The Precautionary Principle.


My attention was drawn today to an excellent article in The Guardian newspaper by Andy Stirling, Professor of Science and Technology Policy at Sussex University.

www.guardian.co.uk/science/political-science/2013/jul/08/precautionary-principle-science-policy

Prof Stirling argues a case that often, people who advocate taking a precautionary approach are accused of being “unscientific” or “anti-technology”. He cites as examples asbestos, lead, benzene, pesticides, ozone-depleters and overfishing. He argues that in each of these cases, “early precautionary action was dismissed as irrational by governments, business and scientific establishments alike – claiming there were no alternatives”. Yet, in every case, there actually were viable alternatives available, and that the levels of risk were “quite significantly understated” by the proponents of these innovations at the time.

He also cites GM food and nuclear power as present-day examples where the precautionary principle is being overridden in favour of a full-speed ahead agenda. He discusses the relationship between risk and uncertainty, and points out that, typically, the burden of proof falls more heavily on the people who are advocating the precautionary principle, and that all decisions made in these circumstances are essentially political decisions. He asserts that the “balance of emphasis tends to favour those products with most powerful backing”.

Sound familiar? Prof Stirling could easily be describing the fluoridation debate. Yes, it has been going on for a long time, fluoridation is hardly a new innovation. And, yes, most fluoride advocates assert that the debate has been “settled” a long time ago. But, if it really has been “settled” in favour of fluoride, how come the recent tribunal hearings in both New Plymouth and Hamilton, where the actual evidence was presented by both sides: how come in both cases the tribunal ruled in favour of the precautionary principle? It would seem that, by any reasonable standard, if it has indeed been “settled”, that it was actually settled in the opposite direction to what is being claimed!

That being the case, let us now work from the basis that it has not actually been finally “settled” at all. Prof Stirling also makes the point that in cases like this, where there is uncertainty, the notion that making a decision based entirely on science “is an oxymoron”, the decision is inevitable political. He also discusses the scenario of using "policy-based evidence" to assert some pre-decided outcome. Sound familiar? In the case of fluoridation in NZ, the “policy-based evidence” is continuously used by the health authorities to indeed justify a pre-determined decision.

By “policy-based evidence”, I include the bland assurances that all the “alarmist” precautionary-principle based health risks of fluoride in the human body are “unsubstantiated, and “lacking in evidence”. This (supposed) lack of hard evidence of harm is then used as a justification for labeling the people advocating the precautionary principle as “nutters”, flat-earthers” and “scare-mongerers”, as well as being “unscientific”.

I remind the reader of this blog of what I said in yesterday’s posting, about the health risks of fluoride to renal patients, and that I have been unable to find any research or studies regarding this. All we have are some more of these bland assurances, with no actual supporting evidence.

However, it is ignored that the actual reason for the paucity of really high-class evidence is that the full-speed-ahead pro-fluoride people are the same people who control the purse-strings of health-related research grants, and they have sat on their hands for about sixty years and done absolutely nothing to produce any really high quality studies or research that proves their thesis, of the absolute safety of fluoride in drinking water, at 0.7 to 1ppm concentration, once and for all.

Why? A cynic would ask, “What are they hiding”, and indeed at the tribunal hearings, this question was asked, but not answered. That question was met with a deafening silence from the “pro” side of the debate, apart from their usual carefully-worded bland assertions. If you do not believe me, watch the videos of the evidence yourself on the Hamilton Council’s website…

www.youtube.com/user/HamiltonCityCouncil/videos?view=0

So, getting back now to Prof Stirling’s argument in favour of the precautionary principle. I suggest that what has actually happened over the past sixty years is that there has been a growing awareness among many people that the pro-fluoride case is actually very dodgy, despite all the bland assurances, and that, in the absence of any actual proof to support those assurances, the precautionary principle should apply. This is basically what some of the Hamilton Councilors said during their decision-making debate, which is also in video form on the Council website, and in remarks that some of them have made since then, including this very good interview with Cr Dave Macpherson…

www.youtube.com/watch?v=Zcu7XIIZyt4

So, what are the viable alternatives to fluoridation? These are well-known and have been widely canvassed. They were discussed extensively at the Hamilton tribunal, and also at the Thames District Council Annual Plan Hearings, where one of the councilors posed a direct question to the Waikato DHB Chief Dental Officer, asking the question would water fluoridation be needed at all if it was possible to have a really effective oral health programme for all children? The answer was “No, fluoridation would not be needed, if that was possible.”

