Tag Archives: Tracey Brown

Responding to Tracey Brown on fluoridation

CWFwaterI appreciate Tracey Brown, Director of Sense About Science, taking the time to respond to some of the comments in my article The ugly truth about critics of “the ugly truth” in science (see “The ugly truth” – Tracey Brown ticks me off). Despite apparent differences I think Tracey and I are singing from the same hymn sheet regarding the need to confront assumptions and check the evidence supporting common claims. That was the message from her lecture and I simply expanded this to include claims of the sort Tracey herself was making.

An apology

First, I must apologise for implying Tracey relied only on the reading of the two papers that were cited to me. I of course have no idea what other reading she has done on the subject – although some of her comments did reflect the views of Peckham, a well-known anti-fluoride activist, as expressed in his misleading paper Peckham (2012).

I also did not know for sure she had based her comments on “inadequate knowledge – claims from anti-fluoride campaigners she uncritically accepted.” That should have been expressed as my view, my conclusion, drawn from her lecture – rather than a statement of fact.

I did say “even scientists, and pro-science people, can suffer from confirmation bias – just like anyone else. They can sometimes adopt a partisan position which restricts them to considering only the misinformation and distortions peddled by anti-science campaigners.” However, I was simply presenting that as  a general problem – not accusing her specifically of this. We should be able to raise these possibilities without being accused of “rudeness” or “brittleness.” This oversensitivity can be an obstacle to the necessary tasks of demanding evidence for the claims being made by anyone.

The fluoridation issue

I don’t, for a minute, think Tracey has jumped on the anti-fluoride bandwagon. But I am concerned that she seems, at this stage, to have uncritically accepted some of the claims made by people like Peckham and Connett.

Tracey’s understanding of community water fluoridation (CWF) is important. A she said in her lecture, “members of the public have asked “Sense About Science” about it.” Her organisation needs to be able to correct misunderstandings and provide an objective summary of CWF. (In this respect Sense About Science is a similar position to Making Sense of Fluoride, a group I belong to). I think, at the moment, Tracey’s comments indicate her organisation’s advice on CWF could be misleading.

Tracey’s response struck me a being largely defensive – objecting to the style of some of my specific comments rather discussing the evidence for or against CWF or its handling by health authorities and decision makers. As it stands she still appears to adhere to the claims made in her lecture which, I think, are just wrong. So, it is worth expanding on some of the comments I have already made.

Is there really no critical assessment of the evidence for CWF?

It is ironic that Tracey uses CWF as an example where evidence has not been questioned. She even says that “governments went about fluoridation in the 50s by stealth, without discussion which caused a backlash.”

But the facts are that in most jurisdictions the decisions on CWF are usually made by local bodies and water companies, not governments. These decisions usually involve consultations and often very contentious debates.  Unlike many other health measures, CWF has been countered from its very beginnings by protests and representations. Although this has usually been ideologically driven and sometimes, but not always, extreme, such opposition has guaranteed a high level of discussion, consultation and scrutiny of the evidence.

That continues to the present day. In my own city (Hamilton, New Zealand) pressure from activists to cease CWF lead to a limited consultation by the council in 2013, and a decision to stop fluoridating. Citizens, many of them quite knowledgeable on the subject, reacted because they felt they had not been properly consulted or listened to and the council had ignored previous referendums and their own polling data. A new referendum showed overwhelming support and subsequently  the council reversed their decision and CWF returned to our city in 2014.

Actually, this illustrates two features which must be taken into account in our defence or criticism of social health policies.

  1. Often the central issue is one of values – even the conflict between a social approach or a libertarian one. Decision-makers should take account of such values in their community as they may be more relevant than the science.
  2. Decision-makers often just do not have the skills to judge scientific evidence. This was particularly true for the Hamilton City Council which was effectively swamped by anti-fluoride activists promoting misinformation and distortion.

For many people involved in this process, and many citizens, CWF has been revisited so many times, the evidence scrutinised and criticised so many times, there is indeed a backlash. Citizens are not happy about their local bodies spending so much time and money on repetitive consultation and even react negatively to new referenda. New Zealand local bodies now wish to unload the whole issue onto Central government arguing, quite legitimately, they do not have the expertise to make such decisions. They have had a gutsful of the issue.

