Standards 2.1, 2.2, 4.1, 4.2 and 4.5 of the ABCCode of Practice 2011 (revised 2013)
14 March 2014
No breach standards 2.1, 2.2, 4.1, 4.2 and 4.5 of the ABCCode of Practice 2011 (revised 2013)
Between 2 September and 9 October 2013 the Australian Communications and Media Authority (the ACMA) received three separate complaints about an episode of Catalyst broadcast by the ABC on 18 August 2013.
This investigation commenced in September 2013.
The complainants each submitted that the program was biased towards water fluoridation and lacked impartiality.
The complainants have also said that the segment omitted material and was not accurate.
The ACMA has considered the ABC’s compliance with standards 2.1 [reasonable efforts to ensure accuracy], 2.2 [factual content that will materially mislead], 4.1 [gather and present information with due impartiality], 4.2 [present diversity of perspectives over time] and 4.5 [unduly favour one perspective over another] of the ABC Code of Practice 2011 (revised 2013) (the Code).
Catalyst is broadcast nationally on ABC TV on Thursdays at 8:00pm, and repeated on Fridays at 11:00am. It is described on its website in the following terms:
At Catalyst we know that science is a dynamic force for change. Each week Catalyst brings you stories from Australia and around the world. Our passion to meet scientists at the forefront of discovery is matched by our fascination with science breakthroughs however big or small. Science changes all our lives. For better or worse, we are committed to showing you what our future holds.1
The segment broadcast on 18 August 2013 ran for nine minutes and nine seconds and reported on the effects of the controlled addition of fluoride to drinking water to improve dental health. The segment was introduced by the narrator in the lead up to its broadcast as follows:
Ahead ... water fluoridation, and how it protects our teeth.
The segment focused on the different approach taken in Queensland compared with the rest of Australia on decisions about controlled water fluoridation. It noted that water fluoridation has been controversial particularly in Queensland where decisions about fluoridation are made by local Councils, rather than at the State government level. The segment referred to the differences in dental health in people living in areas where water is fluoridated, compared with those living in un-fluoridated areas.
In this context, the segment considered the science on any adverse health effects in Australia of adding fluoride to water. The segment referred to the findings of two studies:
A Systematic Review of the Efficacy and Safety of Fluoridation – Australian Government National Health and Medical Research Council (NHMRC) – released in 2007 (the 2007 NHMRC review).2
An Assessment of Bone Fluoride and Osteosarcoma – Harvard University - released in 2011 (Access to abstract only via internet).
The segment included interviews with:
Dr Michael Foley - introduced in the segment as ‘Director, Brisbane Dental Hospital’.
Dr Denis Ingham - introduced in the segment as a Bundaberg Dentist, and the ‘family dentist’ of the reporter.
Mr Stephen Bennett - introduced in the segment as ‘Queensland State MP for Burnett’.
Councillor Mal Forman – introduced in the segment as ‘Mayor, Bundaberg Regional Council, Queensland’.
Professor Michael Moore - introduced in the segment as ‘Vice-president, Australasian College of Toxicology & Risk Assessment’.
The segment also featured:
File footage of a journalist commenting on early water fluoridation in Australia.
File footage of Ms Merilyn Haines – referred to in the segment as an ‘Anti-fluoride campaigner’ (Queenslanders For Safe Water, Air and Food Inc and retired Medical Laboratory Scientist) addressing a council meeting.3
A vox pop comprising four women and four men commenting on fluoride. And
File footage excerpt of a well-known Australian advertisement for Colgate Fluoriguard toothpaste (featuring Mrs Marsh) from the 1970s.
A transcript of the segment is at Attachment A.
The investigation is based on correspondence between the complainants and the ABC, submissions from the complainants and from the ABC to the ACMA, and a copy of the broadcast provided to the ACMA by the ABC.
Excerpts of correspondence and submissions relevant to the investigation are attached as follows:
Submissions and correspondence from Complainant 1 (Attachment B)
Submissions and correspondence from Complainant 2 (Attachment C)
Submissions and correspondence from Complainant 3 (Attachment D)
Submissions and correspondence from ABC Corporate Affairs (Attachment E)
The complainants have also provided several links to literature and publications on the adverse effects of fluoride. A list of these is included at Attachment F.
The ACMA has considered these publications only insofar as they are relevant to the issues raised under the Code and broadcast.
Other relevant sources have been identified where used.
Matters not pursued
The complaints to the ACMA included some matters which had not been included in their original complaints to the ABC. As the complainants did not first complain to the ABC about these matters as required under section 150 of the Broadcasting Services Act 1992, the ACMA has not pursued these aspects of the complaints in this investigation.
