Category Archives: Health and Medicine

Declan Waugh scaremongers over fluoride – again

Mary Byrne, the convener of the anti-fluoridation activist group Fluoride Action Network of NZ, is promoting “alarming information” about incidence of neural tube developmental defects like spina bifida with the implication they are caused by community water fluoridation. Her authority for this is Declan Waugh!

DeclanWaugh_photo

Declan Waught - promoted as a “leading expert” on fluoride by anti-fluoride movement

Any critical examination of Waugh’s claims on fluoridation (and there are many) would show him to be the last person one should trust on the issue. Unfortunately, though, he does seem to fool some people – using a mixture of extensive, but misleading, citation of scientific papers and claims about the high incidence of many illnesses in the Republic of Ireland. Anti-fluoride activists love to quote him as “scientific proof” for their own extreme claims and, worryingly, the Hamilton City Council was persuaded that he is indeed a reliable “expert” – citing one of his reports in the list of 10 documents which convinced them to stop fluoridation last year (see When politicians and bureaucrats decide the science).

Very often simple checking will show his claims about the incidence of illnesses are actually completely wrong, and the scientific papers he cites don’t actually say what he claims. Completely dishonest but  it seems you can fool some of the people some of the time with fancy sciency-looking reports. Especially if your citations are so intimidatingly extensive few readers have the energy to check them.

Here I will take apart the fear mongering he is currently promoting over spina bifida and similar neural defects.

The incidence of neural defects in Ireland

The “alarming information” on incidence of neural defects in The Republic of Ireland  he relies on is a paper by McDonnell et al (2014), Neural tube defects in the Republic of Ireland in 2009–11.  The authors concluded:

“The incidence of NTDs [neural tube defects] in the Republic of Ireland appears to be increasing. Renewed public health interventions, including mandatory folic acid food fortification, must be considered to reduce the incidence of NTD.”

A press release from the UCD School of Medicine and Medical Science in Dublin put this in context:

“This comprehensive national audit over three years found that the incidence of neural tube defects (NTDs) increased slightly during the period studied, reversing the trend of the previous ten years.

NTD incidence had increased from 0.92/1 000 in 2009 to 1.17/1 000 in 2011. And nowhere was fluoride implicated as a cause of this.

So no basis for Waugh’s fear mongering and implication of community water fluoridation as the cause. However, I imagine the average anti-fluoride activist would be aghast at the idea of a social health policy involving mandatory folic acid food fortification and would campaign against it.

Manufacturing a link to fluoride

Declan Waugh manufactures a link of NTDs to fluoride and community water fluoridation in two ways:

1: The old trick of using a brief report from an area of high dietary fluoride intake. In this case the paper of Gupta et al (1994). This brief 2 page report studied children suffering dental and skeletal fluorosis in India. Drinking water concentration was high (4.5 to 8.5 ppm compared with the recommended 0.7 for community water fluoridation). Fourteen of the 30 children studied showed spinal bifida occulta (the mildest form which usually presents no problems) on X-rays but not on clinical examination.

Although the incidence in this small sample is higher than the 20% normally found in average spines the number of subjects is low so no conclusions are possible. In fact, all the authors did was to propose “a randomised controlled study to evaluate a possible correlation between spina bifida and high fluoride intake.” The also pointed out that they could not find any literature reports correlating spina bifida with fluoride.

So all pretty speculative – but enough for a desperate anti-fluoride “authority” like Declan Waugh to do a bit of scaremongering.

2: Waugh goes out of his way to suggest a mechanism for community water fluoridation causing neural tube defects – fluoride reduces folic acid concentration in the body! And he manages to cite a couple of scientific papers to support his ideas. Problem is – they don’t.

He argues in a 2012 report (which he describes as his “main report”) that “Fluoride is known to be an inhibitor of enzymatic activity and research has identified fluoride as an inhibitor of homocysteine hydrolase363 and this causes a decline in folic acid levels.

The cited paper is Mehdi S, Jarvi ET, Koehl JR, McCarthy JR, Bey P. The mechanism of inhibition of S-adenosyl-L-homocysteine hydrolase by fluorine-containing adenosine analogs. J Enzyme Inhib. 1990;4(1):1-13.

Waugh is citing work using “fluoride-containing adenosine analogs” to make the claim about the fluoride anion. Specifically, the compounds (Z)-4,5′-Didehydro-5′-deoxy-5′-fluoroadenosine, 5′-deoxy-5′-difluoroadenosine, and 4′,5′-didehydro-5′-deoxy-5′-fluoroarabinosyl-adenosine  - not fluoride.

Extremely sloppy!

Declan Waugh has just pulled out any old citation referring to fluoride – maybe he hasn’t even read past the title of the paper.

Yet the tame alternative health media make the claim that “amongst the international scientific community, Waugh is now regarded as a leading expert on the subject!”

That reminds me of the local anti-fluoridation activists who continually describe Paul Connett, from the sister activists organisations Fluoride Alert, as a “World expert on fluoridation!”

Actually, Waugh gave the show away in his 2013 report when he said:

“To my knowledge no study has ever been undertaken to examine if fluoride exposure combined with nutritional status may be a contributory factor to the alarming levels of congenital defects in fluoridated compared to non-fluoridated countries.”

But as is often the case with these sorts of admissions, the very lack of evidence appears to be used to infer a cause. He is advancing the fallacy that the lack of evidence really means the evidence is there but just hasn’t been found yet – probably because evil scientists are conspiring to prevent the necessary research.

The old trick of making a wild claims, suggesting something as a possibility and then promoting the idea as some sort of scientifically proven fact in his scaremongering.

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Pandering to anti-fluoridation campaigners

Screenshot-2014-04-07-11.19

Twitter time-line from an anti-fluoride propagandist – Click to enlarge

Social media can be bloody frustrating at times.

