Category Archives: Health and Medicine

Debating science

The Science March in Palmerston North. Credit: Erin Wilson, Twitter.

This last week has certainly raised the profile of the “science debate” in New Zealand. Most importantly we saw big turnouts for the Science March in several major cities – a demonstration that lots of scientists and supporters of science feel that science could be threatened – or at least that it is unappreciated by the politicians and other decision-makers. Maybe even by a section of the public.

And at the other end of importance, we saw a childish spat by local anti-fluoride activists who had attempted to use a member of Parliament’s experience of miscarriages to make the scaremongering claim that these were caused by community water fluoridation. Then they attempted to divert attention from the embarrassing (for them) widespread condemnation by promoting, through their own press releases,  the fake news they had organised a “TV debate” on fluoridation with a local scientist.

The Science March

The Science March was many things to many people. I saw it as a general demonstration of support for science and opposition to attempts to discredit science – examples being the science around climate change, vaccinations, evolution – and yes even fluoridation. Some of the media presented it as a demonstration against US president Trump and his policies – and there may have been many in the US Science Marches who had these motivations. But every country and every region have examples where politicians have downplayed scientific evidence or even attempted to discredit that evidence and the scientists who produced it. These sort of struggles went on long before Trump and they will go on after Trump.

For example, in New Zealand, we have some specific issues over water quality and climate change which are quite unconnected to the US and its politicians. We have to fight out those issues here. Scientists, anyway, strongly resist linking their issues to politics and political movements. We have had a few bad experiences from that. This resistance and the silly intervention of identity politics into the organisation of the US Science Marches did make many scientists wary of participation.

But, in the end, the Science Marches around the world had good turnouts and my impression is that participants felt they had been both worthwhile for science and good experiences personally.

Of course, the Science March will not make the problems go away. There is still a need for the day to day struggle on issues like climate change, water and environmental quality and even fluoridation. This is one of the points I attempted to make in my article Trump didn’t invent the problems – and his opponents didn’t invent protest.

Debating science

And this is where a continuing debate around science issues is important. To be clear – I am not using the word “debate” in the formal sense (more on that later) but in its most general sense. And not necessarily debate involving specific contact between adversaries.

Issues about water quality and the environment come up continually in New Zealand. In the media, in local body and parliamentary considerations, and in government statements. A lot of the commentary may downplay the science on the issue or overplay economic and financial aspects. Some of the commentaries may be outright anti-science – or present misinformation, even distortions, about the science. Activist claims about the “dangers” of the use of 1080 to control predator pests are an example.

The misinformation and downplay of scientific information cannot be allowed free passage – it must be challenged. Hence there is a debate – again not a formal debate, but a debate, nevertheless. The public is exposed to various claims and counterclaims via the media and the internet. Regional bodies and parliamentary committees are deluged with submissions and scientists and supporters of science have a role to play there too.

Scientists and supporters of science should not stand aside and let the opposition win by default – simply because they abhor the political process or ego-driven participation in media reports. But they need to choose their battles – and they need to consider the effectiveness or otherwise of different forms of participation in public debate.

Problems with formal debates

So what about formal debates of the sort the Fluoride Free New Zealand (FFNZ – the local anti-fluoride organisation) claimed via their press releases to have organised? A TV debate between New Zealand Scientist Professor Michelle Dickinson from Auckland University, and Dr. Paul Connett – chief guru at the US Fluoride Action Network. This proved to be a kickback from FFNZ, a diversion from the bad publicity that came their way when Dickinson publicly criticised their use of scaremongering tactics in an email sent to a Green member of parliament. Public commenters were disgusted at the FFNZ claim the miscarriages she had suffered were caused by community water fluoridation.

Professor Dickinson pointed out she had not agreed to a TV debate (which FFNZ then childishly used in another press release to claim she had reneged). And Dr. Paul Connett did not even publicly respond – indicating that while the debate challenge had been made in his name he knew nothing about it.

Kane Titchener, the Auckland FFNZ organiser who made the challenge to Michelle Dickinson, is a bit of a Walter Mitty character and often makes debate challenges in Paul Connett’s name, but without his authorisation. These challenges are his way of avoiding the discussion of the science when he is outgunned. He made a similar challenge to me four years ago – I called his bluff and nothing happened. The debate I did eventually have with Paul Connett was arranged through Vinny Eastwood (a local conspiracy theorist who promote anti-fluoride propaganda), not Kane Titchener – who was probably not even in contact with Connett.

But, in general, scientists are unwilling to take part in the sort of formal debates Kane Titchener was proposing. There are often similar challenges made to evolutionary scientists by creationists and religious apologists, and to climate scientists by climate change deniers. Scientists generally feel their opposition make these challenges in an attempt to gain recognition or status they do not deserve. (I think in this particular case Kane Titchener may have naively thought he could use Michelle Dickinson’s connections with TV personalities to get Connett on TV – something he has found impossible on his recent visits to NZ).

Another, more important, reason is that such formal debates are usually more entertainment than information. In fact, debating is a recognised form of entertainment often driven by egos and aimed at ‘scoring points’ which appeal to a biased and motivated audience. They are rarely a way of providing information and using reasoning to come to conclusions – which is the normal and accepted process of scientific discussion.

Good faith discussion

Don’t get me wrong – I am not opposed to all forms of one-on-one “debate” or discussion. These can be useful – especially when the audience is not stacked by biased activists. An exchange of scientific views or information in front of an interested but unbiased audience can be a useful and good experience.

Similarly on-line, written debates or discussion of the sort I had with Paul Connett in 2013/2014 can also be useful (see Connett & Perrott, 2014. The Fluoride Debate). In this format, ego and debating or entertainment skills are less effective. Participants need to produce information – and back it up with evidence, citations or logic. And one’s discussion partner always has the opportunity to critically comment on that information.

I feel that debate was successful – it enabled both sides to prevent information in a calm way without put downs or ego problems. I often use that debate when I want to check out citations and claims. Interestingly, though, Paul Connett behaves as if the debate never happened – claiming that no-one in New Zealand has been prepared to debate him. The FFNZ activists do the same thing. Ever since that debate, I have been blocked from commenting on any anti-fluoride website or Facebook page in New Zealand and internationally. It’s almost as if some sort of Stalinist order went out to treat me like a “non-person.”