So, that is the alternative. It is well-known, and both sides of the debate agree on it. Why cannot we all work together to find ways to implement such a programme? This same question has recently been asked of the MOH by the Thames District Council, and I will examine this discussion in a future blog, as it is very interesting, and is closely related to my interest in the power, policy and authority issues surrounding the fluoride debate.

Hello everybody, Peter Archer here.

In this blog, I will be posting details of my research project on the subject of the social science of the issue of water fluoridation in New Zealand. I am an undergad student at Massey University, majoring in anthropology, with a focus on what is known as “medical anthropology”, which is the study of the social science of the medical system. I have recently completed two papers in medical anthropology, with good grades (a B and an A), and am presently enrolled in two more anthropology papers, one on Food and Eating, the other one on Practice of Fieldwork. (These will be my fifth and sixth anthropology papers. Nine are needed for a major for my degree, and I sometimes describe myself as an “ultra-mature” student.)

For my Practice of Fieldwork paper, I am going through the process of planning a fieldwork research project, and I have chosen fluoridation in NZ as my research subject. I plan to research this using the method known as “participant observation”, which is the fieldwork method that most anthropologists use in undertaking their fieldwork research. When undertaking participant observation, it is normal to actually take part in the everyday activities of the group of people being researched, to actually join in and participate as an active member of the group.

In this research project, I am participating as a member of the anti-fluoride movement. I make no pretence of being “unbiased” or “objective” in this. I am not a “detached observer”; I am an integral part of the group of activists, and I make no apology for this. In modern-day anthropology practice, it is very normal for the researcher to also be an advocate for the group that he/she is studying: to not only study the people and the subject, but to also take a partisan position of being an advocate for them. In other words, the researcher has a social conscience, and does not attempt to hide behind a façade of “neutrality” or so-called “objectivity”.

In my case, I only became an anti-fluoridation advocate from early 2013. Prior to that, I had avoided taking a position on the issue, and had kept an open mind on the subject. Our local council (Thames) was reviewing fluoridation of the Thames water supply, and had called for public submissions. I decided to do my own research on fluoridation, expecting that either the evidence would be inconclusive, or that maybe the health authorities were correct and that fluoridation of the water supply was indeed relatively safe and also effective in reducing tooth decay.

What I discovered really surprised me, and the deeper I looked, the more surprised I became. In my opinion, the evidence is actually fairly clear. Fluoridation of the public water supply is of very dubious value, and there are some serious concerns about the health effects, especially long-term, and very little evidence that these concerns are either trivial or vexatious. I was especially concerned to discover that it is very difficult for fluoride to be excreted from the bodies of renal patients, people with kidney failure, as I am a renal patient (I am on peritoneal dialysis).

I cannot find any research, or any studies, regarding whether or not fluoride is able to escape from the body of a renal patient. Not even any simple, low-cost trials to take blood, urine and dialysis fluid samples from renal patients, testing to see how much fluoride is being excreted from the body by the various potential exit pathways. I have raised this issue with my doctors. I have asked public questions at the council fluoride hearings. Nobody has any answers. Nobody has any idea. I have been met with a wall of silence on this issue.