I do find Twitter useful for identifying interesting newspaper reports, scientific articles and videos – often long before I would see them myself on other sources. But, boy, there is loads of rubbish – especially when following a search term rather than people you trust.

Take search terms like #fluoride and #fluoridation – most of the time these are a complete waste because they are dominated by crazies who are using Twitter as a political propaganda tool. Click on the image to the left to see just a small part of the timeline from one of these propagandists.

But there are exceptions. Over the weekend these search terms went crazy with links to a great article in the Guardian by David Robert Grimes -  Politicians should stop pandering to anti-fluoridation campaigners. I recommend you read this if you haven’t already.

Sound and fury of opposing ideology

Grimes

David Robert Grimes

Grimes is commenting on the irrational backlash against fluoridation in the Republic of Ireland – and expecting a similar backlash to last week’s report from Public Health England urging more councils to consider fluoridating their water supplies. He said “as with so many public health interventions, the sound and fury of opposing ideology often trumps rational analysis.”

“Fluoride has been added to water in Ireland since the 1960s and has substantially improved the nation’s dental health, even in the era of fluoridated toothpaste. Despite this, a small but highly vocal opposition repeatedly pops up to claim fluoridation is harmful to health. These claims have been debunked time and time again.

The current incarnation of the opposition relies heavily on a report by self-proclaimed “fluoridation scientist” Declan Waugh, who blames fluoride for a range of illnesses. The report has been roundly dismissed by the Irish Expert Board on Fluoridation and Health, its chairman Dr Seamus O’Hickey concluding that … in spite of its presentation, its content is decidedly unscientific … the allegations of ill-health effects are based on a misreading of laboratory experiments and human health studies, and also on an unfounded personal theory of the author’s.”

Despite this, clever use of social media and strong lobbying has gained fluoridation naysayers considerable political traction, prompting the Irish government to promise yet another full review of the practice.”

Appeasing politicians

And this is his concern –  appeasement by politicians:

“perhaps the ugliest facet of the Irish debate is how elected representatives have given such outlandish fringe assertions a sense of legitimacy. One Irish politician has claimed that fluoridation causes cancer and Down’s syndrome; others have demanded an end to the practice, parroting claims that would have taken all of three minutes on Wikipedia to expose as utter nonsense.

The Irish government’s response is appeasement, and a waste of time and public money. Not only is there already an Irish body that routinely reviews the safety of fluoridation, this is a Sisyphean task because anti-fluoride groups have already reached their conclusion, and will trust no expert body unless it agrees with their assertions. Almost certainly fluoride will get yet another clean bill of health, campaigners will reject the findings and the same tedious cycle will repeat again, in much the same way parents who oppose vaccination are impervious to the scientific literature undermining their position.

It is irresponsible for politicians to show such contempt for science that they’re willing to take the lead from pseudoscientists and conspiracy theorists rather than experts. Leadership should be about making the best decisions based on the data available, even on emotive issues such as fluoridation and vaccination.”

Hear, hear – that is exactly how I felt about the Hamilton City Council politicians who gave far more weight to “pseudoscientists and conspiracy theorists rather than experts” in their deliberations on fluoridation last year.

A quirk of human psychology?

Grimes makes an interesting observation that the sort of irrationality, conformation bias, motivated reasoning and conspiracy theories we see in the anti-fluoridation and similar movements is really just part of human nature.

“That such beliefs persist in the face of strong evidence may be a quirk of human psychology. Campaigners may see themselves as enlightened crusaders, so when their assertions are questioned or contradicted by the data, this is viewed not as a useful correction of error but rather an attack on their identity and narrative. Conspiratorial thinking is endemic in such groups with critics being regarded as agents of some ominous interest group – big pharma is a common bogeyman – that wants to conceal the truth. This becomes a defence mechanism to protect beliefs that are incompatible with the evidence.

If all else fails, attacking the messenger may be easier than accepting that your whole raison d’être is misguided.

Motivated rejection of evidence is often a symptom of cognitive dissonance, a psychological phenomenon that occurs when individuals are challenged by information inconsistent with their beliefs. They may reject unwelcome information, seek confirmation from those who already share their beleaguered viewpoint, and try to convince others of the veracity of their world view. This may explain why some people proselytise even more vigorously after their beliefs have been debunked.”

So, perhaps we can understand the psychological motivations of people promoting pseudoscience and conspiracy theories. But, as Grimes says,” this does note excuse the fact that “elected representatives have given such outlandish fringe assertions a sense of legitimacy.” That goes for Hamilton as well as Ireland.

Grimes finishes with a message to the politicians:

“what is crucial is that decisions are based on scientific research, not misinformation and fear. The cost of such folly is clear to anyone who remembers the human suffering in the wake of the misinformed panic over the MMR vaccine just a decade ago.”

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Fluoridation returns to Hamilton City.

referendums-being-ignored

The Hamilton City Council voted this afternoon to recommence fluoridating the city’s water supply

The vote was overwhelming - 9 for, 1 against. The overwhelming support for fluoridation in last year’s referendum was decisive in the decision.

There is a threat to bring legal action against the council – the Deputy Mayor’s comment on this – “Bring it on – a legal decision will decide for the whole country.”

See also:

Fluoride to return to Hamilton’s water supply
Hamilton votes to restart fluoridation
Fluoride back for Hamilton – Council backs the community response

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Dental fluorosis: badly misrepresented by FANNZ

Ideologically motivated political activists often make extreme claims. Perhaps they feel their claims will never be challenged because they are aimed at their own supporters. Sometimes I think it is because they just don’t get challenged enough by reasonable people.

