This is Paul Connett’s response to Ken Perrott’s last article Fluoride debate: Response to Paul’s 5th article
For Paul Connett’s original article see – Fluoride debate Part 1: Connett.
Ken’s response to my last posting once again is incomplete and evasive. Let me review what has happened here.
Ken was asked to present the case FOR fluoridation. After four attempts Ken has produced very little science to support such a case. In part 6 of this thread I laid out what I felt would be the necessary components for such a scientific case and asked some very specific questions in the hope that Ken would present that case. Ken’s response has been disappointing
Ken’s response in part 7 of this thread
Apart from further discussion on the theoretical mechanism of fluoride’s topical mechanism of action, a few citations on benefits, more criticisms of the opponents of fluoridation and more discussion on the ethical arguments Ken failed to present many primary scientific studies to support the case for fluoridation. Instead, he either ignored the questions I posed, was evasive or sought to obfuscate the key issues I presented. This meandering response may satisfy Ken’s urge to demonstrate his general distaste for opponents of fluoridation in NZ (based on the emails I have received this distaste cuts both ways) but it does not advance his scientific case for fluoridation one iota.
Instead of making a serious or even good faith effort to address the scientific questions I posed he attempted to dismiss my whole effort by claiming that I was unfairly throwing the kitchen sink at him (my words). His own words were new to me. He described my series of specific questions as follows,
“It’s a real Gish gallop – suddenly demanding answers about arthritis, kidney function, thyroid function, osteosarcoma, individual sensitivity to fluoride, menstruation, effect on babies, monitoring bone concentrations and finally, all or any health concerns in New Zealand. Without any background to any of the issues. (Wikipedia describes Gish gallopers as using ‘a rapid-fire approach during a debate, presenting arguments and changing topics quickly’). “
As far as Ken’s claim that I have failed to present the background to my questions he is wrong on two counts. First, I have raised several of these issues before in one or both of our threads – thus there is nothing sudden about many of these questions. Second, plenty of background was laid down on all of the issues in our book The Case Against Fluoride, a pdf copy of which was sent to Ken over a month ago.
If Ken was more familiar with the literature he would have known that the response to each question I posed was not difficult at all.
One sentence on most of these questions would have sufficed, for the simple reason that incredibly NO (or very few) studies on these topics have been undertaken in NZ or other fluoridated countries like Australia, Canada, Ireland, Israel, the US or the UK. More specifically:
1) There have been NO attempts to investigate arthritis rates in fluoridated communities in NZ or other fluoridated countries, even though it is known that the first symptoms of fluoride poisoning of the bone are identical to arthritic symptoms. I have given citations to some of these studies.
2) There have been NO attempts to investigate a possible relationship between fluoridation and an earlier onset of menstruation in young girls or puberty in boys in fluoridated communities in NZ or other fluoridated countries, even though there is some evidence that this maybe occurring (Schlesinger et al., 1956) as well as Luke’s work on the pineal gland (Luke, 1997, 2001).
3) Neither NZ nor any other fluoridating country has attempted to investigate the issue that some individuals report increased sensitivity to fluoride even though independent observers (e.g. Taves, discussed in chapter 13 of our book) and one governmental organization (Australia’s NHMRC, 1991) have recommended that this sensible measure be undertaken. Ken does not acknowledge this and misses the point by attacking the studies and numerous anecdotal reports that have waved “red flags” on this issue.
4) There have been NO systematic or comprehensive efforts by government health agencies to monitor the fluoride levels in the urine, blood or bones of any fluoridated community in NZ or any other fluoridated country. Australia’s NHMRC in 1991 recommended bone levels be collected as a basis for epidemiological studies on fluoride’s impact on the bone but no attempt has been made there in the 22 years that have elapsed since this recommendation was made; nor in NZ.
5) There has been NO published study refuting Bassin’s finding of an age-related window of vulnerability (ages 6 through 8) for young boys being exposed to fluoridated water and succumbing to osteosarcoma. The promised study (Kim et al, 2011) miserably failed to refute this finding despite the promises made in 2006 that it would do so.
6) There has been little or no attempt to see if the current epidemic of hypothyroidism in NZ and other fluoridated countries has anything to do with exposure to fluoride even though doctors in Argentina, France and Germany used fluoride treatment to lower thyroid activity in hyperthyroid patients from the 1930s to the 1950s (See Galleti and Joyet, 1958).
7) There have been practically NO studies investigating possible health concerns in NZ possibly associated with fluoridation. Nor have there been attempts to reproduce studies that have found harm in countries with high natural fluoride levels. I was not aware of any studies in NZ other than a small IQ study from the 1980s but I thought it wise to find out if Ken knew of any. But he didn’t respond. I also asked him if he felt the absence of study was the same as the absence of harm but again he didn’t respond.
