Category Archives: Health and Medicine

An answer to the anti-fluoride critics – in one image

Undeserved-Reputations-Fluoride-724x1024

Click image to enlarge. 

The chemical website Compound Interest, is producing a series of infograms to communicate some chemistry.  Here is an excellent one they produced on fluoride. I think it would make a great poster.

It is accompanied by some straightforward text describing the science behind fluoridation and countering a lot of the misinformation anti-fluoride propagandists promote.

Worth reading. See Fluoride & Water Fluoridation – An Undeserved Reputation?

The chemically minded may also be interested is some of their other infograms –  here are just a few examples:

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Elected officials must ignore activists and listen to own voters

Seel

Karen Williams Seel, a member of the county board of commissioners in Pinellas County, Fla.

A recent US blog article made some very pertinent points about the role of elected officials, such a local body councillors, on important social health issues like fluoridation.  These officials have a responsibilty to avoid pressure from misinfomred activists and must instead  listen to their constituents.

Karen Williams Seel, who wrote the article Fluoridation: Elected officials have a critical duty is a member of the county board of commissioners in Pinellas County, Fla., USA. Three years ago, the board voted 4-3 to stop fluoridating its water supply but reversed that decision in 2012 after voters defeated two incumbent commissioners who had voted against fluoridation. In both instances, Seel voted in favor of fluoridation.

She wrote:

“As Americans increasingly seek health information online, elected officials and other policymakers need to recognize that anti-fluoride activists have created a web-based panoply of false fears. For many fluoride critics, these online messages are the source of their concerns. This spring, for instance, a New York resident wrote a letter to his local newspaper, saying he “was surfing the Web and came across information on water fluoridation and the dangers that lie within this practice.”

And

“Public officials have a responsibility to listen to their constituents. We also have a duty to not allow false fear to drive public health decisions. We should direct our constituents to reputable websites like these sites. We shouldn’t let “guess what I read on the internet” be the reason that we abandon a proven, safe practice like water fluoridation.”

Rotorua District Councillors should take Seel’s points on board as they confront their own decisions about Rotorua’s fluoridation and how to consult citizens on it (see Council votes for referendum on fluoridation).

They should also beware of the”Tribunal” trap the Hamilton City Council fell into which effectively led to them being captured by politically and ideologically motivated anti-fluoridation activists, ignoring the information from scientific and health professionals, and ignoring the views of voters. A mistake which eventually led to pressure for another referendum and a reversal of the council’s faulty decision.

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The irony of some peer-review and citation complaints

peer_review

Anti-fluoridation propagandists and other promoters of pseudoscience have a sort of “love-hate” attitude towards science and the scientific literature.

On the one hand they love to cite scientific papers they claim support their message. Very often the citation is completely unwarranted, misrepresents the paper or even distorts the findings reported. Declan Waugh stands out as a repeat offender of such misrepresentation and distortion of the literature on the fluoride issue.

But, on the other hand they sort of recognise that they cannot rely on support from the scientific literature so will often denigrate the scientific process. Sort of having a bob each way.

A sordid affair

“Penelope Paisley” at Fluoride Free Hamilton NZ  is indulging in the latter by posting a link to a news report about exposure of a “peer review  and citation ring” at the Journal of Vibration and Control (JVC). This was reported at Retraction Watch in its article SAGE Publications busts “peer review and citation ring,” 60 papers retracted.

Besides retraction of the 60 papers this exposure led to the editor in chief of the journal resigning and a  professor in Taiwan who was responsible for the ring resigning from his employment.

A sordid affair which unfortunately does happen from time to time in the scientific community. We are, after all, human.

But it is ironic for local anti-fluoride propagandists to “point the finger” at this case. Periodically they promote “their own” peer-reviewed paper from a journal with a somewhat similar scandal. I wrote about this in Peer review, shonky journals and misrepresenting fluoride science.

The hypocrisy of the complaint

The paper is Peckham & Awofeso (2014), Water Fluoridation: A Critical Review of the Physiological Effects of Ingested Fluoride as a Public Health Intervention, The Scientific World Journal Volume 2014 (2014). It has been heavily promoted in the anti-fluoride social media –  “natural” health web sites, blogs, Facebook pages and Twitter.

However, The Scientific World Journal was described as a” bottom feeding” journal because of its approach to peer review and citation.  It relies on author fees, and not subscriptions, and is therefore open to the charge that it provides an easy way for unscrupulous authors to buy space for their articles. It was banned from lists of impact ratings because it allowed the unethical practice of self-citation.

So there is one irony in anti-fluoride propagandists’ exposure of  a shoddy incident in science publishing – they happy to use it to attack the scientific publishing process in general while on the other hand giving support to a similar shoddy case because it supports their word-view.

But there is another irony. “Penelope” is the on-line name used by Lynn Jordan – the  Fluoride Free NZ Committee member for Wellington. She also practices as a  cranio-sacral therapist in Wellington. Cranial-sacral therapy is an alternative or “natural” therapy which Edzard Ernst  described as more or less bogus (see Up the garden path: craniosacral therapy). I imagine that “Penelope” consults very few peer-reviewed scientific journals as part of her job. More likely she relies on “natural” health and pseudoscientific publications and on-line sites.