A challenge to anti-fluoridation activists

If these activists are so keen on debating the issue then why don’t they allow it to happen? Why do they block pro-science people from commenting on their Facebook pages? Why do they ignore open letters and offers of rights of reply of the sort I sent to Stan Litras and other anti-fluoride activists (see A challenge to anti-fluoridationers to justify their misrepresentation of New Zealand research). Why did Lisa Hansen – the solicitor for the NZ Health Trust who has been making incorrect scientific claims in her High Court cases opposing fluoridation ignore my offer of a right of reply (see Open letter to Lisa Hansen on NZ Fluoridation Review)? Even the “great helmsman” himself, the man who Kane Titchener seems to think will answer all the questions, refuses to respond to offers of right of reply (see Misrepresenting fluoride science – an open letter to Paul Connett).

Why do these people ignore such opportunities?

One thing I noticed about the submission made by opponents of community water fluoridation to the recent parliamentary Health Committee consideration of the Fluoridation Bill was the overwhelming reliance on scientific claims in almost all their submissions. Claims that fluoridation causes IQ loss, fluorosis and a whole host of sicknesses. Many of the submitters actually used citations to scientific journals or attached copies of scientific papers.

These people claim they have science on their side – yet they seem to be extremely shy about discussing that science in any open way. Why is that?

No, it’s not a matter of Walter Mitty types making debate challenges in the name of Paul Connett. Why don’t Kane Titchener, Mary Byrne, Stan Litras, Lynn Jordan (alias Penelope Paisley on Facebook) and similar activists who love to make “authoritative” scientific claims in submissions or behind the protection of a ring-fenced Facebook page or website participate in an honest open debate?

For a start – what about stopping these silly”challenges” in Paul Connett’s name. Then they could remove restrictions on the discussion on the websites and Facebook pages they control.

And, yes, I would be happy for them to participate in good faith scientific discussion in articles on this blog. That is what my offers of the right of reply to my articles were all about.

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No, fluoridation is not associated with leading causes of death

We are all going to die but fluoridation isn’t killing us.

Oh, dear – the local anti-fluoridation people are at it again. More cases of fiddling statistics  – and yet again the guilty party is the US anti-fluoridation activist Karen Favazza Spencer. She should really take some advice about statistics.

Although I suspect she doesn’t care – she is just once again cherry picking in an attempt to paint a bad picture of community water fluoridation.

In this case, she claims the death rates for the leading causes of death in the USA are up to 30% higher in the more fluoridated states than in the less fluoridated ones. And here is her cherry-picked table to “prove it.

Her conclusions are wrong, of course. Look at what we find if we use the data for all the states instead of a few selected ones,  and look at it for signs of any correlation between fluoridation extent and death rates? The data is readily available.

I have done this and found a statistically significant correlation in only one case – cancer. Here is that data and the regression line accounts for about 10% of the variance in cancer rate. Obviously, other factors are involved.

But, wait – there is more. As I explained in my last post Anti-fluoridationists exploit infant deaths by fiddling statistics such statistically significant associations often disappear when other important factors are included in the regression analysis.

So let’s look at what happens when we include mean state elevation in the statistical analysis. As I explained last time there is an association between fluoridation extent and mean state elevation which means that fluoridation is often acting as a proxy for elevation in statistical analyses. Multiple regressions including both fluoridation extent and mean state elevation picks this up.

This table shows the results of such multiple regressions.

Table: Association of death cause with fluoridation extent and mean state elevation. Results from a multiple regression

Fluoridation 2014

p value

Mean altitude

p value

Amount of variance accounted for (%)
Heart disease 0.542 NS 0.007 ** 19.7
Cancer 0.363 NS <0.001*** 38.6
Stroke 0.955 NS 0.180 NS 4.4
Alzheimer’s 0.274 NS 0.834 NS 3.3
Diabetes 0.955 NS 0.445 NS 1.4
Kidney disease 0.441 NS 0.017* 16.3

What does that tell us? Well, the apparent association of cancer death rates with fluoridation is false – it disappears when altitude is included.

None of the death rates for any of the causes of death had a statistically significant association with fluoridation. But heart disease, cancer, and kidney disease were significantly associated with altitude. These associations accounted for from 16% to 39% of the variances in the death rates. The role of mean state altitude may have something to do with the size of cities or possibly improved health at higher elevations (the death rates declined with elevation for all causes considered).

I can only finish with the same words of warning I used last time:

“So, once again the lesson is – never take at face value the claims made by anti-fluoridation activists – no matter how “sciency” their information looks or what data they invoke to “prove” them.

Always check such claims for yourself.”

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Anti-fluoridationists exploit infant deaths by fiddling statistics

A useful reminder of how activists lie with statistics

The local anti-fluoride people have not stopped rabbiting away with their “science” – searching for anything bad they can argue is caused by community water fluoridation. The latest claim they make – fluoridation is responsible for infant deaths!

And they have some statistics to “prove” this. The table below presented by well-known US anti-fluoride activist, Karen Favazza Spencer, in her article America First – Chemical Warfare on Infants:

That table is simply lifted from a conspiracy style web page Why Pregnant Women Should Not Drink Fluoridated Water.

OK – these statistics might fool some people – especially if you have a bias to confirm. But the more critical person might pick up that these figures are most likely cherry-picked and want to see the full data set or some analysis of the data.

It’s not hard to find this data as there are tables of all sorts of things for US people organised by state. So, is there a relationship between infant deaths in each state and the extent of fluoridation in each state?

There actually does appears to be one at first sight – here is the graph of the data for infant deaths in 213 plotted against the extent of fluoridation in 2012.

ID-fl

But, just a minute – it is not actually statistically significant (p=0.106) and would account for only about 5% of the variance in infant deaths. Fluoridation is certainly not the main factor – and probably involved at all if other factors are considered.

Here I will just take into account the influence of state elevation – because I know from previous work that fluoridation extent is related to mean state elevation (see ADHD linked to elevation, not fluoridation).

Here is that relationship for the extent of fluoridation in 2012:

Fl-elev-2012

So, the extent of fluoridation in each state is related to mean state elevation and this relationship is statistically significant (p=0.005). Actually not surprising as the larger and older cities where fluoridation might be expected are generally situated at lower elevations for a number of reasons.

