Category Archives: politics

Social health policies, freedom of choice and responsibility

Social health policies inevitably raise the issue of the individual’s freedom of choice. While debates around these policies often concentrate on questions of fact, scientific consensus and reliability of evidence, these tend to be surrogates for the underlying values issues. To what extent should I sacrifice my freedom of choice, or my freedom of choice to decide for my children, for the good health of the community? And what if my freedom of choice violates the freedom of choice for others?

hall-offit-fullPaul Offit discussed these issues in a recent Point of Inquiry podcast – Paul Offit, MD, on Measles in the Magic Kingdom and the Anti-Vaccine Movement. He is a Professor in the Division of Infectious Diseases and the Director of the Vaccine Education Center at the Children Hospital of Philadelphia. Offit is the author of the book Do You Believe in Magic?: The Sense and Nonsense of Alternative Medicine.

He basically talks about the spread of measles throughout California and neighboring states because of a source of infection at Disneyland. Although measles were eliminated in the U.S. by 2000, the misinformation of the anti-vaccine movement has caused a return of a full-fledged outbreak.

Levels of responsibility and consequences

Paul makes the comparison of opposition to vaccination with opposition to blood transfusion.

1: Blood transfusions. A person my refuse to accept treatment involving blood transfusion because of their personal religious beliefs. More questionably they may refuse on behalf of their children. However, the consequences are limited to the person or her child. The decision does not harm the community at large.

2: Vaccinations. A person may refuse a measles vaccination for themselves or their children. But in this case the consequences are not personal – they affect the whole of society. By lowering the degree of immunisation in the community they threaten the lives of others – particularly the most vulnerable, children.

In these two cases the person has refused an intervention, a medical treatment or vaccination, which could be seen to violate their freedom of choice – or even to violate their body. In the first case the consequences are personal, limited to the person who made the wrong decision. But in the second case the consequences are social. An personal wrong decision has taken away the freedom of choice, the health and in some cases the lives, of others in society.

A bit like the personal decision to drive on the wrong side of the road. Society has taken away a small personal freedom of choice in our road rules to protect the lives of all of us.

3: Fluoridation. Social health policies like community fluoridation of water, salt, milk, etc., are recognised as being safe, beneficial and cost-effective. But they are opposed by a vocal minority. Activists will passionately promote the freedom of choice argument and, considering they don’t have the scientific evidence on their side this is often seen as their strongest argument. After all, it is values-based and therefore can’t be tested and rejected by evidence.

But, this third case is different to the other 2.

  • The act of fluoridation or not is social, taken by society as a whole or their representatives. An person may contribute to the decision but cannot decide the issue by a personal action as they can with vaccinations or blood transfusions. Although individual political action, or dissemination of information or misinformation, may influence that social decision – and hence the social consequences.
  • Fluoridation does not involve an intervention or treatment, medical or otherwise. No one is forced to drink fluoridated water or milk, or to consume fluoridated salt. The freedom of choice argument is invalid here because there are always alternatives.

Despite actively promoting the freedom of choice argument even the NZ anti-fluoride activist Fluoride Free NZ provides information on these atlernatives. They list alternative water sources, distillation, ion exchange filters and reverse osmosis. Most of these choices are cheap and available.

So what is driving anti-fluoridation propagandists?

Unlike opponents to blood transfusion they cannot argue freedom of choice to refuse an intervention on religious grounds. There is no intervention. The only personal imposition is that they may wish to buy a water filter (many already have these) or buy water from a different source.

Again, unlike opponents of vaccination they cannot argue freedom of choice to refuse an intervention even on grounds of personal belief – because there is no personal intervention.

Given the lack of any forced or personal intervention I am forced to conclude the freedom of choice issue that concerns the anti-fluoride activists is their freedom of choice to decide the oral health quality of other members of their community. And given the health and scientific expert consensus on the issue they are really arguing for their freedom of choice to decide the oral health of others on the grounds of their own minority personal beliefs or convictions.

