Fluoridation: What’s happening with the New Zealand legislation?

The second reading of the fluoridation bill is now on the order paper for the current parliament. Public submissions have been heard, the Health Committee has reported back to the House and the Ministry of Health (MoH) has provided its own responses to submissions.

Of course, we don’t know yet what the final Act will be like exactly. But the submissions, the committee report, and the MoH responses give us some idea of likely changes to the original bill.

Submissions

I have described before how the anti-fluoride activist groups organise to deluge consultation processes with their submissions. This was certainly the case here and their submissions accounted for most of those opposed to the Bill.

However, because the legislation is about the decision-making process and not the scientific or ethical validity of social health policies simple opposition to fluoridation was irrelevant  – outside the scope of the bill. This was true of most submissions (85%) and these should be considered a waste of every bodies time.

I am surprised the anti-fluoride organisations organising this submission campaign chose to take such an irrelevant approach. Surely if they had put a bit of thought into their efforts they could have directed their submission at relevant aspects such as the consultation process, the decision-making body and the question of referenda.

That said, a small number of the anti-fluoride submissions did address aspects of the bill and these were considered by the Health Committee and the MoH.

Putting aside the anti-fluoride submissions which did not address the bill, 20% percent supported the Bill and 80% opposed to the Bill as currently drafted. Most supported extending fluoridation cover, but disagreed with specific parts of the Bill and suggested changes.

The legislation does not mandate fluoridation

This is a common misunderstanding promoted by anti-fluoride campaigners – obviously attempting to use scare-mongering to motivate their supporters. For example, Fluoride Free NZ formally names the legislation the “Mandatory Fluoridation Bill“ which is dishonest – the correct name of the bill is “Health (Fluoridation of Drinking Water) Amendment Bill.”

The bill transfers decision-making from local bodies to District Health Boards (DHBs) – but it does not require DHBs to make a decision about fluoridation. That is up to local DHBs and local conditions such as dental health, likely advantages and establishment costs.

Consideration of other health factors

A number of submitters expressed concern that while the bill requires DHBs to consider dental health effects, consideration of other possible health issues is not provided for. However,  the response from the MoH to this is:

“While DHBs are required to consider the evidence in relation to oral health, DHBs are not prevented from considering other factors, including the effect of fluoridation on overall health. However, officials do not consider it necessary for the Bill to require DHBs to consider these other factors.”

So, consideration of other health factors will depend on specific situations, the board members or public interest. Importantly, DHB’s are not prevented from considering wider health aspects.

Considering the science

I was interested to see that:

” The Ministry of Health is currently exploring options for the ongoing monitoring and assessment of research on fluoridation within the Ministry to align with the implementation of the Bill.”

The MoH sees this as carrying on the role formerly played by the now disbanded National Fluoridation Information Service. But this also goes some way to satisfying a suggestion in my own submission that the assessment of research on fluoridation is carried out by some sort of central expert body (see Fluoride, coffee and activist confusion). My concern was that the DHBs are not really suitable bodies for making expert reviews of the literature and evaluating the current state of the science. Handing this over to a central body could also prevent boards being deluged with misinformation and unsupported claims about the science – a feature of local body consultation which caused so much trouble to councils.

It was the pressure of submission campaigns including misrepresentation and false claims about the science which drove local bodies, who do not have the expertise to consider the science, to request a change to the legislation. DHBs will confront the same situation unless they can direct scientific consultation to a central expert body.

Community consultation

Many submitters (12%), both for and against fluoridation, suggested the bill should specifically require DHBs to consult the community about fluoridation decisions. While the bill did not make such specific requirements it also did not prevent such consultation.

In practice, public consultation will depend on the level of demand for it. It is up to DHBs to decide when consultation is appropriate and there is already a regulatory requirement for DHBs “to foster community participation in health improvement” which could cover that.

There is also provision for the Minister to describe a fluoridation decision as a “significant service change” which would require DHBs to undertake community consultation on regional service plans including fluoridation.

So, the anti-fluoride activist claims of denial of community consultation is wrong. While consultation is not specifically required it is not prevented by the bill and will depend on the level of public interest.

Engagement with local authorities

The health committee is recommending the bill be amended to explicitly require DHBs to consider the views of the drinking water supplier. This accommodates suggestions made by some local bodies who feared the imposition of decisions without considering their local situations.

However, the committee also suggested an amendment to make clear that engagement with local authorities does not require them to consult communities. The DHB which makes the ultimate decision would have that responsibility where necessary.

The Committee also suggested “the Government consider whether
it intends to contribute funding towards the costs of establishing fluoridated water supplies” because there is a “moral hazard arising from the DHBs making a decision that will impose costs on local authorities and ratepayers.”  It looks like the Government has accepted this point as they have already made $12 million dollars available to local bodies setting up new fluoridation systems (see Government commits $12m to help councils cover costs of fluoridation in water supplies.).

Provision of non-fluoridated alternatives

Some local bodies have already introduced “fluoride-free” taps at the request of local anti-fluoride campaigners., The MoH is suggesting an amendment to the bill to make clear that “DHBs can direct local government water supplies in their region on a supply by supply basis if they wish.”