The irony here is that the “natural” health and pseudoscience publication industry will never have a scandal involving peer review and citation. Peer review and responsible citation is completely outside the ethos that guides them.

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“Creative” reporting of fluoridation science

duane

I am all for genuine creativity in science, and elsewhere. But some people seem to think anything goes when the are promoting their ideology or political views.

Again and again I come across campaigners , especially in areas like “natural” health, climate change denial and promotion of creationism, who seem to think “creative embellishment – or outright distortion – is OK when claim that science is “on their side.”

Here’s a typical example from Fluoride Free NZ (FFNZ) who are attempting to deny the science indicating that fluorosilicates used for fluoridation of water supplies decompose to form the fluoride anion. They are desperate to assert that fluorosilicate species remain and these “might” be toxic.

FFNZ cites the National Toxicology Program (NTP), part of the US Department of Health and Human Services. But puts words into their mouths to create exactly the opposite conclusion to tat which should be taken from that web site.

According to FFNZ:

the NTP “says the assumption that fluoridation chemicals disassociate into free fluoride ions is not supported by experimental evidence. This is good to remember when the fluoridationists claim that fluoride, is fluoride is fluoride. They are operating on belief rather than scientific fact.”

But the NTP says nothing of the sort. The page simply lists a 1999 nomination, from a “private individual”, for research to consider possible toxicity. Yes, the “private individual” gives as grounds “lack of toxicity information; assumed complete dissociation to free fluoride under normal conditions of use not supported by experimental evidence.” But that is the view of the nominator – not of NTP.

In fact, the NTP has a statement making clear that selection of an agent for study does not imply support for the nominators views:

” Selection of an agent for a study does not imply that the agent is hazardous or a potential carcinogen in laboratory animals; likewise, an agent not selected for toxicologic study by the Program should not be taken to mean that the agent is not potentially hazardous or potentially carcinogenic in laboratory rodents.”

Interestingly the cited web page includes “The following information related to “fluorosilicates  “including history from earlier or later nominations for this same agent.” Specifically  Nomination Background a pdf document “Review of Toxicological Literature.” It is a comprehensive review, but on page 4 it says:

“In water, fluorosilicic acid readily hydrolyzes to hydrofluoric acid and various forms of amorphous and hydrated silica. At the concentration usually used for water fluoridation, 99% hydrolysis occurs and the pH drops to 4.2. As pH increases, hydrolysis increases. At the pH of drinking water, the degree of hydrolysis is “essentially 100%” (Crosby, 1969; Urbansky and Schock, 2000).

H2SiF6(aq) + 4 H2O    →    6 HF(aq) + Si(OH)4(aq)”

Exactly the opposite of what FFNZ assert!

Now who is ” operating on belief rather than scientific fact.”

A clear example of extreme confirmation bias amounting to complete distortion.

For more information on the science of the decomposition of fluorosilicates in water have a read of Declan Waugh’s misinformation on fluorosilicic acid and An open letter to Declan Waugh – new mechanism for fluoride toxicity?

Credit: Thanks to Duane for the image.

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What happens when fluoridation is stopped?

Tooth fluoride protection icon isolated

When fluoride becomes incorporated in teeth, it makes the enamel more resistant to demineralization, preventing the decay process. Illustration: TuftsNow.

Anti-fluoride propagandists continually assert that fluoride is not effective in reducing tooth decay. One piece of “evidence” they rely on for this is a claim that when fluoridation is stopped dental health does not decline, But is this claim true? Does the scientific literature really show tooth decay doesn’t rise when fluoridation is stopped?

Connett misrepresents the science again

Well, here is what Paul Connett – the self-described world expert on fluoridation – claimed in our exchange (see Fluoride debate: Response to Paul’s 6th article. December 9, 2013):

“modern studies have not found tooth decay when fluoridation has been stopped in various communities.”

In chapter 5 of his book The Case Against Fluoride he provided more detail:

“there is no evidence that where fluoridation has been started and stopped in Europe there has been a rise in tooth decay. Indeed, two studies published in 2000, from Finland and the former East Germany, show that tooth decay continued to decline after fluoridation was halted.11,12 There have been similar reports from Cuba13 and Canada’s British Columbia.14

Pretty definite claim isn’t it? “No evidence” of the expected increase in tooth decay after fluoridation is stopped. And he cites scientific reports to “prove” his claim. But what do those four scientific reports actually say? Let’s look at each one in order and, unlike Connett, I will quote from the papers.

11. L. Seppä, S. Kärkkäinen, and H. Hausen,Caries Trends 1992–1998 in Two Low-Fluoride Finnish Towns Formerly with and without Fluoridation.” Caries Research 34, no. 6 (2000): 462–68. I can’t find the full text, or even an abstract, for this paper but the authors commented on this research in Seppa et al (2002). They found their “longitudinal approach did not reveal a lower caries occurrence in the fluoridated than in the low-fluoride reference community.” But commented:

“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.”

12. W. Künzel, T. Fischer, R. Lorenz, and S. Brühmann,Decline of caries prevalence after the cessation of water fluoridation in the former East Germany Community Dentistry and Oral Epidemiology 28, no. 5 (2000): 382–89. These authors found no increase of caries in two German cities after fluoridation of water was stopped. But again the authors suggest why:

“The causes for the changed caries trend were seen on the one hand in 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.).”

