Fluoridation science and political advocacy – who is fooling who?

misinformation

It is a false balance to equate the advocacy of scientific and medical experts concerned with truth and child health to the advocacy of ideologically-motivated anti-fluoride and anti-vaccination activists known for their misrepresentation of science. Credit: World Congress for freedom of scientific research

I thank Dr Ghali for taking up my offer of a right of reply to my article Scientific integrity requires critical investigation – not blind acceptanceThis sort of discussion is important and I am pleased he took the time to read my article.

Unfortunately, he did not respond to my point about the need to critically examine research findings and claims. Or my point that he seemed to be attempting to “sweep aside” critical reviews which are inherently part of the scientific process. His characterisation of the letter sent by 30 academic and health experts to the US National Institute of Environmental Health Science (NIEHS) about the  Green et al (2019) study (see Experts complain to funding body about quality of fluoride-IQ research) was unjust and simply avoided the necessary discussion.

However, in his reply, he raises a new issue that is worth discussion. That of how scientists should respond to “advocacy positions.”

Equating political and scientific/health advocacy

He says:

“. . we tried in our presentations to shed some light on the controversy, and to show how advocacy positions have focused on attacking both the evidence on benefits of fluoride (e.g., the multi-pronged attacks on Lindsay McLaren’s study on CWF), and the more recent evidence on potential negative cognitive effects in developing brains.”

This characterisation falls into the trap of equating the advocacy of anti-fluoride activists, organisations like the Fluoride Action Network (FAN) and Fluoride Free NZ (FFNZ), who are well known for distorting and misrepresenting the science, with scientific and medical experts who are attempting to present a good faith expert scientific interpretation and critique of current research.

I believe this is a dangerous position because it comes across to policymakers as saying the scientists disagree with each other, that there is not a majority consensus,  and equates the standard of science presented by both sides. This impression is, of course, very much favoured by political activists because it is an easy way of discrediting scientific information, of avoiding the need to properly and objectively consider the information.

I saw this myself when the fluoridation issue was being considered by the local Hamilton City Council in 2013. Councillors were clearly not up to the job of considering the science (and why should they be) so reacted to any attempt to present scientific details by arguing that “scientists disagree with each other,” that there are “two sides to the science.” In the end, they even based their decision on things like the number of submissions as the deciding factor instead of on the science.

Incidentally, the voters in Hamilton did not let the council get away with such a sloppy disregard for the science and of their own previously expressed majority support for fluoridation. A new referendum was demanded and the result confirmed that of the previous referendum showing 70% support for community water fluoridation.

I cannot understand why Dr Ghali promotes this understanding – even to the extent of appearing to favour those who misrepresent the science above those who are attempting a good scientific critique. For example, he describes the anti-fluoride activist attacks on the science merely as “strong” and “rooted in positional anti-fluoride advocacy,” while he refers to “the unusually vigorous attacks on the fluoride cognition studies” and argues these are “seemingly rooted in the challenging findings of those studies. “

Interpreting normal scientific critique as an “attack”

Dr Ghali specifically mentions the fluoridation cessations study of McLaren et al (2016) as being strongly attacked. Part of that “strong attack” was a published critique of FAN members – Neurath et al (2017) – the sort of critique fully acceptable and expected in the scientific community. McLaren et al., (2017) in turn responded to that critique. Again a normal and necessary process in science. In fact, the opening sentence in this response was:

“Thank you for the opportunity to respond. We are pleased to see thoughtful debate in the peer‐reviewed literature and agree that careful consideration of study limitations can stimulate improvement.”

That is how such critiques should be dealt with – welcomed and responded to. That should have been the way to respond to the critique of the 30 scientific and medical experts who responded to the Green at al (2019) study in their letter (see Experts complain to funding body about quality of fluoride-IQ research).

