Hamilton councillors are just the latest folk to fall prey to fear-raising arguments against 'mass medication' and in favour of individual choice, while ignoring science. What's going on? 

Judith Collins once introduced me to one of her staff members saying, "Tim writes mean things about me on his blog". It was a jokey dig done with a wonderfully straight face and it charmed me. So I'm going to take this chance to applaud her no-nonsense response to Hamilton City Council's daft decision on fluoride this week.

The Justice Minister described the decision variously as "gutless", "a cop-out" and "bollocks". Which sums it up nicely. The move will cost millions of dollars and thousands of teeth in the years to come. And how refreshing to have a minister give a non-partisan and unambiguous view.

The only case you can make in defence of the decision is that it's democratic. On one level you can strongly argue that if people don't want something in their water, they should have the right to say so and the power to make changes.

However as anyone who's read the news this week knows, the 2006 referendum on fluoridation held in the city gave majority support to continuing the practice, so that's not much of an argument.

The science -- the proper science, that is -- seems pretty clear that we have low fluoridation levels in our water and bumping it up a little helps our oral care en masse. Health agencies from WHO down say it helps dental hygiene and is a human right. There is no proof of fluoride poisoning, if that's what you'd call it, in the New Zealand population over recent generations and every reason to think a significant number of New Zealanders will have more teeth problems as a result of less fluoride in the water. Just about everything becomes a poison at the right dose, but at a lower dose it's fine, even beneficial.

As the Herald writes today, it defies all logic.

I mean, if we're going to take the 'mass medication' line to its ultimate conclusion, surely you go along with the raw food argument and add nothing artificial to your diet. And presumably you'd be opposed to all fertiliser, because that's mass medication of animals and crops and, ultimately, us. Of course that would re-introduce animal diseases and lower yields, but hey, who are those farmers to force those fertilisers on us, eh? They're just like those Nazis.

But it's indicative of a wider trend in these modern times, which is worrying, and that's the rise of the instant expert and the 'I know better than the majority of scientists' brigade.

There's an odd dynamic going on within our society in terms of our relationship to authority. New Zealanders have long been suspicious of people who tried to tell them how to live their lives - especially politicians and self-declared experts. But there was a reverance for the doctor and, by extension, the scientist. That seems to have been turned on its head.

Now we trust John Key despite the brain fades, because our instinct says he's a decent bloke and we trust that. We trust the celebrities (even people who front ads) because, well, we wish we were like them and had their lives. We trust Willie Apiata - because he's brave and good at killing people?

Yet in contrast, well, those sneaky scientists are to be doubted first and only believed if we can prove it ourselves on the internet. Look at the climate change debate, for example.

Frankly, we've got it back to front. We've ascribed self-interest to the most detached and objective group and assumed the biggest self-promoters are the ones to be believed. Is it because we've witnessed the healthy scepticism within science debates and interpreted it as uncertainty or even deviousness? Or have we become so self-helpified that we think we just know better? Are we so wed to 'balance' and 'fairness' that we suspend judgment and give the same credit to the scientist and the pseudo-scientist alike?

The other problem is that we've made choice a holy grail. The biggest reaction against public health initiative such as fluoridation, folic acid in bread and vaccinations are that they're forced on the many whether we want it or not. They are - horror - "mass medication". And that's always and only a pejorative term because it denies individual choice.

Of course it never does completely deny choice, as there is bottled water, there would have been non-foliced loaves and no-one can compel an injection on you by law. But the fear is there and that's enough to turn people against what is typically in the greater public good.

Each of those 'mass medication' debates are issues, to greater and lesser degrees, of the community good coming up against individual choice. And it's about time we started paying more attention to the community good.

Many kids living in poverty, for example, don't have the choice - for all kinds of complex reasons - to get enough fluoride and will suffer as a result of this decision by the council in Hamilton, and those in other cities. So what about the choice of them all?

And as we holler in favour of choice, we conveniently ignore all the times we put the community good first -- look at the road rules, for example. So why not on these medical occasions?

I'd be interested to know what you think's going on.

 

Comments (65)

by Richard Aston on June 07, 2013
Richard Aston

I don't quite understand the hysteria Tim. If Hamiliton ditches flouridation the sky will not fall in .

Quite aside from the science the 'mass medication' debate is a very valid one to have. Yes its a balance between indiviual choice the good of the community but I think we need a better argument for going down the good of the community other than scientists telling us we should.

Public awareness raising of the importance of fluride for teeth would be a good start, there are many ways to individual add fluoride via tooth paste etc.

I don't have the same faith that you have in scientists or public policy people and I want the right to hold a different view . Its called democracy.

by Andrew Geddis on June 07, 2013
Andrew Geddis

Oh ... this is going to be a good thread!

So to really help kick it off:

So I'm going to take this chance to applaud her no-nonsense response to Hamilton City Council's daft decision on fluoride this week.


+ 1.

I don't have the same faith that you have in scientists or public policy people and I want the right to hold a different view . Its called democracy.

Of course you have the right to hold whatever view you want. Just as others have the right to question the basis for that view, wonder why you think you have a better understanding of the issue than scientifically/medically trained experts, and suggest that you are being quite selfish by putting amorphous fears that flouridation compromises the purity and essence of your natural ... fluids ahead of the demonstrated dental benefits (thereby condemning a whole bunch of kids to very painful treatment down the track) .

Now - in the words of a great man, let the games begin!

 

by Matthew Percival on June 07, 2013
Matthew Percival

Yes its a balance between indiviual choice the good of the community

by Matthew Percival on June 07, 2013
Matthew Percival

What the... my carefully written post just disappeared upon submission!!!

I blame the fluoride Nazi's

by Kyle Matthews on June 07, 2013
Kyle Matthews

I'm down with people being able to look at the solid science, and say "nah, we'll do without that". I think they're wrong, but it's a relatively free world.

I don't get why they did it in this instance. Indeed I see only about a third of our local bodies flouridate drinking water - I'm shocked - I thought almost the whole country did. Are we really that anti-science, pro-choice?

by Tim Watkin on June 07, 2013
Tim Watkin

So, Richard, 'aside from the science'? Isn't that rather core?

