Fluoridation – freedom of choice

This sort of image springs to mind when I see claims of forced fluoridation. Aren’t activists like “Forced Fluoridation Freedom Fighters” misrepresenting the real situation? Credit: FALUN DAFA MINGHUI.ORG – enacting claimed forced feeding in Chinese camp.

I think the “freedom of choice” argument is the most reasonable argument that anti-fluoride campaigners can use. Unfortunately for them, they usually only resort to it after their “science-based” arguments have been exposed as misleading or completely false. And even then, they usually present their “freedom of choice” argument in a naive and hostile way.

Have a look at this discussion from a local anti-fluoride Facebook page.

Here an opponent of community water fluoridation (CWF)  has declared she doesn’t want fluoridation – fair enough. She has also declared that she doesn’t drink fluoridated water. Also fair enough.

I would say she has exerted her freedom of choice – she doesn’t drink fluoridated water so must have made other arrangements.  And I am all for people exerting that right – even when they refuse to partake of a safe and effective social health policy.

But, in the next breath, she declares that she doesn’t have freedom of choice!

How does that work? It is as illogical as someone who votes on election day and then declares to everyone that they have been denied their right to vote!

“Forced fluoridation”

Some campaigners are even worse – declaring that they are being forced to drink fluoridated tap water!

That brings up a picture of someone being held down and water being forced down their throats. But we know that does not happen. Worse – we also know that most of the people making this claim do not even drink unfiltered tap water. The serious anti-fluoride person almost always uses a system to remove fluoride from the tap water, or finds a different source of water to consume.

When New Zealand councils provide “fluoride-free” public taps they get very little use. This suggests that the anti-fluoride campaigners (who may have lobbied for the taps) have already made their alternative arrangements (see Fluoridation: Freedom of choice – and responsibility).

So, I just don’t buy this naive “freedom of choice” argument – especially when presented in such aggressive ways. The fact is that where most social policies are concerned they are not forced on people – there is usually a chance for objectors to avoid the policy or use alternatives. No one is forced to send their kids to secular schools or to use free hospitals. There are alternatives in such cases.

A community’s freedom of choice

Anti-fluoride campaigners should just stop using this argument at the personal level – it just discredits them. Where it does have validity is at the community level. Because it is a controversial issue there is usually some level of public consultation when health authorities recommend the introduction of fluoridation.

The public has a right to feel aggrieved when they are denied their freedom of choice if decisions to start or stop fluoridation are just imposed on them by officials. But that “freedom of choice” argument is an argument for democracy – not an argument for or against a social health policy.

The freedom to deny others their freedom of choice

Unfortunately, many anti-fluoride campaigners will still advance their personal “freedom of choice” arguments even when decisions have been made democratically by using referenda or some other method of polling voters opinions. It’s like a voter who supported a minority party in a general election claiming their rights are being violated by the party or parties with the most votes actually got elected!

So what “freedom of choice” are these die-hard anti-fluoride campaigners really thinking about?

If they have already exerted their own personal freedom of choice by use of tap filters or alternative water supplies, and they have been given a chance to express their views or take part in a democratic referendum, what freedom do they think they have lost.

I can only conclude the freedom that really concerns them is their perceived freedom to prevent others from taking advantage off a safe and effective social health policy.

And that attitude is hardly democratic.

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Attempting a tyranny of the minority on fluoridation

Tom O’Conner, president of Grey Power, describes community water fluoridation (CWF) as the “Tyranny of the Majority” (see “Fluoridation of water a trampling of our right,” Timaru Courier, May 26th).

Well, it is nice to see an anti-fluoridation piece which does not resort to scientific misrepresentations and distortions.* These fallacious “scientific” arguments a really just a proxy for the underlying political or values beliefs of the person advancing them. It would be more honest if we discussed these instead of wasting time on the scientific arguments. So, thank you,Tom.

But what about this “tyranny of the majority” argument? Most anti-fluoride campaigners will probably support it.  While we might have  an idea of what it means here is a more specific definition offered by Wikipedia:

“The phrase “tyranny of the majority” (or “tyranny of the masses“) is used in discussing systems of democracy and majority rule. It involves a scenario in which decisions made by a majority place its interests above those of an individual or minority group, constituting active oppression comparable to that of a tyrant or despot. In many cases a disliked ethnic, religious, political, or racial group is deliberately penalized by the majority element acting through the democratic process.”

