Seems if there is an anti-scientific bandwagon to climb on New Zealand’s own self-described “investigative journalist” just can’t help himself. Having self-published books on climate change (he denies the science) and evolution (he supports creationism) it shouldn’t be long before he will be producing a book on fluoridation. And, yes, he is agin it.
Until then we will have to make do with an article by him, in the April/May 2014 issue of his self-published magazine “Investigate.” It’s called “Brushing up on the science” (and no, it doesn’t contain any reliable science at all – what did you expect?). Bloody hell – he is going to have to find more material if he is to write a book. This is nothing more than extensive quotes from Paul Connett (remember him?), a Mickey Mouse alternative dentistry group (the International academy of Oral Medicine and Toxicology) and Justice Hansen’s judgement on the New Health NZ vs South Taranaki District Council High Court case (it’s worth downloading and reading this 43 page judgement).
Mind you, in the past I have found Wishart’s “investigative” journalism to rely heavily on quotes from newspapers and unreliable sources rather than any objective material or reasoning. In my review of his book on climate change Air Con, for example, I noted that 43% of the book was straight out quotes – with 75% of one chapter straight quotes (see Alarmist con)!
IAOMT – an authority??
The first of Wishart’s sole 2 authorities on fluoridation is the International Academy of Oral Medicine and Toxicology (IAOMT). Yes – they are also agin it – claiming in Wishart’s quote:
“There is no discernible health benefit derived from ingested fluoride and . . . the preponderance of evidence shows that ingested fluoride in dosages now prevalent in public exposures aggravates existing illnesses, and causes a greater incidence of adverse health effects.”
But IAOMT are neither authoritative or reliable.
Wishart describes them as “a major North American dental professional association.” Others are not as impressed (or as willing to pull the wool over readers’ eyes). RationalWiki informs us that the IAOMT:
“is a quack organization based in Canada that promotes dental woo. They were responsible for the “smoking tooth” video that frequently gets passed around in altie circles. Their main issue is mercury amalgam fillings, which they claim can cause all sorts of neurological illnesses such as Parkinson’s and autism. They sell filling removal kits for “dentists” along with various other nature woo, mostly vitamin supplements. The organization also opposes water fluoridation, claims to put out peer-reviewed “research,” and supports “health freedom.””
So, another “alternative” organisation one can sign up to and use for letters after your name. Hardly a mainstream or respected organisation – it has only 2 affiliated members in New Zealand! One of these is Lawrence Brett from Whangarei. Brett often fronts for the anti-fluoride activist group Fluoride Action network of NZ (FANNZ). For example in his submission to the Hamilton City Council Fluoride Tribunal he gave his affiliation as the International Academy of Oral Medicine and Toxicology. I guess some councillors who knew no better thought this meant he was an internationally recognised expert – he isn’t. (In fact, according to FANNZ sopkesperson Mark Atkin, Brett was denied a graduate degree from Otago University because his thesis was unacceptable).
The Connett interview
Most of Wishart’s article is just extended quotes from an interview he had with Paul Connett (his second “authority,” during Paul’s last annual visit to New Zealand. Nothing new there at all. The same tired old arguments he used in our exchange (see the Fluoride debate). I’ll just deal here with the dishonest use of quotes by Connett and Wishart on “topical application” of fluoride and the reduction of tooth decay.
Wishart misattributes this quote to the American Dental Association Journal:
“that the mechanism by which fluoride may have a meaningful impact on the reduction of dental caries is by topical application, not ingestion.”
Anti-fluoride activists are always misrepresenting this issue of topical mechanisms so I searched for the full quote. Only 2 hits – Wishart’s article and an anti-fluoridation site. Couldn’t help wondering if that is Wishart’s real source. Not very professional if it is.
Still, the anti-fluoridation site did attribute their claim (not a quote) to “the cover story of the July 2000 Journal of the American Dental Association (JADA).” And that cover story was a paper by J. D. Featherstone (2000) The science and practice of caries prevention, Journal of the American Dental Association, 131(7), 887–99. You can get an idea of what Featherstone wrote from the paper’s abstract which reads in part:
Conclusions. Caries progression or reversal is determined by the balance between protective and pathological factors. Fluoride, the key agent in battling caries, works primarily via topical mechanisms: inhibition of demineralization, enhancement of remineralization and inhibition of bacterial enzymes.
Clinical Implications. Fluoride in drinking water and in fluoride-containing products reduces caries via these topical mechanisms.
So the old story of changing “topical mechanism” to “topical application” – hence implying fluoridated toothpaste and not fluoridated water. And removing the word “primarily.” A finer point is that Featherstone is referring to specific mechanisms involved in “caries progression or reversal” and “battling caries.” This does not negate an overall role for fluoride in strengthening the apatites in teeth and reducing wear which can contribute to oral health (see Ingested fluoride is beneficial to dental health).
The Hastings project
Wishart refers to the exchange I had with Connett but misrepresents me when he says:
“Perrott was forced to admit the New Zealand study was certainly “Bad science” but was offended by the allegation of fraud.”
What I wrote is easy enough to check. Referring to possible influence of changes in dental practice Connett relied on for his charge of “fraud” I wrote:
Akers (2008) agrees these changes confounded the experiment:
“The changing of NZSDS [NZ School Dental Service] diagnostic criteria for caries and the cessation of the NZSDS nurses’ practice of prophylactic restoration of fissures further confused interpretations. While later antifluoridationists justifiably claimed that the changed diagnostic criteria contributed to the fall in caries (Colquhoun, 1999), their “science or swindle” questioning of methodology and findings (Colquhoun and Mann, 1986; Colquhoun, 1998; Colquhoun and Wilson, 1999) simplified confounding variables and dismissed international evidence supporting community water fluoridation as one factor in declining community caries incidence (de Liefde, 1998).”