But what is the relationship between infant death and mean state elevation? Well, it is stronger than for the extent of fluoridation (p=0.002). Elevation accounts for about 18% of the variance in infant deaths in 2013.

ID-ele

Finally, let’s combine both elevation and extent of fluoridation into a multiple regression and see what the relationship when both factors are combined.

This multiple regression shows a statistically significant association (p=0.007) of the extent of infant deaths in each state in 2013 with the mean state elevation. However, there is no statistically significant association (p=0.592) with the extent of state fluoridation.

So while infant deaths could be explained by mean state elevation and most probably one or more other factors, they certainly are not explained by the extent of fluoridation. Not at all!

Preterm birth and conspiracy theory

In her article, Karen Favazza Spencer makes the bald claim “Fluoridation is positively correlated with preterm birth and increased death rates by state “ – again citing from the conspiracy style web page mentioned above.

Sure, that page makes that claim – “Domestic water fluoridation was independently associated with an increased risk of PTB [preterm birth].”  But that is hardly credible evidence because that page goes on the say:

“This study was never published nor was any follow-up research done, despite the fact that 2 years earlier, the US Institute of Medicine reported: ‘Those born preterm have an appreciable risk of long-term neurological impairment and developmental delay.'”

Strange! It is not hard to find data for preterm birth. In fact, here it is for 2014 compared with the extent of state fluoridated in 2012:

Clearly, there is no association between preterm births and extent of fluoridation. Yet that web page claimed there was and that the information had been suppressed!

I guess that is another way ideologically motivated activists “prove” these sort of things – invoke a conspiracy theory to claim a relationship exists but the data is suppressed.

So, once again the lesson is – never take at face value the claims made by anti-fluoridation activists – no matter how “sciency” their information looks or what data they invoke to “prove” them.

Always check such claims for yourself.

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Another anti-fluoridation whopper

We are all used to political activists fiddling statistics – but this has gone too far. Local anti-fluoride activists are so narcissistic they are now presenting their own clamouring as representing public opinion – even putting figures to it.

I find this really offensive. As a Hamiltonian, I objected to the undemocratic put our council took in stopping fluoridation in 2013. The attitude of voters was clear from a previous referendum which showed overwhelming support fo this safe and effective social health measure.Protests led to another referendum in October 21013 and again overwhelming support for community water fluoridation (CWF). A clear result and several months later the council reversed its stance –  we now have community water fluoridation again.

Yet anti-fluoride activists argued to reject the referendum result – so what is all the talk now about Patea and Waverly? Are they now objecting to a council which rejected the views of its electors?

Not at all. No referenda were held in Patea or Waverly. As far as I can tell there were no household surveys either. Simply the normal consultation process involving submissions. So where does Fluoride Free NZ (FFNZ) get its figures for the views of residents for the above poster? Are 85% of Patea and 75% of Waverly really opposed to CWF?

Again, no. Those figures represent the proportion of submissions presented to the council arguing against CWF. In fact, half of those submissions came from out of town – somewhere else in New Zealand or overseas. (Paul Connett, from the USA, and other members of his political activist group, the Fluoride Action Network, are regular submitters to New Zealand councils). This is typical of the way that these activists submerge councils with “submissions” when CWF is considered. Many submissions are simply copies or form letters.

By the same logic, FFNZ could argue that 75% of Hamiltonians were against fluoridation (because the overwhelming proportion of submissions to the council were). Despite the clear referenda results showing the opposite. In fact, FFNZ does list the submission number in the case of Hamilton as one of their referenda results!

Now we expect FFN to argue that over 90% of New Zealanders oppose fluoridation because that was the proprtion of anti-fluoride “submissions” to the recent selct committee hearings on the current fluoridation bill!

As they say – pull the other leg.

Wait – there is more!

But FFNZ goes even further over the top in their facebook presentation of this poster. They claim:

 

“In 2012 the South Taranaki District Council asked residents of Patea and Waverley if they would like fluoridation chemicals added to their water supply. The resounding answer was “NO”. However, Council went ahead and voted for it anyway. Because of the blatant disregard for the community’s wishes, New Health New Zealand took STDC to court. STDC have now spent $320,000 fighting this when they could have just backed off from fluoridation. This issue is going to go to Supreme Court some time in the future.
You have to wonder who these people are working for don’t you.”

So somehow the South Taranaki District High Council is to blame for the expenses involved in defending itself against court action – action taken by a lobby group of the New Zealand “natural”/alternative health industry. A big business worth billions that is pumping something like $100,000 a year into court actions agaisnt fluoridation. See Who is funding anti-fluoridation High Court action?Big business funding of anti-science propaganda on health and Anti-fluoridationists go to Supreme Court – who is paying for this?

How ridiculous – even for these political activists.

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Fluoride, coffee and activist confusion

Havana Coffee Works in Tory Street, Wellington. Great coffee and chance to see roasting in action. On the site of what was the old Wellington Milk Department in the 1950s.

I have been in Wellington for the Parliamentary select committee hearings on fluoridation. Well, that was the excuse – I was really there to catch up with my family (always a joy and am amazed at how tall my grandson has become) and to enjoy the great food in Wellington cafes.This time I

This time I also set out to acquire some freshly-roasted coffee beans from one if the many roasters in Wellington.

The Havana roaster turned out to be a surprise. Not only are their coffee beans excellent ( I am looking forward to getting home and drinking coffee made with them) – they are based in Tory Street as the site of what used to be the old Milk Department. Some of you may still remember the days when milk was delivered to your house in the middle of the night by a milkman. My Dad was one of those milkmen, and my siblings and I all spent time helping him deliver milk in the dead of night. So that building brought back memories. Even got to walk along Channing street on the way back to my hotel. You wouldn’t know it now but that street was very disreputable in the 50s because of the opium dens in the old houses.

Select Committee Hearings

These were interesting. Submissions were called for on  Health (Fluoridation of Drinking Water) Amendment Bill currently before parliament. This legislation is not about fluoridation itself. It is about how decisions should be made – about the process, not the science. In effect, it proposes transferring decisions from local councils to District Health Boards.