This could make it possible for specific local supplies, like Petone in the Hutt region or some supplies in Christchurch to remain unfluoridated if their communities demand it even if a decision is made to fluoridate a region.

The DHB or the director general of health?

Many of the submitters opposed to the bill in its present form suggest that the decision-maker should not be the DHBs but the Director-General of Health or central government. This is because of the likely low expertise of DHB members, low voter turnout for DHB elections and concerns of legal challenges to DHB decisions. There was also the expressed belief that the anarchic and dishonest coordinated submission campaigns previously experienced by local bodies would simply be transferred to the DHBs.

Some submitter proposed that fluoridation be mandatory thereby removing the need for an elected body to be responsible for the decision making.

The committee report and response from the MoH show that parliament will probably stick with the DHBs as the decision maker. There are some advantages in this (the DHB have responsibilities in health areas) and the proof of the pudding will be in the eating. Will the DHB approach to consultations be able to successfully give more credence to credible and peer-reviewed science than the misinformation and distortions of science promoted by anti-fluoride campaigners?

Possibly. I hope so.

Conclusions

Despite the anti-fluoride campaigns and the resulting deluge of misinformed or misleading submissions, the submission process has been successful. Problems in the current wording of the bill were identified and reasonable solutions to these problems have been advanced.

We should now see how MPs react to the bill and the recommended changes in the second reading. Anti-fluoride activists have carried on an intensive campaign of emails, letters and representations aimed at MPs. On the whole, this will have been counterproductive as MP are surely aware this bill is not about the science or ethics of fluoridation but simply the decision-making process.

I am picking that these campaigns have produced more heat than light and will have little influence on the progress of the bill. However, I do expect a lot of teeth-grinding, hairpulling, garment rending, lamentations that democracy doesn’t work or that various MPs should be shot or otherwise disposed of from anti-fluoride campaigners. This is already happening and will no doubt intensify when the final bill is passed into law.

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Fluoride, coffee and activist confusion

Havana Coffee Works in Tory Street, Wellington. Great coffee and chance to see roasting in action. On the site of what was the old Wellington Milk Department in the 1950s.

I have been in Wellington for the Parliamentary select committee hearings on fluoridation. Well, that was the excuse – I was really there to catch up with my family (always a joy and am amazed at how tall my grandson has become) and to enjoy the great food in Wellington cafes.This time I

This time I also set out to acquire some freshly-roasted coffee beans from one if the many roasters in Wellington.

The Havana roaster turned out to be a surprise. Not only are their coffee beans excellent ( I am looking forward to getting home and drinking coffee made with them) – they are based in Tory Street as the site of what used to be the old Milk Department. Some of you may still remember the days when milk was delivered to your house in the middle of the night by a milkman. My Dad was one of those milkmen, and my siblings and I all spent time helping him deliver milk in the dead of night. So that building brought back memories. Even got to walk along Channing street on the way back to my hotel. You wouldn’t know it now but that street was very disreputable in the 50s because of the opium dens in the old houses.

Select Committee Hearings

These were interesting. Submissions were called for on  Health (Fluoridation of Drinking Water) Amendment Bill currently before parliament. This legislation is not about fluoridation itself. It is about how decisions should be made – about the process, not the science. In effect, it proposes transferring decisions from local councils to District Health Boards.

Pressure for the law change came from local councils who were sick to death of the hounding from activists and being forced into making decisions – not about whether to fluoridate or not – but about the science. Activist submitters continued to deluge them with passionately-worded submissions full of scientific claims – councillors with no scientific skills were being forced into making decisions about the science – were the activists correct in their claims that fluoridation causes all the ills known to mankind or should they accept the science presented by the experts. After all, activist submissions could look very sciencey – they were often full of citations to the scientific literature!

True to form the anti-fluoride activists deluged the select committee with submissions which were irrelevant to the bill – very few of them actually suggested changes or showed any evidence they had read the bill. No, they did their usual trick of preaching about the “science” – their claims of harmful effects from fluoridation and that it does nothing for oral health anyway.

It is amazing to hear people make outrageous claims about the scientific literature – claims which make clear they have never bothered to read the source they are citing. I guess they think they can get away with such porkies and misrepresentations because they are talking to politicians. However, my impression was this failed at these hearings – unless submitters raised suggestions about the process they were simply politely thanked and sent away.

So I found it frustrating to hear such lies being peddled about the science (and discussion by the public was not allowed) but confident in the fact the select committee was just humouring these people. Responses from committee members were always about process – not the scientific claims.

My submission

There were only a few submissions which dealt properly with the wording of the bill – the vast majority were just empty anti-fluoride rhetoric. I made a submission as an individual scientist but also as part of the Making Sense of Fluoride (MSoF) team. It was great to catch up with MSoF people who I tend to talk with on-line every day but have not till now met in person.

This was my oral submission:

---

As Monty Python used to say: “And now for something completely different.”