In last year’s High Court judgement on the question of fluoridation in South Tarinaki, Justice Hansen wrote:

“Provided it does not have consequences for public health a person has the right to make even the poorest decisions in respect of their own health. But where the state, either directly or through local government, employs public health interventions, the right is not engaged. Were it otherwise, the individual’s right to refuse would become the individual’s right to decide outcomes for others. It would give any person a right of veto over public health measures which it is not only the right but often the responsibility of local authorities to deliver.”

The freedom of choice the anti-fluoride activists are promoting is their freedom of choice to decide health outcomes for others – not themselves.

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Reality of war for civilians

The civil war in Ukraine is almost forgotten by our news media but it is only getting worse. Poroshenko’s announcement that the US is to supply lethal weapons to the Kiev government means things are going to get much worse before they get better.

But this is what it is like for civilians being evacuated by Donetsk forces from the current battle area near Debaltseve.

[eng subs] Uglegorsk residents evacuated by the militias from the town destroyed by UAF “Grads”.

As one of the refugees demands – Poroshenko should negotiate. A political solution is necessary and it is the only way to end this war. It is what the suffering civilians need.

Update

For balance here is some footage on the evacuations from the side of the Kiev troops.

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US meddling in Ukraine behind coup

Ukraine Deputy has proof of USA staging civil war in Ukraine

Just came across this video. It is useful as we tend to forget the early history of the current crisis in Ukraine. This is a speech in the Ukrainian parliament made just before the outbreak of the Maidan demonstrations and riots which eventually lead to the overthrow of the elected government in February and installation of an unelected junta. Everything was downhill (or downhill at a faster rate) from then on.

The speaker is Oleg Tsarov. He eventually ran in the early 2014 presidential election where Poroshenko was elected. However, he withdraw just before election day because of intimidation and violence (he was beaten up by nationalist thugs several times). Several other candidates withdrew in similar situations, one having been the victim of a failed assassination attempt.

You get a flavour for the conflict and struggle of the time from the constant heckling and interruptions by ultra-nationalist/neo-fascist groups in the parliament. Members of the ultra-nationalist Svoboda Party are easily recognisable in the video.

Some other reminiscences from that period

nuland---pyatt

Assistant US Secretary for European and Eurasian Affairs Victoria Nuland and Ambassador Geoff Pyatt walk inside the protester’s tent camp in Kiev, Ukraine, in December 2013.

US politicians were often present in the Maidan demonstrations. Hell, Geoff Pyatt was even involved in directing traffic during one tense period. John McCain was another US politician prominent for his close association with anti-government forces in Ukraine.

nuland-in-ukraine

Victoria Nuland gets chummy with Oleh Tyahnybok (leader of neo-fascist Svoboda Party, Vitaly Klitschko and Arseniy Yatseniuk (current pro-war PM).

Phone call

A leaked phone conversation between Victoria Nuland and US ambassador to Ukraine Geoff Pyatt became infamous because of her comment – “Fuck the EU.” It is often forgotten that the conversation involved decisions on who should become President and Prime Minister in the government they hoped to install to replace that of democratically elected Viktor Yanukovych  – This was soon before the coup which overthrew Yanukovych.

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Six months on – concerns about MH17 investigation

People around the world are frustrated over the sluggishness of the official investigation into the MH17 tragedy. The documentary “Reflections on MH17″ describes some of this frustration felt by families of the victims and those who are carrying out their own investigations or attempting legal actions.

This short video from the BBC endorses the concerns at the slow investigation felt by a Dutch family of victims.

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“Internet and social media misinform thousands daily”

A recent analysis of the internet and social media illustrates the up-hill battle science and health professionals, and pro-science lay people, often face with misinformation and outright distortion of science. The authors show the problem for the case of community water fluoridation and concluded:

“The Internet and social media are misinforming thousands of people daily about the safety, health, and economic benefits of community water fluoridation. The leading anti-fluoridation website had 5 to 60 times more traffic than the two leading profluoridation health organizations. All Groups and Pages analyzed on Facebook were against fluoridation, while 99 percent of the videos searched on YouTube and the majority (70 percent) of fluoridation tweets on Twitter were anti-CWF fluoridation.”

