Media coverage of health issues: a study of advertorials in the Slovene daily newspapers.

Kovacic, Melita Poler ; Volcic, Zala ; Erjavec, Karmen 等

According to many scholars, it is not only the medical establishment, but increasingly mass media that provide health information to the citizens (e.g., Kreps, 1990; Brown & Walsh-Childers, 1994; Brodie et al., 1999; Gibney & Kearney, 1997; Johnson, 1998; Seale, 2002; Wang & Gantz, 2007). However, there are different reasons for the rise of health news in the media. Tanner writes that health issues attract readers and "feed the appetite of media consumers" (Tanner, 2004, p. 24). Furthermore, any health related topic sells the advertising time well (Seale, 2002; Zgonc, 2004). Health topics attract advertisers, and as McManus argues, advertising revenues are the foundation of the contemporary market-driven journalism (McManus, 1994).

Empirical studies point to the fact that a number of health-related messages in the news has increased considerably in the last decade. However, these messages are often accompanied by advertisements (e.g., Bunton, 1997; Seale, 2002; Zgonc, 2004). Usually, the regular advertisements are published close to a journalistic text or independently. But as some researchers in different Eastern-European countries pointed out, there is a tendency to publish commercial messages in the form of news, promoting products or services in different branches, including pharmaceutical industry (e.g., Oseli, 2001; Babic, 2003; Malovic, 2003; Kapus, 2004; Jurisic et al., 2007; Erjavec & Poler Kovacic, 2010). These messages are a hybrid genre between advertisements and editorials, and are named "advertorials". The existing studies on advertorials (e.g., Cameron, 1994; Dahlen & Edenius, 2007; Eckman & Lindlof, 2003; van Reijmersdal et al., 2005) are mostly based on the premise that the readers are able to recognize their commercial nature by at least one external characteristic, i.e., a label.

In this study, we focus on health-related hybrid messages which had been paid for and then published as news. However, as we will show, these hybrid messages do not contain any label that they are promotion materials and that in fact they promote products. Our goal is to uncover their textual characteristics. On the basis of a textual analysis of health-related hybrid messages in three most-read Slovene quality daily newspapers, and in-depth interviews with producers we will explore the production practices as well as the main producers' explanations and justifications for participating in this unethical and illegal practice.

First, we create a theoretical background for understanding health-related issues in the media. Next, we shortly describe Slovene media context and explain our methodologies. In the last part, we analyze our data and offer conclusions.

Theoretical Background

Studies that focus on health-related topics in the media have so far concentrate on four major areas: a) the extent to which specific health issues had been covered in the media; b) media portrayals of public health crises; c) the framing of health news stories related to public policy; and d) the portrayal of health behaviors in the media (Wilkins & Ball-Rokeach, 2006). Health journalism studies explore news coverage of a specific health-related topic in magazines (e.g., Andsager & Powers, 1999; Martinez et al., 2000; Potter et al., 2000), newspapers (e.g., Brittle & Zint, 2003; Jamieson et al., 2003; Traquina, 2004), or both (e.g., Shoebridge & Steed, 1999). Studies on framing of public health policies mostly deal with specific topics, such as tobacco and care/health reform. For example, Wenger et al. (2001) studied the newspapers' coverage of tobacco industry and compared it to health consequences of tobacco use. Several other studies on news coverage of managing health care reform in major newspapers and magazines were conducted (e.g., Brodie et al., 1998; Lepre et al., 2003; Walsh-Childers et al., 1999). These authors point out that health care reform is inherently a normative as well as an economic and organizational activity. In particular, DiMaggio (2009) points to the neo-liberal media coverage of health reform in USA. He writes that American media in general and The New York Times specifically divert public attention from >>the real reason for rising medical costs--the for-profit, private health care system. They prefer to explain rising costs as a function of over indulgent patients who seek too many medical services.<< He concludes that pressures to achieve better expenditure control and/or greater productivity need to be balanced against deeply rooted moral imperatives to maintain universal access to necessary care.

Research on electronic media focuses on the portrayal of behaviors such as smoking, eating, alcohol consumption, sex, and violence, in entertainment programs or movies, rather than news coverage of health issues (e.g., Diefenbach & West, 2001; Greenberg et al., 2003; Tirodkar & Jain, 2003). Most of these studies found out that health stories were not providing the necessary information needed to teach the media audiences how to identify, prevent, or deal with health problems.

The practice of unlabeled advertorials has been so far neglected in health journalism research. Scholars have mainly analyzed advertisements in health-related magazines (e.g., Kim & Lennon, 2006; Albright et al., 1988). On the basis of their research, Cameron & JuPak (2000, p. 65) defined advertorials as "blocks of paid-for, commercial messages, featuring any object or objects that simulate the editorial content of a publication in terms of design/structure, visual/verbal content, and/or context in which it appears". Advertorials are designed to "blend in" with the newspaper's overall content to increase their effectiveness as marketing vehicles (Eckman & Lindlof, 2003). Advertiser-based stories that perform as editorial content can draw higher audience attention and carry more credibility than the same information does when presented in recognizable advertising formats (Cameron, 1994). In a comparative study of advertorials versus traditional advertising, Kim et al. (2001) found that consumers of advertorials were generally unaware that what they had watched or read was actually an advertisement for a product or service. Studies by Cameron & Curtin (1995) and Cameron & Ju-Pak (2000) indicated that even labeling advertorials as such is ineffective in informing readers that the editorial-like content is linked to an advertiser, and in that, its main purpose is not to inform, but to sell either a product or a practice. Dahlen & Edenius (2007) tested consumers' perception of different advertising stimulus and found that advertorials make it much more difficult to identify the message than advertising. Van Reijmersdal et al. (2005) found that advertorials gained more attention and were rated more positively when the medium was perceived as a (co-)sender of the advertised message. As a result, consumers activate their advertising schemas to a lesser extent and evaluate the message more favorably (Dahlen & Edenius, 2007).

Because of the lack of studies on the production practice of health-related messages which have been paid for and then published as news without a clear label, we have posed the following research question:

RQ 1: What is the production practice of advertorials like?

