean a drug is absolutely needed," said Dr. Emil Miskovsky, medical director at Cigna Healthcare of St. Louis. Dr. Daniel J. Murphy, a medical director at Group Health Plan in St. Louis, added, "It probably won't be a first-line therapy in the beginning." On the other hand, Dr. Stephen Spurgeon, chief medical officer for United Healthcare of the Midwest, was more optimistic about Celebrex's acceptance. "It can give great relief and protect the stomach, and we would encourage physicians to use this as a first-line therapy for the clinical indications," he said. (41)

5.3. Frame three

The fight for positioning was spread almost evenly across the news (35%), health (35%), and business (30%) sections. Most of the news articles could be considered neutral (34%) stories; yet, there were more favorable (16% Vioxx; 21% Celebrex; 21% both) articles than unfavorable (4% Vioxx, 4% both).

An article in the St. Louis Post Dispatch described each company's position. "Merck's biggest advantage is that it has been approved for acute pain and menstrual pain as well as for osteoarthritis," said William Fiala, who follows Monsanto and Merck for the Edward Jones brokerage. Searle's "biggest advantage is that Celebrex was first on the market." (42) A story in the Wall Street Journal, noted the importance of these positions. The writer quoted Jeffrey Chaffkin, an industry analyst at Paine Webber, who said the battle between the two drug companies would ultimately be decided by marketing clout because, "despite the hype, there is not all that much difference between the two drugs." (43)

In the battle of hype, as one researcher noted, "framing is a critical activity in the construction of social reality." (44) This study suggested that as public relations practitioners attempt to construct meanings for their organizations and their products and services they may have more influence on what the media covers than how reporters present the story. Practitioners may be able to convince the media to cover their topic, but they may have a more difficult time persuading the media to cover the story in the desired manner.

William B. Anderson is an assistant professor in the Manship School of Mass Communication at Louisiana State University.

(*.) Tel.: + 1-225-578-2179.

E-mail address: bandersl@lsu.edu (W.B. Anderson).

References

(1.) Video Monitoring Services of America, "Good Morning America," ABC Network Programming, May 8, 2000.

(2.) Melody Petersen, "Pushing Pills With Piles Of Money Merck and Pharmacia In Arthritis-Drug Battle," The New York Times, October 5, 2000.

(3.) Celebrex is copromoted by Searle, now part of Pharmacia Corporation, and Pfizer Inc. When Celebrex was launched in January 1999, Searle was part of Monsanto, and became part of Pharmacia in December 1999. For simplicity, the rest of the article will refer to only Searle as the promoter of Celebrex.

(4.) Petersen, "Pushing Pills With Piles Of Money Merck and Pharmacia In Arthritis-Drug Battle," The New York Times, October 5, 2000.

(5.) David J. Morrow, "Pushing New Arthritis Drugs, Monsanto And Merck Step Up Sales Calls To Doctors," The New York Times, August 3, 1999.

(6.) IMS America Ltd., National Prescription Audit, 1/1/99-12/31/99. Does not include generic products. Available online: http://www.celebrex.com/celebrex/index.htm.

(7.) Projected number based on NDC Health Information Services, Source (TM.) Retail Pharmacy Database, June 2000.

(8.) W. A. Gamson and A. Modigliani, "The Changing Culture Of Affirmative Action," in R. G. Braungart and M. Braungart (eds.), Frontiers in Social Movement Theory (New Haven: Yale University Press, 1987), p. 57.

(9.) T. E. Nelson, Z. M. Oxley, and R. A. Clawson, "Media framing of a civil rights conflict and its effect on tolerance," American Political Science Review 91 (1997), p. 567.

(10.) Kirk Hallahan, "Seven Models of Framing: Implications for Public Relations," Journal of Public Relations Research 11 (1999), p. 207.

(11.) This is similar to Entman's description of framing as "selecting some aspects of a perceived reality and making them more salient in a communicating text." Robert M. Entman, "Framing: Toward Clarification of a Fractured Paradigm," Journal of Communication 43 (1993), p. 52. See also Robert M. Entman, "Framing U.S. Coverage of International News: Contrasts in Narratives of the KAL and Iran Air Incidents," Journal of Communication, 41 (1991), pp. 6-27.

