Darwin, sexual selection and Putin

Credit: RussiaFeed.

Must edge my way back in into blogging after a period of mourning. So here is something provocative.

Perhaps President Putin is “making Russia great again” in a way we haven’t thought of. Via Darwinian sexual selection?

If this song is anything to go by maybe Putin as a role model will lead to improvement in the Russian gene pool if women start preferring men with his moral and lifestyle characteristics.

Or perhaps his influence will operate more quickly by encouraging Russian men to smarten themselves up if they want to find a partner?

Is this yet another positive influence Putin has had on Russian life after the disastrous experiences of the criminal anarchy of the 1990s?

Or is it a sign that Putin has finally decided to run in next March’s Russian Presidential elections and this is his first campaign song?

Whatever – it’s a welcome (and tuneful) change from the usual demonisation of the man we get from our mainstream media. (And I expect to get from commenters here).

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Fluoridation: Open letter to Democrats for Social Credit

The only New Zealand political party opposing community water fluoridation relies on false information

The only political party in New Zealand campaigning against community water fluoridation is the Democrats for Social Credit. It is a minor party, nor represented in Parliament and of little influence. However, it does have connections with Fluoride Free NZ, the main anti-fluoride activist group, and its members have imposed anti-fluoridation policies on some groups they belong to. Two examples are Grey Power and the Hamilton Residents & Ratepayers Association – both of which presented anti-fluoride submissions to the recent parliamentary health committee hearings.

I wish to promote an open discussion with the Democrats for Social Credit about their anti-fluoridation policy so have sent them this Open Letter. If they are open to a good-faith discussion I am happy to provide space on this blog for an exchange of views on their policy.


David Trantor, Health Spokesperson for Democrats for Social Credit

Dear David Tranter,
Health Spokesman,
Democrats for Social Credit

You wrote an open letter to the Minister of Health critiquing the government’s policy on community water fluoridation (CWF) and posing some questions about dental health programmes, documented evidence relating to CWF and human rights aspects you consider relevant.

Here I take issue with some of your claims – particularly about dental health in Denmark and the scientific evidence supporting CWF. I believe the evidence does not support the anti-fluoridation policy of your party and your party should reconsider that policy.

If you believe my arguments here are mistaken or otherwise wish to defend the current anti-fluoride policy of your party I am open to a good-faith exchange of opinions and offer you the right of reply and the opportunity for a further discussion on this blog.

Natural fluoridation in Denmark

You point to the good dental health in Denmark and assert “they have never fluoridated their water.” This is true – but you ignore the fact that much of the Danish population benefits from natural levels of fluoride in their drinking water.

Unlike New Zealand parts of Denmark have drinking water fluoride concentrations similar to the optimum concentrations recommended for CWF. Map 1 from Kirkeskov et al., (2010) shows the distribution of different drinking water fluoride concentration ranges.  Map 2 shows the population distribution. We can see a significant fraction of the Danish population does have access to drinking water containing fluoride.

Map 1: Distribution of natural drinking water fluoride concentrations in Denmark. The town of Nexo is on the Baltic island of Bornholm – shown in the top left-hand rectangle.

Map 2: Population distribution in Denmark.

These natural levels of drinking water fluoride are beneficial to oral health in Denmark. Here is some data from Kirkeskov et al., (2010) illustrating this. The following graph compares the dental decay (numbers with more than 2 decayed, missing or filled teeth surfaces – dmfs) at various drinking water fluoride concentrations for 5 year-olds born in 1989 and 1999.

As we can see, the extent of decay declines with fluoride concentration.

There is a similar pattern for 15-year-olds born in 1979 and 1989. This figure shows the relative numbers with more than 2 decayed missing or filled teeth surfaces, DMFS, for 15-year-olds.

And the same pattern for 15-year-olds with more than 6 decayed, missing or filled tooth surfaces.

Danish dental health programmes

You refer to a “Nexux” programme and argue that this could be an alternative to CWF in New Zealand.

I think you are referring to the programme run in Nexo – a town on the east coast of the Baltic island of Bornholm, Denmark. It is a successful local dental health programme, but only one of several in Denmark. Nexo was in an area of very low socio-economic status and introduced a dental programme at the end of 1987 aimed at improving the dental health fo children.  Ekstrand & Christiansen, (2005) give this description of the programme:

“Since 1992, the program has been offered to children from the age of 8 months. It is based on three closely interrelated principles applied according to the individual child’s needs: (1) education of parents, children and adolescents in understanding dental caries as a localized disease, (2) intensive training in home-based plaque control and (3) early professional, non-operative intervention, including professional plaque removal, local application of 2% NaF and application of sealants. In the period when the children have erupting permanent first or second molars, the parents and children are instructed in using a tooth brushing technique specially designed for erupting molar teeth.”

As you can see it is a rather intensive programme and is not a Denmark-wide programme. It has been successful in Nexo, where 15-year-olds had DMFS (decayed, missing and filled tooth surfaces) values in 1986 (before introduction of the programme)  slightly higher than the Danish average. The equivalent values of DMFS for Nexo were the third lowest for all municipalities in 1993 and the lowest in 1999 (Ekstrand & Christiansen, 2005).

Elements of the Nexo programme will be used in other parts of Denmark, and in other countries. Especially where school-based programmes exist.

Incidentally, Map 1 indicates the concentration of natural fluoride in the drinking water on the island where Nexo is situated is similar to that recommended for community water fluoridation. Ekstrand et al., (2005) reports that the fluoride concentration in the Nexo drinking water is 0.8 mg/L.