Advertorial products are designed to blend in with the media overall content to increase their effectiveness as marketing vehicles. With advertorials, advertisers not only get their advertisement that mimics a real news story. Often an advertiser has the opportunity to control the entire environment within which the message is embedded (Eckman & Lindlof, 2003) and interpreted. Because the existing studies focused only on labeled and marked advertorials, and because they presented the reasons for their production in a simplified way, we posed a second research question.

RQ 2: How do the main producers of advertorials explain and justify this practice?

In Slovenia, publishing commercial texts without identifying their advertiser or without clearly marking that they are paid for messages is unlawful. It works against journalism ethics (Association of Journalists of Slovenia, 2002), advertising ethics (Slovene Advertising Chamber, 1999), and the Mass Media Law (Slovene Parliament, 2006). Further, numerous international law documents prohibit publication or broadcasting hybrid messages. For example, according to the Audiovisual Media Services Directive (European Parliament & Council of EU, 2007), the EU Member States shall ensure that the media comply with the requirement that they "audiovisual commercial communications shall be readily recognisable as such", and "surreptitious audiovisual commercial communication shall be prohibited". And the Unfair Commercial Practices Directive (European Parliament & Council of EU, 2005) prohibits "using the editorial content in the media to promote a product where a trader has paid for the promotion without making that clear in the content". Because advertorials violate ethical and legal norms, it is important that the readers know how to recognize them. Only if they are recognized, they can eventually be sanctioned and the practice of producing them suppressed. Therefore, our third research question is:

RQ 3: How can the readers recognize advertorials?

Media Landscape and Coverage of Health-Related Issues in Slovenia

Slovenia is an independent parliamentary democracy and a full member of the European Union. Since Slovenia proclaimed its sovereignty from the communist state of Yugoslavia in 1991, it underwent enormous changes in politics, economy, media, and society in general. Since the early 1990s, when the media lost the state subsidies, we see the commercialization of all media spheres. For example, in a small Slovene media and advertising market with only two millions population, the newspapers attempt to compete with each other by commercializing all of their activities (see Basic Hrvatin & Petkovic, 2008), giving in to the demands of advertisers and public relations advisers (e.g., Splichal, 2001; Erjavec, 2004; Erjavec, 2005). Journalists have been performing their every-day work in the situations of their media being "vulnerable to manipulation by political forces and commercial corporations which limit resources, variety, and autonomy" (Splichal, 1999, p. 15). Concentrations of ownership, clientelism, and extreme commercialization have certainly contributed to media's promotion of particular political-commercial interests. Instead of truthful and unbiased informing of the public on matters of public relevance, scholars point out that what we witness is the dominance of entertainment and advertising media themes.

The signs of politically dictated channeling of advertising money for state-owned and state-controlled companies have been explored throughout the post-socialist period in Slovenia. The same economic and political links which are crucial to understand the media ownership in Slovenia also govern the advertising field. The impact of these networks is mostly felt by the print news media (Basic Hrvatin & Petkovic, 2008, p. 76). The media power is closely connected with economic and political power, and "[t]he barrier separating advertisements from editorial content has been breaking down under the weight of the drive for profit" (B. Hrvatin et al., 2004, p. 89). A particular system of striving for economic goals has been developed by companies, in the sense that if you do not write in a way that we want you to, we will not advertise in your newspaper. Such extortion is particularly productive due to the small media and advertising market in Slovenia. Namely, every cancellation of advertisements by big advertisers can cause financial instability of a newspaper. In this way, critical reporting in politics, economy and other spheres has been rendered difficult, and several unethical and illegitimate forms of mass communication, such as advertorials, developed.

The practice of publishing hybrid messages can be plentiful also because the majority of journalists are faced with poor working conditions, low salaries, irregular payment for contractual work, and various pressures from politicians, influential individuals, owners, advertisers, management boards, and editors (Basic Hrvatin & Petkovic, 2008, pp. 67-68). In such circumstances, journalists are vulnerable, while the journalistic union and the association of journalists are too weak to protect them (Nahtigal, 2006; Petkovic et al., 2006).

Furthermore, there is a low respect for professional journalistic standards (e.g., Kosir, 2003; Poler Kovacic, 2003, 2008; Erjavec & Poler Kovacic, 2010) in general, insufficient self-regulation in the media and frequently inefficient legal sanctioning of any law transgressions. These all contribute to the prosperity of advertorials practice. Although the Code of Slovene Journalists (Association of Journalists of Slovenia, 2002) is repeatedly violated not only in tabloids, but also in the supposedly serious, quality press, there are no efficient measures (no policies) to prevent or punish them. In the worst case, a journalist who breaches the code can be expelled from the journalistic association or journalistic union. However, journalists themselves often refuse to acknowledge the legitimacy of these entities (e.g., Rovsek, 2005, p. 100; Bervar, 2002, pp. 61-62).

Slovene media strive for success or even survival in the small and competitive market by covering topics which will be well-read among the widest possible audience, and will at the same time attract advertisers; and health-related topics usually meet these criteria. Health-related topics are usually understood as "safe" enough (not connected to politics) and therefore they appear in several media in Slovenia. There are numerous life-style magazines covering health issues, each daily newspaper has a supplement about health topics, and some free sheets are also dealing with health themes. There are also many internet editions and forums about health issues. The public television station broadcasts talk-shows having a health rubric, while commercial national, regional and local television and radio stations regularly broadcast news about health-related topics.

According to several studies (e.g., Atkin & Wallack, 1990; Seale, 2002), for media industry, health messages represent a possibility to attract audiences and advertising money. Health-related industry, especially the pharmaceutical industry, has been the most profitable branch in Slovenia and elsewhere in the world. Pharmaceutical industry in particular is one of the main media advertisers, which puts it in the position of power to make demands concerning the production of advertorials (Kapus, 2004; Oseli, 2001). However, according to the latest research (e.g., Setinsek & Bozic Marolt, 2009), the pharmaceutical industry in Slovenia reduced its advertising in 2009, in times of general economic recession, thus forcing the media to find (new) ways of keeping the income of these advertisers, especially in the press.

