Bradfield Resident

Information. Issues. Insight. Investigation.

Fri 11 Sep 09 | To: Health On the Net Foundation | Australian Dental Association (ada.org.au) HONcode compliance

Posted by bradfieldresident on 11 September 2009

[Note: the “AMA” reference toward the end was a typo accidentally propagated from the previous email and should, of course, be “ADA”.]

From: Bradfield Resident <bradfieldresident@gmail.com>
Date: Friday 11 September 2009 00:39 (+10)
Subject: Australian Dental Association (ada.org.au) HONcode compliance
To: honcode-en@healthonnet.org

Health On the Net Foundation,

it is unclear as to whether your email is in response to my original email complaint on 25 August (https://bradfieldresident.wordpress.com/2009/08/25/to-health-on-the-net-foundation-honcode-principles-and-the-australian-dental-association/), to my online form submission on 28 August, or both. I write here assuming the email complaint (with considerably more information than the online form submission) was considered.

I find some of the explanations offered with regards to the Australian Dental Association website’s compliance with the published HONcode guidelines to be quite weak, especially considering the ostensible aim of the HONcode to improve the quality of medical information published online.

Principle 1 – Authority

The “ADA Inc. Oral Health Education Committee” is not identified. It is not a person – one might also suppose its members change over time – and as such I do not understand how it can be considered to be the “author”. As the committee is not identified, it follows that its (members’) qualifications have also not been identified. Additionally, the site does not indicate what the “Consumer Information” section is, which this committee allegedly authored. The statement that “[t]he views and opinions expressed on this site are not necessarily those of the ADA Inc., the ADA State Branches or their affiliates” on the disclaimer page (http://www.ada.org.au/disclaimer.aspx) further clouds the situation.

Principle 2 – Purpose of the website

The ADA site makes good on the requirement to declare that the site is not to replace the advice of a health professional. It goes on to disclaim any impression of reliability, accuracy, completeness or usefulness. Although not being able to stand behind one’s documentation (website) erodes the reader’s confidence, it is in keeping with the HONcode guidelines, and I haven’t complained about that aspect of the requirements.

I have noticed that the website has been updated/repaired since my complaint; the About page (http://www.ada.org.au/about/default.aspx) links to the Overview (http://www.ada.org.au/about/overview.aspx) and Functions (http://www.ada.org.au/about/functions.aspx) pages are now functional.

However, there is no “description of the website’s mission, purpose and intended audience”:

  • “All information is intended for your general knowledge only” is not a description of the website’s purpose
  • “its aim the encouragement of the health of the public and the promotion of the art and science of dentistry” is the aim (purpose/mission?) of the ADA (“also necessary”); there is no separate description for the website itself
  • You write, “[t]his site contains three portals for General public, Dental Professionals, and Members. / Therefore it is understood that this site is for the General public and health professionals.” Whatever you happen to mean by there being three “portals”, and whether or not one might infer that this site is for (effectively) everyone, there is no actual description of the intended audience.

Personally, I think these are minor issues and very easily addressed (eg “the purpose of the ADA and of this website is to…”, “the intended audience of this site is…”). However it does concern me that your evaluation drops the bar so low on “necessary” requirements to the point where they are not actually required – either your guidelines are enforced or they are pointless and the overall quality of the entire HONcode accreditation comes under question.

Principle 4 – Information must be documented: Referenced and dated

Sources information are not needed, becuase this site information was authored
by fully qualified dentists.

Did an authorised Health On the Net Foundation representative really write that, or am I reading a forged email? This statement is completely ludicrous. I quote again from the HONcode Guidelines documentation (http://www.hon.ch/HONcode/Guidelines/guidelines.html):

All sources of the medical content must be given. You have to clearly indicate the recognized, scientific or official sources of health information quoted in your articles. If you used another website, a book, an article, a database or any other support, it has to be specified. You have to provide a precise link to the source, whenever it is possible and the references should be in relation with the content referred.

To say now that sources of information are not needed is a complete farce. I would also reiterate that the authors of the information are not identified, but that is hardly the point here. Is it truly the Health On the Net Foundation’s intention for principle 4 to be something like “All sources of the medical content must be given unless the author is a dentist”? If so, please amend the HONcode guidelines documentation accordingly.

You write:

The complaint regarding the principle 4 – Date is justified.
Therfore we are taking care of your complaint. A member of the HONcode team has
contacted this site about this matter.

So, we agree on one point at least. Perhaps an investigation of your procedures is in order to determine how the lack of dates was missed in previous reviews.

Principle 5 – Justification of claims

You write:

we were not able to find any treatment information on the following link:
http://www.ada.org.au/oralhealth/FLN/flfaqs.aspx

This page contains some information about Fluoride, but not the treatments.

Again I have to ask, did an authorised Health On the Net Foundation representative write that, or am I reading a forged email? The entire page is about fluoride treatments in all shapes and sizes. The first occurrence of the word “treatment” on the page is in the statement: “Drinking fluoridated water several times a day is the ideal way to give your teeth a quick fluoride treatment.”

