There must be a template for this.
Time and time again, I have seen journalists cover so-called complementary and alternative medicine (CAM) in a way that is so similar, it鈥檚 making me think they must teach that template in journalism school.
It鈥檚 a story structure that sounds good at first. It aims to be balanced in giving voice to both patients and practitioners, as well as proponents and skeptics. It uses storytelling to grab the reader鈥檚 attention. All the ingredients are seemingly there to cover the topic responsibly.
I was recently interviewed by a CBC journalist on the topic of traditional Chinese medicine (which is nowhere near as traditional as its name implies), and in the process I ended up squeezed into that template. (Article聽, video聽.) And that鈥檚 a problem, not just for me but for anyone seeing a piece of media hoping to truly understand what the evidence says about the benefits of CAM.
Here's the template.
- The Protagonist.聽Open with a named patient who has an illness and is using the CAM intervention. Alternatively, open with a named practitioner and showcase their amazing clinic.
- The Believers.聽Quote well-regarded people who believe in this CAM intervention and who will make unverified claims to its benefits. They can also explain the pre-scientific belief system that underlies it, which the journalist can then repeat in a non-judgmental, anthropological way.
- The Researcher.聽Find a researcher who is willing to say that they don鈥檛 fully believe in this CAM but they鈥檙e interested in researching it because it might prove to work. Importantly, this researcher must act as if we have聽zero studies聽into this CAM and we鈥檙e starting fresh. The goal is research-oriented open-mindedness.聽
- The Token Skeptic.聽Open a paragraph with 鈥渂ut some are wary鈥� or 鈥渂ut not everyone agrees,鈥� and distill a 45-minute conversation with an evidence-based skeptic into a single paragraph.
- A Note of Hope.聽End the article by returning to The Protagonist and including a statement about the untapped and promising possibilities of this CAM intervention.
Once you understand this template, you will never read another health story the same way again. This skeleton will glow through the flesh of the article.
The template is a useful starting point for a reporter covering the closing of a local library or the construction of a controversial safe-injection site. But applied to interventions that can either be proven or disproven by science, it fails the reader. It shoehorns a scientific issue聽into a human-interest story. Imagine if journalists routinely did this for human behaviour.
鈥淗ealth Minister Carl Woondoggle decided on Monday to close down St. Barnaby鈥檚 Hospital after consulting with a Tarot card reader. The decision weighed heavily on his shoulders, but Mary Pluckstring, his personal astrologer and intuitive for the past 23 years, managed to boost his confidence. 鈥楬e鈥檚 always nervous before making a big decision,鈥� she told us from her kitchen office. 鈥楤ut he knows the answer lies in the cards.鈥�
鈥淭he International Tarot Divination Society has existed for 146 years. Its president, Nigel Wycombe III, told us it is very effective. 鈥楾arot has helped people with their divorce, with finances, and with toxic jobs. I鈥檓 surprised it hasn鈥檛 cured cancer yet!鈥�
聽鈥淒r. Margaret Pettigrew, a researcher who has published a couple of papers about the reliability of Tarot card divination, says we need to keep an open mind. 鈥極bviously, we need to study this with rigour, but my pilot study done in four volunteers shows a lot of promise.鈥�
鈥淏ut not everyone agrees. Jonathan Jarry, a science communicator with 不良研究所鈥檚 Office for Science and Society, has doubts about the claims made about Tarot. 鈥楬E USED TAROT CARDS TO CLOSE DOWN A HOSPITAL?? ARE YOU SERIOUS?鈥�
鈥淪till, Woondoggle says he had no choice. 鈥楾he three of pentacles brings bad luck and pestilence. At least it did in the 1400s. One can never be too careful.鈥� Some scientists may disagree with his system, but Woondoggle knows the proof is in the pudding. 鈥業 went into politics after Mary pulled the Fool card on me ten years ago. And I鈥檝e never looked back.鈥濃��
Yet, when health issues are on the line, this is exactly how most journalists treat unscientific interventions, as long as their marketing has brushed loose threads away to reveal a patina of legitimacy.