Benefits of opposition

This continual consultation and rehashing of the evidence has produced some positive outcomes – the anti-fluoride activity has a silver lining. The Royal Society of NZ, together with the Office of the PM’s Chief Scientific advisor produced a review updating the evidence relevant to the efficacy and safety of CWF to the middle of 2014. The citation is:

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

This was partly financed by local bodies who felt thoroughly confused by the competing claims. I suggest Sense About Science people read this document, and others, in their efforts to get up to speed on CWF.

Not only does NZ now have an up-to-date review of CWF we also have several High Court decisions which put to rest some of the claims made by activists. Poetic justice perhaps – as funding  from the “natural”/alternative health industry has actually produced scientific and legal judgements supporting CWF! The opposite of what they intended.

Setting “optimum” levels

Tracey said in her response:

“I stated, briefly, that the one part per million figure originates from those old studies. Other parts of the world have rejected it in favour of different concentrations. My reading of the subsequent research on concentrations was that it was not possible to come up with a clear case for one part per million, as opposed to say 0.7 as used elsewhere, and that although the need for controls is better understood and sometimes applied, the multiple and variable sources of other contributors to dental health have made it harder to get a signal from the noise. In the lecture, I pointed out that it’s very difficult to control and measure the dose that people actually get from water. It’s not clear whether you disagree with this.”

Her original comment on “old studies” still stands. As I said before, standards are set according to the studies available at the time – this does not mean they are not revisited or changes as new studies become available. This has, in fact, happened with CWF and it is misleading to imply otherwise.

I don’t think it is a matter of “rejecting” the research. Health authorities and decision makers in each country make decisions about “optimum” levels taking into account their own specific situations, dietary intake, drinking water consumption, etc. Counties don’t “reject” decisions of other countries.

Of course it is hard to control and measure the “dose”, or intake – but that is true for any beneficial element – most of which have upper and lower bounds for recommended intake. Dietary consumption is hardly an exact science – one should not be concerned about the 0.7 or 1 ppm difference. Why should fluoride present a special problem?

Personally, I see talk about “dose” as another misleading argument promoted by anti-fluoride campaigners. Firstly, because of the implication such accuracy is required and secondly because it is painting fluoride out to be in the same class as a very active and possibly toxic drug requiring accurate control – which it isn’t. Really, fluoride is in the same class as sodium, potassium, phosphorus, magnesium and selenium. It is not a drug.

Trends of declining dental decay

No one claims CWF is a magic bullet, or that it is the only factor behind improving oral health. Yet the graphic Tracey used is promoted constantly by campaigners to “prove” CWF is ineffective by implying health authorities see fluoride as the only factor involved.  The graphic “proves” nothing except that oral health has improved over the years.

In my article I assumed Tracey used the image from Cheng et al (2007). In fact, her comments on Austria introducing gobstoppers suggest she probably used the one below from Peckham (2012). There are warning signs there as the citation was a personal communication from Chris Neurath – an activist and “research director” in the management of Paul Connett’s Fluoride Action Network. Even the journal citation should ring bells as Fluoride is a poor quality journal effectively managed by the anti-fluoride community.

Peckham image

And, as I pointed out in my original article, these images avoid showing the WHO data within countries – which do show that CWF is effective. It is extremely naive, and misleading, to suggest that the WHO data shows that it is not effective.

I am seriously concerned that inadequate review of the scientific literature will lead to Sense About Science promoting this misleading graphic in its response to public requests for information.

Real world problems for public discussion of evidence

Institutional cultures often restrict the ability of staff to comment publicly. This may be expressed as a condition of employment or it may just be informal discouragement. On the fluoridation issue, it may just be a matter of institutions preventing staff from participating in the “street-fighting” nature of many of the public discussions. In fact, some local institutions have said they are not ready to expose their staff to the threats and abuse which are often part of these public discussions. It is a health and safety issue for them.

Consequently, these discussions are often handled better by non-institutional “activist” groups like Sense About Science. The group Making Sense of Fluoride (MSoF)is effectively a sister group to Sense About Science, but concentrating on the scientific and ethical issues around community water fluoridation. It was formed precisely because institutions like District Health Boards are not able to take part fully in the public debate. Many MSoF people are not limited by institutional requirements.

