Fluoridation debate: Responding to Tom O’Connor

This is the second article in the debate between Tom O’Connor and me. It is a response to his post Debating fluoridation and tyranny – Tom O’Connor responds).

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I think Tom’s concept of “freedom of choice” is confused. He appears to be arguing for his own right to determine a social decision. But that is undemocratic, it imposes an individual’s wish on society.

We all have the freedom to influence, make submissions on, contribute to, etc., a social decision. In the end, that decision is made democratically. The minority does not have the right to use the individual’s “freedom of choice” argument to demand that decision not be democratic.

That is not the ‘tyranny of the majority”  Tom claims because on  most issues the individual still has the “freedom of choice” to make individual arrangments to satisfy their position. No one is being coerced and the individual can take personal responsibility for their own arrangements. This is particular true with community water fluoridation (CWF).

Tom and I have different values or politic outlooks underlying our different attitudes towards CWF.

Opposing values systems

I don’t want to put words in Tom’s mouth but in practically he is opposed to CWF despite the clear social benefits. He is claiming his personal “freedom of choice” is more important than the community’s – or at least the majority of the community.

In contrast, I support CWF because of its social benefits. However, I accept the obligation of governing bodies to consult the community when there is a controversy and support the decisions of the community (I also support the right of individuals and communities to make the wrong decision – within reason, of course).

In the most general terms, these boil down to issues of social responsibility vs individual or personal responsibility. Put simplistically, some would see the conflict a between a “socialist” or “libertarian” perspective. (I apologise for using labels.) These different values systems lead to different understandings of freedom of choice (and of being “forced”).

Given the stand of personal responsibility, as a personal values system, Tom should not need to seek the justification of advancing or questioning facts. He should simply stand on principle, and seek support for that principle. On the other hand, there is an obligation on people arguing for social responsibility. We need to show that the advocated social policy provides a net advantage to the community and/or individuals. If there are no advantages there is no point in such policies and the personal responsibility or “libertarian” position may as well stand.

Tom is welcome to his values system, and he no doubt says the same about me. We live in a pluralist society and most of us accept such differences are handled by the democratic process. I should also add that most people do not adhere to an absolutist “libertarian” or “socialist” approach and prefer a more balanced and sophisticated approach to social issues.

Society usually attempts to balance individual rights/responsibilities and freedom of choice against social responsibility. After all, individual rights and social responsibility are co-dependent. Our individual rights and freedom of choice cannot survive where our freedom, rights, health and well-being are not supported by sensible social policies.

A democratic social decision may appear to result in the loss of that freedom of choice. After all, I can express my freedom of choice to have a Green government, but after the election I have to accept that freedom is put on hold for another three years and in the meantime I have to put up with a National-led government. But that does not deprive me of the freedom to advocate for policies underlining my preference for the Greens – and under MMP such advocacy can be effective even between elections.

Similarly, the minority in a decision on CWF does not lose personal “freedom of choice.” If they are willing to take personal responsibility for their situation they can with very little effort, make personal arrangements. Those with a hangup about fluoride can use to filters or alternatives sources. Those who wish to use fluoride can resort to mouth rises or alternative water sources. In taking these actions we are exerting our freedom of choice.

Tom has stepped outside the ethical issues to argue some statements of fact which need challenging.

Raising doubt and the balance fallacy

Tom asserts:

“Both sides have accused the other of engaging in pseudo-science and scare mongering. Both are, to some extent, probably accurate and in agreement on that point alone. However, where doubts exist, it is probably better to err on the side of caution.”

Putting “both sides” into the same box of “engaging in pseudo-science and scare mongering” is a Clayton’s argument. A claim made without any substantiation but appealing to “balance” nad “fairness. Rather than relying on such “warm fuzzies” Tom should present the examples and evidence if he wishes to make such claims.

Similarly, unsupported claims of doubts and the need for caution can be a way of discounting the science and its quality. Hence, the emotional slogan “if in doubt, leave it out!” Society should make decisions based on evidence, not warm fuzzies and catchy slogans.

We are familiar with the financially and ideologically motivated purposeful raising of doubt on issues like the science regarding tobacco use and climate change.  Merchants of Doubt by Oreskes and Conway provide a good description of such dishonest tactics – and the title is very appropriate.

Drinking water standards

Tom claims:

“The principle responsibility of local authorities, as outlined in the Drinking Water Standards for New Zealand, administered by the Ministry of Health, is to ensure drinking water is as free from all other substances and organisms as possible.”

Where do the standards say that, Tom? My checking of Drinking Water Standards for New Zealand produced these principles:

“all water suppliers have a duty to ensure their water is safe to drink.”