Nexo is a complement to, not a substitute for, CWF

Each country and region adopt health programmes appropriate to their circumstance. In New Zealand, we have programmes which include some aspect of the Nexo programme or similar programmes like the ChildSmile programme in Scotland (see ChildSmile dental health – its pros and cons and ChildSmile – a complement, not an alternative, to fluoridation). For example the use of fluoride varnish treatments, especially in non-fluoridated areas.

New Zealand can learn from the experience of other countries and in practice, we may introduce some aspects of other programmes. But blanket transfer of full programmes is rare.

The important aspect, though, is none of these programmes is considered an alternative to fluoridation. They are considered as complementary to CWF, and not substitutes for CWF.  The Danish Dental Association has supported fluoridation for areas of low natural fluoride concentrations. Similarly, the British Dental Association in Scotland supports both ChildSmile and CWF and has publicly called for communities to move towards introducing water fluoridation.

In fact, we can consider that the programme used in Nexo (where the drinking water contains fluoride at 0.8 mg/L) actually complements the effect of natural community water fluoridation.

“Documented evidence”

You ask the Minister:

“Why do you ignore all the documented evidence against fluoridation instead of applying positive dental health policies such as the Denmark example?”

The “Denmark example” is dealt with above and it is not what you suggest. Similarly, I suggest the “documented evidence” you refer to really doesn’t give the viable argument “against fluoridation” you imply.

Unfortunately, you do not present any of this “documented evidence” for discussion. Perhaps, if you respond positively to my suggestion of a right of reply and an ongoing discussion, you can give this evidence.

“Informed consent”

You refer to the “H&D Commissioner’s Code of Rights” asserting that:

“no-one can be medicated without giving their informed consent” and “people have the right to give – or refuse – their INFORMED consent when fluoridation is applied to public water supplies?”

Well, I am all for people being properly informed and providing consent to the treatments used for their water supply. I see this as a democratic issue and I support democracy.

But you destroy your argument by suggesting fluoridation is a “medication” when it clearly is not – either legally or rationally. The legal argument was surely settled by the High Court decision in 2014 (see Corporate backers of anti-fluoride movement lose in NZ High Court) where Justice Rodney Hansen concluded:

“[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].”

Is scientific knowledge  really “one-sided” propaganda

You also weaken your argument by claiming:

“the one-sided propaganda used to support fluoridation is not informing people”

Describing objective scientific research and findings as “one-sided” simply displays your own bias – and willingness to discredit or ignore the science. Again, you do not give specific examples of the science you consider “one-sided propaganda” – hopefully, you will do so if you take up my offer of a right of reply and a continued discussion.

Democratic rights

You assert:

“when fluoridation is forced upon people it is nothing less than mass medication concerning which people have no opportunity to give – or refuse – their consent.”

The common anti-fluoride claim that people are having fluoridated water forced upon them always raises the picture in my mind of a person being held down and water being forced down their throat as in force-feeding.

Of course, that is ridiculous – for a number of reasons.

  • In New Zealand, there has usually been a democratic public consultation of some sort before the introduction of CWF – or even after its introduction. Local bodies have surveyed residents or used referenda. They have also used a consultation procedure relying on submissions from the public.The opportunity “to give – or refuse – their consent” has in most cases been far greater than for most decisions made by our representatives in this democracy of ours. Some voters find it annoying when asked for such consent (preferring their representatives decide) but I firmly believe it important to include the public in controversial decisions – even where the controversy results from scaremongering rather than facts (as it does with CWF).
  • There are alternatives for the minority. This means that democratic decisions made by a community can actually be a win-win situation. The majority get the social policy they want and have voted for. the minority have access to alternatives. In fact, most anti-fluoride activists already use alternatives – they filter their tap water or source a different supply. Some cities already provide “fluoride-free” water sources to help this. Sometimes I think the real motivation of these ideologically driven activists is to deny this social health policy to others rather than any real concern they have for their own access to water.
  • Some activists will acknowledge there is no evidence of any harmful side effects from CWF but invoke a “precautionary principle” to argue against it. They should be mollified by the fact that CWF is one of the most extensively researched topics. In a sense, we must thank the ideologically and commercially motivated anti-fluoride campaigners for this. Their activity is rarely successful in preventing CWF or fooling most of the public. But it does mean that researcher keep an eye on the arguments and are continually checking them out.

Conclusion

David, I believe you are mistaken, or misinformed, about the dental health programmes in Denmark. You ignore completely the availability of effective natural levels of fluoride in much of Denmark’s drinking water and seem unaware of the nature of the Nexo programme or its limited area of operation.

Expert opinion considers programmes like Nexo and the Scottish ChildSmile are effective complements to CWF – not substitutes for, or alternatives to, CWF. I support our health officials considering use of similar programmes in New Zealand but it is misleading for the Democrats for Social Credit to advocate for such programmes simply as a way of preventing or opposing CWF – which is  an effective, beneficial and safe social health measure.

I appreciate you may not accept my arguments or the facts I have presented here. If that is the case I urge you to accept my offer of a right of reply and ongoing good-faith discussion and am happy to help this by making space available on this blog.

I look forward to your response.

References

Ekstrand, K. R., & Christiansen, M. E. C. (2005). Outcomes of a non-operative caries treatment programme for children and adolescents. Caries Research, 39(6), 455–467.

Kirkeskov, L., Kristiansen, E., Bøggild, H., Von Platen-Hallermund, F., Sckerl, H., Carlsen, A., … Poulsen, S. (2010). The association between fluoride in drinking water and dental caries in Danish children. Linking data from health registers, environmental registers and administrative registers. Community Dentistry and Oral Epidemiology, 38(3), 206–212.