I have previously shown examples of misrepresentation of science by local anti-fluoride activists (see Fluoride and heart disease – another myth , Anti-fluoridation porkies – Mullinex’s ratsFluoridation: the hip fracture deceptionAnatomy of an anti-fluoridation myth , Fluoridation – the IQ mythActivists peddle chemical misinformation for fluoridation referendaCherry picking fluoridation dataFluoride sensitivity – all in the mind?Fluoridation – topical confusionFluoridation – it does reduce tooth decayFluoridation – are we dumping toxic metals into our water supplies?).

Here’s another blatant example – their misrepresentation of dental fluorosis. In this case it involves knowingly using the wrong photographs while quoting a Ministry of Health (MoH) source on the subject. I have posted below both the official photographs used by the MoH and the photographs they were replaced with in the anti-fluoridation quote. This blatant misrepresentation occurs on the official website of the Fluoride Action Network of NZ (FANNZ).

But first, this is what I wrote about dental fluorosis in my exchange with Paul Connett. The graph illustrates the nature of dental fluorosis observed in New Zealand.

Proponents of fluoridation do acknowledge dental fluorosis in a negative, although minor, aspect of fluoridation.

Opponents of fluoridation will often quote high values of the incidence of fluorosis which ignore the fact that much of it is “questionable” and/or “very mild.” These grades are really only cosmetic and usually can only be detected by a professional. Opponents may also hide the fact that the incidence of fluorosis for children living in fluoridated may often be the same as, or only slightly greater than, the incidence for children living in non-fluoridated areas.

The graphs below shows the situation reported for New Zealand in the 2009 New Zealand Oral health Survey (see Our Oral Health).

Health experts have generally concluded that the apparent rise in the incidence of fluorosis is caused by increases in other forms of fluoride intake, such as from eating toothpaste, and not from fluoridated water.

Ministry of Health version

I am quoting here from the MoH website page - Infant formula and fluoridated water. This is the page FANNZ quoted from

Enamel fluorosis

Tooth enamel fluorosis is one of a range of changes to tooth enamel. Living in an area with fluoridated water can increase the mild white flecks or streaks in the tooth enamel.

The following photos provide examples of normal teeth and the types of mild to moderate diffuse enamel fluorosis that is most commonly associated with water fluoridation. The most recent New Zealand information indicates that about 29 percent of 9-year-old children in Southland who had always received fluoridated water had these changes to the tooth enamel. This level had not changed since several earlier studies undertaken in the 1980s. (Bold my stress)

normal-dental-enamel
Normal dental enamel
mild-diffuse-enamel-hypoplasia
Mild white spots on teeth – mild diffuse enamel hypoplasia
moderate-diffuse-enamel-hypoplasia
Mild white spots on teeth – moderate diffuse enamel hypoplasia
moderate-white-streaks

Moderate white streaks associated with enamel fluorosis

Other defects on teeth

Severe enamel fluorosis involves brownish defects to the tooth enamel which may also be pitted.

This form of enamel defect is uncommon in New Zealand. The most recent New Zealand information from 9-year-old children in Southland indicates that about 5 percent of children had similar defects.

These defects were just as common in children who had received fluoridated water as non-fluoridated water and the level of these defects had decreased about three fold from about 15 percent of children in the mid-1980s.

FANNZ version

The quote here is from the FANNZ website page Dental health.

Fluoridation causes dental fluorosis

Dental fluorosis is the outward sign that has a child has consumed too much fluoride – it is a bio-marker of over-exposure.  In New Zealand, dental fluorosis statistics are lacking, even though the Ministry of Health acknowledges this condition to be an undisputed side effect of fluoridation.

fluor_mild
Very mild fluorosis
fluor_mod
 Moderate fluorosis
dental_fluorosis_severe
Severe fluorosis
fluor_sev1
Severe fluorosis

According to the Ministry of Health*, “The most recent New Zealand information indicates that about 29 percent of 9-year-old children in Southland who had always received fluoridated water had these changes to the tooth enamel. This level had not changed since several earlier studies undertaken in the 1980s.” (Bold my stress).

* Note this link goes only to the MoH front page – not the page from which the quote was taken and which contains the photographs. Now, I wonder why the link isn’t direct?

So a blatant example of misrepresentation. Conscious misrepresentation at that because it involved substitution of the official photos by others. The intention was clearly to make the MoH seem to state that fluoridation causes severe fluorosis when the MoH clearly did not state that.

I really wonder how these people sleep straight in their bed at night.

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Fluoride and heart disease – another myth

Here is another anti-fluoride rubber duck which keeps surfacing – the myth that cardiovascular disease is “linked to” fluoride. This myth relies on misrepresentation of a study reported in Nuclear Medicine Communications 2 years ago.

The paper is Li et al (2012) Association of vascular fluoride uptake with vascular calcification and coronary artery disease. (download pdf). It shows that an injected fluoride isotope (18F) concentrates in existing calcified material in coronary arteries. The authors suggest detection of the injected 18F could provide a clinical method of identifying cardiovascular risk.

This is very clear from the conclusion reproduced in their abstract:

“CONCLUSION: sodium [¹⁸F]fluoride PET/CT might be useful in the evaluation of the atherosclerotic process in major arteries, including coronary arteries. An increased fluoride uptake in coronary arteries may be associated with an increased cardiovascular risk.”

The “fluoride uptake” refers to uptake of the radioactive isotope in the coronary arteries, 40 minutes after its injection – not dietary uptake of fluoride. The correlation observed is between arterial calcification and 18F uptake – not dietary fluoride.

Yet anti-fluoride activists are referring to the paper to claim that heart disease is linked to dietary fluoride intake, especially from fluoridated water. For example, Declan Waugh claimed:

“Current research has also identified the link between fluoride and atherosclerosis.370

And yes his reference 370 is Li etal (2012) (see When politicians and bureaucrats decide the science).

