City Research Online City, University of London Institutional Repository Citation: Rowlands, Barbara Ann (2015). The Emperor's New Clothes: Media Representations Of Complementary and Alternative Medicine: 1990-2005. (Unpublished Doctoral thesis, City University London) This is the accepted version of the paper. This version of the publication may differ from the final published version. Permanent repository link: https://openaccess.city.ac.uk/id/eprint/13706/ Link to published version: Copyright: City Research Online aims to make research outputs of City, University of London available to a wider audience. Copyright and Moral Rights remain with the author(s) and/or copyright holders. URLs from City Research Online may be freely distributed and linked to. Reuse: Copies of full items can be used for personal research or study, educational, or not-for-profit purposes without prior permission or charge. Provided that the authors, title and full bibliographic details are credited, a hyperlink and/or URL is given for the original metadata page and the content is not changed in any way. City Research Online: http://openaccess.city.ac.uk/ [email protected] The Emperor’s New Clothes: Media Representations of Complementary and Alternative Medicine: 1990-2005 BARBARA ANN ROWLANDS A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy by prior publication Department of Journalism City University London May 2015 VOLUME I: DISSERTATION CONTENTS Acknowledgements 4 Declaration 5 Abstract 6 Chapter 1: Introduction and summary 7 Research challenges 11 Chapter 2: CAM: The Media’s Darling 15 Medicine in the Dock 16 The Health-Conscious Consumer Hero 18 Women and CAM 19 Chapter 3: Literature Review: Media Coverage of CAM 22 Sourcing and Accuracy 24 Anecdotal Evidence 30 The Coverage of CAM in Magazines 33 Chapter 4: Covering CAM: a critical appraisal 36 Sourcing “general” CAM 41 Pinning down Acupuncture 42 Mediating Meditation 43 Detoxifying Traditional Chinese Medicine 45 Sourcing Supplements 47 Chapter 5: How my journalism in CAM relates to scholarship in sourcing 51 Secondary Sources 51 Primary Sources 54 The Search for Credible Sources 56 The Power of the Case History 59 PowerPoints, Press Releases and Press Trips: a PR case study 62 Chapter 6: The Framing of CAM 68 Re-visiting Framing Theory 68 2 Narrative Structures: Telling the Story of CAM 70 Creating CAM Frames 72 The Three Fallacies Frame: Natural, Traditional, Safe 72 The Blame Game Frame: Holism and the Myth of Total Health 74 The Baby Boomers’ Frame: Boutique Religion 75 CAM’s Counter Frame 77 What Editors Wanted 79 How the Reporting of CAM differed from that of Mainstream Medicine 80 Chapter 7: Savvy or Suckers? Why CAM works 82 CAM and the Will to Believe 83 Chapter 8: Conclusion Editors and Evidence: from hero to zero 87 Why coverage of CAM matters 90 References 93 Appendices List of Publications 105 Documentation From Which? Books 107 Details of Bioforce press trip 111 3 Acknowledgements I would like to thank Professor Ivor Gaber for his invaluable guidance, comments and support during the writing of this dissertation, Professor Chris French for the full run of his extensive library and Dr Dick Middleton, Jane Symons and Victoria Lambert for their candid remarks and observations. Barbara Rowlands 4 Declaration I grant powers of discretion to the University Librarian to allow this thesis to be copied in whole or in part without further reference to me. This permission covers only single copies made for study purposes, subject to normal conditions of acknowledgement. 5 Abstract The purpose of this dissertation is to reflect on the author’s published work in the field complementary and alternative medicine, specifically that produced between 1996 and 2005. It examines how the production of this work was influenced by the author’s previous and concurrent experience as a medical journalist and the methodological challenges arising from sourcing complementary and alternative medicine and framing it for audiences of broadsheet newspapers and two books – The Which? Guide to Complementary Medicine and Alternative Answers to Asthma & Allergies. It explores how this work relates to scholarship in three key areas: the theory of sourcing, the theory of framing and the study of erroneous beliefs. The author demonstrates that a “perfect storm” – sociologically, culturally and economically – created a narrative that suited the new consumer-driven cult of the empowered individual, which in turn led to most sectors of the print media becoming impervious to any real investigation of the subject. 