And:

“all drinking-water suppliers providing drinking-water to over 500 people must develop and implement a water safety plan (originally known as a Public Health Risk Management Plan, PHRMP) to guide the safe management of their supply. This quality assurance approach is complemented by the DWSNZ, which specify the maximum acceptable concentrations of harmful contaminants in the water.”

What these standards do is set maximum acceptable values (MAVs) for a whole list of possible “harmful contaminants” – occurring naturally or from the water treatment itself. Think about it – no realistic body would set standards demanding water was “free from all other substances and organisms as possible” – leaving interpretation up to the individual operator!

Of course, individuals may want to lower these MAVs (or even make them zero) – but they are derived from the best available science and practical considerations. If individuals are unhappy they can, of course, challenge the standards. But they do not have the “freedom of choice” to arbitrarily  replace them with their own personal values. They do have the freedom of choice to use other water sources or tap filters. That is the sensible and responsible thing to do, rather than childishly demand a change just to satisfy their own hangup.

Chlorination

This involves additions to water that Tom has absolutely no control over. Why does he not object to that addition on his ethical stance that he has the “freedom of choice” to control what goes into community water supplies?

Personally, I would oppose chlorination  long before I objected to fluoridation because irrespective of whether there is any detectable chlorine “at the end of the process” (there should be),  chlorine can react with naturally occurring organic material to produce possible hazardous or carcinogenic compounds. That is why local authorities check for these in our water.

My city uses UV irradiation for the early disinfection process and only adds chlorine at the end so that the tap water remains organism free. But if I lived in a city where the first disinfection use chlorine I would seriously consider using a tap filter to remove possible hazardous compounds.

Iodised salt

Tom is OK with the “mass medication or treatment” involved in iodised salt because there is “always un-iodised salt as a practical, convenient and affordable option on grocer shop shelves for those who did not want it.”

Does he bother to exert that “freedom of choice” when he shops? Has he even checked the availability of uniodised salt? I checked the other day and my supermarket had plenty of iodised salt but no specifically non-iodised salt. It had boutique salts (even “chemical free” salt) and I imagine the chemophobic shoppers might prefer those products to iodised salt – not realising they also contain iodine.

This can get silly. There are anti-fluoride people who treat their water by reverse osmosis – then replace the removed minerals by adding Tibetan salt which contains fluoride (and is sometimes sold as “chemical-free.”

Folic acid

I would willingly support mandatory folic acid fortification. More countries will probably do this in future because the evidence is pretty clear that it helps prevent the tragedy of neural tube defects. It seems a sensible approach because of the need for folic acid at the stage of pregnancy where the mother may be unaware.

At the moment, New Zealand has a voluntary folic acid fortification system. About 17% of packaged bread was fortified with folic acid in 2012. The industry is working towards fortification levels of 50%  – with at least 25% meant to be achieved by the end of 2014.

Tom, you appear to oppose folic acid fortification. Do you check your bread packaging to check it hasn’t been fortified? I suggest hardly anyone does so.

There are lots of things individuals can have hangups about. Some people object to chlorination. Some to pasteurized milk. Given that society does set standards for our food and water it is inevitable individuals may sometimes have to take personal responsibility and check the food and water they purchase. But I cannot understand the directed concern over fluoride as it is one of the easiest things to check and make personal arrangements for.

While I had plenty of choice at my supermarket if I wanted “fluoride-free” water. I had no choice if I wanted “iodine-free” salt” or unpasteurized milk. If I had a hangup about folic acid I would need to make the effort to carefully scrutinise bread packaging to find “folic-free” bread. And do that often because of plans to increase folic acid fortification of bread over time.

Removal and personal responsibility

Tom really should back up this claim:

“Suggesting that those who object to fluoride in the water they pay their local authority to deliver can obtain alternative supplies from a community tap or buy it from the supermarket is unacceptable. These options are not possible, practical, convenient or affordable for many people.”

What about some monetary figures to claim alternatives are not affordable? Frankly I do not think he has a leg to stand on here as people who choose to opt out of our secular education  and free hospital systems face far bigger financial costs. In my experience most anti-fluoride campaigners already take such steps for themselves and when pressed claim they are speaking up for others less fortunate than themselves. Yeah, right!

Tap filtration practical and convenient. “Fluoride-free” water is readily and cheaply available (more so than unpasteurised milk and non-iodised salt I have found). And the slight inconvenience involved is of little consequence to someone who really believes the anti-fluoride story.

Incidentally, several cities provide “fluoride-free” community taps. the fact these get very little use suggests to me that those who are really concerned already have more convenient arrangements.

