Category Archives: Health and Medicine

It’s time we did something about sugar

sugar-caries

I saw this image in the paper:

Sheiham, A., & James, W. P. T. (2014). A reappraisal of the quantitative relationship between sugar intake and dental caries: the need for new criteria for developing goals for sugar intake. BMC Public Health, 14(1), 863.

It’s a very graphic illustration of the central role played by dietary sugar in tooth decay. Certianly makes one think about how to drastically reduce our dietary sugar intake.

There are a couple of “take home messages” in the paper:

“Sugar is the primary cause of dental caries”

Ths seems to have been debated in the past but is now widely accepted. Because acid attack arising from sugar metabolism is the only mechanism for inducing caries:

“the only confounding factors i.e. tooth brushing and the use of fluoride in drinking water or toothpaste serve to reduce the magnitude of the simple relationship between sugar intake changes and caries incidence.”

However fluoride is not a “silver bullet:”

“although fluoride reduces caries, unacceptably high levels of caries in adults persist in all countries, even in those with widespread water fluoridation and the use of fluoridated toothpastes [21].”

We shouldn’t neglect adult tooth decay

Perhaps we have been underestimating the problem because the apparent improvement in oral health comes from considering data for children:

“The sugar-caries relationship in adults has been largely ignored: all the conclusions on safe levels of sugar and the relationship between sugar and caries are based on children’s data. With fluoride and greater dental care caries has declined in children so some dental authorities have concluded that sugars are not a major determinant of caries provided fluoride toothpaste is use diligently with or without water fluoridation. However, it is now evident that the majority of caries occurs in adults, not in children, because the disease is cumulative and the rates of caries in individuals tracks from early childhood to adolescence and then into adulthood [21,26]. So the conclusion that sugar is not the major determinant of caries, is simply wrong.”

The impact of fluoride

Anti-fluoride propagandists are already quoting this research – using the central role of sugar to imply this proves fluoride is ineffective. But the authors say:

“Fluoride is associated with about 25% lower caries experience when sugar intakes are constant between 10-15%E [10-15% of energy itnake from sugar]  in 12 year-old children [20]. The widescale use of fluoride toothpaste is a reasonable explanation for the decline in children’s caries in many countries since the 1970s, yet what then becomes relatively evident is that caries becomes more prominent in adolescents and adults [4,21].

Ireland has had a mandatory national water fluoridation policy since 1964 but some areas have not implemented the fluoridation policy thereby allowing a comparison within a country where fluoride toothpaste is in widespread use but drinking water fluoride varies. Additional benefits accrued from having fluoride in water as well as toothpastes but 7.3% of even the youngest adults aged 16-24 years with lifelong fluoride exposure still had dental caries experience in 4.6 teeth as did 53% of the 35-44-year-olds assessed 35 years after the beginning of water fluoridation: the mean DMFT was 13.3 and 16.0 in those living in non-fluoridated areas [15]. Australia has water fluoridation in a number of cities, but despite fluoride use from both toothpastes and drinking water the mean DMFT and DF Surfaces for all adults increased; adults aged 65 years and older had ten times higher levels of caries than 15–24-year-olds [16]. Thus although fluoride reduces caries, unacceptably high levels of caries in adults persist in all countries, even in those with widespread water fluoridation and the use of fluoridated toothpastes [21].”

So research is showing a strong need to cut dietary sugar intake by both children and adults.  The authors say “for multiple reasons, including obesity and diabetes prevention, we need to adopt a new and radical policy of progressive sugar reduction.” They conclude:

“that public health goals need to set sugar intakes ideally <3%E with <5%E as a pragmatic goal, even when fluoride is widely used. Adult as well as children’s caries burdens should define the new criteria for developing goals for sugar intake.”

Obviously community water fluoridation (CWF) remains an important issue in New Zealand because political activists still work hard to remove it, or prevent it when health authorities attempt its introduction. It seems to me, though, that CWF, once achieved, plays its important role without having to continually educate and encourage the population to change their dietary habits. The battle over sugar will be so much harder because it will involve social pressure to change personal habits, as well as countering all the anti-science and freedom of choice arguments.

At least local body councils, and immature local body politics, will not play a key role.

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Crude dredging of the scientific literature

I am always amazed at how some people will crudely misrepresent the scientific literature in their efforts to pretend their particular political agenda is scientifically valid. The way they will dredge the scientific literature searching for studies they can quote and misrepresent seems an extreme form of cherry picking and confirmation bias. Surely those indulging in such crude literature dredging are fully aware of what they are doing.

Here is an example of literature dredging I picked up recently. The offender is Michael Connett, Special Projects Director for Paul Connett’s Fluoride Action network (yes – a bit of nepotism there. Son Michael and Wife Ellen are on the payroll). Michael has a legal qualification, but no scientific qualification. Nevertheless, one of his special projects is a litrerature database anti-fluoride activists can use in their propaganda.

Any and every scientific publication that can be quoted, misquoted or misrepresented in arguments against fluoridation.

Here are a couple of slides from Michael’s talk at recent anti-fluoride get-together organised by the Connetts. It’s about “Fluoride and  IQ Studies” and the section was meant to show that recent research confirms community water fluoridation is bad for our brain. So he found 4 studies from on rats from 2014.

