Making Science-based Decisions
There are a lot of tough, fact-based questions in our everyday lives. For most of us, whether or not Trump won re-election is not one of them.
However, for an inordinately high number of questions that should be answerable through scientific inquiry, it is a struggle to balance conflicting studies and to separate independent research from efforts to produce scientific results that will sway purchasing dollars. At the same time, a variety of considerations, including a lack of funding for research with no foreseeable profit advantage, may result in a dearth of scientific findings on some matters. The lack of an unambiguous scientific conclusion on a matter that ideally would be resolved by science often leaves scientists or government officials to weigh the ethics of a situation in responding to public health concerns.
The lack of a consistent process for making highly impactful decisions related to public health in instances where the science is not definitive is as apparent today with regard to communications regarding the utility of nutritional supplements in mitigating Covid-19 as it has been for years in relation to fluoridated drinking water.
Covid-19 and Nutritional Supplements
When Covid-19 first started to be recognized as a serious health concern, many natural health practitioners recommended ingesting high doses of vitamins, C, vitamin D3 and zinc to aid the immune and respiratory systems. Their rationale was that these supplements support a healthy immune and respiratory system and there has been no credible evidence that ingesting relatively high doses is harmful.
There were, of course, no studies at that time regarding the benefits of these supplement to treating Covid-19. However, hospital efforts in China and European countries as well as anecdotal commentary from doctors began to indicate a significant value in supplementing with these vitamins and minerals. A study performed in Spain in September 2020 provide compelling evidence of the efficacy of Vitamin D3 to manage Covid-19 when half of the 50 patients that did not receive vitamin D3 were admitted to the intensive care unit while only one of the 50 patients that received a high dose of vitamin D3 was admitted to the ICU.
In general, governments around the world did not take clear and convincing steps to notify the public regarding the probable benefits of taking these supplements to mitigate Covid-19. In an article published on January 10, 2021, The Guardian quoted UK public health experts as asserting that there is insufficient evidence to warrant this recommendation and expressing concern that if people were told that these supplements might protect against Covid-19, they might be less cautious in efforts to avoid being exposed to Covid-19. To-date, much of the reporting on the utility of Vitamin D3 in combatting Covid-19 remains indefinite but somewhat optimistic.
In the case of Covid-19, experts and government bodies opted not to share information with their constituents that could have minimized the effects of Covid-19. There is insufficient evidence to conclude that the public would have adopted the recommendations to take supplements but not the recommendations/requirements to engage in social distancing or wearing masks. Moreover, there is no evidence that mask wearing and social distancing provide superior protection than is provided by taking the immune supporting supplements, or vice versa. Accordingly, there is only a tenuous argument that not sharing the information had any upside to it for any member of society while there was no credible downside to widely promoting the use of these supplements as a defence against Covid-19.
In deciding not to recommend vitamin D3 supplements to the public, government officials and their scientific bodies made an incorrect, possibly devastating, public health decision.
Fluoride and Municipal Water
Sodium fluoride has been added to drinking water for decades, based on government assertions, supported to some extent by scientific research, that doing so poses minimal health concerns while reducing dental caries.
A number of dental organizations around the world, the US Center for Disease Control and the World Health Organization publicly continue to reflect this view and assert that the research supports their position.
Fluoride is a commonly prescribed medication in the US. It is prescribed largely in oral form (tablet, mouthwash, oral drops, toothpaste) to prevent cavities. So, a lot of American doctors and dentists seem to believe it works. Some researchers are studying whether prescribing fluoride as part of a treatment program could help address other health concerns such as rheumatoid arthritis. Clearly, despite sodium fluoride basically being an industrial waste by-product, scientists do not generally dismiss it as a possible medication.
Despite the apparent support for fluoridated drinking water and its relatively low price tag, just 24 countries, accounting for less than 6 percent of the world’s population, opt to fluoridated drinking water.
China, Japan, and many European countries have stopped adding fluoride to their drinking water. The US, Canada, Australia and New Zealand continue to do so. There are research finding supporting both approaches.
The European Scientific Committee on Health and Environmental Risks concluded in 2010 that there is strong evidence that the topical application of fluoride is effective in preventing tooth decay. The SCHER concluded that evidence regarding the effectiveness of fluoridated drinking water is “less convincing.”
There is some evidence that sodium fluoride may be corrosive to titanium-based dental implants, causing small metallic particles to leak into human tissue, which may cause damage to certain organs. Numerous studies have concluded that a range of adverse health implications are attributable to ingesting sodium fluoride including, dental and skeletal fluorosis, brittle teeth and bones, osteoarthritis, calcification of tendons and ligaments, osteosarcoma, neurological issues, endocrine issues, lowered IQ and other health implications.
These studies support the conclusion that as fluoride intake increases, so does the prevalence and severity of a multitude of health concerns.
While not deliberately adding fluoride to drinking water, some areas of China have very high levels of fluoride in the water due to industrial contributions. Consequently, the researchers were able to evaluate fluoride intake levels from 0 mg to 10 mg per day.
Since there are a number of countries that have stopped adding fluoride to municipal water, studies have been done to determine whether this change impacted the incidence of dental caries within the population. After reviewing the conflicting research in this regard, the SCHER concluded that “there has been a consistent decline over time in tooth decay in 12 year old children from the mid-1970s, regardless of whether drinking water, milk or salt are fluoridated.”
Based on public comments made by responsible government officials, it seems that some countries found insufficient scientific evidence to justify fluoridation. In countries that recognized that fluoridated drinking water could potentially benefit some members of the population, officials had concerns about the health risks it posed to others. They noted that there are alternative ways to provide fluoride to individuals who would benefit from it, and the alternatives would not necessitate subjecting others to “forced medication.”
Some authorities concluded that a decision to add fluoride to drinking water would unnecessarily prioritize the benefits to one group over the risks to another.
Clearly, reasonable scientific minds can reach opposing conclusions on this issue. Where the science unsettled, governments should not effectively mandate their constituents ingest medication.
Typically, most fluoride is ingested from drinking water and other beverages made with fluoridated water (e.g., coffee, tea and commercial soft drinks and other beverages manufactured in locations with fluoridated municipal water). Filters can be purchased for home use to remove the fluoride from tap water.
These issues are far from the only instances where the science seems so muddled that experts widely disagree and a decision must be made based largely on ethics rather than science. In such instances, often a group of scientists is charged with making a decision based on factors other than science on a science-related issue. In some instances, scientists present their decision as if it were supported by incontrovertible scientific proof. Arguably, these scientists were not elected, hired, appointed or qualified to make decisions that are not science-based. The public should not be misled into believing science has definitively settled a matter when substantial uncertainty remains.
Questionable decisions like these exacerbate the public’s already low inclination to trust their government. Holding back on information and asserting that decisions are science-based when the science is muddled at best and absent at worst is going to continue to erode public trust in government. Members of the public will continue to draw their own conclusions through a combination of access to multiple primary and secondary sources of information and advice obtain from experts with an email list/social media following who keep them informed using readily understandable language and citations to primary sources.
Governments can no longer effectively control the message. If they seek to be the final arbiter on matters of public health, they need to foster public trust through open and honest communication.