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Fluoridation: What’s happening with the New Zealand legislation?

The second reading of the fluoridation bill is now on the order paper for the current parliament. Public submissions have been heard, the Health Committee has reported back to the House and the Ministry of Health (MoH) has provided its own responses to submissions.

Of course, we don’t know yet what the final Act will be like exactly. But the submissions, the committee report, and the MoH responses give us some idea of likely changes to the original bill.

Submissions

I have described before how the anti-fluoride activist groups organise to deluge consultation processes with their submissions. This was certainly the case here and their submissions accounted for most of those opposed to the Bill.

However, because the legislation is about the decision-making process and not the scientific or ethical validity of social health policies simple opposition to fluoridation was irrelevant  – outside the scope of the bill. This was true of most submissions (85%) and these should be considered a waste of every bodies time.

I am surprised the anti-fluoride organisations organising this submission campaign chose to take such an irrelevant approach. Surely if they had put a bit of thought into their efforts they could have directed their submission at relevant aspects such as the consultation process, the decision-making body and the question of referenda.

That said, a small number of the anti-fluoride submissions did address aspects of the bill and these were considered by the Health Committee and the MoH.

Putting aside the anti-fluoride submissions which did not address the bill, 20% percent supported the Bill and 80% opposed to the Bill as currently drafted. Most supported extending fluoridation cover, but disagreed with specific parts of the Bill and suggested changes.

The legislation does not mandate fluoridation

This is a common misunderstanding promoted by anti-fluoride campaigners – obviously attempting to use scare-mongering to motivate their supporters. For example, Fluoride Free NZ formally names the legislation the Mandatory Fluoridation Bill which is dishonest – the correct name of the bill is Health (Fluoridation of Drinking Water) Amendment Bill.”

The bill transfers decision-making from local bodies to District Health Boards (DHBs) – but it does not require DHBs to make a decision about fluoridation. That is up to local DHBs and local conditions such as dental health, likely advantages and establishment costs.

Consideration of other health factors

A number of submitters expressed concern that while the bill requires DHBs to consider dental health effects, consideration of other possible health issues is not provided for. However,  the response from the MoH to this is:

“While DHBs are required to consider the evidence in relation to oral health, DHBs are not prevented from considering other factors, including the effect of fluoridation on overall health. However, officials do not consider it necessary for the Bill to require DHBs to consider these other factors.”

So, consideration of other health factors will depend on specific situations, the board members or public interest. Importantly, DHB’s are not prevented from considering wider health aspects.

Considering the science

I was interested to see that:

” The Ministry of Health is currently exploring options for the ongoing monitoring and assessment of research on fluoridation within the Ministry to align with the implementation of the Bill.”

The MoH sees this as carrying on the role formerly played by the now disbanded National Fluoridation Information Service. But this also goes some way to satisfying a suggestion in my own submission that the assessment of research on fluoridation is carried out by some sort of central expert body (see Fluoride, coffee and activist confusion). My concern was that the DHBs are not really suitable bodies for making expert reviews of the literature and evaluating the current state of the science. Handing this over to a central body could also prevent boards being deluged with misinformation and unsupported claims about the science – a feature of local body consultation which caused so much trouble to councils.

It was the pressure of submission campaigns including misrepresentation and false claims about the science which drove local bodies, who do not have the expertise to consider the science, to request a change to the legislation. DHBs will confront the same situation unless they can direct scientific consultation to a central expert body.

Community consultation

Many submitters (12%), both for and against fluoridation, suggested the bill should specifically require DHBs to consult the community about fluoridation decisions. While the bill did not make such specific requirements it also did not prevent such consultation.

In practice, public consultation will depend on the level of demand for it. It is up to DHBs to decide when consultation is appropriate and there is already a regulatory requirement for DHBs “to foster community participation in health improvement” which could cover that.

There is also provision for the Minister to describe a fluoridation decision as a “significant service change” which would require DHBs to undertake community consultation on regional service plans including fluoridation.

So, the anti-fluoride activist claims of denial of community consultation is wrong. While consultation is not specifically required it is not prevented by the bill and will depend on the level of public interest.

Engagement with local authorities

The health committee is recommending the bill be amended to explicitly require DHBs to consider the views of the drinking water supplier. This accommodates suggestions made by some local bodies who feared the imposition of decisions without considering their local situations.

However, the committee also suggested an amendment to make clear that engagement with local authorities does not require them to consult communities. The DHB which makes the ultimate decision would have that responsibility where necessary.

The Committee also suggested “the Government consider whether
it intends to contribute funding towards the costs of establishing fluoridated water supplies” because there is a “moral hazard arising from the DHBs making a decision that will impose costs on local authorities and ratepayers.”  It looks like the Government has accepted this point as they have already made $12 million dollars available to local bodies setting up new fluoridation systems (see Government commits $12m to help councils cover costs of fluoridation in water supplies.).

Provision of non-fluoridated alternatives

Some local bodies have already introduced “fluoride-free” taps at the request of local anti-fluoride campaigners., The MoH is suggesting an amendment to the bill to make clear that “DHBs can direct local government water supplies in their region on a supply by supply basis if they wish.”

This could make it possible for specific local supplies, like Petone in the Hutt region or some supplies in Christchurch to remain unfluoridated if their communities demand it even if a decision is made to fluoridate a region.

The DHB or the director general of health?

Many of the submitters opposed to the bill in its present form suggest that the decision-maker should not be the DHBs but the Director-General of Health or central government. This is because of the likely low expertise of DHB members, low voter turnout for DHB elections and concerns of legal challenges to DHB decisions. There was also the expressed belief that the anarchic and dishonest coordinated submission campaigns previously experienced by local bodies would simply be transferred to the DHBs.