Yet  Dr Ghali’s response to that letter was:

  • He described it as “The notion that you can just talk away 10 years of research.”
  • He leapt to an emotional defence of the authors of the Green study, saying: “I respect the doers of the research and the deliverers of the evidence and don’t think they should be shot for tough messages.”
  • He uses phrases like  “once published it can’t be unpublished” and refers to this critique as “sweeping aside because one disagrees.”
  • And in his response here (see Scientific integrity & fluoridation – Dr Ghali responds) he reverts to this emotional rejection of the normal scientific critique saying  he could not “pretend that the new studies do not even exist or that they are fatally flawed with irrelevant results.”

Ignoring the real political attacks on the science

But where is his emotional response to the way anti-fluoride activists have resorted to disgusting personal attacks on Lindsay McLaren for her work? That is surely unacceptable in any scientific discussion

An example of the personal attacks on Lindsay McLaren for her fluoridation cessation work. Source: Why the anti-fluoride haters are attacking a Calgary academic, calling her a ‘fraud’

Or to the way that these activists have misrepresented and distorted the findings of the Green et al (2019) study?

Image used in advertising campaigns of FAN and FFNZ which completely misrepresents the scientific findings.

This sort of scaremongering advertising has appeared quite widely in newspapers and public billboards in New Zealand and caused a lot of concern among health professionals and their patients.

Who is advocating for what?

The political position of the anti-fluoride activists is clear – they advocate to end fluoridation or prevent it where it is being considered. This advocacy comes from ideological positions as can be seen with their alliance with anti-vaccination activists in Health Liberty and their funding by the “natural”/alternative health industry (eg., Mercola.com and the NZ Health Trust and see Big business funding of anti-science propaganda on health).

But it is simply wrong to put the advocacy of scientific and medical experts as operating at the same level. This is made clear in the letter from the 30 experts (that Dr Ghali dislikes) which says in its summary:

“The aim of science is to gain a better understanding of our natural world and to build a shared knowledge base for the benefit of all. Every scientist is interested in the truth. If fluoride at common levels of maternal exposure does lead to lower IQ scores, we would certainly want to know. This is why transparency related to the Green article is crucial.”

To be clear – the scientific and medical experts are advocating for good science and the health of the public, especially children. That is what drives their legitimate demand for transparency in the science.

So, I think Dr Ghali is disingenuous to present a false balance between the arguments of scientific and medical experts and the ideologically-driven anti-fluoride activists. He is wrong to treat scientific and medical experts as just another “advocacy group” like FAN. And he is especially wrong to use this false balance to ignore or discredit normal scientific critique which is so essential to good science.

Dr Ghali falsely equates the advocacy of anti-fluoride activists as illustrated by this scaremongering billboard with the advocacy of medical and scientific experts who are concerned about child health and want to know the truth.

Dr Ghali’s characterisation of the new fluoride cognitive studies

I also find the way Dr Ghali’s presentation of both the recent cognitive studies and the expert discussion of them disturbing. he says:

“The new cognition studies (led, interestingly, by two Canadian public health research teams) and the ensuing NTP draft report from the US are now such that it would have been absurd for us to pretend that the new studies do not even exist or that they are fatally flawed with irrelevant results.”

Who the hell is pretending that these studies do not exist? How is a rational, good-faith scientific critique of these studies pretending they “do not even exist?”

As for the question of the possibility these studies “are fatally flawed with irrelevant results,” how can anyone ever decide that question if the scientific critique of the studies is not permitted – or thoughtlessly, even emotively, disregarded?

Even Dr Ghali admits these studies have limitations (although I am unaware of any discussion by him of those limitations). Surely an honest scientific discussion of the is work requires a discussion of these limitations – and that is exactly what the letter from the 30 experts did. It listed ten important limitations – yet Dr Ghali wishes to dismiss the letter. He has certainly shown no interest in considering the specific limitations of the study.