Pressure for the law change came from local councils who were sick to death of the hounding from activists and being forced into making decisions – not about whether to fluoridate or not – but about the science. Activist submitters continued to deluge them with passionately-worded submissions full of scientific claims – councillors with no scientific skills were being forced into making decisions about the science – were the activists correct in their claims that fluoridation causes all the ills known to mankind or should they accept the science presented by the experts. After all, activist submissions could look very sciencey – they were often full of citations to the scientific literature!

True to form the anti-fluoride activists deluged the select committee with submissions which were irrelevant to the bill – very few of them actually suggested changes or showed any evidence they had read the bill. No, they did their usual trick of preaching about the “science” – their claims of harmful effects from fluoridation and that it does nothing for oral health anyway.

It is amazing to hear people make outrageous claims about the scientific literature – claims which make clear they have never bothered to read the source they are citing. I guess they think they can get away with such porkies and misrepresentations because they are talking to politicians. However, my impression was this failed at these hearings – unless submitters raised suggestions about the process they were simply politely thanked and sent away.

So I found it frustrating to hear such lies being peddled about the science (and discussion by the public was not allowed) but confident in the fact the select committee was just humouring these people. Responses from committee members were always about process – not the scientific claims.

My submission

There were only a few submissions which dealt properly with the wording of the bill – the vast majority were just empty anti-fluoride rhetoric. I made a submission as an individual scientist but also as part of the Making Sense of Fluoride (MSoF) team. It was great to catch up with MSoF people who I tend to talk with on-line every day but have not till now met in person.

This was my oral submission:


As Monty Python used to say: “And now for something completely different.”

I support this bill as far as it goes but don’t think it will solve the basic problems without changing the way the science is considered. I want to suggest a change.

The current submissions show the problem. This committee has been inundated with large numbers of written and oral submissions. Many of these are duplicates or form letters. Most are opposed to community water fluoridation and usually make scientific claims – such as fluoride is a neurotoxin, that it causes a high prevalence of dental fluorosis or uses contaminated chemicals.

Submissions often cite scientific articles – some have even attached copies of these articles. This sort of thing can impress the layperson – perhaps some of the members of this committee are impressed? After all, it is easy to fool the ordinary person with scientific claims, citations, documents and publications. Advertisers do it all the time.

But this committee is simply not considering the science. Political committees – parliamentary, local body or District Health Board should not make scientific decisions. They do not have the skills for this. Yet that is what most of these submissions are asking of this committee. It’s what was being asked of local councils and it will be what is asked of DHBs.

Consideration of the science behind community water fluoridation requires people with scientific and health skills. Such people need to check evidence provided, check citations when they are presented, check what the scientific literature actually says (which could be very different to what submitters claim). Proper scientific consideration requires that the claims and cited scientific literature need to be considered intelligently and critically. The wider literature needs to be consulted. Cited claims need following up.

I have attached a couple of documents that do this – these are responses to documents used by several submitter arguing against community water fluoridation.

The current wording this bill requires DHBs to consider the scientific evidence. That just invites opponents of community water fluoridation to inundate DHBs with the sort of submission this committee has received – and local councils have been inundated with. DHBs are no better equipped to deal with this than this committee or local councils.

I suggest a change requiring DHBs to take advice on the scientific evidence from central bodies – the Ministry of Health and the Public Health Advisory Committee. This would transfer responsibility for scientific considerations to central bodies better equipped to do that evaluation.

The Public Health Advisory Committee has a legislated role to consider questions like this and advise the Minister. It is also able to consult interested organisations, experts like the Royal Society and the Prime Minister’s Chief Scientific Advisor who performed the most recent fluoridation review. It can also consult appropriate individuals.

This would not remove the right of lay persons to make submissions about the science – it simply redirects those submissions to a more appropriate body.

I think a change like this should be welcomed by everybody. It removes from DHBs the impossible job of making decisions about the science they are not equipped to make. It provides a proper venue for the science to be considered intelligently and critically. It is a credible and authoritative body for scientific organisations, health organisations, activist groups and the ordinary person who has concerns on this issue – whether for or against community water fluoridation.

After all – if someone has a genuine concern or has evidence they think will stand up to scientific scrutiny why should they want to waste time submitting it to a committee of politicians? Wouldn’t they be far happier knowing they are appealing to people who have the skills to evaluate their concerns properly?

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Anti-fluoride authors indulge in data manipulation and statistical porkies

Darrell Huff & Irving Geis wrote a classic book – How to Lie With Statistics. They outline various ways data can be presented to give the wrong story. However, there is an even more naive use of statistics to misrepresent data – just declare that a relationship is statistically significant, don’t show any data or statistical analysis.

Unfortunately, many people are fooled by the use of those magical words – “statistically significant.”

I suppose the lay person could be excused – although it would pay even them to be a bit more sceptical about such claims. But it seems that even some “scientific” journals, or perhaps inadequate peer reviewers, can be fooled by those magical words. Here is an example in the paper by Hirzy et al., (2015) in the journal Fluoride. (Yes, I know, this journal is well known for its anti-fluoride stance and poor scientific quality but I would have thought the editor, Bruce Spittle,  would have picked this one up – even if they do not have an adequate peer review system. Perhaps the fact Spittle is one of the authors of the paper is a factor).

I critiqued the paper in my article Debunking a “classic” fluoride-IQ paper by leading anti-fluoride propagandists and have submitted a more formal critique to the journal (see – Critique of a risk analysis aimed at establishing a safe dose of fluoride for children.) But here I just want to deal with those magical words used in the paper – “statistically significant.”

Hirzy et al (2016) rely completely on data reported by Xiang et al., (2003) and claim they “found a statistically significant negative relationship between . . . .  drinking water fluoride levels and IQ.” Trouble is – you can search through the data presented by Xiang et al., (2003) and there is absolutely nothing to indicate a “statistically significant” relationship. Sure, that paper actually claims “This study found a significant inverse concentration-response relationship between the fluoride level in drinking water and the IQ of children.”  But there is no table or graphic presenting the individual data points and no statistical analysis for drinking water F and IQ. Rather surprising because Xiang et al., (2003) did present the individual data points for urinary fluoride and did present some results for statistical analysis of other relationships.

The trick behind the misleading use of Xiang’s data

However, what Xiang et al (2003) did do was separate their drinking water fluoride and IQ data into different ranges. This is a table of their result.