Some submitter proposed that fluoridation be mandatory thereby removing the need for an elected body to be responsible for the decision making.

The committee report and response from the MoH show that parliament will probably stick with the DHBs as the decision maker. There are some advantages in this (the DHB have responsibilities in health areas) and the proof of the pudding will be in the eating. Will the DHB approach to consultations be able to successfully give more credence to credible and peer-reviewed science than the misinformation and distortions of science promoted by anti-fluoride campaigners?

Possibly. I hope so.

Conclusions

Despite the anti-fluoride campaigns and the resulting deluge of misinformed or misleading submissions, the submission process has been successful. Problems in the current wording of the bill were identified and reasonable solutions to these problems have been advanced.

We should now see how MPs react to the bill and the recommended changes in the second reading. Anti-fluoride activists have carried on an intensive campaign of emails, letters and representations aimed at MPs. On the whole, this will have been counterproductive as MP are surely aware this bill is not about the science or ethics of fluoridation but simply the decision-making process.

I am picking that these campaigns have produced more heat than light and will have little influence on the progress of the bill. However, I do expect a lot of teeth-grinding, hairpulling, garment rending, lamentations that democracy doesn’t work or that various MPs should be shot or otherwise disposed of from anti-fluoride campaigners. This is already happening and will no doubt intensify when the final bill is passed into law.

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May ’17 – NZ blogs sitemeter ranking

Image credit: THE #1 WAY TO GET TARGETED TRAFFIC TO YOUR BLOG

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 May 2017. 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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The “information war” and social media, or how to tell if you are a Kremlin troll

New NATO headquarters cost US$1.23 billion – yet they are worried about that you and I might be Kremlin Trolls because we comment on social media. Image credit: New NATO headquarters could run €1 billion

Well, what do you know? According to NATO, I must be a Kremlin Troll. I fit all four of the criteria they present in this film produced by  Stratcom  – the NATO Strategic Communication center of excellence of excellence.

1: Comments longer than 4 lines. I don’t think any of my comment have been less that 4 lines – verbosity plagues me, and always has.

2: Comments out of context. – I guess some people might say that about my comments. In fact, some people have questioned their relevance at times.

3: Comments openly aggressive and hostile. Must admit I mine are sometimes – but usually only after someone has called me a shill in the pay of Big Pharma or Big Fluoride. Or called me a Kremlin troll!

4: Comments have language errors. That certainly qualifies me. It might be that I am chronologically and/or optically challenged. Or maybe it is my erratic 1 finger typing, the lack of a backlit keyboard and laziness of spell checking. But I certainly qualify with that one.

So, that’s it. I am officially (according to NATO) a Kremlin troll. And it looks like NATO is now threatening to do background research on me (I am sure our SIS can help). Then they will label me. I guess the label is Kremlin troll. As if name-calling was a new phenomenon on social media.And then they will ignore me. If only – experience tells me that Big Brother organisations like this never ignore anyone.

But this is what the world has come to. An international military organisation, incredibly well-financed and armed, is worried about people like you and me who might be commenting on social media!

What the hell is that about? And why have they got their nickers in a twist about social media. It’s almost as if they feel they have lost the ability to control what people think and have set out on a programme of weeding out people who might not accept the official narrative.

Still, perhaps there is hope for me. there is another analysis which I prefer – described by Adam in his article 5 steps to becoming a Putin Agent. Of course, he is being satirical with his title (he says “‘Putin Agent’ sounds a bit better than ‘guy with informed opinions’”) but I do think his list describes me better than the NATO one.

Here is his list (and it is worth reading what he says abotu each point):

  1. Be A Free Global Thinker
  2. Question Authority, Question the ‘Experts’, Question EVERYTHING
  3. Respect Other Nations
  4. Don’t Be A Fanatic
  5. Have A Sense of Humour 

Mind you, I picked up this article on Facebook via RussiaFeed. Whoops, that has  one of NATO’s keywords in its title which identifies it as a “fake news source.” Yes NATO has got into judging news sources and attempting to prevent us reading the “bad” ones as well as judging our social media comments.

This really does underline that NATO has adopted a new weapon in armoury – the “information war.”

Problem is, in this war NATO considers that you and I are the enemy.

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Anti-fluoridationists commonly misrepresent Ministry of Health data

Anti-fluoride activists tell porkies about the Ministry of Health’s data on child dental health. They cherry-pick the data to make it appear that community water fluoridation is ineffective. And when challenged to discuss the issue they run away.


I am currently dealing with family issues so am reposting this article, “A challenge to anti-fluoridationers to justify their misrepresentation of New Zealand research”  from April 2016.  It shows how local anti-fluoride activists are misrepresenting the Ministry of Health’s data on child oral health


One of the frustrations I have with the fluoridation issue is the refusal of anti-fluoride activists to engage on the science. They will pontificate, but they won’t engage in discussion.

On the surface, one would think there is a difference of opinion or interpretation of scientific issues and that could be resolved by discussion. Yet local anti-fluoride campaigners refuse to enter into discussion. Again and again, I have offered space here to local anti-fluoride campaigners so that they could respond to my articles and they have inevitably rejected the offer. They have also blocked me, and other people discussing the science, from commenting on any of their social media pages or web sites. Even when they, themselves, call for a debate they reject specific responses I have made accepting that call.

So I am left with the only alternative of responding to their claim with an article here – or on a friendly web or blog site. At least that gives me space to present my argument – I just wish I could get some intelligent responses enabling engagement on the issues.