8) There have been a number of studies on teeth in NZ and other fluoridated communities as if this was the only tissue of concern in the baby’s developing body or of concern for adults with lifelong exposure. Ken has still yet to discuss the wisdom – or otherwise – of exposing a bottle-fed baby to about 200 times the level of fluoride that nature intended (0.7 ppm in fluoridated water versus 0.004 ppm in mothers’ milk).
9) In short. While the NZ government has poured over $1 million into the NZ Fluoridation Information Service, which is little more than a PR operation for fluoridation, they have taken little or no steps to fund any primary studies to see if this practice is harming anyone in NZ.
More Broad-brush dismissals
On the issue of fluoridation’s effectiveness Ken attempts to use the same broad-brush dismissal of the citations I offered in support of my case that evidence for swallowing fluoride reduces tooth decay was very weak. Ken responded:
“So, I am not impressed by Connett’s paragraph of about 30 unexplained citations – nor by a long reference list at the end of his article.”
I am baffled as to why he should describe these citations as “unexplained” when I made it clear that the citations were all discussed in three chapters of our book (chapters 6-8). Ken had already explained that he had read up to chapter 9 in our book so his claim that the citations are unexplained is rather sloppy. As far as the number of citations is concerned it would be more understandable if Ken was complaining about my giving too few citations, not too many!
I ask the reader to consider for a moment, which is more convincing – my extensive list of references to the literature which suggest the ineffectiveness of fluoridation or the very sparse list of references provided by Ken which he claims support the effectiveness of fluoridation. However, at least he gave some references here; he gave none on the health concerns I raised.
Instead of responding scientifically – or at least conceding that the science has not been undertaken – Ken chose to either ignore or obfuscate most of the scientific issues I raised in the following ways:
1) His response is very familiar. He chose to attack the messenger and ignore the message. From Ken’s perspective there is nothing wrong with the practice and promotion of fluoridation – it is Paul Connett and other opponents of fluoridation who are the problem!
2) Really substantial issues I have raised are being ignored, in some cases for the second and even third time of asking. For example where are his comments on the
a) difference between dose and concentration;
b) the need for a margin of safety analysis when extrapolating from the doses that cause harm in animal and human studies and
c) the need for a weight of evidence approach to the scientific literature on this subject.
3) Where Ken does address an issue his response has often been evasive and clouded with obfuscation. For example see his response to my reasonable scientific request for a list of studies that negate or balance out (i.e. weight of evidence analysis) the long list of studies that indicate that fluoride can damage animal brain and interfere with human behavior and intellectual development. His response was to classify such a request as “the IQ gambit” and to bring up the distraction of “Hitler using fluoride to control prisoners” when he knows full well that I have disowned such claims in public and in writing. See for example, these quotes from our book:
“It is true that a few people who oppose fluoridation do so based on claims that Nazi Germany and other totalitarian regimes used it as a method of mind control. There is little evidence that would satisfy a historian to support such claims. The vast majority of fluoridation opponents repudiate such views and base their opposition on science and ethics.” (pp. 256-7)
“Two speculations we reject outright are that fluoridation is (1) some sinister plot to“dumb down” the population or (2) part of some worldwide plan to reduce the size of the global population.” (p.258)
4) Thus, Ken has still to present a substantial case FOR fluoridation based upon the citation of primary studies.
5) Unfortunately, he is leaving it to others to present some of his case in the comments section. I made it clear to Ken when we discussing the format of this debate that I was not interested in these kind of blog comments which become very personal and sometimes insulting. I thought we had agreed that this was going to be a scientific exchange between the two of us. I am not prepared to sift through the insulting chaff in the comments section to get to the scientific wheat.
Someone has forwarded to me a recent personal attack on me by Steve Slott, DDS:
Steve Slott | December 19, 2013 at 1:40 pm |
You got it Stuart. Sarah Palin epitomizes the antifluoridationist. Being totally oblivious to her own ignorance she just blusters along, totally bewildered as to why she gets no respect from the mainstream.
