Tag Archives: SciBlogs

Leader of flawed fluoridation study gets money for another go

christine-till

Professor Christine Till has been given a $300,000 grant to test for harmful effects of fluoride.

Malin and Till (2015) published research indicating a relationship between fluoridation and Attention Deficit Hyperactivity Disorder (ADHD). However, that study was flawed because it omitted important confounders. When these are included the relationship disappears.

I analysed that study in my article ADHD linked to elevation not fluoridation where I showed the relationship of ADHD to elevation was much more important than fluoridation. Huber at al., (2015) published work confirming the relationship of ADHD with elevation. So, obviously, elevation is an important confounder and  Malin and Till (2015) did not consider it in their study.

My own analysis indicated that there were a number of other confounders which are related to ADHD – with correlations similar to (eg., educational attainment, proportion of the sate’s population older than 65  and Per Capita personal income) or better (mean state elevation, home ownership and % living in poverty ) than that for fluoridation. That rings alarm bells – why consider only one factor (fluoridation) if there are other factors which appear equally or more important? Isn’t that confirmation bias? (I concede that Malin and Till did include a socioeconomic measure in their statistical analysis – but this was clearly not enough).

I tested the relative importance of the different facts using multiple regression and – sure enough – found that once a few important confounders were included water fluoridation could not explain any of the variance in ADHD! The statistically significant factors were mean elevation, home ownership, and poverty. The contribution of fluoridation was not statistically significant in this multiple regression.

A model including mean state elevation, home ownership and poverty explains about 45% of the variance in ADHD – much better than fluoridation could (Malin and Till explained 27 -32% for the fluoridation data).

Now, I read that Professor Till has been given research finds to have another go and possible harmful effects of fluoride. (see York professor leads study that could help answer fluoride safety questions). She plans to look at data from a Canadian investigation of pregnant women exposed to  contaminants. She says:

“Our study employs a prospective design that includes biomarkers of exposure to fluoride, detailed assessment of potential confounders, a comparison group, and the use of sensitive cognitive and behavioural measures that have been collected in one of the world’s most comprehensively characterized national pregnancy cohorts (MIREC).”

Now, I am pleased she aspires to a “detailed assessment of potential confounders” but wonder how detailed this will be after the problems with the Malin and Till (2015) study.

I have not yet seen any published response to the Malin and Till paper – maybe the cost of publication (US$2020) that journal is discouraging critics. It certainly discouraged me (I do not have institutional support for publication costs). Nevertheless, I hope professor Till has been acquainted with some of the criticism of that paper so that she can pay more attention to important confounders in the coming work

We can draw a few lessons from this.

Be careful of published statistical relationships

These days it is so easy to hunt down data and do this sort of exploratory statistical searching for significant relationships. But a statistically significant relationship is not evidence of a real cause. For example, there is a strong relationship between the sales of organic produce and prevalence of autism – but I have yet to hear anyone seriously suggest the relationship is at all causal.

But the scientific literature is still full of such studies – and I guess the motivated author can easily find arguments and other data in the literature that they, at least, feel convincing enough to justify publication.

Refereeing of scientific papers is, on the whole, abysmal

All authors have a pretty good idea of which journals, and reviewers, will be friendlier to their work – and which would be antagonistic. It is only natural tosubmitt to the friendlier journal.

Unfortunately, the Malin and Till paper was submitted to a journal with editors known to be friendly to a chemical toxicity model of cognitive deficits. Further, it turns out that the reviewers chosen for the paper were also supportive of such an approach.

While one reviewer did suggest including lead as a possible confounder (again showing a chemical toxicity bias) none of them suggested consideration of other confounders more likely to be connected with ADHD.

I discussed the editorial and reviewer problems of the Malin and Till paper in . (The journal, Environmental Health, has a transparent peer-review process which provides access to the names and reports of the reviewers.)

Again – another example of readers beware – even readers of scientific papers in credible journals.

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Anti-fluoride claims often not relevant to New Zealand

xiang-Endemic fluorosis

Much of the anti-fluoridation propaganda used by activists relies on studies done in areas of endemic fluorosis. Slide from a presentation by Q. Xiang to an anti-fluoride meeting organised by Paul Connett’s Fluoride Action Network in 2014.

As we head towards the parliamentary consideration of new legislation on fluoridation in New Zealand the anti-fluoride groups are building a campaign to oppose the transfer of responsibilities from local councils to District Health Boards. So, their Facebook pages are promoting myths that fluoridation is dangerous to health – and we expect this to intensify as parliament moves into its Health Committee hearings on the bill.

Also expect that the local anti-fluoridation groups, and their backers, will bring out tame “experts” to make presentations to the parliamentary Health Committee and to public meetings.

Has Connett lost his effectiveness in New Zealand campaigns?

Maybe (once again) Paul Connett or Bill Hirzy who are paid propagandists from the US Fluoride Action Network. An activist group financed by the US “natural”/alternative health industry. But perhaps these two are “old hat.” Connett has been making regular visits to Australia and New Zealand during the Southern Hemisphere summers for some time now and the locals have got a bit tired of him. Bill Hirzy accompanied him on last years summer vacation and really didn’t contribute much to the campaign. Thames overwhelmingly supported fluoridation in their referendum last year (see Thames voters decisively support fluoridation) – despite the highly publicised opposition by Connett and Hirzy).

A possible new anti-fluoridation “expert?”

susheela

Poster for an anti-fluoride meeting in Region of Peel, Canada. Image credit: Reiki with Christine

Perhaps local activists recognise this because they are floating ideas of bringing out a new “expert” – Dr A. K. Susheela. She might also have more credibility than either Hirzy or Connett – because, unlike them, she has actually published scientific papers on fluoride. In fact, she is the executive director of India’s Fluorosis Research and Rural Development Foundation – a small non-government organisation based in Delhi. The purpose of the foundation is to encourage awareness of fluorosis in both medical and local Indian communities to curb the spread of this crippling skeletal disease in India.

Susheela has also been doing  the circuit of anti-fluoride campaign meetings in North America (see, for example, ‘Fluoride is a deadly poison’ Peel’s water fluoridation committee has heard). As the poster above indicates, she is being promoted as an expert on fluoride toxicity and fluorosis.  But please note – this does not make her an expert on community water fluoridation.  All her work has concentrated on areas of endemic fluorosis – where dietary intake of fluoride is much higher than in fluoridated areas of New Zealand.

In a 1999 article for UNICEF (Susheela, A. K., Mudgal, A. (1999). Fluoride in water : An overview. UNICEF WATERfront, (13), 11–13.) she admitted:

“According to 1984 guidelines published by the World Health Organization (WHO), fluoride is an effective agent for preventing dental caries if taken in ‘optimal’ amounts.”

She went on to described the WHO recommendations for fluoride in drinking water:

“Water is a major source of fluoride intake. The 1984 WHO guidelines suggested that in areas with a warm climate, the optimal fluoride concentration in drinking water should remain below 1 mg/litre (1ppm or part per million), while in cooler climates it could go up to 1.2 mg/litre. The differentiation derives from the fact that we perspire more in hot weather and consequently drink more water. The guideline value (permissible upper limit) for fluoride in drinking water was set at 1.5 mg/litre, considered a threshold where the benefit of resistance to tooth decay did not yet shade into a significant risk of dental fluorosis.”