(12.) The notion that journalists can frame a story derives from Gaye Tuchman's application of social construction of reality theory to the news making process, in Making News: A Study in the Construction of Reality (New York: The Free Press, 1978). Agenda-setting research further illustrated how journalistic presentation of the news could affect news consumption. See, for example, Maxwell McCombs, Edna Einsiedel, and David Weaver, Contemporary Public Opinion: Issues and the News (Hillsdale, NJ: Erlbaum, 1991). Robert M. Entman narrowed the concept of framing in the newsroom in "Framing: Toward Clarification of a Fractured Paradigm," Journal of Communication 43 (Autumn 1993), pp. 51-55.

(13.) Dorothy Nelkin, "Journalism and Science: The Creative Tension," in Mike Moore (ed.), Health Risks and the Press (Washington, D.C.: The Media Institute, 1989), pp. 53-71.

(14.) Many mass media researchers have noted the role of PR practitioners in shaping news content. See, for example, Mark Fishman, Manufacturing the News (University of Texas, 1980); Herbert Gans, Deciding What's News: A Study of CBS Evening News, NBC Nightly News, Newsweek and Time (New York: Panthenon, 1979); Pamela J. Shoemaker & Stephen D. Reese, Mediating the Message, 2nd ed. (New York: Longman, 1996); and J.V. Turk, "Information Subsidies And Media Content: A Study of Public Relations Influence on News," Journalism Monographs 100 (1986), pp. 1-29.

(15.) Hallahan, op. cit., p. 228.

(16.) F. Dennis Hale, "Press Releases versus Newspaper Coverage of California Supreme Court Decisions," Journalism Quarterly 55 (1978), pp. 696-702.

(17.) Turk, op. cit.

(18.) Julie Andsager and Leiott Smiley, "Evaluating the Public Information: Shaping News Coverage of the Silicone Implant Controversy," Public Relations Review 24 (1998), pp. 183-201.

(19.) After the initial search for articles, the author found 7 in the Chicago Sun Times, 15 in the New York Times, 39 in the St. Louis Post Dispatch, 19 in the Wall Street Journal, and 6 in the Washington Post. After the deletion process, remaining articles included those found in Chicago Sun Times (1 article), New York Times (8), St. Louis Post Dispatch (20), Wall Street Journal (10), and Washington Post (6).

(20.) Bobbi P. Markowitz, "Q & A/Dr. Geoffrey Gladstein; Explaining Treatments for Arthritis," The New York Times, July 4, 1999.

(21.) Robert Steyer, "FDA Approves New Arthritis Drug; OK Gives Monsanto Economic Boost; Company Says Celebrex Is Easier On The Stomach Than Other Treatments," St. Louis Post-Dispatch, January 1, 1999.

(22.) Press release, "FDA Approves Celebrex(TM) (celecoxib) for Osteoarthritis and Rheumatoid Arthritis; A New, Important Therapy for Arthritis Patients," PR Newswire, December 31, 1998.

(23.) Press release, "FDA Approves Vioxx(R) (rofecoxib), A New Medicine from Merck; Vioxx is Approved for Osteoarthritis, Acute Pain in Adults and Menstrual Pain," May 21, 1999.

(24.) Petersen, op cit.

(25.) Petersen, op. cit.

(26.) Petersen, op. cit.

(27.) Robert Steyer, "For Arthritis Sufferers, Fighting the Pain Becomes a Way of Life," Sr. Louis Post-Dispatch, February 14, 1999. See also Press release, "Largest Medicaid Program in U.S. Places Celebrex(TM) on Formulary; New Arthritis Treatment Gains Rapid Managed Care Acceptance," PR Newswire, June 7, 1999.

(28.) Osteoarthritis is the most prominent form of arthritis, which is a collection of some 100 diseases. Osteoarthritis, which affects 16 million Americans, is found mostly in older people and results from a wearing and deterioration of joints. Rheumatoid arthritis affects 3 million Americans, mostly younger people; it is caused by the immune system turning against joints and other parts of the body.

