Are we all anti-fascist now?

US neo-Nazis and fascists supporters march in Charoltsvill, USA.
Image credit: Alejandro Alvarez/News2Share via Reuters

Wouldn’t that be nice? What if the current almost universal condemnation of fascism by the main stream media and social media commenters were genuine.? That it represents an abhorrence for fascism and its modern supporters who attempt to revive it – and not just partisan politics.

Because fascism is abhorrent. And it does have its modern apologists, even revivalists. It is not new, even in the US, and people shouldn’t be surprised at its manifestation in Charlottesville.

After all, we have seen similar actions in other parts of the world – in parts of the world which understandably understand fascism and its consequences far better than the average US citizen does.

Thousands of nationals, neo-Nazis and pro-fascists march in Kiev, Ukraine, on the anniversary of the birth of Nazi collaborator Stepan Bandera.
Image credit: South China Morning Post.

Yes, I know. Our media tends to treat the marchers in Kiev and Riga as “freedom fighters” and not what they really are – supporters of  Nazi collaborators and those organisations derived from them which still exist today and play a role in the politics of those countries. But, unlike the USA, those collaborators were responsible for thousands of deaths of their fellow citizens(see my article Don’t put all the blame on the Germans – a lesson from World War II).

Supporters of Latvia’s Waffen-SS legion hold an annual commemoration Nazi SS division formed from Latvians during World War Two. Image Credit: The Telegraph.

 

Sculpture of the “Unbowed man” at the Khatyn Memorial site near Minsk in Byelorussia. The sculpture depicts Yuzif Kaminsky, the only adult to survive the massacre by Ukrainian Nazi groups, holding his dead son Adam.
Image credit: John Oldale.

Which brings me to my real message – my suggestion for action

Why not take advantage of this new-found anti-fascist feeling? Rather than let the lessons of Charlotteville disperse and die out why not do something meaningful and specific? Something that might last. And something with an international influence.

My suggestion – the US should change its stance next time the regular United Nations General Assembly resolution on “Combating the glorification of Nazism, neo-Nazism and other practices that contribute to fuelling contemporary forms of racism, racial discrimination, xenophobia and related intolerance” comes up.

The resolution expresses concern about the fact that in some countries, famed Nazi movement leaders and former members of the SS are honoured, and monuments to fighters (e.g partisan heroes) against fascism are demolished or subjected to desecration. It calls on states to pass legislation prohibiting the denial of crimes against humanity and war crimes during the Second World War.

It was last passed in November 2016. Then the only countries voting against the resolution were Ukraine, the United States and Palau!

Just imagine, if the US goes with its current anti-fascist feelings it could, at last, vote for this resolution. Of course, Palau as a client state will also automatically reverse its vote.

As for Ukraine – well, who could say the country is such a mess. Chances are the current government in Kiev may not be in power next time the vote occurs. But, unfortunately, the extreme nationalist and neo-fascist forces which seem to dictate affairs in that country will still be around.

But what about closer to home

Can not New Zealand also learn from the current anti-fascist feelings emanating from the USA? New Zealand traditionally takes the cowards way out and abstains on this resolution. Apparently aligning itself with the 131 countries supporting the resolution in 2016 would have caused too much displeasure from the USA – something we still seem to be afraid of. So we joined the group of 48 countries that abstained.
But, I guess, if the USA changed heart and voted for the anti-fascist resolution we would meekly snap into line and also vote for it.

A job for the US (and NZ) House of Representatives?

OK, the current US president may be even less willing than previous presidents to take a real international stand against fascism. But don’t we have some recent history that might provide a solution. Why don’t the US Congress and Senate follow on from their recent almost unanimous resolutions constraining the president in his handling of international affairs?

They made it impossible for President Trump to take any action on sanctions against Iran, North Korea and the Russian Federation without a decision from Congress.

So why not a near unanimous Congressional resolution demanding the USA in future votes for this resolution in the UN General Assembly? A resolution that prevents the US Ambassador from voting against it again without a decision from Congress?

Perhaps the New Zealand Parliament could place a similar restriction on our representatives at the UN

After all, aren’t we all anti-fascist now?