Methodology

First, textual analysis of the journalistic discourse is conducted in order to address the RQ 3. We employed a critical discourse analysis (see Fairclough, 1995; van Dijk, 1988), which means that a more interpretative approach is adopted if compared to mere "content analysis". The textual analysis is carried out on five different levels, i.e., topic, genre, perspective, choice of sources, and over-lexicalization.

The sample for textual analysis consists of 146 unlabeled health-related advertorials, which were published from January 2009 until December 2009 in three most-read Slovene quality daily newspapers, i.e., Delo, Vecer, and Dnevnik (Valicon, 2010). The interviewees helped us to identify unlabeled health-related advertorials which were then included in the sample; when they were revealing the production process to us, they pointed to their own texts which were advertorials, however, unlabeled. We chose quality daily newspapers because they explicitly emphasize their attachment to high professional standards. It is a serious press that should respect ethical and legal regulations, which prohibit publication of hybrid messages.

Because critical discourse analysis is only text-based, we combine it with in-depth interviews. In-depth interviews are an appropriate method to address the RQ 1 and the RQ 2, because they enable researchers "to go deep, to uncover new guidelines, open novel problem dimensions and provide with a clear, accurate and inclusive opinion based on a personal experience" (Walker, 1988, p. 4). The usefulness of in-depth interviews has been shown by different studies, even though they have dealt only with particular groups of advertorial producers, for example, news producers (Eckman & Lindlof, 2003) or advertising agency practitioners (Goodlad et al., 1997). In this study, we conducted in-depth interviews with all the main participants actively involved in the production of advertorials in the Slovene quality daily press. Our goal is to explore their articulations: the explanations and justifications for being part of this practice, as well as the course of the production practice of making advertorials.

Interviews (14) were conducted with one editor, one assistant editor, three reporters, one newspaper marketing agents from each newspaper, and six advertisers in the fall of 2009. Our informants were between 27 and 53 years old, and the majority were women. They would only speak with us on the condition of complete anonymity--due to illegality of advertorial practice. So we labeled them using letters. The words which could identify them were replaced by ellipses.

Textual Analysis of Advertorials

The aim of the textual analysis was to uncover discursive elements of promotion. These are drawn from news items that were identified by our informants as paid-for. We will present the common characteristics of all analyzed unlabeled health-related advertorials. However, we will demonstrate these characteristics with only one typical example of unlabeled health-related advertorial (Table 1).

Topics

According to many scholars (e.g., Bell, 1991; Boyd, 2005; van Dijk, 1991), topics are an important aspect of news, as they represent what news producers construe to be the most important pieces of information. On the basis of propositions, van Dijk (1988) worked out the thematic structure of a news story in the form of topics (generalized from macropropositions). Topics are defined as the "main idea unit" of a news story.

Our analysis of unlabeled health-related advertorials revealed the following topics: production of new drugs (64 items); healthy food and drinks (41 items); new or improved health-related products/ services (12 items); new or improved wellness products/ services (11 items); reports on successful medical treatments (10 items); reports on events of several pharmaceutical companies (6 items); reports on service/business success of pharmaceutical companies (2 items). Thus, the macro-semantic analysis showed that unlabeled advertorials most often include information about production of new drugs, most frequently drugs which are required by a large number of patients, or drugs which are considered to be a big discovery. Our typical advertorial, which is presented in the Table 1, also fits in this category, positively presenting a new drug for osteoporosis. Namely, in Slovenia, every third woman falls sick with osteoporosis (Grasic, 2009).

The typical advertorial as well as all other analyzed advertorials did not deal with more complex and social themes, such as problems concerning reduction of health insurance rights. Instead they represented a simplified and a commercialized way of looking at health, being most of all in the interest of the pharmaceutical industry. The analyzed advertorials did not cover social events in a way typical of news items, but rather dealt with the positive features of the subjects in question, which is typical of promotional texts, i.e., advertisements, press releases and advertorials (Cameron & Ju-Pak, 2000; Wernick, 1991).

Genre

Within the academic literature, van Dijk's (1988) and Bell's (1991) schematic conception of genre is most established. According to this conception, a schematic structure (headline + lead + satellites) is made up of stages, either all obligatory or some obligatory and some optional. The generic structure of unlabeled health-related advertorials was at first glance the same as in other news items; a reporter answered all basic journalistic questions (who, what, where, when, whom, why, how). No schematic structure included a meaning that the item was an advertorial, as the message had been paid for.

Only a detailed discourse analysis could reveal that unlabeled health-related advertorials included elements of promotional discourse. The first specific characteristic of advertorials was found already in the headline. All the headlines evaluated the topic in a more or less explicitly positive way, as demonstrated also by the typical example: [Name of the drug]: [Name of the pharmaceutical company] offered a new efficient drug for treatment of postmenopausal osteoporosis. The headlines in the analysed advertorials were short statements, they mostly consisted of one or two sentences, with one categorical claim, praising the health-related organisation, its product or service, more or less explicitly, for example: in [name of the town] they opened a new center for efficient [name of the therapy]; in [name of the hospital] they were the first in Slovenia to perform [name of the operation]; and [Name of the company] has sent a biologically produced healing juice to the market. This is a typical characteristic of headlines of contemporary promotional genres, such as "news/information headlines" in advertisements (Jefkins, 1994) and headlines in press releases (Wragg, 1993). Since one of the main characteristics of the headline is that it orients the reader to process the text in a pre-determined direction (van Dijk, 1991), the analysed headlines gave the preferred positive meaning on the subject discussed.

A key feature of analysed texts is that they do not report on social events, which is typical of news reports (van Dijk, 1988; Bell, 1991), but rather, already in the first paragraph, present some health problem. The health problem in our typical case was osteoporosis. This schematic structure was preceded by background describing the disease, i.e., how the disease occurs and what are its effects. Immediately after the problem had been presented, a solution was offered, i.e., a specific drug, which was identified by its name and the name of the pharmaceutical company. It was followed by a comment by a doctor, shortly presenting a research on efficiency of this drug. The last schematic structure was comment made by the reporter--the drug was praised as being the solution for osteoporosis patients.

