Ever get the feeling that complementary medicine is a target in the media? Have you been frustrated by the ways media have extrapolated and bastardised evidence to reflect CAM in a negative light?
Today we're joined by sociologist Dr Monique Lewis who takes us through her eye-opening research into how and why the media frames unflattering narratives about complementary and alternative medicine (CAM). Monique shares her research findings and what she uncovered as key drivers and influencers, as well as her insights into how professionals, researchers and industry could do more to press for more balanced views in media.
Covered in this episode
[00:43] Welcoming Dr Monique Lewis
[01:50] Monique's research: Why is CAM a media target?
[05:52] The findings of Monique’s research
[08:53] Comparisons of framing
[16:34] The construction and evolution of the news
[19:26] CAM portrayals in the media
[23:58] Risk in the CAM industry
[30:34] Increasing health and media literacy
[32:04] Closing remarks
Andrew: This is FX Medicine. I'm Andrew Whitfield-Cook. Joining us on the line today is Monique Lewis, who is a sociologist and lecturer in media and communication at Griffith University in Queensland, Australia. Her research spans across media, health and medicine, and risk sociologies, with a particular interest in herbal medicine, complementary and alternative medicine (CAM), and medicinal cannabis.
Her investigations have focused on news and biomedical media representations of herbal medicine and CAM, as well as exploring how risk is constructed in these representations by a range of different interest groups. Her more recent research has investigated the delegitimisation of CAM in news media stories, as well as analysing articles on medicinal cannabis in biomedical professional journals.
Welcome to FX Medicine, Monique. How are you?
Monique: Thanks, Andrew. It's really good to be here. I'm quite honoured.
Andrew: I should have said Dr Monique Lewis, because you have a PhD.
Monique: I do. That's right. Thank you for that.
Monique: So, back some years, starting my PhD research, I was looking at how herbal medicine was represented in news media, as well as biomedical media. And this actually came in the wake of the Pan Pharmaceuticals crisis, let's say.
Monique: So, you know, Australia's largest recall ever, I think, of medicine.
Monique: I think it still is the largest recall. So the complementary medicine industry suffered quite phenomenally. And we saw some interesting and valuable leadership from some of the leading industry organisations that weren't as badly affected. I think Blackmores was one of those.
And I wanted to just have a look at what was happening in the news landscape, the mediascape, if you like, as well as some of the biomedical...the "Medical Journal of Australia." I wanted to look at how herbal medicine was being framed in these stories.
So with the… when I say framing, I'm talking about the kind of angle, what is made most salient in the overall story, and that comes from a whole line of communication researchers and Robert Entman is a really important communication scholar that does frame analysis.
So that was where I kind of...that was my starting point with herbal medicine. And I found quite a very high rate of references to risk. At the same time in the study, there were a surprising number of references, too, efficacy as well across these news stories. So I stuck with news stories, not some lifestyle list-outs or anything like that.
So, then we had, later on in the 2000s and 2011, a lobby group started up which consisted of a group of doctors and scientists, and other just lay people can be members of this particular lobby group as well. They're called the Friends of Science in Medicine. And their agenda at the time was to try and rid universities of complementary medicine courses. So their concern that they articulated was that it wasn’t scientifically credible, thus had no place in the university system.
So of course, I was involved in a university environment. I would think I was close to submitting my PhD at the time, or had already submitted it, so I was sort of watching it with interest, what was going on and how universities were reacting to this. And, over time, you know… so I did observe the studies over time, and I guess it was one of those things that bugged me a bit and I thought, "I just want to put this under the microscope a little more carefully and see...and just map this out, and see what's really happening. So, what are the most predominant frames across these news stories that mention Friends of Science in Medicine? Are they all negative? You know, what sort of...?"
So I measured the tone. I had a whole list of different frames that were most prevalent. And looking at those frames, I drew on earlier research that I'd undertaken, as well as some research of others. So people like a naturopath called Jeff Flatt and a sociologist called Caragh Brosnan had written articles about the Friends of Science in Medicine as well.
