Cui Bono
My previous blog ended with alliances being formed. “This political, legislative and fiscal background allowed a Council decision without resort to a referendum. With respect to community water fluoridation in New Zealand, Hastings represented the primary interface between science and politics. Moreover, protagonists demonstrated that the weight of scientific evidence could produce a favourable executive response in the political domain.
The school dentists in the area of the experiment were instructed (cui bono?) to change their method of diagnosing tooth decay, so that they recorded much less decay after fluoridation began. Before the experiment they had filled (and classified as “decayed”) teeth with any small catch on the surface, before it had penetrated the outer enamel layer.
After the experiment began, they filled (and classified as “decayed”) only teeth with cavities which penetrated the outer enamel layer. It is easy to see why a sudden drop in the numbers of “decayed and filled” teeth occurred. This change in method of diagnosis was not reported in any of the published accounts of the experiment.
However, this was the end of the “honeymoon” era of United States’ acceptance of adjusted fluoridation (Akers and Porter,2004). In November 1953, after the Hastings plant had been in operation for about eight months, opposition emerged that coincided with the election of a new mayor and five new councillors. This was the beginning of a New Zealand anti-fluoride movement, and it grew quickly.
Hastings 1954-1957
A brief account of events at Hastings between 1954 and 1957 is worthwhile because it demonstrates the role of national political and bureaucratic resolve in maintaining community water fluoridation in New Zealand. In response to an enquiry by the new Council in March 1954, the Director-General of Health (J. Cairney) advised the Hastings Borough Council that the “Municipal Corporations Act (1954) gave them authority to do things necessary for the preservation of public health and that he ruled that fluoridation of a public water supply is for the preservation of public health” (Taylor, 1955).
Several months later, the Director of the US National Institute of Dental Research (F.A. Arnold) and English researcher G. F. Parfitt visited Hastings and gave public assurances about the safety and effectiveness of community water fluoridation. Fluoridation continued.
Sir Dove Myer Robinson
The 1956 election of articulate anti-fluoridationist Sir Dove Myer Robinson (born Mayer Dove Robinson aka Robbie) as the Mayor of Auckland was a political setback for fluoride advocates (Fuller, 1997). Either perceiving the increasing political unease or mirroring the U.S. Public Health Service policy, the New Zealand Dental Association’s 1956 edict “Fluoridation” acknowledged the importance and desirability of community water fluoridation but continued:
“The Dental Association believes that the request for fluoridation should come willingly from the public and realises that extensive dental health campaigns may be necessary to inform people of the correct facts…” (The Executive of The New Zealand Dental Association, 1956).
Adversaries in the Public Domain
New Zealand’s fluoride advocates now had to engage their adversaries in the public domain. Paradoxically, developments at Hastings became vexatious; this carried obvious consequences for the future of fluoridation in New Zealand. It was a “project” or “demonstration” and problems of scientific method negated any prospective status as a field trial (Ludwig, 1958).
The abandonment of the control city (Napier) because it had a lower initial caries rate than that of Hastings (Ludwig, 1958) implicated soil science as a confounding factor in New Zealand cariology (Ludwig and Healey, 1962; Ludwig, 1963). Moreover, the inappropriate original fluoridation equipment produced variations in fluoride concentrations, which disrupted the MRC’s before-and-after-fluoridation dental investigations (Ludwig, 1958).
The changing of NZSDS (nz-specifier defined string)” diagnostic criteria for caries and the cessation of the NZSDS nurses’ practice of prophylactic restoration of fissures further confused interpretations. While later anti-fluoridationists justifiably claimed that the changed diagnostic criteria contributed to the fall in caries (Colquhoun, 1999), their “science or swindle” questioning of methodology and findings (Colquhoun and Mann, 1986; Colquhoun, 1998; Colquhoun and Wilson, 1999) simplified confounding variables and dismissed international evidence supporting community water fluoridation as one factor in declining community caries incidence (de Liefde, 1998).
However, to defend the Hastings backdrop much of which was in the public domain by 1958 presented obvious difficulties. Growing public opposition at Hastings and an injunction to stop fluoridating stalled further fluoride implementations in New Zealand. Furthermore, Hastings Borough Council decided to conduct a poll that “required central government approval” (Colquhoun and Wilson, 1999).
A referendum carried significant ramifications because the pioneering background of the Hastings proposal and the emotional nature of fluoride politics impeded objective debate in the media. Moreover, the caries epidemic remained an urgent national problem.
A Question of Methodology
In addition, at this critical time in the formation of public opinion in New Zealand, Exner and Waldbott published their book The American Fluoridation Experiment, which questioned the methodology of the North American field trials under the catch phrase of “twenty-eight million guinea pigs” (Exner and Waldbott, 1957). This background explained the National Government’s intervention with a commission to authoritatively assess community fluoridation as a public health measure.
New Zealand’s early fluoride advocates enjoyed a fortuitous topography, demography and constitutional background, which laid the foundations for their contagious culture of multi-disciplinary research and institutional liaison. To an external and retrospective observer, New Zealand’s public dental policy was visionary. This also contributed to the nation’s early penchant for community water fluoridation. Moreover, exceptional dental epidemiology and political resolve further underpinned the pre-1970 implementation of community water fluoridation.
However, in spite of New Zealand’s early contribution to the international fluoride debate, a paradox exists. Although behavioural scientists and historians have intermittently examined fluoride-related controversy, the failure of political scientists to fully integrate the role of centralised political authority with the weight of scientific evidence remains a surprising inadequacy in the New Zealand literature.
A tale of Two Cities: Napier (Non-Fluoridated)
Another city, Napier, which was not fluoridated but had otherwise identical drinking water, was at first included in the experiment as an “ideal control” — to show how tooth decay did not decline the same as in fluoridated Hastings. But when tooth decay actually declined more in the non-fluoridated control city than in the fluoridated one, in spite of the instructions to find fewer cavities in the fluoridated one, the control was dropped and the experiment proceeded with no control.
The claimed excuse was that a previously unknown trace element, molybdenum, had been discovered in some of the soil of the control city, making tooth decay levels there unusually low, but this excuse is not supported by available information, from the files or elsewhere, on decay levels throughout New Zealand.
The initial sudden decline in tooth decay in the fluoridated city, plus the continuing decline which we now know was occurring everywhere else in New Zealand, were claimed to prove the success of fluoridation. These revelations from government files were published in the International Environmental Journal, The Ecologist, and presented in 1987 at the 56th Congress of the Australian and New Zealand Association for the Advancement of Science.”
Cui Bono
Cui bono, literally means ‘as a benefit to whom?’ Let me direct you then to district forums being staged throughout our region entitled: Central Hawke’s Bay: Owning Our Future ‘Building Prosperous Communities for our Grand Children.” They are a Council initiative in collaboration with CHB Promotions and John Wise who has been contracted to assist with the facilitation of these district forums. John is a practitioner with many years experience at the leading edge of Community Economic Development.
By now, you will have established that my position is firmly in the AGAINST fluoridation camp. I’m NOT a social, political or any other kind of scientist. I’m an ordinary person. I’m sure Council has no wish to speak with a forked tongue, so I urge it to reconsider again its ability to rescind its motion to continue with the fluoridation of our town’s water supply.
Cui Bono, as a benefit to whom? Nga mokopunas, for its grandchildren. No rocket science needed there. Nga mokopunas, for its grandchildren, plain and simple.
* This is 5 of a 7 part blog. The NEXT blog is entitled ‘Water Water Everywhere’