13. W. Künzel and T. Fischer,Caries Prevalence after Cessation of Water Fluoridation in La Salud, Cuba.  Caries Research 34, no. 1 (2000): 20–25. Again this study found no increase in caries after stopping fluoridation but the authors suggested why:

“A possible explanation for this unexpected finding and for the good oral health status of the children in La Salud is the effect of the school mouthrinsing programme, which has involved fortnightly mouthrinses with 0.2% NaF solutions (i.e. 15 times/year) since 1990.”

14. G. Maupomé, D. C. Clark, S. M. Levy, and J. Berkowitz,Patterns of dental caries following the cessation of water fluoridation.” Community Dentistry and Oral Epidemiology 29, no. 1 (2001): 37–47. The authors reported “Caries incidence . . .  was not different between the still-fluoridating and fluoridation-ended communities.” However, they considered other factors and limitations in their own study and concluded this issue was complex:

“Our results suggest a complicated pattern of disease following cessation of fluoridation. Multiple sources of fluoride besides water fluoridation have made it more difficult to detect changes in the epidemiological profile of a population with generally low caries experience, and living in an affluent setting with widely accessible dental services. There are, however, subtle differences in caries and caries treatment experience between children living in fluoridated and fluoridation-ended areas.”

So when we actually read these cherry-picked reports we find that, while no increases in tooth decay were found after fluoridation stopped, in all 4 cases this was attributed to the existence of other sources of fluoride and fluoride dental treatments. This is a similar situation to that I reported about one of Colquhoun’s papers in my recent article Fluoridation: what about reports it is ineffective? In that case all children from non-fluoridated areas had been given six-monthly dental fluoride treatments whereas most children from fluoridated areas had not. So the lack of an effect due to fluoridation is hardly surprising.

Read scientific literature critically and intelligently

This underlines the need to always read the scientific literature critically and intelligently, doing our best to avoid confirmation bias and cherry-picking. Perhaps that was Connett’s mistake – he was just selecting reports supporting his bias without being aware of these details. However, in his book he says:

“The ADA claims that in cases where fluoridation has been halted and no increase in tooth decay observed, other steps have been taken to fight tooth decay.”

So these details had been brought to his attention. But it did not stop him misrepresenting the scientific reports he cited. Nor has it stopped him continuing this misrepresentation, even today. All he has done is to attempt a diversion when these details arise:

“Whether or not that is the explanation, European countries have clearly demonstrated that there are other ways of reducing tooth decay without forcing everyone to take a medicine in their drinking water.”

He had the same response in our exchange when I pointed to the role of other fluoride treatments in these studies. Connett attempts to avoid the issue of his misrepresentation of the published science to support his claim that fluoride does not help prevent tooth decay – by acknowledging fluoride can be beneficial but pretending the argument was about the mode of delivery when it wasn’t!

Connett’s reference to ADA is actually to their booklet Fluoridation Facts. It appears the he has read page 15 – What happens if water fluoridation is discontinued. He has taken the 4 citations he uses from that page. But tellingly he ignores completely another 5 citations reporting deterioration of oral health when fluoridation was stopped. He cannot have missed those citations – in this case his cherry-picking amounts to dishonesty.

Studies do show increase in tooth decay when fluoridation stopped

The ADA booklet referred to above answers its question about the consequences of discontinuing fluoridation this way:

“Over time, dental decay can be expected to increase if water fluoridation in a community is discontinued, even if topical products such as fluoride toothpaste and fluoride rinses are widely used.”

In Fluoride debate: Ken Perrott’s closing response to Paul Connett? I discussed one of the ADA cited papers which did show an increase in tooth decay –  Attwood and Blinkhorn (1991),“Dental health in schoolchildren 5 years after water fluoridation ceased in South-west Scotland.”  They measured dmft and DMFT – decayed, missing and filled teeth in primary and permanent teeth respectively.

The figures below illustrate the data from this paper which compared changes in oral health of two Scottish towns  in both 1980 and 1988. One town, Annan, had never had fluoridated water while the other, Stranraer, had it until 1983. This enabled the effects of both cessation of fluoridation and the generally observed improvement in oral health due to other factors to be compared and considered. The graphics show the results for 5 year old and 10 year old children.

Decayed missing and filled deciduous teeth for 5 year olds. Stranraer fluoridated until 1983. Annan not fluoridated.

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

The plots indicate aspects of the complexity of these sort of studies. Because 2 different towns were compared it was possible to measure the decline in oral health after discontinuation of fluoridation against a background of the general improvement in oral health, even in a non-fluoridated situation.

The moral here is don’t accept at face value the claims made by anti-fluoridation propagandists – even if they, or their supporters, insist the propagandist is “the world expert on fluoridation.”

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Controversial IQ study hammered in The Lancet

I have discussed the paper by Grandjean & Landrigan (2014) before in the article Repeating bad science on fluoride. So have other bloggers and commenters. On the other hand anti-fluoride propagandists are still promoting it heavily in social media and “natural” health web sites.

But the cogs of science publishing have ground slowly on and the scientific critiques are starting to appear. The last issue of The Lancet (which published the original paper) has several articles in the correspondence section critical of the paper (see Neurodevelopmental toxicity: still more questions than answers). Two of these related to claims made about fluoride.