Who better to tell us what we should do on matters to do with science than scientists? Or should I be taking the plumber's word on what's wrong with my aching back? Or ask my baker about child abuse rather than someone like you? Of course we should all have our own opinion and get informed, but don't we have room left to respect expertise?

There's a common sense place between brainlessly following authority figures and listening the the majority of experts, a place in which we should err on the side of expertise, isn't there?

Sorry, don't mean to bombard you with questions, but that's how it all came out!

by stuart munro on June 07, 2013
stuart munro

One of the things that leads the public to mistrust scientists is empiricism.

Scientists using the best available data during the development of the atom bomb, set and revised safe radiation levels six or seven times. Each time they cloaked their revised advice in that aura of professional expertise that approaches infallibility, with the result that by the 1970s and 80s there was a growing loss of confidence in magisterial scientific announcements.

Rutherford used to say that if a scientist couldn't explain what he is doing to the lady who cleans the floor, he doesn't know what he's doing. It is not improper of the public to require full simplified explanations from people who claim expertise. I'd quite like to hear a fully costed explanation of the asset thefts for example, but I think it's clear by now that no such calculations were made, because the asset thefts are ideological, and cannot be justified.

Fluoridation would make a great public debate, if the source studies were dug up and weighed critically. There is evidence on both sides.

by Viv Kerr on June 07, 2013
Viv Kerr

I am a dentist and I hate drilling on kids (ok that's not scientific,but it helps explain my interest in this issue)

I have looked at the fluoride action network’s website to try and understand why they are so anti- fluoride. It has many anecdotal claims of ‘fluoride poisoning’. They talk of fluoride ‘allergy’, but clearly do not understand what an allergic reaction actually is.

One of the claims they make is that “fluoridation has much in common with the GE issue” because “both have been promoted by vested commercial interests based in the US” $48,000 to fluoridate Hamilton’s water supply, yep you’d really want to get the big guns onto that. If they are seriously looking for some money making conspiracy involving fluoride, perhaps they should first ask themselves why the vast majority of dentists are in favour of fluoridated water which reduces the decay rate and so reduces the money dentists can make.

 

by Tim Watkin on June 07, 2013
Tim Watkin

Thanks Viv, appreciate you coming on to offer that comment.

Stuart – so you think because some scientists have over-reached we the public have tarred them all with the same brush? Well, it's happened to journalists, so maybe you're right! But the explanations in recent days from scientists as to the efficacy of fluoride have been pretty, cleaning-lady clear. So I don't think that's lacking in this case.

by stuart munro on June 08, 2013
stuart munro

I suspect the core studies will come down on the side of fluorodation, but that fluoride is not something to blithely add to everything, there are some problems.

The public mistrust that descends from changing expert opinions is problematic - in science people should change their minds as better data emerges, but this creates an impression of unreliability, which really descends from overselling the quality of the expertise. Scientific expertise beats the hell out of ignorance, but the universe is complex, we still have things to learn.

by mudfish on June 08, 2013
mudfish

Not just the 70's and 80's.

Uncertainty. The climate change debate, strung out over decades, with ever changing numbers and two polarised sides, both claiming eminent scientists, with a broad normal curve of voices on the majority side, some shrill and extreme and others more conservative perhaps for fear of being perceived as shrill. How many have switched off because it's taken so long and there's still not that much consensus? And there won't ever be (until after the fact) because actually it's too complex and considerable uncertainties remain and will continue to remain. Hands up in horror, too hard, too far into the future, ignore, ignore, perhaps it'll all go away. Now we've stopped listening, the poor scientist has been taken of his/her pedestal and only gets heard as one voice of many - in a broad normal curve of wanna-be scientists.

Surprised it's gone as far as councillors not taking more notice of the scientists though.

by stuart munro on June 08, 2013
stuart munro

Climate change is an unfortunate example, because it pitted professional lobbyists against scientists. The media often reports as if the issue were contentious in science, but with the exceptions of a few iconclastic outliers like Freeman Dyson,(not exactly a professional climatologist) most of the contention comes from industry shills like Lomborg.

Fluoride is more doable. No scientist would assert that large quantities of halides are particularly safe, but there is evidence that trace quantities provide benefits. The anti groups are particularly concerned by commercial influences on early research, the 'better living through chemistry' campaign that brought us delights like DDT, PCBs and Dioxin. This is an issue that someone like Gordon Campbell could probably put to bed, and educate the public while he was at it.

by Mike Osborne on June 08, 2013
Mike Osborne

"It is useless to attempt to reason a man out of a thing he was never reasoned into." -Jonathan Swift

Science - the process by which theory is postulated, tested and proven or disproven. The method is transparent, repeatable and, generally, published works peer-reviewed. In all, pretty hard to argue against the results of a scientific study (conducted fairly and without fudging, bias etc) unless you produce a comparable study.

Where you sit on the "fluoridation argument" likely indicates your worldview and your perceptions of risk. The Cultural Cognition Project set out to discover why clear scientific findings don't get accepted by portions of the population. Check it out here www.culturalcognition.net or the abridged version here http://en.wikipedia.org/wiki/Cultural_cognition.

For example, if you don't accept climate change (the science is settled) you're probably an individualist / heirarchist. If you don't accept vaccinations you're more likely to hold an egalitarian/communitarian worldview (which is somewhat ironic as presumably this worldview wouldn't want disease to spread).

The challenge is for us to see beyond our own worldview - and look at the science as dispassionately as possible. Not easily done - as that may require or result in a shift of our worldview and mostly we're not up for that.

by Chris Webster on June 08, 2013
Chris Webster

Tim: my esteemed cousin Dr Albert Kewene reckons his Hamilton-based health provider service workload will increase given this recent vote. And because he works specifically for and with Maori families and Maori communities - naturally his focus is on the economic impact of a lack of fluoride in the water - will impact on the welfare of Maori citizens (already ravaged in statistics) - who Albert says will be badly affected by the decision.