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Once more on the IQ and fluoride myth – why ignore other factors?

The “fluoride damages IQ” myth won’t go away – mainly because it is avidly promoted by campaigners against community water fluoride (CWF). This is despite the fact that no link has even been drawn between CWF and IQ (the only relevant study shows no connection). But that doesn’t stop ideologically driven campaigners who rely on poor quality studies from areas of endemic fluorosis where dietary fluoride intake is higher than in areas using CWF.

There are plenty such studies, but a more recent one illustrates their problems – and the role  confirmation bias seems to play in these studies. It is:

Kundu, H., Basavaraj, P., Singla, A., Gupta, R., Singh, K., & Jain, S. (2015). Effect of fluoride in drinking water on children′s intelligence in high and low fluoride areas of Delhi. Journal of Indian Association of Public Health Dentistry, 13(2), 116.

It’s another study where the IQ values of children from a “high fluoride” area were compared with those for children from a “low fluoride area.” There was a statistically significant difference and the paper goes on to claim:

“High F concentration in the drinking water was found to have marked systemic effects on the IQ of children. Though the precise mechanism by which F crosses the blood brain barrier is still not clean‑cut; enough evidence survives for the influence of F intake via drinking water and low IQ of the child.”

However they do acknowledge:

“Apart from fluoride there are other factors which also affect IQ of children. In the present study, mothers diet during pregnancy also significantly affected the IQ of the children.”

The supporting data is poorly presented and described – for example, no indication is given of the fluoride concentration in the drinking water of the “high fluoride and “low fluoride” areas used. Although they do cite areas in Delhi (where the study was located) with fluoride concentration as high as 32.5 ppm!. And I cannot find any details on “mothers diet during pregnancy” (except perhaps division into two groups – “routine” or “special diet as suggested by the doctor during pregnancy”).

Those confounding factors

These sorts of studies almost always rely on finding a statistically significant difference in the IQ values of children in two different areas or villages. But that statistical significance says nothing about the causal factors involved – it may have nothing to do with differences in fluoride levels.

Kundu et al., (2015) do at least include some data on confounding factors which is often missing from such studies. These show significant difference between the groups from the “high fluoride” and “low fluoride” areas which have no connection with fluoride in drinking water – such as father’s occupation, mother’s education and father’s education) – or only an indirect connection (dental fluorosis).

Here is a summary of the data for the various factors. I have selected the data so to show as two values – equal to “high fluoride” and “low fluoride.”

You get the picture. The areas were chosen according to the concentrations of fluoride in drinking water (whatever they were), but they could equally have been chosen on the basis of parental education, father’s occupation or prevalence of the more severe forms of dental fluorosis.

In fact, rather than concluding drinking water fluoride has a “marked systemic effects on the IQ of children” we could equally have concluded:

• “The father’s occupation has a marked effect on the IQ of children with the children of unskilled fathers having a lower IQ.”
• “The mother’s and father’s education has a marked effect on the IQ of children with the children of parents with a higher education having a higher IQ.”
• “Diet of mothers during pregnancy has a marked effect on the IQ of children.” (The paper did not include data suitable for plotting for this.)

The dental fluorosis factor interests me as I have suggested that, in areas of endemic fluorosis, the physical appearance of defective teeth could lower quality of life and cause learning difficulties which are reflected in lower IQ values (see Severe dental fluorosis the real cause of IQ deficits?, Severe dental fluorosis and cognitive deficits – now peer reviewed and Free download – “Severe dental fluorosis and cognitive deficits”).

I think that this is more reasonable as a mechanism than the chemical toxicity mechanism that almost all authors of these sorts of papers assume – but never support with any evidence. Even when dental fluorosis is considered it is usually treated as an indicator of lifetime intake of fluoride (which it is) rather than and independent cause of low IQ.

Conclusions

Most studies like this seem to be motivated by confirmation bias. Despite the possibility of a range of factors being involved, and some of these such as parental education being a more obvious cause, there appears to be an urge to interpret data as evidence of a chemical toxicity mechanism involving fluoride. And there is never any experimental work to confirm this preferred mechanism.

To my mind, if fluoride is implicated in the low IQ values the mechanism involving effects of dental fluorosis on quality of life and learning difficulties appears more credible than an unproven chemical toxicity.

Note: None of this is directly relevant to areas where CWF is used. The prevalence of more serious forms of dental fluorosis is very small in these areas and not related to CWF. Also, no study has yet found an effect of CWF on IQ. Given the higher levels of fluoride used in the studies from areas of endemic fluorosis, and the higher levels of serious forms of dental fluorosis, extrapolation of the results to areas where CWF is used is completely unwarranted.