Unsubstantiated claims, misquoted studies

Virginia Feldman wrote that the authors:

“make unsubstantiated claims and misquote previous studies to pull together heterogeneous elements and drugs into a group of substances termed neurotoxicants.

The investigators’ claim of new data is undermined by 24 of the cited references being their own previous, mostly review articles . . . . . . Their “strong evidence” for adding fluoride was a finding from Grandjean’s own review of older Chinese studies. Contrary to their statement—“Confounding from other substances seemed unlikely in most of these studies”—findings from many previous meta-analyses have shown the faults of using intelligence quotient (IQ) data from countries with highly polluted air and water; non-validated IQ tests; poor controls for parent IQ, socioeconomics, and other variables; and studying mega-doses in animals and in human beings. By contrast with this review of Chinese studies, all of problematic methodological robustness, more than 3000 studies of the safety of water fluoridation stretch over 65 years. During this time, as fluoridation increased from 0% to 72% of US households, average US IQs have not decreased, but have instead increased by 15 points.”

She also directs the authors’ attention to a paper by one of their frequent co-authors, David Bellinger, about determining IQ points lost (Grandjean & Landrigan 2014 claimed fluoride can cause a 7 point drop in IQ). Bellinger specifically says the meta-analyses of the sort used by Grandjean & Landrigan (2014) are just not suitable for calculating IQ points lost.

Unacknowledged research

Julianna Gelinas and Myron Allukian were also concerned about the authors’ reliance on very flimsy evidence. The “claim that fluoride might cause neurodevelopmental harm” is “based on only one paper, of which Grandjean is a coauthor.” Further describing the limitations of that study they say “it contains several flaws that undermine its credibility and calls into question its applicability to the community water fluoridation programme in the USA.”

“The study is a meta-analysis of 27 cross-sectional studies done in poor, rural communities in China, Mongolia, and Iran, countries where the drinking water contains high levels of naturally occurring fluoride. The 27 original studies did not adequately control for a variety of intervening and confounding variables that could have affected intelligence quotient (IQ) scores, such as parents’ education and socioeconomic status and air and water pollution. It is unfortunate that Grandjean and Landrigan did not mention these limitations.

Additionally, they did not clearly state that the reference groups in their article use water fluoridated at about the recommended level. Thus, another interpretation of their analysis could be that communities fluoridated at the recommended level have a higher IQ.”

Nor did Grandjean and Landrigan acknowledge research showing fluoride was not harmful:

“No credible scientific studies show a relation between fluoride consumption and IQ levels; however, several have shown that fluoride ingested at recommended levels is not harmful. Grandjean and Landrigan did not acknowledge the animal study that showed no evidence of a neurotoxic effect of fluoride, even at levels up to 230 times the recommended concentration; an earlier study showing that fluoride causes no harm to children; two formal reviews that delineate weaknesses in the Chinese fluoride and IQ studies; and the conclusion by one of these sets of investigators that biological plausibility for a link between fluoridated water and IQ has not been established.”

Request for statement on fluoridation

They are also concerned at the way the original paper is being used by anti-fluoride propagandists:

Unfortunately, Grandjean and Landrigan’s Review has been aggressively and improperly used by antifluoridationists to frighten the public about the effects of fluoridation, a well-established public health measure that has been shown to be cost-effective and safe. As a result, the public’s oral health, especially that of the most vulnerable people, is put in jeopardy. . . .

A statement from Grandjean and Landrigan clearly stating that their addition of fluoride to their list of neurotoxins does not apply to fluoridation at the recommended levels of 0·7—1·2 ppm would clarify our concerns on the misuse and misinterpretation of their paper.”

The authors’ response to these criticisms was brief and rather flippant.  They claim other reviewers of their meta-analysis were “without access to important background information” – without providing information on this. They dismissed Feldman’s reference to the increase in population mean IQ as a “serious error” – again without justification or explanation.

The remained silent about the way they had relied on very few sources, often their own, in their review.

So some important criticisms of the original paper and ones that the authors did not respond to properly. But will this stop anti-fluoride propagandists relying on this paper – one that very few of them have bothered reading?

I doubt it.

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New group challenging the anti-science brigade

Here’s a recent press release from a new group, The Society for Science Based Healthcare, which is having some successes in challenging anti-scientific advertising.


ASA2s

Controversial Church Caught Red Handed

The Advertising Standards Authority (ASA) upheld three complaints from the newly formed Society for Science Based Healthcare today regarding misleading health claims.

The Universal Church of the Kingdom of God, DailyDo and Pure Wellbeing have all been asked by the ASA to remove adverts that make misleading health claims.

The Universal Church of the Kingdom of God, which was recently embroiled in controversy regarding claims that its holy oil could heal a variety of serious health problems, has had a second complaint upheld against it. Bishop Victor Silva, when responding to a previous successful ASA complaint, had promised that:

“When we come to hold another similar event, we will take external advice as to the content of any promotional material to doubly ensure that it is fully compliant with all regulation and that there is no chance of another complaint of this nature.”