In a recent IV on Radio Waatea 603:

A lot of our Maori people dont get the fluoride. They cannot afford a lot of toothpaste. A lot of the families we see in our clinics, a lot of the children don't even have toothbrushes so we supply them.  Fluoride is good yes - but people want the choice. If you put it in water it reaches more people. Now (poor Maori families) they will be to buy it (fluoride) in toothpaste.'

Albert says in his practice he does not see the adverse effects of fluoridation like mottled teeth that opponents were claiming - but he does see more tooth decay in children who live in areas where there is no fluoridation.'

I reckon Albert would agree with both you and Judith.

 

 

by william blake on June 08, 2013
william blake

Flouride is good for the teeth, statins 'should be put in the water' according to my GP,  what else should be put in the water? Prozac, Benzedrine (Mondays)  LSD ?

What about what is taken out of the water; mud, wood, cats, giardia, poo, isn't it just as  wrong to subtract from the water supply as to add to it?

 

 

by M Croft on June 08, 2013
M Croft

"So I'm going to take this chance to applaud her no-nonsense response to Hamilton City Council's daft decision on fluoride this week."

Tim, I normally read your column with general agreement, however your emotional out burst at what was a very difficult but sensible, and rational decision by the Hamilton City Councillors urges me to write when normally I would remain silent. Even a cursory read of the information coming out of Hamilton would have revealed to you that this was a decision not made lightly.

The Mayor is quoted as saying:

"Ms Hardaker was unrepentant in the face of Ms Collins' attack.

"My council and I have sat through four days of what I would regard as a very, very good process, listening to and receiving info, evidence, data, statistics, expert advice from both sides of this debate."

You speak as if the people giving evidence against fluoridation have no expertise whatsoever; that they are indulge in non-science; are to be pitied and wondered at. I know personally several of those who presented at the tribunal. For example, Dr Jane Beck is a specialist in Occpational Health and has done extensive reseach on this matter, Many other presenters were also medical professionals who are concerned at the safety and the overall efficacy of public water fluoridation. The fact that the Pro Fluoride lobby were unable to convince the Council to continue with water fluoridation speaks volumes in itself. The simple fact is, that although the American Medical Association has recommended the fluoridation of public water supplies since 1945, no reseach has ever been conducted into its safety, yet the percieved wisdom is that because it is administered in small quantities it is safe. In fact nothing could be further from the truth.

To begin with I would take it that almost none who have commented here, despite being intelligent people, have any idea what it is, and how much of it, is added to our water in order for it to be "fluoridated". I certainly didn't and before I began to carry out my own investigation of the matter I too thought that fluoridation was the "silver bullet" to good oral health, like the majority of the population. After all, we have all been brought up on fluoridated water - and what harm has it done us? Has it done us any good? - we might also ask!

The stuff that is added to our water is a waste product from fertiliser works producing superphosphate. Previously it was emitted into the atmosphere, however, after trees and animals around the works began dying the discharge of flurosilicates into the atmosphere was banned. The fluorosilicates are "scrubbed" from the exhausts of the works by fine mist sprays of water and form fluorosilicic acid H2SiF6, a highly reactive and toxic product. It is not to be dispossed of in water ways, or in the ocean, or in general landfills - but you can add it to our drinking water. This waste product the fertiliser works would have to pay big money for to dispose of - but they can sell it to us (via council rates). As you can see, it is not Sodium fluoride that is the compound of choice used by toothpaste companies. But even then the toothpaste carries the warning that it is NOT to be swallowed.

Fluorosilicates are NOT simple fluoride ions. The Medical fraternity, state that fluorosilicates disassociate in water of pH around 7. This may be so, but the fact is the human gut has a pH of 2 - 3 and under this highly acidic environment fluorosilicates reform - the fluoride ions are not as readilly available as before, and fluorosilicates are highly toxic. The recommended maximum dosage for fluorosilicates is 0.02 mg /kg. With water being treated at the rate of 1mg /L a bottle fed infant will exceed this dosage daily.

The Australian Kidney Association has done a study on the rates at which fluoride ions are exceted from the body. Their report notes that 1 in 7 adults in Australia have some form of Chronic Kidney Malfunction, from mild to severe. The normally 50% of fluoride ions ingested are excreted within a day, however with kidney malfunctions that rate will decrease. An infant will retain up to 85% of the ions they ingest, as will the aged (kidneys start to become less efficient after age 65 according to the report) and the infirm. Those on dialysis for instance are particualry vunerable.

It is of note that the European Union has recently done an extensive study into fluoridation and have concluded that while there is some evidence to suggest that water fluoridation may have some slight benefit in reducing the number of cavities within the general population, persons over the age of 12 recieve no benefit what so ever! It is also worth noting that the average number of cavities in children in the general population has been reducing in the developed countries since the 1930's (25 years before the introduction of fluoride) and that rate is similar in countries whether or not they fluoridate their water supplies.

What I have covered here is just a fraction of the mass of evidence presented to the councillors in Hamilton. There is not the time nor the space, nor is this the place to deal with them all. Pro Fluoride lobbyists had the opportunity to deal with all these matters and to satisfy the councillors that they were negligible concerns, the simple fact is they they were unable to, and in a rational decision, the obvious course of action is to remove the problem.

It was not a daft decision. it was the right and proper one.

by George Hendry on June 08, 2013
George Hendry

Tim W and Andrew G, our two leading Pundits currently aiming at jointly accumulating more posts than all other pundits combined, do however agree that there needs to be quality as well, measured by the number of responses each post gets.

Of concern to Andrew must be that Tim may have committed a professional foul to try to take the lead outright, by abandoning his usual incisive well-reasoned style in favour of daftness in the hope of infuriating bloggers into posting in record numbers.

Only someone who knows all logic can rightly say when a decision defies all logic. Logic consists of repeatable steps taken from a starting point, but says nothing about how starting points may be chosen. If you write a number, tell me what it is but keep it hidden, and show me other figures to add to it, my mathematical logic may be faultless but I'll still get the total wrong if the first number you told me was not what you wrote.