I have extracted from each cited paper details from the conclusions and the fluoride concentrations of the drinking water given to the rats.

Keep in mind that in New Zealand the recommended optimum concentration for community fluoridated water is 0.7 – 1.0 mg/L.


1-connett-m.fan-conference

“We found that NaF treatment-impaired learning and memory in these rats.” The NaF treatments were 25, 50 and 100 mg/L!


4-connett-m.fan-conference

“these results indicated that long-term fluoride administration can enhance the excitement of male mice, impair recognition memory, . . ” The NaF treatments were 25, 50 and 100 mg/L!


3-connett-m.fan-conference

“exploration preference in the novel object recognition test was significantly altered in mice treated with 5 and 10 mg/L NaF compared with the water-treated control animals.”


2-connett-m.fan-conference

“These data indicate that fluoride and arsenic, either alone or combined, can decrease learning and memory ability in rats.” “The rats in the F, As, and F+As groups had access to drinking water with a 120 mg/L NaF solution, 70 mg/L NaAsO2 solution, and combined 120 mg/ L NaF and 70 mg/L NaAsO2 solution for 3 months, respectively.


It’s the old story. Find evidence for adverse effects at concentration much higher the optimum and pretend the results apply to the optimum.

Beware of political activists who claim their agenda has scientific support. There is a good chance they are manipulating the science.

Update

Surpise, suprise. FAN has used young Michael’s talk at their get-together to launch a press release - Fluoride’s Brain Damage Studies Mounting. This will be sent through their usual social media merry-go-round in the hope that the MSM picks it up somehwere.

Just what one expects from a political activist organisation.

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Anti-fluoride activists define kangaroo court as “independent”

A kangaroo court is a mock or illegal court that is set up in violation of established legal procedure

The international anti-fluoride movement seems somewhat pre-occupied with thew situation in New Zealand.  In the last few months they have unleashed their “big guns” to attack two publications from local scientific researchers.  First was their attempt to discredit the paper Broadbent, J. M., Thomson, W. M., Ramrakha, S., Moffitt, T. E., Zeng, J., Foster Page, L. A., & Poulton, R. (2014). Community Water Fluoridation and Intelligence: Prospective Study in New Zealand. American Journal of Public Health. Now they have produced an International Peer Review of the  review Health Effects of Water Fluoridation: a Review of the Scientific Evidence. This was commissioned by Sir Peter Gluckman, the New Zealand Prime Minister’s Chief Science Advisor and Sir David Skegg, President of the Royal Society of New Zealand at the request of Auckland City on behalf of several local Councils.

Fluoride Free NZ pretends that the Royal Society Review “was sent out for review by five independent international experts” and a press release from their astroturf organisation the NZ Fluoridation Information Service repeats the independent claim (see NZ fluoridation report trashed by international reviewers).

Well let’s have a look. How independent are the authors of the critique?

An “independent” peer review?

I don’t think so. Here are the authors – chosen by the anti-fluoride movement, of course – together with affiliations and a little history


Kathleen Theissen, Environmental Risk Scientists. I don’t know what the affiliation “environment Risk Scientists,” is. Perhaps a consultancy. However, she is still listed as an affiliate on the Oak Ridge Center for Risk Analysis web site. Theissen was one of the minority* anti-fluoride members on the National Research Council Committee on Fluoride in Drinking Water which produced the NRC reviewFluoride in Drinking Water: A Scientific Review of EPA’s Standards.” She frequently writes articles and submissions opposing community water fluoridation

Chris Neurath, Research Director, American Environmental Health Studies Project. Neurath is also the “Research Director,” of Paul Connett’s Fluoride Action Network (FAN). The American Environmental Health Studies Project is really just the Fluoride Action Network in drag with a couple of other similar organisations tied in.

Hardy Limeback, Head of Preventive Dentistry, University of Toronto. Limeback was also an anti-fluoride minority member of the  National Research Council Committee on Fluoride in Drinking Water which produced the NRC review Fluoride in Drinking Water: A Scientific Review of EPA’s Standards.” He is also an anti-fluoride activist who writes often on the issue and a member of the Advisory Board of Paul Connett’s Fluoride Alert Network.

 

James Beck, a co-author together with Paul Connett of the anti-fluoridation book The Case against Fluoride.

Spedding Micklem, also a co-author together with Paul Connett of the anti-fluoridation book The Case against Fluoride.


So, definitely not independent

This is a serious distortion of the truth by Fluoride Free NZ because they have continual described the authors of the Royal Society Review as not independent. They wrote, for example (see Fluoridation review ‘Dirty Science’ – Fluoride Free NZ):

“The NZ “expert panel” included only people who were already known to be ardently in favour of fluoridation and not one single person who is known to be opposed, or even someone neutral. It was therefore already a foregone conclusion.”

So, I can only conclude that these people define “independent” to mean that they agree with them – they have an anti-fluoride political stance. And they define anyone whose scientific work produces an objectively determine conclusion favourable to the consensus understanding of the effectiveness and safety of community water fluoridation as not independent!

I can only repeat, how do these hypocritical people sleep straight in their bed’s at night.

How valid are their criticisms

OK, so these people are not independent – but how valid are there criticisms. That is another issue. I am preparing a detailed analysis of the claims made in this critique and will post it in the next few days. So, watch this space.