6 Chapter 1: Introduction This dissertation is based on my work as a health journalist over 25 years and specifically my journalism in the field of complementary and alternative medicine. I wrote on this subject for specialist and consumer magazines and national newspapers and was the author of three health books aimed at a lay audience. In this reflective analysis, I will outline, explore and discuss how I conducted my journalism in this field, with specific reference to The Which? Guide to Complementary Medicine and Alternative Answers to Asthma & Allergies and to my articles, mainly for the Daily Telegraph and The Express, but I will refer to others, published elsewhere. So as not to repeat the full title of The Which? Guide to Complementary Medicine, I shall abbreviate it to The Which? Guide. I shall use the initials CAM throughout to describe complementary and alternative medicine. It is not a description with which I agree, as describing this disparate group of therapies as “medicine” conveys a credibility most of them do not deserve. However, CAM is commonly used in academic literature, though some researchers use CTs (complementary therapies) or CATs (complementary and alternative therapies). Medicine is described by a variety of adjectives – Western, orthodox, conventional, mainstream, allopathic and biomedicine. To avoid a proliferation of terminology, I shall use the terms “mainstream” and “biomedicine”. I will examine the reasons for the popularity of CAM, a popularity that was eagerly picked up by commissioning editors and book publishers. Through a powerful combination of personal anecdotes, increased consumerism and traditional news values, most sectors of the print media proved to be not only impervious to any real investigation (and therefore criticism) of CAM, but resistant to it. Some still are. The dissertation explores how my published work relates to the academic literature in three key areas: the theory of sourcing, the theory of framing and the study of erroneous beliefs – why people believe things for which there is no evidence. Woven through this will be an examination of how science journalists conduct their work. It is not my aim to examine whether or not CAM “works” or has potential risks, though this was the focus of my journalism. Instead, I shall look at the academic literature examining media coverage of CAM and investigate how journalists, including myself, operated in this field at a specific time in history. Is there any neat definition that can scoop all these diverse therapies into a single rubric? The British Medical Association (BMA) defined CAM as “forms of treatment which are not widely used by orthodox health-care professions, and the skills of which are not 7 taught as part of the undergraduate curriculum of orthodox medical and paramedical health-care courses” (1993: 7-8). Eisenberg and colleagues define CAM as “medical interventions as not taught widely in US medical schools or generally available in US hospitals” (1993: 246). Both definitions are problematic as some therapies are now offered in hospitals and taught in medical schools, as Coulter and Willis (2007) note. Moreover, defining something by what it is not is not particularly helpful at defining what it actually is. Coulter and Willis argue that what links therapies as disparate as reflexology and chiropractic is what they term “vitalism” – a natural force that CAM practitioners believe exists within all living organisms, one “that is both different from, and greater than, physical and chemical forces” (216). This implies some sort of natural order, whereby the CAM practitioner merely facilitates the body’s own healing powers. This neatly scoops up all CAM modalities under one umbrella and contrasts them with mainstream medicine, where disease is explained (largely) in terms of biology. A further definition is provided by Edzard Ernst. Ernst, now emeritus professor at the University of Exeter, was the UK’s only professor of complementary and alternative medicine and a prolific researcher into the efficacy of CAM and its associated risks. Ernst and colleagues define CAM as the “diagnosis, treatment and/or prevention which complements mainstream medicine by contributing to a common whole, satisfying a demand not met by orthodoxy, or diversifying the conceptual framework of medicine” (Ernst, Pittler and Wider, 1993: 2). These last two definitions I find the most useful. Ernst noted in 2008 that there were around 42 million websites bombarding the public with information about CAM and numerous studies have shown how unreliable and misleading such information often is. Despite a plethora of information, 77% of patients feel “insufficiently informed about CAM” (Ernst, 2008). When I wrote The Which? Guide, CAM was booming – and yet the public was even less informed. It was my job, and those of other journalists in the field, to provide them with