These limitations may well mean the results are irrelevant to the question of community water fluoridation. I have argued that in several articles. I think the conflicting and contradictory results from the different papers and different databases (ELEMENT in Mexico City, MIREC in Canada, INMA in Spain, and NHANES in the USA) do suggest the quality of the results mean they should not directly influence health policy. I have also raised the issue of naive presentation of statistical analysis, reliance only on p-values with no discussion of the small size of the effects as indicated by the inability of the relationships to explain more than a few per cent of the variance in cognitive factors. There is also the problem of using a large number of factors with the inevitable p-hacking – a problem which, I believe, is actually quite widespread in science and needs to be countered.

Dr Ghali appears to argue that these new studies are not fatally flawed despite acknowledging they have “limitations” and that the results of the studies are relevant to CWF. But how can he come to that conclusion without making an objective analysis of the study’s methodology, considering the weak nature of the relationships reported? He is certainly not performing a proper scientific review by simply taking the authors’ claims as fact.

Dr Ghali appears to argue that these new cognition studies be given a free pass – that they not be subjected to the normal scientific process of proper peer-review and critical analysis. He appears to be turning a blind eye to the way these studies have been misrepresented and their finding distorted in scaremongering advertising by anti-fluoride organisations. Does he not realise his attitude plays directly into the hands of the ideologically motivated anti-fluoride and anti-vaccination activists? Can he not draw an appropriate conclusion from the fact that his arguments are being promoted by ideologically motivated activists known for their misrepresentation and distortion of science?

Conclusions

If readers think I have been too harsh in my discussion here they should consider that Dr Ghali’s response did not in any way deal with the points I raised about the need for ongoing scientific discussion. In fact, he went further suggesting that I, or others,  may be pretending “that the new studies do not even exist or that they are fatally flawed with irrelevant results.”

That is patently not true as I have critiqued and discussed these studies in a number of articles here – there is no pretence in my position or the position of others who have participated in a principled discussion of the limitations and faults in this work.

I also did not appreciate Dr Ghali’s suggestion that we could “have a chat some time.” In my experience invitations to private chats as a substitute for participation in a good-faith open scientific discussion are simply a bureaucratic attempt to close down that discussion – or to silence a participant.

Another important factor is that while Dr Ghali attempts to discredit those who honestly critique these new cognitive studies from a scientific perspective he is apparently unwilling to criticise anti-fluoride activists who misrepresent the work and use that misrepresentation in scaremongering claims and advertising campaigns. I specifically asked Dr Ghali if he could point me to any video content where he was critical of the anti-fluoride campaigners – so that I could use it in this post as a balance to the video in my article Scientific integrity requires critical investigation – not blind acceptance where he strongly criticises those participating in a scientific critique. He did not respond which make me think he is unable to find anything where he has subjected anti-fluoride activists to the same emotive attack as he leveled at those critiquing the Green et al (2019) paper.

It is sad to see such partisanship in one who has had the responsibility of reviewing the research in this area.

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10 responses to “Fluoridation science and political advocacy – who is fooling who?

  1. Thank you, Ken. Ghali’s arrogance and obvious bias in this whole affair has been astonishing, to say the least.

    Steven D. Slott, DDS

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  2. Bill Osmunson DDS MPH

    Ken,
    You say, “he did not respond to my point about the need to critically examine research findings and claims. Or my point that he seemed to be attempting to “sweep aside” critical reviews which are inherently part of the scientific process.”

    Sometimes silence is the less confrontational response and loudest. Or less disagreeable. Or more professional. Or simply an oversight.

    In any case, I think he would agree with us that all research needs to be critically examined, not just the research which disagrees with Ken’s bias, but also dosage.

    And he gave a professional response to the illogical and misguided complaint to the NIEHS attacking funding rather than evidence. Early research and all research is incomplete.

    Perhaps a history of fluoride and fluoridation would help soften your bias.

    Fluoride research is in its infancy. Sure, there have been years of marketing “safe and effective.” But the claims were never backed up by good research.

    Researchers evaluating fluoride lost funding, lost tenure, lost much, and learned that fluoride research is a career buster. Therefore, the research on fluoride is minimal and although in its infancy is rapidly growing consistently gaining quality. No one research study is “proof.” The weight of evidence from all streams of evidence is needed for judgment.