*Three of the 12 members of the committee expressed disagreement with some fo the committee’s conclusions.

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Do you prefer dental fluorosis or tooth decay?

Anti-fluoride propagandists often use the incidence of dental fluorosis as an argument against community water fluoridation. However, they exaggerate the problem by misrepresenting the issue in two ways:

1: They present the issue as if the figures for the incidence of dental fluorosis relate to the severe forms when they don’t. Most cases of dental fluorosis in areas using CWF are classified as questionable or mild. Yet the anti-fluoride people will present images of severe dental fluorosis which is never caused by CWF (see ). Severe forms are caused by excessive toothpaste consumption, high natural fluoride levels or industrial contamination. Never by CWF.

The figure below shows the incidence of the different dental fluorosis categories in New Zealand (data taken from 2009 New Zealand Oral health Survey – see Our Oral Health).

And here are some accurate images of dental fluorosis provided by the Centers for Disease Control and Prevention (CDC).

Accurate-Photos-of-Fluorosi

 (Double click to enlarge)

2: They will then go on to claim that dental fluorosis is disfiguring and destroys the quality of life of the afflicted. Of course this may be true in countries where severe dental fluorosis occurs,* but not in countries like New Zealand where CWF is used.

A recently published study objectively determined the effect of dental fluorosis and dental decay on 5,474 North Carolina schoolchildren and their families – Effects of Enamel Fluorosis and Dental Caries on Quality of Life. It found no statistically significant association between dental fluorosis and oral-health related quality of life scores. Probably what one would expect because the incidence of dental fluorosis was about 28% and most of this was questionable or very mild.

But what about the effect of tooth decay on quality of life? In this case the results were statistically insignificant showing that dental caries does decrease the quality of life.

Their overall conclusions – a child’s caries experience negatively affects oral health-related quality of life, while fluorosis has little impact.

I think many of us can relate to this from our own childhood experience.


*The mainly poor quality IQ studies anti-fluoridation activists like Paul Connett love to quote were made in areas of high natural fluoride where dental and skeletal fluorosis is endemic. Such studies are not relevant to the issue of CWF, but they do raise in my mind the effect of severe dental fluorosis on quality of life, learning problems and hence possibly IQ measurements (see my article Confirmation blindness on the fluoride-IQ issue). Personally I think any disfiguring oral defect like bad tooth decay or severe dental fluorosis would effect a child’s quality of life and potentially cause learning defects and so drop in IQ.

In countries like NZ such effects on quality of life and learning are much more likely to result from bad dental decay than severe dental fluorosis. If anything, perhaps CWF actually reduces learning problems and potentially prevents decreases in IQ.

Update:

Another study invesdtigatign the influence of tooth decay and dental fluorsis on quality of life is described in the paper by Do, L. G., & Spencer, A. (2007). Oral Health-Related Quality of Life of Children by Dental Caries and Fluorosis Experience. Journal of Public Health Dentistry, 67(3), 132–139.

This also concluded that caries and less acceptable appearance showed a negative impact, while mild fluorosis had a positive impact on child and parental perception of oral health-related quality of life.

See also:

New report from the National Fluoridation Information Service – Dental fluorosis – is it more than an aesthetic concern? Its key findings are:

“Evidence does not indicate there are any health risks associated with CWF at the levels of 0.7 to 1.0 mg/L in New Zealand, and no severe dental fluorosis, or skeletal fluorosis, has been found. While fluoride is incorporated into teeth and bones, there is no robust evidence of toxic accumulation of fluoride in other tissues in the body. CWF in New Zealand has been found to not lead to anything more than very mild or mild dental fluorosis for a small “

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Ingested fluoride, dental health and old age

dentistWhen we who are chronologically challenged get together we often discuss health – and sometimes compare notes.  But, strangely, I have never heard people discuss their dental health. Don’t know why, but I started to wonder if I was the only one with my particular problem.

These days I seem to visit my dentist quite often – but current tooth decay is never the problem. Its more likely to be tooth fracture – bits of teeth breaking away or chipping off. So I asked a couple of dentists if I was unusual – or is tooth fracture just another problem of old age.

Turns out I am quite normal, at least in this respect. Dentists do find tooth fracture is more common than tooth decay at my age.* To me this underlines an important fact – what happens in our youth can affect us for the rest of our life, and particularly in our old age.

This goes for our teeth, as well as our brain. Our teeth form and develop in our early years. So the damage we do during their development comes back to bite us, as it were, 60 or more years later. Just as child abuse or neglect can have psychological effects in old age, it can also have dental effects.

Nutritional deficiencies during these early years can increase risk of developmental defects of the teeth and dental caries throughout the rest of our lives. Because teeth development is completed by age 8 we are stuck with these defects for the rest of our lives.

Fluoride and teeth development

Fluoride deficiency can be a factor in tooth development defects. This is because it is a normal and natural part of the tooth mineral, the tooth apatite. Fluoride lowers the solubility of apatites and makes them stronger and harder. Consequently, fluoride deficiency in childhood weakens tooth enamel and can  produce a susceptibility to tooth fracture later in life.

I think it is important to realise this. Recently I heard someone claim that ingested fluoride only has an effect on developing teeth in children so was of no benefit to adults.  A very short-sighted understanding –  children turn into adults.

