THE PROBLEM WITH PUBLIC HEALTH
Said Dr. Bill Osmunson on November 30, 2013, as part of the Open Parachute debate:
The last class of my public health master’s degree, the instructor said, “you must promote and do everything your superior tells you to do regardless of the science.” I raised my hand and asked, “does that mean if my boss tells me to promote smoking tobacco I have to promote tobacco smoking?” My instructor paused, considered, and then said, “Yes.”
Holtgrave published an article, “Public Health Errors: Costing Lives, Millions at a Time,” J Pub Health Man & Prac. May/June 2010, Vol 16 Issue 3 p. 211-215 And see Commentary in that Issue by De Ville Novick “Commentary: Toward a Taxonomy of Public Health Error”
Whereas a single medical error may cost one or more lives, a public health error may cost millions of lives and trillions of dollars. Yet public health policy is too often without external scientific evidence based review, open dialogue with stake holders’ input, or patient freedom. In the case of fluoridation, the focus is to help the poor, and ironically it is the poor who can least afford the loss of IQ and who are most harmed.
Holtgrave divides public health errors into three types of situations, errors of deliberate commission such as contrary to standards, practices, laws or ethical norms (such as fluoridation); willful omission such as not providing action (label, branding, informed consent for treatments like fluoridation); and complacency such as paying insufficient attention to a disease (or treatment of the disease without approved drug).
Holtgrave suggests, “A common feature in those three categories of errors is an intent to do harm, or at least the lack of caring about fully discharging one’s public health duty to serve the public good.” Holtgrave argues, “that policy makers can indeed commit “errors” and should be held accountable for said errors if the policy makers know that the action they are taking is demonstrably harmful (relative to another policy option) and they have the financial, legal, and human resources to avoid implementing the relatively harmful policy.”
I had a public health dentist tell me, “I don’t care about science. I do whatever I want until a judge tells me otherwise.”
My point is, tradition is very hard to change and my public health profession has really no oversight or scientific training. The CDC dental division is made up to a great degree with military dentists who are accustomed to taking orders and following them. They take their marching orders on fluoridation from the ADA.