Thus, in the analysed advertorials, the comments category with a positive evaluation was dominant, which clearly showed the incorporation of characteristics of promotional genres, such as advertisements and press releases (Cook, 1992; Wragg, 1993).

Perspective

On the macro-semantic level of analysis, an important feature of unlabeled health-related advertorials is the perspective, i.e., the point of view from which events and actions are described (van Dijk, 1991). The perspective is both a local and a global feature of semantics and is expressed by various textual signals, analyzed in more detail later on. For now, we focus on the global semantics of news items.

One of the main features of analyzed advertorials was partiality, as the topic was covered from one point of view only. They covered one product/service, or more than one within the same interest group, and they presented their positive characteristics only. They never pointed to controversial or negative attributes, which is typical of promotional texts (Cameron & JuPak, 2000; Wernick, 1991). The typical unlabeled health-related advertorial also presented the drug from the positive side, offering no critical or negative information, such as its side effects or its high price, or making reliable comparisons to drugs offered by the competition.

Choice of Sources

One of the characteristics of news texts is the reliance on various sources of information (van Dijk, 1988; Bell, 1991). Hence, quotes--both direct and indirect--are frequently a part of news discourse to give it a semblance of "facticity". A quote from the newsmaker's own words renders it as incontrovertible fact (Tuchman, 1978). In the analysed advertorials, the primary sources came only from the side of the organisation and its clientele. There was no multiplicity of sources, which might offer perspectives differing from the one in question. In other words, there were no sources contradicting or critically questioning the original sources. The most frequent source was a doctor, who was directly linked to an organization and a product or service; then there were managers of health-related organizations, such as pharmaceutical companies, hospitals, wellness centers, research institutes, and public relations agents, while in longer news reports other representatives of the company also appeared. The so-called "independent" sources, i.e., the sources not directly linked to an organisation, were rare, but when they appeared, they always confirmed the general opinion on the subject in question and added to it. Doctors were used most frequently as "independent" sources, which implicates how doctors and the pharmaceutical industry are linked. In the texts, sources constructed an illusion of truthfulness and legitimized the partiality of advertorials.

As seen in our typical example also, the key source of information is a doctor, linked to a pharmaceutical company, who was presenting results on the efficiency of the drug.

Over-lexicalization

The unlabeled health-related advertorials used vocabulary which is clearly connected to promotion language. The key characteristic was the use of positive words which presented a particular subject in a favorable light (Wernick, 1991, p. 181). This was especially visible in the lexical device called over-lexicalization. The analyzed unlabeled health-related advertorials provided "a large number of synonymous or near-synonymous terms for communication of some specialized area of expertise" (Fowler & Kress, 1979, p. 211), giving rise to a sense of "over-completeness" (van Dijk, 1991). As Fowler (1985, p. 65) argued, vocabulary might be seen as a map "of the preoccupations of a culture. /.../ Detailed systems of terms develop for the areas of expertise, the features of habitat, the institutions and relationship, and the beliefs and values of a community".

Let us first examine the pervasive use of lexical cohesive devices to promote health-related products/ services. The most direct and obvious form of lexical cohesion is the repetition of positive adjectives which explicitly evaluate the subject discussed. The use of synonymous adjectives and other direct references to "good", such as fine, pleasant, expert, competent, capable, effective, efficient, quality, new, unique, helpful, safe, reliable, natural, distinguished, original, powerful, indispensable, contribute to the co-referentiality of the effectiveness of health-related products/services to promote them. In our typical case, the drug was described as new and efficient already in the headline, which served to its promotion. Even further, the drug was denoted as a big progress in osteoporosis treatment twice in the text; the drug reduces risks of fractures and also helps the bone mass growth.

For the vocabulary of health-related advertorials, which do not cover topics directly linked to health (drugs, medical treatments, hospitals and other medical institutions), it was typical that repetition of the word health and its synonyms was used to promote particular institutions, their products and services. Advertorials about food and drinks and wellness products/services repeated the word health at least three times in a text. For example, in the text titled [Name of the company] has sent a biologically produced healing juice to the market, reference to healing was repeated twice more, although it was about a "common" apple juice. Such examples indicate that advertisers try to promote their products as "healing" because of anticipated higher price value and bigger chance of sale.

Ethnographic Study of Advertorials Production

Production Practice

In-depth interviews with the key participants of advertorial production practice revealed that initiators of the production process usually are advertisers, who cooperate well with the newspaper marketing agents. However, the interviewees also described the practice of newspaper marketing agents who offer free advertorials to their most important advertisers. It is common that they communicate by e-mail, on the phone, or personally (often at the so-called "working lunches"). They make arrangements about the price and manner of publication (timing, page, length, signature) in an informal atmosphere.

The price of advertorials is the same as the price of traditional advertisements, or just slightly lower. Newspaper marketing agents justify the price with the fact that "now, what is supposed to be editorial content is paid for. You see, this space in our newspaper would have to be filled in one way or another, so in this way, we even get payment for it." (Newspaper Marketing Agent G) Buying a space for advertorials is not registered in contracts as advertorials, so that media inspectors would not be able to trace it. It should be noted here that the same agents, who earlier stated that this is "just about filling editorial content", now claim that it is about advertisements, but still justify it: "There is really no need to indicate specifically that it is an advertisement." (Newspaper Marketing Agent G)

When an advertiser and a newspaper marketing agent agree on the contents and manner of publication, the agent informs the editor and one of the reporters about the arrangements via e-mail. Usually, the reporter who is going to write an advertorial is known in advance. It is a common practice that these are younger reporters, who have less institutional power in the editorial office. These are mostly reporters who have not been working long as journalists, or have not been fully employed, or students.

