Will we be using contact lens cameras in future?

contact_patent

A future contact lens camera – from a patent by Sony

A few decades ago I taught photography to night classes. We had no idea then that it would not be long before almost everyone would be carrying around a small camera in the form of a mobile phone. I couldn’t even get students interested in the concept of digitising their photos and processing or storing them on their computers.

It’s hard to predict the paths of new technology or its uptake by industry and the population. But I wonder if this new patent by Sony might give some insight to how we well take photographs in a few decades time. Just imagine – all it may take is to blink!

This article from Digital Photography Review, Sony patents contact lens camera with blink-triggered shutter, predicts privacy problems if the technology goes ahead.

The patented contact lens:

“comes with an integrated miniature camera module and all its components, such as image sensor, lens, processor, storage and even a wireless module to transfer images to a smartphone or other connected device. The camera is triggered by a “conscious” eyelid aperture and closure. A sensor measures the pressure of your eyelid, and other settings such as aperture and zoom can be controlled via eyelid movement as well. A display unit allows you to view captured images directly on the lens.”

So not any old blink will fire the shutter. Even so, I imagine there will be lots of accidental shots. And I have a picture of newbies pulling all sorts of facial expressions as they learn to apply just the right sort of pressure via their eyelid. Then there will be subjects who interpret the “conscious” blink as a wink!

As the article says:

“It’s impossible to know if a product like this will ever hit the market but if it does, it’s certain to raise even more privacy concerns than Google Glass at the time.”

The patent document is available here for anyone who enjoys torturing themselves with the convoluted language which seems unique to patents.

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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

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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

Korean community water fluoridation supported by new evidence

Azaleas

Royal Azaleas in the mountains near Habcheon

New scientific evidence for the effectiveness of community water fluoridation (CWF) is appearing all the time. So that is hardly news – but I just thought it worth mentioning this latest example from Korea because I get told again and again that there is no evidence to show CWF is effective in improving oral health.

This latest Korean study was reported in this paper :

Jung, J., Kim, J., Kim, S., Lee, J., Kim, J., & Jeong, S. (2016). Caries-preventing effects of a suburban community water fluoridation program on permanent dentition after adjusting for the number of fissure-sealed teeth. Journal of Korean Academy of Oral Health, 40(1), 61–68.

The full text is available but only the abstract and tables are in English.

The study compares children from the fluoridated Habcheon township area with children from non-fluoridated areas.

The graphic below compares dental caries on permanent teeth for the different age groups. Clearly, children in the non-fluoridated areas have poorer dental health.

Jung-1

On average, the data indicates fluoridation is responsible for prevention of 24.6% of decayed, missing and filled permanent teeth (DMFT) and 29.9% of decayed missing and filled tooth surfaces (DMFS) (a more sensitive measure than DMFT).

Jung-2

This result is very recent but not at all surprising. Similar results have been reported before.

For example – this paper reported prevention of 27.5% of decayed, missing and filled permanent teeth (DMFT) and 24% f decayed missing and filled tooth surfaces (DMFS) for 12-year-old children in Gimhae.

Kim, H., Cho, H., Kim, M., Jun, E., Han, D., Jeong, S., & Kim, J. (2014). Caries Prevention Effect of Water Fluoridation in Gimhae , Korea. J Dent Hyg Sci, 14(4), 448–454.

Again this is full text but only the abstract and tables are in English.

There are more studies reporting a similar effectiveness of CWF in Korea.

These authors are recommending that CWF, which covers only 6% of the population in the republic of Korea, should be extended to other regions in the country.

CWF has been controversial in the Republic of Korea. Health authorities are promoting the extension of CWF but this is opposed by some groups. Surveys show  the majority of people whose children have good oral health, who are aware of fluoridation  programmes or who understand the protective role of fluoride support extension of CWF. But support is much less among people who are a=unaware of the benefits or whose children have poor oral health.

So, while health authorities support the extension of CWF they also accept there is a need for more public education about the benefits.

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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-fluoride campaigners cherry-pick irrelevant overseas research but can’t find relevant New Zealand research

fluorosis

Ever seen this in New Zealand?! Example of skeletal fluorosis from an overseas study used by local anti-fluoride campaigners to argue against community water fluoridation. Image Credit: Das et al., (2016)

Yes, I know. This is getting boring. A local anti-fluoride campaigner misrepresents research on fluoridation – yet again.

