Anti-fluoridation cherry-pickers at it again

Anti-fluoride campaigners seem to be a sixes and sevens on whether community water fluoridation (CWF) is effective or not. Some will accept CWF is effective in improving oral health but moan about the ethics or reports of harm. Others will simply claim CWF is not effective.Stans-lie-annot

Stan Litras is a Wellington dentist and anti-fluoride campaigner in the later camp. He continually denies that CWF is effective and claims he has science to back up his claim. However, what he actually means is that of he cherry-picks the science, holds his mouth the right way and prevents you from looking at the context and data – he can find a quote to support his position.

I have debunked his claims before in my articles – such as, Cherry-picking and misinformation in Stan Litras’s anti-fluoride article and Cherry-picking and misinformation in Stan Litras’s anti-fluoride article. But he is at it again. This time he is misrepresenting a recent New Zealand research paper in a recent letter to the Christchurch Press.

There are several misrepresentations in his letter but here I will just take issue with the highlighted text. Stan claims:

“The DHB’s Dr Martin Lee published a research paper recently which showed little or no benefit from water fluoridation, a finding consistent with the modern weight of evidence.”

It is always best to check out such claims and I have hunted down the paper Stan probably refers to. It is:

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.

This is linked to the full-text version so readers can check out the paper itself.

Far from showing “little or no benefit” from water fluoridation the abstract actually says:

“Significant and sustained differences were observed between Māori and non-Māori children, and between CWF and non-CWF exposed groups.”

Stan ignored that sentence but latches on to (or cherry-picks) the next sentence:

“However, a convergence of dental profiles between non-Māori children in CWF and non-CWF regions was observed.”

But he ignores completely the authors’ discussion of this apparent convergence. Obviously, the discussion doesn’t support Stan’s anti-fluoride bias! But that discussion is interesting and worth considering.

Is there a convergence?

I have noted this convergence before in my articles Cherry picking fluoridation data and Fluoride debate: Response to Paul’s 5th article where I used similar data to that used in Schluter & Lee (2016). That data is available on the Ministry of Health’s website.

The graphs below show the raw data for all (“total”) children and for Māori:

% CARIES FREE

MEAN DECAYED, MISSING AND FILLED TEETH

So, yes, there is a convergence in the sense that the differences in the oral health of children in fluoridated and unfluoridated areas appears to be reducing with time. I have speculated that the apparent convergence could have something to do with 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 thew school – rather than their residence. This will lead to incorrect allocation in some cases.

However, this paper suggests another reason for the convergence which I hadn’t considered.

Changes in and composition of the non-Māori group

The authors say:

“Another notable feature was the apparent convergence of prevalence estimates amongst non-Māori children in CWF and non-CWF areas. 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.”

This is interesting and is supported by the data.

First, let’s note that while I compared data for Māori children with the total data in my figures above these authors have actually compared data for Māori and non-Māori. This shows a clearer convergence for non-Māori children than for all children – see this figure for 5-year-old children from the paper (dmft = decayed, missing and filled teeth per child):

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

The picture is similar for year 8 children.

So you can see why anti-fluoride campaigners would love to cherry pick the non-Māori data. I predict that Stan and other anti-fluoridation campaigners will be reproducing parts of this figure in their propaganda for future use.  That graph is just too good for them not to cherry-pick.

But we need to remember that the non-Māori group is not ethnically uniform. In particular, Pacifica make a large contribution to this group. That contribution is unevenly distributed between the fluoridated and fluoridated groups. And it has changed over time.

  • In 2013 about 86% of Pacific live in fluoridated areas – over the period covered by these MoH records this proportion has varied between 80 and 90%.
  • In 2013 Pacifica make up about 12% of the non-Māori group (between 2007 and 2o13 this has varied between 9.0 and 12.7%)
  • In 2013 Pacific make up about 19.3% of the non-Māori fluoridated group (between 2007 and 2013 this has varied between 14.9 and 20.7% of the non-Māori fluoridated group).

MoH data confirms problem of Pacific inclusion

So the oral health of Pacifica can have a relatively large influence on the data for the non-Māori group – particularly for the fluoridated non-Māori group where they are included. This becomes important when we realise that the oral health of Pacifica is markedly poorer than for the rest of the non-Māori group. I have illustrated this using the average of data for fluoridated 5-year-olds in the period 2007 – 2013.

other-pacifica

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

So the poorer oral health of Pacifica will drag down the % caries free and drag up the mean dmft data for the fluoridated non-Māori group. However, this will have little influence on the unfluoridated non-Māori group because of the very small Pacific contribution.