For comparison, the target fluoride concentration for community fluoridation in New Zealand is about 0.7 – 1.0 mg/litre. The natural levels of fluoride in New Zealand’s drinking water are even lower. There is no significant risk of skeletal or dental fluorosis of concern due to CWF, or natural levels of fluoride,  in New Zealand.

Dr Susheela has no expertise in the area of community water fluoridation – or areas of the world where drinking water fluoride levels are similarly very low. Perhaps this is why she made the mistake of including Australia and New Zealand among countries where fluorosis is endemic in the above article which included the map below.

susheela-unicef

Dr Susheela is mistaken about fluoride in New Zealand and Australia. Map from her article 

Fluoride Freee NZ disingenuously used this mistake to claim that New Zealand suffered from endemic fluorosis – and cited UNICEF in support.  I would hope that Dr Susheeela, if she does come to New Zealand to campaign against the upcoming fluoridation bill, publicly admits and apologises for this  mistake.

Conclusion

We are used to anti-fluoride campaigners misrepresenting the scientific research on the efficacy and possible health effects of community water fluoridation. But we should also be wary of their claims derived from research in areas of endemic fluorosis where dietary intake of fluoride is much higher than in New Zealand. This includes studies on possible IQ effects and skeletal fluorosis.

The research may be respectable – but the findings are just not relevant to countries like New Zealand where the drinking water fluoride concentrations (in fluoridated and unfluoridated areas) is much lower.

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Flogging a dead horse – anti-fluoridationists lose in court again

flooging-horse-certificate

This certificate should be awarded to New Health NZ, the NZ Health Trust and the anti-fluoridation movement for not knowing when to give up on the “fluoridation is medicine” myth.

The NZ Court of Appeal has rejected the latest legal attempt by New Zealand anti-fluoridation campaigners to hinder community water fluoridation. You can read a summary of the ruling in the Court’s press release – New Health v South Taranaki District Council. The full Court of Appeal ruling can also be downloaded.

Of course, you might find it boring – it is full of legalese. The appeals (there were three and all were rejected) themselves were  about details – the definition of a medicine and the right of governments to make regulations. But readers might want to reflect on who took the legal action and who paid for it.

follow-the-money

New Health NZ took the High Court actions and appeals. It is an incorporated society set up in 2005 by the The New Zealand Health Trust. This Trust is the lobby group for the “natural”/alternative health industry in New Zealand and is financed by that industry. So, in effect, this legal action was taken by the alternative health industry – and paid for by this industry – which is big business.

We can get some idea of the costs involved from the financial statements of the NZ Health Trust (strangely registered as a charity) and New Health NZ (statements available on the society’s register). Unfortunately, the latest statements only provide information for the 2014 and 2015 financial years – but the legal action is several years old so you can get an idea of the money flows involved.

The NZ health Trust appears to receive grants in the hundreds of thousands per year from the alternative health industry($250,000 in 2014 and $190,000 in 2015). In its turn, it distributed “grants & donations” in the hundreds of thousands (125,000 in 2014 and $130,000 in 2015).

nz-health-trust

New Health NZ received grants of around $100,000 per year ($100,00 in 2014 and $95,000 in 2015). It paid out similar amounts in “Professional and Consultancy Fees” ($95,156 in 2014 and $95,124 in 2015).

new-health-nz

These amounts are of the order required for the legal actions taken by this group.

So here we see a money flow from the “natural”/alternative health industry, through the New Zealand Health Trust to New Health NZ to pay for legal attempts to halt community water fluoridation.

At least, this time, New Health NZ was ordered to pay costs – a sure sign that the court believes their legal actions no longer have any community value.

A sign that they should stop promoting their myth that community water fluoridation is a medicine – they should stop flogging that dead horse.

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Fluoridation & democracy: Open letter to DHB candidate Andrew Buckley

Community water fluoridation looks like becoming a hot topic in October’s elections to District Health Boards. Anti-fluoride candidates should stop preventing open discussion and critique of their unscientific claims.


Legislation transferring fluoridation consultation and decision-making tasks from councils to district health boards (DHBs) will probably be introduced into New Zealand’s parliament next year. Anti-fluoride activists are preparing for this by transferring their attention from councils to District Health Boards. In particular, they are standing candidates for elections to DHBs in October’s elections.

andrew-buckley

Andrew Buckley is standing for the Waikato District Health Board. He calls for open debate on the fluoridation issue but will not allow any critique of his claims in his web page discussion.

Andrew Buckley is a retired osteopath who is standing for the Waikato DHB. He is making community water fluoridation a central issue of his campaign and presented his views in a blog article – Fluoridation and democracy – and in a press release.

I welcome candidates who make their views clear on issues like this during their campaign where they can be discussed. But the problem with Andrew is that he does not seem to either want to discuss his claims or allow any discussion of them in the comments on his article. I contributed a comment which dealt with his claims point by point but he has not allowed it to appear – despite showing supportive comments from many of the usual anti-fluoride brigade.

This anti-democratic behaviour is ironic given that he was arguing for democracy and open debate on the issue. It is also deplorable that he prevent this open debate during an election campaign where he is making community water fluoridation a central issue.

As he won’t allow proper discussion on his web page I have put my comments into an open letter to Andrew. I, of course, offer him the right of reply here and welcome any contribution he can make to the discussion here.


Hi Andrew,

I welcome your declarations that you are “not pro- or anti-fluoridation as a matter of principle”  and decisions about community water fluoridation (CWF) “simply cannot and should not be made on the basis of hearsay and urban legend.”  However, the claims you make in this article (Fluoridation and democracy“) suggest you may have succumbed a few urban legends and been influenced by hearsay yourself.

Let’s consider some of your claims:

Hamilton City Council’s fluoridation fiasco

You claim the “Hamilton City Council councillors voted unanimously to stop” CWF – but that is just not true.

In June 2013 the council voted 7 to 1 (with several imposed abstentions) to stop CWF. There was public opposition to this decision as it ignored polling and a previous referendum result showing community support for fluoridation. A new referendum held along with the October 2013 local body elections again showed overwhelming public support for CWF and in March 2014 the council voted 9 to 1 in favour of reinstating CWF.

You claim the Hamilton City council “delivered a scathing commentary on the practice of fluoridation.” Could you identify that document and link to it? I am completely unaware of such a document despite having followed the issue closely at the time and having discussed the scientific basis of CWF with several councillors. My impression was that individual councillors were incapable of discussing the issue and, in fact, several councillors were very hostile towards science and scientists and very rude to correspondents as a result. I thought that highly disturbing for councillors in a city which houses several very reputable scientific institutions. But it seemed their stance, and emotive response, had more to do with pre-election political infighting than any appreciation of the science.

Are anti-fluoride claims validated?