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Local anti-fluoride activists tell porkies yet again

FFNZ confuses lack of low fluoride studies on rats with human studies

Well, I suppose that’s not news. A bit surprising, though, because they are claiming the absence of research on fluoridation and IQ – which sort of conflicts with the previous attempts to actually condemn and misrepresent the actual research on fluoridation and IQ.

Fluoride Free NZ’s (FFNZ) face book page is claiming:

Would you be interested to know that no studies have been conducted on fluoridated water at 0.7ppm to determine whether there is IQ reduction? The National Toxicology Program are currently completing research to fill this gap. You would have thought that they would have done this in the 1950s before starting the fluoridation program wouldn’t you?

There have actually been three recent studies from three different countries which have specifically investigated the claim of an effect of fluoridation on IQ – and, unsurprisingly, all threes studies showed there was no effect.

Here are those studies:

New Zealand

Broadbent, J. M., Thomson, W. M., Ramrakha, S., Moffitt, T. E., Zeng, J., Foster Page, L. A., & Poulton, R. (2014). Community Water Fluoridation and Intelligence: Prospective Study in New Zealand. American Journal of Public Health, 105(1), 72–76.

In fact, anti-fluoride activists in the US, as well as New Zealand, have campaigned against this study. Their major criticism is that the study also included the effect of fluoride tablet use. They argue that this makes the unfluoridated control group useless because many participants will have consumed fluoride tablets. However, they ignore the fact that the statistical analysis corrected for this but still found no statistically significant difference in IQ of children and adults from fluoridated and unfluoridated areas.

Sweden

Other critics of the Broadbent et al. (2014) study have raised the issue of experimental power because of the numbers of people in the study. This could be a valid issue as it would determine the minimum effect size capable of being detected. Aggeborn & Öhman (2016) made that criticism of Broadbent et al., (2016) and all other fluoride-IQ studies. Their study is reported at:

Aggeborn L, Öhman M. (2016) The Effects of Fluoride in the Drinking Water. 2016.

Aggeborn & Öhman (2016) used much larger sample size than any of the other studies – over 81,000 observations compared with around 1000 or less for the commonly cited studies. It was also made on continually varying fluoride concentrations using the natural fluoride levels in Swedish drinking waters (the concentrations are similar to those in fluoridated communities), rather than the less effective approach of simply comparing two villages or fluoridated and unfluoridated regions. The confidence intervals were much smaller than those of other cited fluoride-IQ studies. This makes their conclusion that there was no effect of fluoride on cognitive measurements much more definitive. Incidentally, their study also indicated no effect of fluoride on the diagnosis of ADHD or muscular and skeleton diseases.

Canada

Another recent fluoridation-IQ study is that of Barbario (2016) made in Canada:

Barberio, AM. (2016). A Canadian Population-based Study of the Relationship between Fluoride Exposure and Indicators of Cognitive and Thyroid Functioning; Implications for Community Water Fluoridation. M. Sc. Thesis; Community Health Sciences, University of Calgary.

This study also had a large sample size – over 2,500 observations. This reported no statistically significant relationship of cognitive deficits to water fluoride.

Incidentally, Barberio (2016) also found there was no evidence of any relationship between fluoride exposure and thyroid functioning. That puts another pet claim of anti-fluoride campaigners to rest.

Animal studies

So much for NZFF’s claim that “no studies have been conducted on fluoridated water at 0.7ppm to determine whether there is IQ reduction.” But, just a minute, they are quoting the National Toxicology Program (NTP):

“No studies evaluated developmental exposure to fluoride at levels as low as 0.7 parts per million, the recommended level for community water fluoridation in the United States. Additional research is needed.”

But they omit the next sentence from the quote:

“NTP is conducting laboratory studies in rodents to fill data gaps identified in the systematic review of the animal studies.”

The NTP is discussing the research with animals, mainly rats, where effects of fluoride on the cognitive behaviour of the test animals have been reported but the fluoride concentrations are very high. And NTP’s assessment base on the review of the literature found only “a low to moderate level of evidence that the studies support adverse effects on learning and memory in animals exposed to fluoride in the diet or drinking water.” Hence the need for more research.