We can confirm this with the raw data from the Ministry of Health website. That data is given separately for Māori, Pacifica and “other” (non-Māori/non-Pacific). The figure below shows this data for the 5-year-old children.

Other

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

OK – there is still some evidence of convergence from about 2007 on between fluoridated and unfluoridated children. But the graphs do indicate that CWF is still having  a beneficial effect.

But I think Stan and his mates will prefer to cherry-pick the data for the non-Māori group and keep very quiet about the distorting effect that inclusion of Pacific in this group has had on the apparent convergence.

Note: I have used the raw Ministry of health data in this discussion. Schluter & Lee (2016) used standardised estimates to account for the difference in the numbers of unexamined children according to ethnicity.

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March ’16 – NZ blogs sitemeter ranking

blog-cartoon

There are about 300 blogs on the list, although I am weeding out those which are no longer active or have removed public access to sitemeters. (Let me know if I weed out yours by mistake or get your stats wrong).

Every month I get queries from people wanting their own blog included. I encourage and am happy to respond to queries but have prepared a list of frequently asked questions (FAQs) people can check out. Have a look at NZ Blog Rankings FAQ. This is particularly helpful to those wondering how to set up sitemeters. Please note, the system is automatic and relies on blogs having sitemeters which allow public access to the stats.

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

You can see data for previous months at Blog Ranks

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

Fluoridation: My podcast with with Howard Farran

This is a bit embarrassing.

I really don’t like seeing myself on video or listening to myself on audio And this one is even worse as the interviewer makes some extreme over-the-top complimentary statements at the beginning. But if you can get through that we do have a sensible discussion and cover most of the topical issues related to community water fluoridation.

The interviewer, Howard Farran, is  a leading light in the US dental community group Dentaltown. As part of the group, he operates a blog/podcast Dentistry Uncensored. It seems to be very active – this podcast is number 347.

So, I was really very honoured when he approached me to request an interview.  Also gratified that my attempts here to debunk the misinformation and distortions promoted by anti-fluoride campaigners has come to the notice of dentists in the USA. Howard also asked all the right questions – he has been active in campaigning for community water fluoridation in the US and in the process has debated Paul Connett from the Fluoride Action Network. So he knows what the issues are.

Sorry for the length (46 min) but we cover a lot of material. Most of it scientific – although we do end up discussing New Zealand’s attraction to sensible tourists.

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Why is Donald Trump so successful – and will he win?

Trump-web

I think Donald Trump is a buffoon – but perhaps I have got it all wrong. According to ‘Dilbert’ creator, Scott Adams, Trump is the ultimate politician – especially in deploying his powers of persuasion. And surely that is what all politicians want to do? In fact, Adams believes  Trump is so good at persuasion that he will win the election in a landslide.

Michael Cavna outlines Adams’s arguments in the Washington Post article Donald Trump will win in a landslide. *The mind behind ‘Dilbert’ explains why. Basically, it boils down to the fact that:

“On the stump, the real-estate mogul is not running on the knowledge of his numbers or the dissection of the data. He is running on our emotions, Adams says, and sly appeals to our own human irrationality. . . . .

“Most simply put: Adams believes Trump will win because he’s ‘a master persuader.’”

OK – that analysis appeals to me -I have often asserted that humans are not a rational species – more a rationalising one. Emotions play a huge role in our decisions – even when we think, and claim, we are acting rationally. “Psychology is the only necessary skill for running for president,” writes Adams, adding: “Trump knows psychology.”

So, here are 6 things Trump is doing to win hearts and minds:

People are irrational

1. Trump knows people are basically irrational.

“If you see voters as rational you’ll be a terrible politician,” Adams writes on his blog. “People are not wired to be rational. Our brains simply evolved to keep us alive. Brains did not evolve to give us truth. Brains merely give us movies in our minds that keeps us sane and motivated. But none of it is rational or true, except maybe sometimes by coincidence.”

2. Knowing that people are irrational, Trump aims to appeal on an emotional level.

“The evidence is that Trump completely ignores reality and rational thinking in favor of emotional appeal,” Adams writes. “Sure, much of what Trump says makes sense to his supporters, but I assure you that is coincidence. Trump says whatever gets him the result he wants. He understands humans as 90-percent irrational and acts accordingly.”