Often, a reporter writes an advertorial in a form of a news conference. In that way, a newspaper attempts to create an image of newsworthiness and trust. Sometimes, an advertiser prepares a text in advance and a reporter only rewrites it in a way that obvious traces of promotional function of the text are deleted, or--as reporters say--, the text is neutralized: "To neutralize a text means that I must cover up promotion in a way that I delete clear promotional words. However, sometimes I even do not have to make many changes, because writers themselves already know how to do it." (Reporter J) Neutralization also means that a reporter rearranges a text in an appropriate genre, or that he/she signs under it, according to an advertiser's wishes.

The majority of interviewees also pointed out that the majority of advertisers want to check the "quality" of an advertorial: "Yes, they want to see what I have written before it is going to be published. Usually, they make some further but minimal changes." (Reporter D) The so-called "quality" of an advertorial is measured in regards to how much a company or its products/services are mentioned in the text in an as much implicitly-promotional way as possible: "The most important thing is that you mention them and praise them, however, in a way that is not too obvious." (Reporter F)

According to advertisers' wishes, advertorials are published on particular pages, most often on the pages devoted to health issues, or even to science new: for example, when writing about new medical procedures and new medicaments.

The interviewees also said that when an advertorial is too long, the problem is solved not by making it shorter, but by withdrawing other journalistic items: "If a text is too long and there is not enough space on a particular page, we must remove some other text." So, in such a case, advertisers actually set the media agenda.

Main Participants' Explanations and Justifications

In this section, the interviewees' answers will be presented according to the groups of the main participants in the advertorials production practice:

The advertisers whom we interviewed stated three kinds of explanations why they participated in advertorials production. The majority claimed that being big, important advertisers they have the right to control the production of paid texts in the form of news, when these texts cover their products and/or services. A typical statement was: "Listen, if our company brings a lot of money to a newspaper, it is beyond doubt that we want to have control over what they are writing about us . about our products." (Advertiser A) The interviewees understood having control as defining the contents, genre, timing and place of publication: "By having control, we define what they will write about us, what genre they will use, on which page they will publish it. All of these are important." (Advertiser B) One of the key explanations offered by advertisers was that they anticipated advertorials to have more effect than the ordinary advertisements. A typical statement reads: "I rather pay for an advertorial than classical advertisements, because they have more impact, as they look like real journalism." (Advertiser C) Two advertisers even emphasized that they were doing advertorials to help their readers: "Look, the readers of today do not have enough time to test all the products. So we help them . we give them presentation of products, which is more useful for them than just seeing an image of a product in an advertisement. Yes, we help our readers!" (Advertiser F)

Newspaper marketing agents also offered three different explanations for their participation in supporting advertorials. More than half of them argued that the main reason was their newspapers' economic weakness during times of recession and reduced advertising revenues. With advertorials, marketing agents contribute to financial survival of their newspapers. For example: "Now, our newspaper is in a deep crisis, and we would go down if we did not have additional income. There is no other way." (Newspaper Marketing Agent A) Two agents claimed that advertorials are a bonus for good clients, to prevent them from going to other media: "In the present time, we are forced to offer something extra, something more; if not, they will go somewhere else . for example, internet interviews are very cheap." (Newspaper Marketing Agent D) And one of the key explanations offered by this group of interviewees was that advertorials attract new advertisers. A typical statement reads: "It is not possible to get a new client if you only offer the usual. You must make up something new. Only in this way, you are competitive!" (Newspaper Marketing Agent B)

The interviewed reporters and editors resorted to two sets of explanations. The majority claimed that they made advertorials because their newspapers' marketing agents had demanded it from them. In the words of one of the informants: "Now I must describe the darker side of our work, which is our subordination to marketing agents. We do what they want us to do. If we wouldn't, me and my colleagues would lose our jobs." (Editor A) There were also more individual explanations--three reporters admitted that they were making advertorials because of advertisers' gifts. However, they pointed to their social situation as journalists: "Listen, as long as my salary is so miserable, I will cover those events where I will get some reward from advertisers. I do not care what I write about, but here at least I get something out of it; otherwise, those who are above me profit only." (Reporter A)

Discussion and Conclusion

When compared to other studies of advertorials practice, this study is different because it combines a textual of unlabeled health-related advertorials with in-depth interviews of the main protagonists involved in the production process. This methodological approach is unique in that it allowed us to get a clearer insight into the unlabeled health-related advertorials production practice. It also allowed us to identify advertorials' textual characteristics as well as the main participants' explanations and justifications for being part of this unethical and illegal practice.

With our research we wanted to contribute to the debate on the importance of heath-related advertorials in Slovene major newspapers. In answering the RQ 1 on the advertorials' production process, we found out that the initiators of this practice are usually advertisers, and sometimes newspaper marketing agents. It is common that they make arrangements by e-mail, on the phone, or personally. The price is the same or lower than the price of traditional advertisements, however, due to their illegality, advertorials are not openly registered in contracts. Editors and reporters are informed about the arrangements by e-mail. A news conference is often a point of departure for advertorials, linking the report to an event and thus giving it an appearance of newsworthiness. A reporter rewrites the material to make the promotion language as little noticeable as possible. However, promotion of course remains very much a part of the text.

The RQ 2 was also answered on the basis of the in-depth interviews with the main participants who presented their explanations and justifications for participating in the process. Advertisers claimed it was their right to have control over the production of texts covering their products/services, because of the money they devote to the media. Their motive to engage in advertorials production was their belief that advertorials are more effective than the regular advertisements. They see advertorials as helpful to the readers. Newspaper marketing agents agree with advertorials because of financial weakness of their media, and described advertorials as a way to cope with the uneasy economic situation on the media market. Advertorials also served as a bonus for good clients, or as a way of attracting new advertisers. The editors and reporters said that they were just carrying out orders from marketing agents, and some of them admitted gifts from advertisers to be their main motive. However, they understood accepting presents as justified because of their low salaries and weak social situation.