    Both pro and con have their weak areas. I promoted fluoride supplementation for many years as a dentist with masters in public health. Like Steve and you, I casually looked at the limited evidence and tradition. And my bias is prevention.

    To admit the research on benefit is weak was very difficult. I thought I could see in my patients the benefit. And the question of risks. . . well, incomplete. Now we know better. There is no excuse for overdosing by public health policy.

    However, start with dosage and then the limited research becomes highly significant.

    Ghali has not been looking at the fluoride research for years, spending thousands of hours looking at all streams of evidence and keeping up with the constant flow of new research coming out monthly.

    He did a reasonable job responding to your biased questions.

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  3. So Bill, you are accusing Ghali of being confrontational, loudest, disagreeable and unprofessional. Don’t forget he refused to be silent about the letter from the 30 academic and health professionals. In fact, he was demanding that they be silent and was unjustly criticising them for participating in the normal scientific discussion.

    Give me your evidence that Ghali would agree “all research needs to be critically examined.” Why did he specifically attack scientists for doing exactly that and pretend this involved suppression of studies or shooting researchers?

    You say he gave a “professional response to . . . the letter to the NIEHS.” I have not seen such a response – could you please point me to that – provide the text or a link? Seriously, if he has done so I want to know about it as he has not made this available to me in our exchange – he has simply attacked and misrepresented the letter.

    Refusal on your part to provide that text and link will be interpreted by me as simply another attempt by you to lie about the situation.

    You say Gahli did a “reasonable job responding” to my post (talk about damning with faint praise).

    Can you point me exactly to the text in this response which was specifically responding to my points about the need to enable normal scientific discussion? Nowhere has he been able to justify his attempt to sweep aside the content of the letter which listed 10 serious limitations in the Green study and requested the release of the data. Nowhere!

    Come on Bill, at the beginning of your comment you were straw clutching to support Ghali’s silence (lack of response) on my points and at the end you say he did a “reasonable job of responding.” you cannot have it both ways – unless you are a buffoon like your president who seems to do it all the time. You seem to have a lot in common.

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  4. Bill Osmunson DDS MPH

    Ken,

    I think you misunderstand a comment of disagreement over a person’s comments with their position on scientific process.

    I can’t speak for you or Steve or Gahli, but I am confident we all do our best for open scientific discovery. Anything less is not science. And the greatest risk is when scientists all agree. . . hang on to your wallet.

    From your comments, I get the feeling that anyone who does not see eye to eye with you, in your opinion does not want scientific debate.

    However, the scientific debate needs to be scientific and reasonable rather than personal attacks.

    And I would suggest, the open scientific debate is often best presented in peer reviewed publications rather than on twitter or forums. A case in point is you and me. You want to get into the fine details of a study and I take a look at the big picture to find out where to establish the foundation. I would maintain the concerns you raise on studies are only a few of the concerns. Yet we need to start at the basic fundamentals to keep each research in perspective and all streams of evidence.

    Ken, Gahli is not your whipping boy. You can’t force him to waste his time on debating you. He responded, you should be pleased. Back off. He did well.

    I have asked you so many times to tell me how much dosage is optimal and how much is safe and how much is too much. What do you want?

    You avoid those questions and have a double standard for Gahli and expect him to spend many hours debating you. He is smart, I’m stupid in wasting my time on you when you are not honest or fair in responding to me.

    Gahli probably knows you would not provide a fair debate, just as you are not fair with me. At least Steve started to be factual. Of course he then went on tto personal attacks.

    Gahli did will.

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  5. Bill, how did Ghali “do well?” He did not respond to the very important specific points I raised and instead offered a closed-door “chat.”

    No, he is not my whipping boy but his mistakes needed pointing out. He made an impermissible attempt to inhibit scientific critique and that is my only interest in him. I have dealt with that and it is up to him if he responds or not. My impression is that he won’t respond as does not understand the science well enough to discuss it and his comments are purely made at the political level.