Adams adds: “People vote based on emotion. Period.”

Fact don’t matter

Apparently this cynical approach has the advantage that facts are not longer important:

3. By running on emotion, facts don’t matter.

Adams writes. “There are plenty of important facts Trump does not know. But the reason he doesn’t know those facts is – in part – because he knows facts don’t matter. They never have and they never will. So he ignores them.

“Right in front of you.”

4. If facts don’t matter, you can’t really be “wrong.”

Trump “doesn’t apologize or correct himself. If you are not trained in persuasion, Trump looks stupid, evil, and maybe crazy,” Adams writes. “If you understand persuasion, Trump is pitch-perfect most of the time. He ignores unnecessary rational thought and objective data and incessantly hammers on what matters (emotions).”

5. With fewer facts in play, it’s easier to bend reality.

Trump can be thin-skinned when his “reality” is challenged. “The Master Persuader will warp reality until he gets what he wants,” writes Adams, noting that Trump is “halfway done” already.

Identitiy politics

Finally, something which many of us find especially hateful – the denigration of people – turns out to be yet another powerful trick in Trump’s persuasion arsenal.

6. To bend reality, Trump is a master of identity politics — and identity is the strongest persuader.

“Do you think it is a coincidence that Trump called Megyn Kelly a bimbo and then she got a non-bimbo haircut that is … well, Trumpian?” Adams writes. “It doesn’t look like a coincidence to this trained persuader. . . .

“Writes Adams: “Identity is always the strongest level of persuasion. The only way to beat it is with dirty tricks or a stronger identity play. … [And] Trump is well on his way to owning the identities of American, Alpha Males, and Women Who Like Alpha Males. Clinton is well on her way to owning the identities of angry women, beta males, immigrants, and disenfranchised minorities.

“If this were poker, which hand looks stronger to you for a national election?”

It’s a pretty convincing argument. We ignore the irrationality of humans at our peril and most political commenters had dismissed Trump because he is irrational. They ignored the fact that he had special skills at appealing to emotion and using crude identity politics.

But, I hope Adams is exaggerating in his claim that Trump will win the presidency in a landslide. I hope there enough people who refuse to be led by such crude emotional and identity politics appeals. However, the fact that there is a large number of American’s who are persuaded by such buffoonery is a worrying thing.

Mind you – I think all politicians use similar techniques – appeal to emotions and our irrational nature, neglecting or bending facts and use of identity politics. But I like to think there is a large proportion of the population who are concerned with facts, are appalled by identity politics and are suspicious of emotional manipulation.

Hopefully, this proportion is large enough to prevent the landslide victory Adams is predicting. Mind you – the alternative may present equally large problems to the world?

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Why are our politicians so silent on Palmyra’s liberation from clutches of Daesh?

Palmyra_-_Monumental_Arch

Palmyra’s historic monumental arch. Bernard Gagnon

Robert Frisk, The Independent’s multiple award-winning Middle East correspondent, is angry with Western Political leaders who are silent about the liberation of Palmyra (see Why is David Cameron so silent on the recapture of Palmyra from the clutches of Isis?).

So am I. We should all be angry.

Frisk says:

“The biggest military defeat that isis has suffered in more than two years. The recapture of Palmyra, the Roman city of the Empress Zenobia. And we are silent. Yes, folks, the bad guys won, didn’t they? Otherwise, we would all be celebrating, wouldn’t we?

Less than a week after the lost souls of the ‘Islamic Caliphate’ destroyed the lives of more than 30 innocent human beings in Brussels, we should – should we not? – have been clapping our hands at the most crushing military reverse in the history of Isis. But no. As the black masters of execution fled Palmyra this weekend, Messers Obama and Cameron were as silent as the grave to which Isis have dispatched so many of their victims. He who lowered our national flag in honour of the head-chopping king of Arabia (I’m talking about Dave, of course) said not a word.”

Yes, the silence of these political leaders has been deafening. But not all leaders.

According to the Syrian Arab News the UN Secretary General Ban Ki-Moon welcomed the restoration of Security and stability to Palmyra and the expelling terrorists of the Islamic State (ISIS) from the historic city:

“We were happy with the announcement of the Syrian army the restoration of security and stability to Palmyra… the Syrian army will protect and preserve this human heritage.”

