Fluoride debate: Response to Daniel Ryan’s critique – Rita Bartlett-Rose

Rita F. Barnett

Rita Barnett-Rose, author of Compulsory water fluoridation: Justifiable public health benefit or human experimental research without informed consent” has replied to Daniel Ryan’s critique of her paper. Daniel’s critique was posted yesterday at Fluoride debate: A response to Rita Barnett-Rose – Daniel Ryan.

Rita’s reply is available to download as a pdf


RE: CWF Working Paper Article

Dear Daniel,
I have now had a chance to consider your comments to my draft article. In some respects, I am flattered that you have devoted so much time to an unpublished working paper, and I thank you for giving me some of your opinions. I absolutely want to make sure that I have cited to sources accurately and have not mischaracterized any particular study I reviewed. To that end, I have now engaged independent review of my article from several highly-qualified scientists/researchers with the specific request that they review my article for scientific accuracy. After I have received their comments, I will revise my draft accordingly.

Unfortunately (or fortunately for me), I did not find in your review any specific places where I actually mischaracterized any cited study. Instead, your primary points of contention seem to be twofold: (1) you object to my use of Fluoride Action Network’s (“FAN”) website as a cited source; and (2) you object to my failure to include contrary studies that reaffirm the (English-speaking countries’) public health agencies’/dental lobby positions on the safety and benefits of compulsory water fluoridation.

First, with respect to my reliance on FAN. Of the 209 footnote references in my article, I believe only 17 of them are cites to FAN. Of those 17 cites, I am citing to the FAN website primarily as an easy way to get to the primary source material (e.g., studies or newspaper articles from around the world). For example, in footnotes 85-87, I could have listed the primary source studies, but I have found that many of these studies are hard to get on the internet for those who do not have paid subscriptions to the various science databases. I myself had to order a number of the primary sources from my University intra-library loan system and felt that it would be better to simply provide a link so that the reader could see the names of the studies and determine for himself/herself how to get to those primary sources. Nevertheless, your point is well-taken that I should not give the appearance of relying upon an advocacy group (including yours), and I will review those 17 cites to see if I should instead cite to primary sources.

Second, with respect to your complaint or desire that I cite to contrary (i.e., pro-fluoridation) studies in addition to (or in lieu of) the published studies that I cite that tend to weigh against fluoridation, as I have already indicated to you on two occasions: I am not interested in a battle of the studies debate, and I urge you to conduct such a battle with a more appropriate sparring partner, such as FAN-NZ. Specifically: you complain about FAN not being a legitimate source of credible scientific information, but your organization is also a political advocacy (pro-fluoridation) group, and, from your critique, you are just as guilty of “cherry picking” your sources and your studies as you suggest I am. Moreover, and in stark contrast to you, the section of my article where the studies are discussed is specifically entitled: “Scientific Evidence Against Compulsory Water Fluoridation.” It is not meant to be an exhaustive examination of all studies on fluoridation and is specifically and accurately identified for what it is. I am well aware of many of the pro-fluoridation studies — as well as the criticisms of many of those studies (in terms of who funded them, flaws in methodology, conflicts of interest, etc.) by those opposed to fluoridation. I do not believe either side has definitively proved their case with respect to safety/benefits or lack thereof. However, what I do believe is that the burden of proving safety and effectiveness lies with the pro-fluoridation side, as it is your side that is insisting on imposing this “public health measure” on everyone else, even in the face of substantial objection and despite existing studies suggesting serious risks of harm. It also appears to me that the pro-fluoridation side is playing “whack a mole” with the studies weighing against CWF – often trying to hammer down/marginalize the opposition each time a negative study pops up, rather than trying to consider the evidence objectively. I note throughout your critique that you often refer to studies that weigh against fluoridation as “flawed” or “debatable” or as somehow lacking in proper control mechanisms – while studies that support fluoridation are “quality studies.” (p.8). You also minimize any existing evidence weighing against fluoridation by qualifying it: “there is no quality research” (p. 4) “there is no robust evidence” (p. 4), “there is no strong evidence” (p. 6). However, to me, if even one strong study exists, then the entire compulsory practice must be reevaluated.

