Category Archives: New Zealand

Fluoridation: One small step sideways?

elephant in room

Fluoridation. Let’s not ignore the elephant in the room – the need to separate scientific review from community consultation.

Most health officials and science-minded people welcomed the recent announcement of the government’s plan to transfer decisions on water fluoridation from local councils to district health boards (see Fluoridation decisions to be made by District Health Boards). But the welcome was, in most cases, luke warm. The health and scientific community would probably have preferred that central government take on that responsibility itself. Given that District Health Boards employ staff with much more scientific and health expertise than councils the decision was seen as one small step forward – by a government too timid and politically sensitive to local backlash to “go the whole hog.” But I believe this step ignores the elephant in the room – the need to separate the review of the science from political considerations such as community consultation.

On the other hand, anti-fluoride campaigners have presented the decision as a giant step backwards – at least in their public announcements and campaigns. But their disingenuous claims (describing the step as introducing mandatory fluoridation and removing democratic consultation) suggest this has more to do with scaremongering and rallying of the troops. In reality, they probably welcome the announcement of the plans as providing them yet another chance to deluge the public and politicians with their misinformation and scare stories.

I fear that the government’s moves may turn out to be only one step sideways – although the required legislative process does provide possibilities to make changes that clearly separate scientific consultation from community consultation. That would be a step forward

A small step sideways

Simply transferring the hysterical discussions from elected local councils to elected district health boards will provide the same level of access by ideologically and commercially motivated campaigners and their misinformation. In practice, the elected members of health boards may suffer the same degree of scientific ignorance, ideological biases and hubris amply demonstrated by local councils in the past.

Anti-fluoride campaigners recognise this. They already have supporters on some health boards and are consciously planning to increase their numbers with upcoming local body elections.

Jane Clifton recognised that this sideways step is the most likely outcome in her recent NZ Listener column (subscription required):

“Finally rolling up its sleeves to sort out this nonsense once and for all the Government has  . . .  relocated the decision with district health boards. DHB members are no less subject to fearsome lobbying than councils, so this major public health issue will remain the push-me, pull-you of unqualified, internet-schooled amateur lobbyists and ill-equipped local politicians.”

She says controversies like this are “beyond” councils as demonstrated by the “wondrous variety in their deliberations over fluoridation.”

A real step forward possible

According to the Ministry of Health, the government’s plans require an amendment to the New Zealand Public Health and Disability Act 2000. Page 19 of this act has the following section describing a public health advisory committee:

14 Public health advisory committee

(1) The national advisory committee on health and disability must establish a committee called the public health advisory committee to provide independent advice to the Minister and to the national advisory committee on health and disability on the following matters:
(a) public health issues, including factors underlying the health of people and communities:
(b) the promotion of public health:
(c) the monitoring of public health:
(d) any other matters the national advisory committee on health and disability specifies by notice to the committee.
(2) The advice given by the public health advisory committee is to be formulated after consultation by the committee with any interested organisation or individual that the committee considers appropriate.
(3) The Minister must make publicly available, and present to the House of Representatives, a copy of any advice given by the public health advisory committee.”

I think this advisory committee should be given responsibility for the  overseeing and regular review of the science around community water fluoridation. It could do this by commissioning bodies like the Royal Society of NZ and the Office of the PM’s Chief Scientific Advisor in the same way the Auckland Council on behalf of several local Councils did last year to produce the report Health effects of water fluoridation : A review of the scientific evidence (Eason et al., 2014). Maybe an approach similar to the previous National Fluoridation Information Service, which continually reviewed the literature, could be used. Or maybe such scientific consultation could be tailored to fit the specific situation taking into account any movement in the science and public concern.

Clause 2 above enables consultation with “any interested organisation or individual that the committee considers appropriate.” That would give scope for the credible serious opponents to the currently accepted science but, hopefully, would exclude (or reduce the significance of) the  mindless political campaigner and form letters in submissions.

Yes, the anti-fluoride campaigners would moan about the requirement that submitters be “appropriate” – but the honest ones should welcome the chance to present their scientific claims to a scientifically credible body.