He added ISIS terrorists don’t only kill people in a brutal way, but they also destroy the heritage of the human civilizations that date back to thousands of years.

UN Gen Sec

UN Secretary General Ban Ki-Moon

Even the former US Ambassador to Russia, Michael McFaul, expressed gratitude for the liberation of the ancient city of Palmyra. “Thank you,” he wrote in Russian in response to the message of the Russian Embassy in the US on the complete liberation of Palmyra.

McFaul

The Russian President congratulated the Syrian president on Palmyra’s liberation – although maybe that doesn’t count as his country contributed to this defeat of the Daesh jihadis in Palmyra.

Why this reticence?

Perhaps that is the problem – even if such a reason is childish. The policies and strategies of the US, NATO and the EU have been shown to be an absolute failure and then their political opponent – that upstart President Putin – comes along and shows them up. He gives substance to those criticisms of the failed policy of regime change in Syria.

As Frisk writes:

“When Palmyra fell last year, we predicted the fall of Bashar al-Assad. We ignored, were silent on, the Syrian army’s big question: why, if the Americans hated Isis so much, didn’t they bomb the suicide convoys that broke through the Syrian army’s front lines? Why didn’t they attack Isis?

“If the Americans wanted to destroy Isis, why didn’t they bomb them when they saw them?” a Syrian army general asked me, after his soldiers’ defeat.  His son had been killed defending Homs. His men had been captured and head-chopped in the Roman ruins. The Syrian official in charge of the Roman ruins (of which we cared so much, remember?) was himself beheaded. Isis even put his spectacles back on top of his decapitated head, for fun. And we were silent then.”

Back in September Putin asked during his speech to the UN General Assembly – “Do you realise what you have done?” He called for unity in the fight against terrorism – unity of the sort we experienced during the struggle against Nazism during World War II. But he didn’t sit back and wait for this unity – he provided help to the Syrian regime whose collapse, which was imminent,  would have thrown the country into anarchy of the sort that only breeds more terrorism. An anarchy which was the only clear future of the “regime change” policy. So, as Frisk points out:

“[Putin’s] aircraft attacked Isis – as US planes did not – in advance of the Syrian army’s conquest. I could not help but smile when I read that the US command claimed two air strikes against Isis around Palmyra in the days leading up to its recapture by the regime. That really did tell you all you needed to know about the American “war on terror”. They wanted to destroy Isis, but not that much.

“So in the end, it was the Syrian army and its Hizballah chums from Lebanon and the Iranians and the Russians who drove the Isis murderers out of Palmyra, and who may – heavens preserve us from such a success – even storm the Isis Syrian ‘capital’ of Raqqa. I have written many times that the Syrian army will decide the future of Syria. If they grab back Raqqa – and Deir el-Zour, where the Nusrah front destroyed the church of the Armenian genocide and threw the bones of the long-dead 1915 Christian victims into the streets – I promise you we will be silent again.

“Aren’t we supposed to be destroying Isis? Forget it. That’s Putin’s job. And Assad’s. Pray for peace, folks. That’s what it’s about, isn’t it? And Geneva. Where is that, exactly?”

“Regime change” is a threat to Europe

Europe is suffering the largest immigration crisis since the last World War – a crisis caused by the thoughtless application of “regime change” strategy in the Middle East.

I don’t go along with the claims that this immigration is being used by ISIS to infiltrate trained terrorist groups into Europe – after all, the groups we have seen in action have been essentially “home-grown.” But jihadists have captured territory in Iraq, Syria and now Libya –  have set up their own “caliphate” which enables the training of such “home-grown” jihadis. This also provides an ideological “homeland” for these terrorists. Daesh (ISIS) public sponsorship of terrorist actions in Europe – and elsewhere (which our media practically ignores) is clear evidence of a direct link.

Yes, the social and cultural problems of current European citizens of Middle East origin contributes to their radicalisation as well. But surely this massive immigration will only help set up a future situation of increased ghettoisation and radicalisation of the immigrants and their children.

Politicians have failed to develop policies in Europe capable of preventing the current ghettoisation and radicalisation – it’s an open question whether they will be able to develop policies suitable for the new wave of immigration.

Meanwhile, these same politicians in Europe, NATO and the US have created the current problems with their ‘failed “regime change” interventions in the Middle East. Realists have started to realise this and complain about that strategy. But, so far, they seem incapable of completely rejecting it, accepting the right of the peoples in those countries to decide their own regimes – and decide for themselves any changes they consider necessary.