    My record shows that I am perfectly willing to have a scientific exchange (your record shows exactly the opposite). Paul Connett and I did not agree but we had the exchange. It was very useful. People still download and refer to the document to get an idea of our positions – that says something, doesn’t it?

    The fact remains that Ghali’s approach to scientific discussions was to discredit it – although only if it came from one side. He did not try to close down the critique of McLaren et al. for example. And it is very telling that FAN is using him for their propaganda purposes. That says something, doesn’t it? FAN is not known for any honesty about the science.

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  6. Still whining about non-existent ”personal attacks” I see, Bill. It is truly comical to see you attempt to chastise Ken, or anyone else, about providing facts when the only thing you ever provide in that regard are your own unsubstantiated personal opinions which you unilaterally deem to be “facts”.

    Steven D. Slott, DDS

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  7. Ken,
    I do take exception questioning FAN’s honesty. Be specific. The accusation is not factual. What document do you have from FAN which is dishonest? I don’t think you understand. FAN has no control over what people say who agree with FAN.

    Steve,
    Ken simply made the accusation of dishonesty without any fact.

    I do present my opinion and I also present facts, so do you.

    The bias, in part, has to do with our previous knowledge. No two people have the same evidence and back ground to process the evidence. Few are willing to candidly and carefully examine evidence which does not support their bias.

    You don’t respond to facts I present which make you uncomfortable
    #1. Fact: FDA requires RCT studies for approval of all substances used with the intent to prevent disease. http://www.FDA.gov

    #2. Fact: EPA DRA RSC was clear about one third to two thirds of children are ingesting too much fluoride.

    #3. Fact. All surveys indicate dental fluorosis prevalence is between one third and two thirds.

    Do you dispute those facts?

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  8. Bill:

    Fact: The FDA has no jurisdiction over the contents of drinking water supplies. What it may require of substances under its jurisdiction is therefore irrelevant to water fluoridation. Your continual denial of reality is unfortunate for you but does not change this fact.

    Fact: An unsubstantiated claim about what somebody or other “was clear” about is meaningless.

    Fact: An unsubstantiated claim about what “all surveys” may indicate is meaningless.

    You have not presented any facts for me to dispute.

    Steven D. Slott, DDS

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  9. Bill, you want examples of FAN’s dishonesty? The following blatant example of the dishonesty of this group took me all of two minutes of searching its little website. There is little, if any, truth in this nonsense:

    THREE REASONS TO END WATER FLUORIDATION

    Reason #1: Fluoridation Is an Outdated Form of Mass Medication

    Unlike all other water treatment processes, fluoridation does not treat the water itself, but the person consuming it. The Food & Drug Administration accepts that fluoride is a drug, not a nutrient, when used to prevent disease. By definition, therefore, fluoridating water is a form of medication. This is why most western European nations have rejected the practice — because, in their view, the public water supply is not an appropriate place to be adding drugs, particularly when fluoride is readily available for individual use in the form of toothpaste.

    Reason #2: Fluoridation Is Unnecessary and Ineffective

    The most obvious reason to end fluoridation is that it is now known that fluoride’s main benefit comes from topical contact with the teeth, not from ingestion. Even the CDC’s Oral Health Division now acknowledges this. There is simply no need, therefore, to swallow fluoride, whether in the water, toothpaste, or any other form. Further, despite early claims that fluoridated water would reduce cavities by 65%, modern large-scale studies show no consistent or meaningful difference in the cavity rates of fluoridated and non-fluoridated areas.

    Reason #3: Fluoridation Is Not a Safe Practice

    The most important reason to end fluoridation is that it is simply not a safe practice, particularly for those who have health conditions that render them vulnerable to fluoride’s toxic effects.