Please also note that any and all of your cites to the ADA lobby, or to the CDC (which, though its oral health division, works hand in hand with the ADA promoting fluoridation and thus has a serious conflict of interest/credibility problem) are unpersuasive to me – as they should be to anyone conducting even a minimum level of research into the history of and politics behind fluoridation (some of which is chronicled in my article, including the story of the EPA’s NTEU battle). Incidentally, as someone who did not have a pony in this race before doing the actual research (i.e., I am not a long-time anti-fluoridation advocate), it does not take long to discover how politically motivated many “public health agencies” and “professional dental associations” are — or how willing they are to obscure, minimize, or bury contrary evidence or to marginalize the anti-fluoridation messengers, regardless of the evidence or the credentials of those messengers (e.g., Waldbott, Taylor, Marcus, Mullenix, Bassin, Hirzy).

With respect to the NRC Report, I agree with you that it did not specifically address compulsory water fluoridation. However, I believe that its review of fluoride toxicology is highly relevant to exposures from fluoridated water (and its exposure data itself suggests that some people drinking fluoridated water can, indeed, receive doses that can cause adverse health effects, including severe dental fluorosis and bone fractures). In addition, in a number of health risk areas, the NRC panel concluded that there was not enough data, and/or that more research needed to be conducted, before definitive statements could be made with respect to other potential adverse health effects due to excess exposure to fluoride. This is hardly a ringing endorsement of the safety of fluoride or fluoridation. Nor is the NRC Report irrelevant to the fluoridation debate.

I see no point in going through your critique page by page to point out various flaws in it, as mostly you seem to be trying to persuade me with contrary evidence rather than identifying any mischaracterizations of the studies I did cite. I will, however, point out that your opening accusation on p. 2 that my “paper starts off by saying there is mounting scientific evidence against fluoridation” and that I used an opinion piece by John Colquhoun as my “evidence” to support this statement is outrageously incorrect, and it almost prompted me not to respond to you at all, as I do not appreciate my words being twisted or my cites misused to inflate your argument. This statement about “mounting scientific evidence” at the start of my paper (near fn. 2) actually references an entire section of my article – (“See discussion infra Sec. II-B”) — and not an opinion piece by Colquhoun, which is only referenced – appropriately – at footnote 65 (referring to “formerly avid fluoride proponents” who have changed their minds). I have no desire to engage with insincere zealots, so I hope that you simply made a mistake there.

As I said to you privately, I am more than willing to revise my article where I have misstated any of the cited scientific evidence. However, I disagree with you that a discussion on the legal and ethical aspects of CWF would be “confusing” or “pointless” at this point and I would genuinely be interested in knowing why you feel so strongly that imposing this practice on everyone is ethically justifiable. Data published by the WHO suggests that the decline in dental caries is similar in both fluoridated and unfluoridated countries, and I have heard of no massive outbreak of a worldwide dental carie epidemic that has been attributed to a lack of fluoridated water (rather than to poverty, poor nutrition, or a lack of access to proper dental care). Thus, I am very curious as to why there appears to be such an aggressive campaign on the pro-fluoridation side to impose this practice on the world – and why anyone believes that personal liberties and rights to bodily integrity should be sacrificed for a public health practice addressing a non-contagious disease. I would also be interested in understanding where you personally believe compulsory public health practices should begin and end (e.g., do you believe governments should mandate compulsory flu shots? What about the HPV vaccine that the Governor of Texas tried to mandate for girls? Where should the personal right to bodily integrity begin and end, in your opinion? And how comfortable are you with public health officials mandating what is good for you? Do you contend that they haven’t been wrong on a public health issue before?).