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Flight MH17 in Ukraine – what do intelligence services know?

Despite claims of proof made by politicians like David Cameron, Barack Obama and Tony Abbott after the downing of flight MH17 in Ukraine in 2014 no intelligence agencies in their countries ever provided any evidence. I find that surprising as these intelligence agencies were obviously monitoring the area and should have been able to give evidence to back up the claims. In fact, rumours suggested the intelligence evidence didn’t back up the claims.

I am forced to conclude the claims owe more to politics, in particular, the geopolitical struggle, than they do to facts.

Perhaps it is in their (and their political masters) nature that intelligence agencies may not be forthcoming on this issue. But I recently came across a largely unpublicised  report which I think does give some idea of what the intelligence community did know at the time. The  Review Report arising from the crash of flight MH17 was prepared by the Dutch Review Committee on the Intelligence Services specifically to answer questions from the Dutch government on what the intelligence community knew, and what they could have done to avert the disaster.

The review covers the role and knowledge of the Netherlands’ Military Intelligence and Security Service (MIVD) and the General Intelligence and Security Service of the Netherlands (AIVD).

No, it doesn’t give the intricate details. But it does summarise their knowledge at the time – a knowledge which was informed by material from allied intelligence agencies (The Netherlands is part of NATO) and which they would have passed on to those agencies. As such, I think it provides a valuable insight into what was known – an insight enabling us to judge the claims being made by the politicians at the time. Perhaps an insight helping us to decide for ourselves which party was likely responsible for the downing of the plane, and hence the killing of 283 passengers and 15 crew.

Possible culprits

The report says:

“there were three relevant actors with military capacities in the period prior to the crash:
• Russian armed forces
• Ukrainian armed forces and
• Pro-Russian separatists.”

I have made this point repeatedly in the discussion we have had on the issue here – also saying I did not commit to any conviction that either of these parties had yet been shown to be the real culprit.

However, I now think  the intelligence community probably rules out the “Pro-Russian separatists.” The report says that neither of these parties had the intention to destroy a civil aircraft and only the Russian and Ukrainian armed forces had the weapons required. It concluded:

“Prior to the crash of flight MH17, the AIVD and the MIVD possessed the following information regarding the security situation in Eastern Ukraine that was relevant for assessing a threat to civil aircraft flying over the area:
• The Russian and the Ukrainian armed forces did have the capacity and potential to hit a civil aircraft at cruising altitude. However, they did not have the intention. There were no indications that they were engaged in activities (such as preparations) targeting civil aviation.
• There were no indications that the Separatists had the capacity to hit civil air traffic at cruising altitude. Moreover, there were no indications that they would target civil air traffic or that they were engaged in activities with this objective in mind.”

What capabilities did the “pro-Russian separatists” have?

The report concluded:

“Even though there was information pointing to the fact that the Separatists had been supplied with heavy weapons by the Russian Federation, there were no indications that these were powerful anti-aircraft systems.”

Politicians may debate that. After all, the Ukrainian Armed forces were shelling and bombing the separatist cities and villages and the separatist armed forces were certainly shooting Ukrainian planes out of the sky. But it was the very fact that separatists had been successfully shooting down those planes (particularly an An-26 military cargo plane on July 14 (3 days before flight MH17 was hit) that led intelligence forces to look closely at their capabilities. Here’s how the report describes this:

“On 14 July 2014, an An-26 military cargo aeroplane (referred to hereafter as: the Antonov), belonging to the Ukrainian airforce, was shot down. The Ukrainian authorities reported the event the same day in a briefing with Ukraine’s presidential administration in Kiev. The MIVD also received a concise report of the briefing from the Dutch Defence attaché. The report revealed that the Ukrainian Minister of Foreign Affairs, Klimkin, declared that the situation in the east had reached a new and dangerous phase because the Russian Federation was now openly providing the Separatists with military support. As an example of the escalation, Klimkin cited the Antonov’s being shot down in the area of Lugansk. Klimkin reported that the Antonov was flying at an altitude of 6,200 metres and could only have been hit with Russian equipment, because the Separatists did not possess this kind of anti-aircraft systems.
According to a media report on 14 July 2014 (which the MIVD possessed), the Ukrainian authorities stated that the aeroplane was flying at 6,500 metres and was not shot down by a portable anti-aircraft system but by a more powerful system. This was probably carried out from Russian territory. In the media, the Separatists claimed that they had shot down the aeroplane and taken some of the crew prisoner.”

