Does community water fluoridation reduce diabetes prevalence?

diabetes

Maybe community water fluoridation reduces the prevalence of diabetes?

You will be seeing headlines claiming a link between community water fluoridation (CWF) and diabetes. Or even that fluoridation can predict an increase in the prevalence of diabetes. But they are misleading

These articles report results from a recently published study indicating that in the majority of situations CWF is linked to a decrease in diabetes prevalence. But many of these articles, and especially those from anti-fluoride activists are making opposite claims.

Why the confusion? Well, the study used modelling to relate a number of factors to the prevalence of diabetes. According to the model’s prediction CWF using fluorosilicic acid and sodium fluorosilicate is related to a decrease in diabetes prevalence. However, the saving clause for anti-fluoride activists is that the model predicts an increase in diabetes prevalence when the least common fluoridation chemical, sodium fluoride, is used.

A 1992 survey found that only 9% of the US population received water fluoridated with sodium fluoride – compared with 63% for fluorosilicic acid and 28% for sodium fluorosilicate. I got the latest figures from a fluoridation engineer at the US Center for Disease Control. The current figures are 75% for fluorosilicic acid, 13% for sodium fluorosilicate and 7% for sodium fluoride.

In New Zealand only on water treatment plant for a small community uses sodium fluoride.

So this subheading by the Fluoride Action Network (FAN) is completely  misleading – “Regression analyses suggest association between increases in consumption of fluoridated water and type 2 diabetes.” The only way anti-fluoride propagandists can make mileage out of this study is by deliberately ignoring the results indicated for over 90% of the population!

Perhaps supporters of CWF should be the ones reporting and promoting this study – arguing that CWF could reduce diabetes prevalence! However, I would not push that idea on the basis of a single report. This study has a number of deficiencies – and recommendations should not be based on individual cherry-picked studies anyway.

This is the paper reporting the study:

Fluegge, K. (2016). Community water fluoridation predicts increase in age-adjusted incidence and prevalence of diabetes in 22 states from 2005 and 2010. Journal of Water and Health.

Here are some of the problems I see with it.

Insufficient consideration of confounders

It is a modelling study looking for correlations between selected parameters. Such studies often suffer from little or no consideration of important confounders. Statistically significant correlations can disappear when such confounders are later included. For example, consider my criticism of the Malin and Till (2015) ADHD study – see ADHD linked to elevation not fluoridation and ADHD link to fluoridation claim undermined again.

Fluegge included obesity prevalence and leisure time physical inactivity as confounders but more could have been considered.  One that sticks out like a sore thumb to me is the community size. It could be that the sodium fluoride data he used could be acting as a proxy for community size as these days sodium fluoride is usually only considered for small water treatment plants.

Adjustment of fluoride exposure data

Fluegge compared his model prediction for diabetes prevalence using two different measurements of fluoride exposure – drinking water fluoride concentration (ppm) and an adjusted estimate of fluoride intake (mg/day). His estimation was made from per capita domestic water deliveries per county. I find this questionable as the proportion of water consumed will vary by location where there are different requirements for things like lawn and garden watering, car washing, swimming pools etc.

Whereas the drinking water fluoride concentration showed a negative correlation with diabetes prevalence (the prevalence decreased with increasing fluoride concentration), the adjusted exposure values showed a positive correlation (the prevalence increased with increasing fluoride concentration). He declared the second correlation more “robust” but his reasons seem more related to confirmation bias than any proper analysis.

Confused discussion

Fluegge seems completely unaware that sodium fluoride is now only rarely used as a fluoridating chemical. He even suggests a possible policy outcome of his research could be switching from sodium fluoride to fluorosilicic acid!

He refers to Hirzy et al. (2013) claiming it showed cost savings from using sodium fluoride but critiques Hirzy for not including consideration of effects on diabetes prevalence. He seems completely unaware that Hirzy’s paper was discredited and he had to withdraw its claims about cost savings.

This suggests to me that Fluegge is not familiar with fluoridation research. In fact, his very brief publication history indicates his interest is more associated with cherry-picking various health measures to find fault with by using statistics and modelling.

How reliable is the modelling?

I have drawn attention to possible problems with poor selection of confounders and lack of familiarity with the fluoridation literature. But there may also be problems with the modelling methods used.

I do not have the modelling skills or time to delve into his model in any depth but note there has been some controversy about another modelling paper he was involved in.