You claim “validated claims of the multitude of opponents to water fluoridation [are] not refuted by sound supportive evidence in public debate.” Again not true.

Anti-fluoride activists like Paul Connett, Stan Litras, etc., often claim this but refuse to debate the issue themselves. I had one on-line debate with Paul Connett in 2013/2014 where (I believe) every claim he made was soundly refuted. You can find the record of that debate on my blog (Fluoride debate) or a pdf version of Fluoride Debate  from my publications on ResearchGate . This is quite substantial and covers most issues that are raised by opponents of CWF.

The claims made by opponents of CWF have not been scientifically validated and are often based on misinformation or distortions of the science. It is telling that since my debate with Paul Connett he has simply refused every opportunity I have offered him for a right of reply to my articles where I have critiqued his claims (see for example Misrepresenting fluoride science – an open letter to Paul Connett“). Similarly, Stan Litras has refused my offers of a right of reply in similar situations.

What about this “multitude?”

You are incorrect in using the word “multitude” as recent referenda have shown in New Zealand. This was confirmed in more detail by the NZ oral health survey as reported in this paper:

Whyman, R. A., Mahoney, E. K., & Børsting, T. (2015). Community water fluoridation: attitudes and opinions from the New Zealand Oral Health Survey. Australian and New Zealand Journal of Public Health.

I discussed date from this paper in my article Anti-fluoride propagandists get creative with statistics. The graph below summarises the data:

While support for CWF may not appear as massive as recent referenda results show (which don’t record the undecided), the fact that only about 10% of people are strongly opposed (and another 5% somewhat opposed) to CWF in the survey. This does suggest your use of the word “multitude” is an exaggeration.

The opponents of CWF may be very organised and vocal (a fact which has led councils to see the fluoridation issue as a poisoned chalice) but they basically represent the minority ideological and commercial interests of the alternative health industry – which in many cases funds their work and give avenues for their propaganda.

WHO data misrepresented

You claim “according to the World Health Organisation, [there is] an equal reduction of dental caries in countries throughout Europe, irrespective of whether there is water fluoridation or not” is just not true. You have blindly accepted a popular anti-fluoride urban legend.

In fact, the WHO data show different reductions of dental caries for different countries. The reductions are just not equal. Here is the graph that anti-fluoride activists often use to promote this urban legend:

Slide from Paul Connett’s 2016 New Zealand presentation

There is actually very little data for each country in this graphic (hence the predominance of straight lines). The bigger problem is that no sensible comparison can be made between countries without taking into account the multitude of factors which influence tooth decay and which vary from country to country and year to year. Surely that is obvious?The more sensible and scientifically accepted approach is to compare fluoridated and unfluoridated areas within countries. I discussed this in my article

The more sensible and scientifically accepted approach is to compare fluoridated and unfluoridated areas within countries. I discussed this in my article Misrepresenting fluoride science – an open letter to Paul Connett and illustrated it with the WHO data for Ireland where fluoridated and unfluoridated areas are compared:

People like Paul Connett and his followers promote this urban legend again and again – despite having been shown why it is wrong (for example in my debate with Connett). They are knowingly promoting a distortion of the facts.

CWF a “medicine?”

You ask “Why was fluoride removed from the medicines list . . ?” but CWF was never on a “medicines list” as you would be aware if you had read the High Court ruling in the case brought by the “natural”/alternative health industry lobby group New Health NZ against the South Taranaki District Council.

I refer to this in my article Corporate backers of anti-fluoride movement lose in NZ High Court but you could also read Justice Hansen’s  judgment. This was confirmed in Justice Collin’s ruling on the subsequent appeal (see Another legal defeat for NZ anti-fluoridation activists).

The concentrations of fluoride used in CWF are below that required for listing. As Justice Collins determined:

“when fluoride is added to domestic water supplies within the maximum allowable concentration of 1.5 mg/l the concentration of fluoride in domestic water supplies will be well below the concentration threshold required for fluoride to be a medicine in Schedule 1 of the Regulations.”

and

“ . . fluoride would be a medicine under the Act if it was added to domestic water supplies in concentrations of 10 mg/l or more.”

The only change to regulations was to introduce a clause clarifying that when chemicals like sodium fluoride, fluorosilicic acid or sodium fluorosilicate are used for CWF they are not considered a medicine. A clarification, not a change.

Why transfer decision and consultation on CWF to DHBs?

You ask why the Minister of health has “decided to take the decision away from local authorities and give it to DHBs to decide?”

As you are a candidate for election to a  DHB you have a responsibility to consult the official documents outlining reasons for the proposed changes. I suggest you read Proposed legislative changes: decision-making on the fluoridation of drinking-water supplies,  Transferring decision-making on the fluoridation of drinking-water from local authorities to district health boards the cabinet paper Decision-making on the fluoridation of drinking-water supplies).

I also suggest you refer to discussions at the Local Government NZ conferences and individual council statements requesting that central government take responsibility for CWF decisions and consultations away from councils. As they have often argued, they do not have the expertise to consider the science involved and feel that they are unfairly exposed to a highly organised minority of ideologically and commercially motivated activists.

Questions for you, Andrew

Do you think a body like the elected DHB or local body councils are the appropriate place to make decisions about the science of health issues like CWF? After all, they do not have the expertise and surely such scientific decisions are not made by the board on other health issues relevant to all the procedures carried out in a hospital. Don’t you think that DHBs and Councils should instead rely on the best up-to-date reviews of the science by a body like the Royal Society of NZ?For example:

For example:

Eason, C., & Elwood, JM. Seymour, Thomson, WM. Wilson, N. Prendergast, K. (2014). Health effects of water fluoridation : A review of the scientific evidence.

Surely the task for board member on this issue is to receive such up-to-date reviews, together with data from staff on the oral health issues in the area and the feasibility and likely efficacy of CWF. On top of that, they should take into account the balanced views of the community – using polls or referenda. This should then allow them to make an informed decision about any proposal for or against CWF in their region.

Getting bogged down with the activist claims and counter claims and their propaganda based on misinformation and distortions of the science (as happened initially with the Hamilton City Council) is certainly not a responsible approach.

Andrew, you criticised the democratic processes of the DHB for which you are standing. I cannot judge if your complaints are sincere as I have not see the full picture. But I certainly support your conclusion about this issue:

“I believe we must follow democratic process and proper debate.”

So, why have you denied the democratic process with your blog article Fluoridation and democracy? You did not allow my comment, which covered the areas above, while at the same time allowing comments from known anti-fluoride activists slavishly praising you for your article?

Does this illustrate the sort of rejection of open and democratic discussion you will follow if you are elected?

I believe voters have a right to know how you have purposely acted to prevent open discussion while hypocritically calling for it.

Surely that is a reason not to vote for you in the October elections?

Finally, Andrew, I offer you a right of reply to my open letter. I am willing to post a reply for you here. After all, I do support open discussion of the CWF issue and, particularly, I am keen that these “urban legends” and “hearsay” be properly debunked and their promoters exposed.

I look forward to a fruitful good-faith discussion.

