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What is the truth behind the rise in strokes? Anyone?

By Angela Harbutt
May 12th, 2015 at 8:10 pm | 1 Comment | Posted in health

News channels are awash today with the latest horror story – that strokes have risen over past 15 years among working-age people.  Cue health “experts” and charity spokespeople of various guises rushing to the TV sofa’s to point accusing fingers at the Great British public’s failure to take enough exercise, and our consumption of too much sugar/salt/fat, to explain the rise.

Newspapers are also falling over themselves to tell us that the latest health crisis is all our own fault. This is the Daily Mail‘s lead paragraph:

“Strokes among middle-aged men have soared because of obesity and lack of exercise, experts said yesterday.”

“Their research shows the number of cases is up 46 per cent on 15 years ago. For women in the same 40s and 50s age group the rise is 30 per cent.”

Or this from the Independent (with obligatory photo of a couple of fat blokes):

“Sharp rise in strokes among people of working age leaves thousands devastated by disability”

“The Stroke Association said the increase was due to more unhealthy lifestyles”

Undoubtedly health choices have a part to play in preventing strokes, perhaps a significant part for all I know, but before we all give ourselves a stroke worrying about the latest health scare let’s just be aware of the facts.

The Stroke Association study these headlines refer to, states that in 2000 there were around 4,260 hospital admissions for strokes among men aged between 40 and 54 in England, compared to 6,221 in 2014. For woman the figures are 3,529 in 2000, to 4,604 in 2014.

Over a similar period, the UK population has grown by over 5 million – and, according to the ONS  (since 2001) “there have been high levels of net inward migration, adding to the population at younger working ages”. I don’t have the precise numbers for England (rather than the UK) nor the increased numbers of men aged 40 to 54 living in England today compared with 15 years ago but the chances are they have risen since 2000. What matters is the % of the 40-54 year olds experiencing strokes today vs 2000, not the rise in absolute number of strokes surely?

I can’t help but wonder why the percentage changes have not been reported?

Lost in the story is also the fact that “hospital admission practice” (mentioned in passing in the press release) is also having an impact on the rise in numbers. Have we got better at diagnosing strokes over the last 15 years (probably)? Could that also account for some of the rise?

We should also note that the causes of strokes are many and various. The BBC managed to find two young stroke victims on its web site, one was a 34 year old whose stroke was caused by a (previously undiagnosed) heart condition and the second was a “very fit” (49 year old), who was “in the gym six days a week”, “ate healthily”, but had (again undiagnosed) high blood pressure. Neither of those men appear to had a stroke as a result of their lifestyle choices – far from it.

But does the BBC lunchtime news talk about either the population growth or indeed, the possible improvement in diagnosis as possible reasons for the “rise”? Does it bother to alert the “fit and healthy” that they may still be at risk of stroke even if they have a perfect diet and  take regular exercise? (eg according to the Stroke AssociationSouth Asian and black people in the UK are also at increased risk of stroke. Although the reasons for this are not completely understood, we do know that black people are twice as likely to have a stroke compared to white people and that black and South Asian people also tend to have strokes at a younger age than white people.”)

No. Nor any mention of the fact that if you have had (often undiagnosed) TIAs (mini strokes) you are at high risk; likewise you are at higher risk if there is a family history of strokes.

The tack taken by the Stroke Association and health journalists across the board is nothing less than irresponsible. The data extracted from the NHS by the Stroke Association shows a snap shot of the number of strokes occurring amongst those of a certain age in England and nothing more. The headlines/soundbites from them creates an impression that the sole cause of the “rise” in strokes amongst 40-54 year olds is “lifestyle choices”.  That is nothing more than a hypothesis/best guess/hobby horse from the health spokespeople. It is not only not backed up by any evidence presented in its press release or elsewhere, it runs the risk of leading to stigmatization of those suffering from strokes (“it’s their fault”) and creates a false sense of security among the fit and healthy – but otherwise vulnerable groups – that they are low risk or risk free.

It also displays, yet again, sheer laziness from the so-called journalists. When I spoke to the BBC after the lunch time news edition to put some questions to them; why they had shown the rise in strokes in absolute terms and had not factored in population growth in the last 15 years; whether there was any evidence to show if diagnosis had improved; and whether they had figures showing the percentage of stroke victims defined as obese, it was quite clear they had not even considered these points. Indeed they started off by trying to tell me that they thought the figures had taken into account population growth.

By the Six O’clock news, the BBC had added a line to its report stating the increase in the number of strokes “can’t be accounted for by population growth and by changes in the way strokes are treated. Experts say obesity and sedentary lifestyles are to blame.” But that was as far as they were willing, or able, to go.

Where is the journalism from the media? All they seem to have done, by and large, is to have taken the Stroke Association press release and top and tailed it with a “personal story” and/or a sound bite from a “health expert”.  More importantly, where is the responsibility from the the Stroke Association to provide the UK population with factually accurate, evidence-based information? Why have they stooped to shock tactics?