Despite these assurances, within 3 weeks of this promise the church sent out another advertisement for a “chain of prayer” series of events. This advert claimed that “IT WORKS!” and that a “HEALING” session covered cases such as “When doctors & medicines are not enough” and “incurable diseases”. A majority of the complaints board agreed that “the Advertiser had presented their religious beliefs in evangelical healing as an absolute fact, rather than opinion, and may mislead and deceive vulnerable people who may be suffering from any of the illnesses listed in the advertisement”. The board ruled to uphold the complaint.

DailyDo, a daily deals website, advertised amber teething necklaces with phrases such as “Traditional homeopathic treatment for teething babies, designed to help provide relief”. As the advertiser was unable to provide any evidence to support their claims, the ASA ruled that “the advertisement was misleading and had not been prepared with the high standard of social responsibility required for products with intended therapeutic use”.

This is the latest in a long series of successful complaints regarding misleading health claims about amber beads, which resulted in a new ANZA guideline being written. In response to the complaint, the ASA has sent a copy of this guideline to other “one day deal” sites.

A number of advertisers of these products, such as Baa Baa Beads, have had complaints upheld against them but have refused to remove their misleading claims. Now that the Fair Trading Act has been recently updated to prohibit unsubstantiated claims in trade, the Society for Science Based Healthcare hopes that the Commerce Commission will step in to put a stop to claims such as these. The Society intends to file a complaint with the Commerce Commission against companies that continue to make these misleading claims.

The Pure Wellbeing website advertised Detox Foot Patches, claiming that they could remove “toxins” and heavy metals “By stimulating the reflexology points and the blood circulation”. Because the advertiser failed to provide any evidence that the claims they were making were true, the complaints board ruled that the advertisement was misleading and must therefore be removed, upholding the complaint made against it.

There were also two settled complaints from the Society for Science Based Healthcare, against a homeopathy advert by Ngaio Health and a colour therapy advert by Colour Therapy Manukau. Both companies had claimed that they were able to treat serious health conditions such as cancer, but did not substantiate these claims. In both cases the company agreed to remove the claims.

The Society for Science Based Healthcare welcomes these decisions, and hopes that the advertisers involved will take them to heart and refrain from making misleading health claims in the future. These are the latest in a long line of complaints about misinformation regarding healthcare, and as there is still plenty of misinformation out there you can expect to hear more from the Society in the future.


About the Society for Science Based Healthcare

The Society for Science Based Healthcare is a newly formed consumer advocacy group that aims to protect consumers’ rights to make informed healthcare decisions. Although the society itself is new, over the past 2 years its founders have lodged over 50 successful complaints with the ASA regarding misleading health claims, dealing with products and services ranging from chiropractic and acupuncture to magnetic mattress underlays and a quantum magnetic health analyser.

Mission statement

“We believe that a strong basis in rigorous science is a necessary prerequisite for providing safe and effective healthcare. Decisions regarding public funding of healthcare in New Zealand should therefore be science based. We support public health measures that have a clear basis in science and evidence, and oppose those that do not.
We will work to counter misinformation about health issues propagated by individuals and organisations in New Zealand.
Consumers have the right to make an informed decision about their healthcare, and should not have to worry about being misled by unsubstantiated claims.”

Relevant links

Society for Science Based Healthcare – http://sbh.org.nz
Advertising Standards Authority – http://www.asa.co.nz
Universal Church of the Kingdom of God – http://www.uckg.co.nz/
DailyDo – http://www.dailydo.co.nz/
Pure Wellbeing – http://www.purewellbeing.co.nz/

Upheld Complaints:
http://asa.co.nz/display.php?ascb_number=14219
http://asa.co.nz/display.php?ascb_number=14205
http://asa.co.nz/display.php?ascb_number=14250

Settled Complaints:
http://asa.co.nz/display.php?ascb_number=14266
http://asa.co.nz/display.php?ascb_number=14290

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Fluoridation: what about reports it is ineffective?

fluoride-treatment

Fluoride dental treaments also reduce tooth decay

Anti-fluoridation activists are always making claims that fluoridation is not effective. Even sometimes claiming that children in non-fluoridated areas have less tooth decay than those in fluoridated areas. And they will sometimes cite, or link to, scientific papers they believe support these claims.

It’s always worth checking out such claims. Check the paper, find out what it does actually report and what other factors are involved. We should approach the scientific literature intelligently and critically – not cherry pick to support our confirmation bias.

Here is an example of a paper promoted by Declan Waugh purporting to claim that dental health is a result of “social class” and not influenced by fluoridation. The paper is Colquhoun, J. (1985). Influence of social class and fluoridation on child dental health. Community Dentistry and Oral Epidemiology, 13(1), 37–41.

Of course, the role of social economic status in oral health is well known so I am not questioning that. But can that paper actually be used to prove the claim that fluoridation is ineffective or that fluoride does not play a role in oral health?

Colquhoun found no statistical difference in the caries-free percentage of children in fluoridated and non-fluoridated areas around Auckland when areas of “similar social rank” were compared. And of course anti-fluoridation activists like Declan Waugh pounce on that finding – which is supported by the data. But what other factors are involved.

If Declan had read the paper – or was at all interested in conveying the important facts – he would have seen this important note by Colquhoun:

“It should be noted, when comparing child dental health in different areas in this way, that in New Zealand all school dental clinic patients in unfluoridated areas receive routine 6-monthly topical fluoride applications, while only selected “at risk” children receive them in the fluoridated areas. Also, vigorous educational and preventive work, including encouragement of use of fluoride toothpastes, has been carried out in both kinds of areas.”

