Pulling a stroke?

The Stroke Association received massive media coverage last week when it released research it had carried out which showed hospital admission rates for stroke rising sharply amongst younger people

Its press release which was entitled “Stroke rates soar among men and women in their 40s and 50s”  was picked up by print and broadcast media both here and across the length and breadth of Britain.

These were disturbing findings and the release quoted Jon Barrick, Chief Executive of the Stroke Association as follows: “These figures show that stroke can no longer be seen as a disease of older people. There is an alarming increase in the numbers of people having a stroke in working age. This comes at a huge cost, not only to the individual, but also to their families and to health and social care services.”

The research was based on a sharp rise of the number of both men and women of working age being admitted to hospital for stroke. It seemed irrefutable. But was it right to draw what seems like an obvious conclusion: that rises in hospital admissions means that incidence of strokes are rising? 

BBC Radio 4’s More or Less programme, a show which analyses and often debunks statistics used in the media and in public debate, says it wasn’t.

It had had a number of calls questioning the validity of the analysis. So it spoke to Consultant Stroke Physician Professor Tony Rudd who claimed that the Stroke Association’s claims “did not fit with more detailed evidence.”

On the contrary he said that incidence of stroke were falling and not rising across all age groups. It was true that hospital admissions were rising but this was a consequence of the impact of public awareness campaigns which encouraged people to go to hospital and a change in hospital policy whereby more patients who have experienced mini strokes are admitted.

This raises all sorts of questions about how Third Sector advocacy groups use research and whether we can believe all the claims that are made.

The Stroke Association is sticking to its guns and when contacted by Scope said it welcomed further debate on the topic.

It has published a further statement about More or Less, claiming that it had offered to put someone up for interview for the show but the invitation had not been taken up.

It stated: “Hospital admissions are not the same as stroke incidence rates” then admitted: “There are some indications that the incidence rate for stroke has gone down in recent years” before adding: “but this does not necessarily mean that there are fewer strokes.”

But the original release has not been altered and is still on its website with its original claims and quotes.

It’s all a bit confusing. Scope is not in a position to arbitrate between Professor Rudd and the Stroke Association.

From the charity’s perspective this has been a good few days – there’s been massive publicity for an extremely important cause, and awareness levels of the risk of stroke has been further heightened. That has got to be good. The dissenting views expressed on More or Less reached a much smaller audience and will have done little to dent the impact. The messages that the organisation wished to get across have been conveyed very successfully indeed.

But is there a cost to this? And what does it say about the way the media reports such research?

The influential Science Media Centre (SMC) which works with journalists to help make sure the media’s science coverage is right made a series of recommendations to the Leveson Inquiry which were highly praised at the time. One was to introduce basic science and numeracy into journalism training and the SMC issued guidelines for reporting of science stories which included the following which seem relevant to coverage of the stroke story:

“When reporting a link between two things, indicate whether or not there is evidence that one causes the other.

“Especially on a story with public health implications, try to frame a new finding in the context of other evidence – e.g. does it reinforce or conflict with previous studies?

“Be wary of scientists and press releases over-claiming for studies.

“Distinguish between findings and interpretation or extrapolation.

“Headlines should not mislead the reader about a story’s contents and quotation marks should not be used to dress up overstatement.”

This makes sense: there have been a lot of instances over the years of the media picking up on scientific reports and then misunderstanding, misrepresenting or sensationalising them.

Here’s one example from hundreds. In 2009 a paper in Nature reported that rapamycin, a drug discovered in the soil of a South Pacific island in the 1970s, may have the effect of extending lifespan when given to mice.

Dr Lynn Cox, a researcher in ageing stated that “This is a very exciting study where a single drug… increases the life expectancy of mice.” But she went on to say: “in no way should anyone use this drug to try to extend their own lifespan as rapamycin suppresses immunity.”

The mice were given the drug under laboratory conditions and therefore protected from infection.

However, the media carried headlines including "Scientists discover Easter Island 'fountain of youth' drug that can extend life by ten years", "Easter Island drug 'adds decade to life" and "New pill can add decades to life".

Nobody can accuse the Stroke Association of pulling that kind of stroke. Their media foray will have done good, raising awareness and helping an important cause. But there is a fine line between strong advocacy and good science and if you push it too far you start to put hard won reputations at risk.