As for the possibility of united action to combat terrorism, I think there have been hopeful signs with the US-Russian cooperation over the cessation of hostilities in Syria and support for the Geneva negotiations on Syria’s future. Perhaps that is a good start which can be built on. But so far such cooperation appears to be confined to the activity of the US Secretary of State John Kerry.

Given that president Obama couldn’t bring himself to welcome Palmyra’s liberation I wonder what John Kerry says in private?

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The US speaks in two tongues on terrorism

Palmyra liberation

I wonder how democratically minded people reacted to news of the defeat of the Nazis at Stalingrad during World War II. Or to the liberation of inmates from German concentration camps in Poland by Russian forces towards the end of the war.

Surely they welcomed these victories – even reacted ecstatically. I find it hard to believe otherwise.

But now I wonder. Surely the liberation of the Syrian city of Palmyra from Daesh (ISIS) occupation must be welcomed ecstatically by democratically minded people. Yet we find this pathetic hand wringing by a US State department spokesperson Mark Tonner.

He was far from enthusiastic the other day when asked if the US considered Palmyra’s liberation a positive development. Less than 24 hours before the Syrian Arab Army’s major push, Toner was asked on Wednesday if the US would like to see “the regime retake Palmyra, or do you prefer that it stays in Daesh’s hands?”

But no clear support for such a liberation. Instead, Tonner talked about “alleged violations of the cessation of hostilities” by the “regime.”  How the hell could a responsible State Department spokesperson talk that way – surely he is aware that the cessation of hostilities agreement brokered by the US and the Russian Federation specifically excluded Daesh!

He effectively refused to answer the journalist’s question instead suggesting there was little difference between Daesh and the “regime” of President Bashar Assad. After giving an evasive non-answer, Toner was pressed to clarify his remarks.

“No, I mean, look, I mean, broadly speaking, it’s not a great choice, an either/or, but – which is worse, Daesh or the regime – but we think Daesh is probably the greater evil in this case,” Toner replied.

Bloody hell! With such an evasive attitude by someone representing a country which is claiming to play a decisive role against international terrorism no wonder we have problems.

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Chemistry is everywhere – even in those natural products

egg

Here’s a thought – what of natural products came with a list of ingredients in the same way processed food does?

James Kennedy, an Australian chemistry teacher, has put together some images to illustrate what this would be like. And the article What if natural products came with a list of ingredients? reproduces the detailed infographics which show even the simplest of foods are anything but.

Kennedy said:

“I want to erode the fear that many people have of ‘chemicals’,’ and demonstrate that nature evolves compounds, mechanisms and structures far more complicated and unpredictable than anything we can produce in the lab.”

Banana

He added:

“With these graphics, I wanted to show that Chemistry is everywhere.”

 

Blueberries

Mind you – this won’t stop me reading the lists on packets of manufactured food. But it does show that one should not be automatically frightened by such lists. It is important to understand each component. A chemical is not dangerous, or unnatural, just because it is a chemical.

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Life for women under Daesh (ISIS)

This video was taken in the Syrian city of Raqqa – the Daesh (ISIS) capital and stronghold in Syria. It portrays the life for ordinary women under the tyranny of these Islamic terrorists.

Fortunately, this situation may soon be reversed. Armed forces of Syria and its allies are currently massing to retake the historic city of Palmyra.

Palmyra

The ruins at Palmyra are shown here in 2009. Source: PETER RAYNER/AXIOM/ZUMA

Battles are also occurring around Deir ez-Zur. The capture of these cities well enable liberation of Raqqa.

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The toxicity of chemophobia

ChemophobiaImage credit: A dirty word?

Chemophobia is rampant on the internet. It seems to range from a reasonable concern over the potential adverse effects of synthetic chemicals to an irrational fear of these substances because of misconceptions about their potential for harm. Often it is accompanied by a complete misunderstanding of risk and an unrealistic understanding of the role of concentration in toxicity.

The Soapbox Science blog article, The presence of a chemical is not the same as presence of risk, from a few years back, describes both these problems.

All substances are chemicals

“Chemical” is not a dirty word. Nor is it a synonym for “poison” or “toxin.” Chemicals are the basic building blocks of all matter and classifying them as “safe” or “dangerous” is inappropriate. But of course there are safe or dangerous ways of using chemicals. In any case, chemicals are not to be feared or worshipped, they are to be understood. And perhaps the most important point to understand is that the presence of a chemical does not equate to the presence of a risk.