Monique: Right. So, between 2011 and 2017...so I'll just clarify that I was only looking at articles referring to Friends of Science in Medicine. I found 76 articles that met the inclusion criteria. And what I found in terms of tone overall, with headline and article tone, was that there was 68% rate of negativity and a 23% rate of neutrality, and only 9%, so 7 articles carried a positive tone.
And then the general tone towards complementary medicine was, there were 42 articles that were quite negative towards complementary medicine, 21 articles that had a mixed tone, 8 articles neutral, 3 articles positive. Now, it’s probably dull, me talking about it to listeners, but I can give you access to my paper if people want to sort of look at the data more carefully.
So that's regarding the intonation, but, you know, I also wanted to talk about, or to look at the frames. What were some of the most common frames that came out of this study?
Andrew: What interests me there though, is you're talking about the frame, how it is intonated, or inferred, if you like, but there was 23% that were neutral.
Monique: So that was me… So I measured the tone and frames separately.
Monique: So the framing was, you know, a description of what the overall frame towards the issue was going to be. So it might've been that CAM is illegitimate, or CAM is legitimate. Or that the evidence for CAM is good or that it is poor, but about regulation of the profession. So that's what I mean by frames. But I deliberately measured tone separately, because I just wanted to get a feel for that, you know, across all the articles, what the general tone was in relation to complementary medicine.
Andrew: Got you. And was it complementary medicine in general across the board or were there particular pockets or professions that were singled out, like herbal medicine practitioners, nutritional practitioners, naturopaths?
Monique: Yeah. So that's a good point. So, I was looking across the board. So I did divide it into supplements, or herbal medicines. I looked at chiropractic, naturopaths as well. But the overall search sort of factored in all of those elements.
Andrew: Got you.
Monique: Now I’ll give you the most common frame that came out of this study. So the most common frame referred to complementary medicine as being part of a lucrative or unethical industry. So it's something like 32 articles. And it highlighted the concerns about the CAM industry as being led by profit-driven companies and unethical conduct. As well, this also came into play over this period, the university industry research collaborations, and the risk that this posed about bias towards positive findings that favour the industry's agenda.
So that was quite an interesting finding, I thought. Because that was included, that as a frame, was included in my earliest study, the 2011 study, and that really came up, that idea of lucrative, unethical industry. And actually in a more recent look at how cannabis is being reported in biomedical publications in Australia, again that's something that isn't coming up very much.
Andrew: Right. And yet when we look at drugs, or pharmaceutical drugs, wasn't there an exposé done on pharmaceuticals looking at the mark-up of drugs compared to the actual molecule of them?
Andrew: So some of these drugs, for instance, some of the biologicals, the monoclonal antibodies, for instance, some of them cost thousands of dollars for three vials. Three injections. I guess the issue that I have is inequity. It's like if you're going to say, okay, look, have an opinion, I get it, but compare it to something.
Monique: Yes. And what you were referring to there, also, is what became known, I think starting in the '70s and through the '80s, as the medical industrial complex. So that connection, affiliation between medicine in terms of the practice between the pharmaceutical industry and commercial interest of this overall machine.
But what I observed in this study was...and here's a quote from one of the Friends of Science in Medicine spokespeople in relation to one of the university collaborations with industry, "There would be pressure on researchers with $15 million at stake. We wouldn't really want to produce negative results."
Now, rather than this coming across as an admission of what might go on when biomedical research and the pharmaceutical industry consort, which is where you would think...this happens in the biomedical, pharmaceutical, or medical industrial complex. This is a key problem. But rather than it coming across in that way, the reasoning being put forward is that this is kind of a new CAM industrial complex.
Andrew: Even today, I was reading a story regarding NPS MedicineWise in Australia, which is supposed to be an authoritative research devoid of commercial interest. And we find out that there is a sort of arm of MedicineWise which has indeed been commercial. What's happened though, that arm is now closing down and the things that were of commercial nature are supposedly being handled in-house i.e. one thing. So does that not taint one of our most honoured unbiased resources with regards to pharmaceutical medicines?
Monique: Indeed. It's a really, really valid point there, Andrew.
Andrew: So it's like what goes around comes around. If it's going to be done, let's look at it all.