As for me, I remain convinced that CWF is legally and ethically unjustifiable. My article sets forth my reasons, so I won’t repeat those arguments here. These reasons would remain even if compulsory water fluoridation were proven to be entirely safe, which it most definitely has not, despite the presumed “majority” view in the English speaking countries. You will also find many of my reasons articulated by dissenting justices in fluoridation cases over the last 60+ years, when presumably even less “science” was available to support their nevertheless valid legal/ethical objections to CWF. I include some of these cases and dissenting opinions in my article.

Daniel, I thank you for your (heretofore) civilized exchange with me and I do welcome your thoughts if you have any on the legal and ethical justifications of CWF. After this exchange, however, I am only interested in a private discussion with you, which is something you may not be interested in as it may not advance your organization’s agenda. However, your facebook posting has generated some contact to me by a few rude (and seemingly unbalanced) pro-fluoridation folks, and I have no interest in entertaining their rants (which certainly do nothing but convince me that the pro-fluoridation side has something to hide). In any event, I do thank you for reaching out and for your interest in my article. I hope to ensure that my final draft will address any legitimate criticisms/issues.
Sincerely,
Rita


Daniel Ryan’s response to Rita’s reply will be posted tomorrow. See Fluoride debate: Second response to Rita Barnett-Rose – Daniel Ryan.

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7 responses to “Fluoride debate: Response to Daniel Ryan’s critique – Rita Bartlett-Rose

  1. Yep, Rita provides nothing but irrelevant personal opinion, peppered with the standard conspiracy nonsense so characteristic of antifluoridationists. The American Dental Association and the CDC have a “conflict of interest” on a dental/healthcare issue? Whom exactly would she deem an appropriate source for dental/healthcare information….the American Plumbing Association? That one ridiculous statement perfectly examples the antifluoridationist tactics. These factions have learned through the decades that the science and appropriate healthcare entities are all in full support of fluoridation. As there is no valid science which supports opposition, and not one, single, respected organization anywhere in the world which opposes fluoridation, what are they to do? The only thing they can do……attempt to discredit and demonize the very people and healthcare organizations to whom we all turn for sound recommendations. Connett has made a cottage industry out of so doing, with those such as Rita being prime candidates to lap up his spoon-fed nonsense.

    Rita, if you are reading this, it makes no difference how many of Connett’s cronies you have review your paper. The facts will not change. They have no sound arguments, period. The courts which have clearly agreed with this through the years are not “corrupt”, and are not “politicized” in their rulings on fluoridation. They have simply listened to arguments presented by antifluoridationists……. the same ones you attempt in your paper and the same ones which Connett, Thiessen, Limeback, Hirzy, etc, will return back to you, then listened as the knowledgeable science and healthcare experts completely dismantle these arguments with facts supported by valid scientific evidence. The courts are interested in facts, not conspiracy theories, and not the junk science which Connett pushes. Once they hear the evidence, they rule…..and those rulings clearly demonstrate the fallacies of the antifluoridationist arguments.

    Once you and all other antifluoridationists get it through your heads that this is not some absurd conspiracy, that the only greedy issues with money come from antifluoridationists, that the science does not support opposition, and that dentistry and healthcare in general do not profit from fluoridation….the better off we will all be. Hopefully, should by some miracle this utopian scenario occur, the time and money wasted by antifluoridationists just to be told the same thing over and over and over again, could then be utilized far more productively in actually helping, rather than worsening the plight of the underserved populations of the world.

    Steven D. Slott, DDS

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  2. Rita,

    I did not find in your review any specific places where I actually mischaracterized any cited study.

    As every science denier has before you, whether it be the health effects of tobacco, climate science, evolution, vaccinations etc, you misrepresent the the central issue, which is the weight of scientific evidence.

    Want to polish your denial tactics? Read Naomi Oreskes’ “The Merchants of Doubt”, you’ll find the two Fred’s have been there before you, being still a babe in the woods. you can only learn an hone your craft.

    I am not interested in a battle of the studies debate

    Yeah right.
    Yet, you cite studies.

    I urge you to conduct such a [citation] battle with a more appropriate sparring partner, such as FAN-NZ.