I would add to this the confusion many people have about “natural” substances and “synthetic” chemicals. All substances are chemicals and the properties of a specific chemical are completely independent from whether it occurs “naturally” or has been manufactured or synthesised. Yet, again and again, I get comments from people who declare that fluoride in fluoridated tap water is bad – because the fluoridating agent is a manufacture chemical or by-product of a chemical industry.

Similarly, commenters will argue that the “natural” fluoride in our water is good because it is derived from the naturally occurring fluoride mineral fluorite or calcium fluoride. The chemical species in the water, whatever its origin, is the hydrated fluoride anion. Its origin has absolutely no influence on its properties, its reactions in our body or on its toxicity.

The actual concentration is relevant

Thanks to our analytical capabilities, we can now routinely detect substances down to the part per trillion (ppt) level. That’s not finding a needle in a haystack; it’s finding a needle in a world full of haystacks. At that level, we can detect a myriad of chemicals should we choose to look for them! And by selectively referencing the scientific literature, the spectra of risk can be readily raised.

Practically any element and most chemicals can be detected in all of our foods and beverages. But in most cases they are only present in incredibly small concentrations. Modern analytical techniques are capable of identifying chemicals at incredibly low concentrations – so low they are just not relevant to concerns about safety or toxicity.

This means that regulations controlling the presence of contaminants in our foods and beverages must define the maximum allowable or acceptable concentrations – otherwise, all foods would be rejected no matter how “natural” or “chemical-free” they are.

The problem is that chemophobic people react to analytical evidence of a contaminant chemical without considering the concentration. The very fact that it may have been detected in a sample (or even not detected at the analytical sensitivity available) is enough to raise concerns.

For example, I have seen opponents of community water fluoridation wave around certificates of analysis of fluoridating chemicals as if they proved these chemicals a loaded with toxic heavy metals.

But look at this example of data from a certificate of analysis for fluorosilicic acid purchased by Hamilton City Council at the time anti-fluoride campaigners were using the heavy metal argument in their campaign against fluoridation.

Hamilton CofA

The use of the “less than” indicator (<) shows that the concentration of several of these heavy metals was below the detection limit for the recommended analytical method (in this case antimony, mercury, molybdenum and selenium).

All the other heavy metals have concentrations well below the regulated maximum for this concentrated fluoridating chemical. Check this out – the regulated maxima (mg/kg) are 132 for arsenic, 40 for cadmium, 660 for chromium, 132 for lead and 132 for selenium. (Remember, this data are for the concentrated chemical which must is diluted millions of times before consumption). In fact, in many the contribution to drinking of heavy metals from water treatment chemicals like fluorosilicic acid may be less than from natural sources (see Fluoridation: putting chemical contamination in context and Another defeat for anti-fuoridation claims about arsenic).

So these campaigners may scare chemophobic people by waving around a certificate containing analytical data – but a calm reading of the data and comparison with the regulated maxima shows there is absolutely no risk.

The risk of chicken soup

The article illustrates the silliness of chemophobia by considering a bowl of soup:

“For example, eat a bowl of chicken soup and hundreds of chemicals will flood your bloodstream, including many (benzene, methanol, etc.) that are potentially “highly toxic.” Although they are not toxic in the dose found in the soup, if you look for them in the urine, you will find them. Nobody bothers to look, because these chemicals are not deemed important; after all they are “natural,” and nobody has a political interest in banning chicken soup.”

The author says:

” I’m a big proponent of eating fresh, unprocessed foods.  However, remember that chicken soup made with fresh vegetables and organic, free range chicken can still flood the urine with plenty of compounds that could be vilified the same way as BPA or phthalates, if only one cared to make the effort.”

And that is the problem. Chemicals get vilified – even when they are harmless or at extremely low concentrations – because propagandists and activists make that effort.

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Anti-fluoridation campaigner, Stan Litras, misrepresents WHO

stan litras-300x225

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

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

A blatant  misrepresentation of WHO recommendations

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

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

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

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

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

Here is what the WHO document actually recommends:

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

It recognises that:

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

And it concludes from the available research reviews that:

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

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

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

And then goes on to warn:

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

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

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

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

Using “monitoring” to fear-monger

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

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

Most at-risk individuals

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

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

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

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

A question to Stan Litras

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

If not – why not?

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