Perhaps I should apologise for yet another article debunking this sort of misrepresentation. In my defense can I just say this is just such a clear example that it can help drive the message home. These people cherry-pick research from areas of endemic fluorosis in China and India – pretend they are relevant to New Zealand or the USA – and ignore those studies which are relevant to countries which carry out community water fluoridation.

Stan Litras is (yet again) the guilty party. He has disseminated a press release, FIND cites new research, which will, of course, be reproduced by the Fluoride action network and make its way into the “natural”/alternative health media. That will, in turn, be cited by other anti-fluoride campaigners as “proof” that community water fluoridation is harmful!

Stan claims that:

“New research has confirmed that increased fluoride in water results in reduced intelligence. The research, published in the journal,of environmental monitoring and assessment, found that the higher the fluoride content in water, the lower the IQ of children, . . “

The paper Stan Litras relies on reports data from an area of endemic fluorosis in India. An area quite unlike New Zealand. Here is the citation for the paper (it’s a full-text version if you wish to check it out for yourself):

Das, K., & Mondal, N. K. (2016). Dental fluorosis and urinary fluoride concentration as a reflection of fluoride exposure and its impact on IQ level and BMI of children of Laxmisagar, Simlapal Block of Bankura District, W.B., India. Environmental Monitoring and Assessment, 188(4), 218.

Whatever its findings we can see how inapplicable that research is to New Zealand by comparing its data for dental fluorosis with similar data for New Zealand, USA and China. In this graphic below I compare prevalences of the mild forms (“none,”, “questionable,” very mild,” and “mild”) with the prevalences of “moderate” and “severe” forms. Only the latter forms are of concern (the milder forms are usually considered positively by adolescents and parents – see Water fluoridation and dental fluorosis – debunking some myths).

(Note: for a discussion of how severe dental fluorosis may influence IQ see Severe dental fluorosis and cognitive deficits.)

The figure  contrasts data for prevalence of dental fluorosis in NZ and theUSA where CWF is common with data for an area of endemic fluorosis in China and data from this paper (Das).

DF severe

While there is hardly any dental fluorosis of concern in USA and New Zealand these forms are very prevalent in the region of India covered by this study and a similar region of endemic fluorosis in China.

Or perhaps we should look at some more graphic evidence. Das et al., (2016) include the photo at the head of this article as an example of skeletal fluorosis found in the subjects they studied. And the photo below as an example of dental fluorosis found in their subjects.

DF Das 2016

Example of dental fluorosis observed by das et al., (2016) in subjects studied.

Come  on Stan – how often have you seen dental and skeletal fluorosis like this in New Zealand?

It is just not honest to cite this study in any discussion of the New Zealand situation. It has absolutely no relevance here.

To make this worse, Stan completely ignored New Zealand studies on these issues. For example the paper:

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

These researchers found no influence of community water fluoridation on IQ – see figure below.

NZ-IQ

Data from Broadbent et al., (2014)

So yes – just one more example of how local anti-fluoride campaigners are misrepresenting research on fluoridation. But a clear example of cherry-picking overseas studies irrelevant to community water fluoridation in New Zealand while, at the same time, ignoring New Zealand studies relevant to community water fluoridation.

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Cochrane fluoridation review described as “empty”

What-the-Cochrane-Review-Should-Have-Concluded

Image credit: MSoF – Ooops, [Newsweek] Did It Again

Publication of the Cochrane fluoridation review last year caused quite a flurry. Anti-fluoridation activists launched an avalanche of cherry-picked quotations and claims that completely misrepresented the review’s findings. On the other hand, the Cochrane review was poorly written and laid itself open to this cherry picking and misrepresentation.

Now, an authoritative group of authors has published a new critique which summarises the faults of the Cochrane review and shows how it has come to be misrepresented. The paper is:

Rugg-Gunn, A. J., Spencer, A. J., Whelton, H. P., Jones, C., Beal, J. F., Castle, P., … Zusman, S. P. (2016). Critique of the review of ‘Water fluoridation for the prevention of dental caries’ published by the Cochrane Collaboration in 2015. Bdj, 220(7), 335–340.