This even made it to the abstract:

“In the unfluoridated areas all the children, and in the fluoridated areas only selected children, had received regular topical fluoride treatments. In both areas the use of fluoride toothpastes and oral hygiene had been encouraged.”

This information is vital to the conclusion. Colquhoun had allowed for the “socioeconomic variable” but had not allowed for the different dental treatments of the two groups of children. The fact that all children of non-fluoridated areas were receiving 6-monthly topical fluoride applications and most children from fluoridated areas were not is an important factor.

Maybe Colquhoun’s paper can be used to argue that other fluoride treatments may be as effective as community water fluoridation – but his data certainly does not support the claim that fluoridation is ineffective. I guess there was a bit of confirmation bias on Colquhoun’s part – but certainly cherry-picking and confirmation bias on Waugh’s part.

Community water fluoridation is only one of the ways to improve oral health using fluoride. Regular brushing with fluoridated toothpaste, fluoridated salt or milk, and regular fluoride dental treatments also work. These other sources and treatments should always be considered when evaluating this sort of data.

Maupomé, et al (2001) made this point in their conclusions from a study on patterns of dental caries after cessation of water fluoridation. They wrote:

“Our results suggest a complicated pattern of disease following cessation of fluoridation. Multiple sources of fluoride besides water fluoridation have made it more difficult to detect changes in the epidemiological profile of a population with generally low caries experience, and living in an affluent setting with widely accessible dental services. There are, however, subtle differences in caries and caries treatment experience between children living in fluoridated and fluoridation-ended areas.”

An intelligent and critical approach to the scientific literature means we should always keep this in mind when reading papers like this.

And we should never take the claims made by activists like Declan Waugh at face value.

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Declan Waugh’s misinformation on fluorosilicic acid

Declan Waugh argued recently that silica species produced when fluorosilicates are hydrolysed in water cause a whole range of health problems and deaths. A new theory for him - silica is the problem, not fluoride! He is wrong, of course (see An open letter to Declan Waugh – new mechanism for fluoride toxicity?).

Declan had previously argued the exact opposite. That fluorosilicates do not hydrolyse completely in water and it is the remaining fluorosilicate species that are toxic and cause all these effects. He summarised his arguments and evidence for this in his 2012 report Hexafluorosilicic Acid, Raw Materials, Manufacture, Toxicity and Public Health Concerns as an Active Ingredient in Drinking Water.

This report is typical of Waugh’s writings. He distorts or misrepresents the literature and makes unwarranted inferences. He is not the only person doing this – it’s a common feature of the confirmation bias and cherry picking endemic to the anti-fluoridation movement. However, for some reason some people consider he is an authority on the subject (perhaps they have been fooled by his own hubristic claims to be an “environmental scientist and fluoride researcher”) so his reports get used as evidence and are something quote. For example, the Hamilton City Council listed one of his reports first in the “scientific evidence” which convinced them to stop fluoridation last year (see When politicians and bureaucrats decide the science ). Mark Atkin, the science and legal spokesperson for the local anti-fluoridation group is also fond of citing Declan Waugh – maybe because Waugh is the only source he can find to support his own confirmation bias.

Waugh Hamilton

A poster prepared by Declan Waugh to advertise the decisive effect of his submission to the Hamilton City Council fluoride tribunal

In this article I consider some of the claims Waugh makes in the above report and show how he uses distortions and misrepresentation of the literature he cites to support them.

Exaggerating toxicity of fluoride

This part of Waugh’s report is confused but he quotes the relative toxicities of CaF2 and H2SiF6 (1 to 25) to apparently argue “that 1 ppm of hexafluorosilicic ingested orally is the equivalent of 25 ppm calcium fluoride.”  He then seems to argue that the regulated  concentration limits for fluoride are really for CaF2 – implying that since we use fluorosilicic acid for water fluoridation we should introduce a factor of 25. He seems to say that the limits should not be 1.5 ppm F (he says is set for CaF2) but 1.5/25 = 0.06 ppm! He says:

“The drinking water standards were established for the much less toxic calcium fluoride which is listed as a moderately toxic compound compared to hexafluorosilicic acid, which is categorised as extremely toxic.”

All this ignores that the toxic species in CaF2 is the fluoride anion. This is the same for fluorosilicic acid in drinking water as the fluoride anion is the end product of its hydrolysis when added to water. In fact the relevant species is the fluoride anion whatever the source – NaF, CaF2 or fluorosilicic acid. So the relative toxicities Waugh quotes for solid CaF2 and concentrated fluorosilicic acid are irrelevant.

Calcium fluoride is relatively insoluble (about 15 ppm CaCl2 = 7.3 ppm F) so when the solid is ingested there is less dissolved fluoride anion available to exert a toxic effect. That is why it is less toxic than the readily soluble NaF and fluorosilicic acid. But CaF2 is soluble enough to easily maintain the optimum concentration of fluoride anion required for the beneficial effect (0.7 ppm F). One could use it to fluoridate water – although the mechanics would be difficult as very little dissolves. Whatever the source, NaF, CaF2 or fluorosilicic acid, the end product in drinking water is the same so introduction of such relative toxicities is misleading.