He co-authored a paper with his brother claiming a link between glyphosate and ADHD. This created some controversy because it was rejected by the journal and then published by mistake. So the journal had to retract the paper. You can read about it at Retraction Watch – A mess: PLOS mistakenly publishes rejected ADHD-herbicide paper, retracts it.

The paper was rejected because it did not satisfy the standards of experimental and statistical analysis required, or describe these in enough detail. Also because the conclusions were not presented in an proper way or supported by the data.

OK, we should not discredit future work because an earlier paper was rejected, even for the given reasons. Authors can learn from their mistakes. But it does ring warning bells. With this history, I would prefer a deeper critique of the methods used and the reliability of his conclusions.

These questions just underline my warning that one should never base policies, or final interpretations, on single papers – especially cherry-picked ones. Conclusions should be based on a more complete reading of the scientific literature.

Conclusions

So, always take headlines with a grain of salt. In this case they will be completely misleading – especially if promoted by anti-fluoride activists.

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“Filtering” out fluoride

filter TWBTFLPB1

Systems for removing fluoide from tap water can cost less than $300

Many anti-fluoride campaigners and their sympathisers use “filters” to remove fluoride from their tap water. Despite this, they will often claim the procedure is “too expensive” for the ordinary person – or that it is ineffective.

Fluoride Free Nelson (FFN) combined both reasons in this exchange on their Facebook page.

fluoride size

But she is wrong on both counts. Suitable water filters can be relatively cheap (just do an on-line search  to check this out) and they just do not work by filtering out particles. The argument that fluoride “is so small most filters do not remove it at all” is naive. FFN does not understand how these systems work and her advice is completely unreliable.

Firstly, The word “filter” is commonly used but is technically not correct for “filters” that remove fluoride. Filtration is usually understood to involve removing particulate matter, and not soluble ions. The actual mechanism of fluoride removal is not by filtration of particles.

Yes, some “filters” do not work with fluoride – because they are not intended to. Activated charcoal is great for removing organic matter and tastes – but is not mean to remove anions like fluoride.

Apart from distillation, there are three ways for the ordinary consumer to remove fluoride and similar anions from tap water – anion exchange, surface adsorption and reverse osmosis. Here is a brief description of each method but readers can also refer to a useful local report:

National Fluoride Information Service (2012). Household water treatment systems for fluoride removal.

Anion exchange

This involves attraction of negatively charged anions like fluoride by positively charged surfaces. Water is passed through a bed of anion exchange material which has positive charges on its surface balanced by negatively charged anions like chloride (Cl) or hydroxide (OH).

Anion exchanger

Anion exchange particle. Positive surface charges are balanced by negatively charged ions.

Anions like fluoride in the tap water replace the existing charge-balancing anions on the exchanger. For example:

Exchange

Fluoride anion in tap water replace chloride anions on the surface of the anion exchanger.

Of course, these anion exchange cartridges eventually become saturated with fluoride or other anions being removed, and their efficiency drops. They are then replaced or recharged by flushing with the proper salt solution.

Surface adsorption

Interaction of fluoride anions and anion exchangers is basically a physical electrostatic one. But some filters rely on a chemical interaction where the fluoride anion reacts with the surface to form a chemical bond. Absorbents like bone char and alumina are common.

Bone char is made from cow bones and is a high surface area, porous calcium phosphate (apatite) providing active calcium for reaction with fluoride. Alumina provides a surface containing active aluminium which reacts with fluoride.

The chemical reactions occurring at the surface of these materials are of the form:

surface reaction

 

alumina F

Schematic of a water filter using alumina. Source: National Fluoridation Information Service.

The efficiency of both the anion exchange and surface adsorption methods can be improved by the way the filter is set up, the use of pre-filters, etc. And by regular recharging or replacement of cartridges.

Reverse osmosis

This relies on the ability of certain semi-permeable membranes to allow transport of water molecules but not ions like fluoride. So much for the naive concept that fluoride anions are too small to be filtered out of water.

It gets its name from the phenomena of osmosis which is probably familiar to most school children. Remember the experiment where pure water would pass through a membrane into a solution of sugar or salt – but water from the sugar or salt solution could not pass through into the pure water.

reverse osmosis 1

A semi-permeable membrane is a membrane that only allows through molecules of a certain size or smaller. The cell membranes of plants and animals are semi-permeable membranes, they let water molecules pass through while keeping out salts. Image credit: Solar-Powered Desalination Plants.