Ideally, then, legislation could provide that scientific consideration is separated from the community consultation when fluoridation of a community is considered. It could make clear that the elected district health boards should not consider the science – that they are not the appropriate body for this. Their role should be to make recommendations after consideration from their staff on the oral health of a community and the need and practical possibility for community water fluoridation.  The board would also have a responsibility to consult the community to determine if fluoridation proposals are supported.

But, please, don’t let such elected boards become bogged down with sifting through piles of submitted misinformation about the science as councils have been. Otherwise, we will just see a future demand, this time from DHBs, for central government to take responsibility for the issue.

Deja vu!

Conclusions

At the moment, we are unclear how the new legislation will pan out. Anti-fluoride campaigners are taking advantage of  the current situation to scaremonger (both about fluoridation and about democracy in general) and spread misinformation. They are making the most of this – and probably enjoying the opportunity as these sort of campaigners recognise that the campaign itself brings more psychological  benefits than the actual decisions.

But the drafting and consideration of this new legislation provide opportunities to turn what could be just a small step sideways into an actual step forward. This could be the time to attempt a separation of scientific considerations and reviews from community consultations.

Perhaps the health and scientific communities could learn a little from the anti-fluoride campaigners activity though. Rather than allowing such campaigners to bombard our lawmakers with their misinformation without challenge, as is currently happening, perhaps there is some scope for sensible lobbying to strengthen the legislation by clarifying that scientific considerations must take place at the central government level and be separated from local consultations.

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“Do the math” – a bit like “Do the research!”

ChCh press letterCherry-picking data is an old technique used by those who wish to raise doubt about a scientific consensus. On the one hand, it isolates the cherry-picked data from their context and the rest of the data. On the other hand is present a “sciency” authority to the argument by pretending to be evidence-based.

I have written about cherry-picking in several articles discussing the fluoridation issue – so nothing new here. But the current surge of activity by anti-fluoridation activists  attempting to raise doubt with the upcoming parliamentary discussion of new legislation on fluoridation is producing a fresh wave of cherry-picked arguments.

The image here is just one example in a letter to the Christchurch Press a few days ago. I thought it worthwhile to actually check out the quoted figures to see if the arguments awere justified.

Firstly, the figures were taken from the Ministry of Health’s 2014 data for the dental health of New Zealand children. Unfortunately, while the actual numbers used are correct, the data has since been withdrawn because of errors in the spreadsheet. So I will use the data for earlier years,  2005 – 20013, in my analysis.

The overall picture

First off – the overall picture shown by the Ministry of Health data is that community water fluoridation does reduce tooth decay. Of course, that is why the anti-fluoride campaigner rarely discusses the overall picture – instead, they cherry-pick data to confirm their bias. The figure below is for 5-year-olds  averaged over the years 2005-2013

MoH-overall

I have separated the data by ethnicity because of the big differences Māori and Pacifica on the one hand and the other ethnic groups on the other. In particular, the dental health of Māori and Pacifica children is poorer. This is an important factor which needs to be taken into account when comparing data from different regions. I discussed this further in my article Anti-fluoridation cherry-pickers at it again.

Data for Canterbury

It is likely that at least some of the 2014 spreadsheet mistakes were in the Canterbury data – but still the claim that there is no real difference between data for fluoridated and non-fluoridated areas could well be true – at least for some years. The figure below displays the data for 5-year-old children. Choose your year and you will get the answer you want to confirm your bias. Children from fluoridated areas seem to have poorer teeth in 2008 and 2010 and better teeth in 2012 and 2013.

Canterbury-5-years

MoH 5-year-old child dental health data for 2005-2013. dmft = decayed, missing and filled teeth.

The plots in the above figure indicate how unreliable such comparisons are for Canterbury because the fluoridated data is all over the place. This is because of the very low number of children in the fluoridated area: 22 – 70 over the years, 42 on average. There were on average 4720 children in the non-fluoridated areas. Children from the fluoridated area usually comprised less than 1% of the total.