    What on earth for? Why indulge the crackpot fringe. Better to seek and accept the position of every single public health and dental authority on the planet: that properly implemented CWF is a safe and effective means of improving a populations dental health. They do the work and they review the science. It’s their job to protect the health of the public.

    Moreover, and in stark contrast to you, the section of my article where the studies are discussed is specifically entitled: “Scientific Evidence Against Compulsory Water Fluoridation.” It is not meant to be an exhaustive examination of all studies on fluoridation and is specifically and accurately identified for what it is

    Well done, you are you admitting your paper is a one-eyed cherry pick.

    It also appears to me that the pro-fluoridation side is playing “whack a mole” with the studies weighing against CWF – often trying to hammer down/marginalize the opposition each time a negative study pops up, rather than trying to consider the evidence objectively.

    What total nonsense. The statement shows that you are a conspiracy theorist.

    Name a single health authority on the planet that opposes CWF on the grounds that it is unsafe.

    Go on.

    Name one.

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  3. Not unexpectedly we see the usual trite, and non informative responses from the pro zealots.
    Strange that so many governments globally have long ceased to promote CWF as a solution to tooth decay. Strange that so many experts that have retired or resigned from the health bodies you cite have criticised or condemned CWF as a practise.
    Have a read of this published journal article from the European Journal of General Dentistry, Volume 2 Issue 1, Jan-Apr 2013.
    “This review of literature on fluoride research reveals a situation where people in fluoridated communities are required to ingest a harmful and ineffective medication with uncontrolled dose. The medication actually doesn’t need to be swallowed, since it acts directly on tooth surfaces. The benefits of fluoridation is at best a reduction in tooth decay in only a fraction of one tooth surface per child. It is time for advanced nations and fluoridation countries to recognize that fluoridation is outdated and has serious risks that far outweigh any minor benefits, violates sound medical ethics and denies freedom of choice.”
    You guys are lot like a certain dictator who, in the later days of his reign, was planning campaigns with troops and resources that no longer existed to win a battle that had already been lost.

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  4. Trevor, can you tell us why you have chosen to quote from this paper in particular? I don’t think the authors really have an established history in the field (as can be seen by the failure to quote any of their own papers) and the journal is new (I can’t comment on its reputation but perhaps one of our dentist readers can).

    I have read it in the past and was somewhat unimpressed by its selective citations and naive understandings. For example their definitions of topical and systemic.

    Did you find the paper thorough citation searching, was it recommended to you, did you pick it up as a citation from other papers, or was it offered up by Paul Connett’s crowd? Why choose these authors in a officials – do you know them? Are you impressed by their reputations?

    I keep saying to people they should approach the literature critically and intelligently. Not cherry picking something because it confirms their bias but actually assessing the quality of the papers and evidence.

    Personally I would not rely on citing this paper – certainly not by itself. Perhaps as an example of a minority view – maybe. Although I could find better ones for that. It is a very poor, highly motivated, review. That is my honest judgment.

    Trev, you have a preoccupation with fluoridated water and continue to inform the widespread use of other fluoridated produces like salt and milk. You also ignore the widespread use of dental fluoride treatments which are common in countries with the better social health systems.

    So come on. If fluoride is bad it is bad, whatever intake or treatment method is used. There are many reasons why CWF is not suitable for good technical, geographic and political reasons (unlike much of NZ which has good treatment plants and a population which mostly supports it).

    >

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  5. Ms Barnett accuses Daniel of attempting “to marginalize the anti-fluoridation messengers, regardless of the evidence or the credentials of those messengers (e.g., Waldbott, Taylor, Marcus, Mullenix, Bassin, Hirzy).”

    If I may concentrate just on Bassin, I must say that if ever a paper was well and truly marginalised it is that one, not by Daniel, but by Science. Even Bassin advises caution by concluding with the remark: “Further research is required to confirm or refute this observation.” Those further studies convincingly demonstrated there was no link between CWF and water fluoridation. I cite just two below but there were several others.