As part of the NTP’s research, which is currently underway, there are plans to extend studies to low fluoride concentrations more typical of that used in community water fluoridation.

The high concentrations used in animal studies is a major flaw in the anti-fluoride activist use of them to oppose community water fluoridation. For example, Mullinex et al (1995) (very commonly cited by anti-fluoride campaigners) fed test animals drinking water with up to 125 mg/L of fluoride (concentrations near 0.8 mg/L of fluoride are used in community water fluoridation).

While it is unlikely that the NTP research will find any significant effects of fluoride on the cognitive behaviour of rats at the low concentrations used in community water fluoridation the anti-fluoride campaigners have their fingers (and probably toes as well) crossed.

NTP will begin publishing the results of their new research next year (see Fluoride and IQ – another study coming up).

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July ’17 – NZ blogs sitemeter ranking

SiteMeter “permanently retired.” Image credit: David Melin.

Well, Sitemeter seems to have finally died.

According the CurrentlyDown.com it has been down since July 5 and the image above taken from Twitter indicates it has been permanently retired. This follows many problems in the past so it appears unlikely to appear again.

My advice to those who have been using Sitemeter is to consider replacing it with Statcounter or a similar counter. Have a look at the NZ Blog Rankings FAQ. for advice on this. 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.

So this month’s list is greatly reduced. At last count, there were about 45 NZ blogs on the ranking list using Sitemeter.

Here are the rankings of New Zealand blogs with publicly available statistics for July 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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Don’t rely on sources – follow the evidence

CNN pushes this mantra but many believe they promote fake news

When scientists evaluate published research we are more interested in evidence than in conclusions. In fact, the same evidence may lead scientific readers to different conclusions. That’s not surprising as in the real world no research project is able to consider all the theoretically possible evidence. Readers may, in fact, have other evidence. Or they may detect faults in authors’ interpretations.

I think this is a good thing. Considering the evidence allows competent critiques to be made and encourages knowledge to advance.

However, it annoys me that when we move outside the scientific environment we have to deal with situations where evidence may rarely be considered. People indulge in debating conclusions often with no regard to evidence. In fact, debaters seem to rely more on the real or perceived authority of their sources to support or discredit an argument, than on the evidence.

That’s just lazy. Source authority proves nothing and I would like to think that my discussion partners are capable of coming to a more reasonable position when they are forced to actually consider the evidence.

Both sides are guilty

Unfortunately, both supporters and opponents of a scientific viewpoint or consensus fall into this trap. Take the “fluoridation debate.” It annoys me that some supporters of the scientific viewpoint will respond to an opponent by disparaging their sources. The fact that the opponent is citing the activist Fluoride Action Network, the “Fluoride” journal or one of the shonky pay-to-publish journals where anti-fluoride activists sometimes get published does not, in itself, discredit their argument. On the other hand, if the actual evidence involved in those reports were discussed it might just be possible for the faulty conclusions to be exposed.

On the other hand, how often have I heard opponents of community water fluoridation reject the authority of scientific journals or published research because the workers were paid by the government (we must all get a wage from somewhere) or the journal or conference received industry sponsorship? I am not at all impressed by the refusal to consider the real evidence implied by falling back on disparaging sources.

The other tactic of supporting a claim by pointing to the high authority of the source is also repugnant. Even researchers and journals we generally consider “reputable” can still publish flawed work and even rubbish.

One of the most common arguments used by anti-fluoride campaigners is that the highly respectable, authoritative journal “The Lancent” has “officially” declared fluoride to be a “neurotoxin.” This is wrong on so many counts. The Lancet publishes research papers. It is not in the business of making official declarations on toxic compounds. The paper referred to did not describe fluoride as a “neurotoxin” – that word is inappropriate for describing a chemical of inorganic origin. The work cited in that paper was from areas of endemic fluorosis mainly in China and is not relevant to community water fluoridation. And the paper itself was not justified in making the limited conclusions it did on such poor evidence. I have discussed the paper more fully in “Repeating bad science on fluoride.“

The odds are, of course, that those activists citing this paper in such a manner have not actually read the paper – a common problem with people who rely on the authority of their sources rather than evidence. In fact, they are probably not at all interested in the details in most cases.