The textual analysis enabled us to uncover those characteristics of advertorials which are recognizable to a critical reader, and thus to answer the RQ 3. Unlabeled health-related advertorials do not cover social events, but only specific promotional topics: production of new drugs, healthy food and drinks, new or improved health-related products/services, new or improved wellness products/services, reports on successful medical treatments, reports on events of several pharmaceutical companies, and reports on service/business success of pharmaceutical companies. The genre structure is promotional; it is not diverse, but just follows the promotional function: in the beginning of a text, a certain health problem is stated, and then presented as solved by the help of a particular organization, its products or services. In the analysed advertorials, the comments category with a positive evaluation is dominant, which clearly shows the incorporation of the characteristics of promotional genres. The perspective is distinctly one-sided, presenting the topics entirely positively. Sources are directly linked to an organization, or they are quasi-independent sources, most often doctors. In unlabeled health-related advertorials, promotional words, praising the subject in question, appear. In those items which do not cover health topics directly, words referring to health are repeated. In this way, the producers try to create the image that the item covers a health topic, which contributes to better sale.

Numerous factors in the Slovene media landscape provide circumstances favorable to the growth of advertorials production practice in Slovenia, as described earlier. This practice is not a totally new phenomenon on the Slovene scene, but, in times of economic recession in 2008-2009 it increased, according to our interviewees. Economic downturns reduce advertising expenditures (see Picard, 2001), and according to several studies (e.g., MacLeod, 2008; Setinsek & Bozic Marolt, 2009), advertising was slumping in this period. The market research (Setinsek & Bozic Marolt, 2009) showed that in 2009 advertising fell particularly in daily newspapers, and that advertising of medical products in general also fell; the fall of advertising was noted in the biggest Slovene advertisers of medical products (i.e., pharmaceutical companies Krka and Lek). Smaller advertising budgets may mean that advertisers, newspaper marketing agents and news producers are all forced to find additional channels of income, ways to reduce costs and to invest advertising money well.

By participating in the practice of publishing unlabeled health-related advertorials, newspapers privilege the pharmaceutical-commercial view on health, while a more complex social view, such as rights in health insurance or health problems, is neglected. The practice of publishing advertorials may be described as a kind of covert censorship, preventing any critical or negative information to be published about advertisers who are among the biggest providers of health-related products and services in Slovenia. In this way, newspapers renounce their role of accurately and fairly informing their readers about matters in public interest, which is commonly accepted as the primary function of the news media (e.g., McManus, 1994). Instead, they promote the pharmaceutical industry which is represented in a simplified and one-sided way as the one that is efficiently solving health problems of people.

We have discovered that the production practice of unlabeled health-related advertorials is present, although not prevalent in the (Slovene) dailies which may be classified as quality press, thus expected by their readers to offer impartial news or, at least, news which has not been bought (see Sparks, 2009). The question is whether and how this practice is performed in other media. More studies are needed on the social consequences of such journalism, when journalists apparently engage in the role of lapdogs that are dependent on advertisers, instead of playing the role of watchdogs following high professional standards. Who will impartially uncover information about the pharmaceutical industry which is one of the biggest industries in the world, if the media rather become its celebrants and promoters?

References

Albright, C. L., Altman, D. G., Slater, M. D., & Maccoby, N. (1988). Cigarette Advertisements in Magazines. Health Education & Behavior, 15, 225-233.

Andsager, J. L., & Powers, A. (1999). Social or Economic Concerns. Journalism and Mass Communication Quarterly, 76, 531-50.

Association of Journalists of Slovenia (2002). Code of Slovene Journalists. Retrieved February 8, 2010, from http://www.novinar.com/dokumenti/kodeks.php.

Atkin, C., & Wallack, L. (eds) (1990). Mass Communication and Public Health. London, New Delhi: Sage.

B. Hrvatin, S., Kucic, L. J., Petkovic, B. (2004). Media Ownership. Ljubljana: Peace Institute.

Babic, D. (2003). Mediji u regionu. Mediaonline.ba: Southeast European Media Journal. Retrieved February 8, 2010, from http://www.mediaonline.ba /ba/?ID=294.

Basic Hrvatin, S., & Petkovic, B. (2008). You call this a media market? Ljubljana: Peace Institute.

Bell, A. (1991). Language of News Media. Oxford: Blackwell.

Bervar, G. (2002). Freedom of Non-Accountability. Ljubljana: Peace Institute.

Boyd, A. (2005). Broadcast Journalism. Oxford: Focal Press.

Brittle, C., & Zint, M. (2003). Do Newspapers Lead with Lead? Journal of Environmental Health, 65, 17-22.

Brodie, M., Brady, L. A., & Altman, D. E. (1998). Media Coverage of Managed Care. Health Affairs, 17, 9-26.

Brodie, M., Kjellson, N., Hoff, T., & Parker, M. (1999). Perceptions of Latinos, African Americans, and Whites on Media as a Health Information Source. The Howard Journal of Communications, 10, 147-167.

Brown, J. D., & Walsh-Childers, K. (1994). Effects of Media on Personal and Public Health. In J. Bryant & D. Zillmann (eds), Media Effects (pp. 389-415). Hillsdale: Lawrence Erlbaum Associates, Inc.

Bunton, R. (1997). Popular Health, Advanced Liberalism and Good Housekeeping Magazines. In A. Petersen & R. Burton (eds), Foucault, Health and Medicine (pp. 223-248). London, New York: Routledge.

Cameron G. T., & Ju-Pak, K.-H. (2000). Information Pollution? Newspaper Research Journal, 21, 65-77.

Cameron, G. T. (1994). Does Publicity Outperform Advertising? Journal of Public Relations Research, 14, 185-207.

Cameron, G. T., & Curtin, P. A. (1995). Tracing Sources of Information Pollution. Journal of Journalism and Mass Communication Quarterly, 72, 178-189.

Cook, G. (1992). The discourse of advertising. London: Routledge.

Dahlen, D., & Edenius, M. (2007). When is Advertising Advertising? Journal of Current Issues and Research in Advertising, 29, 33-42.