The local anti-fluoride activist organisation Fluoride Action Network of New Zealand (FANNZ) today repeated this misinformation on their Facebook page (see Los Angeles Healthcare System Study Links Fluoride With #1 Cause Of Death – Cardiovascular Disease):

“The results of this study therefore have vast implications for our collectively becoming aware of one main contributing factor to the ongoing scourge heart disease, namely municipal water fluoridation. “

They also make similar claims on their webpage – see Fluoridation and Heart Disease):

“Research published in January 2012(1) concluded that there was a direct correlation between the fluoride level in arteries, including coronary arteries, and artherosclerosis . . . . . this unquestionably proves that fluoride does accumulate in soft tissue – something fluoridation promoters deny emphatically, claiming it all goes to the bones or teeth, and never the soft tissues.”

I repeat – the correlation reported is between atherosclerosis and the injected 18F. Nothing to do with dietary F intake at all. This correlation results from the fact the injected fluoride has an affinity with calcium and is therefore attracted to clacifying material . As the authors say:

“Currently, sodium [18F]fluoride positron emission tomography (PET)/CT is the most sensitive imaging modality to detect active bone formation”

And:

“Calcification in atherosclerosis occurs through an active process that resembles bone formation”

Misrepresentation by motivated confirmation bias

So a clear misrepresentation of a scientific paper. Is this a mistake or is it intentional?

Clearly there is motivated confirmation bias going on. Understandably these activists will select anything to fit their case, even to the extent of making such whopping mistakes. Perhaps one can understand an individuial making such a mistake if they are simply glancing through titles, or abstracts, looking for “ammunition.”

But this is a mistake that keeps repeating. And it get’s included in their “authoritative” statements. For example Declan Waugh’s report is often used in submissions to councils and the Hamilton City Council admitted to being impressed by it. They describe it as one of the key pieces of information that lead them to their mistaken decision to stop fluoridation (see When politicians and bureaucrats decide the science). You can down load their own assessment of the information they considered important  -Scientific research supporting the stopping of fluoridation

On the one hand activist organisations like this should take more care with the material they prepare. When mistakes like this are pointed out they lose their credibility.

On the other had bodies like city councils should take more care in accepting information from submitters. They should be aware of the ever-present problem of confirmation bias which is inevitable with activist groups. They should not be impressed by something that looks “sciency” with large numbers of references.

Above all, they should always seek expert advice, rely on information from people who have the skills to undertstand the scientific literature and be aware of these sorts of mistakes.

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Corporate backers of anti-fluoride movement lose in NZ High Court.

HC-water

Image Credit: 3 News NZ

New Zealand anti-fluoride activists (and their industry backers) suffered a signficant blow with the release of a High Court Judgement on Friday. This Judgement found that all the arguments used by New Health NZ attempting to prevent fluoridation  of the water supplies in Patea and Waverly had failed.

Readers can download this 43 page judgement – I have included the Summary and Conclusions at the end of this post.

Not about the science

Commenters can easily slip into arguments this is a judgement on the scientific merits or problems of fluoridation. It isn’t.  Justice Rodney Hansen says:

[5] It is important to make it clear at the outset that this judgment is not required to pronounce on the merits of fluoridation. The issues I am required to address concern the power of a local body to fluoridate drinking water supply. That is a legal question which does not require me to canvass or express a view on the arguments for and against fluoridation.

The failed arguments put forward by New Health NZ did not relate to the science but to legal issues. Specifically they argued councils do not have the legal right to make decisions on fluoridation, or if they do this is a breach of the NZ Bill of Rights Act (NZBORA).

Justice Hansen’s judgment that councils do in fact have the right to make decisions on fluoridation is quite detailed – and well beyond my legal ability so I will not comment on it.

Medicine and the right to refuse

Justice Hansen’s  judgments on the NZBORA are clear to the layperson. Inclusion of medical treatment in the NZBORA “was a specific response to the atrocities of the Nazi concentration camps.” However:

[80] In my view, fluoridation cannot be relevantly distinguished from the addition of chlorine or any other substance for the purpose of disinfecting drinking water, a process which itself may lead to the addition of contaminants as the water standards themselves assume. Both processes involve adding a chemical compound to the water. Both are undertaken for the prevention of disease. It is not material that one works by adding something to the water while the other achieves its purpose by taking unwanted organisms out.

[81] The addition of iodine to salt, folic acid to bread and the pasteurisation of milk are, in my view, equivalent interventions made to achieve public health benefits by means which could not be achieved nearly as effectively by medicating the populace individually. . . . All are intended to improve the health of the populace. But they do not, in my view, constitute medical treatment for the purpose of s 11″ [the relevant section of the NZBORA].

Even if the “medication argument” was relevant the “right to refuse” is irrelevant for fluoridation:

“Provided it does not have consequences for public health a person has the right to make even the poorest decisions in respect of their own health. But where the state, either directly or through local government, employs public health interventions, the right is not engaged. Were it otherwise, the individual’s right to refuse would become the individual’s right to decide outcomes for others. It would give any person a right of veto over public health measures which it is not only the right but often the responsibility of local authorities to deliver.”

Appeal – the fly in the ointment?

In principle this should remove any legal or judicial questions that may have concerned councils. They should now be able to go ahead with fluoridation. The Hamilton City Council,  got itself into a mess last year by deciding to stop fluoridation and was then forced into allowing a referendum which showed almost 70% support for fluoridation. The Council delayed putting the referendum result into effect citing the High Court case. They should now have no excuse to ignore the referendum result.

Unfortunately, New Health NZ will appeal the judgment – and this give wriggle-room to anti-fluoridation councillors, and councillors worried they may still yet face costly legal action, to argue that fluoridation remain suspended.

And that is most probably their intention with the appeal. New Health NZ must realise that the thorough judgment really gives them no room to pursue their arguments. But tactically this appeal could continue the hiatus situation faced by Hamilton and other councils. A decision on the appeal could be delayed for another year or so – meanwhile a number of New Zealand cities could be denied the advantages of a well proven and safe social health measure.

