Statins and Strokes & disgraceful headlines

On Saturday 12th October 2013 I thought that the Daily Express front page had been mixed up with the Daily Mail. The Express is notorious for its statin scare tactic headlines. The Daily Mail is usually more balanced when it comes to these heinous drugs. Indeed the comments on most statin articles on The Mail on line show readers to be very knowledgeable about the lucrative and harmful cholesterol scam.

“Wonder drugs cut toll of strokes by 40%” was the Mail headline on  Saturday. The Telegraph proclaimed “Strokes fall by 40% due to increased statin use” and The Mirror went with “Statins reduce number of stroke sufferers by 40% in 16 years”. (Those words recorded the original headlines. You may notice that all of these headlines have changed – see the Press Complaints Commission review at the end of this blog).

This is the original article from which these headlines totally inexplicably came. I have a copy of the full article and it doesn’t mention the word “statins” once. You can see that neither does the abstract.

The Daily Mail, The Telegraph & The Mirror

I have written to Jenny Hope, Rhiannon Williams and Damien Fletcher at The Mail, Telegraph and Mirror respectively asking them the following:

Dear …
Please can you help me understand how this headline (their own particular headline inserted) came from this original article?

I have a copy of the full article, as well as the abstract, and neither mention the word statins even once. Neither claim that statins and strokes are even associated, let alone the causation you claimed.

Many thanks
Best wishes – Zoe

I will update this article with any replies received.

The Mail article appeared on line on Friday 11th October at 23.06pm and it formed the front page of the actual newspaper on Saturday 12th. The Telegraph online  article is dated 12th October 12.35am. The Mirror article is dated 12th October 08.50am. It may be the case that the Telegraph and Mirror simply copied The Mail – we will see.

The lead researcher

I also emailed the lead researcher on the article – Dr Yanzhong Wang to ask:

Dear Dr Wang
Please are you aware of any press release that accompanied your recent article in the Stroke Journal?

I am struggling to see how your interesting original article was reported as follows when your article makes no mention of the word statins.

Thank you for your time
Kind regards – Zoe Harcombe

Dr Wang replied by return to say:

Thanks, Zoe. Yes, it’s our paper and you’d better ask DM journalists why and how they linked statins to our paper. A good summary of our paper in the media can be found here.

Best wishes
Yanzhong

The study

The study is an interesting one and the Guardian article is indeed a pretty fair summary.

I’ve gone through the full journal article and would give the headlines as follows:

The SLSR is the South London Stroke Register and it covers a defined region of Lambeth and Southwark. The study has managed to cover 357,308 people in this area and the region is multicultural – enabling the researchers to make comparisons between black and white people as well as men and women and people of different ages and people exhibiting different lifestyle factors (smokers or not, diabetic or not for example).

During a 16 year study (1995-2010) 4,245 first ever strokes were recorded among the population. That means that each person in the study (and there was no upper age limit for excluding people) had a 1 in 84 likelihood of having a first stroke during the entire 16 year study. That’s a 1 in 1,346 chance in any one study year. I don’t know about you, but I wouldn’t lose any sleep over those odds.

The study abstract noted that “Total stroke incidence reduced by 39.5% during the 16-year period from 247 to 149.5 per 100 000 population.” This is a relative, not absolute reduction: 247 in 100,000 is 0.247%; 149.5 in 100,000 is 0.1495%. Moving from 247 out of a big number to 149.5 out of the same big number is a 40% reduction but the absolute numbers are too small to get your head around. It’s the big 40% number that makes the headlines and makes things look much more impressive than they are. Would this, more accurate, headline be quite as attention grabbing?

“First time stroke incidence in South London falls from 0.247% to 0.1495% in 16 years”?

The most interesting findings of the study are:

1) That stroke incidence has fallen in this study, but…

2) …that this has not happened in all groups in the study. There has been no significant decline for the entire 15-44 age group. That alone is quite a finding. There has also been no decline in stroke incidence in black people.

3) The average (mean) age of first stroke has decreased from 71.7 to 69.6. This is another significant finding. We do not want people to be having their first stroke at a younger age.

4) The incidence of stroke is so massively correlated with age – you almost don’t need to worry about anything else. Table 4 has the incidence of first stroke by age and we can see that in the first period of the study (1995-98), there were 8.4 incidences per 100,000 in the 15-44 age range and 1,933.7 in the 85+ age range. The over 85 year olds were 230 times more likely to have a first stroke than the youngest group in the study. By 2007-10, these incidence rates had fallen to 6.7 for 15-44 year olds and 1,185.2 for the over 85 year olds. That’s still 176 times the incident rate in the oldest vs youngest group.