This study drew important lessons for science and health professions:

Pro-fluoridation organizations need to have a better presence on the Internet and utilize social media to educate the American people about the facts on fluoridation. Individual dental and health practitioners need to educate their patients about fluoridation, so their patients will not be easily misguided by misinformation on the Internet and social media.

And, of course, these lessons are just as applicable to New Zealand.

The study is reported in the paper:

Mertz & Allukian (2014). Community Water Fluoridation on the Internet and Social Media. Journal of the Massachusetts Dental Society, 63(2), 32–36. (You can download a pdf here.)

They monitored website traffic for major fluoridation websites from June 2011 – May 2012 and fluoridation information on Facebook on April 3, 2012. In addition they collected search data for the term “fluoridation” on Twitter for 2 periods (March 1 – 14 and April 1 – 14, 2012) and on YouTube for April 3, 2012.

The data

I illustrate some examples of the data presented in the figures and tables below.

This figure shows that the most important anti-fluoridation website, Paul Connett’s Fluoride Action Network, had far more traffic than the Wikipedia fluoridation section and the institutional web sites (which are pro-fluoridation) on fluoridation.

web-sites

The situation for Facebook groups and pages was even more dire with 193 search results being “anti” while none were “pro.”

Table-1

The Twitter search also showed far more anti- than pro-fluoridation tweets, although the data shows  the numbers are influenced by important articles.

Table-2

Some observations

Of course this is a limited study and much more could be said about this situation, the business interests driving it and possible solutions. I list a few observations below:

1: This study is a snapshot in time. For example, Table 1 would look a little different at this time (January 2015) than it did in April 2012. There are now a number of specifically pro-fluoridation, or at least uncommitted Facebook pages and groups.

My brief search for Facebook “pages” and “groups” using the words fluoride or fluoridation showed about 8 pro-fluoridation, or neutral, pages in the first 50 results for “fluoride” and 2 for “fluoridation.” There were about 4 “pro” Facebook groups in the first 50 for either of these two search terms.

Things are improving. In New Zealand we have seen an increased activity of pro-science groups since the undemocratic decision (now reversed) of the Hamilton City Council to stop fluoridation. This was under pressure from anti-fluoride activists (nationally and internationally) and against the expressed wishes of the citizens. Similar fight-backs are happening overseas – in USA, Canada, Ireland and the UK. The progress is welcome  but more is required. Although I should note there is a tendency for anti-fluoridation activists to set up Facebook pages for many locations where there may have been suggestions of campaigns but the pages become inactive in a short while.

2: Who is financing these anti-fluoridation websites and social media activity? There is a clear connection between the “natural” health industry and anti-fluoridation organisations and activity. Paul Connett’s Fluoride Action Network is organisationally connected with Mercola’s “natural” health business (and anti-vaccination groups) through the “Health Liberty” organisation  and financial flows from Mercolla to FAN are well known. Similarly in  New Zealand the “natural” health industry, through the NZ Health trust, has financed legal action of anti-fluoridation groups (see Who is funding anti-fluoridation High Court action? and Corporate backers of anti-fluoride movement lose in NZ High Court).

3: Is there an underlying purposeful strategy behind then internet and social media anti-fluoridation activity? Definitely. I gave an example illustrating this in Anti-fluoridationist astro-turfing and media manipulation. Activist groups will create press releases pretending to be scientifically authoritative. These are picked up by the “natural” health web sites and magazines (and sometimes, if they are lucky) by the main media. They get coverage on Facebook pages and are tweeted – often automatically by internet bots and the web sites themselves. They can easily create “Twitter storms” this way and widely spread their misinformation.