So, spokesman for the Kiev regime were claiming (although probably didn’t really believe) that the Russian armed forces had directly entered the fray. Perhaps they were implying the Russians were effectively setting up a “no-fly zone” for Ukrainian military planes. At any rate, the possibility of direct involvement of Russian armed forces would explain the presence of Ukrainian anti-aircraft weapons in the area despite the separatists not using aeroplanes.

The intelligence community appears to reject claims of direct Russian involvement:

“If the Antonov had indeed been shot down by, or even from, the Russian Federation, this would have been a game changer. Direct Russian participation in the conflict would have become a fact.

That is why the MIVD immediately launched an investigation into the incident. In the morning of 17 July 2014, the MIVD communicated the results of this investigation in its daily intelligence summary (‘dagintsum’), which had a number of users, including the NCTV and the AIVD.”

This intelligence assessment was communicated on the very day Flight MH17 was shot down.

“The MIVD assessed it to be unlikely that the Antonov had been shot down by a powerful anti-aircraft system (separate from the question whether this had been carried out from Russian territory). From pictures of the wreckage and eyewitness accounts it was clear that the aeroplane’s right-hand engine had been hit and that 5 to 6 parachutes had subsequently appeared. The Antonov had allegedly crashed only then. On this basis, the MIVD concluded that the appearance of the damage was not consistent with a hit by a powerful anti-aircraft system. The aeroplane would in that case probably have been destroyed in the air.

The crew would probably not have survived if this had been the case. According to the MIVD, the wreckage and the eyewitnesses supported the fact that the aircraft was shot out of the air by a MANPADS from Ukrainian territory. This would only have been possible if the Antonov were flying substantially lower than 6,200 or 6,500 metres. Another possibility was that a short-range, vehicleborne anti-aircraft system”

And apparently the Ukrainian authorities, at least in their public statements, also did not believe that separatist armed forces had the capability of shooting down a civil airliner. I need to give the qualification because Ukrainian authorities are well known for providing inaccurate information for political purposes. It is likely they well knew the Antonov was not flying at the height they claim but wished to implicate the Russian federation.

What about the Buk missiles?

Although not completely ruling out an air-to-air missile the Final report of the Dutch safety board determined that MH17 was most probably hit by a missile from a Buk  system (see MH17: Final technical report).  But this review concluded that separatists just did not have such a weapon:

“The AIVD was aware that the Separatists, in addition to a broad range of artillery (eg machine guns), light anti-aircraft artillery (e.g. rocket launchers), anti-tank weapons and tanks, also possessed MANPADS and possibly short-range vehicle-borne anti-aircraft systems. Both types of systems are considered surface-to-air missiles (SAMs). Due to their limited range, the aforementioned weapons do not constitute a danger to civil aviation at cruising altitude.

“On 16 July [the day before MH17 crashed], the AIVD received a report from a reliable source that stated that there was no information that indicated that the Separatists possessed a medium-range SAM system. This comment was made in view of the circumstances related to the Ukrainian armed forces’ Antonov being shot down on 14 July 2014 in Eastern Ukraine.”

“The AIVD did not have any information that indicated that the Separatists possessed an operational, powerful anti-aircraft system such as a Buk system, also called an SA-11, prior to the crash of flight MH17.”

But what about a Buk system the separatists had captured from the Ukrainian armed forces?:

“On 29 June 2014, the Separatists captured a Ukrainian armed forces military base in Donetsk. At this base, there were Buk missile systems. These are powerful anti-aircraft systems. This development was reported extensively in the media prior to the crash. The MIVD also received intelligence information on the subject, on 30 June and 3 July 2014 as well as on other dates. During the course of July, several reliable sources indicated that the systems that were at the military base were not operational. Therefore, they could not be used by the Separatists.”

I had always considered the separatists could have been the culprit because of the availability of a captured Buk system but the intelligence community seems to have confidently ruled out that possibility.

What about a Russian Buk system?

Some motivated sources have promoted on social media a story that flight MH17 was shot down by a Russian Buk system specifically brought into eastern Ukraine for the job and removed directly after the crash. Of course, investigators must look into such stories but there does not appear to be any intelligence evidence to back them up.The review describes the relevant tasks of the Dutch intelligence bodies as investigation focused of the Russian Federation and the possible risk of an incursion into Eastern Ukraine (MIVD) and investigation of the politico-strategic aspect of the conflict in Eastern Ukraine and on the Russian Federation’s political influence on Ukraine.

The review describes the relevant tasks of the Dutch intelligence bodies as investigation focused of the Russian Federation and the possible risk of an incursion into Eastern Ukraine (MIVD) and investigation of the politico-strategic aspect of the conflict in Eastern Ukraine and on the Russian Federation’s political influence on Ukraine (AIVD).