That creates an osmotic pressure. Reverse osmosis involves applying pressure to the sugar or salt solution (or whatever solution needs purifying). This causes pure water to flow through the membrane and the contaminants to stay behind providing a way of removing ions and molecules from the original water.

This schematic animation shows how reverse osmosis works in practice – although the membranes are rolled into cylinders to provide a greater surface area and increased efficiency.

reverse-osmosis-info-anim

Image credit: Reverse Osmosis Works

Consumers can use either of these methods to remove fluoride from tap water if they choose. While the equipment varies in price and sophistication, like any household appliance, relatively cheap systems are available.

These do work – just beware of claims made about low efficiency as often measurements are made with inappropriate “filters” like activated charcoal, or on systems that have been used for a time and need recharging.

That “freedom of choice” we keep hearing about is available and it is relatively cheap.

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Rio Olympics – what are those gold medals worth?

Medals

Well, that’s a surprise.

Those gold medals athletes are working hard for at the Rio Olympics are not pure gold – just gold-plated silver. In fact, the of the Rio Olympics gold medals is 98.8% silver and only 1.2 % gold.

According to Compound Interest (The Composition of the Rio Olympics Medals):

“Giving out pure gold medals would be financially crippling for the International Olympic Committee, so unsurprisingly some compromises are involved.”

Olympic gold medals haven’t been 100% gold since the 1912 Olympics in Stockholm.

“Since then, they’ve actually been mainly made of silver, with a gold plating on top to give them the expected appearance.”

“Compositions are variable at different Olympics; for example, at the London 2012 Olympics the gold medals consisted of gold (1%), silver (92%) and copper (7%). The value of the Rio Olympics gold medal, based on its metal composition, is approximately $565. Contrast this with their value if they were composed of pure gold: their current market value would be $21,200!”

Seems like a lot of work is involved in moving from second to first place just for a thin plating of Gold.

Still, it’s the thought that counts.

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Fluoridation – freedom of choice

forced water

This sort of image springs to mind when I see claims of forced fluoridation. Aren’t activists like “Forced Fluoridation Freedom Fighters” misrepresenting the real situation? Credit: FALUN DAFA MINGHUI.ORG – enacting claimed forced feeding in Chinese camp.

I think the “freedom of choice” argument is the most reasonable argument that anti-fluoride campaigners can use. Unfortunately for them, they usually only resort to it after their “science-based” arguments have been exposed as misleading or completely false. And even then, they usually present their “freedom of choice” argument in a naive and hostile way.

Have a look at this discussion from a local anti-fluoride Facebook page.

Freedom of choice

Here an opponent of community water fluoridation (CWF)  has declared she doesn’t want fluoridation – fair enough. She has also declared that she doesn’t drink fluoridated water. Also fair enough.

I would say she has exerted her freedom of choice – she doesn’t drink fluoridated water so must have made other arrangements.  And I am all for people exerting that right – even when they refuse to partake of a safe and effective social health policy.

But, in the next breath, she declares that she doesn’t have freedom of choice!

How does that work? It is as illogical as someone who votes on election day and then declares to everyone that they have been denied their right to vote!

“Forced fluoridation”

Some campaigners are even worse – declaring that they are being forced to drink fluoridated tap water!

That brings up a picture of someone being held down and water being forced down their throats. But we know that does not happen. Worse – we also know that most of the people making this claim do not even drink unfiltered tap water. The serious anti-fluoride person almost always uses a system to remove fluoride from the tap water, or finds a different source of water to consume.

When New Zealand councils provide “fluoride-free” public taps they get very little use. This suggests that the anti-fluoride campaigners (who may have lobbied for the taps) have already made their alternative arrangements (see Fluoridation: Freedom of choice – and responsibility).

So, I just don’t buy this naive “freedom of choice” argument – especially when presented in such aggressive ways. The fact is that where most social policies are concerned they are not forced on people – there is usually a chance for objectors to avoid the policy or use alternatives. No one is forced to send their kids to secular schools or to use free hospitals. There are alternatives in such cases.

A community’s freedom of choice

Anti-fluoride campaigners should just stop using this argument at the personal level – it just discredits them. Where it does have validity is at the community level. Because it is a controversial issue there is usually some level of public consultation when health authorities recommend the introduction of fluoridation.

