Social health policies, freedom of choice and responsibility

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

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

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

Levels of responsibility and consequences

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

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

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

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

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

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

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

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

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

So what is driving anti-fluoridation propagandists?

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

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

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

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

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

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

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Reality of war for civilians

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

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

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

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

Update

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

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Stephen Fry not pulling any punches

Stephen Fry on God | The Meaning Of Life | RTÉ One – YouTube.

Stephen Fry has a great skill of getting right to the core of an issue.

Here he answers the question of what he, as an atheist, would say if he ended up at the gates of heaven.

January ’15 – NZ blogs sitemeter ranking

Social-Media-Statistics-You-Need-to-Know1

Credit: 10 Social Media Facts, Figures and Statistics You Need to Know

There are now over 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 January 2015. 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

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US meddling in Ukraine behind coup

Ukraine Deputy has proof of USA staging civil war in Ukraine

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

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

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

Some other reminiscences from that period

nuland---pyatt

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

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

nuland-in-ukraine

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

Phone call

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

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Hypocrisy

tin foilCredit: The Skeptics’ Guide to the Universe

This cartoon reminded me of some of the local campaigners against fluoridation. They almost all are either strongly connected to the “natural” health movement and its businesses, or, because of their beliefs, are customers of that industry. Yet they often argue that genuine scientific and health experts are in the pay of “big pharma” or similar businesses and are acting as “shills” for industry! That is plain hypocrisy. Similar articles

Sunday reading – Richard Dawkins reads some of his “fan mail”

This is a more recent version of Richard Dawkins reading some of his “fan mail.”

Don’t remember much of the first batch he read – but get the impression the language skills of fundamentalists has become even poorer in the intervening period.

Warning – explicit language.

via Love Letters to Richard Dawkins – YouTube.

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Is debating with anti-science activists worth the effort?

amount

I often wonder if the effort put into challenging and debunking misinformation and distortion of science on the internet is worth the effort. After all, it often means debating with dyed-in-the-wool people who have an ideological conviction who are immune to facts. And it is rare for me to actually win over a discussion partner – although, on the positive side – I often feel that I have learned something myself from the exercise.

So this Facebook article from The Credible Hulk pressed a few buttons for me. The bold highlights are mine and serve to identify key questions or concepts.


When undertaking the challenge of refuting various forms of scientifically unsupportable claims, a question that often arises is “are we legitimizing and/or drawing additional attention to people and ideas that might otherwise have had lesser reach and impact?” The idea is that we aren’t going to change the minds of dyed in the wool cranks, and by trying to, we give them free publicity.

This is an important and valid question. I think that there are certain cases in which illuminating and addressing certain quackpot claims can bring such claims and their proponents undeserved recognition and attention from people who otherwise might have never even heard of them. It is possible that it may in some instances be complicit in permitting the development of an unwarranted public perception of legitimacy with respect to the claims.

However, it’s a subtle business we’re in with a lot of catch-22s, because sometimes the opposite can occur.

For instance, by not addressing certain contrarian claims, that can be construed by (how shall I say) “alternative theorists” as a conspiracy of silence on the part of the greater scientific community.

In some such cases, the popularity of a set of unsupported claims can rise to dangerous levels due to being ignored (rather than due to being disputed), in which case we then have no choice but to struggle to put out a fire that was downplayed for too long on the grounds that it might not spread if we downplay it.

Also, much of the fight against pseudoscience involves targeting the reasonable bystanders, many if whom may be amenable to evidence and reasoned discourse, but had simply not previously been exposed to the best information on a subject. Maybe they’d seen headlines and claims that compelled them to think a controversy was afoot when only a manufacturversy existed. They see these interactions and can often tell which side is making the more logical and evidence-based arguments. This furthers people’s science education and increases the number of people who are sufficiently aware to watch out for crackpot claims.

This is desirable, because keeping silent doesn’t improve the average scientific literacy of the population, and thus relegates the knowledge to elite academics alone, in which case people who lack the scientific educational foundation to evaluate the veracity of their claims are forced to choose to either believe or disbelieve their claims on the basis of their personal subjective perception of the ethics and competence of the scientists (instead of following the logic of the science itself and understanding why a particular conclusion is reasonable on the basis of the best available evidence at a given time).

I’m not sure that there exists a perfect solution, but I don’t think that ignoring the anti-science voices is the best option (though we do collectively need to be selective and tactful with which ones we spend time and energy refuting).