The on-line version is full text so readers can check it out for themselves.

The authors say:

“The Cochrane Review’s conclusion that ‘there is very little contemporary evidence. that has evaluated the effectiveness of water fluoridation for the prevention of caries’ is self-fulfiling due to its omission of contemporary studies designed for surveillance of public health programmes.

So they say:

“This, it could be argued, led to what is termed ‘an empty review’.”

And this is because a key problem of the review was “the restrictive inclusion criteria  used to judge adequacy of study design and risk of bias.”

Nature of water fluoridation programmes

A problem with the Cochrane review is that its judgement criteria were more suitable for drug trials than for evaluation of a social health policy. Drug evaluation relies on randomised controlled trials (RCTs), but:

“With public health interventions things are different. There will only sometimes be RCTs demonstrating efficacy and effectiveness. There are frequently no such trials because the highly complex practical, ethical and financial factors involved mean that RCTs are not feasible. Consequently, when determining whether a public health intervention is cost effective, evidence has to be drawn from a wide variety of other scientific methods and research designs including cross-sectional ones and process evaluations. . . . .

“In many cases it is simply impossible to make recommendations for public health interventions and policy if reliance is only placed on RCTs. Further, with public health interventions, the issue is not about individual patient benefit but whether the population as a whole will benefit.”

There are also many confounding effects with fluoridation:

“variations in use of other sources of fluoride, mainly from toothpaste, and diet, particularly sugar consumption. In many societies, these are closely linked to SES, and evaluation should also measure and control for these explanatory factors and interactions.”

Therefore:

“Water fluoridation should be evaluated using contemporary methods which are appropriate for evaluating public health interventions with such complexities, and systematic reviews should take this into account.”

The Cochrane review failed to do this and, although these problems were aired in the review’s discussion, the abstract and main conclusions were, therefore, misleading and open to misrepresentation.

Criteria for study inclusion

This “purist” approach was also demonstrated in the review’s criteria for study selection. The Cochrane authors considered:

“only prospective studies with a concurrent control, comparing at least two populations, one receiving fluoridated water and the other non-fluoridated water, with at least two points in time evaluated. Groups had to be comparable in terms of fluoridated water at baseline.”

But baseline data can be irrelevant when considering long-term fluoridation schemes. Rugg-Gunn et al., (2016) point out:

“Over time, in many countries, coverage of the population with water fluoridation schemes was almost complete, at least to the limits of public health requirements and technical feasibility. In such jurisdictions, the priority for health authorities was to monitor the continued effectiveness of existing schemes. Most recent evaluations of water fluoridation have been of this type, using the most appropriate design, which is a single cross-sectional survey of fluoridated and non-fluoridated groups with control for confounding factors.” One of the critical problems with the 2015 Cochrane Review is that these data have been excluded from the Review.

This, although recent evaluations have usually been of higher quality than older ones because of the availability of computer processing, use of more sophisticated statistical analysis and greater awareness of the need to taker confounding factors into account.

The authors discuss the impracticability of requiring baseline data for such long-term schemes. The Cochrane reviewers themselves stipulated baseline data should be taken within 3 years of implementing water fluoridation:

“an acknowledgement that the communities may, mainly through population change, lose comparability after three years. While this assumption of similarity may be reasonable over a short period, it becomes less tenable as the period between baseline and final examinations increases.”

This requirement looks silly when considering recent data from long-term schemes or considering possible benefits for 50-year-olds because:

“baseline information on the caries experience of people of this age would be required in the community to be fluoridated and in a comparable reference community, as well as information to be collected 50 years later on the caries experience of people from the same age group in the same communities which have continued to remain fluoridated or non-fluoridated for the whole of that very long period. Such requirements are unfeasibly stringent given the potential for community demographic characteristics to change over time, and render 50-year historical comparability of intervention and reference communities meaningless for present-day comparisons.[My emphasis]

Rugg-Gunn et al., (2016) discuss in-depth other aspects of the criteria used, exclusions if modern research by the Cochrane authors and study design.