While group F was data for one village (Xinhuai) and the data in the other groups were for a separate village (Wamiao), there was no explanation of the criteria used for the groups – and the numbers in each group very tremendously. Over half the children (290 of the total 512) were in Group F and the size of the other groups seem to arbitrarily vary between 8 and 111.

This manipulation produces data which can be used to imply a statistically significant relationship. Do the statistical analysis for water F and IQ in the above table and sure you get a lovely straight line, a correlation of 0.96 and very significant statistically (p=0.003). But because of the manipulation, this says exactly nothing about the original data.

I will illustrate this by taking some data which Xiang et al (2003) did provide – for urinary fluoride and IQ. The data are illustrated in the figure below from the paper.

A statistical analysis of that data did show it was statistically significant – Xiang et al. (2003) cite a “Pearson correlation coefficient –0.174 , p = 0.003.” Now, that explains about 3% of the variance in IQ and I would have liked to see a similar analysis for water F as other workers have usually found weaker relationships for water F than for urinary F.

But let’s try using the manipulation of Xiang et al (2o03) and Hirzy et al (2016) to make the relationship between urinary F and IQ look a lot better than it is. I used a software tool to extract data from the figure – it didn’t extract all the points (264 out of a total 290) because of overlaps but statistical analysis of my extracted data gave a Pearson correlation coefficient of 0.16, p=0.010. Very similar to that reported by Xiang et al., (2003).

The tricky manipulations

I have absolutely no idea why Xiang et al., (2003) used different group sizes – so, to be fair, I have divided my extracted data into 6 groups of 44 pairs each (after sorting them into order based on urinary F) to produce the following table.

Urinary F IQ
A 1.79 105.57
B 2.30 89.45
C 2.30 77.72
D 2.69 68.58
E 2.48 56.25
F 2.69 40.10

This produces a lovely graph:

But, just a minute, I can get a better graph if I sort  the data according to IQ instead of urinary F:

But why stop there. If I choose different group sizes – remember Xiang et al., (2003) had groups ranging from 8 to 250 in size – I am sure I can get an even better presentation of the data.

TBut these graphs look far better than the one presented in Xiang et al (2003) for urinary F. We have taken data where the urinary F data explains only about 3% of the variance in IQ and produced graphics implying it “explains” up to about 75% of the variance. And we could “explain” more with a bit of extrra manipulation.

Conclusion

Data manipulation like this doesn’t change the fact that while the relationship between urinary F and IQ is statistically significant it only explains about 3% of the variance in IQ. This means that other factors, or confounders, should be considered – and when they are it is likely the significant relationship of IQ to urinary F would disappear.

Although Xiang et al., (2003) did not provide any statistical analysis to support their claim there was a significant relationship between water F and IQ I am sure the relationship is similar to that for urinary F – maybe even worse. Manipulating the data by using a range of groups of different sizes has certainly made the data look a lot better – but it is completely misleading.

I think it shocking that the authors of the Hirzy et al., (2016) paper have used manipulated data in this way – first to claim that fluoride in drinking water has a major negative effect on IQ and secondly to use such massaged data to work out a “safe dose.”

Worse, the journal Fluoride, and its peer reviewers, should never have accepted this paper without querying the claim of a significant relationship between drinking water F and IQ.

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EPA comprehensively debunks anti-fluoride claims of a fluoride-IQ effect

FAN propaganda video promoting their petition to the EPA to stop community water fluoridation

The US environmental Protection Agency (EPA) has denied an anti-fluoride petition to ban community water fluoridation. The document outlining its reasons for declining the petition is valuable because it considers all the arguments and evidence presented in the petition and comprehensively shows them to be misleading or even false.

This is a humiliating defeat for the petitioners – the US  Fluoride Action Network (FAN), Food & Water Watch, Organic Consumers Association, American Academy of Environmental Medicine, International Academy of Oral Medicine and Toxicology and Moms Against Fluoridation. FAN, and in particular Michael Connett, had put a lot of work into their petition. The petition is a 76-page document, heavily referenced and, importantly, presenting all the best arguments that FAN could find. FAN did not keep any of their powder dry.

Of course, FAN and their associated international groups, Facebook pages and websites heavily promoted this petition. They had high hopes – Paul Connett himself has argued that their evidence would bring about the complete demise of community water fluoridation within a few years. The local Fluoride Free NZ issued a press release with the heading EPA Petition Could Spell End of Fluoridation claiming “FAN’s assessment provides unequivocal proof that current allowable levels of fluoride are not protective for all members of the population from damage to the brain.” Mary Byrne, their spokesperson asserted:

“Fluoridation belongs to a by-gone era and far too much is now known about adverse health effects for any further consideration on fluoridation to be seriously considered.”

Many anti-fluoridation submissions to the Parliament Health Committee considering changes to fluoridation legislation in New Zealand have relied strongly on the FAN petition – presenting it as the best thing since sliced bread.

Serious consideration

The EPA did give the petitioners arguments serious consideration – as we should expect from such an authoritative organisation. The petition was not rejected out of hand – the EPA’s 50-page document eexaminesthem in detail.

This is what makes the EPA document so available – it considers all the FAN arguments, the scientific papers presented and the evidence claimed. It shows how many of these papers and claimed evidence are misrepresented by the petitioners. It points to the limitations of the studies FAN relies on. It shows how FAN has not even established a case for reconsideration of recommended safe levels for fluoride and explains that the methodology used by FAN, and the recent publication by FAN staff (Herzy et al., 2016 – see Debunking a “classic” fluoride-IQ paper by leading anti-fluoride propagandists), is not valid.

The documents overall assessment of the petition’s arguments is damning:

“The petition has not set forth a scientifically defensible basis to conclude that any persons have suffered neurotoxic harm as a result of exposure to fluoride in the U.S. through the purposeful addition of fluoridation chemicals to drinking water or otherwise from fluoride exposure in the U.S. Still less has the petition set forth a scientifically defensible basis to estimate an aggregate loss of IQ points in the U.S, attributable to this use of fluoridation chemicals. As noted previously, EPA has determined the petition did not establish that fluoridation chemicals present an unreasonable risk of injury to health or the environment, arising from these chemical substances’ use to fluoridate drinking water “

Some specific rejections

The petition argued about 12 points and the EPA responded to all of them. Here are a few extracts.