Complainant 1 also submitted that the 2007 NHMRC review referred to in the broadcast was ‘a sham and a whitewash which contained many flaws’. The assessment of the methodology of this review is not a code matter within the ACMA’s jurisdiction and it has not been investigated.
Complainant 2 made submissions to the ABC and the ACMA concerning the timing of the ABC’s decision to include footage of Ms Merilyn Haines in the segment. To the extent that these submissions concern editorial decisions which are not matters within the Code, they have not been investigated.
‘Ordinary, reasonable’ viewer
In assessing content against the Code, the ACMA considers the meaning conveyed by the relevant material. This is assessed according to the understanding of an ‘ordinary, reasonable’ listener or viewer.
Australian Courts have considered an ‘ordinary, reasonable’ reader (or listener or viewer) to be:
A person of fair average intelligence, who is neither perverse, nor morbid or suspicious of mind, nor avid for scandal. That person does not live in an ivory tower, but can and does read between the lines in the light of that person’s general knowledge and experience of worldly affairs.4
In considering compliance with the Code, the ACMA considers the natural, ordinary meaning of the language, visual images, context, tenor, tone, and any inferences that may be drawn. In the case of factual material which is presented, the ACMA will also consider relevant omissions (if any).
Once the ACMA has applied this test to ascertain the meaning of the material broadcast, it then determines whether or not that material has breached the Code.
Issue 1: Accuracy
Relevant Code standards
2.1 Make reasonable efforts to ensure that material facts are accurate and presented in context.
2.2 Do not present factual content in a way that will materially mislead the audience. In some cases, this may require appropriate labels or other explanatory information.
Relevant Principles in relation to accuracy include the following:
Types of fact-based content include news and analysis of current events, documentaries,
factual dramas and lifestyle programs. The ABC requires that reasonable efforts must
be made to ensure accuracy in all fact-based content. The ABC gauges those efforts
by reference to:
the type, subject and nature of the content;
the likely audience expectations of the content;
the likely impact of reliance by the audience on the accuracy of the content; and
the circumstances in which the content was made and presented.
The ABC accuracy standard applies to assertions of fact, not to expressions of opinion. An opinion, being a value judgment or a conclusion, cannot be found to be accurate or inaccurate in the way facts can. The accuracy standard requires that opinions be conveyed accurately, in the sense that quotes should be accurate and any editing should not distort the meaning of the opinion expressed.
The efforts reasonably required to ensure accuracy will depend on the circumstances.
Sources with relevant expertise may be relied on more heavily than those without.
Eyewitness testimony usually carries more weight than second-hand accounts. The
passage of time or the inaccessibility of locations or sources can affect the standard
of verification reasonably required.
In applying standard 2.1 of the Code the ACMA generally adopts the following approach:
Was the particular material (the subject of the complaint) factual in character?
Did it convey a ‘material’ fact or facts in the context of the relevant segment?
If so, were those facts accurate?
If a material fact was not accurate, (or its accuracy cannot be determined) did the ABC make reasonable efforts to ensure that the ‘material’ fact was accurate and presented in context?
In applying standard 2.2 of the Code, the ACMA usually adopts the following approach:
Was the particular material (the subject of the complaint) factual in character?
Was that factual content presented in way that would materially (i.e. in a significant respect) mislead the audience?
The considerations which the ACMA generally applies in assessing whether particular broadcast material is factual in character are set out at Attachment G.
Complainant 1 raised the following accuracy concerns with the ABC (see Attachment B):
The segment did not mention that the biggest contributor to the rise in caries is sugar consumption; we were led to believe that caries develop from fluoride deficiency.
The segment omitted to mention that the 2007 NHMRC review qualified its recommendation by repeatedly stating that existing studies are insufficient for firm conclusions to be drawn, particularly for people in population subgroups who may be sensitive to fluoride.
The segment omitted to mention the recent Harvard meta-analysis on the neurological effects of fluoride on children (the 2012 Harvard Developmental Neurotoxicity study).5
Dr Michael Foley cited skewed statistics; the difference in dental caries between Townsville and Brisbane is not 45%.
The program should have shown caries statistics for each state, and should have included caries rates for Tasmania, the first Australian state to be fluoridated and showing the worst caries rates.
The viewer was given the impression that for some reason only Queenslanders objected to fluoridation.
The segment gave the impression that ‘all fluorides are the same’.
The segment, in showing an image of a very white set of teeth, implied fluoride gives you perfect teeth.
