Needles, herbs, and deep introspection: not just flotsam from the 1960s, but tools of alternative medicine. The host of therapies collected under that monolithic term are seen everywhere in the media. All of this herb, acupuncture, and Andrew Weil-selling hype makes you wonder where to turn for good, balanced information. Especially when much of the media coverage sounds like a PR flak attack.

Hugh Downs proclaims St. John's wort is a "truly startling medical breakthrough." Utne Reader shows itself to be the "best of the alternative [medicine] media" by describing elderberry as "magic" against influenza [1]. At least they report their source: some guy in Germany who owns an elberberry extract company. Oh, they also provide an 800 number for easy access.

Anecdotal, yes. How about something more rigorous? Newspapers seemed like a good place to look. People still use newspapers for health information [2], and the big papers usually maintain a reputation for balance. So my colleagues [3] and I chose five U.S. and four English-language overseas papers, then systematically sampled 259 alternative medicine articles published from 1992-1997.

We found coverage to be overwhelmingly favorable. Fifty-eight percent of the articles included positive portrayals of alternative medicine. Many of these stories featured patient recoveries, clinical evidence supporting alternative medicine or statements that alternative medicine was going mainstream. By contrast, approximately 20 percent of the articles cast aspersions on alternative medicine, by portraying it as quackery or reporting ill side effects.

These results are curious. Conventional medicine sources, such as medical journals and doctors, were quoted more than twice as often as alternative medicine sources, such as recovered patients and alternative medicine practitioners. Perhaps the positive coverage stems from the journalists, who may pick predominantly alternative-friendly sources. Or perhaps from a movement building within the medical establishment that supports an "integrated medicine," featuring the best of conventional and alternative medicine. In any case, medical journalists are in a tough spot. Alternative medicine is a hot topic, but with only a trickle of clinical evidence evaluating claims is difficult or impossible.

"I am very cautious when writing about alternative medicine," says Donna Alvarado, who spent twelve years as the medical writer at The San Jose Mercury News and holds a biology degree. "I think there is some value in some of the therapies. There's an awful lot of less worthwhile stuff mixed in. So I'm really careful about what I write about."

Judy Foreman, who writes a weekly personal health column at The Boston Globe, puts it more bluntly: "The quality of research with the alternative stuff is generally shitty."

Nevertheless, she finds herself regularly spotlighting therapies like ginseng, homeopathy, and acupuncture. Foreman says she covers these therapies because people are interested. She appears to be right: A widely cited New England Journal of Medicine study found a full third of U.S. adults say they use some kind of alternative medicine [4].

"There are still a lot of things we don't know how to do. Or cure. Or treat. So people are always searching for something," says Alvarado. "If mainstream medicine can't help them, people will search for some alternative." Another reporter agrees: "Conventional medicine is unsuccessful some of the time. I think the interest in alternative medicine is a reaction to that."

These reporters are just a few of the dozen or so who regularly write about the topic for big city dailies. Many other reporters cover alternative medicine for magazines and broadcast. But all seem to have trouble balancing sources. On one side, many conventionally trained doctors automatically discount anything without large numbers of double-blind studies behind it. On the other, many alternative medicine sources look suspect because they are selling their treatments. "I end up going on anecdotes, then quoting debunkers on the other side," says one reporter. Many articles fit that pattern.

Foreman tries another approach. She says the key is cultivating sources who have the right mixture of skepticism and open-mindedness. By relying on a few conventionally-trained M.D.s who have some sympathy toward new treatments, she is able to point out the potential dangers and benefits of each treatment. A pharmacologist she calls on regularly helps her evaluate herbal therapies.

"The hard part is finding sources . . . who are willing to say, 'This research is so bad, don't put any faith in it,' or 'This research may not be up to Western standards, but it's worth pursuing or writing about,'" Foreman says.

Though Foreman and the other reporters all say they look at each alternative treatment separately, newspaper coverage, as a whole, tends not to do the same. Twenty-two percent of the articles analyzed reported "alternative medicine" or "complementary medicine" as a single item. The most common therapies reported by name were acupuncture (found in 17 percent of the articles), any kind of herbal therapy (11 percent), chiropractic (6 percent), and homeopathy (6 percent).

Reporting alternative medicine as monolithic will provide little help for consumers who are sorting through the slush pile of treatments. "Alternative medicine is a term that covers a huge area," says Alvarado. "There are a wide range of things that come under that label. Some are more carefully researched than others."

Consider some recent newsy treatments. Acupuncture is FDA-approved and clinically supported for some ailments. Chiropractic is well-accepted for back pain. Laying-of-hands therapy has been mocked. Past-lives regressions, heralded by Shirley MacLaine, became a national joke a few years ago. All are called "alternative medicine."

If a newly approved drug fails or a doctor amputates the wrong leg, nobody writes off conventional medicine. Each case, each drug, each treatment is evaluated individually. Alternative medicine deserves the same standard. Lumping therapies together confuses the issues, signals inflexible thinking, and polarizes the dialogue.

Reporting alternative medicine should be easier in the future. The National Institutes of Health's Office of Alternative Medicine is funding more research. And despite the difficulties running double-blind or placebo-controlled studies (how do you not know you're being acupunctured?), the OAM recently decided that current research protocols will work for alternative medicine studies [5]. More of this research should appear in top-tier journals. In fact, the AMA journals are featuring end-of-the-year theme issues on alternative medicine [6]. And more clinicians are blending conventional and alternative medicines [7]. Eventually, there will be more, better-informed sources.

Until then, keep advice from the Health Writer's Handbook [8] in mind. "Approach your task with an open mind, but critically evaluate what you learn. Say what is known and what isn't, and differentiate evidence from opinion. Present your material with sensitivity and respect but also with professional impartiality."

Sounds a lot like writing about conventional medicine.