Another reason I think it is important to understand the importance of ingested fluoride to our teeth throughout our life is the propaganda from anti-fluoride activists claiming that ingested fluoride does not influence out teeth. They have taken on the scientific understanding of the reaction of fluoride at the tooth surface which inhibits demineralisation to argue that ingesting fluoride is like drinking sun tan lotion because the effect is, they claim, purely topical.

That is a misrepresentation – and one that causes  confusion when anti-fluoride campaigners make these claims in their submission to councils. (The Hamilton City Council even advanced this misunderstanding as accepted knowledge – see When politicians and bureaucrats decide the science).

A more balanced understanding of the science shows the beneficial effects of fluoride intake is both systemic (via ingested fluoride) and topical (via the surface reaction at the tooth surface). Incorporation of fluoride into the bioapatites forming our teeth and bones strengthens and hardens them. This occurs during tooth development. Because the tooth material is stronger and harder it is less likely to suffer from fractures, scratching and similar damage.

On the other hand, fluoride intake helps protect existing teeth from decay because of the surface reaction inhibiting demineralisation of the teeth. Just from a chemical perspective the presence of calcium, phosphate and fluoride in saliva and tooth biofilms helps prevent tooth decay resulting from acid attack and demineralisation. But from a mechanical perspective if our teeth are harder and stronger there will also be fewer physical defects providing sites for the chemical acid attack.

Fluoride benefits from ingestion and surface effects

Anti-fluoride propagandists have worked hard to deny any benefits of fluoride on dental health. Often they fall back on the argument that any benefits arise only form a “topical” effect. They usually interpret this to mean tooth brushing or dental topical applications.

However, consumption of fluoridated water and food enables transfer of fluoride to saliva and biofilms on the teeth. This fluoride, together with calcium and phosphate on the saliva, reduces acid attack on the teeth and so helps prevent tooth decay. Because fluoride concentrations in saliva decrease within an hour or so after brushing, fluoridated water complements use of  fluoridated toothpaste. We are in more regular contact with food and water than we are with toothpaste

But ingestion of fluoride in food and drink during tooth development in children also helps harden and strengthen tooth enamel. This benefits a person’s teeth throughout their life by helping prevent  and tooth fracture and physical defects. Harder tooth enamel will reduce tooth decay by preventing physical formation of sites for it to take hold, even though the acid attack is itself a chemical, surface effect.

So, even the chronologically challenged benefit from community water fluoridation. And you young ones – remember one day you are going to be old and your quality of life may well depend on the community water fluoridation you had access to as a child.


*Apparently tooth decay can still return as a major problem in old age because the withdrawal of gums from the tooth roots open new sites for decay. This is known as root caries.

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Making money out of fanatics

bad science

Click on image to enlarge

This looks like a Xcd cartoon. I picked it up from a new Facebook page The Girl Against Fluoride Lies. Good to see more and more Facebook pages like this.

Speaking of fluoride – the cartoon sort of reminds me of Paul Connett’s book – The case against fluoride?

 

Dirty politics on the Royal Society fluoride review

Anti-intellectualism has been a constant thread winding its way through our political and cultural life nurtured by the false notion that democracy means that my ignorance is just as good as your knowledge

In Anti-fluoride activists unhappy about scientific research I related how local anti-fluoride propagandists were busy rubbishing the Royal Society of NZ  fluoride review – even before it was released. Now that it is released (see Health Effects of Water Fluoridation: a Review of the Scientific Evidence) they have gone into a manic mode – launching press releases and facebook attacks. Given that some of these were launched within hours of the report’s release these propagandists hadn’t bother actually reading the report itself.

These attacks are typical of anti-science people when confronted with scientific information undermining their strong beleifs. As we say in New Zealand, these critics “play the man rather than the ball.” But first, let’s deal with  the single criticism of the scientific content of the report – the question of the mechanisms of the beneficial roles of fluoride for teeth.

The old “topical” argument

The anti-fluoride brigade has a thing about this – claiming that the mode of action of fluoride is by topical contact with the teeth – and then usually they try to claim only high concentrations, as in toothpaste, are effective topically. Anything to rule our a role for fluroidated drinking water.

The Royal Society report discusses various studies, saying they:

“suggest that the predominant effect of fluoride is mainly local (interfering with the caries process) rather than systemic (pre-eruptively changing enamel structure), though the latter effect should not be dismissed.”

It then discusses the evidence for a systemic role in the section Contribution of pre-eruptive fluoride exposure to preventive effects.

“Despite a substantial body of evidence suggesting that the predominant effect of fluoride in mitigating the caries process occurs post-eruptively and topically, some recent studies provide additional evidence of a systemic effect of fluoride on pre-erupted teeth. Singh et al.[79] found that fluoride is acquired in enamel during crown completion in the first permanent molars, during the time that the matrix is formed and calcified in the first 26-27 months of life. The same group had previously evaluated the pre- and posteruptive effects of fluoride exposure at the individual level, controlling for multiple fluoride sources and potential confounders, and showed a significant effect of pre-eruptive fluoride exposure on caries in permanent teeth.[80] However, they determined that maximum benefit was gained by having both pre- and post-eruptive fluoride exposure. Other groups have also found that a higher percentage of total lifetime exposure to fluoride was associated with lower caries burden,[81-83] indicating that fluoride is effective throughout the lifespan, including pre-eruptively.”