Complainant 2 alleged that (see Attachment C):
The segment incorrectly stated that Townsville was the only place in Queensland to have fluoridated water prior to 2007.
The segment allowed Dr Foley to say that tooth decay in Townsville was 45% less than in Brisbane, whereas the Queensland government has claimed that the difference is 65%.
The segment did not challenge Dr Foley’s claim that the benefits of water fluoridation for dental health extends to adults, despite being given evidence to the contrary.
The segment included a misleading and ‘utterly ridiculous’ claim that fluoridated water has a much greater topical effect.
The segment included the ‘ridiculous claim’ that it could be a problem to have too little fluoride.
The segment included the incorrect claim that the 2007 NHMRC review reviewed 5,500 papers.
The segment misrepresented Ms Haines’ credentials.
Relevant extracts of the submissions by the complainants are at Attachments B and C respectively.
The ABC’s responses to the complainants and to the ACMA are at Attachment E.
The ABC did not breach standards 2.1 and 2.2 of the Code in relation to each of the factual assertions made in the broadcast of Catalyst on 8 of August 2013.
In respect of each statement set out above, the ACMA has examined wether the ABC made reasonable efforts to ensure that the material facts were accurate and presented in context, and whether factual content was presented in a way that would have materially misled the audience.
Omission of information about the causes of caries
The complaint is that the segment did not refer to the biggest cause of caries, being sugar consumption, and therefore suggested that caries develop from fluoride deficiency.
The ABC dealt with this as a code complaint concerning accuracy. The ACMA notes that there is no requirement in the Code for all facts that are potentially relevant to a program to be presented. The question for the ACMA is whether the omission of facts would render the broadcast inaccurate or take it out of context, or result in factual content being presented in such a way that it would materially mislead the audience.
As noted above, the segment focussed on the different approach to controlled water fluoridation in Queensland compared with the rest of Australia, and the effects of controlled water fluoridation in Australia. It included statistics suggesting that areas where water was fluoridated contained lower caries rates and also illustrated how teeth react to fluoride creating resistance ‘to the acid that causes tooth decay’. It did not discuss or explore the various causes of caries, and did not state that caries is caused by fluoride deficiency.
The ACMA is satisfied that, in the context of the segment, the omission of a fact concerning the cause of caries was not a material fact. The relevant material facts were accurate and presented in context and any factual content concerning the cause of caries was not presented in a way that would have materially misled the audience.
Presentation of the NHMRC review
The complaints about the 2007 NHMRC review include:
the NHMRC had qualified its recommendation by repeatedly stating that existing studies are insufficient for firm conclusions to be drawn, particularly for people in population subgroups who may be sensitive to fluoride; and
The NHMRC did not review 5,500 studies, there were only a hundred or so.
The relevant excerpt of the broadcast includes:
Ruben Meerman [narration] - In 2007, Australia's top research body, the National Health and Medical Research Council, released a major report on water fluoridation.
Professor Michael Moore - They reviewed 5,500 papers, and, on the basis of the papers of the highest quality, concluded that there was no association between fluoridation and illness. [ACMA emphasis added]
The ACMA considers that in the context of a science program, the statement that there was no association between fluoride and illness would have been understood by the ordinary reasonable viewer as factual material. It was specific, unequivocal and capable of independent verification.
Shortly prior to this content the question was posed:
Ruben Meerman – These health concerns are not new. So what is the latest science on the adverse health effects? Is there cause for concern?
The ABC submitted:
The program’s reference to the NHMRC report was in the context of whether the latest science indicated any cause for concern in health risks posed by controlled water fluoridation. The NHMRC report was briefly and accurately summarised as indicating that the latest science did not give cause for concern. The program did not present factual content in a way that would materially mislead the audience.
The ABC also submitted that it had relied on its own assessment of the report and that of Professor Michael Moore, Vice President of the Australasian College of Toxicology & Risk Assessment. It added that it was unable to identify relevant references in the report, about people in subgroups who may be sensitive to fluoride.
The ACMA accepts the ABC’s submission that the 2007 NHMRC review was a systematic review which aimed ‘to identify, evaluate and summarise the findings of all relevant individual studies’. The ACMA is satisfied that the material facts were supported by the review. The NHMRC Public Statement issued at the time of the release of the study,6 summarises the findings of the study noting on the cover page:
The existing body of evidence strongly suggests that fluoridation is beneficial for reducing dental caries.