5) Women have lower incidence of strokes than men in every period of the 16 years studied. And women have higher cholesterol than men. Hence the gender facts render the cholesterol hypothesis invalid for strokes, just as they do for heart disease (women have lower heart disease and higher cholesterol).

The full paper has many useful details on the lifestyle attributes of participants. Are they a current smoker? drinker? do they have diabetes? have they previously had a heart attack?

This additional data can offer an explanation for the decline with one line – smoking. Smoking in white people has declined from 63.5% to 47.2% for 15-54 year olds and from 34.8% to 28.7% in white people over 55 years olds. Smoking in black people has halved from 42.6% to 21.4% for 15-54 year olds and has fallen from 24.9.8% to 18.6% in black people over 55 years old. That’s a halving of the smoking incidence in one case and substantial reductions in all groups.

Why have black people not experienced a lower stroke incidence despite this reduction in smoking? Could the diabetes information offer an explanation? Diabetes has increased five fold in black people aged 15-54 – from 4.3% in 1995-1998 to 21.4% in 2007-10.

The study does not offer these explanations as I do. Their suggestions in the discussion part of the paper are: “The decline in stroke incidence may be partly because of improvements in prevention, combined with an increase in healthy living. A recent study by Marshall et al31 showed antiplatelet and cholesterol-lowering treatment for treating before stroke risk factors had improved significantly from 1995 to 2010 in SLSR, similarly for both white and black patients. We do not have information on the use of these medications among different age groups.

This is the only hint of something related to statins in the article: the mention that another study showed “cholesterol-lowering treatment… had improved”. I can only assume that this means there was more cholesterol-lowering treatment – it tells us nothing about end outcomes. And, as the SLSR study is quick to point out – we have no idea what meds any of the people in the study were taking. The study also explicitly states that they have no information about cholesterol levels in the stroke register.

And yet The Daily Mail has no doubt that “Wonder drugs cut toll of strokes by 40%”. I cannot put this any other way but to say that it is a lie. It is simply not true. It is disgraceful ‘journalism’.

Replies from the journalists

Jenny Hope also replied quickly (and briefly) to say “Hi Zoe, I spoke to and quoted researcher. Best wishes Jenny”. I sent back by return Dr Wang’s email showing the same bafflement as me as to how The Mail came up with their headline.

14/10/2013 UPDATE – I have filed three complaints with the Press Complaints Commission. If you share my view that these articles breach the first clause of the code – Accuracy – it only takes 5 mins to add your complaint. This may help.

I received a further reply from Jenny Hope (shortly after the PCC complaint was filed):

Hi Zoe,

No, I spoke to Professor Charles Wolfe.

The quotes I used in my story were the following:

‘Professor Charles Wolfe, head of the Division of Health and Social Care Research, King’s College London, one of the three researchers behind the latest study, said declining stroke rates among older people were mainly due to better treatment.

He said ‘This group of people are being managed better, their GPs are prescribing medication for high blood pressure and cholesterol that is helping bring down the stroke rate.

‘It’s an optimistic message although we won’t see a drop in the total number of strokes because we have an ageing population, more people are living longer.’

Stroke rates among black people have remained the same, driven by rising rates of diabetes, partly because they are not a target group for GPs to identify factors that put them at risk.

‘High blood pressure is one of the biggest factors, along with high cholesterol and a sedentary lifestyle. 

‘We need to see those at risk who currently miss out because they are thought to be too young for a stroke getting medical checks, advice and where necessary treatment’ he added.’

Prof Wolfe made it quite clear in conversation that blood pressure lowering medication and statins were behind the changing incidence in stroke rates. Obviously Prof MacGregor’s interest lies in declining salt consumption and its predicted effect. But he too gave me the following quote:

‘Statins cut the risk of stroke by 30 to 40 per cent so they have also played a part, but we need to do more.’

As with all research papers like this, it’s a sensible idea to talk to people with the knowledge and expertise in the area to seek their interpretation of the reasons behind findings – especially if the paper does not do so.

Best wishes. Jenny

I replied:

Hi Jenny
Many thanks for this but my complaint still stands. This study was not about statins. It makes no mention of statins. It has no information whatsoever on any medications taken by any of the study participants and Professor Wolfe knows that. Prof MacGregor was nothing to do with this study and the linking of his comment with the 40% (relative) reduction from the SLSR study – in white people over 45 – was misleading. Also – did you request the evidence for Prof MacGregor’s claim, albeit unrelated to this study, that statins cut the risk of stroke, as this needs substantiating.