Claim hydrolysis is incomplete

Waugh says:

“When added to drinking water Hexafluorosilicic acid dissociates into free fluoride ions, it is now accepted that this reaction is not complete with the possibility of some silicofluoride compounds remaining present in drinking water.5
It is further known that the following fluorosilicate species may be present in treated water. However current analytical methodologies are not yet available to accurately measure or quantify the level of residual fluorosilicates or fluorosilicon complexes that may be present.”

Table6

Strange. He is claiming that we currently do not have the analytical methods to measure or quantify residual fluorosilicates but nevertheless “it is now accepted” and “further known” silica fluoride compounds are present in drinking water. Trouble is neither the table he presents, or the paper he refers to (from which the table is taken) say this. They say the exact opposite!

The table simply lists the different silicofluorides species that have been chemically proposed, reported or inferred in solids, gases or solutions. While some of these may logically exist in water (eg SiF62- and Si(OH)4) there is certainly no evidence that they all do. His reference 5 (Urbansky, E. T. (2002). Fate of fluorosilicate drinking water additives. Chem. Rev., 102, 2837–2854) concludes:

“that in drinking water supply with a pH of 5 or higher, fluoridated with sodium silicofluoride [hexafluorosilicate] to the extent of 16 ppm or less, all of the silicofluoride is completley hydrolysed to slicic acid, fluoride ion and hydrogen fluoride. There can be no question of toxicity of SiF4 or SiF62- under these conditions.”

As for rate of hydrolysis Urbansky (2002) clearly says “all the rate data suggest that equilibrium should have been achieved by the time the water reaches the consumer’s tap if not by the time it leaves the waterworks plant.” This “equilibrium” is essentially the complete hydrolysis of the fluorosilicate as Urbansky and Schock (2000) make clear:

“Based on the above information on both the thermodynamics of the hydrolysis reaction and it’s kinetics, we can safely conclude that there is essentially no (<< 1 part in a trillion) hexafluorosilicate remaining in drinking water at equilibrium and that equilibrium is rapidly reached from the combine uncaltalyzed and metal-catalysed reactions.”

Claim reaction of silica with fluoride in stomach and bladder

Waugh claims:

“According to Urbansky, a senior US EPA chemist and expert upon water fluoridation chemicals” such compounds [H2SiF6, NaF, Na2SiF6 and AlF3] may exist in artificially fluoridated drinking water as well as in low acidic environments within the human body (i.e. Stomach and bladder) after consumption of fluoridated water.3

And

“It is also now hypothesized that incomplete dissociated SiF residues may re-associate both at intra-gastric pH and in the bladder which are low ph environments9 (thereby exposing the consumer to toxic harm) and during food preparation (low pH soft drinks) producing SiF species including silicon tetrafluoride, (SiF4), a known toxin. It is also believed that commercial SiFs are likely to be contaminated with fluosiloxanes.”

His reference 3 is to Urbansky (2002) and 9 is to Ciavatta, L., Iulianno, M., & Porto, R. (1988). Fluorosilicate Equilibria in Acid Solutions. Polyhedron, 7(18), 1773–7779.

The falseness of his claim that Urbansky provided evidence of the existence of fluorosilicates in drinking water was discussed above. Urbansky and Schock (2000) actually put the theoretical proportion of silica present as fluorosilicate in the “most acidic gastric conditions” at less 0.0002%. As for Ciavatta et al (1988) – their work has no relevance to the stomach or bladder. They studied the reaction of silicic acid and fluoride in 3 Molar Lithium perchlorate with an acidity between 0.3 and 3 Molar. An ideal solution for the laboratory investigate of chemical equilibria but more extreme than conditions in our stomach and bladder.

So again, Waugh has misrepresented the literature and distorted its relevance to the situation in drinking water and our body.

Nevertheless, Waugh get cited as evidence for incomplete fluorosilicate hydrolysis and for recombination in the stomach. For example Mark Atkin relied on this report of Waugh’s in defending this erroneous claim before the NZ Advertising Standards Authority (see Anti-fluoridation advertising deceptive).

Finney et al (2006) is also often used by anti-fluoridationists to claim recombination in the stomach because they showed presence of an intermediate SiF species at pH values below 3.5 (SiF5-). Again this is a laboratory study with higher F concentrations and no interfering species. In the real world drinking water (and especially the stomach content) has all sorts of chemical species, many of which react with F, Si(OH)4 or both. These will displace any theoretically derived equilibria. I have not seen any reports of detection of silicofluorides species in the stomach or bladder. Nor have I seen anything to suggest that these would be any more toxic than fluoride itself – or any of the other chemical species present in the stomach.

Conclusion

Readers having read my comments here and those on Waugh’s theory about silica toxicity (An open letter to Declan Waugh – new mechanism for fluoride toxicity?) might see a pattern:

  • Citation of scientific literature to given credibility to Waugh’s claims;
  • Misrepresentation of the cited literature – often claiming they report the exact opposite of what they in fact do;
  • Confirmation and cherry picking which is very clear to any intelligent reader;
  • Attempt to establish himself as a “scientific authority” on fluoridation which can be used by anti-fluoridation activists to support their own claims.