Given the size of the Buk systems and the associated vehicles, it is hardly likely intelligence forces could have missed the movement of such a system in and out of eastern Ukraine, crossing the international border in two directions.

My conclusions

This may be the only direct public information about intelligence assessments of the situation in eastern Ukraine at the time of the MH17 crash the public will ever see. It is not detailed but is meant as a reliable summary for governments. And given the degree of cooperation and exchange of information among western intelligence agencies, I think it is probably an indication of the conclusions from all these agencies, not just the Dutch.

Intelligence agencies in the Russian Federation may have different or alternative information. Some, but probably not all, of this has already been released by the Russian government.

In the past, I had considered that it was highly probable Flight MH17 was accidentally shot down by separatist forces using a captured MH17 system and operators who had defected from the Ukrainian armed forces. But I now think that scenario is very unlikely. I had also thought that it was equally probable that the culprits were a unit of the Ukrainian armed forces making a mistake during a training exercise with a Buk system. I thought a scenario involving armed forces of the Russian Federation was far less likely.

Currently, I think the most likely scenario is that MH17 was mistakenly shot down by a unit of the Ukrainian armed forces – maybe in a training exercise or in an act of defense. While there is no evidence of direct involvement by air forces of the Russian Federation it is very likely that story was believed by forces on the ground, if not the politicians in Kiev promoting the story. Fear of a Russian aerial attack would also have been promoted by a series of losses of Ukrainian aircraft in the days before the MH17 crash – especially as the authorities in Kiev were claiming these could only have been shot down by Russian forces.

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Christmas – “White Wine In The Sun”

 

The hardest thing in life . .

This quote by David Russell is so true.

And much as I think this is great advice I think the resolution required to actually burn some bridges is almost as hard.

Door knockers should pay to interrupt us

Found this on Facebook (Shit Aussies say).

Really must get one for our front door. These god-botherers and salesperson seem to think that because you are retired you have all the time in the world.

Don’t they realise that when your retire you stop living at work and start working at life.

And that is a full-time job.

Cochrane responds to misrepresentation of their fluoridation review

Image Credit: Cochrane Oral Health Blog

The latest Cochrane Review on community water fluoridation (CWF) was published in June. Here are a citation and link for those interested:

Iheozor-Ejiofor, Z., Worthington, HV., Walsh, T., O’Malley, L., Clarkson, JE., Macey, R., Alam, R., Tugwell, P., Welch, V., Glenny, A. (2015). Water fluoridation for the prevention of dental caries (Review). The Cochrane Library, (6).

Immediately after publication, anti-fluoride propagandists launched a campaign of misrepresentation and outright distortion of the review’s findings. I dealt with some of this, and commented on the review itself, in the following posts:

• Misrepresentation of the new Cochrane fluoridation review, 
• Cochrane fluoridation review. I: Most research ignored, 
• Cochrane fluoridation review. II: “Biased” and poor quality research?,
• Cochrane fluoridation review. III: Misleading section on dental fluorosis, and
• Comparing the Cochrane and NZ Fluoridation Reviews

The wave of misrepresentation and situations concerned health professionals – some of their on-line feedback and responses are in the Cochrane blog posts – Little contemporary evidence to evaluate effectiveness of fluoride in the water and Our response to the feedback on the Cochrane fluoridation review).

The Cochrane Oral Health Group yesterday published an updated Plain Language Summary (PLS) for the review. If you want to look in detail here is the original version of the review, and here is the abstract and updated Plain Language Summary from the latest version (now online). Their short explanation for this is:

“Following feedback, from a variety of sources, we felt it was necessary to make the language of the PLS simpler.”

This is logical. The PLS is the only part of the Review most policy makers will read. The old version contained too many words like “bias” and references to research “quality” which may have been reasonable to an academic audience but conveyed an entirely different meaning to policy makers who do not have an academic or scientific background. Anti-fluoride campaigners have worked hard to use this in their misrepresentations and distortions aimed at policy makers as well as the public.

Some of the changes

The new PLS does not include the word “bias” and now describes the selection criteria pointing out most studies made after 1975 were excluded (because they did not include initial surveys). Readers will now be more aware that the lack of information in some areas resulted from these strict selection criteria and not from lack of research.

For example, the text:

“No studies met the review’s inclusion criteria that investigated the effectiveness of water fluoridation for preventing tooth decay in adults, rather than children”

has been replaced by

“Within the ‘before and after’ studies we were looking for, we did not find any on the benefits of fluoridated water for adults.”