The public has a right to feel aggrieved when they are denied their freedom of choice if decisions to start or stop fluoridation are just imposed on them by officials. But that “freedom of choice” argument is an argument for democracy – not an argument for or against a social health policy.

The freedom to deny others their freedom of choice

Unfortunately, many anti-fluoride campaigners will still advance their personal “freedom of choice” arguments even when decisions have been made democratically by using referenda or some other method of polling voters opinions. It’s like a voter who supported a minority party in a general election claiming their rights are being violated by the party or parties with the most votes actually got elected!

So what “freedom of choice” are these die-hard anti-fluoride campaigners really thinking about?

If they have already exerted their own personal freedom of choice by use of tap filters or alternative water supplies, and they have been given a chance to express their views or take part in a democratic referendum, what freedom do they think they have lost.

I can only conclude the freedom that really concerns them is their perceived freedom to prevent others from taking advantage off a safe and effective social health policy.

And that attitude is hardly democratic.

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Is water fluoridation better than salt fluoridation?

Salt

Discussion of fluoridation here concentrates on community water fluoridation. But some countries (parts of Europe, and Latin America, for example) fluoridate their salt instead of their water.  This could be for a number of reasons – the state of the water reticulation system, or political opposition to water fluoridation, etc.

The effectiveness of community water fluoridation in reducing tooth decay is well established by research, but there has been far less research on the effectiveness of salt fluoridation. Evidence suggests the effectiveness of the two fluoridation methods is similar but new research from Latin  America found water fluoridation significantly better than salt fluoridation.

It’s a very good study, large numbers of subjects and good consideration of possible confounders. But the authors themselves suggest their findings are more relevant to developing countries than developed countries with better oral health systems.

The paper is:

Fabruccini, A., Alves, L. S., Alvarez, L., Alvarez, R., Susin, C., & Maltz, M. (2016). Comparative effectiveness of water and salt community-based fluoridation methods in preventing dental caries among schoolchildren. Community Dentistry and Oral Epidemiology.

The researchers used data from survey of the oral health of 1528 twelve-year-olds in Porto Alegro, South Brazil  (water fluoridated) and 1154 twelve-year-olds in Montevideo, Uruguay (salt fluoridated). Diagnostic procedures were standardised and the data adjusted for gender, maternal education, school type, brushing frequency, use of dentifrice, professional fluoride application, access to dental services and consumption of soft drinks.

Caries prevalence and decayed missing and filled teeth (DMFT) were measured using standard WHO procedures, and modified WHO procedures (which also included noncavitated lesions).

The graphs below show the adjusted data for caries prevalence (%) and DMFT.
Caries water salt

DMFT water salt

Both caries prevalence and DMFT were significantly higher for children from salt-fluoridated Montevideo than similar children from water-fluoridated Porto Alegro.

Apparently this is the first study showing a statistically significant difference between water and salt fluoridated areas. Similar studies in Freiberg, Germany and Dublin, Ireland had shown no signficant differences. The larger sample sizes of the current study may have contributed to the difference. However, the authors also warn that the different situations may also be a factor.

Developing countries have higher prevalence of caries and poorer access to others sources of fluoride than developed countries. Whereas water fluoridation reaches the whole population fluoridated salt may not have such a regular use. In Uruguay the salt fluoridation programme is limited to salt for domestic use. It does not cover public and private canteens, restaurants and bakeries (which the WHO recommends).

So, an interesting study with a clear result – but one that should not be cherry picked to confirm a bias. It indicates community water fluoridation will probably be more effective than salt fluoridation in developing countries – especially if a salt fluoridation programme is not complete. But this should not be used to argue against a good salt fluoridation programme in developed countries.

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Ethics and the doping scandal – a response to Guest Work

Rodchenkov

Grigory Rodchenkov, Russia’s sacked anti-doping lab director. Considered a criminal in Russia and a “whistle blower” in USA. Credit: Emily Berl for The New York Times

International Olympic Committee (IOC) decisions about participation of athletes from the Russian Federation in the Rio Olympics have brought both criticism and support – from the political as well as the sporting communities.

The issues of sports doping, the responsibilities and actions of sporting bodies and the political context and factors all need discussing. So I am pleased to see a Guest Work blog post at SciBlogs from Ian Culpan discussing the ethical questions involved (see Ethics, Doping the Olympics and Russia).