Forgive me for straying off topic, Ken, but the most frustrating thing about antifluoridationists is their ignorance, and their total oblivion to it. Somebody like Connett comes along with just enough education and charisma to come across as being an “authority” on the issue, yet totally lacking understanding of basic facts, far overestimating of his own knowledge, and convinces the blind followers who crave any and all anti-authoritarian causes, that the establishment is corrupt, ignorant, and lacks the “knowledge” that only he possesses through his “study” of new “emerging science “. Being totally unaware that what is “new science” to him is nothing more than basic knowledge of which the true experts and authorities have long since been aware and have fully addressed, he blusters forward confident that he has the “truth” on his side. The worldwide body of respected healthcare is either “corrupt “, conspiracy laden, or ignorant of the “facts” that he is trying his utmost to bring to their attention. Dentists are running the fluoridation show, yet are all dumber than doorknobs and totally lacking in any knowledge of the human body outside of the portions of the teeth that are visible above the gum line, and decision makers are all unwittingly manipulated by big money interests. The people to whom he plays buy into his spiel, lock, stock, and barrel, thus becoming in their own minds far more knowledgeable about the issue than the dumb dentists, corrupt mainstream healthcare, and unwitting politicians who are stripping away personal freedoms and poisoning everyone in the process. Portland and Wichita are poster-children for the chaotic circus side-show that he creates by convincing a very active, very vocal, very ignorant few, of the “validity” of his own ignorance.
Steven D. Slott, DDS
Ken you are the moderator of the comments posted on your website, can you explain to me how this comment contributes to the science of this debate? Can you explain to me why you allow this kind of personal attack on your opponent – completely unrelated to any scientific argument that I have raised – to be part of the visible record on this matter? Just what purpose does it serve other than to muddy the waters and poison the minds of any independent observers? Surely such a posting has no place in a debate that is supposed to be about the science of this controversial issue.
Now I will address some of the issues on which Ken offered a response.
1) On Randomized control studies (RCT).
I complained that after 68 years no government promoting fluoridation has undertaken an RCT to demonstrate effectiveness. This is the gold standard in epidemiology. In response , Ken suggests that I should have done an RCT of my own!
As far as safety is concerned I agree that you cannot prove a negative, however such an argument neither explains nor excuses the lack of responsible attention to health concerns by fluoridating countries. The absence of study on many very important health concerns is inexcusable and cannot be explained away with rhetoric.
2. The ethical argument.
Ken claims that opponents of fluoridation merely focus on the violation of informed consent and ignore the social benefits of the program. However, that line of argument assumes that:
a) such a benefit actually exists (and Ken hasn’t presented much of a case for that yet);
b) that very little – if any -risk is involved (Ken hasn’t presented much primary evidence to support that);
c) that the benefits greatly exceed the risks (not possible unless Ken has produced a strong case for both a) and b) which he has not;
d) that there are no practical and cost effective alternative social strategies which avoid the violation of the individual’s right to informed consent. In this respect it is very disappointing that Ken has yet to comment on the successful program being used in Scotland to fight tooth decay in children from low-income families there. Nor has he reviewed any of the other programs being used in the vast majority of European countries that don’t force people to drink fluoridated tap water.
I would also hope that at some point Ken would address the Precautionary Principle as it applies to the ethics of this issue (see chapter 21, in The Case Against Fluoride…)
3) Does tooth decay go up when fluoridation is halted?
In two of the four studies I cited (from Cuba, former East Germany, Finland and British Columbia) where tooth decay did not go up when fluoridation was stopped, Ken says that other measures were taken in two of those communities (Cuba and former East Germany). That’s a good point. However, it undermines his argument that water fluoridation is the only way to go as far as fighting tooth decay is concerned. If these communities have found alternative methods why aren’t fluoridating governments studying these alternative methods? Again I refer to the successful and cost-effective program with children in low-income families in Scotland.
It is not clear if Ken believes that alternative methods were applied to explain the results in Finland and British Columbia.
In personal correspondence I have had with Rudolf Ziegelbecker, Jr., from Austria, who has studied this matter (and his father before him) for many years, he maintains that there has been no increases in tooth decay in any of the European countries that have stopped fluoridation. Is Ken aware of any evidence to the contrary?
4. Does fluoridated water deliver a significant topical benefit over and above that delivered by fluoridated toothpaste?
I notice that Ken twice combines discussion of fluoride’s topical exposure via water and via food. He states:
“So fluoride concentrations in saliva after drinking water or eating food containing fluoride can be quite variable.”
“Fluoride concentrations in saliva and plaque do reach a maximum after drinking water and eating food containing fluoride…”
This is interesting because it goes back to my original skepticism about drinking fluoridated water doing much of anything in the oral cavity before it goes down the gullet – that is unless one swishes. On the other hand I can understand that any fluoride present in food is going to be made readily available to both the tooth surfaces and the saliva during the chewing of food and therefore may participate in the theoretical mechanisms that Ken discusses.