Kind regards,

Ken Perrott

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Dissecting pseudoscientific and political propaganda

Tactics used in anti-science and pseudoscience propaganda are essentially the same as used in political propaganda.

Everyone has their own ideological and political starting points – and none of us are really rational, even when we think we are. So we shouldn’t be surprised to find we are fully  in agreement with some people on one issue but on the opposite sides of the fence with the same people on other issues.

I often find this  in my on-line discussions . Some of my “allies” in the fight against pseudoscience (for example, in debunking anti-fluoride propagandists) will become my “opponents” when I discuss issues like the war in Syria. (I use quote marks because I do not feel any enmity towards discussion partners when the discussion is civil).

Nevertheless, I do not consciously separate my approaches to science and politics (and I guess my discussion partners would make the same claim). People can often be more resistant to anti-science propaganda because claims can be tested against reality. This is sometimes harder to do with political issues but if we don’t try we can be fooled by political propaganda. So, a recent article –  Dissecting the Propaganda on Syria – appealed to me as I immediately recognised that the tactics used by propagandists against the Syrian government are essentially the same as those tactics used by anti-fluoridation propagandists.

The article identifies three propaganda tactics:

1: Demonise the enemy

Those pushing pseudoscience do this continually. Scientists are claimed to be only in it for the money. How often do we hear the chant “follow the money” (and how hypocritical is this considering many of these propagandists are making money out of the “natural”/alternative health industry.

paul-connett

Anti-fluoride campaigner Paul Connett regularly charges NZ scientists with fraud – but he fraudulently distorts the evidence to do so.

Honest scientists are accused of fraud and researchers whose work contradicts the propaganda are personally attacked.

On Syria, we continually hear about the Syrian “regime” and its “brutal dictator” – despite the fact that the Syrian government and president have been elected. Words like “regime” instead of “government” are a way of demonising.

Responsibility for all the deaths in this war is often attributed solely to President Bashar al-Assad. This is absurd as these deaths also include those fighting on the government’s side. As the article says:

This propaganda “deems Assad responsible for everything, including the killing of Syrian soldiers by the armed opposition. This opposition, which is financed and armed by Saudi Arabia, Qatar, Turkey and the U.S., includes extreme jihadist groups, including Al Qaeda’s longtime affiliate and the Islamic State. Yet, none of the leaders supplying these rebels – in defiance of international law – bears any blame for the death and devastation of Syria, according to” the propaganda.”

This demonisation of Assad is part of the interventionist strategy of “regime change.” We saw it before in Iraq and Libya. Liberal intervention to correct a wayward government appeals to many, and fools even more. After all, it is easy to find fault with the governments and leaders in these countries. But those who want regime change in Syria do everything to protect the regimes and leaders of other countries, like Saudi Arabia, with far greater violations of human rights. And the “regime change” doctrine violates the fundamental rights of people to decide their own government and leaders.

nazi-fluoride-myth

What better way to demonise advocates of community water fluoridation than to compare them to Hitler?

In a parallel way those anti-fluoride propagandists who demonise honest scientists can easily be found to be guilty of the very charges they lay against others. Aren’t these propagandists often paid shills for big business – the “natural”/alternative health industry? And don’t they frequently misrepresent and distort the science? Are they not the ones who should be charged with fraud?

2: Romanticise the opposition

Anti-fluoride propagandists continually describe themselves as fighters for truth who have “done their research.” They are fighting for natural, pure, food and water and against the wicked big business “fluoride industry” which is disposing their contaminated waste by dumping it in our water supply. And how often do we get the David vs Goliath analogy – even when it is the anti-fluoride activists who have dominated submissions to local bodies?

On Syria, our mainstream media

“portrays the conflict as a “civil war” which began with peaceful democracy-loving Syrian revolutionaries who were ruthlessly repressed by a brutal regime.

In reality, there was a violent faction from the start. In the first protests in Deraa, seven police were killed. Two weeks later there was a massacre of 60 security forces in Deraa.

In Homs, an eyewitness recounted the situation: “From the start, the protest movements were not purely peaceful. From the start I saw armed demonstrators marching along in the protests, who began to shoot at the police first. Very often the violence of the security forces has been a reaction to the brutal violence of the armed rebels.”

In the first two months, hundreds of police and security forces were killed. Yet, . . . the West’s mainstream media, ignores this reality because it clashes with the desired image of white-hatted protesters being victimized by a black-hatted government.”

baath-party

Violence against the Syrian government occurred even during the early demonstrations.

This romanticisation is hardly suprising when we realise that most of our information on the Syrian war is coming from rebel or terrorist sources – or sources sympathetic to antigovernment fighters. Al Jazeera has reporters embedded in  “rebel”/”terrorist” militia forces. And so often our news reports cite “activists” or sources like the Aleppo Media Center, White Helmets, or the Syrian Observatory for Human Rights which are sympathetic to the rebels.

Similarly, anti-fluoride propagandists very often cite sources from their own anti-science side. Their hope is that their reliance on sources such as “NaturalNews”, The Health Ranger, the Fluoride Action Network and Mercola, and continuous promotion of articles from those sources, can be translated into a similar acceptance by our mainstream media.

3: Attack anyone who questions the dogma

Many health professionals who recognise community water fluoridation as a safe and effective social health measure refuse to speak up in its defence because this can lead to personal attacks. A dentist who recently took issue with the misinformation being promoted by an anti-fluoride group was told in an anonymous personal letter:

“How dare you try to shut the truth down, people like you are a total insult to the art of Dentistry.”

And that is a mild example. How often are people who attempt to inject some logic and fact into this argument accused of being “shills?” Or attacked in a memes on social media – almost always from behind a wall where they are banned from participating in the discussion or answering their critics.

Similarly, those who attempt to debate the “party line” on Syria are often accused of being “Asad supporters” or worse. I was recently described as being a “fanatical follower of the Soviet camp” when I attempted to argue that there are child casualties in the government-held west Aleppo as well as in the “rebel”terrorist” held east Aleppo. (Some readers may object to my use of the word “terrorist” in this context – but the fact is the anti-government “Army of Conquest” which unites all the “rebels forces” in the current battle for Aleppo is led by Al Nusra – officially recognised as a terrorist organisation by the Russian Federation, USA and the United Nations).

Such attacks are simply a way of shutting down honest discussion of this conflict. A way of preventing information undesired by our political leaders from getting through the propaganda we are exposed to. Such attacks are really just a neo-McCarthyist tool in the information war.

Anti-fluoride propagandists and their allies in the “natural”/alternative health industry use exactly the same tactic. By attacking and labelling honest scientists and others who attempt to debunk the pseudoscience propaganda they hope to intimidate people and raise doubts about the science. We have seen this before from climate change deniers and creationists. They also use such attacks to raise doubts about the science of evolution and the findings of climate scientists.

Conclusions

This article quotes a leader of the US Veterans of Peace:

The U.S. peace movement has been demobilized by disinformation on Syria.”

I think he is correct. The tactics of demonising the Syrian government and president, of romanticising the “rebels” by selective reporting of history and current events, and of attacking anyone who speaks out against such propaganda, has been very effective in muting opposition to this war and encouraging “regime change.”