But I think the article missed important ethical considerations and I do not think the issue can properly be discussed without these. To me the following ethical and legal principles, which Ian did not discuss, are central:

  1. Proper testing of claims and evidence;
  2. Presumption of innocence until proven guilty;
  3. Inadmissibility of collective punishment
  4. Avoiding direct or implied political direction in decision-making.

A brief background

The Russian Federation does have a problem with sports doping. It should be in everyone’s interests for this to be dealt with. Interestingly, the Russian national officials and politicians do appear to be cooperating with international sports bodies. They have transferred testing of athletes to non-Russian laboratories. Officials (including the deputy Minister of Sport) implicated by Richard McLaren’s World Anti-Doping Authority (WADA) commissioned report have been suspended pending investigation. The President himself has urged officials not to react defensively but to deal with the problem.

Grigory Rodchenkov, the former head of Moscow’s anti-doping laboratory, was a key figure in the current scandal. He was taking bribes to supply illegal drugs to athletes and (apparently) to enable falsification of test results. When he was sacked and criminal proceeding taken against him he fled to the US. Now treated as a “whistle blower” instead of a criminal he made charges implicating higher officials in the doping scandal. His claims made in a May New York Times article (see Russian Doctor Explains How He Helped Beat Doping Tests at the Sochi Olympics) sparked the decision of the WADA to commission the McLaren report.

Richard McLaren’s report effectively supports Rodchenkov’s claims and found Rodchenkov to be trustworthy. But this appears to be McLaren’s opinion, rather than a conclusion based on testing of claims and evidence. There was no attempt to interview officials in the Russian Federation which is surely required for a proper evaluation. And results of the “forensic testing” commissioned by McLaren (DNA data and testing the methods for removing and replacing seals on sample vials and scratches on the vials) are not even included in the report. We are asked simply to accept his judgment on these.

I agree, the time limit of 57 days may well be to blame but in the absence of presentation of the forensic evidence, relying on the claims of an obvious criminal and lack of any consideration of evidence from Russian officials I think Culpan’s judgment the report “seems to contain irrefutable evidence” is just not valid. To interpret a situation where there had been no opportunity given to refute as meaning the evidence was “irrefutable” is hardly fair. Or ethical.

The reliability of the McLaren report and the information he gathered appears to be unravelling – according to articles in The Australian (unfortunately behind a pay wall but see WADA ‘sexed up’ anti-Russia case, implicated clean athletes – Australian media, citing officials). These claim the president of the Australian Olympic Committee, John Coates, who is also an IOC vice president, wrote to Australia’s Health Minister Susan Ley, saying that the IOC had a “lack of confidence in WADA.” There are also problems with the list of “implicated” Russian athletes not named in McLaren’s report but provided to the sporting federations by McLaren. The Australian cites a senior sports official as saying “We were asked to make a judgment about Russian competitors based on McLaren’s report but without having any of the detail to understand the significance of them being named.”

For Richard McLaren’s description and defence of his work see ‘No time to ask Russia’s opinion, I had enough evidence anyway’ – WADA doping report author to RT

Unwarranted judgments are easily made in the context of the current geopolitical struggle and the resulting information war. They can have consequences which are hardly ethical and I think Richard McLaren himself is concerned about this. He said recently:

“The focus has been completely lost and the discussion is not about the Russian labs and Sochi Olympic Games, which was under the direction of the IOC.”

“But what is going on is a hunt for people supposed to be doping but that was never part of my work, although it is starting to (become) so.’’

“My reporting on the state-based system has turned into a pursuit of individual athletes.’’

This treatment of individual Russian athletes, which was described as being like a “Stalinist witch hunt” by one commentator, is what concerns me. I think this raises ethical issues.

Presumption of innocence

This seems so fundamental to our legal (and ethical) system I just cannot see why critics of the IOC have been so prepared to ignore it – or worse, knowingly violate the principle.

Many Russian athletes who have never had a positive drug test have been denied the opportunity to participate in the Rio Olympics. The criteria applied to other Russian athletes has been much harsher than for other nations with sometimes impossible demands being made to prove a long history of clean test results. While athletes from other nations who have been found guilty in the past of doping and “served their time” in suspension are able to compete this is not the case for Russian athletes.

These clean athletes justifiably ask “Why me?” Russian sports fans may well be thoroughly disappointed by this scandal and particularly with athletes and officials who have found to be guilty of doping. But you can understand they are also angry at the unfairness of such discriminatory and unethical judgments made against their clean athletes.