I am a big admirer of your work and am gutted to be having this exchange, as I thought you and The Mail were aware of The Great Cholesterol Con – to quote the work of someone we both know. It is simply not accurate to state “Wonder drugs cut toll of strokes by 40%” – not at all and certainly not as an outcome of this study.

Best wishes – Zoe

To which Jenny replied:

Hi Zoe,

Sorry you’re not happy.

I’m equally a fan of The Great Cholesterol Con – ask Malcolm Kendrick.

However, I’m a reporter. I ask people in a position to know what they attribute the findings of research to and then we print what they say.

I’m equally fine with the fact that you don’t agree with their interpretation.

Best wishes

Jenny

This is not about me being happy. It is about whether or not the statement “Wonder drugs cut toll of strokes by 40%” can be stated as fact and it can’t.

Update following the Press Complaints Commission investigations

The following amends were made by the newspapers following the PCC investigations:

Daily Mail

Complaint:

Ms Zoe Harcombe complained to the Press Complaints Commission that the newspaper had published inaccurate and misleading information in breach of Clause 1 (Accuracy) of the Editors’ Code of Practice. The complainant said that the newspaper had incorrectly stated as a fact that a 40 per cent fall in the number of strokes was due to an increased use of statins. The study which reported the decreased incidence of strokes made no reference to statins.

Resolution:

The complaint was resolved when the PCC negotiated the alteration of the headline of the online article and the publication of the following footnote:

An earlier version of the headline stated that “Statins reduce number of stroke sufferers by 40% in 16 years”. We are happy to make clear that the King’s College London research itself did not attribute the reduction to statins.

Date Published: 06/12/2013

The Telegraph:

Complaint:

Ms Zoe Harcombe complained to the Press Complaints Commission that the newspaper had published inaccurate and misleading information in breach of Clause 1 (Accuracy) of the Editors’ Code of Practice. The complainant said that the newspaper had incorrectly stated as a fact that a 40 per cent fall in the number of strokes was due to an increased use of statins. The study which reported the decreased incidence of strokes made no reference to statins.

Resolution:

The complaint was resolved when the PCC negotiated alterations to the online article to make clear that the increased use of statins correlated to the decrease in the number of strokes, rather than necessarily causing the decrease. It also published the following footnote:

UPDATE: An earlier version of the headline stated that “Strokes fall by 40 per cent due to increased statin use”. We are happy to make clear that the King’s College London research did not attribute the reduction to statins.

Date Published: 14/11/2013

The Mirror:

Complaint:

Ms Zoe Harcombe complained to the Press Complaints Commission that the newspaper had published inaccurate and misleading information in breach of Clause 1 (Accuracy) of the Editors’ Code of Practice. The complainant said that the newspaper had incorrectly stated as a fact that a 40 per cent fall in the number of strokes was due to an increased use of statins. The study which reported the decreased incidence of strokes made no reference to statins.

Resolution:

The complaint was resolved when the PCC negotiated the alteration of the headline of the online article and the publication of the following footnote:

NOTE: An earlier version of the headline stated that “Statins reduce number of stroke sufferers by 40% in 16 years”. We are happy to make clear that the King’s College London research did not attribute the reduction to statins.

Date Published: 14/11/2013

The last word

These amends are somewhat useless after the inaccurate headlines. People will be left with the completely non-evidence based impression that statins had something to do with an observational study, which had nothing to do with statins. I could never get the newspapers unprinted. However, I hope that three newspapers will think a bit more carefully next time before printing dangerously inaccurate and misleading headlines.

 

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11 comments on “Statins and Strokes & disgraceful headlines
  1. avatar Liza Scrivens says:

    Are NICE really going to approve statins for widespread use in the population ? Where is the analysis that this is going to yield any benefits – all I have seen from the papers that you have analysed are increased risks for taking the medication or an absence of positive benefits in many sectors of the population

  2. avatar HELENA WOJTCZAK says:

    Thank you very much Zoe for another wonderful article. I agree 100% with Annabel that “It’s long overdue for there to be a law which disallows the ‘summarisation’ or ‘reporting’ of any health study without a direct link to the transcript of the actual study under the ‘article’.”

    Absolutely there should be!

  3. avatar Jessica says:

    Annabel – kindred spirit!!! My doctor was also blatant about the “secret” food I was eating since I was having my five a day, along with low fat food with regular exercise and I was putting on weight. It got to the point where I couldn’t eat five a day – it would have been too many calories (apparently) for me!