Being a scientific review, let’s list the citations used in the section quoted. Interested readers can check them out:

79: Singh, K.A., A.J. Spencer, and D.S. Brennan, Effects of water fluoride exposure at crown completion and maturation on caries of permanent first molars. Caries Res, 2007. 41(1): p. 34-42.
80: Singh, K.A., A.J. Spencer, and J.M. Armfield, Relative effects of pre- and posteruption water fluoride on caries experience of permanent first molars. J Public Health Dent, 2003. 63(1): p. 11-9.
81: Slade, G.D., et al., Associations between exposure to fluoridated drinking water and dental caries experience among children in two Australian states. J Public Health Dent, 1995. 55(4): p. 218-228.
82: Slade, G.D., et al., Caries experience among children in fluoridated Townsville and unfluoridated Brisbane. Aust N Z J Public Health, 1996. 20(6): p. 623-9.
83: Spencer, A.J., J.M. Armfield, and G.D. Slade, Exposure to water fluoridation and caries increment. Community Dent Health, 2008. 25(1): p. 12-22.

Hardly suprising to anyone recognising that reality is rarely as simple as they might desire. The benefits of fluoride are confered both by a systemic effect on pre-erupted teeth and by a topical or surface effects on existing teeth.

Yet Fluoride Free NZ claims (see Fluoridation review ‘Dirty Science’)

“One surprise is that the review has gone so far as to claim that fluoridation works systemically (i.e. by swallowing) before teeth erupt.

This belief was not only scientifically discredited 15 years ago by the US Public Health Service’s Centers for Disease Control, but has also been acknowledged as wrong in court in sworn affidavits by Health Ministry representatives and is contrary to what the top consultant to the MoH’s National fluoridation Information Service told the Hamilton City Council last year”

No real citations there to list – just the “authority” of ignorance. The idea that, as Isaac Asimov said, “democracy means that my ignorance is just as good as your knowledge.”

I discussed this attempt by Fluoride Free NZ to distort the evidence and literature in my articles Fluoridation – topical confusion and Topical confusion persists. It seems that Fluoride Free NZ would have been happier if the authors of this review had actually ignored the scientific literature on the topic.

Media Manipulation

I will leave aside for now the emotive language and personal attacks used by the anti-fluoride propagandists in their attacks on this review. Also, I will ignore their laughable suggestions for the “experts’ they would have liked to see on the review panel and their demand that such review should actually be a public discussion (yet they refuse to allow any open discussion on their own facebook pages!).

Let’s just consider why these people take the effort to submit press statements that few credible news sources would bother picking up. I discussed this in Anti-fluoridationist astro-turfing and media manipulation where I illustrated how planted press releases were picked up by tame “natural” health websites, Paul Connett’s Fluoride Alert website and their own Facebook and twitter social media. this self-promotion get’s requoted by anti-fluoride propagandists around the world – and sometime even makes its way into mainstream media.

Wellington Anti-fluoride dentist, Stan Litras, planted just such a press release. He provided a misleading headline Review ‘confirms fluoridation must end’ which was picked up and circulated by Connett’s Fluoride Alert. It has also been heavily circulated on Twitter and anti-fluoride Facebook pages.

I guess there are now a host of anti-fluoride activists around the world who actually believe the Fluoride Review produced by the Royal Society of New Zealand recommended the end of fluoridation!

Yet, in fact, the review concluded:

“Councils with established CWF [community water fluoridation] schemes in New Zealand can be confident that their continuation does not pose risks to public health, and promotes improved oral health in their communities, reducing health inequalities and saving on lifetime dental care costs for their citizens. Councils where CWF is not currently undertaken can confidently consider this as an appropriate public health measure, particularly those where the prevalence and severity of dental caries is high.”

How do these guys sleep straight in their bed at night?

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Anti-fluoride activists unhappy about scientific research

Mark Atkin (“Science and legal advisor” for FFNZ) and Mary Byrne (“National Co-ordinator and media contact” for FFNZ) promote their “magic” fluoride free water.

These activists have a really weird understanding of science and the nature of scientific research. How’s this for press releases from the NZ Fluoride Free Science and Legal Advisor, Mark Atkin:

1: Rubbishing a planned review of the published science around fluoridation by Sir Peter Gluckman (the Prime Minister’s Chief Science advisor) and the NZ Royal society. Mark declares the review is “totally one-sided” and that Gluckman admits this (see Secret Fluoridation Review Totally One-Sided Admits Chair)!

And what is Atkin’s “evidence” for that? Well Gluckman did say:

“this is just straightforward scientists reviewing what’s in the peer reviewed literature about what we know about the safety and efficacy of fluoride in water. It is reviewing the scientific literature.”

And Atkin chose to distort that to mean:

This “‘review’ of water fluoridation will only look at research that supports fluoridationists’ belief in ‘the safety and efficacy of fluoride in water’, says Sir Peter Gluckman, co-chair of this thereby-admitted ‘kangaroo review’.
It is no wonder that scientific studies showing water fluoridation is neither safe nor effective have not been sought for this bogus ‘review’.”

Mark Atkin seems to have a serious comprehension problem.

2: Claiming Waikato University is commissioning research to obtain  predetermined conclusions.

The same day Atkin produced another press release (see Predetermined ‘research’ outcome commissioned by Waikato Uni). He certainlychurns out press releases even if their quality leaves a lot to be desired.