While the same tactics being used by the anti-fluoride and similar pseudoscientific or anti-science movements has been less effective for the population at large it still resonates with many.

Such propaganda tactics need to be resisted.

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An anti-fluoride trick: Impressing the naive with citations

One way to make an article look impressive is to use citations – the more you use, the more impressive. Well, so some people think.

citations

Some of the over 140 references in Geoff Pain’s article. These references impress some people but are irrelevant to Pain’s arguments.

Again and again I find anti-fluoridation campaigners refer to the number of references in an article or book as a sign of scientific credibility. Paul Connett often promotes his anti-fluoride book by referring to its 80 pages of references. And in a recent on-line discussion where I criticised an article by the anti-fluoride campaigner Geoff Pain I was told that it contained over 140 references, as if that was the end of the story – his article must be valid!

Pain’s article is Fluoride causes heart disease, stroke and sudden death.” It’s one of series of propagandist articles which he has placed on the Researchgate we site. That website also impresses the anti-fluoride people as they think it gives the articles the scientific credibility of publication in a scientific journal. But anyone can belong to Researchgate and upload their articles. There is no peer review or any other form of quality control.

Geoff Pain has uploaded a screed of anti-fluoride propagandist articles with titles like :

  • Fluoridation Causes Cancer, so does the Fluoride content of Tea
  • Fluoride causes Death and Disease
  • Toxicity of Fluoride
  • What do you know about Fluoride?/
  • Impact of Fluoride on Women, the Unborn and Your Children
  • Fluoride is a bio-accumulative, endocrine disrupting, neurotoxic carcinogen – not a nutrient
  • Plumbosolvency exacerbated by Water Fluoridation
  • Fluoride Causes Diabetes
  • NHMRC = Politics, Not Science. Australians – Victims of Tragic Fluoridation Experiments
  • Fluoride doped hydroxyapatite in soft tissues and cancer. A literature review.

So you get the idea. With titles like this you will not be surprised to find his Twitter tag is @FluoridePoison. Although he describes some of these articles as “conference papers” they are, of course, talks given to anti-fluoride meetings. He describes the other articles as “technical reports.”

He is a consultant with a science degree and claims to specialise in analytical chemistry. But there is no credible science in his “technical reports” and “conference papers” on fluoride.

Literature trawling

Pain uses the technique of literature trawling that Declan Waugh has made famous in his anti-fluoride articles. This involves searching the scientific literature for any reference to fluoride and possible toxic effects. A technique which produces mostly irrelevant articles – but so what. They just bung the citations into their articles and make unjustified claims. They rely on their readers never to check the references anyway The committed anti-fluoridation person is only impressed by the number of references  – not their relevance.

No-one has the time or interest to completely debunk such articles by going through every single claim and checking every single citation. Nor are such articles worthy of such attention.

So let’s settle for a “partial debunking.” Here I will just take a single central claim in Pain’s article linked to above and check the relevance of his supporting citations. This should be sufficient to show how he misuses citations and misrepresents the science. Readers can draw their own conclusions about the rest of this article and about his other articles.

The claim

He claims a literature search shows “numerous examples of evidence relevant to cardiovascular damage by Fluoride” and cites “[Houtman 1996, Tyagi 1996, Artru 1997, Johnson 1998, Maheswaran 1999, Jehle
2000, Kousa 2004, Bogatchera 2006 and references therein].” So let’s see how relevant those citations are and if they actually support his claim.

Let’s see how relevant those citations are and if they actually support his claim.

Houtman 1996 reported:

” In general, the elements selenium, copper, zinc, chromium, and manganese seem to counteract the development of cardiovascular diseases, whereas cadmium and may be lead seem to stimulate it. Effects of arsenic, silicon and fluorine are unclear and for cobalt absent.”

So no evidence of fluoride causing cardiovascular damage there.

PMSF

The organic phenyl methyl sulfonyl fluoride does not contain fluoride.

Tyagi et al., 1996 (Post-transcriptional Regulation of Extracellular Matrix Metalloproteinase in Human Heart End-stage Failure Secondary to Ischemic Cardiomyopathy“) used the metal chelators  phenanthroline and phenyl methyl sulfonyl fluoride in laboratory identification of bands identified in immunoblot analysis of proteinases extracted from heart tissue. This has absolutely nothing to do with fluoridation or the fluoride anion. Phenyl methyl sulfonyl fluoride is an organic compound and does not contain the fluoride anion.

 

Artru et al 1997 investigated use of anaesthetics sevoflurane and isoflurane and their effect on intracranial pressure, middle cerebral artery flow velocity, and plasma inorganic fluoride concentrations in neurosurgical patients. There was no investigation of cardiovascular damage. The plasma fluoride was derived from breakdown of the anaesthetics – there was no fluoridation involved.

4 ami

4-amidinophenylmethanesulfonyl fluoride

Johnson et al., 1998 does deal with heart-related matters – atherosclerosis, infarction and stroke. But there is no mention of fluoride or fluoridation. Pain has picked up this article in his literature trawling purely because the study used the protease inhibitor 4-amidinophenylmethanesulfonyl fluoride as a reagent. Again, this is an organic chemical – it does not contain the inorganic fluoride species. The study has no relevance to fluoridation.

Maheswaran 1999 (“Magnesium in drinking water supplies and mortality from acute myocardial infarction in north west England“) investigated the relationship between magnesium and cardiovascular problems and found none. Yes, fluoride and other ions were considered as possible confounders but the paper specifically states:

“Calcium and fluoride appeared to have no significant association with mortality from acute myocardial infarction.”

So Pain’s literature trawling has found  a paper mentioning fluoride and cardiovascular problems but it does not support his claim they are related.

Jehle 2000 did research the human coronary artery but again it was produced by Pain’;s literature trawling simply because the investigation used the protease inhibitor reagent phenylmethylsulfonyl fluoride (see comments on Tyagi 1996). Nothing here to do with fluoridation or the inorganic fluoride species used in community water fluoridation.

Kousa 2004 (“Geochemistry of ground water and the incidence of acute myocardial infarction in Finland“) obviously is related to cardiovascular problems and, yes, fluoride was one of the chemical species in water considered. But what do the authors say:

“Fluoride concentrations of around one mg/l in household water may be beneficial . . . In this study one mg/l increment in the fluoride concentration in the drinking water was associated with a 3% decrease in the risk of AMI [acute myocardial infarction ]. “

And they concluded that their findings suggested fluoride played a protective role.

So a success for Pain’s literature trawling – a reported relation between fluoride and cardiovascular problems – but the opposite to what Pain claim. And he didn’t bother mentioning  this, did he? How honest is that?

Bogatchera 2006 does not seem to relate at all to cardiovascular issues, but sodium fluoride was used to stimulate bovine cells. The concentration of sodium fluoride used was 20mM – equivalent to 380 ppm fluoride. Well above concentrations found in drinking water and the recommended optimum level of 0.7 ppm. Not at all relevant to community water fluoridation and it simply does not support Pain’s claim.