If, in fact, this mode of delivery (i.e. via food) is the relevant one then Ken would do better either a) to recommend making fluoridated salt available to those who want it in NZ or b) recommend that parents tell their children to swish the fluoridated water in their mouths before they swallow it. But there we are back to education again, and that is something that Ken wishes to avoid. We are also back to the potential harm from swallowing fluoride.
Beyond theoretical mechanisms
Whatever the theoretical mechanism for fluoride’s action (and I will leave it to the specialists in this field to fight that out), as a promoter of fluoridation, Ken still has to demonstrate that the weight of evidence from epidemiological studies indicates that there is a significant benefit from drinking fluoridated water over and above the use of fluoridated toothpaste. I don’t think he has done that.
He has also yet to explain why it is in the largest surveys there appears to be little difference in tooth decay in the permanent teeth between fluoridated and non-fluoridated communities, states and countries (see chapter 6 in The Case Against Fluoride…), with the one possible exception of the comparison between the Republic of Ireland and Northern Ireland, that Ken has cited.
In short, in the majority of the large surveys the relationship between tooth decay and the presence or absence of fluoride in the drinking water does not appear to rise above background noise. However, the relationship between fluoride levels and dental fluorosis certainly does rise above background noise (see chapter 7 in The Case Against Fluoride…) as does the inverse relationship between tooth decay and income levels (see chapter 6 in The Case Against Fluoride…).
Nor has Ken addressed the fact that in the only study that has looked at tooth decay as a function of how much fluoride children were ingesting (from all sources) there was no significant relationship between the amount of fluoride ingested on a daily basis and the level of tooth decay (Warren et al, 2009).
Although the late Dr. David Locker was not opposed to water fluoridation, he did have the integrity to admit in the review of dental studies worldwide, which he performed for the Ontario government in 1999, that:
“The magnitude of [fluoridation’s] effect is not large in absolute terms, is often not statistically significant, and may not be of clinical significance.”
My final challenge to Ken.
Ken I have patiently tried to debate the scientific issues with you but apart from your interest in bioapatites and the theoretical mechanism of fluoride’s actions (both interesting subjects but insufficient to demonstrate the wisdom of forced fluoridation) I believe that you have offered little in the way of science to support the case for fluoridation. Meanwhile, as moderator you are allowing insulting and personal attacks on me by people like Steve Slott to be posted as part of this exchange. I am happy to engage in a rational scientific exchange on this issue but not happy for it to be an excuse for an unscientific attack on my integrity.
I would like to extend you one more shot at demonstrating that there is convincing primary scientific evidence, which shows:
1) That the weight of evidence of the primary studies indicates that drinking fluoridated water provides a large and significant benefit to the permanent teeth.
2) That the weight of evidence of the primary studies indicates that there is an adequate margin of safety to protect everyone drinking fluoridated water and getting fluoride from other sources from damage to the developing brain documented in areas of moderate to high natural levels of fluoride. Note: that margin of safety should protect for the bottle-fed infant.
3) My preference would be for you to do the same with other health concerns that I have raised including those where we need to protect someone consuming uncontrolled quantities of fluoridated water over a whole lifetime – but if it simplifies matters for you, then for now I will settle for you just tackling the impacts on the brain (i.e. 2 above).
4) That the benefits you demonstrate in 1) outweigh the risks I have presented in my book and in these threads.
And that the case you present in 1-4 is so strong that it justifies:
a) overriding the individual’s right to informed consent to human treatment.
b) overriding the Precautionary Principle
c) ignoring the fact that there are alternative ways of fighting tooth decay which are universally available – and the successful programs that are reducing tooth decay in children from low-income families in countries like Scotland and most of the rest of Europe without forcing this practice on people who don’t want it.
As far as the Scottish program is concerned we can add a few more bones to the BBC report I included earlier. This is how my colleague Dr. Bruce Spittle summarized the situation in Scotland:
Instead of water fluoridation, the newly devolved Scottish Government opted, in its 2005 dental action plan (their Childsmile program), to pursue:
a) school-based toothbrushing schemes;
b) the offering of healthy snacks and drinks to children;
c) oral health advice to children and families on healthy weaning, diet, teething and toothbrushing;
d) annual dental check-ups and treatment if required, and
e) fluoride varnish applications (The Scottish Government, 2005; Macpherson LMD et al., 2010; Turner S et al., 2010; Chestnutt, 2013; Healthier Scotland, Scottish Government, 2013).
Encouraging results have been reported from this national dental programme with the proportion of children in Primary 1 (aged 4–6 years) without obvious dental decay rising from 42.3% in 1996 to 67% in 2012 (Information Services Division Scotland, 2012).