And the text:

“There was insufficient information available to find out whether the introduction of a water fluoridation programme changed existing differences”

has been replaced by:

“We found insufficient information to determine whether fluoridation reduces differences in tooth decay levels between children from
poorer and more affluent backgrounds.”

Will the misrepresentation continue?

Of course it will. Even the most carefully worded summary can be distorted to misrepresent reported findings. Hopefully, though, these changes will make it harder for campaigners to pull the wool over the eyes of policy makers. The careful reader will now have a better idea of the limitations of the review resulting from the strict selection criteria. Hopefully, they will also be aware that statements like “We found insufficient information . . .” do not mean there is no information. Nor does the inability, within the restricted selection criteria, to find an effect mean there is no effect.

I am disappointed that their changes did not make the situation of dental fluorosis clearer. They do now stress that most of the dental fluorosis studies reviewed “were conducted in places with naturally occurring – not added – fluoride in their water.” But this is not adequate:

“results of the studies reviewed suggest that, where the fluoride level in water is 0.7 ppm, there is a chance of around 12% of people having dental fluorosis that may cause concern about how their teeth look.”

is just not adequate

The choice of 0.7 ppm will be seen as relevant to the concentration used in CWF – but this does not mention that any difference between the  prevalence in fluoridated and unfluoridated areas is very small and not statistically significant. In other words, their comments on dental fluorosis are still not relevant to CWF.

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Australian census religion question – progress

World Religions. Credit: Islam Beyond Borders

Looks like Australians have won another small victory in the way that their religiosity is officially assessed. In particular how census forms pose the religion question on census forms is posed.

I discussed the problems in my article Non religious in Australia and New Zealand. The Australian census form buried the “no religion” option – and may, therefore, have skewed results – see below:

Compare that to the New Zealand census question below:

I asked the obvious question:

“Do Australians opt for a religion in their census answers because they don’t , at first glance, notice the “no religion” option?

Does the Australian census overestimate religiosity?”

Greater minds than mine also asked this question. Rationalist and sceptic groups lobbied the Australian Bureau of Statistics to change the question during the post-2011 census review. They argued it was about accuracy. And they succeeded (see Census change: Is Australia losing its religion?).

“No religion” moves to first

So, for the first time “no religion” will be first on a list of answers to the question “what is the person’s religion”, and the “Catholic” option will move into second place – see below:

It may seem like a subtle change, a psychological victory for the “nones,” but The Sydney Morning Herald argues it “may completely change the way Australia sees itself and have drastic consequences for the way government money is spent on welfare and education.”

“If Christianity did lose its position as the majority religion, this could impact government spending programs such as the school chaplaincy program, according to those advocating for the change.

“Many government services and resources depend on census accuracy, and the figures are used by religious organisations to maintain their status and influence in terms of grants, tax-free services, access to schools for religious instruction, and for their generally privileged position within the community,” president of the Rationalist Society of Australia, Meredith Doig, said this week.”

So it is more than a psychological victory. Surely it is important that allocation of resources to people of different beliefs should not be wroughted by the trickiness of questions like that in the old census form.

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New Zealand science book prize – 2015 Short list

The Royal Society of NZ has announced the shortlist of titles for 2015 Science Book Prize (see 2015 Royal Society of New Zealand Science Book Prize).

Here they are – together with the judges comments:

Tangata Whenua: An Illustrated History by Atholl Anderson FRSNZ, Judith Binney, Aroha Harris (Bridget Williams Books)

“Tangata Whenua is a beautifully produced, well illustrated and comprehensive record of the tangata whenua. Atholl Anderson, Judith Binney and Aroha Harris present archaeological and genetic evidence alongside history, traditional narratives and oral sources to produce this powerful story – both scholarly and readable – of Maori people and the land they live in.”

 

The Wandering Mind by Michael Corballis FRSNZ (Auckland University Press)

“Neuroscience, psychology and evolutionary biology are helping scientists to learn more about our brains. In this scientifically rigorous and quietly humorous book, Michael Corballis, one of the leaders in this field, explores what happens in our brains and to our minds when we are not paying attention. He takes us on a meandering and enlightening exploration of our wandering minds.”

 

Gathering Evidence by Caoilinn Hughes (Victoria University Press)

“From Johannes Kepler to Marie Curie, and from genetics to nuclear physics: in this book, which is rich with scientific themes, scientific words and phrases become poetry. Caoilinn Hughes gives readers new and unexpected perspectives on science in her lively and powerful poems that explore and communicate science with an emotional intensity that makes for a memorable read.”