Collective punishment

Punishing clean athletes for the crimes of those who used doping is simply collective punishment. It brings to mind the actions of Nazi occupiers in Eastern Europe who killed innocent villagers (or in some cases killed entire villages) as collective punishment for the actions of partisans. For the life of me, I cannot see how those critics who believe that the entire Russian Olympic Team should have been punished for the (as yet unproven) crimes of some officials consider they occupy the “moral high ground” as Culpan appears to argue.

Not that collective punishment is anything new when it comes the history of staging important international events by the Russian Federation (and the previous USSR). In the 1980s we saw boycotts of the Moscow and San Francisco Olympics. Attempts at collective punishment of entire nations because of disagreements in the international political arena.

There were attempts to inject political issues into the Sochi Olympics, and even promoting the idea of boycotts,  and who seriously doubts that there will be political attempts to harm, or even prevent, the 2018 World Football Cup in the Russian Federation.

Yet, international sporting and cultural events offer great opportunities to encourage goodwill and understanding between nations. They should not be used as weapons in the geopolitical struggle – because that, in turn, only enhances that struggle and harms peace.

Political motivations can prevent a solution

Fortunately, the IOC avoided a blanket ban on athletes from the Russian Federation, despite coming under political pressure to do so. The consequences of such an unprecedented and radical step may have been unpredictable but include a possible break-up of the Olympic movement. This would not have solved the sports doping problem.

As things stand there is now room for progress in a proper investigation of the charges made by Rodchenkov – particularly those suggesting the involvement of state officials. Such serious charges, made by someone facing criminal action, should not be left as they are without a proper balanced investigation. And this investigation must involve officials and legal bodies from the Russian Federation. It is hardly surprising that McLaren’s report is now being described as unfinished. The Australian articles reported IOC spokesman Mark Adams as saying:

“To have someone who didn’t (commit) a competition doping offence but was counted as such is a very dangerous thing. We encourage a full report by Professor McLaren before we make any full and frank ­decisions.’’”

Surely such a proper investigation will have more chance of eliminating Russian sports doping and corruption than external allegations primarily based on claims made by someone fleeing criminal proceedings.

Finally, we should not allow the current concentration on Russian sports doping to fool us into thinking it is only, or even primarily, a Russian problem. The fact is that sports doping is world-wide and there is plenty of evidence that international sporting bodies themselves are not free from corruption.

I presented the most recent official data from WADA n my article Quantifying the problem of international sports doping. This showed that the proportion of positive doping tests for Russian athletes was just less than average for the whole world. More importantly, there are a number of nations with a higher proportion of positive doping tests than the Russian Federation – including India, France, Belgium, Mexico and Turkey.

proportion

Yes, the data was for 2014. It did not (could not) cover the current Russian doping scandal or the McLaren report. But let’s not rely on an unethical presumption of guilt to discredit the data.

Let’s not allow geopolitical differences and prejudices get in the way of battling the sports doping problem.

And let’s not allow such differences to lead us to ignore important ethical principles.

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Being better informed – unexpected advice from The Guardian

guardianKillingTruthLogo

How often does The Guardian attack truth instead of presenting it? Credit: “The Guardian” Blaming Trump for Racism in America

This opinion piece by Piers Robinson in The Guardian surprised me – and then it pleased me – Russian news may be biased – but so is much western media.

Surprised me because, of late, The Guardian has been shockingly one-sided. Particularly in its treatment of Russian politics, nationally and internationally. Unfortunately doesn’t include any self criticisms – that would have been nice but let’s be thankful for small steps. The fact the article appeared may mean some people at The Guardian recognised the their paper’s toeing of the “party line” on these issues may have been counterproductive.  Alexander Mercouris goes so far as to pose the question:

“Could it possibly be that the new editor – Katherine Viner – does not share the obsessive anti-Russian mania that took hold at the Guardian under the preceding Rusbridger regime?”

Wouldn’t it be  nice if this opinion piece was providing notice of a new policy, and is not just a one-off – an aberration?

Pleased me because the article makes recommendations I fully agree with and have often advocated:

“The first step towards becoming more informed is to avoid seeing our governments and media as free from manipulation while demonising “foreign” governments and media as full of propagandistic lies.

The second step is to recognise that one can gain useful insights and information from a variety of news sources – including those that are derided as “propaganda” outlets: Russia Today, al-Jazeera and Press TV should certainly not be off-limits.”