I support this bill as far as it goes but don’t think it will solve the basic problems without changing the way the science is considered. I want to suggest a change.

The current submissions show the problem. This committee has been inundated with large numbers of written and oral submissions. Many of these are duplicates or form letters. Most are opposed to community water fluoridation and usually make scientific claims – such as fluoride is a neurotoxin, that it causes a high prevalence of dental fluorosis or uses contaminated chemicals.

Submissions often cite scientific articles – some have even attached copies of these articles. This sort of thing can impress the layperson – perhaps some of the members of this committee are impressed? After all, it is easy to fool the ordinary person with scientific claims, citations, documents and publications. Advertisers do it all the time.

But this committee is simply not considering the science. Political committees – parliamentary, local body or District Health Board should not make scientific decisions. They do not have the skills for this. Yet that is what most of these submissions are asking of this committee. It’s what was being asked of local councils and it will be what is asked of DHBs.

Consideration of the science behind community water fluoridation requires people with scientific and health skills. Such people need to check evidence provided, check citations when they are presented, check what the scientific literature actually says (which could be very different to what submitters claim). Proper scientific consideration requires that the claims and cited scientific literature need to be considered intelligently and critically. The wider literature needs to be consulted. Cited claims need following up.

I have attached a couple of documents that do this – these are responses to documents used by several submitter arguing against community water fluoridation.

The current wording this bill requires DHBs to consider the scientific evidence. That just invites opponents of community water fluoridation to inundate DHBs with the sort of submission this committee has received – and local councils have been inundated with. DHBs are no better equipped to deal with this than this committee or local councils.

I suggest a change requiring DHBs to take advice on the scientific evidence from central bodies – the Ministry of Health and the Public Health Advisory Committee. This would transfer responsibility for scientific considerations to central bodies better equipped to do that evaluation.

The Public Health Advisory Committee has a legislated role to consider questions like this and advise the Minister. It is also able to consult interested organisations, experts like the Royal Society and the Prime Minister’s Chief Scientific Advisor who performed the most recent fluoridation review. It can also consult appropriate individuals.

This would not remove the right of lay persons to make submissions about the science – it simply redirects those submissions to a more appropriate body.

I think a change like this should be welcomed by everybody. It removes from DHBs the impossible job of making decisions about the science they are not equipped to make. It provides a proper venue for the science to be considered intelligently and critically. It is a credible and authoritative body for scientific organisations, health organisations, activist groups and the ordinary person who has concerns on this issue – whether for or against community water fluoridation.

After all – if someone has a genuine concern or has evidence they think will stand up to scientific scrutiny why should they want to waste time submitting it to a committee of politicians? Wouldn’t they be far happier knowing they are appealing to people who have the skills to evaluate their concerns properly?

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Accidental Renaissance – or intuition?

Saw this photo on the Guardian – see Accidental Renaissance: the photos that look like Italian paintings. The author says:

“Currently doing the rounds on Twitter is the image below, taken from Facebook by artist James Harvey, whose tweet has been shared thousands of times. It depicts one of the fairly frequent brawls in Ukrainian parliament which, while undoubtedly ugly to fans of democracy and national stability, is beautiful on a purely aesthetic level.”

I can appreciate the good composition in the photo even without the description of it’s adherence to the Fibonacci spiral. But I am happy with the description if this sort of photo as a happy accident:

“A court photographer obviously didn’t have the kind of time Michelangelo did to compose his image, but its serendipity makes it even more magical. The hands that swarm in at the edges of the photograph give it a weirdly Renaissance quality too: in those paintings, hands do so much of the emotional heavy lifting – they supplicate, pray, and constantly reach for the divine.”

I think that composition comes naturally to an experienced and good photographer. They might not be consciously thinking about Fionacci spirals or the golden ratio but years of practice helps them recognise good composition and the “right moment” to push the shutter.

Let’s give the photographer some credit and attribute the results to intuition based on years of experience rather than a happy accident or serendipity.

Appealing to spirits

In last Monday’s New Zealand Herald John Armstrong ridiculed the “jiggery-pokery” which started the Greens conference on Saturday (Hello spirits … woops, goodbye National). He said: “Any party which begins its conference by lighting a candle so it can be guided by the “symbolic gesture of a flame” while “calling in the spirits” of Rod Donald, the Treaty, the sun, and just about everything else bar the kitchen sink would seem to be in fruitcake territory, as in nutty as.”

He suggests that such behaviour should send potential coalition partners into a rapid retreat: “..observing them invoke “the eternal golden thread” which apparently links past and present would have been enough to have National running in the opposite direction.”

I agree. While symbolic ceremonies are important that can appear ridiculous and nutty when they descend to empty appeals to the supernatural.

But why pick on the Greens? To me their ceremony appears to have much more meaning than the Christian prayer used to open New Zealand parliamentary sessions, and probably also used to open New Zealand National Party Conferences.

The Christian prayer is surely just an empty appeal to the supernatural. To many of us it appears “nutty.” And having appeal to only part of the community (possible a minority of the community) it is also divisive.

Franky, I would prefer the Green’s candle.

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