Monique: And it's socially valuable to look at this because it ties into the whole neo-liberalisation of healthcare more broadly, that we're seeing. Where we're all becoming...kind of, we're having to self-regulate and be self-disciplined, good citizens. It's part of our moral obligation and duty to look after our health. And, of course, governments benefit from that.
Monique: Because, you know, it means a more preventative approach which, you know, it saves money across the health sector in the long run. Certainly saves the government a lot of money.
So, yeah, it is an inequity, and it irks me because it's also not very intellectually rigorous, besides.
Monique: And it reduces what's going on with this particular group. It just highlights, I suppose, that it's an ideological movement, and there's a lot of political motivation there…
Monique: …rather than what you would hope would be a more genuine concern. And I'm not saying that the group members are, you know, just self-interested. I believe they actually feel that they're doing the right thing, but probably lack a bit of reflection on the biases that are influencing their whole approach.
Monique: Now, there was another frame that came up a lot as well, after the lucrative industry one, and that was the illegitimacy of complementary medicine.
Monique: So it conveyed CAM as illegitimate, pseudoscientific, quackery, nonsense. So, of course, articles with that sort of frame had negative headlines and tone. And they tended to relate to stories that had framings suggesting that CAM shouldn't be taught in university programs, or the state shouldn't support it in the healthcare system.
And in terms of the primary sources that are found in these articles… I mean, it's, you know, across the board, the FSM was the primary voice. Followed by industry, actually, industry representatives from the complementary medicine industry for balance.
Andrew: Right. But not professionals?
Monique: Fewer professionals. So, firstly we had, the most prominent forces were Friends of Science in Medicine spokespeople. So it was 41 out of the 76 articles. Then we had people from professional CAM bodies. So that was 20 articles. And then we had university, but from biomedical side, so there was 18 of those. Followed by a spokesperson from a professional biomedical body.
University management came up quite a bit because of that attack on the university system, so vice chancellors were having to sort of justify themselves across these stories. But complementary medicine researchers from universities were hardly ever quoted.
Andrew: It's interesting, isn't it? Was there any reference in these articles about the historical pharmacy subject, or elective now, called pharmacognosy, which, of course, where pharmacy began?
Monique: No. I didn't come across any references to that at all...
Monique: ...in the articles. Yeah. And to me, it is really problematic that… I mean, I probably should've started with this, but in the whole media landscape… you know, I'm looking at, as a communications scholar, I'm looking at news as something that's constructed over time.
Monique: And I mortified a journalist the other day in a lecture because I referred to that construction process and she was offended, but I thought that she was someone that would construct news. But I explained to her, "It's not that you're there fabricating it or making it up, it's just there's a lot of forces there influencing how a news story evolves."
So it's not just about the journalists, it's about their media organisation. The news outlets’ values itself, but there's also the idea of news values, how the news value that a journalist carries when...you know, what makes a story interesting. And I think Friends of Science in Medicine have been fairly good at exploiting the “conflict negativity” angle. And that, of course, appeals. Plus that idea of consonance, something that journalists might take up because, you know, it's a common knowledge...not knowledge, but a common understanding that, you know, that link between CAM and medical hucksters or quackery.
Monique: It's become a popular narrative that gets...it's kind of become the default position.
And, of course, as we know that...and, you know, listening to your podcast, you know, there's a lot of scientific content on some really good research that's being undertaken. It just, it ignores all of that.
Andrew: My issue is when you'll get orthodox health professionals decrying the quackery of, let's say, herbal medicine, and yet they have been purveyors of herbal medicine for decades.
Monique: Yeah. And arguably what we're seeing in the media landscape with medicinal cannabis is certainly not a delegitimisation. So I've looked across some biomedical journals in Australia, and that is not what we're seeing. It is, you know, overwhelmingly being reported on in these publications. Like, you know, in "Medical Journal of Australia" Australian doctor as a legitimate medicine with a role to play in the Australian healthcare system.
Monique: It does look at…well lucrative industry is hardly looked at at all, that idea of...which is also interesting because you've got some, you know, clinics opening up that might be providing products, supplying the products that get sold to the patients, which, you know, is arguably problematic and needs to be scrutinised and overseen.