Yet, there are thousands of renal patients, just like me, out there in the community. Who is speaking up for them? Most of the focus in the fluoridation debate is about teeth, specifically children’s teeth. I find it incredible that the teeth of my neighbour’s children merits so much attention, and yet the physical health of thousands of very vulnerable renal patients is being ignored. If I am wrong, and there is indeed nothing to be concerned about, then where is the evidence? To date, I have not been able to find any evidence.

As I understand it, when fluoride is ingested into the body via the digestive tract, some of it is immediately excreted in the urine, and some of it ends up being stored in the bones, the teeth, and also in various soft tissues, including the thyroid gland, the pineal gland, and the brain (it crosses the blood-brain barrier). There are also some suggestions that fluoride itself can somehow effect the kidneys. The standard response from the pro-fluoride health authorities is that such talk as this is “unsubstantiated scare-mongering”. Maybe it is. Maybe I am being misled. But, I have not seen any real evidence that my concerns are unfounded. Where are the detailed, high-quality studies? I have not been able to find any. Why have no such studies been done?

Because as a renal patient, I cannot afford to take risks with my health, I have decided to do two things. (1) I am continuing my research, including this project. (2) I have taken myself off fluoride. I have moved away from Thames, where the water is still fluoridated, to the Hauraki District, which is not fluoridated. My personal anecdotal evidence is that since ceasing to ingest fluoride, I feel generally better. I feel less tired, and I sleep better. It’s only anecdotal evidence, but it is my body that is feeling better, which, in the absence of any other proper scientific evidence, is the best I can do for now.

The point is, for a person with renal failure, it is obvious that all forms of toxins are excreted from the body at a slower rate than in a “normal” person with healthy kidneys. Can fluoride be removed by dialysis? Nobody seems to know. Even if it can, what about the renal patients who are not on dialysis? Those whose kidneys are marginal. Nobody seems to know.


My Research Project

Getting back now to the subject of my research project. While I am also very interested in the science aspects of the fluoridation issue, by project is mainly about the social science. For example, what do people think of fluoridation? How do they make their decisions as to whether or not they approve of fluoridation? Do they believe the authorities? Why? Do they believe the anti-fluoride people? Why?

Also, what are the (mainly hidden) power structures involved? Who is making the key decisions, and what is their motivation? Who holds the actual power? What is the role of government? Why is government taking the stance that it does? Why is our government’s stance different from many other governments in various other countries? What about the Dental Association, the Medical Association, the Ministry of Health (MoH), the District Health Boards (DHBs), and the WHO? Why are they so vehemently in favour of fluoridation? What is really behind this? Who holds the real power, and why is that power being wielded in the manner that it is?

Alongside, and related to, my participant observation fieldwork of this research project, I will be attempting to explore those questions. I will be applying my knowledge of various social science theories in an attempt to shed at least some light on the answers to those questions. Specifically, I will be applying the social science theories of three well-know theorists to these questions. Michel Foucault, Pierre Bourdieu, and Eric Wolf. I will explain some details of their pertinent theories on this blog as the project progresses.

I will also be doing extensive literature searches as my project proceeds. I will be looking for peer reviewed journal articles on both the physical science of fluoridation, and the social science. I will cite some of these in my project, and I will no doubt critique some of them.

At the end of this project (not that there ever will really be an “end”, it is the kind of issue that is never really totally finished), I will be writing an ethnographic-style account of my experiences. “Ethnography” is the kind of writing that anthropologists (and, now, other social scientists, like sociologists) often undertake, in the form of a book. There is a long tradition of anthropological ethnographic writing, going back to the nineteenth century, and it is my intent to produce a book that will shed some light on the subject of fluoridation from a different viewpoint than what is used by any of the other existing books on the subject. Some of the material that will end up in my book will be published on this blog as I undertake my research, so you can effectively “read over my shoulder” as we go, and all constructive suggestions will be gratefully received.

That will do for the basic introduction. In my next posting, I will introduce you to some of the details of the social science theorists: Foucault, Bourdieu and Wolf, and attempt to explain some main points of their theories and how I see them applying to the power structures of fluoridation.