The data for Canterbury does not deny the effectiveness of fluoridation, as the letter writer claims. They just show that no conclusion can be drawn from this cherry-picked data. At least I cherry-picked the data from 2005-2013 which enabled me to see how unreliable they were. The letter writer just cherry-picked one year! What will they do if the corrected spreadsheet for 2014 no longer supports their bias – switch to 2010 instead?

Comparing Canterbury and Waikato data

Here we have a different problem. The letter writer has simply cherry-picked these figures because they confirm her bias. She has not taken into account the important influence that ethnic composition has. Any intelligent analysis of this comparison must consider this aspect.

This is the ethnic composition of the 5-year-olds MoH data (averaged over 2005-2013).

Canterbury Waikato
Māori (%) 10.2 31.5
Pacifica (%) 3.2 2.1
Other (%) 86.6 66.4

So, whereas only 13.4% of Canterbury 5-year-olds are Māori or Pacifica, 33.6% of Waikato 5-year-olds are Māori or Pacifica. This is an important difference – especially as the dental health of Māori and Pacifica is poorer than others as demonstrated in the first figure .

Any analysis that does not take this difference into account will be misleading.

As well as ethnic distribution between regions there is also the influence of ethnic distribution between the fluoridated and non-fluoridated areas. This was a factor I discussed in Anti-fluoridation cherry-pickers at it again. The graphic below for 5-year-old children shows Māori and Pacifica are more concentrated in the fluoridated Waikato areas than in the non-fluoridated ones.

MoH-ethnic

Distribution of Māori and Pacifica between fluoridated and non-fluoridated areas.

We can ignore the bar for fluoridated Canterbury because of the very small numbers.

What this means is that the mean value for fluoridated Waikato areas is decreased by the higher presence of Māori and Pacifica than in the non-fluoridated Waikato areas. This higher proportion Māori and Pacific in the Waikato region also affects the comparison of the two regions made by the letter writer.

Rather than comparing oranges with apples, let’s compare Canterbury and Waikato for the same ethnic group – Others (not including Māori and Pacifica). As the figure below shows, removal of the effect of Māori and Pacifica from the Canterbury data increase the caries-free percentage – but it is still slightly less than the equivalent data for the fluoridated Waikato areas.

Waikato-Canterbury

So much for children from non-fluoridated Canterbury areas having better teeth than children from fluoridated Waikato areas.

Auckland and Counties/Manakau

Some anti-fluoride campaigners are pulling the same trick – asserting the dental health of non-fluoridated Canterbury children is better than for the fluoridated Auckland and Counties/Manakau children.

Here is a comparison of the ethnic composition of the three regions for the 2013 5-year-old MoH data.

% Māori + Pacifica
Canterbury

13

Auckland

32

Counties/Manakau

52

See the problem? It is just completely naive – or worse, dishonest – to compare data between regions like this without taking ethnic composition into account.

But that is not going to stop the determined activist who will just cherry-pick whatever fits their bias. I think the naive presentation of data in this way is no more justified by the declaration “Do the math” than misrepresentation of the science is justified by the declaration “Do the research!”

Note: I am well aware that the MoH data have other problems. A truly scientific analysis would also take into account factors like the degree of misallocation of children due to different fluoridation status of home and school, dental treatments such as fluoride varnishes differently used in different regions, missing data, different proportion of attendance according to region and ethnicity, etc. I am not the person to make such a thorough analysis. My sole purpose here is to show how such raw data can be misused for confirmation bias and “sciency” support of mistaken political agendas.

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Barrel bombs, hell cannons, Aleppo and media bias

The result of terrorist shelling of Aleppo

I guess most readers have become familiar with barrel bombs – an indiscriminate weapon currently being used by government forces in the Syrian war. But how many have heard of “hell cannons?”

I hadn’t until recently and I think this shows the bias in our media coverage of the conflict. Hell cannons are an indiscriminate weapon used by rebel/jihadist forces, cause terror and  civilian damage and loss of life. Unfortunately, our media often seems to paint the picture that only government actions cause civilian losses.