My point is reliance on authority is not a valid supporting argument any more than disparaging a source is a valid opposing argument. We should always follow the evidence – and rely on that evidence for our arguments in such discussions.

The political arena

This problem is even worse in the political sphere where so often we actually do not have evidence to fall back on. In fact, this situation seems to have got a lot worse of late where, for one reason or another, facts and evidence seem to be the last thing in the minds of “reporters” – or at least those who are continually telling us what we should think.

Unfortunately, discussion of political issues often leads people to claim they are using what they think as “reliable sources” or disparaging an opponent’s argument by claiming they are using “unreliable sources.” In fact, people who should know better, seem to often support their claims against any criticism by claiming it came from a “reliable source” or “authoritative source.” And these people who should know better will often resort to “attacking the messenger.” Criticising or rejecting information because it was reported by what they consider an “unreliable source.” The facts or evidence seem to be forgotten.

This can get pretty silly. I once had to confront the argument of a discussion partner who rejected the video recording of a statement made by a spokesperson for the US Department of State because it was part of a piece of RT news coverage! Especially silly as the video recording was probably an official one made by staff of the Department of State.

How often do we see people promoting partisan claims about the political hysteria in the US or the war in Syria by using sources like the Washington Post, New York Times, CNN or Al-Jazeera? Sources they claim are “reliable?” In my article An Oscar for Al Qaeda? I described how the New Zealand Ministry’s of Foreign Affairs and Internal Affairs carried out “due diligence” on the White Helmets organisation they were planning to give money to by referring simply to a report from Al-Jazeera. No attempt to dig deeper, to evaluate the veracity of the Al-Jazeera reports or to follow-up other sources critical of the White Helmets. Yet Al-Jazeera has a reputation for supporting “rebels”/”terrorists” in Syria. It is shocking that a New Zealand ministry was not prepared to make a more sensible judgment.

On the other hand, how often do we see people disparaging information or claims about the current US political hysteria or the war in Syria which with they disagree because it was reported by Sputnik, RT or one of a host of other “alternative” news sources?

Both sides of a political argument now denigrate the sources used by the other side as promoting “fake news.” And, to an extent, each side is probably right as every news sources these days has its own point of view – its own bias.

Reader beware – use a range of sources

Unfortunately, many readers seem more interested in confirming their own biases than dealing with real facts or evidence. Understandably these people will select the news source that suits them. That’s OK if you simply want to follow the “party line.” But it is lazy because it avoids any intelligent or critical analysis.

It is incumbent on the rest of us who are more interested in real facts and in drawing more credible conclusions to make an effort to consult a range of news sources and to critically analyse the claims, opinions and information we get from them. I believe that in today’s world there is no such thing as an authoritative or reliable source when it comes to political information. All the media – the “established mainstream media” as well as the “alternative media” are equally capable of publishing and promoting fake news.

We need to be aware of this, be prepared to use a variety of sources to avoid the “party line” problem, and critically analyse what we read so we can separate facts from opinions and unsubstantiated claims.

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June ’17 – NZ blogs sitemeter ranking

Image credit: How to Write SEO-Friendly Blog Posts Your Audience Will Read – and Love

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 June 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

Subscribe to NZ Blog Rankings Subscribe to NZ blog rankings by Email Find out how to get Subscription & email updates

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

Subscribe to NZ Blog Rankings Subscribe to NZ blog rankings by Email Find out how to get Subscription & email updates

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.

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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

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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.

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.

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.

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?

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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

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

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I am currently dealing with family issues so am reposting this article, “ChildSmile dental health – its pros and cons” from 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.

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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?

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.

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.

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: 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.

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I am currently absorbed in dealing with family issues at the moment so am reposting this article, “Chemophobic scaremongering: Much ado about absolutely nothing.” Unfortunately is is still very much relevant.

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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.

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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