So science, probably bad science, but not the “swindle” Paul wants to believe – and wants us to accept. As an aside, I think changes in dental practice like this will have also contributed to the graphs Paul and other anti-fluoride activists love to use to prove improvement of oral health in the absence of fluoridation – yet they never discuss that sort of detail. It is a potential problem with any longitudinal study and Colquhon was criticised for ignoring it in his own presentation of New Zealand data.
Wishart misquotes my “probably” as “certainly”. Actually, on reflection it should have been “possibly” as I was really referring to the problems one sees in long-term experiments of this nature when observed in hindsight. I did refer to this later saying:
“I know from experience the complexity of long term trials involving many people doing different jobs. It is easy to take a bureaucratic letter out of context, oversimply or misinterpret problems of personal approaches to methodology and ignore the fact that managers of such trials inevitably face difficulties from factors outside their control. As for reporting findings, the data amassed and details of methodology and their changes can be mind-boggling for an outsider who attempts an understanding.”
As for being “offended” by Connett’s unwarranted allegations of fraud (Connett did not bother checking out the published reports from the project relying only on an out of context bureaucratic letter) – yes I guess I do find that sort of dishonesty offensive. Worse I think it is professionally irresponsible as I wrote:
“I think Paul is irresponsible to make such damning charges of “fraud” without considering all the material. He actually has no evidence at all the project was a “fraud” or that the reasons for dropping Napier as a control were “bogus.” His behaviour is unprofessional.”
The Napier “control”
Wishart’s extensive quote of Connett refers to the dropping of Napier as a “control” region “for reasons that may not have been legitimate.” In our exchange Connett said:
“after about two years the control city of Napier was dropped for bogus reasons.”
So “bogus” or “not legitimate” – but what reason does he give? – None! I asked him for a justification and his response was simple – avoidance:
“However, whether the control city was dropped for bogus or legitimate reasons the central charge remains the same.”
Again I just think that is professionally irresponsible. Connett makes charges of scientific fraud and illegitimate behaviour by the scientists without any justification at all.
Incidentally, this is how Akers refers to the problem of using Napier as a control city:
“The abandonment of the control city (Napier) because it had a lower initial caries rate than that of Hastings (Ludwig, 1958) implicated soil science as a confounding factor in New Zealand cariology (Ludwig and Healey, 1962; Ludwig, 1963).”
It would have been irresponsible to pretend that Napier was a proper control in these circumstances).
The “Nanny State”
Wishart’s last words are “Roll on Nanny State”. These show his motivations – not only on fluoridation but also his attacks on climate change science. This is his starting and finishing point. His whole reason for distorting the science. A blatant example of what Professor Gluckman described as using science as a proxy for values or political views.
It’s the old “freedom of personal choice” argument in this case Justice Hansen represents the state so anything he decides or recommends becomes simply an expression of “state interests” – “nanny state interests” at that, and should not be considered as a result of evidence or reason.
Well, everyone is entitled to their own ideology and its political manifestations – we do still live in a free country. Fortunately, because we are a democracy the extremist positions Wishart arrives at from his ideology have very little support. Even if all the Hamilton citizens who voted against fluoridation in the referendum had personal choice as their sole motive (and they certainly didn’t) they amounted to only 30% of the voters. (Or, if I resorted to the silly arguments anti-fluoridation activists have used to explain away the referendum result – to only 30% of 34% (the proportion who voted – about 10% of the population.)
It is one-sided to see fluoridation as merely a “freedom of choice” issue. It is really an issue of balancing freedom of choice against social good. We often have these discussions in our society because social organisation involves balancing these two apparent extremes. In practice we usually find some procedure enabling a working balance on issues – often in ways that allow actions producing social good while still maintaining a high degree of personal choice.
Consider “social goods” like free secular education and public hospitals. Our society supports these (or something close to them) while at the same time not denying freedom of choice to those members of society who refuse to use them. The fact individuals making that choice to avoid the social good incurs costs to them, sometimes substantial costs like medical insurance and school fees, does not deny the fact they are taking advantage of their freedom of choice. The social goods have not caused a loss of freedom of choice.
Yes, people who wish avoid the advantage of a public health measure like community water fluoridation may incur some costs in purchasing other sources of drinking water or kitchen filters (at far less cost than private education and medical insurance fees). But this does not mean their freedom of choice is being denied. These people may complain about these costs but should remember that freedom of personal choice also involves personal responsibility for the consequences.
There is also the point that the exercise of personal freedom of choice should not take away the freedom of choice of many others who benefit from a public health measure. Justice Hansen made this argument in his judgment on the fluoridation issue (Hansen 2014);
“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.”
Dr. John Harris of the Department of Ethics and Social Policy at the University of Manchester, UK, made the same point in his article The Ethics of fluoridation:
“We should ask not are we entitled to impose fluoridation on unwilling people, but are the unwilling people entitled to impose the risks, damage & costs of the failure to fluoridate on the community at large? When we compare the freedoms at stake, the most crucial is surely the one which involves liberation from pain and disease.”
Ian Wishart has relied on two bogus authorities to supported his distortion of the science. But at least he has been honest enough to show his extremist ideological reasons for this by attacking the “Nanny State.”.