Here are some typical examples that get repeated ad nauseum:

And, the misinformation cycle gets repeated. Information on Twitter gets reproduced in blog comments and included in web sites and press releases.

4: Institutional web sites are not really suitable for this sort of debate on the internet and in social media. This is partly the problem of a serious, rational or logical web presence challenging an often emotional web presence. A calm explanation of the science challenging claims appealing to preconceived prejudices and emotional needs.

Also, institutions traditionally have felt such debates are somewhat “below” them, preferring not to get into what they see as “street-fighting.” Recently I heard of a case where an anti-pseudoscience group had asked permission to use material from a professional dental site for use in a booklet. They were turned down because the association could not see why this was necessary!

This suggests that pro-science activists should consider taking the initiative, launching their own web sites, etc., and participating in these sorts of struggles, rather than relying on existing institutions. Similarly such activists should see they can play a far more active role on Facebook and Twitter than institutions can, or a willing to.

Conclusion

This study shows that people are in general being misinformed by social media and the internet about community water fluoridation. I suggest this is not accidental – political and business interests are actively encouraging this misinformation. In particular, the “natural” health industry plays a key role in promoting misinformation on fluoridation.

Recently things are improving a little with a fight back from pro-science groups and individuals. I suggest their activity is essential as institutional groups and media outlets are not suited for  internet and social media debates.

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The victims of terror

Appropriately, some of the most effective protests against the most recent act of terrorism has come from cartoonists.

Charlie Nebdo

Let’s hope the pencil, and brush, are mightier than the weapons of terror.

down with terror

The MH17 blame game

I know this is provocative, but couldn’t help thinking of the blame game going on around the MH17 tragedy (the Malaysian plane shot down over Eastern Ukraine in July) when I saw these on social media.

IMG_0701

Thanks to David for this meme

IMG_0699

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Dirty politics over MH17?

I have followed events in Ukraine for a year now and learned very early on never to be surprised. There have been so many seemingly outrageous things happen. On the one hand this has kept the Ukrainian events in the news. On the other it probably serves as a warning. There is just so much corruption in that country that anything seems possible.

Since August there have been rumours of an agreement between Ukraine, Australia, the Netherlands and Belgium about revealing information from the MH17 investigations. Specifically an agreement on nondisclosure – that the results of the investigation will be published once completed only if a consensus agreement of all parties that have signed the agreement prevails.

While the source for this was apparently a statement made under the auspices of the office of the Prosecutor General Yuri Boychenko. I haven’t seen anything more official than that

Until recently when I came across this letter which appears to be a response to a Freedom of Information request in Australia.

Doc-Aus

This confirms the existence of a nondisclosure agreement and that worries me for 3 reasons:

  1. I had hoped that assurances made at the UN Security Council meetings that the investigations of the MH17 tragedy would be transparent were genuine. This agreement seems to contradict the assurances and is particularly concerning as the current Ukraine government, or elements within it, is a possible suspect for criminal actions leading to the crash.
  2. The non-disclosure agreement itself is classified! What the hell could be in the agreement which makes it a state secret in Australia, Ukraine, Belgium and the Netherlands?
  3. Malaysia, whose airline owned the crashed plane and whose citizens comprised a significant number of the victims has been excluded.

Yes, I know nondisclosure before a report is normal and reasonable. Even sensible because of the rumour mongering and political maneuvering around such events – particularly this event. But why make the nondisclosure agreement itself a state secret? What could they have to hide?

And why exclude Malaysia? I have picked up excuses relating to the existence of a death penalty in Malaysia – but how should that effect this agreement?

Malaysia is often described as cooperating in the investigation, or as a member of the investigation team. But they have formerly been excluded from this agreement – and possibly others.