That likely motive is politically cynical and I hope the appeal decision will award costs against New Health NZ for that reason. Mind you, a simple analysis of the links of New Health to the corporate interests of the “natural” health industry shows cost is not a problem for them.

The deep pockets of the anti-fluoridationists

A while back I described the links between New Health NZ and the “natural” health industry – see  Who is funding anti-fluoridation High Court action? Specifically, New Health NZ is a creation of the New Zealand Health Trust – a political lobby group financed by the “natural” health industry.

This trust is also registered as a charity – which means we are all subsidising their campaigns via their tax exempt status. (Their charitable status really needs challenging).

However, the financial returns available on the NZ Charities Register shows large grants to the trust which in effect pay for their legal expenses (see figure below for year ended 31 March 2013).

One report estimated the cost to the South Taranaki District Council of this High Court action was about $200,000. Relatively small change for the corporate funders of the NZ health Trust/New Health NZ – but certainly large enough to scare individual councillors.

The government should recognise that such a David vs Goliath situation gives an unfair advantage to these corporate interests. This, together with a highly motivated and organised group of anti-fluoride activists enables individual councils to be picked off one by one by a combination of political and financial pressure.

Most councils would prefer the responsibility of decisions on fluoridation be handed over to central government. The find the continual re-litigation of the issue by anti-fluoride activists frustrating, time-consuming and expensive. So far the current government has resisted these call. Perhaps, though, a useful interim step would be for central government to indemnify local bodies on the fluoridation issue.

This would remove the financial pressure of the sort used by the NZ Health Trust/New Health NZ on cash-strapped local councils.  The anti-fluoride movement would then be forced to deal with central bodies which have more substantial financial backing and better legal and scientific resources.


Judgement summary and conclusions

[116] New Health has challenged the Council’s decision to fluoridate the drinking water of Patea and Waverley on the grounds that:

(a) There was no legal power to do so.
(b) If there was power, its exercise by the Council was a breach of the right to refuse medical treatment in s 11 of NZBORA.
(c) In making the decision, the Council failed to take into account relevant considerations.

[117] I have rejected all grounds of challenge. I have concluded that there is implied power to fluoridate in the LGA [Local Government Act] 2002, as there had been in the antecedent legislation, the Municipal Corporations Act 1954 and the LGA 1974. The Health Act confirms that fluoride may be added to drinking water in accordance with drinking water standards issued under that Act. The power to fluoridate drinking water is not a regulatory function; it does not require express authority. Nor does a decision to fluoridate require the consent of the Minister of Health under the Medicines Act as water is not a food for the purpose of that Act.

[118] I have concluded that the fluoridation of water is not medical treatment for the purpose of s 11 of NZBORA [NZ Bill of Rights Act]. While I accept that fluoridation has a therapeutic purpose, I conclude that the means by which the purpose is effected does not constitute medical treatment. I am of the view that medical treatment is confined to direct interference with the body or state of mind of an individual and does not extend to public health interventions delivered to the inhabitants of a particular locality or the population at large. I see no material distinction between fluoridation and other established public health measures such as chlorination of water or the addition of iodine to salt.

[119] In the event that, contrary to my view, fluoridation does engage the right to refuse medical treatment, I discuss whether in terms of s 5 of NZBORA the power to fluoridate is a justified curtailment of the right to refuse medical treatment. I conclude that it is. The evidence relied on by the Council shows that the advantages of fluoridation significantly outweigh the mild fluorosis which is an accepted outcome of fluoridation.

[120] Finally, I examine whether the Council failed to take into account relevant considerations in reaching its decision. I am of the view that the Council was not required to take into account the controversial factual issues relied on by New Health. There is, nevertheless, a plenitude of evidence to show that the Council carefully considered the detailed submissions presented and reached its decision after anxious consideration of the evidence and careful deliberation.

Result

[121] New Health’s application to review the Council’s decision fails.

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Fluoride and the 5 easy steps of a conspiracy theory

flouridationjohn

This brief article by Emily Willingham in Forbes shows how  the internet has been a real blessing to conspiracy theorists – especially those who are attacking scientific consensus. In Hyping Your Conspiracy Theory In 5 Easy Steps. She  is using the anti-vaccination movement as an example. But it is just as applicable to the anti-fluoride movement.


“1. Find something online that is related to your subject. Like this Senate committee report on an investigation of government agencies regarding safety claims of thimerosal in vaccines.”


And there is no short of internet material on fluoride – Activists just have to do a bit of googling If you are too lazy for that others have done it for you. Just go to Fluoride Alert, Mercola and hosts af “natural” health web sites).


“2. Cherry-pick partial quotes that seem to support your position (here, that vaccines cause harm) and assert conclusions that support your claims. Be sure the conclusions are sufficiently scary and conspiracy worthy. Mention of children and/or pregnant women is always good.”


Again, other activists sites have done that for you. Most anti-fluoride activists may have never read any of the scientific papers they “quote.” At most they seem only to have glanced at an abstract.


“3. Ignore the full context that specifically presents the reverse conclusion from the one you want to claim. Full context like this, from the actual Senate committee report (italics mine):”


This is rife in the anti-fluoride community. Take this paper they are currently quoting as “evidence” that fluoridation is not effective:

Majorana et al. BMC Pediatrics 2014. “Feeding and smoking habits as cumulative risk factors for early childhood caries in toddlers, after adjustment for several behavioral determinants: a retrospective study.”  BMC Pediatrics

The study did not even consider fluoridation and their notes on the apparent ineffectiveness of  prenatal fluoride supplementation using fluoride drops have been misrepresented. (See this outline by Andrew Sparrow for further details). 


“4. Use quotable sound bites so that the misleading information spreads to those eager to take it up and use it in similar ways. Like this. And this. And this.”