Dental fluorosis

The Cochrane review’s inclusion of dental fluorosis seems to be “tacked on” and does not use the criteria outlined for their review and selection of caries studies. In particular, it ignored the influence of different sources of dietary fluoride – leaving the impression that the resulting data related to water fluoridation when it didn’t:

“In the Cochrane Review, the effect of water fluoridation on the prevalence of fluorosis should have been isolated from the confounding effect of other fluorides. The Cochrane Review’s analysis of fluorosis studies is silent on the possible contribution of other fluorides, such as fluoridated toothpaste, which risks leaving readers with the impression that all dental fluorosis arises from fluoride in water supplies. Research since 2000 has indicated that a greater proportion of dental fluorosis risk is due to the use (and therefore swallowing) of fluoride-containing toothpastes than to optimally fluoridated water.

Consequently, an intelligent interpretation of the fluorosis data in the Cochrane review requires some extra calculation – of the sort the reviewers themselves did for the caries studies:

“This comparison between intervention and reference communities was the method used for evaluating caries prevention in the Cochrane Review but, for an unexplained reason, not for the evaluation of dental fluorosis. For communities with lower fluoride concentrations (such as 0.5 mgF/L), their fluorosis levels should be compared with those in the corresponding reference (non-fluoridated) community.”

And

“The highly restrictive approach taken by the Cochrane Review in examining the effect of community water fluoridation on dental caries seems to have been abandoned for dental fluorosis. The reason for this difference is unclear.”

I attempted this “extra calculation” in my article Cochrane fluoridation review. III: Misleading section on dental fluorosis.”

When differences between “fluoridated” and “non-fluoridated” areas are considered there was no significant contribution of water fluoridation to the “dental fluorosis of aesthetic concern.” However, because  this comparison was not made in the Cochrane review anti-fluoride campaigners are claiming that fluoridation causes a prevalence of 12% “dental fluorosis of aesthetic concern!”

That is very misleading.

Anti-fluoride campaigners love to quote prevalence figures for all forms of dental fluorosis, not just the more serious – implying that even the mildest forms should concern us. Consequently, they cite the Cochrane review to claim a 40% prevalence of dental fluorosis This is for all forms from the most severe to the mildest. But, in fact, when the differences between “fluoridated” and “unfluoridated” areas are calculated the prevalence of all forms of dental fluorosis attributable to community water fluoridation is only 7%. And, remember, these will be only the mildest forms.

Again, very misleading.

Conclusions

The Cochrane fluoridation review agrees with all other authoritative reviews when it states:

“that water fluoridation is effective at reducing caries levels in both deciduous [primary] and permanent dentition in children.”

But its conclusions conflict with the literature on:

“the effectiveness of water fluoridation in respect of: its effectiveness in adults; its effectiveness in reducing social disparities in oral health; and the effect of cessation of water fluoridation. On these, the Cochrane Review said that there was insufficient evidence; it did not say that water fluoridation was ineffective in these regards.”

On these, the review would only say that “there is insufficient evidence.” But that is a self-fulfilling conclusion given their restrictive selection criteria. Some observers may actually say such a conclusion is irresponsible because:

“It is a fundamental premise of interpreting evidence from trials that the absence of evidence, or the existence of poor-quality evidence, should not be confused with, or taken to imply, an absence of effect. There is a risk that the Cochrane Review will be inadvertently, or deliberately, misinterpreted in this way.”

And we know this is, in fact, what has happened. Motivated anti-fluoride campaigners have chosen to present an absence of evidence (because of the restricted selection of studies) as “proof” that fluoridation is not effective.

It just shows how an “empty review” can be used to make the most unwarranted claims.

Similar articles on the Cochrane fluoridation review

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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A challenge to anti-fluoridationers to justify their misrepresentation of New Zealand research

Challenge

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

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

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

Misrepresentations repeated

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

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

So here we go again.

Kane claims:

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

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

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

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

The apparent convergence

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

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

12903_2016_180_Fig1_HTML

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

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

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

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

Other

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

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

Some data for Pacifica

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

other-pacifica

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

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

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

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

The challenge

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

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


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

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

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

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

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

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

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

Who is this?”

Rather strange – considering he often pesters me with emails.

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

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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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