On the second page, the statement notes:
Fluoridation of drinking water remains the most effective and socially equitable means of achieving community-wise exposure to the caries prevention effects of fluoride. It is recommended that water be fluoridated in the target range of 0.6 to 1.1 mg/L, depending on climate, to balance reduction of dental caries and occurrence of dental fluorosis.
Under the heading ‘additional information’ the statement notes:
Infant Formulae – recent Australian research does not show an association between use of infant formulae and dental fluorosis;
Fluoride supplements, including toothpastes – [use of a low fluoride children’s toothpaste by children up the age of six years ...] has been associated with significant reductions in the prevalence of any fluorosis (especially very mild and mild fluorosis) in Australian children.
Risks associated with Fluoridation
Fluorosis - There is consistent evidence that water fluoridation results in the development of dental fluorosis, however, the majority of dental fluorosis is not considered to be of ‘aesthetic concern’. The prevalence of fluorosis has been significantly reduced with more appropriate use of other fluoride sources.
Skeletal effects - Water fluoridation at levels aimed at preventing dental caries has little effect on fracture risk. Fluoridation at 0.6 to 1.1 mg/L may lower overall fracture risk compared to both no fluoridation and fluoridation at levels well above those experienced in Australia.
There is currently no evidence to determine the impact of milk and salt fluoridation, or other fluorides used to prevent dental caries, upon fracture risk and osteoporosis.
Cancer - There is no clear association between water fluoridation and overall cancer incidence or mortality. The evidence shows variations on either side of the effect, however only two studies present statistically significant results, one showing an increase and one a decrease in cancer incidence.
Other -There is insufficient evidence to reach a conclusion regarding other possible negative effects of water.
Fluoridation. There is currently no evidence available to determine the other possible negative effects of milk, salt or topical fluoride supplementation.
These references verify the statement about the NHMRC recommendation. The ACMA is satisfied that the ABC made reasonable efforts to ensure that the material facts were accurate and presented in context and that factual content was not presented in a way that would have materially misled the audience.
Review of 5,500 papers
The relevant statement is:
[The NHMRC] reviewed 5,500 papers, and, on the basis of the papers of the highest quality, concluded...
The ACMA considers that this would have been understood by the ordinary reasonable viewer as factual material. It was specific, unequivocal and capable of independent verification.
The ABC submitted that the 2007 NHMRC review notes that 5,418 citations were identified from a review of various databases and libraries. Abstracts were then assessed for eligibility to identify the highest quality, most reliable studies from which the review would draw its conclusions.
The ACMA notes that the review states in its Executive Summary:
Due to the availability of recent systematic reviews, searches were limited to publications from 1996 onwards, with the intention that the current review would update the most relevant existing systematic review. Searches were also limited to English-language publications. The search was conducted in December 2006. In total, 5418 non-duplicate citations were identified. After reviewing the potentially eligible, 77 citations were included in the review.
This reference verifies the statement about the number of papers reviewed in the 2007 NHMRC review. The ACMA is satisfied that the ABC made reasonable efforts to ensure that the material facts were accurate and presented in context and that factual content was not presented in a way that would have materially misled the audience.
Omission of the 2012 Harvard Developmental Neurotoxicity studyon the neurological effects of fluoride on children
The ACMA notes that the segment did not include reference to the Harvard study cited by the complainant.
The ABC dealt with this as a code complaint concerning accuracy. As noted above, the question for the ACMA is whether the omission of facts would render the broadcast inaccurate or result in factual content being presented in such a way that it would materially mislead the audience.
The ABC submitted that the 2012 Harvard Developmental Neurotoxicity study referred to by the complainant analysed 27 research papers on fluoride neurotoxicity, 25 of which were conducted in China and two in Iran. These areas ‘have naturally high fluoride levels’ found in ‘plants, rocks, soil, air, food and very low levels in almost all fresh water’, and this ‘fluoride is not added to the water supply in a controlled manner’. It also noted that some of these areas ‘are affected by potential fluoride contamination’, and ‘very high, and uncontrolled fluoride consumption, can be dangerous’. The ABC also stated ‘it would be misleading to compare naturally high levels of fluoridation found in China, to the controlled addition of fluoride that we experience in Australia’.
The ABC also submitted that the lack of reference to the study did not mislead the audience. It was also made clear in the segment that incorrect dosages are not beneficial (discussed below).
The ACMA is satisfied that in the context of a segment about the effects of controlled water fluoridation in Australia, as distinct from the broader subject of the effects of naturally occurring fluoride on communities throughout the world, the 2012 Harvard Developmental Neurotoxicity was not relevant. The relevant material facts were accurate and presented in context and any factual content was not presented in a way that would have materially misled the audience.