There is no such thing as 'the solid science' except in the mind of someone who has already decided what they want to believe.It's still possible, when you read that sodium fluoride is a highly poisonous byproduct of the aluminium industry, which may not legally dump it and for well over half a century has been looking for legal places to put it, to believe and be right in doing so that the aluminium industry fortunately found how this poison could be arranged to benefit people.

Presumably 'gutless' means without courage. Logic, please! Hamilton city councillors going against a clear ratepayers' referendum majority would have expected a backlash and braced themselves for it, and evidence shows they got it. Nor can Ms Collins logically condemn them for following the gutsy example she set when after all that time and care spent on an MMP referendum (majority in favour) and royal commission report, she simply told voters it was not her job to do anything so nothing was going to happen. If she doesn't get voted out at the next opportunity, why should they be?

As Tim would surely say if not aiming at provoking posts via apparent ignorance, dental health has little to do with fluoride in the water and much to do with the ability to afford regular checkups and treatment when decay is small. He might also point out that topical treatment with dental cream directly onto tooth enamel is hardly the same as distributing the remedy aimlessly through the body, or why don't we just vaccinate everyone against tooth decay?! (Or against cuts to save us all the expense of sticking plasters.)

What I believe is going on is that information is becoming far more available, and that as a result of finding out more about what the multinationals are up to  (and no, Tim, I have failed to trust the PM ever since Nicky H clarified what he and his mates have been up to) people are deciding things for themselves and sometimes making mistakes. But isn't it our democratic responsibility to make and live with our own mistakes, no matter how many teeth it might cost us?

by william blake on June 09, 2013
william blake

....and what about Chlorine, that stuff will rip your shorts too.

by James Green on June 09, 2013
James Green

The simple fact is, that although the American Medical Association has recommended the fluoridation of public water supplies since 1945, no reseach has ever been conducted into its safety...

Sorry um what? So according to you, in the same period of time that smoking, asbestos, 2,4,5-T, DDT, etc. all came to the attention of epidemiologists, they never thought to look at fluoride. That's hilarious. And if you'd actually done any research, beyond cutting and pasting the usual drivel about fertiliser, patently false.

by M Croft on June 09, 2013
M Croft

James

I would be delighted if you could provide us with the evidence relating to the safety of hydrofluorosilicic acid in public water supplies. The Ministry of Health has been unable to provide this, but I'm sure you can reassure us all.

Are you disputing the fact regards the origin of the hydrofluorosilicic acid which is added to public water supplies for fluoridation purposes? You might like to check with your local council/water suppiler as to where they obtain the stuff. I know ours get it from the fertilizer manufacturer.

by Sam Vilain on June 09, 2013
Sam Vilain

I don't see what your problem is.  Poor people who need fluouridation can just add fluouride to their water themselves.  It's a violation of civil rights to force rich people to filter it out of their water!

Until I see triple-blind controlled longitudinal studies showing a reduction in the level of caries at the 95% significance level, and epidemic proof that hydrofluorosilicic acid behaves identically to other forms of fluoride in solution, all scientists are ninkompoops!  

You'll never take my precious bodily fluids!!

by william blake on June 09, 2013
william blake

..and while we are at it, let's get the iodine out of salt, more than 2 grammes of that puppy will kill you outright.

by Viv Kerr on June 09, 2013
Viv Kerr

George said “dental health has little to do with fluoride in the water much to do with the ability to afford regular checkups and treatment when decay is small.”

I must disagree with that statement. Dental health is ‘to do with’ what, and how often, you eat and drink , how resistant your teeth are and about how much (and what type of) dental plaque is in your mouth. Visits to the dentist are not the most important thing, it is what you do the other 364 days of the year that really counts. Hope that won’t get me drummed out of the Dental Association.

Fluoride ingested while teeth are forming (ie in childhood) increases the resistance of dental enamel to acid. Acid is made by plaque bacteria from the sugars and carbohydrates we eat. Acid also comes directly from acidic drinks (energy & fruit drinks, diet & standard fizzy drinks) and in some people, from stomach acid reflux into the mouth. If you remove fluoride from the equation, the balance is tipped someway towards decayed teeth rather than sound teeth, if all other things are equal.

Sadly I don’t see the anti-fluoride brigade out there promoting positive dental health messages.

by M Croft on June 09, 2013
M Croft

fluorine replaces iodine William so you'll be ok!

by M Croft on June 09, 2013
M Croft

Viv I think that you will find that the anti fluoride brigade are very strong in supporting positive dental health messages.

The pro fluoride brigade on the other hand with a few exceptions mostly resort to ridicule and have little positive arguement to make except to regurgitate the flawed line that a little of what you don't know about can't hurt you. It was this arrogance that there was no arguement to their cause - evidenced by many commentators here - that ultimately led to the Hamilton Council making the decision that they did. Essentially the pro fluoride lobbists in their arrogance that the science was settled - amen - meant that they had no counter to the concerns raised by the anti fluoride brigade. 

 

by George Hendry on June 09, 2013
George Hendry

Thanks for your reply Viv. You are right of course that how little time plaque gets to sit on our teeth is probably THE major factor in delaying decay. Ironically, were any to assume on the basis of knowing their water was fluoridated that they could omit cleaning their teeth because the fluoride would take care of things, the net dental effect could well be worse.

I believe that it's not the fluoride coatings given by school dentists to kids at appointments that makes anything like as much difference as how they encourage said kids to believe that they are valuable individuals, that their lives should be something to smile about and that therefore their teeth, like themselves as a whole, are worth caring for. The  experience, many years ago, of having a crabby dental nurse order me to cross the street and buy her a pack of cigarettes at the local dairy ( to her credit she did give me the money to pay for them) was an extra thing among the guilt-tripping approach used by some dental nurses back then that helped me not to want to think about my teeth a lot.