Incidentally, institutional restrictions are another reason many people who discuss scientific issues publicly are retired. Such retirees often have the background knowledge and research skills necessary for this discussion but no restriction on what they can say, and where.

Tactical approaches are also important. Very often the public is not interested in the scientific details and qualifications which should be attached to evidential claims. They are often happy to leave such discussion to the “boffins.” Scientific debates may be suitable for some fora but can be a real turn off in referendums. Institutional decisions to forgo scientific debate and detailed qualifications may be completely correct in such situations.

The issue of making disagreements like this public (in the same way Tracey suggests health authorities may not be completely open about the contradictory evidence) is a real one for me with this and my previous post. I had to consider tactical questions. Tracey’s comments on CWF may have been buried within her lecture and not noticed by anti-fluoride activists who just love to publicise and promote such statements. My criticism has now brought them to the attention of the anti-fluoride community. I have handed them a bit of juicy propaganda.

However, my motive is promotion of integrity in science and the need to back up claims with evidence. This is more important to me than a specific campaign of support for CWF. Tracey provided an example which illustrates my concern – so why should I not comment on it?

The public discussion of science, which was the subject of Tracey’s lecture, is not simple and we should not neglect the social and psychological research about public opinion and the way to communicate with the public.

Conclusions

I am grateful to Tracey for responding to my article and wish her and Sense About Science the best in updating their knowledge on CWF.

I am a little disappointed her response was defensive and did not involve an in-depth discussion of CWF. This is probably natural, but it is important that groups like Sense About Science and Making Sense of Fluoride not ignore such challenges. It is also important for such groups to be ready to update their knowledge and opinions on issues when required.

In her article Can you handle the truth? Some ugly facts in science and sensibility introducing her lecture Tracey said:

“The ugly truth is that all of us – however informed, however good our intentions – end up letting things slide once in a while. We overlook, overstate or understate the evidence behind research, claims, or policies, for a number of reasons.”

So true – and something we should continually come back to.

I think Tracey was guilty of this in her claims about CWF. Granted, these were only a small part of her lecture. But to anyone with sufficient knowledge to see her mistakes the claims about CWF did detract from the authenticity of the other claims she made.

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“The ugly truth” – Tracey Brown ticks me off

SAS evidenceDara O’Briain holds a Sense About Science logo

Tracey Brown, Director of Sense About Science, has responded to my article which criticised part of her recent lecture (see The ugly truth about critics of “the ugly truth” in science). Her response is in the form of notes inserted into my article at the points she disagrees with.

Here I include those sections of my article she responded to – with her responses in red.  Hopefully, this will give readers the context required – and if anyone wants more they can refer to my original article.

I answer Tracey’s comment in the next post Responding to Tracey Brown on fluoridation.


She made these points – and claimed that some of our social policies are based on insufficient information. My point was actually that we sometimes assume that there’s a stronger body of evidence than there is because we forget to question. I didn’t touch the question of what is sufficient. Or that we sometimes exaggerate the amount and quality of information we have to support these policies. That is the “ugly truth” she highlighted in her lecture.

Unfortunately though, her lecture was a practical example of another “ugly truth” – simple declarations are not enough. One’s criticisms of accepted knowledge are not necessarily correct or justified just because one is being critical. No, really? There is still the responsibility to base one’s criticism on facts – and to properly research the area before making critical claims. She based her criticism of at least one social health policy, community water fluoridation, on inadequate knowledge – claims from anti-fluoride campaigners she uncritically accepted. There is nothing in the relevant 4 minutes of my lecture to tell you this.


Tracey claimed that community water fluoridation (CWF) has very little empirical justification. She gave two reasons:

  1. The social health policy is based only on the original research which is over 70 years old and does not measure up to current scientific standards. This is different from what I said. I said that the US and UK’s adoption of 1 part per million as the level at which fluoride’s benefits are achieved and fluorosis avoided is based on studies conducted in the 1930s. I said that these studies did not have the controls in place that we usually expect today of evidence in public health.
  2. Data shows that the oral health of both fluoridated and unfluoridated countries has improved over recent decades and this has more to do with the use fluoridated toothpaste and improved health care than CWF. This is what I actually said: This near universal fall has been attributed to fluoride in toothpaste and improvement in dental hygiene and dentistry. Some argue that this masks residual problems for a socially deprived sub-population, and fluoridation is needed for them. That is a good argument and more generally an issue in public health – it is administered to everyone to produce benefits only for some.