Freedom of choice

So I think O’Conner has let his emotions get out of hand here. Sure, CWF usually results from a majority decision, but there is no deliberate penalising of any minority group. In fact, “fluoride-free” community taps are often provided by councils to make sure the minority freedom of choice is maintained. Where is the tyranny in that?

There may be a number of reasons for people to object to the quality of the provided tap water – the taste, presence of chlorine, colour, etc. Tap filters are common – and specific filters are available for removing fluoride, chlorine. colour, tastes, etc. Bottled water or water from different “natural” sources are also used by people who object to tap water for one reason or another. In some countries people (and especially tourists) never drink tap water – they use bottled water.

Whenever I check with anti-fluoride campaigners I find they already exert their freedom of choice by obtaining their drinking water from a separate source or using a fluoride removal system like an appropriate tap filter, distillation or reverse osmosis. You have to ask – if they have already exerted their freedom of choice, what the hell are they talking about with this argument? Perhaps the freedom to prevent the choice of those who voted for a safe and effective social health measure – CWF?

Fluoridation is medicine myth

O’Connor evokes the New Zealand Bill of Rights Act 1990 – in particular the clause which says:

“Everyone has the right to refuse to undergo any medical treatment.”

This clause in Part 2 of the Act – Civil and political Rights – includes rights such as not being deprived of life,  subjected to torture or cruel treatment and not being subjected to medical or scientific experimentation. This suggests he is again being rather extreme to see CWF as a form of forced medical treatment. Hell, it isn’t even a form of forced drinking of tap water given that no-one is denied alternatives.

In fact, New Zealand legislation  is clear that fluoride is not a medicine when used at the low concentration present in fluoridated water. Anti-fluoride campaigners have attempted to challenge that in court but every attempt has been rejected. See, for example, NEW HEALTH NEW ZEALAND INC v ATTORNEY-GENERAL [9 October 2014] and NEW HEALTH NEW ZEALAND INC v ATTORNEY-GENERAL [4 September 2015]

Tom O’Connor plays down these decisions – always hopeful that the next appeal by New Health NZ will succeed. But in doing so he is attempting to push  the proverbial uphill.

[By the way, New Health NZ is an astroturf organisation set up and financed by the NZ Health Trust – the lobby group of the NZ “natural”/alternative health industry. It has deep pockets – see Big business funding of anti-science propaganda on health]

But, to hell with the legislation. O’Connor argues:

“it is illogical to argue that fluoride is not  a medical treatment but then introduce it to drinking water to combat tooth decay.”

Then what does he, and his anti-fluoride mates, think of chlorination of  our drinking water supplies. This disinfection process is not a medical treatment but is clearly meant to prevent disease. According to O’Connor’s logic, it should be seen as a medical treatment and thus subject to the Bill of Rights!Incidentally, many opponents of CWF are also opposed to chlorination. But tend to be less public about this preferring to see CWF as the “low hanging fruit” and mobilisation against chlorination a future project once CWF has been defeated.

Incidentally, many opponents of CWF are also opposed to chlorination. But they tend to be less public about this preferring to see CWF as the “low hanging fruit” and mobilisation against chlorination a future project once CWF has been defeated.

O’Connor extends his logic:

“If it [CWF] is a medical treatment the Bill of Rights clearly prohibits its introduction to communal drinking water. If it is not a medical treatment to combat tooth decay, there is no logical reason to introduce it to communal drinking water. There is no middle ground.”

The fact that exactly the same logic can be applied to iodised salt or the disinfection of communal drinking water by chlorination surely shows the danger of bush lawyers taking it into their own hands to define and interpret the law.

Just imagine if a minority managed to prevent communal water disinfection by using the Bill of Rights, the right to refuse to undergo medical treatment, their perverted concept of “freedom of choice” and arbitrary definition of chlorination as a “medicine.” Doing this, and at the same time denigrating democratic decisions as the “tyranny of the majority” they would, in fact, be imposing their own tyranny of a minority. One that denied a safe and effective water treatment process prevent sickness and spread of diseases.