1104_cannon

“Rebels” load hell cannon with explosive filled gas bottle in Aleppo. (Getty)

This bias seems particularly bad in their current reporting of the civilian deaths in Aleppo. Here are some of the mythical stories our news media is promoting:

1: The government is not attacking a city held by “rebels” as many of our media stories imply. Rebels hold the smaller part of the city in the east and attacks by the government forces and its allies are aimed at removing them. There is also intensive fighting in areas around Aleppo – particularly in the north where Syrian and allied forces recently disrupted rebel supply lines with Turkey.

So, if anyone is attacking Aleppo it is the rebels/jihadists.

2: The claim that the government and its allies are attacking “moderate rebels” is biased propaganda. the anti-government militias are numerous and allegiances are complex. They often fight among themselves.  Some may well be “moderate” but they cooperate and are often integrated with Al-Nusra – the main terrorist/jihadist group in the area.

How does one define “moderate” in Syria, though? I guess one way is to characterize those rebel militia which accepted the recent cessation of hostilities and signed ceasefire agreements with the Syrian government, as outlined in the US/Russian initiative, as the real “moderates” ready to take part in a political solution. It would seem that the “rebel” militia fighting in Aleppo have not accepted the cessation of hostilities agreement.

3: I recently heard an Al Jazeera reporter imply that only the Russians and Syrian government classifies “rebel” groups like Al Nusra as “terrorists” implying this was unfair. Again biased propaganda. The UN specifically lists Al-Nusra, together with Daesh (ISIS) as a terrorist organisation. Those groups were specifically excluded from the cessation of hostilities agreement.

There is a media tendency to describe only Daesh as terrorist or to present the aim of the US-based coalition and the Russian Federation in Syria as fighting Daesh. US spokespersons seem to repeat that description. This is very misleading. The UN and the cessation of hostilities agreement make clear that Al-Nusra is also the enemy.

Al-Nusra is the Al-Qaeda group in Syria (ISIS/Daesh originally broke away from Al-Nusra). Its aims and programme are just as obnoxious as those of Daesh but Al-Nusra has been able to form links with other anti-government militia – often groups that have been backed, armed and financed by the US and its middle eastern allies (eg. Saudia Arabia and Qatar). Very often these militia are operating under the command and structures of Al-Nusra. The ability of Al-Nusra to form these arrangements probably means it will outlast Daesh – and may actually be the bigger danger.

The death of the “last pediatrician” in Aleppo?

A blatant example of bias has been the media claim that a pediatrician who died in the bombing or shelling of a hospital in the rebel-held eastern part of Aleppo meant Aleppo no longer had any pediatricians. Horrible Syrian government denying medical care for children!

But Dr Nabil Antaki, who works in Aleppo, responded to this propaganda with this:

“For three days now, these media outlets have been accusing the “Assad regime” of bombing an MSF hospital [Medecins sans Frontieres] to the east of Aleppo and of killing the last paediatrician in the city. This demonstrates that, for these media, the only priority is this pocket of the city where terrorists are embedded.

The three-quarters of Aleppo under Syrian Government control where numerous paediatricians are practicing is of no consequence for this media. We witnessed the same bias when Al Kindi, the biggest hospital in Aleppo, was targeted by terrorist mortars and then intentionally burnt down about 2 or 3 years ago. The media ignored this criminal act.”

He refers to this sort of propaganda as “lying by omission” saying:

“This media never mention the continuous bombardment and the carnage we have witnessed in western Aleppo where every single sector has been targeted. On a daily basis we see dozens of people murdered.

What makes these omissions even more despicable is that these areas represent 75% of Aleppo and there are 1.5 million people living in them. Compare this to the 300,000 living in the eastern zone which is occupied by terrorist groups.

This twisted narrative engenders the belief that these terrorist groups that are attacking us are actually the victims. Even more abhorrent, these media have distorted our “Save Aleppo” appeal, to make it look as if we are calling for Assad and the Syrian Army to cease hostilities!

This is FALSE. Added to which, they are not “Assad’s forces“, they are the national forces of the regular Syrian army that is defending the Syrian State.

The western and gulf media could at least have had the decency to mention the terrorist massacres of our people. For example, on Friday 30th April, when one of their mortars targeted a mosque at prayer time.”