The specific project Atkins is upset about plans to look in detail at:

“nearly 1700 publicly accessible submissions to the Hamilton City Council on the initial decision to remove flouride from Hamilton’s city water supply with a view to tracing interests and other links to private interests and public lobbying groups.”

Rather than making assumptions about the outcome, the research is aimed at establishing if there were links and their extent. The title of the project is “Public Integrity and Participatory Democracy: Hamilton
City Council’s Water Fluoridation Decision.” Surely it is in all our interests to determined how effective our participatory democracy works at the local body level.

Given that the anti-fluoridation activists often claim our democratic processes are distorted by groups like the District Health Boards I would have thought they would welcome this research. Mind you, they may prefer to leave that particular claim unchecked by objective analysis and actually be far more scared of what an objective analysis of the process reveals about their own manipulation and links to private commercial interests and lobby groups.

Isn’t that weird. A “science advisor” who interprets a scientific review “about the safety and efficacy of fluoride in water” to mean that “scientific studies showing water fluoridation is neither safe nor effective” will be excluded! And that research aimed at tracing interests and links of submitters to commercial and lobby groups will only produce a results claiming the links exist without considering any evidence.

Perhaps this is the way Mark Atkin thinks scientific investigations should happen. Perhaps this is the way the “world fluoridation experts” he idolizes, like Paul Connett and Declan Waugh, carry out their “investigations.”

But it is certainly not the way genuine scientific investigations are done.

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Open letter to Jane Nielson – a “fluoridation convert.”

Hi Jane,

I read your article in the Sonoma County Gazette which was republished at Paul Connett’s Fluoride Alert website – Fluoridation convert. A scientist explains what changed her mind. You briefly described scientific studies which you claim convinced you to take a stance against community water fluoridation. Apparently you found these so convincing you are now a board member and steering committee member of several anti-fluoridation organisations.

My purpose here is to discuss the studies you refer to because I think your interpretation of them is mistaken. I offer my critique of your interpretation in the spirit of normal scientific exchange and discussion and hope you will respond in the same way.

You wrote that you were exasperated with the fluoridation debate so:

“I started researching for myself. This was familiar terrain: I had published many papers, so I know what it takes to prove a point scientifically, and the data required to get a paper published. I had performed analyses, plotted data and defended my research and interpretations in public forums.”

Good on you. I believe experience in scientific research, scientific publication and the use of scientific literature helps cultivate a critical and intelligent approach to the literature. I think this is essential if one seriously wishes to make sense of apparently contradictory evidence and overcome one’s own confirmation bias.

Is fluoridation effective? The WHO data

You say:

“I quickly found World Health Organization data that stunned me:

• Tooth decay has plummeted in developed countries worldwide, regardless of fluoridation.

• Cavity rates are the same—or even lower – in many non-fluoridated countries compared to the U.S.”

Just a minute! Did you look at the WHO data carefully? Did you take into account the well established multiple factors, beside fluoride, influencing dental health? (Things like diet, health services, dental treatments available, other social health services etc.) Did you consider the difficulty of drawing conclusions from data, especially a small amount of data, taken from different cultural, social and political situations? And, importantly, did you check out the WHO data which compared data from fluoridated and non-fluoridated areas in the same country? (Many of the other confounding factors can be eliminated by making comparisons  within a country).

The figure on the left below is the one most often used by anti-fluoride activists for obvious reasons – it confirms their bias. But it suffers from all the problems mentioned above (including the fact that the straight lines result from using just 2 data points for each country) and so does not allow a truly objective  person to conclude what you have.

Surely with your scientific experience you checked out the detail in the data – such as the WHO data for the Irish Republic which included that for both fluoridated and unflouridated areas? The plot of that data (see figure in the right) suggests your conclusion is unwarranted (the dotted line is the average of fluoridated and unfluoridated and corresponds to the data in the graph on the left.).

combined-who-ireland

My conclusion from the WHO data is that tooth decay has decreased in all these European countries over the last 30 years. Fluoride is just one factor in this but it is wrong to conclude from the WHO data that fluoride is ineffective (see Fluoride Debate).

Dental fluorosis

This concerns you because:

• The one clear correlation with water fluoridation is disfiguring “dental fluorosis” supposedly only a cosmetic problem.

But, Jane, have you looked at the available data on dental fluorosis carefully? Your conclusion is a misinterpretation which anti-fluoride propagandist love to promote because it confirms their bias – “fluoridation causes a “disfiguring” complaint – dental fluorosis.” But “disfiguring” or serious dental fluorosis is not caused by community water fluoridation. It is caused by excessively high fluoride dietary intake due to high natural levels of fluoride, industrial contamination or obsessive consumption of toothpaste. It is also very rare in the US, Europe, Australia and New Zealand.

Dental specialists identify various levels of fluorosis ranging from not present, through questionable, very mild, mild, moderate to severe – see the figures below (taken from Fluorosis Facts: A Guide for Health Professionals):

Fluorosis-pie-chart

Some idea of the appearance of dental fluorosis at these various levels in given by the photos below.

df

 I agree that often (not always) the occurrence of total dental fluorosis may be higher for people in fluoridated areas than in non-fluoridated area – but the “disfiguring” moderate and severe forms are not the result of community water fluoridation. The milder forms which may arise from community water fluoridation tend to be either unnoticeable or so mild as to be of only cosmetic significance.