*Note: Mind you, O’Connor still manages to misrepresent the scientific aspects by saying:

“The key issue here, however, is not the effectiveness or otherwise of fluoride as a treatment for oral health. That is an unresolvable argument between competing proponents and opponents which lay people are  not equipped or even obliged to decide.”

Sure – the debate may not be resolvable, given that is driven by ideological factors. But the science is resolvable. The effectiveness or otherwise of CWF is an objective fact which can be determined by proper investigation of reality. Yes, that requires scientific and health experts and not lay people.

The wise lay person recognises her limitations in areas outside her expertise and takes the advice of the expert. We listen to the advice of mechanics about our cars, builders about house construction, engineers about road construction, oncologists about cancer treatment, etc. We should do the same with the science related to CWF.

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Fluoridation: Freedom of choice – and responsibility

Alia Grant, 7, collecting “fluoride-free” water from the Papaoeia Park tap in Palmerston North. Credit: Warwick Smith/ Fairfax NZ

Apparently a source of “fluoride-free” water provided by the Palmerston North City Council since last May has seen little use. Despite the council providing the “fluoride-free” public tap at the request of campaigners, the data on its use shows an average of only about 4 people a day drawing water from it (see comments by Palmerston North City Councillor Aleisha Rutherford and email to her from council officials).

This data will interest other councils, like the Hamilton City Council, who are considering installation of similar “fluoride-free” taps. They might question whether such low use warrants the costs involve (more that $90,000  for Palmerston North and a budgeted $60,000 for Hamilton). But I am more interested in what this low usage implies for they way anti-fluoride campaigners have exerted their own freedom of choice.

Freedom of choice involves responsibility

I have always argued for freedom of choice on issues like community water fluoridation (CWF) where opinions are divided. I believe that freedom of choice is actually guaranteed by democratic processes.

Yes, I know, the minority sometimes complain that such democratic decisions remove their freedom of choice – and certainly anti-fluoride propagandists make much of this. Often claiming that the minority’s freedom of choice, in this case, is more important than the health of the community as a whole.

But that argument is disingenuous. Such choices are about the availability of a service or social health measure – not about having such services or health measures imposed on people. There is always a choice – and that is the great thing about democratic decisions. The community supports socially provided health care and secular education. But that in no way prevents the minority, who oppose such measures, the freedom to organise their own healthcare or education. Free secular education and healthcare is not imposed on anyone.

So, it seems obvious to me that someone who genuinely believes fluoridation is not OK should be responsible enough to take their own steps to either filter the water supply or arrange for a different source if they find themselves in the minority. I am not for a minute suggesting they give up their belief, or even their attempts to convince others. Just that they be responsible, accept the majority have spoken and that the majority decision should prevail – at least until there is a democratic change of mind.

Given the ready availability of alternative water sources or filtration devices, it would be silly not to take advantage of them. That is exactly what I would do if in that situation. But very few of my anti-fluoride discussion partners on this issue, when asked, acknowledge they take such steps. Instead, they will often complain about costs, even claiming these costs are prohibitive, and moan about having fluoridation “forced” on them.

Water filters a common

So the low usage of this “fluoride-free” tap indicates to me that people who seriously object to fluoridation of their water supply are already taking their own steps to remove it – most probably using a relatively cheap filter. And, I believe their use of such filters probably predates any public action they have taken on the issue. Similar filters are, after all, quite common and many people use them for aesthetic reasons to remove the taste of chlorine or organic matter.

So why do anti-fluoride activists make such a fuss – attempting to deny a democratically accepted social health measure to people who support it? After all, any personal claims of their own sensitivity to fluoride are surely invalid if they have exercised their freedom of choice and taken steps to filter their water or find another source.

The water consumption data for the “fluoride-free” tap in Palmerston North suggests that all but a very few (perhaps 4 people?) are responsibility taking their own steps to filter the water. This fuss, then, surely has nothing to do with their own situation. I can’t help thinking it derives from their own ideological and political beliefs about what society as a whole should do.

Perhaps these ideological and political beliefs, rather than any scientific fact, are the real source of their claim about the danger of community water fluoridation?

See also

 

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?

Paul 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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