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’s making me think they must teach that template in journalism school.
It’s 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’s 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 here, video here.) And that’s 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. 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. 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. Find a researcher who is willing to say that they don’t fully believe in this CAM but they’re interested in researching it because it might prove to work. Importantly, this researcher must act as if we have zero studies into this CAM and we’re starting fresh. The goal is research-oriented open-mindedness.
- The Token Skeptic. Open a paragraph with “but some are wary” or “but not everyone agrees,” and distill a 45-minute conversation with an evidence-based skeptic into a single paragraph.
- A Note of Hope. 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 into a human-interest story. Imagine if journalists routinely did this for human behaviour.
“Health Minister Carl Woondoggle decided on Monday to close down St. Barnaby’s 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. ‘He’s always nervous before making a big decision,’ she told us from her kitchen office. ‘But he knows the answer lies in the cards.’
“The International Tarot Divination Society has existed for 146 years. Its president, Nigel Wycombe III, told us it is very effective. ‘Tarot has helped people with their divorce, with finances, and with toxic jobs. I’m surprised it hasn’t cured cancer yet!’
“Dr. 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. ‘Obviously, we need to study this with rigour, but my pilot study done in four volunteers shows a lot of promise.’
“But not everyone agrees. Jonathan Jarry, a science communicator with McGill University’s Office for Science and Society, has doubts about the claims made about Tarot. ‘HE USED TAROT CARDS TO CLOSE DOWN A HOSPITAL?? ARE YOU SERIOUS?’
“Still, Woondoggle says he had no choice. ‘The three of pentacles brings bad luck and pestilence. At least it did in the 1400s. One can never be too careful.’ Some scientists may disagree with his system, but Woondoggle knows the proof is in the pudding. ‘I went into politics after Mary pulled the Fool card on me ten years ago. And I’ve never looked back.””
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.
“Traditional” Chinese “medicine”
To be fair to journalists, unpacking what we know about traditional Chinese medicine (TCM) is more complicated than with, let’s say, homeopathy. With homeopathy, as soon as you mention its foundational principles—that like cures like, that diluting strengthens a solution, and that water somehow remembers what it once held—eyebrows 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, “There are scientific studies of acupuncture.” Oh, well, in that case, I take back the skepticism. Studies, you say? So we did laser acupuncture (yes, that’s 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’s 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 for the same reason. Chairman Mao himself famously revealed to his physician that he did not believe in it. Before he came to power, acupuncture was even banned in China, 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 probably modelled after rivers, 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 “rivers” like veins, nerves, and lymphatic vessels. But meridians? We still don’t see them when we look inside the body. And there are so many acupuncture points now, from different schools of thought, that it might be impossible to find an inch of skin that doesn’t contain several of them.
And ear acupuncture? It’s not even Chinese, but the bizarre idea of a French neurologist in the middle of the 20th century who thought the ear resembled an inverted fetus.
And those Chinese herbs? There are so many reports of people getting seriously injured consuming them, they should come with a warning: “May result in liver and kidney injury.” 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 per se 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 says it works, 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, “There aren’t two sides to every story. Some stories have five sides, some only have one.”
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’s quote has been repeated ad nauseum, yet I must repeat it once more: “Problems in aircraft design,” he wrote, “do not mean that magic carpets can actually fly.”
Seeing it from this perspective, however, requires a different template than journalists are used to relying on.