The central claim of the anti-fluoride petitioners is that  Fluoride is neurotoxic at levels relevant to U.S. population. It cited human studies to support this but the EPA document responded by pointing out “the petition ignores a number of basic data quality issues associated with the human studies it relies upon.”

A central problem is the lack of  consideration of other factors possibly involved in influencing IQ – confounders:

“The petition . . .  does not properly account for the relatively poor quality of the exposure and effects data in the cited human studies (e.g., it appears to give all studies equivalent weight, regardless of their quality). When an association is suggested between an exposure and a disease outcome, the studies need to be assessed to determine whether the effect is truly because of exposure or if alternate explanations are possible. The way to do that is to adjust for potential confounders, such as diet, behavior, and socioeconomic status, in order to appropriately assess the real relationship between the exposures to a specific substance and health effects. In other words, when these confounding factors are potentially present, but not recognized or controlled for, it is not possible to attribute effects to the contaminant of concern (fluoride) as opposed to other factors or exposures. The evidence presented did not enable EPA to determine whether various confounding factors (e.g., nutritional deficiencies) were indeed placing particular subpopulations at a “heightened risk of fluoride .”

The issue of confounders is central to the petitioners claim that recent epidemiological studies corroborate neurotoxic risk in Western populations. The petition cites two studies from Western populations to attempt to corroborate the assertion that exposure to fluoridated water presents unreasonable risks for neurotoxicity. I have discussed these in previous posts – Peckham et al (2015) which claim to show that hypothyroidism is related to fluoridation and Malin & Till (2015) which demonstrated a relationship of ADHD prevalence to extent of fluoridation.

The EPA response says of the Peckham et al (2015) paper that:

“Adjustment for some confounders was considered, including sex and age, but other potential confounders (such as iodine intake) were not assessed. Fluoride from other sources and other factors associated with hypothyroidism were not assessed in this study.”

Iodine deficiency is a well-known factor in hypothyroidism.

The EPA response was relatively kind in its comment on the Malin & Till study:

“Although it is possible that there may be biological plausibility for the hypothesis that water fluoridation may be associated with ADHD, this single epidemiological study is not sufficient to “corroborate” neurotoxic health effects, as stated in the petition. More study would be needed to develop a body of information adequate.”

I showed in my article ADHD linked to elevation not fluoridation that once factors like elevation, poverty, and house ownership were included there was no statically significant relationship between ADHD prevalence and the extent of fluoridation in Malin & Till’s data. That is a clear example how conclusions based on correlations can be completely wrong when confounders are not properly considered.

The petitioners fell back onto their claim that neurotoxic risks of fluoride are supported by animal and cell studies – a common anti-fluoride tactic. However, the EPA document responded by pointing out that the petitioners had misrepresented such studies. It pointed out that these studies had been recently reviewed by the US National Toxicity Program (NTP) and the petitioner’s misrepresentation of the studies:

“do not change EPA’s agreement with the conclusions of the NTP report that their “[r]esults show low-to-moderate level-of-evidence in developmental and adult exposure studies for a pattern of findings suggestive of an effect on learning and memory.”

The petitioners claim susceptible subpopulations at heightened risk from CWF is a common claim of anti-fluoride propagandists. The EPA found this argument unconvincing:

“The data and information provided in the petition do not support the claims that “nutritional status, age, genetics and disease are known to influence an individual’s susceptibility to chronic fluoride toxicity.”

The petition argued there were no established benefits of CWF to public health. The EPA responded by outlining some of the evidence for CWF benefiting oral health and responded to the petitioners claims with:

EPA does not believe that the petition has presented a well-founded basis to doubt the health benefits of fluoridating drinking water.

Despite not showing that community water fluoridation is linked to IQ losses the petitioners asked that because fluoridation covers a large population any harm would affect a large number of people so drinkign water fluoridation should be stopped on those grounds alone. Incidentally, Hirzy et al (2016) promised a future paper where they estimate economic losses to the USA because of fluoridation. I guess they will just ignore the Swedish work that actually shows drinking water fluoride levels are positively related to increased income and chances of employment (see Large Swedish study finds no effect of fluoride on IQ).

The EPA response to this argument:

As noted previously, EPA has determined the petition did not establish that fluoridation chemicals present an unreasonable risk of injury to health or the environment, arising from these chemical substances’ use to fluoridate drinking water. The fact that a purported risk relates to a large population is not a basis to relax otherwise applicable scientific standards in evaluating the evidence of that purported risk.

I like that bit about “relaxing scientific standards.” Doesn’t it just describe the whole approach of the anti-fluoride propagandists to the science?

What now?

According to the rejection letter the Petitioners, the Fluoride Action Network and their ideological mates can appeal the declining of their petition:

“by commencing a civil action in a U.S. district court to compel initiation of the requested rulemaking proceeding within 60 days of the date of this denial letter.”

The letter was dated February 17 – so they have until mid-April to get this underway. Michael Connett – who did the heavy lifting in the preparation of this 76-page petition – is an attorney so may be more capable with such legal action than he appears to be with the scientific arguments.

fluoride-theology

At the moment anti-fluoride propagandists appear more concerned with the theological questions related to leprechauns than they are with the EPA’s rejection of their petition.

At the moment the anti-fluoride groups, including those in New Zealand, are silent. It’s as if they did not receive their rejection letter almost 10 days ago. Perhaps they are busy debating their possibilities – and the public stance on this rejection they will eventually have to take.

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Anti-fluoridationists go to Supreme Court – who is paying for this?

trekearth05-patea-egmont-st

Main street, Patea. Photo credit: TrekEarth

The costly battle to prevent fluoridating the water supply of two small Taranaki towns has gone on for four years – and it looks like continuing.

Last October the South Taranaki District Council won a costly four-year court battle for the right to fluoridate the water supplies of Patea and Waverley. New Health NZ, which took High Court action to prevent fluoridation,  appealed several times against the decisions that went against them. Now the Supreme Court of New Zealand has granted New Health NZ the right to appeal those decisions (see Supreme court grant right for another appeal for New Zealand’s fluoride “test case”).

Hopefully, a Supreme Court rejection of their appeals will put an end to the matter. But it has been an expensive process. South Taranaki District Council’s corporate services group manager Phillippa Wilson said: “The costs to date are in excess of $320,000.”