Misrepresentations repeated

The latest misrepresentation of the science is a claim by the Auckland Fluoride Free NZ Coordinator, Kane Titchener, that recent research proves fluoridation [is] not needed.

It repeats the same misrepresentation made by Wellington Anti-fluoride campaigner, Stan Litras, which I discussed in my article Anti-fluoridation cherry-pickers at it again. Kane has either ignored my article, chosen to ignore it or possibly not even understood it.

So here we go again.

Kane claims:

“A New Zealand study published in Bio Medical Central Oral Health last month shows dental health improved the greatest extent for children in non-fluoridated areas. There is now no difference in dental decay rates between non-Maori children who live in fluoridated areas and non-Maori children who live in non-fluoridated areas, proving that fluoridation is not needed for children to obtain good dental health.”

Although he doesn’t cite the study (wonder why), his use of two figures from the study show he is writing about the paper:

Schluter, P. J., & Lee, M. (2016). Water fluoridation and ethnic inequities in dental caries profiles of New Zealand children aged 5 and 12–13 years: analysis of national cross-sectional registry databases for the decade 2004–2013. BMC Oral Health, 16(1), 21.

His claim relies on the comparison of data for “non-Māori” children in fluoridated and fluoridated areas. No – he doesn’t misrepresent the data – he just ignores the discussion by these authors of problems with simple interpretation of the data for non-Māori because of the fact it is not ethnically uniform. In particular, he ignores the qualifications they place on the data because of the inclusion in non-Māori of data for Pacifica who have poorer dental health than the rest of this group and live predominantly in fluoridated areas. This, in effect, distorts the data by overestimating the poor oral health for “non-Māori” in the fluoridated areas.

The apparent convergence

The data used in this study were taken from the Ministry of Health’s website. This divides the total population of children surveyed into the ethnic groups Māori, Pacific and “Other.” While the “other’ group will not be completely uniform (for example including Pakeha, Asian, other groups) it becomes far less uniform when combined with the Pacific group to form the non-Māori group.

So, Kane salivates over this figure from the paper especially the plots for  non-Māori ethnicities in fluoridated (F) and non-fluoridated (NF) areas.

12903_2016_180_Fig1_HTML

Fig. 1 No obvious decay experience (caries-free) percentages and mean dmft for 5-year old children over years 2004 to 2013, partitioned by Māori and non-Māori ethnicities and fluoridated (F) and non-fluoridated (NF) areas

Yes, that convergence is clear and I can see why Kane is clinging to it – who can blame him. But he completely ignores the warning from the paper:

“It is likely that a substantial driver of this convergence was due to significant changes within the dynamic and heterogeneous non-Māori groups both within and between DHB regions. In effect, the ecological fallacy – a logical flaw whereby analyses of group data are used to draw conclusions about an individual – may be operating within the non-Māori group.”

When the Pacific data is removed (as is the case for the “other” group effectively made up from non-Māori and non-Pacifica) we get the plots below.

Other

Comparison of data for “other” (non-Māori/non-Pacifica) children in fluoridated (F) and unfluoridated (UF) areas.

Nowhere near as useful for Kane’s confirmation bias and the message he wants to promote. OK – there is still some evidence of convergence from about 2007 on between fluoridated and unfluoridated children. But the graphs do show that community water fluoridation is still having  a beneficial effect. And this apparent convergence could be explained by things like the introduction of “hub and spoke” dental clinics after 2004. One problem with this raw data is that children are allocated according to the fluoridation status of the school – rather than their residence. This will lead to incorrect allocation in some cases.

Some data for Pacifica

Just to underline the problems introduced by inclusion of Pacific in the non-Māori group of the study consider the data for Pacifica shown below.

other-pacifica

Data for 5-year-old children. dmft = decayed, missing and filled teeth. The “other” group is non-Māori and non-Pacifica

The oral health of Pacifica is clearly poorer than that of the “other” group.

Also, Pacifica make up about 20% of the non-Māori fluoridated group. So they will influence the data for the non-Māori fluoridated group by reducing the % caries free and increasing the mean dmft.

So Kane, like Stan, is blatantly cherry-picking. He is misrepresenting the study – and its author – by ignoring (or covering up) the qualifications regarding the influence of inclusion of pacific in the non-Māori fluoridated group.

The challenge

Now, I repeat the offer I have made in the past to give a right of reply to both Kane Titchener and Stan Litras. They are welcome to comment here and if they want more space I am happy to give space for separate articles for them in the way I did for the debate with Paul Connett. Now I can’t be fairer than that, can I?

So what about it Stan and Kane? What are your responses to my criticisms of the way you have cherry-picked and misrepresented this New Zealand paper?


NOTE: I have sent emails to both Kane and Stan asking them to respond and offering them right of reply.

UPDATE 1: Great minds and all that – Stan Litras sent out a press release today calling for a nation-wide debate on this issue (see FIND calls for a national debate on fluoridation). However, the seriousness of his request is rather compromised by his reply to my offer of a right of reply to the above article. He did respond to my email very quickly. This is what he wrote:

“Thanks for the offer, Ken, but I have not visited your blog site for a long time, as I object to the way you attempt to defame and discredit me.

You play the man and not the ball, which is not the mark of a reasonable person.

I hope to address that in due course as time permits, but for now I must leave you to indulge yourself without my company.”

So much for his wish for a “national debate” when he will not front up to a critique of his claims about the science.

UPDATE 2: Kane Titchener today also posted a press release today which was the text of the article I discuss in this post (see NZ research proves fluoridation not needed). He also responded quickly to my e-mail. The full text of his response was:

Who is this?”