These are, of course, two claims made again and again by anti-fluoride propagandists and campaigners. She could have taken her critique directly from one of Paul Connett’s political submissions to councils considering fluoridation. If she did so, she was irresponsible as there are plenty of experts who could have provided information of far better quality. But as I didn’t, this is irrelevant ad hominem.

I contacted Sense About Science and found out that Tracey used the following papers to “formulate” her comment on fluoride. A colleague sent you two papers, saying ‘that helped formulate’. It wouldn’t have been my description but it is clear that these were not all.

Peckham, S. (2012). Slaying sacred cows: is it time to pull the plug on water fluoridation? Critical Public Health, 22(2), 159–177.

Cheng, K. K., Chalmers, I., & Sheldon, T. a. (2007). Adding fluoride to water supplies. BMJ (Clinical Research Ed.), 335(7622), 699–702.

So, let’s consider Tracey’s claims about CWF

  1. The first claim is just silly. Of course, decision makers use the information available at the time – 70 years ago they used the information that was available then. But fluoridation decisions have been made again and again  over the years and it is perfectly natural that decision makers will use the current information for thoseThe efficacy and safety of CWF have been investigated many times since it was first introduced. Science does not stop after a single study. If Brown had made a simple literature search she would have realised that (see Water fluoridation effective – new studyfor just one recent example – there are many others).  Or, given that none of us have the time and expertise to be well informed about a wide variety of subjects, she could have consulted somebody with up-to-date knowledge and expertise on the subject. She certainly should not have relied solely on the very one-sided papers by Peckham (a well-known UK anti-fluoride activist) and Cheng et al. Solely? You’ve made that up. This also sets up a straw man to knock down. As above, I stated, briefly, that the one part per million figure originates from those old studies. Other parts of the world have rejected it in favour of different concentrations. My reading of the subsequent research on concentrations was that it was not possible to come up with a clear case for one part per million, as opposed to say 0.7 as used elsewhere, and that although the need for controls is better understood and sometimes applied, the multiple and variable sources of other contributors to dental health have made it harder to get a signal from the noise. In the lecture, I pointed out that it’s very difficult to control and measure the dose that people actually get from water. It’s not clear whether you disagree with this.
  2. From the audio Brown appeared to use this graphic (below – left image) from Cheng et al., (2007) which is very similar to the one promoted by the anti-fluoride propagandist organisation Fluoride Action  Network. I have discussed this graphic in several articles and in my debate with Paul Connett (download the pdf) It is based on extremely limited WHO data (hence the straight lines), makes comparisons which ignore the multiple factors influencing oral health, and ignores the within-country data which show the efficacy of CWF (such as  for Ireland in my second figure). Yes, I hope you don’t mean that we shouldn’t show WHO data if they have been used by a campaign we disagree with. As my point was simply to show that the data for countries with and without fluoridation is a fairly similar downward trajectory, which is surprising to people, including me, who expected to see greater variation, I can’t understand what is objectionable here. Whether it ignores in-country differences is irrelevant. National data ignore in-country differences in natural fluoridation, access to dentistry, use of toothpaste too. As I went on to say, these data may mask problems for socially deprived populations.
    You’re responding as though I’m campaigning against fluoridation, when I am simply showing that the case for it is not as clear cut as many of us might expect. I pasted above and paste again here, my actual words:  This near universal fall has been attributed to fluoride in toothpaste and improvement in dental hygiene and dentistry. Some argue that this masks residual problems for a socially deprived sub-population, and fluoridation is needed for them. That is a good argument and more generally an issue in public health – it is administered to everyone to produce benefits only for some.