Still it seems to fit the agreed current narrative of the health lobby that “lifestyle” is the root of all our health problems. And “health journalists” seem to happily gobble up and spew back out whatever froth they are fed. They have ceased to be the fifth estate, examining the validity of the claims made. They have become the mouthpieces for their friends and colleagues working in health. They may as well just give health campaign groups their login and password and go sit on a beach.

Until the wider health lobby (in which we must include journalists as well as campaign groups) gets off this bandwagon and starts giving people the full facts however dull, rather than the spin that suits their beliefs or grabs the headlines, we should simply ignore everything they say. As an increasing number of people are clearly doing already. And government must start to consider whether health authorities should, in the interests of Public Health, continue to outsource it’s services to charities that persist in playing fast and loose with the facts.

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Hat tip: “Bias at the Beeb?”

By Editor
August 16th, 2013 at 12:30 pm | No Comments | Posted in BBC

Hat tip: Here is a very interesting report compiled by the Centre for Policy Studies looking at BBC online reporting of think tanks. The report appears robust, relying on objective quantitative methods to examine reporting slant.

And the results are pretty conclusive. BBC bias is there for all to see.

If you are a left-leaning think tank you are more likely to be reported without qualification or described by the BBC as “independent”;  if you are a right-leaning think tank then you are much more likely to receive a “health warning” ( an indicator of the think-tanks ideological viewpoint e.g “right of centre think tank Y”).

The report also finds that coverage in The Guardian is a much stronger predictor of coverage by the BBC than is coverage in The Daily Telegraph. (That might be explained by just how many Guardian newspapers the BBC purchases).

The findings and conclusions are not new. But the approach taken by the author of this report appears to be far less subjective than previous studies, making these findings much more compelling.

Of course at face value there is a bit of a “so what?” about it. As the CPS recognises “…who, apart from the think-tanks themselves, really cares if the IPPR is more likely to be referred to as “independent” than the Centre for Policy Studies?” But issue here is that these findings could well be indicative of a much wider problem in areas of BBC reporting where slant is harder to measure. That should set a lot of people thinking.

If you find yourself with time over the weekend, this 14 page report is well worth a read.

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Cracking edition of Question Time

By Editor
March 25th, 2013 at 11:54 am | 2 Comments | Posted in Uncategorized

If you missed Thursday’s edition of Question Time, do take a moment, if you can, to catch up on iPlayer. On the panel last week were Michael Gove (Con), Emily Thornberry (Lab), Natalie Bennett(Greens), Anthony Horowitz (writer extraordinaire) and Mark LittlewoodQuestion_time_logo (IEA).

Many will know that Mark Littlewood was founder of Liberal Vision so we were especially pleased to see him on the panel doing just a grand job – most particularly on the issue of press regulation. Though to be frank he served up aces for every question posed (budget/press regulation/education/Cyprus).

Many on twitter report that it was one of the finest editions of QT in a long time – and we certainly wouldn’t argue with that one.

ps Anthony Horowitz occupying the usual lefty writer slot was a very pleasant surprise indeed – sounded like a good liberal through and through. His comments on Hacked Off were truly top drawer.

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Minimum pricing – policy based evidence

By Guest
November 28th, 2012 at 9:42 pm | No Comments | Posted in BBC, health, pseudo science

Based on the output of the English media, one could be forgiven for not having noticed that Scottish ministers appear to have shelved minimum alcohol pricing ostensibly due to legal challenges. It will be unfortunate if minimum pricing is shelved solely on the basis of illegality because the lessons to be learned from the attempts to justify it via policy based evidence will then once again go unheeded.

We hear much talk of evidence based public health policy these days but what we actually get is “evidence” concocted to suit policy. The public health industry seems utterly incapable of delivering honest, objective, scientific evidence and the media contributes to the problem through lazy uncritical reporting combined with establishment bias. This was typified by the BBCs response to being caught out making wild claims about the number of lives minimum pricing would “save” amongst pensioners.  Rather than investigate the obviously questionable reliability of its source, the BBC simply accepted a lower but no more credible number.

The BBCs source was The University of Sheffield, which has now received involuntary taxpayer funding from two governments and a public broadcaster. On each occasion the motive has been the gathering of policy based evidence and it appears that neither the politicians nor the media appear to care how dubious the quality of that evidence is provided that it suits their purpose.

Petr Skrabanek in his 1994 work The Death of Humane Medicine cited Nobel laureate Irving Langmuir from 1953 when making a case against the “science” that underpins public health. He wrote that it “accepts evidence not according to its quality but according to its conformity with a foregone conclusion”. It seems that his wise observations have been ignored because the ersatz science that provides the “evidence” for policy interventions is nowadays more prevalent than ever. The University of Sheffield study provides a classic  example of this anti-science in which every supportive scrap of data, however poor in quality  is treated as “conclusive” or adding to a “growing body of evidence” and every contradictory piece as “flawed”, “controversial” or “in need of further research”.  Evidence at odds with the authors’ predetermined conclusions is often simply ignored. Take for example evidence statement 13:

“There is consistent evidence to suggest that alcohol consumption is associated with substantially increased risks of all-cause mortality even in people drinking lower than recommended limits, and especially among younger people. High levels of alcohol consumption have detrimental effects. The evidence is more equivocal, however, where it relates to establishing cut-off points for lower risk versus harmful levels of consumption. There is an ongoing controversy as to whether or not there are beneficial (cardio-protective) effects at low levels of alcohol consumption.”