Well, that’s enough. I am not going to search Pain’s “references therin.” Nor will I bother with any of his other claims or cited references. I think you get the picture.

Conclusions

Geoff Pain

Anti-fluoride campaigners always promote people like Paul Connett and Pain as “renowned” or “world experts.” They aren’t

People like Geoff Pain promote themselves as “renowned” experts on community water fluoridation – but they simply aren’t. Surely the dishonest way Pain has used citations in the article considered here illustrates this. And we can be sure that he has approached his other fluoride articles in the same way.

So there is a warning. Just don’t be impressed by large numbers of references. Check them out – or at least check some of them out. If you find the references you check do not support the claims being made, or are maybe even completely unrelated to the claims, then draw the obvious conclusions.

NOTE: I am contacting Geoff pain to offer him the right of reply here and a chance to enter into any discussion.

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Does community water fluoridation reduce diabetes prevalence?

diabetes

Maybe community water fluoridation reduces the prevalence of diabetes?

You will be seeing headlines claiming a link between community water fluoridation (CWF) and diabetes. Or even that fluoridation can predict an increase in the prevalence of diabetes. But they are misleading

These articles report results from a recently published study indicating that in the majority of situations CWF is linked to a decrease in diabetes prevalence. But many of these articles, and especially those from anti-fluoride activists are making opposite claims.

Why the confusion? Well, the study used modelling to relate a number of factors to the prevalence of diabetes. According to the model’s prediction CWF using fluorosilicic acid and sodium fluorosilicate is related to a decrease in diabetes prevalence. However, the saving clause for anti-fluoride activists is that the model predicts an increase in diabetes prevalence when the least common fluoridation chemical, sodium fluoride, is used.

A 1992 survey found that only 9% of the US population received water fluoridated with sodium fluoride – compared with 63% for fluorosilicic acid and 28% for sodium fluorosilicate. I got the latest figures from a fluoridation engineer at the US Center for Disease Control. The current figures are 75% for fluorosilicic acid, 13% for sodium fluorosilicate and 7% for sodium fluoride.

In New Zealand only on water treatment plant for a small community uses sodium fluoride.

So this subheading by the Fluoride Action Network (FAN) is completely  misleading – “Regression analyses suggest association between increases in consumption of fluoridated water and type 2 diabetes.” The only way anti-fluoride propagandists can make mileage out of this study is by deliberately ignoring the results indicated for over 90% of the population!

Perhaps supporters of CWF should be the ones reporting and promoting this study – arguing that CWF could reduce diabetes prevalence! However, I would not push that idea on the basis of a single report. This study has a number of deficiencies – and recommendations should not be based on individual cherry-picked studies anyway.

This is the paper reporting the study:

Fluegge, K. (2016). Community water fluoridation predicts increase in age-adjusted incidence and prevalence of diabetes in 22 states from 2005 and 2010. Journal of Water and Health.

Here are some of the problems I see with it.

Insufficient consideration of confounders

It is a modelling study looking for correlations between selected parameters. Such studies often suffer from little or no consideration of important confounders. Statistically significant correlations can disappear when such confounders are later included. For example, consider my criticism of the Malin and Till (2015) ADHD study – see ADHD linked to elevation not fluoridation and ADHD link to fluoridation claim undermined again.

Fluegge included obesity prevalence and leisure time physical inactivity as confounders but more could have been considered.  One that sticks out like a sore thumb to me is the community size. It could be that the sodium fluoride data he used could be acting as a proxy for community size as these days sodium fluoride is usually only considered for small water treatment plants.

Adjustment of fluoride exposure data

Fluegge compared his model prediction for diabetes prevalence using two different measurements of fluoride exposure – drinking water fluoride concentration (ppm) and an adjusted estimate of fluoride intake (mg/day). His estimation was made from per capita domestic water deliveries per county. I find this questionable as the proportion of water consumed will vary by location where there are different requirements for things like lawn and garden watering, car washing, swimming pools etc.

Whereas the drinking water fluoride concentration showed a negative correlation with diabetes prevalence (the prevalence decreased with increasing fluoride concentration), the adjusted exposure values showed a positive correlation (the prevalence increased with increasing fluoride concentration). He declared the second correlation more “robust” but his reasons seem more related to confirmation bias than any proper analysis.

Confused discussion

Fluegge seems completely unaware that sodium fluoride is now only rarely used as a fluoridating chemical. He even suggests a possible policy outcome of his research could be switching from sodium fluoride to fluorosilicic acid!

He refers to Hirzy et al. (2013) claiming it showed cost savings from using sodium fluoride but critiques Hirzy for not including consideration of effects on diabetes prevalence. He seems completely unaware that Hirzy’s paper was discredited and he had to withdraw its claims about cost savings.

This suggests to me that Fluegge is not familiar with fluoridation research. In fact, his very brief publication history indicates his interest is more associated with cherry-picking various health measures to find fault with by using statistics and modelling.

How reliable is the modelling?

I have drawn attention to possible problems with poor selection of confounders and lack of familiarity with the fluoridation literature. But there may also be problems with the modelling methods used.

I do not have the modelling skills or time to delve into his model in any depth but note there has been some controversy about another modelling paper he was involved in.

He co-authored a paper with his brother claiming a link between glyphosate and ADHD. This created some controversy because it was rejected by the journal and then published by mistake. So the journal had to retract the paper. You can read about it at Retraction Watch – A mess: PLOS mistakenly publishes rejected ADHD-herbicide paper, retracts it.

The paper was rejected because it did not satisfy the standards of experimental and statistical analysis required, or describe these in enough detail. Also because the conclusions were not presented in an proper way or supported by the data.

OK, we should not discredit future work because an earlier paper was rejected, even for the given reasons. Authors can learn from their mistakes. But it does ring warning bells. With this history, I would prefer a deeper critique of the methods used and the reliability of his conclusions.

These questions just underline my warning that one should never base policies, or final interpretations, on single papers – especially cherry-picked ones. Conclusions should be based on a more complete reading of the scientific literature.

Conclusions

So, always take headlines with a grain of salt. In this case they will be completely misleading – especially if promoted by anti-fluoride activists.

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“Filtering” out fluoride

filter TWBTFLPB1

Systems for removing fluoide from tap water can cost less than $300

Many anti-fluoride campaigners and their sympathisers use “filters” to remove fluoride from their tap water. Despite this, they will often claim the procedure is “too expensive” for the ordinary person – or that it is ineffective.

Fluoride Free Nelson (FFN) combined both reasons in this exchange on their Facebook page.

fluoride size

But she is wrong on both counts. Suitable water filters can be relatively cheap (just do an on-line search  to check this out) and they just do not work by filtering out particles. The argument that fluoride “is so small most filters do not remove it at all” is naive. FFN does not understand how these systems work and her advice is completely unreliable.

Firstly, The word “filter” is commonly used but is technically not correct for “filters” that remove fluoride. Filtration is usually understood to involve removing particulate matter, and not soluble ions. The actual mechanism of fluoride removal is not by filtration of particles.