Be very wary when the word “Havard” is used – misleading information coming up! For example - claims like Harvard study shows “exposing youngsters to fluoride could lead to brain damage and reduced IQ.”  Or a Havard paper “looked at 27 studies on children exposed to fluoride in drinking water in China, which on average resulted in a loss of seven IQ points.”

For the story behind these “Harvard studies” have a look at  Quality and selection counts in fluoride research and Repeating bad science on fluoride.


“5. Periodically resurrect dead debates that you lostshined up to look new and scary for a new cohort of anxious folk and make claims of a coverup, despite the fact that the allegations you’re resurrecting have been addressed and debunked again and again.”


Rubber_DuckyBoy does that happen on the fluoride issue. Sceptics call these stories “rubber ducks” It doesn’t matter haw often these fallacious claims get knocked over they continue to resurface – very often used by the same people.

So much for integrity.


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Pseudoscience in your supermarket

pseudoscience1

Image credit: Blueollie

This article by Michael Schulson in the Daily Beast struck a chord with me - Whole Foods: America’s Temple of Pseudoscience. Possibly because I have spent far too much time debating  anti-fluoride activists. But the experience has certainly made me very aware the pseudoscience  extends a lot further than creationism and climate change denial. That’s the point Michael makes:

“you don’t have to schlep all the way to Kentucky in order to visit America’s greatest shrine to pseudoscience. In fact, that shrine is a 15-minute trip away from most American urbanites.

I’m talking, of course, about Whole Foods Market. From the probiotics aisle to the vaguely ridiculous Organic Integrity outreach effort (more on that later), Whole Foods has all the ingredients necessary to give Richard Dawkins nightmares. And if you want a sense of how weird, and how fraught, the relationship between science, politics, and commerce is in our modern world, then there’s really no better place to go. Because anti-science isn’t just a religious, conservative phenomenon—and the way in which it crosses cultural lines can tell us a lot about why places like the Creation Museum inspire so much rage, while places like Whole Foods don’t.”

I have found that in very many cases if you scratch an anti-fluoridationist or anti-vaccinationists you will find a food faddist. Often a dogmatic food faddist.

Schulson makes the point that a lot of food faddism is pseudoscience – but it is a pseudoscience which seems far more acceptable, even to intelligent people, than what we usually think of as pseudoscience:

“there’s a lot in your average Whole Foods that’s resolutely pseudoscientific. The homeopathy section has plenty of Latin words and mathematical terms, but many of its remedies are so diluted that, statistically speaking, they may not contain a single molecule of the substance they purport to deliver. The book section—yep, Whole Foods sells books—boasts many M.D.’s among its authors, along with titles like The Coconut Oil Miracle and Herbal Medicine, Healing, and Cancer, which was written by a theologian and based on what the author calls the Eclectic Triphasic Medical System.”

We all know people who get sucked in by this talk – maybe many of us get sucked in a bit ourselves. Perhaps there is a bit of food faddism in all of us. And isn’t this sort of thing harmless – if it makes you happy and doesn’t hurt anyone else, why bother?

But I think Schulson has a point when he writes:

“The danger is when these ideas get tied up with other, more politically muscular ideologies. Creationism often does, of course—that’s when we should worry. But as vaccine skeptics start to prompt public health crises, and GMO opponents block projects that could save lives in the developing world, it’s fair to ask how much we can disentangle Whole Foods’ pseudoscientific wares from very real, very worrying antiscientific outbursts.”

For some people it is not far from a food fad to chemo-phobia. Start buying sea salt because it is advertised as “chemical free” and it is easy to get sucked into ideas that anything is bad because it contains “chemicals.” “Chemical” becomes a bad word – and “natural” a good one.

In my article Who is funding anti-fluoridation High Court action?  I described how the NZ Health Trust, the organisation behind the recent High Court action attempting to rule fluoridation illegal, is a lobby group for the natural supplement and health practitioner industry. I described their court action as that of a corporate lobby group attempting to stop a public health policy.

One of my critics actually made the point that I was wrong. An industry selling “natural” health products could not be described as corporate because of the word “natural!”

Words like “chemical” and “natural’ can be emotionally laden for many people and this can make them susceptible to other pseudoscientific ideas.

That is what I have found with many people I have debated. Their emotional or ideological committment to food fads like “organic” food and coconut oil treatments often goes together with opposition to fluoridation and vaccination. With many of them it seems to lead to conspiracy theories like depopulation and chemtrails.

To me, that is the message of the poster above.

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Repeating bad science on fluoride

Anti-fluoride propagandists have been trumpetting a new “peer reviewed” scientific paper in their campaign against fluoride. Most of them don’t seem to realise that the claim is not new – just a re-presentation of claims from a paper they already promote ad nuseam (the Harvard study – see Quality and selection counts in fluoride research). Then again, if they did know – would that stop them from such double dipping for their “evidence?”

It’s the old  “fluoride decreases chidren’s IQ” claim. It’s already resulted in a host of claims on blogs, facebook and Twitter and will no doubt produce more in the future. We are sure to see more tweets like these:

SusieOMG (@OmgSusie)
Children Exposed to Brain-Harming Chemicals Fluoride from Drinking Water Can Contribute to a Seven-Point Drop IQ” shar.es/FfXNn
Chad Kanera (@chadkanera)
@RT_com: Children exposed to more brain-damaging chemicals than scientists thought shrd..by/sYrtNq#fluoride is one.

It started with a press release from the Harvard School of Public Health - Growing number of chemicals linked with brain disorders in children. This promoted a paper which went on-line  less than a week ago - Grandjean & Landrigan (2014) The Lancet Neurology, 13(3) 330 – 338, March 2014. Neurobehavioural effects of developmental toxicity.

On the surface – just another paper reviewing evidence for harmful effects of industrial chemicals on child development.