I guess you can fool some of the people some of the time. But it does show that  such material should always be approached critically and intelligently.


PS: I would of course welcome Declan Waugh’s response to this article. After all, I might be completely wrong – but I won’t know that without some sort of exchange with him.

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An open letter to Declan Waugh – new mechanism for fluoride toxicity?

Dear Declan,

You describe yourself as a scientist and fluoride researcher so I feel the responsibility to bring to your attention what I think are major flaws in a recent presentation of yours. I am sure you understand that research and the scientific ethos requires and encourages constructive criticism, and in fact the debate over ideas and hypotheses is an essential part of the scientific process. I offer my criticisms with this in mind and therefore assume you will receive them in the same open spirit  and give them your honest consideration.

Declan-title

In this presentation to the  Nutritional Therapists of Ireland, Health Impacts of Water Fluoridation May 2014 you make several arguments which I think violate basic chemical principles. You then go on to claim a mechanism for many health complaints you claim results from community water fluoridation.This is a novel mechanism because it attributes health problems not to fluoride but to silica resulting from the hydrolysis of fluorosilicates used as fluoridation chemicals.

Below I list the steps in your argument together with my comments on these:

Slide 16:

Declan-15

You claim “ultra fine silica particles”  form on hydrolysis of fluorosilicates. You cite Finney et al (2006) for this. However, nowhere in  Finney et al (2006) is there a reference  to”ultra fine silica particles.”

What they describe is the well-known hydrolysis reaction:

SiF62-(aq) + 4H2O(l) ↔ 4H+ + 6F- + Si(OH)4(aq)

The silica species produce is the monomeric molecule Si(OH)4. This soluble (“reactive”) silica exists in solution but has a very complex chemistry. Polymerisation occurs and a number of molecular species are possible in solution. The end product of such polymerisation can be solid silica but, on the other hand, solid silica can support a concentration of monomeric silica in solution.

Yes, molecules in solution are extremely small but it is plain  wrong to describe them as if they were just very small, or “ultra fine,” particles of the solid.

Slide 17:

Declan-17

You now go further describing these molecules as “nanoparticles” and cite Napierska et al (2010) to tell viewers that nanoparticles can have negative health effects. They can be toxic. This is a huge leap, on top of the huge leap in the previous slide.

You have gone from a monomolecular species (Si(OH)4), to a finely divided solid,  to “nanoparticles.”

No way is it legitimate to describe a small molecule like Si(OH)4 as a “nanoparticle.” One definition of a nanoparticle describes is as a “microscopic particle with at least one dimension less than 100 nm.” Simple molecules like Si(OH)4 are thousands of times smaller.

Slide 18:

Declan1w

You now put these ideas together to imply that fluoridation can cause a large range of health problems via formation of nanoparticles during hydrolysis of the fluoridation chemical and their toxic reaction in the bloodstream. I believe your arguments here are false, you have not given any evidence to support them, and in fact you have misrepresented the citations you used.

Silica in drinking water

Your wild “theory” introduces a big can of worms which you should have considered but actually ignore. Silica, reactive or monomolecuar silica, exists in all drinking water, fluoridated and unfluoridated. Here are some examples from New Zealand community water supplies. Please note, fluoridation  is irrelevant. In fact the highest levels of reactive silica occur in an unfluoridated supply.

Fluoride (mg/L) Reactive silica (mg/L)
Hamilton Templeview Site 23.08.13 0.16 37
Hamilton Site 12.02.14 0.19 34
Christchurch Christchurch <0.1 16
Wellington Waterloo 0.78 15.5
Wainuiomata 0.83 12.55
Auckland Auckland 0.81 13.23

None of this is surprising as silica will be derived from all sorts of natural, geological, sources the water contacts.

Did you bother comparing natural levels of reactive silica with what could be expected from the hydrolysis of fluorosilicates? My estimates suggest that fluoridation with fluorosilicate at the optimum level (0.7 mg F/L) would produce a reactive silica concentration of 0.37 mg SiO2/L. Surely you can agree this is miniscule compared with he natural levels of reactive silica in all drinking waters?

Your hypothesis of a toxic role of monomolecular silica in drinking water implies  all drinking water is unhealthy and that, in fact, fluoridation could contribute only an insignificant amount to this toxicity.

A serious charge which most scientists would consider better justification and evidence than you have given so far. Personally I think it would be irresponsible of you not to publicly withdraw these unwarranted claims.

I think there are similar faults in the way you have used statistical health information to imply a link of fluoridation to a whole host of health problems but that is a separate issue. At this stage I look forward to a response to my specific chemical criticisms listed above.

If you wish to defend your hypothesis, or to debate this specific issue and the wider claims you are making, I would be happy to offer you space on the Open Parachute blog for an exchange of articles. This proved a very effective method of scientific discussion in my exchange with Paul Connett (see Fluoride Debate). Many anti-fluoridation activists seem to hold you in the same regard as Paul and rely on your for much of their information. You have also contributed submissions to local body councils in New Zealand considering the fluoridation issue. I am sure you would therefore welcome the opportunity to present your scientific claims to a scientifically literate audience that this exchange can offer.

I look forward to your response.

Kind regards

Ken Perrott.

 

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