This post has brought Tim's total to just one behind Andrew's for their most recent blogs!!! I have some scientific references up my sleeve in case someone else decides to post and give me the excuse to reply thus taking Tim into the lead and winning this round (please nobody tell Andrew).

by James Green on June 09, 2013
James Green

Are you disputing the fact regards the origin of the hydrofluorosilicic acid which is added to public water supplies for fluoridation purposes?

Is cyanide from apricots safer than synthesised cyanide?

I would be delighted if you could provide us with the evidence relating to the safety of hydrofluorosilicic acid in public water supplies.

Only because you can't prove anything is safe, only to show an absence of harm. But all the evidence (e.g, the York review; ironically often feted by anti fluoridation groups) shows only some mottled teeth. And as I said, despite millions of people drinking fluoridated water, despite epidemiologists discovering exposure to multiple other things turning out to be harmful, there is no evidence of harm, save some mottled teeth.

by M Croft on June 09, 2013
M Croft

"save some mottled teeth. " which is evidence of flurosis.

Do we say that red rimmed gums is ok - its just evidence of mercury poisoning?

"There is no evidence of harm" !

Well that is just what the anti fluoride brigade did show the Hamilton District Council. That there IS evidence of harm. All you are doing is hand waving.

by Tim Watkin on June 09, 2013
Tim Watkin

Nothing in this post was intended to be indulgent provocation – it was genuine frustration at non-scientific minds thinking they can out-think experts and assuming that all science and scientists are somehow equal. Of course we know that science evolves, but does that mean we just assume what we think now is wrong and shrug? It's no excuse for not taking the best possible advice as it stands – and that means more than the people who rock up to some panel in the Waikato when it's so easy to see the global research.

M Croft, four days you say? Why bother with years of dentistry training, let alone all the decades of exprtise gathered at the world's greatest science institutes if you've gt four days to hear submissions. What was I thinking to doubt?

I don't mean to be rude, but your arguments fall into just about every psuedo-scientific trap I've come across down the years – the few anecdotes that outweigh the mass of evidence, the lack of 'safety' (which is unproveable), the 'I carried out my own investigations' line as if a few days with a hammer makes you a master builder (let alone a Dr), the odd 'health expert' here and there who is somehow compared to global panels of expertise... It's just so frustrating. Even the comment that there's no benefit for over 12 year-olds... I mean, even if that's true if much of the protection occurs during childhood, why does that even matter if – I'll say again – there's no evidence of harm. You can make any substance sound bad – as William is alluding to with his comments about iodine and chlorine. Terrible stuff in the wrong amounts, you could come up with all sorts of scare stories about them. But in the right dose and place, they improve our health. Look at sunlight, for pete's sake.

Representation demands judgment, but those councillors need to realise that mans more than simply relying on your own passing lessons. True judgment knows when you bow to those who know more than you; maybe accepting that the leading dental and health organisations in the world are likely to have thought of everything you can come up with in four days and bowing to their knowledge.

The good people over at sciblogs can deal with this much better than I. And this post links to their posts of recent days:

http://sciblogs.co.nz/molecular-matters/2013/06/08/fluoridation-mass-med...

But I add this useful par with links from helenph:

There is a jolly good reason that fluoride is added to many water supplies worldwide. It is because these water supplies have levels of the mineral below that which optimises oral health.  The water in NZ is relatively low in fluoride and adjusting the parts per million of fluoride to 0.7-1.0ppm corrects this deficiency. The NZ Dental Association strongly support and promote community water fluoridation  as do the Ministry of Health and the World dental federation .

And, given M Croft's claims that no research has been done into public water safety and that research shows fluoride makes no difference, I'd point to these:

A NZ study found  a 30% lower rate of tooth decay in five year olds residing in cities with fluoridated water (i.e. Wellington) compared with those without (i.e. Christchurch) and 40% lower rates in 12 year olds and the independent association between fluoridated water and these findings was confirmed after multivariable analysis. The differences are greater for Maori and Pacific children.

The National Health and Medical Research Council in Australia (NHMRC) carried out a systematic review of high level evidence as to both the efficacy and safety of various forms of fluoridation.

It's just sad that the decision is made by people with the relative wealth to make choices about their health, but the impact will be most felt by those who at the other end of the scale. So the rich get 'choice' and the poor get sick.

So yeah, I'd still call it daft.

by Tim Watkin on June 09, 2013
Tim Watkin

Croft, so you have evidence of a direct causal link between fluoride in water and those harms? And that the harms are in proportion to the benefits? And while that proof is so compelling, major organisations from WHO and the World Dental Assn down who specialise in this area are purposefully ignoring those harms and urging a course of action they know will do more damage than good?

Glad you trust what the independent and unbiased NZ-based "pro fluoride brigade" could show a single council in four days ahead of all the other experts (and logic)!

by william blake on June 10, 2013
william blake

http://www.guardian.co.uk/world/2011/may/23/cut-red-meat-cancer-researchers

Yes ham can cause cancer so it would be safer to call that city south of the Bombays Ilton.

by Andrew P Nichols on June 10, 2013
Andrew P Nichols

However as anyone who's read the news this week knows, the 2006 referendum on fluoridation held in the city gave majority support to continuing the practice, so that's not much of an argument.

This is by far the biggest disgrace - a true affront to democracy compounded by those councillors who excused themselves for "conflict of interest" FFS,  they were Waikato DHB members whose job it was to uphold public health matters. Collins is right- these people are totally useless!

 

by Richard Aston on June 10, 2013
Richard Aston

Andrew ,you seem to think  I am anti fluoridation and the experts " you have a better understanding of the issue than scientifically/medically trained experts, and suggest that you are being quite selfish by putting amorphous fears that fluoridation compromises the purity and essence of your natural ... fluids ahead of the demonstrated dental benefits (thereby condemning a whole bunch of kids to very painful treatment down the track) ."

You completely missed the point .  I am concerned about the balance between indiviual choice the good of the community. I am concerned about taking an expert's opinion as truth without debating it , without fully exploring all the options.

I am not necessarily anti fluoride but I do get nervous when experts and govt leaders decide on a mass medication or chemical adjustment programme that may well have some benefits for lower decile children.  It just seem crude and a little over kill to me.