I can’t help feeling this has more to do with the fact that Malaysia has got off-side with the Kiev government because it was prepared to negotiate with the authorities in the crash area. That contact enabled early progress in recovery of the black boxes and bodies. The OSCE observers also were able to give early help because of their contacts with these authorities. In contrast, the Dutch investigation and recovery teams have been extremely tardy because of their unwillingness for direct contact. And their apparent subservience to the wishes of the Kiev government who have discouraged this contact.

trucks

Trucks carrying the wreckage of downed Malaysia Airlines flight MH17 arrive from the Ukraine at Gilze-Rijen military base, Netherlands, Tuesday, Dec. 9, 2014. Photo credit: Peter Dejong/AP

Many wild accusation have been made against Vladimir Putin, the president of the Russian Federation, over this incident. But he at least retained the moral high ground when he warned governments and politicians not to use this tragedy for political purposes.

I think that warning was humane and important. Those using this tragedy for political purposes are showing the worst form of disrespect for the almost 300 innocent victims.

But won’t the governments and investigators who conspire to withhold information or findings also be showing the same disrespect?

Update

Malaysia-acceptedMalaysia annnounced last week, 4 months after the above agreement was signed, it has been accepted as a full member of the MH17 joint investigation team (see MH17: Malaysia to help identify perpetrators: Liow.

I cannot find any indication that this means it has signed the secret non-disclosure agreement or not.

 

wreckage-protocol

 

Also, the Dutch investigation team did eventually get around to negotiating with the local authorities in the crash area – and this lead to rapid decisions (on November 20) on collection and removal of the wreckage to the Netherlands.

This could have happened so much more quickly.

 

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“Real” experts’ on climate change? Really?

The Heartland Institute has produced a new propaganda poster on climate change. Here it is:

heritage poster

And this is what they say about it:

This poster presents clear and undeniable evidence that the debate is not over. Looking out from this poster are 58 real experts on the causes and consequences of climate change. Each of them refutes the existence of a “consensus of scientists” on the size of the human impact on climate, or whether it merits immediate action. Many of these experts say the threat is grossly exaggerated, often to advance a political agenda.

So they have raked up 58 “experts” – and how do they define “real experts?

Apparently their criteria is that they have spoken at one of the Heartland Institute’s climate denial conferences!

Sure they claim of these “real experts:”

“They include current and former professors of climatology, geology, environmental science, physics, and economics at leading universities around the world.”

But I have had a quick glance at the poster and at least 30 of these “real experts” really don’t have training or qualification in a field connected with climate. They include:

  • Journalists like James Delingpole and Christopher Booker.
  • Climate denial activists like Barry Brill, Christopher Monkton, Steve Gorham, Tom Harris and Joanne Nova.
  • Right wing “think tank” executives and fellows like Robert J. Bradley Jr., E. Calvin Betsner, Dennis Avery,Ron Arnold, Paul Driessen, Myron Ebell, Indur Golklany,  David W. Greutzer, Marlo Lewis, Marita Noon and James, M. Taylor.
  • Politicians like Vaclav Klaus, George Christenen and Roger Helmer.

There are also a few meteorologists (mainly weather forecasters), astronauts and economists.

Followers of the climate change debate will also be familiar with the remaining few on these who do have academic qualifications in relevant fields – and maybe some publications. They are the usual contrarians and mavericks who seem to bast in the glory of the promotion they get from climate change deniers.

“Real expert” – come off it.

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Catch 22 in Ukraine

MH17 recovery

MH17 recovery team finally start work at crash site. Credit:  RIA Novosti. Alexey Kudenko

The Dutch team investigating the MH17 Malaysian Airline crash in eastern Ukraine report it has problems collecting debris from the crash site in eastern Ukraine. But aren’t these problems largely of their own making? And isn’t this just one glaring example of the Catch-22 situation presented by problems of recognition in Ukraine?

On the one hand the investigation team has problems organising recovery of material – but on the other hand they refuse to negotiate with the authorities controlling the crash zone! Isn’t the solution obvious? – Talk to the local authorities. Don’t try to pretend they don’t exist and attempt to do everything through intermediaries like the OCSE.