So Jane, I am surprised that with your scientific experience you came to such an unwarranted conclusion. If you had truly looked at the data intelligently and critically surely you would not have drawn the extreme conclusion you did about community water fluoridation and dental fluorosis.

What about studies showing fluoridation is ineffective?

You refer to studies which show only minimal or no difference in oral health between fluoridated and non-fluoridated areas. I have also seen those studies. But you and I are scientists so know we should always look at the details and not rely on the conclusions drawn by political activists who misinterpret these studies. Hell, as scientists we shouldn’t even rely in the conclusions made by the researchers themselves – we should always look at the details.

Tooth decay for children living in fluoridated and unfluoridated areas has been compared in many studies. It is easy to find results confirming ones bias – pro-fluoridation or anti- fluoridation. So as scientists both you and I should consider all the studies – not just those confirming our particular bias. That should be obvious to us.

I have seen plenty of studies showing a positive effect of community water fluoridation on oral health – so how do I deal with those other studies showing no effect? Well, I certainly don’t ignore them but it helps to look at the details. For example, in my article Fluoridation: what about reports it is ineffective?  I discussed a 1985 paper by a New Zealand researcher, John Colquhoun, who found no differences in tooth decay between children in fluoridated and unfluoridated areas.

Colquhoun, who was also an antiifluoridation campaigner, chose to conclude that fluoridation had no effect on oral health. But here is the problem – the children in the non-fluoridated areas he studied all received regular topical dental fluoride application treatments, whereas most of the children in the fluoridated areas did not.  So the lack of effect was hardly surprising. In scientific terminology his control group was not a proper control.

What happens when fluoridation is stopped

The studies showing no increase in tooth decay when fluoridation is stopped are continually quoted by anti-fluoridation propagandists – but never the ones that do show such an increase. So your reading of the published studies cannot have been very thorough for you to conclude:

 “Tooth decay did not go up when fluoridation was stopped.”

For example, consider just one study in South-west Scotland by Attwood and Blinkhorn (1991) I discussed in article What happens when fluoridation is stopped?   The figure below displays some of their data

Decayed missing and filled teeth for 10 year olds. Stranraer fluoridated until 1983. Annan not fluoridated.

This study showed tooth decay increased after fluoridation was stopped in one town (Stranraer) even though there was a general decrease in tooth decay (no doubt resulting from things like improvements in diet, tooth brushing, dental treatments, etc.) indicated by the data from the town that had never been fluoridated (Annan).

Still, what about those studies which showed no increase in tooth decay when fluoridation was stopped? Studies in Cuba, the former East Germany and Finland are frequently quoted by anti-fluoridation activists.  I discussed these  in my article What happens when fluoridation is stopped? 

In all the studies referred to the researchers themselves drew attention to the role of other factors which helped maintain oral health. For example, the introduction of a school mouthrinsing programme, which has involved fortnightly mouthrinses with 0.2% NaF solutions” in La Salud, Cuba. Or “improvements in attitudes towards oral health behaviour and, on the other hand, to the broader availability and application of preventive measures (F-salt, F-toothpastes, fissure sealants etc.)” in the former East Germany.

The authors of the Finnish study even warned against drawing the conclusion you have from these studies:

“The main reason for the modest effect of water fluoridation in Finnish circumstances is probably the widespread use of other measures for caries prevention. The children have been exposed to such intense efforts to increase tooth resistance that the effect of water fluoridation does not show up any more. The results must not be extrapolated to countries with less intensive preventive dental care.”

The whole issue of dental health is clearly complex and many factors influence it. As a scientist used to dealing with complex issues you must surely agree the scientific literature should not be cherry-picked. It must be approached critically and intelligently.

Apply It, or Swallow It?

Finally, Jane, we come to the question of the mode of action of fluoride – does it work systemically via ingestion, or topically by a surface reaction on existing teeth? You assert:

In recent years the differentiation between swallowing fluoride and coating teeth with it has become lost in the discussion. But this differentiation is essential. The overwhelming consensus among scientists, including the Centers for Disease Control CDC and the National Research Council, is that fluoride works when it’s applied to the tooth surface, NOT when it’s swallowed.

I know this is the position anti-fluoride propagandists keep promoting but it doesnt actually accord with the evidence. Research shows ingested fluoride plays a beneficial role during tooth development before eruption (see my article Ingested fluoride is beneficial to dental health.

With existing teeth fluoride transferred from water and food during drinking and eating helps maintain a concentration in saliva and tooth biofilms necessary to inhibit tooth decay by a surface reaction. Researchers usually refer to the reaction of fluoride at the tooth surface responsible for inhibiting demineralisation and promoting remineralisation as the “predominate” – not the only – mechanism for the beneficial role of fluoride.

Jane, you should have read the CDC report you refer to more carefully. Far from denying a role for “swallowed” fluoride the  CDC report Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States actually says:

“However, drinking fluoridated water, brushing with fluoride toothpaste, or using other fluoride  dental products can raise the concentration of fluoride in saliva present in the mouth 100-to 1,000-fold. The concentration returns to previous levels within 1–2 hours but, during this time, saliva serves as an important source of fluoride for concentration in plaque and for tooth remineralization.”