(29.) Press release, "FDA Approves Celebrex(TM) (celecoxib capsules) as New Adjunctive Therapy In The Fight Against a Devastating Hereditary Disease; Leading Arthritis Medication Becomes First Approved Drug Therapy For Familial Adenomatous Polyposis -A Disease Which Almost Always Leads to Colorectal Cancer," December 24, 1999.

(30.) Yuki Noguchi, "Merck's Vioxx Gets Broader Label Than Celebrex," St. Louis Post-Dispatch, April 21, 1999.

(31.) David J. Morrow, "Pushing New Arthritis Drugs, Monsanto And Merck Step Up Sales Calls To Doctors," The New York Times, August 3, 1999.

(32.) Petersen, op. cit. See also Morrow, op. cit.

(33.) Robert Steyer, "Monsanto Readies Sales Blitz For New Drug," St. Louis Post-Dispatch, February 13, 1999.

(34.) Robert Steyer, "Monsanto Pitches New Drug Directly To Consumers Big Ad Campaign; Print-Ad Campaign Focuses On Celebrex," St. Louis Post-Dispatch, September 9, 1999.

(35.) Petersen, op. cit.

(36.) Petersen, op. cit.

(37.) Robert Steyer, "FDA Approves New Arthritis Drug; OK Gives Monsanto Economic Boost; Company Says Celebrex Is Easier On The Stomach Than Other Treatments," St. Louis Post-Dispatch, January 1, 1999.

(38.) "FDA approves new painkiller," Chicago Sun-Times, January 1, 1999.

(39.) "FDA Allows a New Drug To Treat the Pain of Arthritis," The New York Times, January 1, 1999.

(40.) John O'Neil "A Lower Risk and a Much Higher Cost," The New York Times, November 30, 1999.

(41.) Robert Steyer, "HMOs Could Decide The Future of Monsanto Pain Killer," St. Louis Post-Dispatch, January 17, 1999.

(42.) Robert Steyer, "Monsanto Rival Merck Gets an OK for its Arthritis Drug," St. Louis Post-Dispatch, May 22, 1999.

(43.) Robert Langreth, "FDA Approval of Vioxx Allows Merck to Compete with New Arthritis Drugs," The Wall Street Journal. May 24, 1999.

(44.) Hallahan, op. cit., p. 207.
Table 1

Correlations

                              Frame  Paper  Slant  Section

Frame    Pearson Correlation  1.000   .344   .067   .004
         Sig. (2-tailed)              .021   .663   .982
         N                    45     45        45  45
Paper    Pearson Correlation   .344  1.000   .110   -.036
         Sig. (2-tailed)       .021          .472    .814
         N                    45     45     45     45
Slant    Pearson Correlation   .067   .110  1.000   -.084
         Sig. (2-tailed)       .663   .472           .584
         N                    45     45     45     45
Section  Pearson Correlation   .004  -.036  -.084   1.000
         Sig. (2-tailed)       .982   .814   .584
         N                    45     45     45     45

(*)Correlation is significant at the 0.05 level (2-tailed).
Table 2

Section * Slant Crosstabulation

                                 Slant                 Total

                    Unfavorable  Neutral   Favorable

          News       2            6         5         13
Section   Health     4           10         1         15
          Business   4            8         5         17

Total               10           24        11         45
Table 3

Paper (*) Slant Crosstabulation Count

                                    Slant                 Total

                         Unfavorable  Neutral   Favorable

          Sun Times       1                                 1
          Times           4            4                    8
Paper     Post Dispatch   1           11         8         20
          Post            2            2         2          6
          WSJ             2            7         1         10

Total                    10           24        11         45
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Title Annotation:Newspaper coverage of public relations battle between two pharmaceutical companies in arthritis painkiller market
Comment:The media battle between celebrex and vioxx: influencing media coverage but not content.(Newspaper coverage of public relations battle between two pharmaceutical companies in arthritis painkiller market)
Author:Anderson, William B.
Publication:Public Relations Review
Geographic Code:1USA
Date:Dec 22, 2001
Words:5524
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