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Six months on – concerns about MH17 investigation

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

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

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Severe dental fluorosis and cognitive deficits – now peer reviewed

peer-review-cartoon
Last May I raised the possibility that the much touted relationship of small IQ declines for children living in areas with naturally high fluoride in drinking water could be associated with severe dental fluorosis and not a chemical neurotoxicant (see Confirmation blindness on the fluoride-IQ issue). In November I repeated this argument because the recently published work by Choi et al (2015) provided evidence of a statistically significant relationship of cognitive deficits to severe dental fluorosis for Chinese children living in high fluoride areas  (see Severe dental fluorosis the real cause of IQ deficits?).
I am pleased to report the journal Neurotoxicology and Teratology (which published the Choi et al., 2015 paper) have now accepted a peer-reviewed letter to the Editor from me on the subject:

Perrott, K. W. (2015). Severe dental fluorosis and cognitive deficits. Neurotoxicology and Teratology.

Don’t limit possible hypotheses

My letter warns:

“cognitive deficits could have many causes or influences – genetic, environmental and/or social. Researchers need to be careful not to limit their possible hypotheses or research approaches. Unfortunately Choi et al. (2015) appear to be doing just this with their plans for a larger scale study targeted only at “fluoride’s developmental neurotoxicity.””

It points out:

Choi et al. (2012) did highlight the need for further research. Broadbent et al. (2014) showed no effect of fluoride on IQ at the optimum drinking water concentrations used in CWF [community water fluoridation]. However, most of the reports reviewed by Choi et al. (2012) considered data from areas of endemic fluorosis where drinking water fluoride concentrations are higher.”

“Choi et al. (2015) did not find a statistically significant association of drinking water fluoride concentration with any of the neuropsychological measurements. But they did find one for moderate and severe dental fluorosis with the WISC-R digit span subtest.”

This suggests a possible hypothesis involving the effects of negative physical appearance and not a chemical neurotxocant:

“Emotional problems in children have been related to physical anomalies, including obvious oral health problems like severe tooth decay (Hilsheimer and Kurko, 1979). Cognitive deficits can sometimes be related to emotional problems and subsequent learning and behavior problems. Quality of life- particularly oral health related quality of life is negatively related to tooth decay and severe dental fluorosis. It is possible that negative oral health quality of life feelings in children could induce learning and behavior difficulties which are reflected in neuropsychological measurements.”

Difference between areas of endemic fluorosis and CWF

This hypothesis is applicable to children in areas of endemic fluorosis but is not relevant to areas where CWF is used:

“Sixty percent of the children in the Choi et al. (2015) pilot study had dental fluorosis graded as moderate or severe. This likely reflects the endemic fluorosis of the study area. Only a few percent of individuals in areas exposed to the optimum levels of drinking water fluoride used in CWF have dental fluorosis that severe. For example, a recent oral health survey in New Zealand found 2% of individual had moderate dental fluorosis and 0% had severe dental fluorosis (Ministry of Health, 2010). Similarly a US survey found only 2% of individuals exhibited moderate dental fluorosis and less the 1% severe dental fluorosis (Beltrán-Aguilar et al., 2010).”

“Tooth decay and other oral defects negatively impact a child’s quality of life as assessed by children and parents (Barbosa and Gavião, 2008; Nurelhuda et al., 2010; de Castro et al., 2011; Aguilar-Díaz et al., 2011; Biazevic et al., 2008; Abanto et al., 2012Krisdapong et al., 2012; Bönecker et al., 2012; Locker, 2007). Quality of life impacts have also been found for dental fluorosis, but there is a marked difference in physical appearance and quality of life assessments for children with moderate/severe dental fluorosis compared with those having none/questionable or very mild/mild forms.

The physical appearance of moderate and severe forms of dental fluorosis is generally considered undesirable so we could expect these forms to be associated with poor quality of life and this appears to be the case (Chankanka et al., 2010; Do and Spencer, 2007; Chikte et al., 2001). In contrast, most studies report no effect or a positive effect of questionable, very mild and mild forms of dental fluorosis on quality of life (Do and Spencer, 2007; Chankanka et al., 2010; Peres et al., 2009; Biazevic et al., 2008; Büchel et al., 2011; Michel-Crosato et al., 2005).

Given the different patterns of dental fluorosis severity in areas of endemic fluorosis and areas where CWF is practiced and fluoride intakes are likely to be optimal it seems reasonable to expect a difference in ways fluoride intake influences health-related quality of life and possibly cognitive factors.”

My purpose in this letter was to argue that other mechanisms besides chemical neurotoxicity should be considered in these studies. I hope researchers take this on board and look forward to the response of Choi and her co-workers to this suggestion.

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