Yes, some “filters” do not work with fluoride – because they are not intended to. Activated charcoal is great for removing organic matter and tastes – but is not mean to remove anions like fluoride.

Apart from distillation, there are three ways for the ordinary consumer to remove fluoride and similar anions from tap water – anion exchange, surface adsorption and reverse osmosis. Here is a brief description of each method but readers can also refer to a useful local report:

National Fluoride Information Service (2012). Household water treatment systems for fluoride removal.

Anion exchange

This involves attraction of negatively charged anions like fluoride by positively charged surfaces. Water is passed through a bed of anion exchange material which has positive charges on its surface balanced by negatively charged anions like chloride (Cl) or hydroxide (OH).

Anion exchanger

Anion exchange particle. Positive surface charges are balanced by negatively charged ions.

Anions like fluoride in the tap water replace the existing charge-balancing anions on the exchanger. For example:

Exchange

Fluoride anion in tap water replace chloride anions on the surface of the anion exchanger.

Of course, these anion exchange cartridges eventually become saturated with fluoride or other anions being removed, and their efficiency drops. They are then replaced or recharged by flushing with the proper salt solution.

Surface adsorption

Interaction of fluoride anions and anion exchangers is basically a physical electrostatic one. But some filters rely on a chemical interaction where the fluoride anion reacts with the surface to form a chemical bond. Absorbents like bone char and alumina are common.

Bone char is made from cow bones and is a high surface area, porous calcium phosphate (apatite) providing active calcium for reaction with fluoride. Alumina provides a surface containing active aluminium which reacts with fluoride.

The chemical reactions occurring at the surface of these materials are of the form:

surface reaction

 

alumina F

Schematic of a water filter using alumina. Source: National Fluoridation Information Service.

The efficiency of both the anion exchange and surface adsorption methods can be improved by the way the filter is set up, the use of pre-filters, etc. And by regular recharging or replacement of cartridges.

Reverse osmosis

This relies on the ability of certain semi-permeable membranes to allow transport of water molecules but not ions like fluoride. So much for the naive concept that fluoride anions are too small to be filtered out of water.

It gets its name from the phenomena of osmosis which is probably familiar to most school children. Remember the experiment where pure water would pass through a membrane into a solution of sugar or salt – but water from the sugar or salt solution could not pass through into the pure water.

reverse osmosis 1

A semi-permeable membrane is a membrane that only allows through molecules of a certain size or smaller. The cell membranes of plants and animals are semi-permeable membranes, they let water molecules pass through while keeping out salts. Image credit: Solar-Powered Desalination Plants.

That creates an osmotic pressure. Reverse osmosis involves applying pressure to the sugar or salt solution (or whatever solution needs purifying). This causes pure water to flow through the membrane and the contaminants to stay behind providing a way of removing ions and molecules from the original water.

This schematic animation shows how reverse osmosis works in practice – although the membranes are rolled into cylinders to provide a greater surface area and increased efficiency.

reverse-osmosis-info-anim

Image credit: Reverse Osmosis Works

Consumers can use either of these methods to remove fluoride from tap water if they choose. While the equipment varies in price and sophistication, like any household appliance, relatively cheap systems are available.

These do work – just beware of claims made about low efficiency as often measurements are made with inappropriate “filters” like activated charcoal, or on systems that have been used for a time and need recharging.

That “freedom of choice” we keep hearing about is available and it is relatively cheap.

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Ethics and the doping scandal – a response to Guest Work

Rodchenkov

Grigory Rodchenkov, Russia’s sacked anti-doping lab director. Considered a criminal in Russia and a “whistle blower” in USA. Credit: Emily Berl for The New York Times

International Olympic Committee (IOC) decisions about participation of athletes from the Russian Federation in the Rio Olympics have brought both criticism and support – from the political as well as the sporting communities.

The issues of sports doping, the responsibilities and actions of sporting bodies and the political context and factors all need discussing. So I am pleased to see a Guest Work blog post at SciBlogs from Ian Culpan discussing the ethical questions involved (see Ethics, Doping the Olympics and Russia).

But I think the article missed important ethical considerations and I do not think the issue can properly be discussed without these. To me the following ethical and legal principles, which Ian did not discuss, are central:

  1. Proper testing of claims and evidence;
  2. Presumption of innocence until proven guilty;
  3. Inadmissibility of collective punishment
  4. Avoiding direct or implied political direction in decision-making.

A brief background

The Russian Federation does have a problem with sports doping. It should be in everyone’s interests for this to be dealt with. Interestingly, the Russian national officials and politicians do appear to be cooperating with international sports bodies. They have transferred testing of athletes to non-Russian laboratories. Officials (including the deputy Minister of Sport) implicated by Richard McLaren’s World Anti-Doping Authority (WADA) commissioned report have been suspended pending investigation. The President himself has urged officials not to react defensively but to deal with the problem.

Grigory Rodchenkov, the former head of Moscow’s anti-doping laboratory, was a key figure in the current scandal. He was taking bribes to supply illegal drugs to athletes and (apparently) to enable falsification of test results. When he was sacked and criminal proceeding taken against him he fled to the US. Now treated as a “whistle blower” instead of a criminal he made charges implicating higher officials in the doping scandal. His claims made in a May New York Times article (see Russian Doctor Explains How He Helped Beat Doping Tests at the Sochi Olympics) sparked the decision of the WADA to commission the McLaren report.

Richard McLaren’s report effectively supports Rodchenkov’s claims and found Rodchenkov to be trustworthy. But this appears to be McLaren’s opinion, rather than a conclusion based on testing of claims and evidence. There was no attempt to interview officials in the Russian Federation which is surely required for a proper evaluation. And results of the “forensic testing” commissioned by McLaren (DNA data and testing the methods for removing and replacing seals on sample vials and scratches on the vials) are not even included in the report. We are asked simply to accept his judgment on these.

I agree, the time limit of 57 days may well be to blame but in the absence of presentation of the forensic evidence, relying on the claims of an obvious criminal and lack of any consideration of evidence from Russian officials I think Culpan’s judgment the report “seems to contain irrefutable evidence” is just not valid. To interpret a situation where there had been no opportunity given to refute as meaning the evidence was “irrefutable” is hardly fair. Or ethical.

The reliability of the McLaren report and the information he gathered appears to be unravelling – according to articles in The Australian (unfortunately behind a pay wall but see WADA ‘sexed up’ anti-Russia case, implicated clean athletes – Australian media, citing officials). These claim the president of the Australian Olympic Committee, John Coates, who is also an IOC vice president, wrote to Australia’s Health Minister Susan Ley, saying that the IOC had a “lack of confidence in WADA.” There are also problems with the list of “implicated” Russian athletes not named in McLaren’s report but provided to the sporting federations by McLaren. The Australian cites a senior sports official as saying “We were asked to make a judgment about Russian competitors based on McLaren’s report but without having any of the detail to understand the significance of them being named.”