The paper contains only one reference to fluoride – a shonky reference at that (see below) but this ensures that even though main stream media reports mostly didn’t mention fluoride the anti-fluoride brigade are promoting any and every report as if they did.

What do they say about fluoride – and why?

Here is the only mention of fluoride:

“A meta-analysis of 27 cross-sectional studies of children exposed to fl uoride in drinking water, mainly from China, suggests an average IQ decrement of about seven points in children exposed to raised fluoride concentrations.44 Confounding from other substances seemed unlikely in most of these studies. Further characterisation of the dose–response association would be desirable.”

Their sole reference – 44:

Choi, AL; Sun, G; Zhang, Y; Grandjean, P. Developmental fluoride neurotoxicity: a systematic review and meta-analysis. Environ Health Perspect 2012; 120: 1362–68.

Yes, its the paper that get’s the most tweeting, facebooking and blogging from anti-fluoride activists – the paper I analysed in Quality and selection counts in fluoride research. The review that based its conclusion on a few less than randonmnly selected poor quality papers.

Some of the mainstream reports are awake to problems with this new paper.

“In Chemicals erode child IQ: disputed study Health Hub wrote:

“Other experts, however, said the paper had limitations and was based on an array of previously published surveys of varying reliability.

“Because the paper lacks rigour, it is impossible to assess the validity of the authors’ claims, many of which seem highly speculative,” said David Coggon of the University of Southampton’s Lifecourse Epidemiology Unit.

“The conclusions of more focused and thorough reviews have been less alarming,” he said.

Others said autism, ADHD, cerebral palsy and dyslexia have not been definitively associated with industrial chemical exposure.

As for fluoride:

“In comments prepared by the Science Media Centre, epidemiologist Jean Golding of the University of Bristol accused the pair [Grandjean and Landrigan] of issuing scare statements.

“To implicate high fluoride, which they quote as one of the new chemicals… they quote only one paper; this only compares the mean IQs of children in villages with different levels of fluoride, with no allowance made for any other differences, and no actual measurement of fluoride in individual children and comparison with their IQs. This is not good evidence.””

Another poor quality paper?

Attentive readers may notice that Philippe Grandjean is senior author on both this current paper, and the review mentioned in Quality and selection counts in fluoride research.

Warning signals – here is an author relying excusively on his own work to draw a conclusion that fluoride has been confirmed to be detrimental to child IQ! What’s more, his qualifications about confounding factor have dissapeared in the 18 months between the two papers. A case of double dipping his data and removing qualifications second time around.

In the first paper,  Choi et al (2012), Developmental fluoride neurotoxicity: A systematic review and meta-analysis, they wrote:

Still, each of the articles reviewed had deficiencies, in some cases rather serious ones, that limit the conclusions that can be drawn. However, most deficiencies relate to the reporting of where key information was missing. The fact that some aspects of the study were not reported limits the extent to which the available reports allow a firm conclusion. Some methodological limitations were also noted.”

and

“most reports were fairly brief and complete information on covariates was not available,”

On other possible factors possibly influencing IQ they wrote:

“Information on the child’s sex and parental education were not reported in > 80% of the studies, and only 7% of the studies reported household income. These variables were therefore not included in the models.”

and

“Although official reports of lead concentrations in the study villages in China were not available,”

In fact the only other factors considered were year of publication and mean age of the study children! All those qualifications above were thrown away in the intervening period and in Grandjean & Landrigan (2014) Neurobehavioural effects of developmental toxicity he claims:

“Confounding from other substances seemed unlikely in most of these studies.

Frankly I call that misleading – especially as he lists fluoride as a “newly identified “industrial chemical known to cause neuorotoxicity!” I don’t have the expertise to comment on the other chemicals he claims neurotoxic but this example makes me really suspicious. I could not rely on this paper with any confidence as a source of information on chemicaltoxicity.


Note: The American Council on Science and Health went further in their criticisms of Grandjean and Landrigan’s paper than other commenters seem to have. In the article Upholding its tradition, a new Lancet piece on chemicals aims to scare rather than inform they question the authors’ credibility in toxicology. Instead they are:

“experts in the subject of trying to scare parents and the media about remote or hypothetical chemical threats. In this case, they wave the skull-and-crossbones banner of a “pandemic of developmental neurotoxicity.”  If they hoped to garner media attention — and they surely did — they succeeded beyond expectations: fright is in the air.”

Their Executive Director and Medical Director Dr Gil Ross says of the paper:

“This piece in essence is simply a call for the precautionary principle: if there is ‘concern’ about a chemical — or substance, or behavior — then ban or restrict it until/unless it can be proven ‘safe.’ But when applied to the tens of thousands of chemicals in our environment, our commerce, and our consumer products, if applied as these authors demand, it would require a complete abandonment of our way of life, period. They don’t seem to care, or even take notice. But why should they: they got what they wanted, publicity and scare-mongering adherents.”

Actually, his comments on the journal, The Lancet, weren’t too complimentary either.

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Quality and selection counts in fluoride research

I think the paper most quoted by anti-fluoridation activists must be Choi et al (2012), Developmental fluoride neurotoxicity: A systematic review and meta-analysis. I say quoted but, I suspect, not read. It is always coming up in articles on natural health web sites and continually thrown into blog and Facebook discussions. Often as a link without explanation.

It is also heavily promoted on Twitter. The same tweet is often sent from the same account daily, or more often. Here are examples.

Harvard Study: #Fluoride Lowers Children’s Intelligence By Seven IQ Points
davidicke.com/headlines/harv…
Harvard Study Confirms Fluoride Reduces Children’s IQ huff.to/111fe5o via @HealthyLiving
Harvard Study Confirms Fluoride Reduces Children’s IQ: articles.mercola.com/sites/articles…

The paper also gets a lot of mention when anti-fluoride activists petition local bodies to prevent or stop fluoridation. It was one of the papers that had a big effect on the Hamilton City Council during the hearings they held last year (see When politicians and bureaucrats decide the science).

