Category Archives: Health and Medicine

Preempting the annual misrepresentation of NZ dental health data by anti-fluoride activists

Dental therapist Heather Dalton examines an Avondale College student in Auckland in 2010. Image credit: Te Ara: The Encyclopedia of NZ.

The latest NZ school dental service data again confirms that community water fluoridation is effective.  The data show benefits of up to about 30% improvement in oral health. But, anti-fluoride activists will, once again,  reject this evidence and instead cherry-pick the data to support their claims.

The NZ Ministry of Health (MoH) has posted the latest summary of child dental health collected by the dental health service. So it is time for local anti-fluoride activists to indulge in their annual activity of cherry-picking and misrepresentation to claim the data “proves” community water fluoridation (CWF) is ineffective (see my comment on last year’s misrepresentation – Anti-fluoridationists misrepresent New Zealand dental data – an annual event).

I haven’t seen this year’s expected press release from Fluoride Free NZ. I may have missed it or perhaps they haven’t got their A into G yet (although there is a bit of notice on their Facebook page). Nevertheless, I will post here my annual analysis of the data.

My comments are much the same as last year – the data has not really changed. But first an explanation of how the data should be used

Nature of the MoH dental health data

The published spreadsheets are simply records of dental health (% caries free and mean Decayed, Missing and Filled Teeth (DMFT and dmft) for 5-year-olds and year 8  children. There has been no selection of children to give representative data. Distortion due to ethnic and socioeconomic factors has not been taken into account.

Data are presented for all children – (Total), Maori, Pacific Island and “Other.” I have previously explained that the Total data is distorted by ethnic factors – different ethnic groups have differences in oral health, irrespective of fluoridation. In particular, the predominance of Pacific Island children in fluoridated areas distort the “Total” data – 85% live in fluoridated areas. Pacific Island children comprise about 15.1% of children in fluoridated areas but only about 3.2% of children in non-fluoridated areas.

Because Pacific Island children generally have poorer health they increase the value of dmft/DMFT and lower the value of caries-free % in the fluoridated areas in the Total figures. Therefore the “Other” figures are more reliable than the “Total” figures for interpretation.

The 2017 data

You can download the two spreadsheets, and the spreadsheets for earlier years, from the MoH website – Age 5 and Year 8 oral health data from the Community Oral Health Service). I will just give the overall New Zealand data for Māori and “Other” (this is all except Māori and Pacific Island).

As explained above the “Total” data is misleading because of ethnic effects and the data for Pacific Island is poor because only a small number resided in non-fluoridated areas.

5-Year Old Children

Clearly, the overall data suggest a benefit of fluoridation to Maōri and “other” children – about 14% for “Other” and 25% for Māori children (using the data for mean dmft).

Year 8 Children


Again the data suggests that fluoridation has been beneficial to Māori and “Other” children. The DMFT data suggest a benefit of about 30.5% for Māori and 26% for “Other” children.  Even the %Caries free data indicates benefits of about 16% and 11% for Māori and “Other” children respectively.

Changes over time

It’s worth considering more than one year. This overcomes, to some extent, variations in the data. It may also be helpful in assessing if the effectiveness of CWF is changing.

However, there is a proviso. Let’s not forget this is simply raw data from the school dental service. While I have corrected for ethnic differences I have no way of correcting for other differences. Socioeconomic effects may change over time. Another important factor is that, at least in some regions, dental health authorities are targeting children form non-fluoridated areas with extra treatments like fluoride tooth varnishes. Ideally, a controlled experiment would take all these factors into account.

I will just take one example – the DMFT data for year 8 children.

The table shows the mean values of %Caries free and DMFT of year 8 children over the periods 2005-2017 and 2013-2017.

Year 8 Children Māori “Other”

%Caries Free

Mean 2005-2017 24.2 13.4
Mean 2013-2017 15.6 8.8

MDFT

Mean 2005-2017 31.3 24.7
Mean 2013-2017 30.1 22.2

This data shows that the oral health of both Māori and “Other” children have improved over time irrespective fluoridation. But there is still a difference between fluoidated and unfluodiated areas indicating fluoridation is having a benefit over and above other factors contributiong to oral health improvement.

The differences due to fluoridation seem to be diminishing. However, my comments above are relevant here. This could be due to extra fluoride treatments targeting children from non-fluoridated areas.

It’s obviously a factor for health authorities to consider but limitations in this data should be kept in mind and other sources of information also considered.

Conclusions

Once again the MoH school dental service data show benefits from CWF. But don’t expect anti-fluoride activists to accept this. I expect they will indulge in their usual cherry-picking of the data to confirm their biases.

Fluoridation: Another study shows stopping fluoridation bad for child tooth decay

Stopping community water fluoridation in Alaska’s capital city, Juneau, caused an increase in child tooth decay

In the last week, Windsor in Ontario, Canada, voted to reinstate community water fluoridation (CWF) 5 years after it was stopped because of opposition. This time the City Council was swayed by the Windsor-Essex County Health Unit’s Oral Health 2018 Report which found the percentage of children with tooth decay or requiring urgent care increased by 51 per cent since fluoridation had stopped.