Footnote: I find the New Zealand media pathetic in its coverage of events like the Syrian war and tend to search for other sources. I regularly watch Al Jazeera but now find their coverage of Syria extremely biased. Perhaps this is because the organisation is based in, and financed by Qatar, a sponsor (together with Saudi Arabia and Turkey) of anti-government forces in Syria.

Of late I notice that Al Jazeera has been smudging out the logos identifying sources in many of the videos they display. Can’t help thinking they wish to cover up they fact they are relying on the “rebel’ news media for their videos of action in Syria.

Pathetic if true.

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April ’16 – NZ blogs sitemeter ranking

blog

Image credit: How to Improve Your Online Content for Better Readability

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

You can see data for previous months at Blog Ranks

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

Science and management – a clash of cultures

Balloon_41

Found this while weeding out some old computer files. It certainly described the conflict between science and management I experienced while working – particularly since the reforms of the early 90s. “Science” became a dirty word while “profit” and management-speak became almost compulsory.


A man in a hot air balloon realized he was lost.

He reduced altitude and spotted a woman below. He descended a bit more and shouted,”Excuse me, can you help me? I promised a friend I would meet him an hour ago, but I don’t know where I am.”

The woman below replied, “You’re in a hot air balloon hovering approximately 30 feet above the ground. You’re between 55 and 56 degrees north latitude and between 3 and 4 degrees west longitude.”

“You must be a scientist,” said the balloonist.

“I am,” replied the woman, “How did you know?”

“Well,” answered the balloonist. “everything you told me is, technically correct, but I’ve no idea what to make of your information, and the fact is I’m still lost. Frankly, you’ve not been much help at all. If anything, you’ve delayed my trip.”

The woman below responded. “You must be in Management.”

“I am,” replied the balloonist, “but how did you know?”

“Well,” said the woman, “you don’t know where you are or where you’re going. You have risen to where you are due to a large quantity of hot air.  You made a promise which you’ve no idea how to keep, and you expect people beneath you to solve your problems.

The fact is you are in exactly the same position you were in before we met, but now, somehow, it’s my fault.”

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Anti-fluoridationists misrepresent new dental data for New Zealand children

liar_liar

Another whopper from the anti-fluoridation movement in New Zealand.

They claimed yesterday that “data released by the Ministry of Health today confirm that water fluoridation is having no noticeable effect in reducing tooth decay” (see DHB Data Show No Benefit From Water Fluoridation).

Yet a simple scan of the data (which can be downloaded from the MoH website) shows this to be patently untrue.

Here is a graphical summary of the New Zealand-wide data for 5-year-olds and year 8 children. It is for 2014 and I have separated the data ethnically as well as presenting the summary for all children (“total”).

DMFT and dmft = decayed, missing and filled teeth.

2014_5_years

214---8-yrNow – don’t these figures show the press release headline and the first sentence  are completely dishonest?

The data for all children (“total”) Maori and “other” show children in fluoridated areas have a higher percentage of caries-free teeth and a lower mean value of decayed, missing and filled teeth. The data for Pacifica are less definite – because the vast majority of Pacific children live in fluoridated areas. I discussed this further in my last post A challenge to anti-fluoridationers to justify their misrepresentation of New Zealand research.

Cherry-picking

So the headline and main message of the anti-fluoridationists press release were outright lies. However, they will fall back on the claim that the press release does contain some facts.  But these are just cherry-picked snippets taken out of context to confirm the bias of the anti-fluoride mind.

For example, comparing data for Christchurch and Nelson-Marlborough with those for  Auckland and Counties-Manukau is just disingenuous if the ethnic differences (which we know clearly play a role in oral health) are not considered. Similarly, reference to the 2o14 “overturning” of the Hamilton Council decision to stop fluoridation is just silly considering that there are no separate data for the city and the Hamilton Council fiasco over water fluoridation overlapped the period the data covers.

Of course, this press release has been processed through the international anti-fluoridation – “natural”/alternative health media channels so expect to be bombarded with international reports based on these lies.

The lesson from this little story – don’t take claims made by anti-fluoridation campaigners, or similar activists with an anti-science agenda, at face value. Always check them out.