    First, there is no dispute that fluoridation is causing millions of children to develop dental fluorosis, a discoloration of the teeth that is caused by excessive fluoride intake. Scientists from the Centers for Disease Control have even acknowledged that fluoridation is causing “cosmetically objectionable” fluorosis on children’s front teeth–an effect that can cause children embarrassment and anxiety at an age when physical appearance is the single most important predictor of self-esteem.

    Second, it is known that fluoridated water caused severe bone disease in dialysis patients up until the late 1970s (prior to dialysis units filtering fluoride). While dialysis units now filter out the fluoride, research shows that current fluoride exposures are still resulting in dangerously high bone fluoride levels in dialysis patients and patients with other advanced forms of kidney disease. It is unethical to compromise the health of some members in a population to obtain a purported benefit for another — particularly in the absence of these vulnerable members’ knowing consent.

    And, finally, a growing body of evidence reasonably indicates that fluoridated water, in addition to other sources of daily fluoride exposure, can cause or contribute to a range of serious effects, including arthritis, damage to the developing brain, reduced thyroid function, and possibly osteosarcoma (bone cancer) in adolescent males.

    Communities Are Starting to Get the Message

    In recent years, communities throughout the United States and Canada have started to reassess the conventional wisdom of fluoridating their water. Many of these communities, including over 50 since 2010, are reaching the obvious conclusion: when stripped of its endorsements, well-meaning intentions, and PR-praise, fluoridation simply makes no sense.

    Europe reached this conclusion a long time ago. It is now time for the U.S. and other English-speaking nations to follow suit.

    Steven D. Slott, DDS

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  10. Bill Osmunson DDS MPH

    So you say, without any references. Apparently you expect us to trust what you say without any factual or referenced support.

    Show the evidence, the facts, the research, that those statements are dishonest.

    FDA has confirmed fluoride (or anything) used with the intent to prevent disease is a drug. FD&C Act. 21 USC 321(g)(1)(B)
    All State laws define drugs the same. The Washington State Board of Health, June 4, 2009.

    FDA testified to Congress in 2001that fluoride is a drug.

    Steve Neugeborn, Ass. General Counsel, Water Law Office, EPA 2/14/2013, “The FDA, remains responsible for regulating the addition of drugs to the water supply for health care purposes.”
    If you want to see a copy of the letter and the FDA’s letter, I believe it is on the FAN web site.

    FDA letter to drug companies: “. . .there is no substantial evidence of drug effectiveness as prescribed, recommended or suggested in its labeling. . . marketing is in violation of the new drug provisions of the Federal Food, Drug, and Cosmetic Act; they have, therefore, requested that marketing of these products be discontinued.” FDA Letter to 35 Companies DRUG THERAPY 1975″

    Please provide statements from Congress, state Board of Health, FDA, or EPA that fluoride is not a drug.

    Read your toothpaste tube, “Drug Facts.”

    On the second statement, the American Dental Association Paffenbarger Research Center 2012, “After 60 years of community water fluoridation we still do not know how much fluoride is required to prevent caries.”

    Europe has similar low caries rates as the USA and only 3% fluoridated. British Columbia has almost no fluoridation and the least caries of all Canadian provinces.

    Observational evidence comparing states or countries does not show lower caries rates with fluoridation.

    CDC: “Ingestion of fluoride is not likely to reduce tooth decay.” Achievements in Public Health, 1900-1999: Fluoridation of Drinking Water to Prevent Dental Caries. MMWR, 48(41); 933-940, October 22, 1999

    “The results show that the reviewed original studies on economic evaluation of caries prevention do not provide support for the economic value of caries prevention.” http://www.fluoridealert.org/health/teeth/caries/who-dmft.html

    Källestål C et al. Acta Odontol Scand. 2003 Dec;61(6):341-6.
    Economic evaluation of dental caries prevention: a systematic review.

    No RCT of fluoride benefit.

    And to the third point, Your reference confirms Too many are ingesting too much fluoride.

    Huge increases in DF since fluoridation started.

    See NTP review

    Steve, perhaps you need to look at both sides of the evidence because the statements above are based on good factual evidence and references.

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