Unfortunately, the “ugly truth” Tracey Brown demonstrated was that even scientists, and supporters of science, can be fooled by the claims of anti-science campaigners if they are too lazy to do their own checking. Perhaps she also demonstrated that even scientists, and pro-science people, can suffer from confirmation bias – just like anyone else. They can sometimes adopt a partisan position which restricts them to considering only the misinformation and distortions peddled by anti-science campaigners. This is rude. It is also immensely brittle on your part, despite the grand statements at the start of your piece about not being defensive. My overall point was that this is surprisingly not as clear cut and well-established as we might expect, as indeed I expected. And you’ve drawn from this that I have adopted a partisan position which restricts me to considering only the information and distortions of the anti-science campaigners. Even based on the papers you know I looked at, never mind the many others, do you consider Iain Chalmers, a founder of the Cochrane Collaboration, to be an anti-science campaigner?


The dilemma is that we, as individuals, can not be experts in everything. We are not capable, individually, of making a well-informed critical and objective judgement on all the issues we may have to face in  preparing a lecture like Tracey’s. We have to be careful about relying on our own biases or poorly informed memories. We have to recognise our limitations and not be afraid to consult experts for clarification, updating knowledge or even just getting one’s head around complex issues. I didn’t actually have such memories: as I said clearly in my lecture, I recently looked into it and was surprised. If I had a bias it was that the evidence was surely stronger and clearer than it turned out to be. My observation that it is weaker does not mean there is no case for fluoridation. I used this example to show that we tend not to question things that have been around a long time. I went on to say, especially when the madcap arguments appear to be on the other side. Throughout this piece you seem to refer to anti-fluoride campaigner statements (I’m assuming you’re accurate about them – I’ve not read them) in precisely that way: as an indicator of what is most likely to be correct.


In this example, I have sufficient knowledge about the science behind CWF to judge this aspect of Tracey’s lecture and see she was mistaken. But what about the other subjects she covered? For example, she claimed that current health advice on cholesterol relies on inadequate research and could be wrong. Do I take her word for it? No! Of course not! That is the whole point of my lecture. I certainly don’t feel I should – if she is wrong about CWF she may be just as mistaken about cholesterol.

That also makes me wonder if the Sense About Science organisation is as credible in its pronouncements as I used to think it was.


I respond to Tracey’s comments in my next post Responding to Tracey Brown on fluoridation.

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The ugly truth about critics of “the ugly truth” in science

It’s an interesting issue. Do we sometimes get too defensive about established science? In our efforts to counter the propaganda of the naysayers do we paint an over-optimistic picture of scientific knowledge? Do we sometimes neglect to make a critical analysis of accepted science while at the same time demanding this of the claims made by anti-science critics?

Tracey_Brown

Tracey Brown, director of Sense About Science

Important questions – and don’t tell me they haven’t sometimes caused you to have some uncertainty when defending scientific knowledge from detractors. Of course, you are not alone in this. Tracey Brown, Director of Sense in Science, tackled the subject head on in the annual Sense About Science lecture last week.

The ugly truth

This was the title of her lecture. Perhaps it is a timely warning. We should not be defensive about scientific knowledge – or the policy decisions that rely on that knowledge. We should always be open-minded and critical. And we should always be realistic about the evidence. We should be ready to present and argue for the science – warts and all. Not hiding limitations and uncertainties.

She made these points – and claimed that some of our social policies are based on insufficient information. Or that we sometimes exaggerate the amount and quality of information we have to support these policies. That is the “ugly truth” she highlighted in her lecture.

Unfortunately though, her lecture was a practical example of another “ugly truth” – simple declarations are not enough. One’s criticisms of accepted knowledge are not necessarily correct or justified just because one is being critical. There is still the responsibility to base one’s criticism on facts – and to properly research the area before making critical claims. She based her criticism of at least one social health policy, community water fluoridation, on inadequate knowledge – claims from anti-fluoride campaigners she uncritically accepted.

Falling victim to fluoridation misinformation

Readers can download a podcast of Tracey Brown’s lecture here. I will update this post with a video link when it is available. She discussed fluoridation from 15 – 19 minutes.

Tracey claimed that community water fluoridation (CWF) has very little empirical justification. She gave two reasons:

  1. The social health policy is based only on the original research which is over 70 years old and does not measure up to current scientific standards.
  2. Data shows that the oral health of both fluoridated and unfluoridated countries has improved over recent decades and this has more to do with the use fluoridated toothpaste and improved health care than CWF.

