The most important element of water fluoridation

The subject of water fluoridation in New Zealand can turn a casual conversation at a typical summer BBQ into a parliamentary debate complete with petty comments, unrepentant fallacies and the raising of blood pressure on both sides. Pro fluoridation and anti fluoridation advocates alike tend to take their stances quite firmly and proudly. And so they should, this is New Zealand, the little island known for being adept at navigating the waters of social change and allowing citizens to retain their right of choice.

But there are elements about water fluoridation that poses a real quandary for both sides of the controversy. Does water fluoridation equate to forced mass medication and therefore does the consideration to fluoridate New Zealand water diminish our rights as individuals to choose what we ingest? If we minus the arguments surrounding the safety, efficacy and cost effectiveness of water fluoridation from the debate the one remaining facet is that of the ethics of water fluoridation.

I guess I need to admit something before continuing. I believe that water fluoridation could be incredibly helpful in New Zealand.  The scientific research I found completely dismissed anti fluoridation’s arguments that water fluoridation causes cancer, kidney problems, and oh of course, the mildly humorous proposition that fluoridated water drops the I.Q of people drinking it. However mention the ethical stance that water fluoridation results in a “nanny state” and I leap right over to the side of anti fluoridation, proudly waving my placard renouncing the medication of the masses by our over bearing government.

I doubt I differ from most pro fluoridation advocates.  I suppose many of them would agree that forcing strategies like water fluoridation on people sounds slightly archaic. And then they could swiftly justify the ethical element by stating that the benefits outweigh the risks.  But it is that need to disprove the other side and swift justification that will hinder the debate in the long run.  The ethical implications that are faced by water fluoridation need to be discussed by both sides.  Not just used as a tool to support their respective arguments. But to be used to start a conversation about what is good for all of New Zealanders.

New Zealand has long been a front-runner in advancing the rights of its citizens.  We were one of the first countries to give women the right to vote, to legalize prostitution, and to legalize gay marriage.  Why should we turn our back on human rights now to incorporate a strategy that essentially removes our right to choose? I am confident that New Zealand can make the right decision but only if we choose to identify the most import factor in this debate: Is water fluoridation ethical?

Does water fluoridation cause bone cancer?

For my position paper I argued that all community water resources should be fluoridated in New Zealand. There were vast amounts of literature and primary research arguing that water fluoridation is safe and effective, and that community water fluoridation provided the best defense against dental caries and improving oral health. On the other hand it was not easy to find good research that supported the opposing side of my argument.

I was pleasantly surprised to find opposing journal articles about primary research on the relationship between water fluoridation and bone cancer. I felt that it was important to address this claim, which has predominately come from the anti fluoridation side, in order to address the claim that water fluoridation is harmful.

The first article supports the anti fluoridation argument and researched the link between bone cancer and water fluoridation in the United States and was conducted by Elise Bassin, David Wypij, Roger Davis and Murray Mittleman (2006). This study compared the incidences of bone cancer against the individual’s exposure to fluoridated water. They used logistic regression; method of finding statistical probabilities, to show that males under 20 years of age residing in areas of community water fluoridation have an increased risk of developing bone cancer and concluded that there was an link present. This conclusion was reached due to the fact the authors had to estimate what level of fluoride each subject would have been exposed without being able to obtain actual fluoride levels from each respective area. Bassin et al. (2006) clearly had confidence in their findings, however, no causal relationship was found during this research meaning that they did not prove that water fluoridation causes cancer.

The opposing argument to the previous research study is that there is no link between bone cancer and fluoridation water and that water fluoridation plays no part in causing the occurrence of bone cancer. This second research article substantiates this claim and was completed in Ireland by Harry Comber, Sandra Deady, Erin Montgomery, and Anna Gavin (2011). The research compared bone cancer occurrences and whether the patient had resided in a fluoridated or non-fluoridated area. The data shows no difference in the number of bone cancer diagnosis of those living in an area with water fluoridation present and those living in no fluoridated areas. Therefore, Comber et al. (2011) reached the conclusion that there was no relationship between ingesting fluoridated water and the development of bone cancer, causal or otherwise. The data used in this study was easy to understand and clearly showed no relationship which I believe strengthened the authors’ findings that there was no link between water fluoridation and bone cancer.

Bassin, E. B., Wypij, D., & Davis, R. B. (2006). Age-specific fluoride exposure in drinking water and osteosarcoma (United States). Cancer Causes Control, 17, 421-428.

Comber, H., Deady, S., Montgomery, E., & Gavin, A. (2010). Drinking water fluoridation and osteosarcoma incidence on the island of Ireland. Cancer Causes Control, 22, 919-924.

My lesson with literature

I have always had a lot of confidence in the way I research backed up by the fact I attended the online seminars offered by the library, took notes and established a research routine early on that I have stuck to persistantly.  Although I have often been disappointed to never achieve an A grade I have never thought that my research routine may have played fault in that.  This week I learned better.

To start with I researched the web for the basic topic background for my position paper on the fluoride debate i.e. Wikipedia, fluoridefree.org.nz, and the Ministry of Health website.  With an overall view of the topic and some keywords to search with I hit the library online resource search engines.  Discover gave me some great resources so I skimmed through abstracts and selected 15 or so journal articles that I felt were relevant.

I then got stuck into reading those journal articles and writing a basic outline of my position paper. I never second-guessed the articles I had picked until I started on our weekly lessons.  I felt confident using the library so I choose to skim through the first week’s lectures and focused on week two’s lessons in case there was something new to learn.  While watching lesson one of week two I started to question how I selected my chosen journal articles.  I started to think about how I researched and why.  It stopped me in my tracks.  I went back and watched every lecture again and formulated a new plan of my research steps. I also critiqued how I had carried out my previous research for the position paper. Whoa Lorde what I found!!! My list of research sins is the following:

 - Becoming complacent about using the peer-reviewed filter, 

 - Selecting my articles from one search done by Discover and not bothering to check results for keywords in other engines,

 - Not researching who the author is and their credibility

 - Not checking the year of publication or if the information contained was relevant!!

Now excuse me while I hang my head in shame. My previous confidence was unfounded but alas I can see the error of my ways.  I set up a basic research plan early on and then never revised or questioned the process again.  In psychology speak one would say I made a familiarity heuristic i.e. I took a mental short cut to decide confidence in my researching skills because the way I researched had worked for me before.  This heuristic allows people the world over to continue to make the same mistake repeatedly, never realizing the problem. What works for me is my willingness to change how I work to better what I produce and that definitely played a part in realising my mistakes.  I realize I won’t become an A grade student overnight but I will get there. In the meantime I will strike infallible off my list of student characteristics and savor the fruit of a lesson learned.  Time to get that rough draft complete and start editing my heart out!!!!