Rather strange – considering he often pesters me with emails.

So I guess both of them have turned down my offer.

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ChildSmile – a complement, not an alternative, to fluoridation

Childsmile-Hebrides-Today

New Zealand Health Boards already run elements of the Scottish ChildSmile dental health programme and do not see it as an alternative to community water fluoridation


I am currently dealing with family issues so am reposting this article,ChildSmile dental health – its pros and consfrom September 2015.  Local antifluoride activists are busy presenting ChildSmile and similar programmes as alternatives to fluoridation. They aren’t – and New Zealand District health Boards alreeayd operate elements of these programmes where they consider them effective.


There is some local interest in the Scottish ChildSmile dental health programme. Partly because anti-fluoride campaigners are promoting it to local bodies as an alternative to community water fluoridation (CWF). Their interest is possibly due to the opt-in nature of the programme which they see as satisfying their demands for “freedom of choice” (in this case the choice means excluding their own children from the programme which, after all, does include fluoride treatments).

However, health professionals in the UK are more balanced in their opinions. While welcoming ChildSmile they do not see it as an argument against CWF – rather as “the next best thing – a rather expensive substitute for the fluoridation schemes that have never been introduced.”

I have written about the ChildSmile programme before (see Fluoride debate: Ken Perrott’s closing response to Paul Connett?). But here is some more detail I have picked up from discussion online with health professionals.

What is the ChildSmile programme?

quote-3-1a
On the surface, the ChildSmile programme supplies children with toothbrushes and toothpaste:

“The core programme involves supervised daily toothbrushing for all Scottish three and four year olds attending nursery schools (but not those who don’t attend nurseries). This has been extended to five and six year olds in primary schools in those areas (not necessarily across entire local authorities) counted as being among the 20% most deprived in Scotland.”

Data suggest that about 82% of three and four-year-olds are participating. The children who do not take part do not benefit.

ChildSmile also includes twice-yearly application of fluoride varnish to children’s teeth.  The programme 2013/2014 targets included this:

“At least 60% of 3 and 4 year old children in each SIMD quintile to receive at least two applications of fluoride varnish per year by March 2014.”

In addition to toothbrushing and varnishing, Childsmile involves health education initiatives based principally on public health nurses and health visitors attaching themselves to particular schools in order to give oral health advice to children and parents. Subject to parental consent, they also arrange for children who are not registered with a dentist to undergo check-ups and, if necessary, treatment.

Is it a substitute for CWF?

Not really, but health professionals see it as the “next best thing.” Appropriate for situations where there is no CWF. But it only covers children – and then only those children whose parents give consent (many don’t). In contrast, CWF benefits adolescents and adults, as well as children. Families can, of course, “opt out” od CWF (by using water filters or different sources), but numbers will be lower than those excluded by “opt-in” procedures.

It is wrong to see such programmes as alternatives to, or separate from, CWF. Elements of the ChildSmile programme were already present before ChildSmile was introduced. Similar elements will also be common in countries like New Zealand.

Is it effective?

Childsmile was introduced in 2008 so it is a little early to judge its effectiveness. Scottish children’s dental health has improved and the programme most likely has assisted that.

For example, 58% of five-year-olds were free of decay in 2008, compared with 68% in 2014. The average decayed, missing and filled teeth (dmft) score for this age group has fallen over that period from 1.86 to 1.27.

CS-1

However, there does not seem to have been a reduction in dental health inequalities between children from different social groups in Scotland. In 2008, 42% of children from the most socially deprived quintile of Scottish five-year-olds were free of decay compared with 73% of those from the least deprived quintile. In 2014, 53% of five-year-olds in the most deprived quintile were free of decay compared with 83% of those from the least deprived quintile.

CS-2

According to the Scottish National Dental Inspection programme the absolute inequality between the most and least deprived children remains at 30% (comparing percentages of children without tooth decay), according to surveys conducted in 2008, 2010, 2012 and 2014.

Another concern is that children in the most deprived quintile of five-year-olds have not reached the national target set in 2010 that 60% of them should be free of decay.

Of course, the ChildSmile programme has no effect on the oral health of  current adolescents and adults.

What about the cost?

ChildSmile is far less cost-effective than CWF. Let’s compare the cost of CWF in England with the costs for the ChildSmile programme in Scotland

CWF serves 6 million people in England, costs around £2.1 million a year and is benefiting everyone with natural teeth, regardless of age, education or socioeconomic status. It benefits all children. So the cost per person of is around 35 pence per annum, although if we exclude people with no natural teeth it is likely to be a little higher than that – an average cost of about 40 pence per person benefiting.

If we take a narrow view and assume only children and adolescents aged 0 to 17 (21% of the population in England ) benefitted from CWF the cost would apply to around 1.26 million out of the 6 million supplied with fluoridated water. On that basis, the cost of CWF would be £1.67 per year for each child benefitting.

In contrast:

The total national ChildSmile budget for 2013/14 was £14,956,000, according to a statement by the Minister responsible to the Scottish Parliament in July 2013. This covers everything attributable to Childsmile – the toothbrushing programme, plus targeted varnish applications and associated oral health education initiatives.  Assuming that around 120,000 Scottish children aged between three and six are benefiting, it works out at a cost of around £125 per child per annum.

Compare the Childsmile costs of around £125 per child per annum with the CWF costs of about 40 pence per person per annum or even £1.67 per year for each child benefitting. CWF is obviously many times less expensive that ChildSmile.

What is the attitude of Scottish dentists?

The British Dental Association supports CWF and in Scotland has come out publicly to call for communities to move towards introducing water fluoridation. That position undermines the arguments of New Zealand anti-fluoridation groups claiming that Childsmile is an adequate substitute for water fluoridation. The professional body representing dentists in Scotland does not see it that way.