Diefenbach, D. L., & West, M. D. (2001). Violent Crime and Poisson Regression. Journal of Broadcasting & Electronic Media, 45, 432-45.

DiMaggio, A. (2009). Health Care, Media and the Case for Socialized Medicine. Counterpunch, 2, 1-2 .

Eckman, A. , & Lindlof, T. (2003). Negotiating the Grey Lines. Journalism Studies, 4, 65-77.

Erjavec, K. (2004). Beyond Advertising and Journalism. Discourse & Society, 15, 553-579.

Erjavec, K. (2005). Hybrid Public Relations News Discourse. European Journal of Communication, 20, 155-179.

Erjavec, K., & Poler Kovacic, M. (2010). Relations with the Media. Journalism, 11, 91-109.

European Parliament & Council of EU (2005). Directive 2005/29/EC of the European Parliament and of the Council of 11 May 2005 concerning unfair business-to-consumer commercial practices in the internal market and amending Council Directive 84/450/EEC, Directives 97/7/EC, 98/27/EC and 2002/65/EC of the European Parliament and of the Council and Regulation (EC) No 2006/2004 of the European Parliament and of the Council ('Unfair Commercial Practices Directive'), Official Journal of the European Union, 11 June 2005. Retrieved January 30, 2010, from http://www.berr.gov.uk /files/file27194.pdf.

European Parliament & Council of EU (2007). Directive 2007/65/EC amending Council Directive 89/552/EEC on the coordination of certain provisions laid down by law, regulation or administrative action in Member States concerning the pursuit of television broadcasting activities ('Audiovisual Media Services Directive'), Official Journal of the European Union, 18 December 2007. Retrieved January 30, 2010, from http://eurlex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L: 2007:332:0027:0045:EN:PDF.

Fairclough, N. (1995). Media Discourse. London: Edward Arnold.

Fowler, R. (1985). Power. In T. A. van Dijk (Ed.), Handbook of Discourse Analysis, vol. 4 (pp. 61-83). London: Academic Press.

Fowler, R., & Kress, G. (1979). Critical Linguistics. In R. Fowler, B. Hodge, G. Kress, & T. Trew (eds), Language and Control (pp. 185-213. London: Routledge and Keagen Paul.

Gibney, M. J., & Kearney, M. (1997). Introduction: IEFS pan-EU Survey of Consumer Attitudes to Food, Nutrition and the Health. European Journal of Clinical Nutrition, 51, 2.

Goodlad, N., Eadie, D., Kinnin H., & Raymond, M. (1997). Advertorial: Creative Solution or Last Resort? International Journal of Advertising, 16, 73-84.

Grasic, M. (2009). Seznanjenost pacientov s preprecevanjem nastanka osteoporoze. Maribor: FZV.

Greenberg, B. S., Eastin, M., Hofschire, L., Lachlan, K., & Brownell, K. D. (2003). Portrayals of Overweight and Obese Individuals on Commercial Television. American Journal of Public Health, 93, 1342-8.

Jamieson, P., Jamieson, K. H., & Romer, D. (2003). The Responsible Reporting of Suicide in Print Journalism. The American Behavioral Scientist, 46, 1643-60.

Jefkins, F. (1994). Advertising. London: Pitman Publishing.

Johnson, T. (1998). Shattuck Lecture-Medicine and the Media. New England Journal of Medicine, 332, 87-92.

Jurisic, J., Kanizaj, I., Jokos, I., & Janes, S., Juric, J. (2007). Manipulating Readers. Political Thought, 44, 117-135.

Kapus, V. (2004). Pravni vidiki oglasevanja s poudarkom na nelojalnem oglasevanju. Ljubljana: Faculty of Economics.

Kim, B.-H., Pasadeos, Y., & Barban, A. (2001). On the Deceptive Effectiveness of Labeled and Unlabeled Advertorial Formats. Mass Communication & Society, 4, 265-281.

Kim, M., & Lennon, S. J. (2006). Content Analysis of Diet Advertisements. Clothing and Textiles Research Journal, 24, 345-362.

Kosir, M. (2003). Surovi cas medijev. Ljubljana: FDV.

Kreps, G. L. (1990). Applied Health Communication Research. In D. O'Hair & G. L. Kreps (eds), Applied Communication Theory and Research (pp. 271-296). Hillsdale: Lawrence Erlbaum Associated, Inc.

Lepre, C. R., Walsh-Childers, K., & Chance, J. C. (2003). Newspaper Coverage Portrays Managed Care Negatively. Newspaper Research Journal, 24, 6-21.

MacLeod, C. (2008). Global Economy and Adspend Prospects. International Journal of Advertising, 27, 929-931.

Malovic, S. (2003). Mediji i izbori. Politicka misao, 40, 43-50.

Martinez, R., Johnson-Robledo, I., Ulsh, H. M., & Chrisler, J. C. (2000). Singing "the Baby Blues". Women & Health, 30, 37-56.

McManus, J. H. (1994). Market-Driven Journalism: Let the Citizen Beware? Thousand Oaks: Sage.

Nahtigal, N. (2006) Pregled kadrovskih sprememb v slovenskih medijih. Media Watch, 25-26, 27-29.

Oseli, P. (2001). Prodajajo sampon v informativnih oddajah. Mediawatch, winter. Retrieved February 8, 2010, from http://mediawatch.mirovniinstitut.si/ bilten/seznam/10/reklama/index.html#17.

Petkovic, B., B. Hrvatin, S., Kucic, L. J., Jurancic, I., Prpic, M., & Kuhar, R. (2006). Media for Citizens. Ljubljana: Peace institute.

Picard, R. G. (2001). Effects of Recessions on Advertising Expenditures. The Journal of Media Economics, 14, 1-14.

Poler Kovacic, M. (2003). Preiskovalno novinarstvo, ustvarjanje skandalov in novinarska etika. Teorija in praksa, 40, 207-228.

Poler Kovacic, M. (2008). Journalism Ethics in Multinational Family: "When in the EU, Should One Do as the EU Journalists Do?" Journal of Mass Media Ethics, 23, 141-157.