Follow the money

If there is any justice the courts this time will award costs to the Council. But how is it that an anti-fluoridation group can afford to take such costly legal action – and continue taking it despite many defeats?

The answer is big business backing. New Health NZ is not supported by donations from anti-fluoride activists. It is financed by big business – specifically the “natural”/alternative health industry through their lobby group, the NZ Health Trust. This lobby groups set up New Health NZ as an incorporated society whose functions seems to be almost exclusively the campaign against fluoride.

It is quite easy to see the money flows (although specific details are not available) because the annual statement of income and expenditure for the NZ Health trust and New Health NZ are available on-line.

Between 2013 and 2016 the NZ Health Trust received grants ranging from $190,000 – $320,000. Always round figures indicating lump sum grants. It has listed “consultancy and legal expenses” ranging between $74,000 and $208,400. I assume these have been for their other ongoing campaigns on Natural and Traditional Health Products legislation.

But the interesting figure is the “Grants and Donations” made by the NZ Health trust. This was zero in 2013 but has ranged from $110,000 – $130,000 between 2014 and 2016.

Those figures fit in with the declared “Grants received” by New Health NZ: zero in 2013, $100,00 in 2014 and $95,000 in 2015.  Again – round figures indicating lump sum payments instead of donations. Most of this was paid out as “Professional and Consultancy Fees” by New Health NZ.

This fits in with the sort of legal expenses involved in taking these High Court actions. The graph below illustrates the movement of funding from the “natural”/alternative health industry, through the NZ Health Trust – New Health NZ to legal funding. No transfers occurred in 2013 and we do not yet have the New Health NZ financial report for 2016.

follow-the-money

The “natural”/alternative health industry in New Zealand was estimated to be worth $1.4 billion dollars in 2015 (see Inside story: Alternative medicines, quackery or not?). It is also growing fast – 40% in the five years up to 2015. As a big business, with a strong ideological flavour, it can afford and is motivated to take the sort of legal action we have seen in South Taranaki.

But the influence of the “natural”/alternative health industry does not stop at funding legal actions. According to the 2015 article, there are also a bewildering:

“multitude of alternative health practitioners such as homeopaths, naturopaths, osteopaths, chiropractors, acupuncturists, iridologists, reflexologists, aromatherapists, massage therapists and goodness knows who else.”

“ACC payments to osteopaths, chiropractors and acupuncturists alone have more than doubled in the past decade and are now around $40 million a year.”

Have a look at the huge number of submissions on fluoridation made to local councils over the years – or even the submissions to the Parliamentary Health Committee considering current legislative changes to fluoridation. You will see large numbers of “alternative health professionals.” They have the ideological motivation – and, as self-employed “practitioners,” they seem to have the time for such activism.

Then look at the propaganda disseminated by these activists – much of it comes from publications and websites of the “alternative” health industry. Or look at the main US anti-fluoride activist group – the Fluoride Action Network (FAN). It receives the bulk of its funding from Mercola.com – a well established alternative health company.

An unholy alliance?

Most New Zealanders have had a gutsful of the never-ending fluoridation issue. Local councils certainly have. After the consultation fiasco in Hamilton one councilor’s recommendation to other councils was:

“If you can stay out of the fluoridation debate, stay out of it, it’s an absolute nightmare.”

This “debate” has only gone on as long as it has because of an alliance between big business – the “natural”/alternative health industry – with big pockets, and ideologically motivated activists on the ground able to swamp decision makers with meaningless submissions.

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Debunking a “classic” fluoride-IQ paper by leading anti-fluoride propagandists

epa-meeting-sept5-2014

Three of the paper’s authors – Quanyong Xiang (1st Left), Paul Connett (2nd Left) and Bill Hirzy (far right) – preparing to bother the EPA.

Anti-fluoride groups and “natural”/alternative health groups and websites are currently promoting a new paper by several leading anti-fluoride propagandists. For two reasons:

  1. It’s about fluoride and IQ. The anti-fluoride movement recently decided to give priority to this issue in an attempt to get recognition of possible cognitive deficits, rather than dental fluorosis,  as the main negative health effect of community water fluoridation. They want to use the shonky sort of risk analysis presented in this paper to argue that harmful effects occur at much lower concentrations than currently accepted scientifically. Anti-fluoride guru, Paul Connett, has confidently predicted that this tactic will cause the end of community water fluoridation very soon!
  2. The authors are anti-fluoride luminaries – often described (by anti-fluoride activists) as world experts on community water fluoridation and world-class scientists. However, the scientific publication record for most of them is sparse and this often self-declared expertise is not actually recognised in the scientific community.

This is the paper – it is available to download as a pdf:

Hirzy, J. W., Connett, P., Xiang, Q., Spittle, B. J., & Kennedy, D. C. (2016). Developmental neurotoxicity of fluoride: a quantitative risk analysis towards establishing a safe daily dose of fluoride for children. Fluoride, 49(December), 379–400.

bruce-spittle

Co-author Bruce Spittle – Chief Editor of Fluoride – the journal of the International Society for Fluoride Research

I have been expecting publication of this paper for some time – Paul Connett indicated he was writing this paper during our debate in 2013/2014. FAN newsletters have from time to time lamented at the difficulty he and Bill Hirzy were having getting a journal to accept the paper. Connett felt reviewers’ feedback from these journals was biased. In the end, he has lumped for publication in Fluoride – which has a poor reputation because of its anti-fluoride bias and poor peer review. But, at last Connett and Hirzy have got their paper published and we can do our own evaluation of it.

The authors are:

david-c-kennedy

Co-author David C. Kennedy – past president of the International Academy of Oral Medicine and Toxicology – an alternative dentist’s group.

Bill Hirzy, Paul Connett and Bruce Spittle are involved with the Fluoride Action Network (FAN), a political activist group which receives financial backing from the “natural”/alternative health industry. Bruce Spittle is also the  Chief Editor of Fluoride – the journal of the International Society for Fluoride Research Inc. (ISFR). David Kennedy is a Past President of the International Academy of Oral Medicine and Toxicology which is opposed to community water fluoridation.

Quanyong Xiang is a Chinese researcher who has published a number of papers on endemic fluorosis in China. He participated in the 2014 FAN conference where he spoke on endemic fluorosis in China.

xiang-Endemic fluorosis

Much of the anti-fluoridation propaganda used by activists relies on studies done in areas of endemic fluorosis. Slide from a presentation by Q. Xiang to an anti-fluoride meeting organised by Paul Connett’s Fluoride Action Network in 2014.