Some commenters have attacked me here for daring to use “unapproved” sources or questioning the prevailing “official” attitudes. I have also often warned about the demonising of governments and politicians  which, unfortunately appears to drive the political thinking of many people.

The article is directed mainly at common media reaction in the UK to the Russian news outlet RT. This has always seemed to me a rather childish reaction to the success of a competitor. However, it has led to serious calls for clipping RTs wings, even somehow banning it. There have been similar, perhaps more serious, calls from US politicians.
The author says of these complaints:
“Whatever the accuracy, or lack thereof, of RT and whatever its actual impact on western audiences, one of the problems with these kinds of arguments is that they fall straight into the trap of presenting media that are aligned with official adversaries as inherently propagandistic and deceitful, while the output of “our” media is presumed to be objective and truthful. Moreover, the impression given is that our governments engage in truthful “public relations”, “strategic communication” and “public diplomacy” while the Russians lie through “propaganda”.”
And yet:
“Neither of these claims has significant academic support. A substantial body of research conducted over many decades highlights the proximity between western news media and their respective governments, especially in the realm of foreign affairs. For reasons that include overreliance on government officials as news sources, economic constraints, the imperatives of big business and good old-fashioned patriotism, mainstream western media frequently fail to meet democratic expectations regarding independence.”
It refers to a Manchester University study showing that “UK media coverage of the 2003 Iraq invasion . . . . found that most UK mainstream media performed to reinforce official views rather than to challenge them.” And the recent Chilcot report  describing how “Tony Blair had discussed how phases 1 and 2 of the “war on terror” would require a “dedicated tightly knit propaganda unit”.”
The article is certainly true in its assertion:
“These are confusing times for consumers of the news, and the issue of which media outlets should be trusted is as demanding and critical as ever. Given the level of conflict and potential conflict in the world today, plus pressing global issues regarding environmental crisis, poverty and resources, it is essential that people learn to navigate the media and defend themselves against manipulation.”
All the more reason to avoid bias – to avoid:
“seeing our governments and media as free from manipulation while demonising “foreign” governments and media as full of propagandistic lies.”
And especially to be open minded. To obtain:
“information from a variety of news sources – including those that are derided as “propaganda” outlets.”
Now, wouldn’t be nice if The Guardian followed this advice in future.

July ’16 – NZ blogs sitemeter ranking

There are about 300 blogs on the list, although I am weeding out those which are no longer active or have removed public access to sitemeters. (Let me know if I weed out yours by mistake or get your stats wrong).

Every month I get queries from people wanting their own blog included. I encourage and am happy to respond to queries but have prepared a list of frequently asked questions (FAQs) people can check out. Have a look at NZ Blog Rankings FAQ. This is particularly helpful to those wondering how to set up sitemeters. Please note, the system is automatic and relies on blogs having sitemeters which allow public access to the stats.

Here are the rankings of New Zealand blogs with publicly available statistics for July 2016. Ranking is by visit numbers. I have listed the blogs in the table below, together with monthly visits and page view numbers. Meanwhile, I am still keen to hear of any other blogs with publicly available sitemeter or visitor stats that I have missed. Contact me if you know of any or wish help adding publicly available stats to your bog.

You can see data for previous months at Blog Ranks

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Quantifying the problem of international sports doping

rio-olympics-logo

With the 2016 Olympics about to start the problem of sports doping is topical. Most attention  is concentrated on sports men and women from the Russian Federation.

The specifics of the current Russian doping scandal have yet to be sorted out. There has yet to be a proper investigation. But I thought it worth attempting to quantify the problem – and, in particular, illustrate that sports doping is not just a problem in the Russian Federation.

I have taken the latest official figures available. Released in February 2016 these are the international doping figures for 2014 and are published in the World Anti-Doping Agency (WADA) report “2014 Anti-doping Rule Violations (ADRVs) Report.” 

What do these data show?

Numbers of positive doping tests

Perhaps not surprising to the average reader the Russian Federation scores the largest number of positive tests. But perhaps, given the current news coverage, the surprise is that the numbers are not that great and not much greater than for other countries

Number of violations

But let’s put that into some sort of context

Number of doping tests

When we look at the number of doping test actually taken we find a very important factor. The total number of doping tests taken was much larger for the Russian Federation than for most other countries. So the higher number of positive tests is not so surprising. Do more tests and you will catch more violations.