I recently reread the paper – this time paying special attention to the selection and quality of the papers reviewed. I think both of these are important to anyone attempting to understand the significance of this review.

Selection

Choi et al (2012) selected 27 papers for their review. Their selection was clearly not random – 25 of these are Chinese studies with 2 Iranian. Very few of these papers are directly available to western readers. One of the Iranian papers has an English abstract and 3 of the Chinese studies were published in English (guess which journal – you are right – Fluoride). 

The authors do not give any details of translation of the papers but 8 of them seem to have been translated under the auspices of Paul Connett’s Fluoride Alert (FAN) activist group (FAN describes them as the “FAN English translation”). Copyrights for these English translations are held by the International Society for Fluoride Research (ISFR) and included in their journal Fluoride. They are also available on FAN. (It is sort of difficult to locate the boundaries between FAN, ISFR and Fluoride. And did you know the ISFR has charity status in New Zealand. Yes, as taxpayers we are subsidsing them through their tax exemption!).

The authors acknowledge the reviewed studies were selected and give several reasons:

1: Studies from rural China had not been included in earlier reviews:

“We specifically targeted studies carried out in rural China that have not been widely disseminated, thus complementing the studies that have been included in previous reviews and risk assessment reports.”

2: High fluoride concentrations in drinking water are not common in the west:

“Opportunities for epidemiological studies depend on the existence of comparable population groups exposed to different levels of fluoride from drinking water. Such circumstances are difficult to find in many industrialized countries, because fluoride concentrations in community water are usually no higher than 1 mg/L, even when fluoride is added to water supplies as a public health measure to reduce tooth decay.”

Well, I can understand the logic behind that selection – provided readers don’t think they are seeing a balanced, representative review of all the existing literature. And the reasons given for this selection makes nonsense of Paul Connett’s charge that the lack of material in the industrialised countries indicates at least an unwillingness to research problems or at worst a conspiracy not to do the research and/or hide the results.

Quality

Here I will just take the size of the reviewed reports as a possible indicator of their quality. Not that I am against short papers, far from it. But in this cases most of the papers were very short - basically because they reported only a simple relationship found between IQ and fluoride in drinking water. Very few papers consider confounding factors like family education, schooling, breast-feeding, etc. Factors known to influence IQ. Nor did they discuss their results in any depth.

The authors acknowledge the brevity of the reports reviewed:

“In regard to developmental neurotoxicity, much information has in fact been published, although mainly as short reports in Chinese that have not been available to most expert committees.”

And:

“Although most reports were fairly brief and complete information on covariates was not available, the results tended to support the potential for fluoride-mediated developmental neurotoxicity at relatively high levels of exposure in some studies.”

The histogram below gives an idea of the size of these reports – obviously some were extremely short –  19 of the 26 considered were of 3 pages or less!

Choi-paper

Another reason for brevity is that most papers give hardly any discussion, let alone critical assessment, of the reported results. I wonder if this is because of the well-known problem of excessive levels of fluoride in many Chinese well waters and the associated incidence of dental and bone fluorosis. Perhaps this encourages researchers to simply consider fluoride as a factor in other problems when we might think it more rational to look at factors traditionally related to IQ. Like education and breastfeeding.

Even Paul Connett has conceded the poor quality of many of the studies considered in this review (while of course still scare-mongering that fluoridation is somehow going to make us all dumb). The authors of the study itself warned their paper was not relevant to the fluoridation issue (see Harvard scientists: Data on fluoride, IQ not applicable in U.S):

“Two of the scientists who compiled the Harvard study on fluoride said it really doesn’t address the safety of fluoridation levels typical of American drinking water.

“These results do not allow us to make any judgment regarding possible levels of risk at levels of exposure typical for water fluoridation in the U.S.,” the researchers said in an e-mail response to questions from The Eagle. “On the other hand, neither can it be concluded that no risk is present.”

The researchers noted that the fluoride levels they studied were much higher than what is found in fluoridated water in the United States and recommended “further research to clarify what role fluoride exposure levels may play in possible adverse effects on brain development, so that future risk assessments can properly take into regard this possible hazard.””

I guess this paper, and its continual promotion, must impress many anti-fluoridation activists and even some local body councillers and staff. But scientists and other experts familair with the subject are not so impressed.  The NZ National Fluoridation Information service last year reviewed  literature on possible effects of fluoridation on IQ (see A review of recent literature on potential effects of CWF programmes on Neurological ):

“The available evidence raises the possibility that high levels of fluoride in drinking water may have subtle effects on children’s IQ. However all of these studies have limitations in design and analysis, a clear dose-response relationship between DWFCs and assessed IQ are often not evident. The study authors are frequently very cautious in their comments, and several noted that any indicated negative effect applied only to high DWFCs. An hypothesis of fluoride neurotoxicity would also be supported by some experimental animal studies, however the great majority of these have only considered high fluoride intakes.
However collectively the data described are not robust enough to draw a firm conclusion that high fluoride levels in drinking water supplies contribute to retarded development of children’s brains. Also there is no clear evidence to suggest an adverse effect on IQ at lower fluoride intakes such as that likely to occur in New Zealand, where fluoridated water supplies contain fluoride in the 0.7 to 1.0 mg/L range.”

Since then a local New Zealand study has failed to find any relationship between fluoridation and IQ (see Dunedin fluoride-IQ study finds no ill-effect). The study did find a positive influence of education and breast feeding on IQ though – just as we would expect.

In a typical sour grapes comment Paul Connett, who was told of this research by a reporter, quipped “rather convenient.”

Confirmation bias in action! I guess he won’t be promoting the New Zealand research in the way he does the poor quality research in the Choi et al (2012) review.

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