Similarly, the proportion of children in Primary 7 (aged 10–12 years) without obvious dental decay rose from 52.9% in 2005 to 69.4% in 2011 and 72.8% in 2013 (Information Services Division Scotland, 2013).
The introduction and uptake of nursery school toothbrushing is likely to have contributed to a large extent to the improved oral health in five-year-old Scottish children (Macpherson, 2013).
I know these are tough challenges but they are the kind of challenges that should have been tackled years ago by government agencies promoting the unusual (and I say unacceptable) practice of using the public water supply to deliver human treatment. But they weren’t. But for those who continue to support this practice like you the tasks above have to be addressed.
If you are not prepared to attempt this challenge in good faith then I will end my participation in this exchange forthwith.
Dec 22, 2013
Bassin EB et al. (2006). “Age-specific Fluoride Exposure in Drinking Water and Osteosarcoma (United States),” Cancer Causes and Control 17, no. 4: 421–28.
Connett, P., Beck, J and Micklem HS. The Case Against Fluoride. Chelsea Green, White River Junction, Vermont, 2010.
Galletti P. and G. Joyet (1958). “Effect of Fluorine on Thyroidal Iodine Metabolism in Hyperthyroidism,” Journal of Clinical Endocrinology 18, no. 10: 1102–10.
Healthier Scotland, Scottish Government, NHS Scotland (2013). Childsmile: home, parents and professionals. Available from: http://www.child-smile.org.uk/sitemap/index.aspx
Information Services Division Scotland, NHS National Services Scotland (2012). National Dental Inspection Programme 2012 Report. Available from: https://isdscotland.scot.nhs.uk/Health-Topics/Dental Care/Publications/2012-11-27/2012-11-27-DentalNDIP-Summary.pdf?27395266295
Information Services Division Scotland, NHS National Services Scotland (2013). National Dental Inspection Programme 2013 Report. Available from: https://isdscotland.scot.nhs.uk/Health-Topics/Dental-Care/Publications/2013-10-29/2013-10-29-NDIP-Summary.pdf?27395266295
Jones CM, Woods K, Taylor GO (1997a). Social deprivation and tooth decay in Scottish schoolchildren. Health Bull (Edinb) 55:11-15.
Kim FM et al. (2011). “An assessment of bone fluoride and osteosarcoma.” J. Dent. Res 90(10): 1171-6.
Locker, D (1999). Benefits and Risks of Water Fluoridation: An Update of the 1996 Federal-Provincial Sub-committee Report, prepared under contract for Public Health Branch, Ontario Ministry of Health First Nations and Inuit Health Branch, Health Canada (Ottawa: Ontario Ministry of Health and Long Term Care, 1999.
Luke, J, 1997, “The Effect of Fluoride on the Physiology of the Pineal Gland,” PhD thesis, University of Surrey, Guildford, UK, 1997. Excerpts at http://fluoridealert.org/studies/luke-1997/ and a complete copy of Dr. Luke’s dissertation can be downloaded at http://www.fluoridealert.org/wp-content/uploads/luke-1997.pdf (with the author’s permission).
Luke, J, 2001. “Fluoride Deposition in the Aged Human Pineal Gland,” Caries Research 35, no. 2 (2001): 125–28.
Macpherson LMD, Ball GE, Brewster L, Duane B, Hodges C-L, Wright W et al. (2010). Childsmile: the national child oral health improvement programme in Scotland. Part 1: establishment and development. Br Dent J 209:73-78.
Macpherson LM, Anopa Y, Conway DI, McMahon AD (2013). National supervised toothbrushing program and dental decay in Scotland. J Dent Res 92:109-113.
McMahon AD, Blair Y, McCall DR and Macpherson LMD (2010). The dental health of three-year-old children in Greater Glasgow, Scotland. Br Dent J 209:E5. doi: 10.1038/sj.bdj.2010.723.
NHMRC (1991). National Health and Medical Research Council, The Effectiveness of Water Fluoridation (Canberra: Australian Government Publishing Service, 1991), 109.
NRC (2006). Fluoride in Drinking Water: A Scientific Review of EPA’s Standards (2006) http://www.nap.edu/catalog.php?record_id=11571
Schlesinger ER, et al. (1956) “Newburgh-Kingston Caries-Fluorine Study XIII. Pediatric Findings After Ten Years,” Journal of the American Dental Association 52, no. 3: 296–306.
Warren, JJ et al. (2009) “Considerations on Optimal Fluoride Intake Using Dental Fluorosis and Dental Caries Outcomes—A Longitudinal Study,” Journal of Public Health Dentistry 69, no. 2: 111–15.
Anyone wanting to follow the debate and/or check back over previous articles in the debate can find the list of articles at Fluoride Debate.