The input : Add a chemical to everyone's water supply .

The outcome : 30 - 40 % lower rates of tooth decay in 5 - 12 yr olds.
is we still  have tooth decay just 30-40% less of it . Yes a difference but not a profound difference. 

Were there other ways to achieve the same outcome? The report ( New Zealand Dental Journal) does not look at other approaches . It is after all a scientific report and by its very nature will be specialised and narrow in focus.

eg It would have been interesting to look at statistical difference between multiple ways to deliver fluoride to teeth, clearly drinking it is just one option.

But no , that's what the experts recommend and we will follow that recommendation without question. I bet you if the cost of fluoridation was more in the millions we would have had a much wider debate on the alternatives.

And I see the debate so far is down to the us and them polarity . The pro lobby condescendingly see any one against as ignorant. 

Coming back to Tim's header question " What does this say about a Kiwi cultural shift?"   It wasn't really a question Tim , you are not at all interested in any cultural shift. You have already prejudged any dissent as having no value and you have no interest in the wider debate of the relationship of individual sovereignty to the good of the larger group.

 

 

 

by Tim Watkin on June 10, 2013
Tim Watkin

"The science is settled" says Sir Peter Gluckman. Fluoride is not significantly harmful. You can debate the values of using food supply for medical purposes, but let's not pretend it's a scientific debate. Oh, and he says it's clearly good for teeth - both kids' and adults'. Listen here.

Richard, fluoride is in the water anyway. There's just not as much in NZ water as in some other places. I think it's fair to ask if there are other ways to get the stuff into people's mouths, but all would amount to 'mass medication' or 'chemical adjustment', so it sounds as if you'd be just as concerned about any other method.

No-one is saying to follow without question - just that we know that the experts have thought of those questions and asked them already, rather than assuming that a)we've thought of something they haven't or b) they're trying to pull the wool over our eyes.

I don't think it's condescending to see the patterns in how people are swayed by psuedo-science on similar public health issues and point them out in an opinion piece. And I AM interested in that culutural shift question. I'm LESS interested in debating the value of fluoride and the "dissent" you mention - although I've been drawn into that - because that's an entirely different question. I'm happy to agree with Gluckman and others that the science is settled, as far as we know. But I am interested in why we seem to trust expertise less than we did and think we know better and what's caused this switch in the sort of people we trust. 

by william blake on June 10, 2013
william blake

A contributing factor to the distrust of science is its own open ended process, with its sensible avoidance of absolutes and ongoing empirical revision.

Couple this with big interest groups (tobacco, oil etc)that have levered into this open mindedness to put their agendas, whatever the proofs, equally, in the eyes of story hungry media, but unfairly or disproportionately. 

by Richard Aston on June 10, 2013
Richard Aston

"I am interested in why we seem to trust expertise less than we did and think we know better and what's caused this switch in the sort of people we trust. "

Tim that my friend is a very very good question . 

I am not sure less trust always moves directly to "we think we know better" but I can see the vacuum left from an absence of trust in experts is disconcerting for many and the temptation to fill it with anything could be huge.

In cultural change terms I wonder it the explosion of information may have something to do with it.  A side effect of which is we can now read a lot more about expert failures, about experts being bought - Big Tobacco had a few . I am not postulating another conspiracy theory just saying whats a ordinary Joe to do when a financial expert's advice turns bad or he gets misdiagnosed in hospital or he reads someone with scientific credentials who says global warming is not man made - see the impressive list here http://bit.ly/DmacJ  ( sorry don't know how to embed urls here) .

Who can you trust ? and what  do you need to form trust in someone?

Call me cynical but I need a bit more that "they are scientists ".  I have known a surprising number of scientists in my life, friends and relations. Without exception they were specialists , tightly focused on specific areas of knowledge. That focus is a strength and a weakness. 

 

 

 


by Peggy Klimenko on June 10, 2013
Peggy Klimenko

With regard to some early comments: Argh! It's FLUORIDE. Nobody's talking about putting flour in the water supply, I hope; too much of that, we'd be drinking wallpaper paste.

Characterisation of fluoridation as "mass medication" is disingenuous. Fluoride's modus operandi is to make tooth enamel more resistant to attack from mouth acids. It cannot cure disease - for all that those afflicted with tooth decay would like it to be otherwise.

@ M Croft, 08 June; the information that you've posted I assume is derived from the Hamilton City Council hearing. I found much of it - some, I think, word for word - on an Australian website "Offgrid Living".

In partial response, I insert here a quote from the Scientific Committee on Health and Environmental Risks (SCHER), one of the independent committees which gives advice on scientific issues to the European Commission. Around 2010, SCHER was asked by the Commission to review the latest evidence on fluoride.

Hexafluorosilicic acid and hexafluorosilicates are the most commonly used agents in drinking water fluoridation and it has been claimed that incomplete dissociation of these agents in drinking water may result in human exposure to these chemicals. The toxicology of these compounds is incompletely investigated. Recent studies have addressed the equilibrium of the free fluoride ion and fluorosilicate species in aqueous solutions over a wide concentration and pH range. In the pH-range and at the concentrations of hexafluorosilicates/fluoride relevant for drinking water, hydrolysis of hexafluorosilicates to fluoride was rapid and the release of the fluoride ion was essentially complete. Residual fluorosilicate intermediates were not observed by sensitive 19F-NMR. Other hydrolysis products of hexafluorosilicate such as Si(OH)4 are rapidly transformed to colloidal silica (Finney et al. 2006). Si(OH)4 is present naturally in drinking water in large quantities and is not considered a risk. In summary, these observations suggest that human exposure to fluorosilicates due to the use of hexafluorosilicic acid or hexafluorosilicate for drinking water fluoridation, if any, is very low as fluorosilicates in water are rapidly hydrolyzed to fluoride, as illustrated in the following equation:
H 2 SiF6 ( aq ) + 6OH − ( aq ) ⇔ 6 F − ( aq ) + Si( OH )4 ( aq ) + 2 H 2 O( l ) Studies on Na2SiF6 and H2SiF6, compounds used to fluoridate drinking water, show a pharmacokinetic profile for fluoride identical to that of sodium fluoride (NaF) (Maguire et al. 2005, Whitford et al. 2008). It therefore seems unlikely that the rate and degree of absorption, fractional retention, balance and elimination of fluoride will be affected if these fluoride compounds are added artificially in low concentrations, or if fluoride is naturally present in drinking water.