 

Dolphins of Aotearoa: Living with New Zealand Dolphins by Raewyn Peart (Craig Potton Publishing)

“New Zealand’s five resident dolphin species are among the most-loved and cherished of our native fauna. In this beautifully produced book, Raewyn Peart goes beyond the traditional illustrated natural history book to tell a scientifically-grounded, moving and engaging story of the relationship between humans and dolphins in New Zealand.”

Manuka: the Biography of an Extraordinary Honey by Cliff Van Eaton (Exisle Publishing)

“Manuka honey is a uniquely New Zealand product, valued here and internationally for its rich taste and therapeutic properties. In this delightful and surprising book Cliff Van Eaton tells the captivating story of the science behind the discovery of the antibiotic effects of manuka honey, with a focus on the scientists and beekeepers who have brought this product to the world.”

 

 

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Dirty tactics by anti-fluoride activists in Taupo

Fly fishing in Lake Taupo. Image credit: Great lake Taupo

Local body councils have had a gutsful of the fluoridation issue. Most councillors don’t have the skills to objectively judge submissions – and the field is so controversial they get plenty of these. It’s also an area where extremists and people with obsessions are very active.

So it is no wonder that local body councils are asking for this whole issue to be taken off their plate. For it to be handed to central government, the Ministry of Health and District Health Boards.

Abuse and libel of councillors

A few days ago a Taupo District councillor, Dave Cozens, gave examples of the personal abuse he was receiving from an anti-fluoride extremist (see Councillors abused and libelled by anti-fluoride activists). He is one councillor who has done his own research on the topic:

“I was elected to office in 2013 and in my time in that position I have endeavoured to understand the finer details of what is the very controversial Fluoride Debate.

I approached the issue with an open mind in hope that whatever evidence I came across would steer me toward a well-informed path and that this would then encourage some solid proper decision making to occur.

What I found was a vast weight of material that supported the retention of Fluoride in our public water supplies and little substantiated proof that existed to support the contrary. There was however a wealth of alarmist articles ranging from fluoride’s use in the death camps of World War II to the decalcification of bones in children of third world nations. All of these articles appeared to be written by lay people with questionable, if any, notable qualifications.

Admittedly it can be proven that there can be some ‘mottling’ occurring on the teeth of a few scattered members of the community however the benefits displayed to the larger population appear immeasurable. It should be noted that this particular evidence was actually provided by the World Health Organisation.

I have spoken to doctors, dentists, orthodontists and scientists – all of whom support the continued use of Fluoride.

Not one single professional has contacted me to argue its removal from supplies.”

The fact he did his own research appears to have been enough reason for targeting by a Facebook page affiliated* to Fluoride Free NZ:

” I have been made their ‘poster boy’ for what they call the ‘poisoning of children’ in the area. I have received emails threats of legal action, accusations of committing murder, supposed land theft, instigating the dumbing down Māori as a race and now this negative rant has made its way to Facebook courtesy of aTurangi Anti-fluoride page. They have also linked that page to my professional work websites. “

He has repeatedly asked this group to come to him with peer-reviewed material or published documentation supporting their cause:

“But it seems that no amount of reasoning nor gentle coaxing will encourage them to meet me with a round-table discussion and the hope of finding some middle ground.

The hate and anger that has been delivered to me on this topic is beyond anything I have experienced before. It is both slanderous and distasteful but moreover it takes us to a dark place as a community because we as a population in the Southern Lake area are not like this – we simply don’t treat each other this way – it’s not our culture. I have now involved the Police, lawyers, Council and of course Facebook in hope that they will bring an end to this distasteful episode.”

It reminds me a bit of the clamour around the Hamilton City Council over the fluoride issue. When the Council mistakenly decided to stop fluoridation in 2013 suddenly council members (well, all except one who opposed the decision) could do no wrong. They were being quoted by Fluoride Free activists as experts on the issue.

After the Hamilton City Council decided to accept the wishes of the voters and return fluoridation last year they were ridiculed and attacked by the very same Fluoride Free activists. Well, one of the councillors (the only one to vote against the decision) is not attacked. Suddenly he became the darling of the local Fluoride Free activists.

Politics attracts some funny people. But there seem to be none so weird as the anti-fluoride activists involved in local body politics.

Update:

* Of course this affiliation is informal – FFNZ doesn’t have a formal membership as such. But the use of the FFNZ link in the Facebook page “about” section (see screenshot below) certainly implies an affiliation.

Of course FFNZ could formally dissociate their organisation from the Facebook page and from the abusive and libellous content. I suspect they might prefer to claim it is not their page but not to do this formally – a sort of deniability – because the attitudes expressed.certianly represernt many of the people active in their movement.

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