Total numbers

Proportion of positive doping tests

This is a better way to compare the figures by nation. When we make that comparison the data for the Russian Federation is not that out of step with the rest of the world.

proportion

In fact, if we are going to point fingers we should be pointing them at other nations before we point them at the Russian Federation.

I decided to look at the data because of a Facebook post from Nina Kouprianova (see WADA sports doping stats sorted (not by me)) which showed that the Russian Federation was well down the list of nations guilty of sports doping – in fact, 19th.

Here is her table.

dopingThe Russian Federation scores lower than the average for the whole world – 1.05% of positive tests.

Some qualifications which should be obvious.

Before I get attacked for being “pro-Moscow” (yet again) I must mention a couple of factors.

1: Some positive tests for many countries were put aside by WADA after cases were further considered. However, I do not think this changes the main message of the table above. (The numbers are in the report if anyone wants to check this out).

2: The current attention to the doping problem in the Russian Federation concentrates on more recent cases where these is, as yet, no reliable data. In particular there is the revelation of criminal activity by the head of the Moscow testing laboratory. He has since fled the country and surfaced in the USA.

While the officials implicated by these revelations have been suspended or sacked and criminal investigations are underway it is not yet possible to get official numbers.

Finally, I don’t think anyone can justify sports doping – whatever the nationality of the person concerned.  It  must be fought against and guilty athletes and officials should be punished.

However, we should be careful of violating basic elements of justice. Collective punishment is the sort of thing the Nazis went in for – killing a whole village because one of their soldiers had been shot by a partisan.  It is shocking to hear politicians and sportspeople advocating such forms of punishment here.

We should not make clean athletes suffer for the acts of others who indulged in doping.

It seems to me these actions will not solve the problem of sports doing – only make it worse and introduce other worse problems.

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Dental health – it’s not all about fluoride

cross-section-of-tooth

Fluoride is not the only element involved in preventing decay. See Fluoridation – topical confusion  for a description of how fluoride, calcium and phosphate react at the tooth surface.

Fluoride is not the only factor in oral health. But it is generally the only element in drinking water considered for its effect on our teeth.

Drinking water fluoride benefits existing teeth by chemically reacting with the tooth surface. Involvement of fluoride in the apatite structure at the tooth surface helps prevent demineralisation, due to acid attack, and also encourages remineralisation – tooth enamel repair.

But fluoride is not the only chemical species in drinking water and food that promotes this reaction at the tooth surface. Calcium and phosphate must also be involved. (Bioapatites in teeth and bones are chemical compounds of calcium, phosphate and fluoride). However, these other ions have generally been neglected in studies of the effects of drinking water composition on dental health.

I recently came across a scientific paper which helps overcome this deficiency:

Bruvo, M., Ekstrand, K., Arvin, E., Spliid, H., Moe, D., Kirkeby, S., & Bardow, A. (2008). Optimal Drinking Water Composition for Caries Control in Populations. Journal of Dental Research, 87(4), 340–343.

It compared the dental health of Danish children with the most significant drinking water characteristics. Data for the decayed missing and filled tooth surfaces (DMF-S) of 15 year old schoolchildren were used.  The drinking water characteristics included the concentration of a range of cations and anions, organic carbon, hardness, pH, ionic strength and residue content.

Statistical analysis identified calcium and fluoride as having the major effect and the authors used their data to produce a model relating DMF-S to both calcium and fluoride. The figure below give some idea of predictions from this model.

Ca and F

The model explains about 45% of the variance – better than when fluoride is considered alone (Ekstrand et al., 2003 were able to explain 35% of the variance using fluoride alone).

Community water fluoridation is not used in Denmark but the natural concentration of fluoride in the drinking waters reported in this study ranged from 0.06 – 1.61 (mean 0.33) mg F/L. The concentration of calcium ranged from 31.4 – 162.3 (mean 83.5) mg Ca/L.

So, a result that is hardly surprising for chemists familiar with the surface chemistry of apatites. But it does suggest that perhaps health authorities should consider the calcium concentration of drinking waters as well as fluoride.

According to the authors optimal drinking water should contain medium concentrations of both ions – about 90 mg Ca/L and 0.75 mg F/L. I suspect our drinking water calcium concentrations in New Zealand tend to be lower than this.

Perhaps this is something to think about. And perhaps those anti-fluoride fanatics who use distillation or reverse osmosis to remove fluoride are also forgoing the oral health benefits of calcium. A case of throwing out two babies with the bath water.

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