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Fluoridation decisions to be made by District Health Boards

newspaper-changes-fea

Image credit: Constant Contact

This has been on the cards for a while. In recent years ideologically and commercially motivated activists have played havoc with the consultations organised by local body councils. Councils have shown by their own actions they are not capable of considering the scientific and health evidence related to community water fluoridation. The political intrigues of local bodies and the lack of scientific skills have prevented sensible decisions in many cases – and resulted in reversals of decisions – sometimes within a few weeks. yet New Zealanders have in most places voted to support community water fluoridation.

Councils have asked the central government to remove decisions on fluoridation from their responsibility. And now the government has decided to do just that.

This is the text of today’s  press release from the Hon Dr Jonathan Coleman, Minister of Health, and the Hon Peter Dunne, Associate Minister of Health (see Fluoridation decision to move to DHBs):


DHBs rather than local authorities will decide on which community water supplies are fluoridated under proposed changes announced today by Health Minister Jonathan Coleman and Associate Health Minister Peter Dunne.

“New Zealand has high rates of preventable tooth decay and increasing access to fluoridated water will improve oral health, and mean fewer costly trips to the dentist for more New Zealanders,” says Dr Coleman.

“This change could benefit over 1.4 million New Zealanders who live in places where networked community water supplies are not currently fluoridated.

“Water fluoridation has been endorsed by the World Health Organization and other international health authorities as the most effective public health measure for the prevention of dental decay.”

DHBs currently provide expert advice on fluoridation to local authorities.

“Moving the decision-making process from local councils to DHBs is recognition that water fluoridation is a health-related issue,” says Mr Dunne.

“Deciding which water supplies should be fluoridated aligns closely to DHBs’ current responsibilities and expertise. It makes sense for DHBs to make fluoridation decisions for their communities based on local health priorities and by assessing health-related evidence.”

A Bill is expected to be introduced to Parliament later this year. Members of the public and organisations will have an opportunity to make submissions to the Health Select Committee as it considers the Bill.

See also: DHBs could make call on fluoridating water

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March ’16 – NZ blogs sitemeter ranking

blog-cartoon

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

You can see data for previous months at Blog Ranks

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

Anti-fluoridation campaigner, Stan Litras, misrepresents WHO

stan litras-300x225

Stan Litras, Principal Dentist at Great Teeth, Wellington, and anti-fluoride activist but uses fluoride in his treatments

Wellington anti-fluoride campaigner, Stan Litras, has penned an “open letter” about community water fluoridation (CWF) to the Associate Minister of Health, Peter Dunne. He titles his document  HEALTH RISKS TO NEW ZEALANDERS FROM FLUORIDEbut, as we would expect, it is full of distortions and outright misrepresentations. (I have discussed some of Stan’s previous misrepresentations of the science of CWF in my articles:

A blatant  misrepresentation of WHO recommendations

I will just concentrate here on Stan’s whopper about the World Health Organisation’s (WHO) recommendations on the  of monitoring total fluoride intake for populations considering and implementing CWF. It is central to the recommendations he makes to Mr Dunne.

WHO does recommend monitoring the fluoride ingestion by a population before and after implementation of programmes for supplementing fluoride intake (eg., CWF, fluoridated salt and fluoridated milk). This is to make sure that fluoride intake is neither too low for providing dental benefits or too high when problems of dental fluorosis can occur. However, this following claim of Stan’s is just untrue:

“The World Health Organization strongly recommends that where health authorities implement water fluoridation, they must monitor total fluoride ingestion at the individual level. v

WHO notes that community level analysis is inadequate for assuring safety of all individuals.”

Let’s see what WHO actually recommends. Stan “cites” the WHO document Basic Methods for Assessment of Renal Fluoride Excretion in Community Prevention Programmes for Oral Health,” to support these claims but he does not appear to have actually read the document.

Here is what the WHO document actually recommends:

“public health administrators should assess the total fluoride exposure of the population before introducing any additional fluoridation or supplementation programmes for caries prevention.”