The issue is just too important to allow such distraction by childish political games.

This impasse has gone on long enough. Four months since the crash and there has been no recovery of any of the crashed plane parts. This could have been done months ago. People are getting impatient – they want answers and the Dutch investigators are now criticised for dragging their feet. The situation has became more urgent because of the impending winter and the possibilities of destruction of evidence by shelling of the remains.

I can’t help thinking that even this military action, violating UN resolutions on the tragedy, could have been stopped if the Dutch investigators had manned up and applied more pressure on the Kiev government. After all, it is not the rebels who are shelling this area.

Problems of recognition

I understand the wish not to imply recognition of the rebels. But the Malaysian government negotiated with the local authorities right at the beginning and quickly obtained the recovered black boxes and began the task of recovering the passenger bodies. No recognition was implied by the contact – simply the willingness to discuss the practicalities with the people in the area. Why cannot the Dutch investigation team do the same?

The Dutch investigators claim it is because the government in Kiev does not want them to. But that did not stop the Malaysians. Nor should that be a real consideration considering that elements of the Kiev regime are possible suspects in the shooting down of the plane.

Ukraine’s attitude towards Malaysia did cool because of those direct negotiations. But the Kiev regime itself is caught in its own Catch-22 with its unwillingness to imply any recognition of the rebel regimes in the Donbass.

Right from the beginning, the day before the coup in Kiev (see Agreement on the Settlement of Crisis in Ukraine), agreements on Ukraine have referred to the need for constitutional reform in the country, and the need to involve all parts of the country in negotiating a new constitution. Neither the junta resulting from the coup or the subsequent elected president and government have shown any willingness to honour that aspect of agreements. They have negotiated with themselves and the oligarchs – but never with the real authorities in power in eastern Ukraine – or the people who support them.

Even the Trilateral Contact group on Ukraine which produced the recent cease-fire agreements did not have proper representation from the Kiev regime because they refused to negotiate with the representatives from Donetsk and Luhansk. Instead the Kiev government worked through the Second President of Ukraine, L.D. Kuchma.

Negotiation does not imply recognition

Again, there is the wish not to imply recognition. Interestingly Kiev been on the receiving end of that dilemma as the government of the Russian Federation did not recognise any presidential authority in a regime that had come to power via an armed coup after evicting a democratically elected president. That was eventually resolved when new presidential elections brought Poroshenko to power – and in the interim other forms of contact were used. I think this shows that non-recognition does not mean that contact and negotiation is impossible. Nor does negotiation imply recognition.

Since the February coup there have been presidential and parliamentary elections in Ukraine and a referendum plus parliamentary and government elections in the Donbass. One can easily find fault with all these elections and the referendum  but the important thing is that they have given a degree of legitimacy to the governments in Kiev and the Donbass. This means their officials have increased authority in  any negotiations – which surely makes possible better progress in stopping hostilities, carrying out constitutional reform and settling the degree of autonomy granted to the Donbass region.

Instead, the Kiev government is using the increased legitimacy in the Donbass as further reason not to negotiate. The Prime Minister Arseniy Yatsenyuk wants to abandon the Minsk talks altogether and go back to the Geneva negotiations format which did not include representatives of the rebel forces.

“Sitting [down] with them for bilateral negotiations is useless,” Yatsenyuk said. “One of the most efficient and real formats is the Geneva format, which included the participation of the US, the EU, Ukraine and our geographically northern neighbor.”

Yet, surely, negotiation between both sides in this civil war is the only way to reach the peaceful settlement which most Ukrainian’s want. Does this imply the Kiev government refuses to try to reach a peaceful settlement?

How can Yatsenyuk claim such negotiations are useless when he has consistently refused to even try them?

Whatever – his approach does not seem politically mature. Negotiations should never be seen as a sign of weakness, but rather a sign of strength which comes with a willingness to deal with realities on the ground.

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