.................

Once absorbed, fluoride is rapidly distributed throughout the body via the blood. The short term plasma half-life is normally in the range of 3 to 10 hours. Fluoride is distributed between the plasma and blood cells, with plasma levels being twice as high as blood cell levels. The saliva fluoride level is about 65% of the level in plasma (Ekstrand 1977). Plasma fluoride concentrations are not homeostatically regulated, but rise and fall according to the pattern of fluoride intake. In adults, plasma fluoride levels appear to be directly related to the daily exposure of fluoride. Mean plasma levels in individuals living in areas with a water fluoride concentration of 0.1 mg/L or less are normally 9.5 μg /L, compared to a mean plasma fluoride level of 19-28.5 μg/L in individuals living in areas with a water fluoride content of 1.0 mg/L. In addition to the level of chronic fluoride intake and recent intake, the level of plasma fluoride is influenced by the rates of bone accretion and dissolution, and by the renal clearance rate of fluoride. Renal excretion is the major route of fluoride removal from the body. The fluoride ion is filtered from the plasma by the glomerulus and then partially reabsorbed; there is no tubular secretion of fluoride. Renal clearance rates of fluoride in humans average at 50 mL/minute. A number of factors, including urinary pH, urinary flow, and glomerular filtration rate, can influence urinary fluoride excretion. There are no apparent age related differences in renal clearance rates (adjusted for body weight or surface area) between children and adults. However, in older adults (more than 65 years of age), a significant decline in renal clearance of fluoride has been reported consistent with the age-related decline in glomerular filtration rates.

Approximately 99% of the fluoride in the human body is found in bones and teeth. Fluoride is incorporated into tooth and bone by replacing the hydroxyl ion in hydroxyapatite to form fluorohydroxyapatite. The level of fluoride in bone is influenced by several factors including age, past and present fluoride intake, and the rate of bone turnover. Fluoride is not irreversibly bound to bone and is mobilized from bone through bone remodelling.

The entire text can be found at http://ec.europa.eu/health/scientific_committees/opinions_layman/fluorid...

Those of us who've worked in the child oral health sector can attest to the difference that water fluoridation alone makes in smoothing out the differences in decay rates between low-decile and high-decile cohorts. I've worked in both low- and high-decile schools, and in fluoridated and non-fluoridated areas; the difference water fluoride makes in low-decile areas in particular is not just in the number of cavities, but where decay occurs on the tooth surface.  Any dental practitioner will know what I mean when I talk about the difficulty of dealing with lesions on the sides of molar teeth in quite young children, especially when one has to navigate around the tongue and salivary glands.

Anything we can do to spare children the necessity of such treatment, we should do.

by Ross on June 10, 2013
Ross

The Justice Minister described the decision variously as "gutless", "a cop-out" and "bollocks". Which sums it up nicely. The move will cost millions of dollars and thousands of teeth in the years to come.

How many countries in Europe put fluoride in their water? Relatively few I think. Are all those non-fluoride countries gutless? Maybe they're part of one giant conspiracy. Yeah that'll be it.

 

by Ross on June 10, 2013
Ross

Anything we can do to spare children the necessity of such treatment, we should do.

Of course, there are ways that kids can ingest or use fluoride without the entire population taking it. The pro-lobby seem to frequently miss this point. This might explain why they're increasingly losing the debate.

Moreover, it seems that using fluoride isn't going to prevent kids from having bad oral health. "34,000 children under 14 had teeth removed due to decay or infection in 2012."

http://www.stuff.co.nz/national/health/8199941/Dismay-at-tooth-decay-in-Kiwi-kids

by Tim Watkin on June 10, 2013
Tim Watkin

Ross, by your logic no-one should have a flu jab if even one person still gets flu afterwards? Of course hardly any treatment will prevent anything 100% (though some vaccines have eliminated some diseases), but it's a matter of minimisation and doing the most good for the most people. Oh, and there are different fluoride levels in Europe as I understand.

I'd argue that you're missing the point - what does it matter if "the entire population" drinks it? It's in water anyway and in NZ it's in lower doses than in many countries, so if it's raised marginally, what's the harm? A few anecdotes are misleading claims are made to create fear, but the science says there is no harm.

The "entire population" absorbs, consumes, inhales etc all sorts of things. As mentioned above, we all absorb sunlight that can kill us. Do you want to dim the sun as well?

As for other ways kids can ingest it - can it be done as cheaply and effectively? Can it be done, as Peggy points out, in a way that ensures it helps the rich and the poor?

by Ross on June 10, 2013
Ross

there are different fluoride levels in Europe as I understand.

Yes, there are but many countries do not use fluoride as far as I am aware. In the UK, only 10% of the population has access to fluoridated water.

As for other ways kids can ingest it - can it be done as cheaply and effectively?

How cheap and effective are fluoridation and is it necessary for the entire population?

by Ross on June 10, 2013
Ross

Ross, by your logic no-one should have a flu jab if even one person still gets flu afterwards?

Flu jabs are optional, Tim. Fluoridation isn't.

by Ross on June 10, 2013
Ross

As mentioned above, we all absorb sunlight that can kill us. Do you want to dim the sun as well?

Sun cancer is an issue, but then we're able to apply sun screen. Despite it's protective qualities, the use of sun screen is optional, not compulsory.

by Tim Watkin on June 10, 2013
Tim Watkin

Ross, this is part of my point about the collective good v individual choice. Is it necessary? No more than any public health good. Hospitals aren't necessary? They cost all of us, some of us have never used one, but given that they help many we decide they're worthwhile. If you look at it the other way round, I think you're asking the wrong question. Better to ask, does it do the most good for the most people?