It recognises that:

“Today, there are many sources of fluoride, and this needs to be taken into consideration when planning a community caries prevention programme using fluoride.”

And it concludes from the available research reviews that:

“at present, urine is the most useful biomarker of contemporary fluoride exposure.”

But notes its limitations – such as, the influence of diet (vegetables and meat influence the pH of urine and hence the degree of excretion of ingested fluoride through the urine), within-subject variation, lack of correlation between urinary fluoride excretion and fluoride intake and uncertainty about levels needed to give protection. It quotes the conclusion of Rugg-Gunn et al., (2011) in their book chapter Contemporary biological markers of exposure to fluoride:”

“While fluoride concentrations in plasma, saliva and urine have some ability to predict fluoride exposure, present data are insufficient to recommend utilizing fluoride concentrations in these body fluids as biomarkers of contemporary fluoride exposure for individuals. Daily fluoride excretion in urine can be considered a useful biomarker of contemporary fluoride exposure for groups of people, and normal values have been published.” [My emphasis]

And then goes on to warn:

“Urinary fluoride excretion is not suitable for predicting fluoride intake for individuals.” [WHO’s emphasis]

This is the exact opposite of Stan Litras’s claim. The monitoring must be done at a group level – with proper care to make sure of random selection of people to sample. This publication provides lower and upper margins of optimal fluoride intake and the average daily fluoride excretion recommended for fluoride levels to be optimal.

Just to be clear – the limitations due to diet are not caused by the fluoride content of the foods but their different effects on urine pH and hence the excretion of fluoride in the urine. Random selection of people to sample allows these dietary variations to be averaged out for the group.

In fact, the WHO publication describes the methods for “studies” aimed at monitoring a population or group – not for monitoring individuals. So it does not support Litras’s recommendation that our public health system regularly monitor the fluoride level in individuals. And Stan’s claim that WHO asserts community level analysis is inadequate is completely false. It is, in fact, the individual level analysis that is inadequate.

Using “monitoring” to fear-monger

“Monitoring the fluoride levels in individuals” is central to Stan’s advice to Mr Dunne. He is just fear-mongering as this is neither necessary nor meaningful for the normal person. The before and after monitoring of groups recommended by WHO is simply to check if fluoride ingestion is inadequate before the introduction of fluoride supplement schemes like CWF – and to make sure that, after the introduction of the scheme, fluoride ingestion levels fall within the optimum range.

There is absolutely no suggestion by WHO that normal individuals should be regularly monitored for fluoride levels as Stan is recommending. He want’s to see this because it would cause unwarranted concern in the population.

Most at-risk individuals

While the WHO document recommends “priority is given to children of the
younger ages because of their susceptibility to enamel fluorosis” it does recognise a value in monitoring some adults. For example:

“adults, exposed to fluoride in certain industries (for instance aluminium production, addition of fluoride to water, salt or milk, or exposed to drinking water with excessively high fluoride concentrations).”

These are not normal members of the population – but the increased risk of exposure resulting from their professions could warrant some sort of regular testing regime. I compare this to the monitoring of people working with ionising radiation sources like X-ray machines or handling radioactive isotopes. The wearing of radiation detection badges and regular blood testing is warranted for these people – where it is not for the ordinary person in the street who is exposed just to background radiation and the occasional X-ray.

I imagine, then, that regular individual monitoring could be advisable for water treatment staff handling fluoridating chemicals – and dental technicians and practitioners who handle fluoride containing dental formulations such as varnish and filling materials.

A question to Stan Litras

I know for a fact that Stan Litras uses fluoride-containing dental formulations in his practice. Has he organised for regular testing of himself and his staff for possible fluoride contamination? Is he recommending that any of his patients treated with such material receive regular fluoride testing?

If not – why not?

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February ’16 – NZ blogs sitemeter ranking

UPDATE: 8:00 pm 01/03/1016

My apologies – the first version of this post had mistakes in some of the rankings – hopefully, it is now accurate.
BloggingDevotion

Image credit: Isabella Bannerman.

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 February 2016. Ranking is by visit numbers – and there is a little more room at the top at the moment because of the departure of several high-ranking blogs. 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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