Andrew: Yes. One of my issues is a knowledge deficit of a practitioner outside of their realm of expertise. So, for instance, we've recently seen a paper come up about glucosamine, the side effects. And yet the interesting thing that I picked out from that was the date range that was chosen was 2000 to 2011. Well, we're in 2020. There's, you know, eight years of data there that was excluded. Why? It didn't take long for me to find that. I just went, "Date range."
Monique: So where's the scientific rigour?
Andrew: So, where's the rigour? Like, my question is...it then create questions of doubt in my mind of agenda. Whereas I did the same search for the date range with ibuprofen, and there was far more side effects, far more deaths. So, again, there's that inequity.
We're speaking about cannabis, and there was a recent paper very smartly titled, "Cannabinoids Fail with Pain." Now, the inference is cannabis. The actual truth of the article was not on cannabis in its complexity. It was on the drug-isolated cannabinoid product. So, in reality, the failure was on that product, not on cannabis in its entirety. But it was conveniently omitted.
Monique: It is potentially a lot riskier for journalists to come down on a pharmaceutical product.
Monique: There’s a lot less scrutiny of the journalist over, you know, a negative CAM story.
Monique: And they perhaps feel less likely that, you know, there's going to be any sort of repercussion. And I actually think that the CAM industry has become a little bit quiet in a number of ways with this sort of thing.
Monique: And I did speak at... Complementary Medicines Australia invited me to speak at one of their events last year, the annual conference. And there's been this, you know, senior spokespeople from industry and senior researchers who have become media-shy and really reluctant to be interviewed. And this is, you know, perhaps due to some really negative experiences that they might've had in the past with being interviewed, because they feel that it's a done deal. They know how the frame is going to end up, so they've perhaps learnt to just not go there.
Monique: That’s sort of some of the steps, some of the feedback I've had from industry people. The SBS did an insight...their "Insight" program, I think it was earlier last year, and it was featuring, or the topic was “Supplements Industry.”
Monique: So they had a number of consumers on the program talking about it. They had a representative from Friends of Science in Medicine, they had a TGA representative. And something I said at this Complementary Medicines Association conference was, you know, Blackmores were there. And I really noticed that because there were these two people from Blackmores. And my point was, “Where were you all? Where were the rest of you at this event, this ‘Insight’ discussion?”
Monique: And, you know, it was quite an important thing probably to have a presence...and Blackmores were actually thanked by the host at the end of the show for being the only company that accepted the invitation to attend.
Andrew: Okay. So they were invited?
Monique: So there's a bit of bravery required there from industry, and I think that includes speaking out when… not just promoting things when they're good, but also speaking out when you might see some unethical activity that is associated with the complementary medicine industry.
Andrew: Yes. Absolutely.
Monique: I think that's important as well. But I understand why people have become really reticent. But it ties in with communication ethics.
Andrew: Okay. So, I guess the first thing is, what is the real risk of natural medicines in their entirety in Australia? And the second thing, or the second part is, what does all of this mean for people working in the complementary arena, the complementary medicine professions?
Monique: Well, probably in terms of the risk side of things, and in terms of understanding what the real risk is, that's a big one. Part of the problem, I guess, in considering that is that we don't fall into the trap of...we tend to just...this umbrella term of complementary medicine can be a little problematic...
Andrew: Yes. Absolutely.
Monique: ...because a group like Friends of Science in Medicine will say that this includes, you know, you're in therapy. They’ll align you're in therapy with something and they’ll speak about that in the same breath as herbal medicine.
Monique: So that's really, really problematic, too.
Monique: And each profession and each...the products might carry their own risks, and some will be higher than others. And by the way, a risk… references to risk don't necessarily negate a product.
I mean, in the medicinal cannabis study, there's quite a lot of references to you know, the safety issues are a little bit unknown, and we need to make sure. But that's not negating the product itself. And I did find that in my study from 2011 on herbal medicine, is that despite that high level of reference to risk there's also quite a substantial reference to efficacy, and acknowledgement of herbal medicine's efficacy…
Andrew: Well that’s right.
Monique: Rather than the delegitimisation framings and the unethical industry framings that we're seeing in these Friends of Science in Medicine stories.