Unfortunately, opponents of CWF claim this surface mechanism means that ingested fluoride plays no role and fluoride is only effective when topically applied – as with toothpaste. This is a gross simplification and distortion. Ingested fluoride is beneficial to teeth duing their development before eruption. And ingested fluoride contributes to the surface reaction protecting existing teeth.

Fluoridated toothpaste (and dental fluoride applications) also contribute to this surface reaction. But the more frequent “top-up” of saliva fluoride concentrations via drinking fluoridated water also make an important contribution.

An invitation

Jane, I don’t claim to have provided the final answer to all criticisms of community water fluoridation here. I have simply responded to your assessments and shown why I think them wrong.

I am open to hearing your responses to my critique and welcome any scientific exchange on this important issue with you.

I look forward to hearing from you.
Ken Perrott.

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Natural News comes out with a load of heavy metal rubbish on flouride

Heavy-MetalsFRAUD

The web site “Natural News” is a prime source of information for alternative and “natural” health enthusiasts. It promotes a lot of misinformation on fluoridation and is often cited by anti-fluoridation propagandists. So – no surprise to see a recent campaign in social media promoting a Natural News article Natural News exclusive: Fluoride used in U.S. water supplies found contaminated with lead, tungsten, strontium, aluminum and uranium.

The article was dutifully tweeted ad nauseum and of course local anti-fluoride campaigners also dutifully and uncritically promoted it. But no-one actually looked at the data in the article to see if it was in any way meaningful or supported the claims of contamination being made. In fact, it is just another example of the sort of misrepresentation I referred to in the article Fluoridation: emotionally misrepresenting contamination. That is, people getting hysterical about contamination  data which actually show very low levels of contaminants.  Getting hysterical about numbers just because they are numbers without any understanding of what they mean.

Lead researcher – the Health Ranger

Mike Adams, who calls himself the Health Ranger, wrote the article which pretends to be a scientific investigation of contaminants in 6 samples of sodium fluoride obtained from Chinese sources. He reports the maximum and average values of a number of contaminants. Of course he uses parts per billion (ppb) because that gives him larger numbers by a factor of 1000 than the usually used parts per million (ppm). I will convert his values for readers and compare them with values found in Australia and New Zealand for contaminants in fluorosilicic acid, the most commonly used fluoridation chemical (actually fluorosilicic acid is also the most commonly used fluoridation chemical in the USA – so its strange that the “Health Ranger’ didn’t analyse that).

The table below compares “the Health Ranger’s” analytical values with those for fluorosilicic acid reported in my article  Fluoridation: emotionally misrepresenting contamination. Also included are the regulated maximum values for these two fluoridation chemicals. I have included only values for arsenic and lead as these are the only ones of “the Health Ranger’s” list included in New Zealand regulations (see NZ Water and Wastes Association Standard for “Water Treatment Grade” fluoride, 1997).

Arsenic (ppm) Lead (ppm)
Fluorosilicic acid
Regulated maximum 132 132
Range certificates 1.1 – 4.3 <0.001 – <5
Sodium Fluoride – Mike Adams
Regulated maximum 366 366
Maximum – NN 0.14 1.0
Average – NN 0.07 0.3

So, “the Health Ranger” produces hysterical headlines for fluoridation chemicals using figures showing extremely low levels of contamination! They are even low in comparison with the fluoridation chemicals used in New Zealand and they are certainly very much lower than the local regulated maxima. And don’t forget that these concentrated chemicals are diluted millions of times over when added to drinking water.

Yes, I know, there are some people who think any measured value is too much. But put this into context. Even the most pristine water or food will contain (very low) levels of contaminants if we use an analytical method that is extremely sensitive. That is why we should check claims of contamination by comparison with “uncontaminated” material and regulated maximum values. We must put the numbers into context.

Contamination from source water – not treatment chemicals

To put the situation of fluoridation chemicals into further context contribution of contaminants to drinking water from other sources should be considered. In Fluoridation: putting chemical contamination in context I compared the amounts of arsenic contributed from fluoridation chemicals to local drinking water (Hamilton City in the Waikato) to the arsenic already present in the source water from the Waikato River. The figure below shows any contribution from the fluoridation chemicals used is miniscule compared with the natural levels already in the water.

I won’t comment on the other heavy metals “the Health Ranger,” (who describes himself as the “lead researcher” in this pathetic study) mentions as they are not covered by local regulations. However, the certificates of analysis for fluorosilicic acid included in my article Fluoridation: emotionally misrepresenting contamination all reported Uranium at levels  < 2 ppm. “The Health Ranger” reported a maximum of 1.4 ppm and average of 0.2 ppm.  Not so impressive in ppm – you can see why he prefers ppb.

Similarly he makes a song and dance about titanium – despite the fact that he detected it in only 2 of his 6 samples and at concentrations apparently too low to enable “quantitative analysis.”

Conclusion

Cleary another scare-mongering article from Natural news. It is accepted uncritically by anti-fluoride activists and heavily promoted by their propagandists. But it is worthless – some would say fraudulent.

This sort of fraud going on in the “natural” health movement needs to be widely exposed. The ordinary reader has no way of evaluating these claims or the numbers involved. However exposure of these sort of fraudulent articles will help readers  be wary about future claims from these sources.

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