This statement is an extremely misleading interpretation of the available evidence. There is no excuse for this form of words appearing in a document paid for by public funds and intended to guide politicians who are not versed in the subtleties of public health disingenuity. Hiding behind theoretical and contestable risk factors, the authors peddle the scientifically improbable but politically powerful concept of “no safe level” whilst ignoring a large body of evidence showing teetotallers to have lower life expectancy than moderate drinkers.  I could write extensively about the “controversy” they refer to but Christopher Snowdon already covered it in some detail.

Unfortunately this is not an isolated example in a production that goes to extraordinary lengths to provide policy based evidence.  The other “evidence” statements display a similar lack of objectivity and, despite using the Household Survey data provided by the ONS as a basis for much of their modelling, the authors ignore it when considering consumption at the population level.  They open their section on areas for possible future research (and of course more taxpayer funding) with the typically convoluted sentence:

Given the trends in consumption over the past ten years it is unlikely that a ‘do nothing’ policy would result in no change to the consumption of alcohol in the population.

It is hard to tell, but I think that they are trying to say that consumption is trending up so government MUST act. This is a remarkably inept statement to make in the middle of a trend that, according to the ONS has seen household consumption decline by 20% in a decade without any significant government intervention.

I find it hard to understand why politicians continue to pay homage to what Skrabanek described as healthism despite the huge flaws in the “evidence” that underpins it being repeatedly exposed. Perhaps Skrabanek gives some insight into the reasons when he writes:

Politicians find the facile rhetoric of healthism rewarding. It increases their popularity at no cost, and it enhances their power to control the population. It meets no resistance from the opposition, who promise to improve the ‘health of the nation’ even more.

Robin Fox, former editor of The Lancet describes Skrabanek as a “humorous man of immense culture and learning” in the Preface to The Death of Humane Medicine and despite not completely agreeing with Skrabanek’s pessimism, goes on to add that he “speaks many truths that we should heed”. I cannot help but feel that the world would be a better place if politicians, journalists and others did heed the words of this humorous, cultured medical man above the strident clamour of the health zealots. After all, without aggressive healthism there would be no need to insult our intelligence with pseudo-scientific policy based evidence and I sincerely doubt that the public would bemoan redundancies amongst the social “scientists”, non-practicing medics and psychologists who contribute to its socially divisive message. I doubt that these commenters on the BBC’s umpteenth plug for minimum pricing would mind at all:

For anyone who empathizes with Bauer and /or who is interested in a more liberal and less miserable future I recommend reading Skrabanek’s book which can be downloaded for free here.

By Chris Oakley. Chris’ previous posts on Liberal Vision include:  Alcohol is Old News – Minimum Pricing for Digestives is the “Next Logical Step” , Soviet Style Alcohol Suppression Campaign Called for By Public Health Activists , Alcohol Taxation: The truth, the whole truth and nothing but the truth Lies, damn lies, statistics &…

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A short conversation that says so much

By Angela Harbutt
October 23rd, 2012 at 9:53 pm | 2 Comments | Posted in BBC

My eye was drawn to the most bizarre exchange between Lord Patten, (BBC Trust chairman), and Maria Miller (Culture Secretary) today, that just makes you wonder what planet politicians (and the BBC Trust) are actually living on these days.

Miller is reported to have contacted Patten following George Entwistle’s less than impressive performance in front of MPs today. She said that full public trust in the BBC’s inquiries into the Savile affair was of “paramount importance“.

Er no. Finding out what actually happened; who knew; who covered it up; whether others were also abusing children in the BBC; & why the BBC decided not to broadcast what they knew… these questions and others are of  paramount importance. Not public trust in the BBC or its well crafted internal inquiries.

Pattern then effectively tells Miller to back off.

I know that you will not want to give the impression that you are questioning the independence of the BBC.

The sheer nerve of the guy … sorry Mr Patten, I don’t know where you’ve been these past few weeks since this story was broken (by ITV!) the BBC has done nothing but drag its feet, obfuscate and lie. You are in no position to start talking about “the independence of the BBC”. I certainly hope expect Miller to  question the Beebs independence on this matter. To allow them to run their own inquiry is an outrage. It  lost its right to run its own inquiry a long time ago.

I am not quite sure when the BBC and politicians will wake up to the level of public outrage felt by the public on this one. But this bizarre conversation between two of them suggests that it may well be a while yet.

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