Monique: It's true. Yeah. A limitation of this study, too, is that it's only looking at these FSM stories. It's not looking more broadly. What would be valuable is to look more broadly at least, whether their work is impacted more broadly on complementary medicine and how complementary medicine is being represented in news stories.
Andrew: Yes. But, also there is a real need for people who actually know about what they're talking about to do the research. For instance, when you talk about probiotics for antibiotic-associated diarrhoea, a probiotic is not paracetamol. A probiotic is hundreds, if not thousands of organisms, only 14 of which are licensed for use in Australia. But what happens is when you do a meta-analysis of all of the different studies, looking at all of the different probiotics of all of the different genuses and species, and you lump it all into one meta-analysis, it comes up with...no, it doesn't work. Well, that's not really knowledgeable, is it?
Andrew: Because you really need to look at...okay, you really have to look at species, the particular characteristics of that organism, and what that really does in the end for humans. So, you know, again, like I worry, am I being, you know, suspicious here, oversuspicious, or is there a real, you know, agenda going on?
Monique: Well, from a media perspective, so we're looking at the news media landscape here, this sort of depth and level of analysis is often very unappealing in a news reporting context, because there's a lot that has to be fleshed out. And that includes when there's debates and arguments about, you know, the findings of a systematic review or meta-analysis, for example.
It's not something that many journalists...well, often they don't know how to navigate or even comprehend the sort of language that's applied in those sorts of studies. So it is, as a starting point that is a huge problem. And it's messy, it's too messy to be able to nail it in a quick news piece.
Andrew: Yeah. Just a last point on that sort of inequity topic. You know, we've mentioned a recent piece on glucosamine looking at hypersensitivity reactions, and yet when you look at other research in this, it shows very, very few, at least severe reactions. Now, these were reported, but then there's a lot of data that's missing out of these reports on what's called the DAEN in Australia, the Database of Adverse Event Notification, which anybody can search.
What I find strange is that this glucosamine hypersensitivity story was quickly taken up by the newspapers. What I find strange is that just the other day, a story broke regarding macrolide antibiotic birth defects. Now, this was reported in the "British Medical Journal." It's a very honourable journal. It was picked up by the "New York Times" and a few papers overseas. There was zero news articles in Australia.
Monique: There was, I think the ABC may have picked it up.
Monique: Because you had mentioned that to me, and I did a little quick fact-y research to see what's going on with this stuff? And what I found was there were only...so this is quite extraordinary from a finding like that, because I would have thought it's quite important for pregnant women to be aware of this health information.
Monique: So the uptake, you know, even though a number of news outlets took it up, it wasn't on the sort of scale that one might expect. And it was something…I think I found, I think the total was 38 articles. And this is around the world. That would have probably included that "BMJ" article. I did it really quickly before the interview, but I just wanted to get a feel for it. And then I just put in “chondroitin and risk”, and I had a hundred for the same period of time.
Andrew: So, what do we need to do as practitioners to, A, educate ourselves, but also to be able to have a louder voice to educate our patients and the general public in what's really going on with complementary medicine, and indeed what the real risks and benefits are?
Monique: Well, one thing I'll say first up is that I think these particular stories are not necessarily appealing or going to influence patients and consumers. And I don't think they're designed to. You know, my theory is they're designed to gain the attention of the policymakers.
Monique: Yes. I mean, for me, any of the media research I undertake, my main concern is that it will offer some value for all of us developing a better critical media literacy.
Now, health literacy is obviously part of this as well, and I don't think we have time to go into the health literacy side of things today. But, you know, from a perspective of understanding how mediation, how framing, how certain rhetoric can influence our uptake of certain health behaviours, I think in the end that is ultimately a really valuable thing.
Andrew: There's so much to uncover here, and it needs a sleuth like yourself to uncover it. Dr Monique Lewis, thank you so much for taking us through. This is a very messy topic, I've got to say, but thank you for taking us through it today on FX Medicine.
Monique: Thanks, Andrew. Lovely to talk with you all. Thanks.
Andrew: This is FX Medicine. I'm Andrew Whitfield-Cook.