Potter, B., Sheeshka, J., & Valaitis, R. (2000). Content Analysis of Infant Feeding Messages in a Canadian Women's Magazine, 1945 to 1995. Journal of Nutrition Education, 32, 196-203.

Rovsek, J. (2005). The Private and the Public in the Media. Ljubljana: Peace Institute.

Seale, C. (2002). Media & Health. London: Sage.

Setinsek, I., & Bozic Marolt, J. (2009). Kaj se dogaja z oglasevanjem v zacetku leta 2009: Svezi podatki in ugotovitve. Mediana, Institute for Marketing and Media Research, 22 April 2009. Retrieved January 30, 2010, from http://www.dmslo.si/media /fokusl.ibo2.pdf.

Shoebridge, A., & Steed, L. (1999). Discourse about Menopause in Selected Print Media. Australian and New Zealand Journal of Public Health, 23, 475-81.

Slovene Advertising Chamber (1999). Slovene Advertising Code. Retrieved February 8, 2010, from http://www.soz.si/uploads/files/slovenski_oglasevals ki_kodeks.pdf.

Slovene Parliament (2006). Mass Media Law. Retrieved February 7, 2010, from www.dz-rs.si.

Sparks, C. (2009). Popular Journalism. In H. Tumber (Ed.), Journalism: Critical Concepts in Media and Cultural Studies (pp. 237-287). London: Routledge.

Splichal, S. (1999). Ownership, Regulation and Socialisation: Rethinking the Principles of Democratic Media. Javnost/The Public, 6, 5-24.

Splichal, S. (2001). Imitative Revolution and the Media in East-Central Europe. Javnost/The Public, 8, 31-58.

Tanner, A. H. (2004). Communicating Health Information and Making the News. Public Relations Quarterly, Spring, 24-27.

Tirodkar, M. A., & Jain, A. (2003). Food Messages on African American Television Shows. American Journal of Public Health, 93, 439-41.

Traquina, N. (2004). Theory Consolidation in the Study of Journalism. Journalism, 5, 97-116.

Tuchman, G. (1978). Making News: A Study in the Construction of Reality. New York: Free Press.

Valicon (2010). National Readership Survey, 2010. Retrieved January 25, 2010, from http://www. nrb.info/podatki/index.html.

Van Dijk, T. A. (1988). News as Discourse. Hillsdale, NJ: Lawrence Erlbaum.

Van Dijk, T. A. (1991). Racism and the Press. London: Routledge.

Van Reijmersdal, E., Neijens, P., & Smith, E. (2005). Readers' Reactions to Mixtures of Advertising and Editorial Content in Magazines. Journal of Current Issues and Research in Advertising, 27, 39-53.

Walker, R. (1988). Applied Qualitative Research. Vermont: Gower.

Walsh-Childers, K., Chance, J., & Swain, K. A. (1999). Daily Newspaper Coverage of the Organization, Delivery and Financing of Health Care. Newspaper Research Journal, 20, 2-22.

Wang, Z., & Gantz, W. (2007). Health Content and Local Television News. Health Communication, 21, 213-221.

Wenger, L., Malone, R., & Bero, L. (2001). The Cigar Revival and the Popular Press. American Journal of Public Health, 91, 288-91.

Wernick, A. (1991). Promotional Culture. London: Sage.

Wilkins, H. A., & Ball-Rokeach, S. (2006). Reaching at Risk Group. Journalism, 7, 299-320.

Wragg, D. (1993). Targeting Media Relations. London: Kogan Page.

Zgonc, D. (2004). Moc znanja za zdravje. Viva, 123, 15-17.

Melita Poler Kovacic, University of Ljubljana

Zala Volcic, University of Queensland

Karmen Erjavec, University of Ljubljana

Correspondence to:

Dr. Melita Poler Kovacic

Department of Journalism

Faculty of Social Sciences

University of Ljubljana

Kardeljeva pl. 5, Ljubljana, Slovenia

Email: melita.poler-kovacic@fdv.uni-lj .si

Table 1. A typical unlabeled health-related
advertorial in a daily newspaper.

TEXT                                                   SCHEMATIC
                                                       STRUCTURE

[Name of the drug]: [Name of the pharmaceutical        Headline
company] offered a new efficient drug for treatment
of postmenopausal osteoporosis

Main text:

Every third woman, older than 50 years, and also       Situation:
every fifth man over 60 years old, get osteoporosis.   a problem
In the USA and in Europe, more than 30 million of
women are affected, while around 200 million of
women in the world suffer because of the mentioned
disease.

Osteoporosis is a disease of bone, caused by           Background
imbalance in body cycle of bone restructuring, which   information
leads to bone mineral density reduction. Timely        about the
treatment of osteoporosis enables a patient to have    disease
essentially more quality life, and it means lower
costs for the state. The lack of treatment of this
disease has the consequences of frequent bone
fractures, mostly hip, spinal vertebrae, and wrist
fractures. However, even after a successful healing
of broken bones, a joint can remain stiff, and
movement limited. Osteoporosis can also be very
unpleasant, as a patient having this disease can
become lower for even 25 centimeters. Among other
things, the patient's ribs can decrease, and a hump
can occur.

[Name of the pharmaceutical company] launched a new    Situation:
drug on the market--[name of the drug], which is a     offering a
big progress in osteoporosis treatment. Among other    solution
things it facilitates treatment of women with the
mentioned disease, especially those after the
menopause.

"Taking [name of the drug] once a week is              Verbal
therapeutically equal to daily treatment, which        reaction by
reduces risks of fractures, linked to osteoporosis,    doctor:
including hip and vertebrae fractures, to a high       praising the
degree. Among other things, the drug also helps at     solution
the bone mass growth", said dr. [Name of the doctor]   (the drug)
who presented results of a two year controlled
research.

The new drug [name of the drug] means a big progress   Comment
in osteoporosis treatment and thus makes the every-    (evaluation):
day life of osteoporosis patients easier.              praising
                                                       the drug

J. L.                                                  Reporter'
                                                       signature