For Richard McLaren’s description and defence of his work see ‘No time to ask Russia’s opinion, I had enough evidence anyway’ – WADA doping report author to RT

Unwarranted judgments are easily made in the context of the current geopolitical struggle and the resulting information war. They can have consequences which are hardly ethical and I think Richard McLaren himself is concerned about this. He said recently:

“The focus has been completely lost and the discussion is not about the Russian labs and Sochi Olympic Games, which was under the direction of the IOC.”

“But what is going on is a hunt for people supposed to be doping but that was never part of my work, although it is starting to (become) so.’’

“My reporting on the state-based system has turned into a pursuit of individual athletes.’’

This treatment of individual Russian athletes, which was described as being like a “Stalinist witch hunt” by one commentator, is what concerns me. I think this raises ethical issues.

Presumption of innocence

This seems so fundamental to our legal (and ethical) system I just cannot see why critics of the IOC have been so prepared to ignore it – or worse, knowingly violate the principle.

Many Russian athletes who have never had a positive drug test have been denied the opportunity to participate in the Rio Olympics. The criteria applied to other Russian athletes has been much harsher than for other nations with sometimes impossible demands being made to prove a long history of clean test results. While athletes from other nations who have been found guilty in the past of doping and “served their time” in suspension are able to compete this is not the case for Russian athletes.

These clean athletes justifiably ask “Why me?” Russian sports fans may well be thoroughly disappointed by this scandal and particularly with athletes and officials who have found to be guilty of doping. But you can understand they are also angry at the unfairness of such discriminatory and unethical judgments made against their clean athletes.

Collective punishment

Punishing clean athletes for the crimes of those who used doping is simply collective punishment. It brings to mind the actions of Nazi occupiers in Eastern Europe who killed innocent villagers (or in some cases killed entire villages) as collective punishment for the actions of partisans. For the life of me, I cannot see how those critics who believe that the entire Russian Olympic Team should have been punished for the (as yet unproven) crimes of some officials consider they occupy the “moral high ground” as Culpan appears to argue.

Not that collective punishment is anything new when it comes the history of staging important international events by the Russian Federation (and the previous USSR). In the 1980s we saw boycotts of the Moscow and San Francisco Olympics. Attempts at collective punishment of entire nations because of disagreements in the international political arena.

There were attempts to inject political issues into the Sochi Olympics, and even promoting the idea of boycotts,  and who seriously doubts that there will be political attempts to harm, or even prevent, the 2018 World Football Cup in the Russian Federation.

Yet, international sporting and cultural events offer great opportunities to encourage goodwill and understanding between nations. They should not be used as weapons in the geopolitical struggle – because that, in turn, only enhances that struggle and harms peace.

Political motivations can prevent a solution

Fortunately, the IOC avoided a blanket ban on athletes from the Russian Federation, despite coming under political pressure to do so. The consequences of such an unprecedented and radical step may have been unpredictable but include a possible break-up of the Olympic movement. This would not have solved the sports doping problem.

As things stand there is now room for progress in a proper investigation of the charges made by Rodchenkov – particularly those suggesting the involvement of state officials. Such serious charges, made by someone facing criminal action, should not be left as they are without a proper balanced investigation. And this investigation must involve officials and legal bodies from the Russian Federation. It is hardly surprising that McLaren’s report is now being described as unfinished. The Australian articles reported IOC spokesman Mark Adams as saying:

“To have someone who didn’t (commit) a competition doping offence but was counted as such is a very dangerous thing. We encourage a full report by Professor McLaren before we make any full and frank ­decisions.’’”

Surely such a proper investigation will have more chance of eliminating Russian sports doping and corruption than external allegations primarily based on claims made by someone fleeing criminal proceedings.

Finally, we should not allow the current concentration on Russian sports doping to fool us into thinking it is only, or even primarily, a Russian problem. The fact is that sports doping is world-wide and there is plenty of evidence that international sporting bodies themselves are not free from corruption.

I presented the most recent official data from WADA n my article Quantifying the problem of international sports doping. This showed that the proportion of positive doping tests for Russian athletes was just less than average for the whole world. More importantly, there are a number of nations with a higher proportion of positive doping tests than the Russian Federation – including India, France, Belgium, Mexico and Turkey.

proportion

Yes, the data was for 2014. It did not (could not) cover the current Russian doping scandal or the McLaren report. But let’s not rely on an unethical presumption of guilt to discredit the data.

Let’s not allow geopolitical differences and prejudices get in the way of battling the sports doping problem.

And let’s not allow such differences to lead us to ignore important ethical principles.

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Dental health – it’s not all about fluoride

cross-section-of-tooth

Fluoride is not the only element involved in preventing decay. See Fluoridation – topical confusion  for a description of how fluoride, calcium and phosphate react at the tooth surface.

Fluoride is not the only factor in oral health. But it is generally the only element in drinking water considered for its effect on our teeth.

Drinking water fluoride benefits existing teeth by chemically reacting with the tooth surface. Involvement of fluoride in the apatite structure at the tooth surface helps prevent demineralisation, due to acid attack, and also encourages remineralisation – tooth enamel repair.

But fluoride is not the only chemical species in drinking water and food that promotes this reaction at the tooth surface. Calcium and phosphate must also be involved. (Bioapatites in teeth and bones are chemical compounds of calcium, phosphate and fluoride). However, these other ions have generally been neglected in studies of the effects of drinking water composition on dental health.

I recently came across a scientific paper which helps overcome this deficiency:

Bruvo, M., Ekstrand, K., Arvin, E., Spliid, H., Moe, D., Kirkeby, S., & Bardow, A. (2008). Optimal Drinking Water Composition for Caries Control in Populations. Journal of Dental Research, 87(4), 340–343.

It compared the dental health of Danish children with the most significant drinking water characteristics. Data for the decayed missing and filled tooth surfaces (DMF-S) of 15 year old schoolchildren were used.  The drinking water characteristics included the concentration of a range of cations and anions, organic carbon, hardness, pH, ionic strength and residue content.

Statistical analysis identified calcium and fluoride as having the major effect and the authors used their data to produce a model relating DMF-S to both calcium and fluoride. The figure below give some idea of predictions from this model.

Ca and F

The model explains about 45% of the variance – better than when fluoride is considered alone (Ekstrand et al., 2003 were able to explain 35% of the variance using fluoride alone).

Community water fluoridation is not used in Denmark but the natural concentration of fluoride in the drinking waters reported in this study ranged from 0.06 – 1.61 (mean 0.33) mg F/L. The concentration of calcium ranged from 31.4 – 162.3 (mean 83.5) mg Ca/L.

So, a result that is hardly surprising for chemists familiar with the surface chemistry of apatites. But it does suggest that perhaps health authorities should consider the calcium concentration of drinking waters as well as fluoride.

According to the authors optimal drinking water should contain medium concentrations of both ions – about 90 mg Ca/L and 0.75 mg F/L. I suspect our drinking water calcium concentrations in New Zealand tend to be lower than this.

Perhaps this is something to think about. And perhaps those anti-fluoride fanatics who use distillation or reverse osmosis to remove fluoride are also forgoing the oral health benefits of calcium. A case of throwing out two babies with the bath water.

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