鈥淭raditional鈥� Chinese 鈥渕edicine鈥�
To be fair to journalists, unpacking what we know about traditional Chinese medicine (TCM) is more complicated than with, let鈥檚 say, homeopathy. With homeopathy, as soon as you mention its foundational principles鈥攖hat like cures like, that diluting strengthens a solution, and that water somehow remembers what it once held鈥攅yebrows arch up pretty quickly. But TCM, with its needles and herbs, appears more plausible.
I was even open-minded enough to try it many years ago, despite my skepticism.
As my acupuncturist, who knew I was a scientist, kept reminding me, 鈥淭here are scientific studies of acupuncture.鈥� Oh, well, in that case, I take back the skepticism. Studies, you say? So we did laser acupuncture (yes, that鈥檚 a thing), electroacupuncture, and dry-needling. And despite the plausibility that acupuncture needles cause the release of endorphins at the point of insertion, my pain did not decrease. When the acupuncturist suggested I should also take Chinese herbs (and there were studies there too!), a wise medical doctor whom I asked to check on my liver enzymes during the process sat down with me and questioned why I wanted to do something so foolish.
Traditional Chinese medicine is actually a grab-bag of prescientific practices based on all sorts of old beliefs that was put together by Mao Zedong during China鈥檚 Cultural Revolution in an attempt to have something that qualified as healthcare for everyone, a strategy that is now being used by the World Health Organization聽for the same reason. Chairman Mao himself famously revealed to his physician that聽. Before he came to power, acupuncture was even聽, as the country invested in medicine that was based in our scientific understanding of the human body.
The life force known as qi has never been shown to exist. It is incompatible with our modern understanding of biology, but it is the sort of supernatural concept that was common among communities the world over hundreds of years ago as they attempted to understand what life was. The meridians of TCM are聽, since ancient Chinese did not know what the body looked like on the inside but assumed it must be a reflection of nature. Sure, we have 鈥渞ivers鈥� like veins, nerves, and lymphatic vessels. But meridians? We still don鈥檛 see them when we look inside the body. And there are so many acupuncture points now, from聽, that it might be impossible to find an inch of skin that doesn鈥檛 contain several of them.
And ear acupuncture? It鈥檚 not even Chinese, but the bizarre idea of聽a French neurologist聽in the middle of the 20th聽century who thought the ear resembled an inverted fetus.
And those Chinese herbs? There are so many reports of people getting聽, they should come with a warning: 鈥淢ay result in liver and kidney injury.鈥� Yes, many of our pharmaceutical drugs are derived from plants, but plants are the beginning of the process, not the end. We must isolate the active ingredient, modify it as needed to make it safer and more effective, and dose it out in a consistent manner. Otherwise, we end up consuming varying mixtures of plant chemicals, some of which damage our body.
So why does acupuncture seem to work? In part because of a collection of effects that have nothing to do with acupuncture聽per se聽and which we call placebo effects. Symptoms peaking and naturally returning to their average value; our body healing itself as it normally would; our desire to perceive an improvement because of our investment of time and money into a new intervention; and the actual medication we are taking at the same time as the acupuncture we are undergoing. It also appears to work because virtually every clinical trial of acupuncture coming out of China聽, whereas trials performed elsewhere show much more disagreement. Strange.
I said all of those things to the reporter. I must have spent close to 45 minutes with her going over all of these points. But of course, this was never going to be a science story. It was a human-interest story all along.
I have great respect for journalists who must share complex information to the public on a sharp deadline and with ever-dwindling resources. But the templates they are taught in journalism school ultimately fail them if they apply them indiscriminately. They result in false balance: giving two sides equal weight when the evidence is not equally distributed.
To quote a favourite show of mine, 鈥淭here aren鈥檛 two sides to every story. Some stories have five sides, some only have one.鈥�
Our Canadian healthcare system is underfunded and bursting at the seams. The solution is not to add magical thinking to the mix. Dr. Ben Goldacre鈥檚 quote has been repeated聽ad nauseum, yet I must repeat it once more: 鈥淧roblems in aircraft design,鈥� he wrote, 鈥渄o not mean that magic carpets can actually fly.鈥�
Seeing it from this perspective, however, requires a different template than journalists are used to relying on.