I just don't think because it's universal, it's bad. I'll sacrifice some choice for the health of others. And I'm OK with taxes as well.

Um, the sun isn't optional. Sunscreen doesn't save everyone from cancer. By your earliest logic there's no point in sunscreen then. And all those teachers requiring kids to wear it before they go outside in the summer? Mass medication... You get my drift.

by Ross on June 11, 2013
Ross

Tim,

Here's what the Lord Mayor's Taskforce in Queensland said about this issue:

The decision whether or not to fluoridate a public water supply raises a number of issues of an ethical and moral nature, including such questions as whether fluoridation represents mass medication with an uncontrolled dose, and whether it is an infringement of the rights of the individual. Equally it can be argued that a failure to fluoridate deprives those in the community at most risk of dental decay of a health benefit. Taskforce members opposing fluoridation advanced arguments that it constituted mass medication, inter alia: 

- intended to produce an improvement in dental health, therefore a medication;

- administered without consent, therefore contrary to Nuremberg Tribunal standards;

- morally wrong because everyone is compelled to drink it .

Those supporting fluoridation were equally adamant that fluoride was a naturally occurring substance, and simply represents an adjustment to the natural level of fluoride in the water, comparable to the addition of vitamins or minerals to food.

It was clear to the Taskforce that there were no simple, ‘black and white’ answers to these questions... (my emphasis)

Despite there being no simple, black and white answers, you've called the Hamilton City Council's decision daft. I notice you haven't made any comment about Christchurch, Whangarei, Tauranga, Rotorua, Napier, Wanganui, Nelson, Timaru and Greymouth, which have never fluoridated their water, and New Plymouth, which no longer fluoridates. In fact, two-thirds of local councils don't put fluoride in their water - so Hamilton has joined the majority. You wouldn't know that from reading your article.

by Mike Woods on June 11, 2013
Mike Woods

According to Ministry of Health chief advisor for child and youth health, Pat Tuohy, anti-fluoridationalists are a “vociferous minority”.

Well let’s see who is in the minority on the fluoridation issue. 

For starters, although the World Health Organisation supports water fluoridation, of the current 35 member States only one, Australia, supports this policy. Also only 11 countries in the world have more than 50% of their population drinking fluoridated water, and only 5% of the world’s population drink fluoridated water. So who is in the minority here?

As for being vociferous just look at the outrageous derogatory remarks being uttered by Health department lackeys and their mainstream media shrills:  “Flat-earth conspiracy Nutters”, “Absolutely Gutless”, “Utter Cowardice”, “Bollocks”, “Witless imbecility”, “Crazies”, “Pseudo-scientists”, “Total cop-out”, “Stupid decision”.

Anti-fluoridationalists prefer an honest debate based on scientific evidence.  Unfortunately no one from the Ministry of Health or the Otago dental school were willing to debate the pros and cons of water fluoridation with expert Professor Paul Connett on his previous two visits to New Zealand.

When people are on the back foot and have not done any real research they feel backed into a corner and like rats they leave their brains behind and come out with their teeth barred spitting venom and attempting to rip and tear their adversary apart with their claws and teeth. It doesn’t always work though!

by Pete250 on June 11, 2013
Pete250

I have done over 1500 hours research on fluoride and fluoridation. There was a real purpose when I was once a Councillor. Some simple advice. Before commenting on fluoridation one needs to do the research and it is so obvious which side of the camp has and which side has not. Demonising rhetoric just doesn't hold up against research. There was a man who lived quite close to you back in the 90's that is one of my heroes. His name was Dr John Colquhoun. One day he will be properly recognised for his great contribution to science in New Zealand! To make it easy for you here is a YouTube that tells his story. Watch and listen and start your education about fluoridation. This man was the person mainly responsible for the Fluoridation of Auckland, then he woke up! http://www.youtube.com/watch?v=e8th-Bbb0LQ&feature=share

by Tim Watkin on June 11, 2013
Tim Watkin

Ross, it's not an articles it's an opinion piece of a length people might actually read; I'm not required to detail the history of every council and I'm reacting to a news story in which I agree with the comments of a senior minister (for a change). Not sure what your problem is about that.

I'm delighted you've got the Lord Mayor's taskforce expressing doubt. If Australia's your go-to place, I'll raise you The National Health and Medical Research Council in Australia and call you with all the other research already quoted.

My argument is not about claiming a black and white world, but as I've repeatedly said, but about showing respect for proper science, scientists and the scientific method rather than quackery and people who insist 1+1 = 4.

@Mike, it rather undermines your claim to the high moral ground when criticise "derogatory remarks" and call those who disagree with you "lackeys" and "shrills". Can't have it both ways. I think was pretty careful to criticise the decision not the people in my post, as per Pundit's rules of engagement. But that doesn't stop me saying that I have little respect for the arguments pulled together by people who ignore science's best and declare themselves experts.

Look at Pete, above. He's obviously not even read the previous thread comments about Colquhoun and expects us to be impressed by 1500 hours "research". Was that perhaps by reading claims online and watching Youtube? How much of it was actually  studying medicine or dentistry? And am I expected to stack his 1500 hours against the study and careers of Pat Touhy or Peter Gluckman and conclude that, yep, thank goodness Pete has seen through their cunning plan to poison us and asked all the right questions that they obviously never thought of?

 

by Ross on June 12, 2013
Ross

And am I expected to stack his 1500 hours against the study and careers of Pat Touhy or Peter Gluckman and conclude that, yep, thank goodness Pete has seen through their cunning plan to poison us and asked all the right questions that they obviously never thought of?

Goodness, Tim, why even bother having a debate if Pat Tuohy and Peter Gluckman have all the answers? Both of us could have stayed in bed!

by Ross on June 12, 2013
Ross

I'm not required to detail the history of every council and I'm reacting to a news story in which I agree with the comments of a senior minister (for a change). Not sure what your problem is about that.

I didn't suggest you had to detail the history of every council. What you could have said was that Hamilton had joined the majority and that only one-third of councils fluoridated its water.

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