Some unjustified claims from that page:

  • Large numbers of studies over the last fifty years have shown conclusively that fluoride strengthens teeth against decay without causing harmful effects.
  • Fluoride acts in a number of ways to strengthen teeth and make them more resistant to tooth decay.
  • Topical fluoride can not only stop the development of tooth decay, but also make the enamel more resistant to future acid attacks. It also helps by reducing the amount of acid produced by the bacteria in your mouth.
  • While most of the fluoride effect is topical, a systemic effect still occurs, and enamel with built-in fluoride is still more decay resistant.
  • Very high levels can even cause brown staining or pitted enamel. This is very uncommon, and usually results from children swallowing too much fluoride from toothpaste or fluoride tablets rather than from drinking fluoridated water.
  • While these [other fluoride treatment methods] are still beneficial, the safest and most cost effective method, with the greatest reduction in tooth decay is seen when teeth are exposed to frequent, low concentrations of fluoride as in water fluoridation.
  • Because of the mainly topical effect of fluoride, people of all ages and backgrounds will benefit [from water fluoridation].
  • When fluoride is in the mouth, the teeth become much more resistant to decay.
  • Fluoridated water is the safest, most effective, and least expensive way to reduce tooth decay in children and adults.
  • In speaking about Sydney’s water fluoridation, the New South Wales Chief Health Officer in 2002 reported “a significant dental health benefit, by reducing dental caries, along with the associated savings in the cost of treatment.”
  • All Australian capital cities (except Brisbane) have been fluoridated for decades and have not seen an increase in bone fractures or other ill effects.

Your brief comment here refers to just this page, which I suppose is the one I listed in the online complaint form. I repeat below further comments from my initial email complaint which have not been addressed by your email.

The AMA site makes numerous claims about products and treatments that, aside from on occasion appearing to be patently false or contradictory, are completely unjustified.

The site also repeatedly directs readers to, if not a specific brands of products, specific types of product, such as fluoride toothpaste, fluoride tablets, fluoride gels, fluoridated food products and additives, and even fluoridated water, without any “alternative therapy” offered for cleaning teeth and maintaining dental health.

As a simplification, the product/treatment here is fluoride and its application/consumption. There are a number of documents provided on the website, for example, on the Fluoride Resources page (http://www.ada.org.au/oralhealth/fln/flresources.aspx) that might be intended as justification, however there is little or no association made between the majority of claims made in the rest of the site and these documents.

General safety claims are also made about mercury-containing dental amalgam as a type of product.

The medical information is certainly far from balanced. Concerns about harmful effects are, if mentioned a all, mentioned only briefly and in a significantly dismissive way, giving the impression that concerns have been raised only by an uneducated public, when in fact thousands of qualified dental and medical professionals around the world have very strong concerns about the potential harmful effects, and indeed questions about the efficacy of the use of fluoride in the first place. Documents on the website make claims for efficacy of “about half” and even “60%”, which are significant exaggerations at best. Statements such as “There is universal agreement between all the major public health bodies throughout the world regarding the benefits of water fluoridation” (“Fluoride – Nature thought f it first”, prefaced by a letter from the president of the ADA, at http://www.ada.org.au/app_cmslib/media/lib/0609/m16777_v1_fluoride%20-%20nature%20thought%20of%20it%20first.pdf) are grossly misleading (it is an undeniable fact that many countries do not support nor implement water fluoridation).

Finally

It is my expectation that the HONcode seal displayed on the Australian Dental Association website (http://ada.org.au) should indicate that the site is undergoing a reexamination. This is not presently the case.

Bradfield Resident
Sydney, Australia

Friday 11 September 2009

Quoted text:
Wed 09 Sep 09 | From: Health On the Net | In response to your complaint regarding the site : http://www.ada.org


Bradfield Resident
bradfieldresident@gmail.com
https://bradfieldresident.wordpress.com

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4 Responses to “Fri 11 Sep 09 | To: Health On the Net Foundation | Australian Dental Association (ada.org.au) HONcode compliance”

  1. I must firstly commend you on the initiative in looking into the ADA public website. Happy to support your progress with this.

    For the people who don’t know why one would investigate the ADA’s content:

    Dentists can only give a professional opinion on dental care, well, one would expect. If the ADA could live up to their doctor title then they would know taking any medicine has side effects. Fluorosilicic Acid has side effects. They are ignored because it has bypassed our health care system, from the pharmacy straight to our water supply. It should be in a tablet, on a shelf, so people have a choice.

    What about the rest of our bodies: Thyroid, Kidney, Bone Cancer, etc?

    Get informed: www.FluorideAustralia.org

  2. Oji said

    Why do you criticise this mysterious committee for being anonymous when you are hiding behind a pseudonym yourself?

    • bradfieldresident said

      I have made a complaint about what appears to be a failure to adhere to the HONcode principles on a site that displays a HONcode seal. I hold this view both when I write as Bradfield Resident and at other times. Whether or not I use a pseudonym is irrelevant to the complaint and your question.

      From Wikipedia:

      Tu quoque (pronounced /tuːˈkwoʊkwiː/, from Latin for “You, too” or “You, also”) is a Latin term that describes a kind of logical fallacy. A tu quoque argument attempts to discredit the opponent’s position by asserting his failure to act consistently in accordance with that position; it attempts to show that a criticism or objection applies equally to the person making it. It is considered an ad hominem argument, since it focuses on the party itself, rather than its positions.

      Example: “Why do you criticise a pseudonymous writer criticising a mysterious committee for being anonymous when you are hiding behind a pseudonym (and disposable mailinator.com email address) yourself?”

      If you would like to identify yourself and any affiliation you have to the Australian Dental Association and/or any other group or organisation that has some vested interest in adding fluorine to drinking water, please feel free to send an email addressed to bradfieldresident@gmail.com. Please also send opinion(s) on any of the other serious criticisms I have made regarding the ADA website and HONcode principles (which you have conveniently ignored in addressing your current question).

      It is likely that the committee is not a secret commiittee (if it is a secret committee, then it seems there are very serious questions to answer outside of any apparent HONcode violations), and so there shouldn’t be a problem with including that information on the website.

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