Critique of the paper

I have submitted a critique of this paper to the journal involved. Publication obviously takes some time (and, of course, it may be rejected).

However, if you want to read a draft of my submitted critique you can download a copy from Researchgate – Critique of a risk analysis aimed at establishing a safe dose of fluoride for children.  I am always interested in feedback – even (or especially) negative feedback – and you can give that in the comments section here or at Researchgate.

(Please note – uploading a document to Researchgate does not mean publication. It is simply an online place where documents can be stored. I try to keep copies of my documents there – unpublished as well as published. It is very convenient).

In my critique I deal with the following issues:

The authors have not established that fluoride is a cause of the cognitive deficits reported. What is the point in doing this sort of risk analysis if you don’t actually show that drinking water F is the major cause of cognitive deficits? Such an analysis is meaningless – even dangerous, as it diverts attention away from the real causes we should be concerned about.

All the reports of cognitive deficits cited by the authors are from areas of endemic fluorosis where drinking water fluoride concentrations are higher than where community water fluoridation is used. There are a whole range of health problems associated with dental and skeletal fluorosis of the severity found in areas of endemic fluorosis. These authors are simply extrapolating data from endemic areas without any justification.

The only report of negative health effects they cite from an area of community water fluoridation relates to attention deficit hyperactivity disorder (ADHD) and that paper does not consider important confounders. When these are considered the paper’s conclusions are found to be wrong – see ADHD linked to elevation not fluoridation, and ADHD link to fluoridation claim undermined again.

The data used by the Hirzy et al. (2016) are very poor. Although they claim that a single study from an area of endemic fluorosis shows a statistically significant correlation between IQ and drinking water fluoride that is not supported by any statistical analysis.

The statistically significant correlation of IQ with urinary fluoride they cite from that study explains only a very small fraction of the variability in IQ values (about 3%) suggesting that fluoride is not the major, or maybe not even a significant, factor for IQ. It is very likely that the correlation between IQ and water F would be any better.

Confounders like iodine, arsenic, lead, child age, parental income and parental education have not been properly considered – despite the claims made by Hirzy et al. (2016)

The authors base their analysis on manipulated data which disguises the poor relations of IQ to water fluoride. I have discussed this further in Connett fiddles the data on fluorideConnett & Hirzy do a shonky risk assessment for fluoride, and Connett misrepresents the fluoride and IQ data yet again.

Hirzy et al. (2016) devote a large part of their paper to critiquing Broadbent et al (2014) which showed no evidence of fluoride causing a decrease in IQ  using data from the Dunedin Multidisciplinary Health and Development Study. They obviously see it as a key obstacle to their analysis. Hirzy et al (2016) argue that dietary fluoride intake differences between the fluoridated and unfluoridated areas were too small to show an IQ effect. However, Hirzy et al (2016) rely on a motivated and speculative estimate of dietary intakes for their argument. And they ignore the fact the differences were large enough to show a beneficial effect of fluoride on oral health.

Conclusion

I conclude the authors did not provide sufficient evidence to warrant their calculation of a “safe dose.” They relied on manipulated data which disguised the poor relationship between drinking water fluoride and IQ. Their arguments for their “safe dose,” and against a major study showing no effect of community water fluoridation on IQ, are highly speculative and motivated.

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Non-fluoridated Christchurch does not have better teeth than fluoridated Auckland

wrong

It seems every time anti-fluoride propagandists present data it is either cherry-picked, distorted or misleading. Often all three. So it is hardly a surprise to find local anti-fluoride propagandists are telling porkies again.

They have been promoting the above graphic claiming it shows people in “non-fluoridated Christchurch have “better teeth.” But the graphic is based on naive cherry-picking of the data, it ignores the effect different ethnic groups have on the data and it uses a single cherry-picked year which fits their bias.

On top of that, axis values have been chosen to exaggerate differences and the labels are incorrect. The “non-fluoridated Christchurch” category uses data for Canterbury and the “fluoridated Hamilton” category uses data of the Waikato.

It seems that several of the commenters on the Fluoride Free NZ Facebook page where this graphic was first used saw the problems and raised them. All they got is insults for their time. These organisations do not seem capable of a rational discussion.

The Ministry of Health data they use is freely available on the MoH website. It provides oral health data for 5-year-old children and year 8 children. The data is presented annually and for different regions.

So let’s have a look at what the data really says – using more normal axis ranges and separating out ethnic groups.

chch-real

The top graph here is still misleading because it does not take into account the effect of different ethnic groups. However, the correct categories are used and the more rational axis really cuts the exaggerated difference down to size.

In the second graphic the data for Māori and Pacifica have been removed – the MoH describes this group as “Other” – it is mainly Pakeha. We can see that the caries-free % is actually greater for fluoridated Auckland than it is for non-fluoridated Canterbury – exactly the opposite of what the anti-fluoride propagandists were claiming.

It is the same story for Māori – the caries-free % is actually higher in fluoridated Auckland than in non-fluoridated Canterbury.

The problem with the “Total” data is that Pacifica have a large effect – particularly in Auckland where Pacifica are concentrated. Pacifica generally have poorer oral health but are concentrated in fluoridated regions. This drives down the caries-free % figures for the fluoridated areas if the differences are not accommodated.

I referred to this effect of Pacifica on the data in my article A challenge to anti-fluoridationers to justify their misrepresentation of New Zealand research. There I was referring to a similar way anti-fluoride campaigners were misrepresenting data from recent New Zealand research. In this case, they were using data from a paper (Schluter & Lee 2016) and completely ignoring the distortions introduced by inclusion of Pacific – even though the authors had warned against the anomaly introduced by this.

There are other effects which should also be considered in a proper understanding of these data. It is easy to cherry-pick the data for a single year when differences are small – the anti-fluoride people do that a lot. OK if you want to confirm your biases but consideration of the data over multiple years helps indicate trends, identify anomalies and provide an idea of variations in the data. It is also important to consider the numbers in each region. For example, I have not included Pacific in the graphs above because they are concentrated in Auckland and the numbers in Canterbury and Waikato are very low (eg., 45 in Waikato in 2014).

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