    In 2011 Kim et al in The Journal of Dental Research failed to find any links between fluoridation and osteosarcoma, in addition to highlighting shortcomings in Bassin’s method of calculating fluoride exposure. (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3173011/).

    This year the International Journal of Epidemiology published Karen Blakey et al’s 25 year look-back study which also convincingly found no link between fluoridation and osteosarcoma. (see a copy here: http://www.fluoridesandhealth.ie/download/pdf/int_j_epidemiol2014blakeyije_dyt259.pdf)

    Far from being victimised by cruel pro-fluoridationists, Bassin was a willing participant in the philsophically sound process known as modern science. Just as lawyers demand discovery and test a court opponent’s evidence in cross-examination, so too do scientists obtain another’s data (which is provided willingly) and attempt to replicate his or her findings. Many times they succeed but the opposite, as occurred with Bassin, is also often the case. Bassin, I repeat, is not a victim, but a good scientist who had the good sense to admit uncertainty and to openly call on others to test his findings.

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  6. I note an error in my reply above there i state in the second paragraph: “Those further studies convincingly demonstrated there was no link between CWF and water fluoridation.”
    This should read: “These further studies convincingly demonstrated there was no link between Osteosarcoma and water fluoridation.”

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  7. Trevor,

    The European Journal of General Dentistry is an open access journal which charges a fee for publication of articles. It is a publication of the “Dental Investigations Society” whatever that may be. There seems to be no information available on this organization. Judging from the obvious bias of the paper you cited, this journal seems dubious, at best, and like the journal “Fluoride” is probably just a repository for articles which no respected journal will accept.

    The article itself is nothing but a rehash of “fluoridealert” nonsense. It even cites a “survey” by FAN as evidence to support the opinions expressed in the piece. It uses the same stale inflammatory language of FAN such as “waste silico-fluoride”, reports the same, unsubstantiated conspiracy nonsense as FAN promotes, i.e.:

    “Behind the dental and medical associations, who promote fluoridation, are powerful corporate GFFGG interests like-the sugary food industry (e.g., sugar, soft drinks, processed breakfast cereals and sweets) that benefits from the notion that there is a magic bullet that stops tooth decay, whatever junk food our children eat; the phosphate fertilizer industry that sells its waste silico-fluoride to be put in drinking water instead of paying for its safe disposal; and the aluminum industry, which had an image problem with the atmospheric fluoride pollution it produces, and funded some of the early research in naturally fluoridated regions of the USA that appeared to show that fluoride was good for teeth.”

    makes absurd, unsubstantIated claims such as:

    “Some governments support fluoridation because they consider it to be a cheaper way of addressing tooth decay than running effective dental services for school children and older people, and politically safer than tackling the promotion of sugary foods that are the main cause of tooth decay.”

    and cites such sources as http://www.doctoryourself.com” for data on fluoridation and dental decay rates.

    The article claims that benefits of fluoridation are a “fallacy” based on what its authors opine to be insignificant caries reduction as found in two studies. They fail to note any of the countless peer-reviewed studies which clearly demonstrate the effectiveness of fluoridation in the prevention of dental decay.

    The article cites dental fluorosis, and “mottling” of teeth as a significant concern while failing to note the distinct levels of dental fluorosis with mild to very mild being the only levels attributable in any manner to fluoridated water.

    The article makes it appear as though skeletal fluorosis is a consequence of water fluoridation, failing to note that this disorder is nearly existent in the 74.6% fluoridated U.S.

    Antifluoridationists see nothing wrong with this type of hogwash, believing it to be the “science” that supports their position. Then when it is ripped to shreds by those who actually have an understanding of the difference between valid scientific evidence and “junk science”, the antifluoridationists whine about evidence being “marginalized”, “covered up”, or ignored. The total lack of any valid evidence is the problem with antifluoridationist arguments, not corruption, big business, or any of the other ridiculous nonsense put out by uninformed activists.

    Steven D. Slott, DDS

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