    Your 500 a day diet, although utterly unhealthy and hurrendous, might actually help. Low carbing only seemed to work for me after I ‘kick started’ my body by stopping eating altogether. So you might be in the perfect place to start a new diet.

    I wish you luck, and yes, it’s hard to equate eating clotted cream with losing weight but it works! Just shows what government brain washing can do….

  4. avatar glyn says:

    Once people understand what cholesterol is for and how it works it quickly becomes obvious that cholesterol lowering therapies are ridiculous.

  5. avatar Annabel says:

    Misinformation on the effects of dietary intake is so rampant today that I could find a “study” or doctor’s summary to back up almost any type of eating plan. It’s long overdue for there to be a law which disallows the ‘summarisation’ or ‘reporting’ of any health study without a direct link to the transcript of the actual study under the ‘article’. It shouldn’t be such hard work to find out the truth about food intake, metabolism and fat storage in the human body.

    As a vegetarian for 15 years, I struggled awfully with my weight – sticking to regimented eating plans based around carbohydrates, fruits and vegetables. (Insert screams here) I thought I was eating healthily.

    And the worse thing is, I was always hungry. Recently I have been on a 500calories a day shake program for 6 months and have only lost 20kg despite the fact that if calories counting worked, I should have lost over 50+kilograms by now. My doctor’s response to this is that I must be consuming hidden calories – which was his way of saying that I am eating ‘secretly’ or bingeing – which I’m not and have not.

    Now I am only going to follow what sounds right and what I believe to be true based on my experience – it’s obvious that a few food multinationals have ‘taken over’ all avenues for food research and it’s nearly impossible to know what is what when it comes to food. Zoe, I’m glad I’ve found you. I have purchased your book and it makes sense to me. I have given up vegetarianism because it only contributes to my weight problem (actually I gave it up a year ago but rarely eat meat anyway) but I have to admit I am TERRIFIED to eating 3000 calories a day in a protein based diet. I am so conditioned against calories that even starting your diet daunts me. I wish I’d known about these protein facts years ago.

    I will make a start and see what happens…

  6. avatar TeeDee says:

    Hi Zoe,
    Thanks again for an excellent analysis of this paper. At the risk of sounding hyperbolic, I don’t know what I’d do without your dissemination of these studies and headlines. In fact, yours was the first name I mentioned just last night when we were discussing how important it was to educate ourselves(as opposed to just popping in to see the doctor) on how to best feed our bodies/brains. My son-in-law agreed, but said it’s so hard to find the time to not only read a book on the latest health findings, but to follow up and read the studies that accompany them–and I couldn’t agree more. It can feel utterly exhausting at the end of the day, as I’m sure you know all too well.
    I am so grateful for the work you do and can’t possibly thank you enough, but thank you nonetheless!

    All the best to you and yours,
    T.D., Hamilton, Ontario

  7. avatar Jo says:

    That’s a pretty sloppy reply from the journalist – an indicator of her standards of reporting perhaps.

  8. avatar Björn Hammarskjöld says:

    Hi Zoë!

    The answer by Jenny Hope “I spoke to and quoted researcher.” does not tell who the “researcher” was. And with that kind of “information” she has better keep the name hidden as a journalistic source.
    And as Gary Taubes pointed out in his book Good Calories, Bad Calories from 2007, he differentiated strongly between “researchers” and Scientists.
    Most modern “researchers” are just like parrots with the same amount of intracranial hardware and software. They can just repeat what the master tells them.
    Scientists still think for themselves and publish honest scienctific articles.

  9. avatar Stephen Blackbourn says:

    Thank you Zoe for following up this article.

    One wonders how much money changes hands between drug companies and editors who promote their products.

  10. avatar John Williams says:

    Too many modern so-called journalists have little or no respect for facts or, indeed, for their readers. Editors no longer edit. Facts are ignored or distorted to suit political or commercial interests. All that matters is to fill the space and pull in more readers and advertisers. It is a case of “bullshit baffles brains” and it will continue while publishers know they can get away with it because we carry on, largely uncritically, buying their publications.

1 Pings/Trackbacks for "Statins and Strokes & disgraceful headlines"
  1. […] statins are responsible for a 40% reduction in the incidence of stroke. Wonder drug! (etc, etc) Zoe Harcombe's blog post makes informative reading. The reality behind the headlines is more fantastic even than you'd […]

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