The BDA in Scotland points out that CWF would be beneficial to children and elderly people. It argues that water fluoridation “would complement the Childsmile programme” by helping cut the overall burden of tooth decay and reducing dental health inequalities in the elderly. We could look at it another way and see that a Childsmile programme could complement water fluoridation. After all, we must remember that initiatives such as Childsmile rely on personal compliance and that they benefit only those taking part. They give no benefit for the rest of the population, unlike CWF.

CWF and ChildSmile are are not mutually exclusive. Children in fluoridated areas should be encouraged to brush their teeth regularly with a fluoride toothpaste and to receive dental check-ups. Bear in mind, also, that components of a ChildSmile programme, such as supervised toothbrushing, were in use in parts of Scotland before the introduction of the full programme. Elements of the ChildSmile programme will also be in current use in New Zealand.

Conclusions

Despite claims of anti-fluoride propagandists, the ChildSmile programme is not a simple alternative to CWF. And it is wrong to see it as such in New Zealand.

It is far less cost-effective – the Scottish programme costs around £125 per child per annum compared with 40 pence per person per annum (or £1.67 per year for each child benefitting when benefits to adults are excluded) and therefore far less likely to be put in place as an alternative to CWF.

ChildSmile is an “opt-in” programme so its coverage is far lower than CWF which is an “opt-out.” This is important when social differences in oral health are important.

However, the contact between children and their families on the one hand and public health nurses, health visitors and dentists on the other, is very valuable and may have wider benefits than oral health alone. (I am thinking of problems caused by child neglect and abuse).

I think these sort of programmes are socially very helpful and strongly support them. The cost is, of course, a limiting factor. However, elements of such social programmes may be possible within budget constraints that health authorities face.

Health programmes like ChildSmile, or elements of that programme, can be very effective even in areas where CWF exists. They can give that extra boost to the oral health of children and can, therefore, complement CWF.

There are many areas where CWF is not feasible because of low population density, lack of suitable water reticulation systems or local political opposition to CWF. I believe that programmes like ChildSmile, or parts of that programme, can be very helpful in those situations. Northland and particularly NZ’s Far North are obvious examples.

Finally, let’s not be diverted by the programme name. I am sure that elements of the Scottish ChildSmile programme are already in place in New Zealand, or parts of New Zealand. Given the costs of such programmes, and budget limitations, these programmes do have the advantage that they can be targeted to regions or social groups where the need is the greatest.

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Fluoridation helps protect adult teeth as well as children’s

Photo credit: Seniors Benefit From Drinking Water Together

Recent research reveals that community water fluoridation benefits adults as well as children.

While research into the effects of fluoridation in adults started earlier than for children, early studies suffered from a lack of information on effects of socioeconomic status and other confounding factors.  Recent studies with adults have been more robust but there is still some confusion – especially since the often cited recent Cochrane systematic survey of the scientific literature on fluoridation was unable to draw conclusions on this because of the strict inclusion criteria used was not suitable.

This new study checked the effects of lifetime access to fluoridation on the dental health of adults from a city in southern Brazil.  It concluded that lifetime access to community water fluoridation is associated with lower tooth decay in adults.

The study is:

Peres, M. A., Peres, K. G., Barbato, P. R., & Hofelmann, D. A. (2016). Access to Fluoridated Water and Adult Dental Caries: A Natural Experiment. Journal of Dental Research, 95(8): 1-7.

The full text of the paper is available here.

The researchers adjusted their data for well-known confounders such as socioeconomic status, the pattern of dental visiting, smoking, educational attainment, income, and age. Use of fluoridated toothpaste was common for all subjects so could not explain the results.

The final data, adjusted fo confounders, showed a greater protection with a longer exposure to fluoridated water. The figure below shows this data for  DMFT (decayed, missing and filled teeth) and DFT (decayed and filled teeth). The use of both measures helps to accommodate the fact that some teeth are missing for reasons other than decay.

The data is present as ratios of DMFT and DFT for the shorter exposure periods ( <50% and 50%-75%) to the values of DMFT and DFT for exposures of >75%.

So, once again a study showing the benefits of community water fluoridation. this time for adults with long time exposure to fluoridation.

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Fluoridation: the truth about heavy metal contamination

Anti-fluoride activists going on about contaminants in drinking water due to fluoridation have it all wrong. If they avoided their knee jerk, chemophobic reactions to certificates of analysis and did some calculations they would realised they are making a fuss about absolutely nothing.


I am currently absorbed in dealing with family issues at the moment so am reposting this article, .” Unfortunately is is still very much relevant.


Sometimes anti-fluoride propagandists end up shooting themselves in the foot. This always seems to happen when they produce “evidence’ that fluoridating chemicals are loaded with toxic heavy metals.

It feels like shooting fish in a barrel to debunk their use of analytical figures because the data they produce always shows them to be completely wrong. I wrote about this before in Fluoridation: emotionally misrepresenting contamination. So, I am effectively repeating myself by discussing the meme image below that Fluoride Free NZ is currently circulating in social media.

Hill lab

Still, this time, I will show how insignificant these analytical figures by comparing the calculated final concentrations in tap water – due to addition of the chemical – with measured concentrations for these contaminants in Hamilton tap water.

Added contaminants as percentage of MAVs

But first – what contribution would this sample of fluorosilicic acid make to the contaminant levels in Hamilton’s tap water – and how do these levels compare with the maximum acceptable values (MAVs) defined in New Zealand’s Drinking Water Standards? The values for the MAVs are published in:

Ministry of Health. (2008). Drinking-water Standards for New Zealand 2005 ( Revised 2008 ) (Vol. 2005). Wellington.

