Scientific cooperation despite political posturing

I find it heartening scientific cooperation continues (so far) despite all the political posturing going on down here over the Ukraine political crisis.

Here we see the arrival of Russian cosmonauts Alexander Skvortsov and Oleg Artemyev and NASA astronaut Steven Swanson at the  International Space Station (ISS). This brings the ISS to its full capacity of six people. The arriving astronauts were welcomed by three astronauts on board the ISS, Japan Aerospace Exploration Agency (JAXA) astronaut Koichi Wakata, NASA astronaut Rick Mastracchio and Russian cosmonaut Mikhail Tyurin.

Soyuz docks succesfully, astronauts meet

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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European border changes over 5000 years

Once you have reached a certain age border changes no longer seem unusual. I have certainly seen a few in my time. There have been a few videos floating around showing the large number of border changes in Europe over the last few hundred years.

But this video goes back even further – 5000 years.

Have a look at how things changes in Europe from 5000 BCE to 2013 CE

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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What makes something right or wrong?

Here is another of the  4 animated videos produced by the British Humanist Association. They are all narrated by Stephen Fry.

This one deals with aspects of morality – an important subject where the voice of non-theists is often ignored.

“What makes something right or wrong?” Narrated by Stephen Fry 

See: That’s Humanism: Four animated videos about Humanism narrated by Stephen Fry

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How do we know what is true?

The British Humanist Association has produced 4 animated videos explaining humanist ideas. They are all narrated by Stephen Fry

Here is one that particularly appealed to me - “How do we know what is true?.

See: That’s Humanism: Four animated videos about Humanism narrated by Stephen Fry

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Cherry-picking and ring-fencing the scientific literature

studytracker-ba

Don’t believe the advertising hype.

Anti-fluoride activists are promoting a “Study Tracker” which they see as a powerful weapon in their fight against fluoride. It is simply a search facility for their own database of articles – really Paul Connett’s database at Fluoride Alert.

So they can now search Connett’s database – big deal.

But why would anyone use this “study tracker?”  You certainly wouldn’t if you were at all interested in finding out what the current status of knowledge is with a particular area of fluoride research. You would use Google Scholar or one of the more specialised databases fo scientific papers. For example here are the results of a few searches I did using both the “Study Tracker” and the more easily accessible and useful Google Scholar.

Dental fluorosis prevalence

First – lets look at the prevalence of dental fluorosis in humans. The “Study Tracker” does not allow you to use your own search words so I just used theirs – “dental fluorosis,” prevalence, and “human study” (adding the word fluoride) for Google Scholar as well. (That inability to use one’s own search terms is already  handicapping a user).

Results – 16 references from the “Study Tracker” and 4440 references from Google Scholar (click on the images to go to the actual search results.

Dental fluorosis prevalence

16 references

Fluoride-Action-Network---S

4440 references

dental-fluorosis--fluoride-

Arterial calcification and heart disease

I wrote about the dishonest use of a research paper on this topic in Fluoride and heart disease – another myth. So using the words allowed by Connett’s “Study Tracker” – heart, arterial calcification, human study – I found 9 references using the “Study Tracker” and 5850 references using Google Scholar. (Again, click on the images to see the details).

Heart arterial calcification

references

Fluoride-Action-Network---S

5850 references

dental-fluorosis--fluoride-

So why use Connett’s “Study Tracker” when it produces such poor results and Google Scholar is more accessible? Here’s a couple of reasons I can think of:

  1. The cherry-picked database provided by Connett and his family. Activists make a lot of the 1500 references Connett has collected in his database – but that is infinitesimally small compared with the total available literature resulting from fluoride research. But if you were only interested in confirming your own bias, finding papers that you can use to support an anti-fluoride narrative, this “Study Tracker” removes the necessity to do your own cherry-picking.
  2. Unfamiliarity with the concept of literature searching. If you are not used to searching the scientific literature the “Study Tracker” may be the only method you have heard about.
  3. Desire to impress. Again, many activists want to give a “sciency” veneer to the material they produce. How better than to actually quote a scientific reference with journal details and a link?  In my experience most people with this motive don’t bother reading the paper to check that it says what they want it too. Most probably don’t even read the abstract! How else could organisations like the Fluoride Action Network of NZ quote a paper describing a proposed clinical procedure for determining risk of heart disease using a radioactive F isotope as “evidence” for fluoridation causing heart disease (see  Fluoride and heart disease – another myth)!
  4. Some people are happier wearing blinkers. After all, if your whole intention is confirmation bias (and anyway papers providing evidence that doesn’t support that bias are written by “industry shills) why should you even allow your eyes to see anything else? Much safer, and certainly less stressful, to stick with a cherry-picked database than look at all the literature available.

I think cherry-picking and confirmation bias a problems for all of us when searching the scientific literature. These are human failings. But this shouldn’t be encouraged.

The research accessible in published literature is immense and complicated. It should be approached intelligently and critically. One can’t do that using blinkers like the “Study Tracker”.

Unfortunately political activists are very often highly motivated in their use of scientific literature – so it is easy to see why this “Study Tracker” will appeal to most anti-fluoridation activists. But this approach is in direct conflict with the scientific ethos which at least encourages processes aimed at an objective approach.

Franky I see this “Study Tracker” as just another tool encouraging an opportunist use of scientific knowledge, encouraging confirmation bias and dishonesty in using this knowledge, and encouraging people to restrict their sources when looking for scientific support for their claims.

It is a form of ghettoisation of scientific knowledge. Users will only be encouraging their own ignorance, rather than knowledge.

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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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Graphic information in science

Former-Soviety-States-v2

Click image to enlarge.

No, I am not trying to start a debate on the Ukrainian situation (although it is interesting). Just that I came across this graphic presenting data on the post-Soviet economic development of the former Soviet countries. Ukraine does sort of stand out for its poor economic performance - a possible contributor to their present problems.

But what a great way of present a lot of information? I sometimes come across such good examples of graphic presentation in political and economic reports – but hardly ever in the “hard” sciences. Although I think some biological reports can have pretty good graphics.

Wouldn’t it be great if scientists used this sort of approach to graphic presentation in the papers and reports? Those dry old tables and line, bar and scatter graphs have their limitations.

Thanks to: Canadian International Council.

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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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