These are, of course, two claims made again and again by anti-fluoride propagandists and campaigners. She could have taken her critique directly from one of Paul Connett’s political submissions to councils considering fluoridation. If she did so, she was irresponsible as there are plenty of experts who could have provided information of far better quality.

I contacted Sense About Science and found out that Tracey used the following papers to “formulate” her comment on fluoride.

Peckham, S. (2012). Slaying sacred cows: is it time to pull the plug on water fluoridation? Critical Public Health, 22(2), 159–177.

Cheng, K. K., Chalmers, I., & Sheldon, T. a. (2007). Adding fluoride to water supplies. BMJ (Clinical Research Ed.), 335(7622), 699–702.

So, let’s consider Tracey’s claims about CWF

  1. The first claim is just silly. Of course, decision makers use the information available at the time – 70 years ago they used the information that was available then. But fluoridation decisions have been made again and again  over the years and it is perfectly natural that decision makers will use the current information for those decisions.The efficacy and safety of CWF have been investigated many times since it was first introduced. Science does not stop after a single study. If Brown had made a simple literature search she would have realised that (see Water fluoridation effective – new study for just one recent example – there are many others).  Or, given that none of us have the time and expertise to be well informed about a wide variety of subjects, she could have consulted somebody with up-to-date knowledge and expertise on the subject. She certainly should not have relied solely on the very one-sided papers by Peckham (a well-known UK anti-fluoride activist) and Cheng et al.
  2. From the audio Brown appeared to use this graphic (below – left image) from Cheng et al., (2007) which is very similar to the one promoted by the anti-fluoride propagandist organisation Fluoride Action  Network. I have discussed this graphic in several articles and in my debate with Paul Connett (download the pdf) It is based on extremely limited WHO data (hence the straight lines), makes comparisons which ignore the multiple factors influencing oral health, and ignores the within-country data which show the efficacy of CWF (such as  for Ireland in my second figure).
combined-who-ireland

Left: Graphic used by Cheng et al (2007). Right: Same WHO data for Ireland with fluoridated and unfluoridated areas represented

The ugly truth about Brown’s lecture

Unfortunately, the “ugly truth” Tracey Brown demonstrated was that even scientists, and supporters of science, can be fooled by the claims of anti-science campaigners if they are too lazy to do their own checking. Perhaps she also demonstrated that even scientists, and pro-science people, can suffer from confirmation bias – just like anyone else. They can sometimes adopt a partisan position which restricts them to considering only the misinformation and distortions peddled by anti-science campaigners.

But it does highlight a dilemma for people like Tracey Brown who might feel they have a “whistle-blower” mission to insist that science, or its practitioners, pull up their collective socks. (I hasten to add it is a “mission” I  support – as I support “whistle-blowers” in general).

The dilemma is that we, as individuals, can not be experts in everything. We are not capable, individually, of making a well-informed critical and objective judgement on all the issues we may have to face in  preparing a lecture like Tracey’s. We have to be careful about relying on our own biases or poorly informed memories. We have to recognise our limitations and not be afraid to consult experts for clarification, updating knowledge or even just getting one’s head around complex issues.

The debunking of many of the claims made by scientific naysayers is often like shooting fish in a barrel. It may not require much checking or even serious engagement with the subject. But it is irresponsible to transfer that lazy approach to serious consideration of real science or the social policies informed by that science.

It is especially irresponsible when speaking as the head of a respected organisation and where listeners may feel justified in seeing the claims as expert and to be trusted. Again we face the fact that as listeners none of us can critically judge a speaker’s claims on all the subjects covered.

Destroying credibility

In this example, I have sufficient knowledge about the science behind CWF to judge this aspect of Tracey’s lecture and see she was mistaken. But what about the other subjects she covered? For example, she claimed that current health advice on cholesterol relies on inadequate research and could be wrong. Do I take her word for it? I certainly don’t feel I should – if she is wrong about CWF she may be just as mistaken about cholesterol.

That also makes me wonder if the Sense About Science organisation is as credible in its pronouncements as I used to think it was.

See also:
Annual Lecture 2015 · Sense about Science
Can you handle the truth? Some ugly facts in science and sensibility – an article by Tracey brown introducing her lecture.

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