In this table, the “Tap water (mg/L)” data are the calculated final concentrations after addition of the fluoridating agent in the meme. The “%age of MAV” data are these values expressed as a percentage of the maximum acceptable values (MAVs) for the contaminants.

Impurity MAV (mg/L) Tap water calculated (mg/L) %age of MAV
Aluminium 0.1 8.69E-05 0.0869
Antimony 0.02 < 3.56E-07 <0.0018
Arsenic 0.01 1.26E-05 0.1264
Barium 0.7 4.27E-06 0.0006
Cadmium 0.004 2.37E-07 0.0059
Chromium 0.05 4.74E-06 0.0095
Copper 1 1.19E-06 0.0001
Iron 0.2 1.62E-04 0.0810
Lead 0.01 2.37E-07 0.0024
Manganese 0.04 3.56E-06 0.0089
Mercury 0.007 < 1.98E-07 <0.0028
Molybdenum 0.07 < 3.56E-07 <0.0005
Nickel 0.08 3.95E-06 0.0049
Selenium 0.01 < 1.98E-07 <0.0020
Uranium 0.02 2.05E-06 0.0103

Sorry, I have had to use scientific formating for some numbers because the final calculated concentrations in tap water are so low. On average, the calculated concentration  of these contaminants due to the fluoridating agent is about 0.02% of the MAV.  The largest relative contribution is for arsenic – just over 0.1%.

Regulations require that the contribution of contaminants from fluoridating agents should always be less than 10% of the MAV . The actual level of contaminants in this particular sample is well below those regulated maxima.

The Fluoride Free NZ meme is just promoting naive chemophobic scaremongering about absolutely nothing. These activists just haven’t bothered calculating what the analytical data means for the final concentrations in tap water. Or even bothered comparing the data with the regulated maximum amounts allowed for fluoridating chemicals. These values are available in Standard for the Supply of Fluoride for Use in Water Treatment.

Added contaminants as a percentage of concentrations in inlet water and treated water.

Let’s now compare the estimated contribution from contaminants in this sample of fluorosilicic acid to the levels of the very same contaminants in the Hamilton water. I have taken data from this document issued by the Hamilton City Council:

Waikato River and Treated Drinking Water Comprehensive Analysis Report 2013/14

The next table is for samples taken on 18th July 2013 at the intake to the treatment plant (that is the source water before treatment). The “Added FSA%” is the calculated level of impurity resulting from fluoridation expressed as a percentage of the impurity naturally present in the source water.

Impurity Intake (mg/L) Added FSA%
Aluminium 1.68E-01 0.05
Antimony 8.50E-04 <0.04
Arsenic 1.96E-02 0.06
Barium 1.88E-02 0.02
Berylium <1.10E-04 0.18
Cadmium <5.30E-05 0.45
Chromium <5.30E-04 0.89
Copper <5.30E-04 0.22
Iron 2.94E-01 0.06
Lead 1.18E-04 0.20
Manganese 2.15E-02 0.02
Mercury <8.00E-05 <0.25
Molybdenum 3.80E-04 <0.09
Nickel <5.30E-04 0.75
Selenium <1.10E-03 <0.02
Tin <5.30E-04 0.22
Uranium <2.10E-05 9.78
Zinc 8.13E-01 0.00

Now, a similar calculation and comparison – this time “Added FSA%” is the calculated level of impurity resulting from fluoridation expressed as a percentage of the impurity already present in the “treated water” – which is the final tap water. (At this time the Hamilton water supply was not fluoridated).

Impurity Treated (mg/L) Added FSA%
Aluminium 2.04E-02 0.43
Antimony 8.00E-04 <0.04
Arsenic <1.10E-03 1.15
Barium 1.26E-02 0.03
Berylium <1.10E-04 <0.18
Cadmium <5.30E-05 0.45
Chromium <5.30E-04 0.89
Copper 8.00E-04 0.15
Iron <2.10E-02 0.77
Lead 4.82E-04 0.05
Manganese 1.75E-03 0.20
Mercury <8.00E-05 <0.25
Molybdenum 3.70E-04 <0.10
Nickel 3.52E-03 0.11
Selenium <1.10E-03 <0.02
Tin <5.30E-04 0.22
Uranium <2.10E-05 9.78
Zinc 4.82E-03 0.14

The extremely low levels of contaminants – both calculated and already in the intake water and final treated water – mean some of the calculations are rather meaningless. Especially as some of the analysed values are given as less than the detection limit.

However, the very low calculated contribution of contaminants from this fluorosilicic acid sample – usually < 1% of that naturally present – shows how ridiculous the Fluoride Free NZ claims about contamination introduced by fluoridating agents is.

Never trust anti-fluoride campaigners

Fluoride Free NZ is simply scaremongering – relying on naive chemophobia where just the chemical name and analytical data (even where the “<” symbol indicates below the level of detection) seem to scare people.

This example illustrates, once again, that the claims made by anti-fluoride and similar activists should never be accepted at face value. They should always be checked against reliable sources.

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Visualising the numbers – The Fallen of World War II

Today and tomorrow we remember the end of the war in Europe 72 years ago. I think this video provides a fitting illustration of what that war meant to nations and families around the world – and why we commemorate its end.

It’s also an excellent example of what can be done with data visualisation. I don’t think I have seen a better presentation of the reality of that war – of the numbers of soldiers and civilians killed in the different countries during that war.

Something to aspire to for anyone involved in data presentation.

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