Now a new study reports similar increases in child tooth decay after stopping CWF in the Alaskan capital, Juneau. This paper reports the study results for Juneau:

Meyer, J., Maragaritis, V., & Mendelshon, A. (2018). Consequences of community water fluoridation cessation for Medicaid-eligible children and adolescents in Juneau, Alaska. BMC Oral Health, 18:215

Juneau – an ideal community for the study

Juneau maintains all the modern conveniences and standards expected of a capital city but has little in-and-out migration or travel from neighboring countries as it is accessible only by plane or sea. This reduces confounding effects due to population changes, only about 0.006% per year during the study period.

Use of fluoridated toothpaste is widespread and CWF was available to 96% of residents before it was stopped in January 2007.

The researchers compared child oral health data in 2003 (when children were exposed to optimum levels of fluoride: 0.7 – 1.2 mg/L) with that in 2012, 6 years after CWF ceased. During those six years, exposure to fluoride was suboptimum: <0.065 mg/L.

The data used for the study was from Medicaid dental claims records. This means the study population was made up of residents living at near poverty conditions. This limited confounding effects from higher-income groups.

Cessation of CWF resulted in increased child tooth decay

The findings were clear and statistically significant. The number of caries-related dental procedures increased after cessation of CWF.

For all children and adolescents (ages 0 – 18 years) the number of procedures increased by 16%. But binary logistic results indicated “the odds of a child or adolescent undergoing a dental caries procedure in 2003 was 25.2% less than that of a child or adolescent in the suboptimal CWF group.”

The effects of CWF were even greater for children aged 0 – 6 years who had never experienced the advantages of exposure optimum fluoride levels. The number of caries-related dental procedures in this group increased by 63%. However,  binary logistic results indicated “the odds of undergoing dental caries procedures under optimal CWF conditions was 51% less than that for a child of the same age in 2012 under suboptimal conditions.”

CWF cessation increased dental treatment costs

The researchers obtained dental costs from the Medicaid dental claims records so were able to make estimates of the effects of CWF on the financial costs to the community. After adjusting for inflation this data showed that the increased annual cost per person of ages 0 – 18 years due toi cessation of CWF increased by $162, a 47% increase. The corresponding increase for children 0 – 6 years was %303, a 111% increase.

Conclusions

While this study had several advantages over similar studies because of reduced confounding effects due to migration and socioeconomic factors this may also be seen as a limitation when trying o extend to findings to more socially heterogeneous communities. However the authors conclude it does provide stong evidence supporting:

“current evidence that even in modern conditions with widely available fluoride toothpaste, rinses, and professionally applied prophylaxis, CWF is associated with population benefits, including cost effectiveness and caries prevention.”

They also conclude from their results that:

“CWF cessation promoted a marked increase in the number of caries-related procedures and treatment costs for Medicaid-eligible children and adolescents aged 0–18 years. Additionally, the results indicated that children in the younger age group cohorts underwent more dental caries procedures than the older age group cohorts, who had benefited from early childhood exposure to optimal CWF.”

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Protection of teeth by fluoride confirmed – yet again

 

Fluoride protects teeth from the attack of acid and microbes. Figure from Faidt et al., (2018)

The protective role of fluoride in teeth has been confirmed, yet again. A new study nicely demonstrates how incorporation of even a small amount of fluoride into the surface layer of teeth protects them from the acid attack which leads to tooth decay.

Researchers measured the ablation, or loss of surface material from hydroxyapatite before fluoridation and after fluoridation. It showed a clear difference due to inhibition of ablation by fluoride.

The research findings are published in:

Faidt, T., Friedrichs, A., Grandthyll, S., Spengler, C., Jacobs, K., & Müller, F. (2018). Effect of fluoride treatment on the acid-resistance of hydroxyapatite. Langmuir

Measuring ablation

Samples were etched with a sodium acetate buffer at pH 4.5 which simulated the effect of an acid attack on teeth resulting from the formation of acid when sugars are microbiologically decomposed in the mouth. The degree of ablation was measured using atomic force microscopy (AFM). Part of the sample surface was coated with a gold layer to prevent acid attack and give a reference surface.

Fluoridated surfaces, submerged for five minutes in a sodium acetate buffer at ph 6.0 cotnaining 500 mg/L of sodim fluoride, were compared with unfluoridated surfaces.

Results

Interestingly, the AFM height images showed there were two different areas of the hydroxyapatite surface when it came to ablation – a fast etching area and a slow etching area. The authors attributed this to the different orientations of crystallites in the hydroxyapatite sample. The image below is for an unfluoridated sample

Ablation of  fluoridated samples was quite different – no ablation occurred until after 330 seconds – the image below is for a fluoridated sample

The paper summarises the results for the fluoridated and unfluoridated surfaces and the different ablation rates due to crystallite orientation in this figure:

The crystallites that etched slowly (Z2) in the unfluoridated sample did not etch at all in the fluoridated sample. The more rapidly etching crystallites (Z1) did etch in the fluoridated sample but only after a delay.

The authors concluded that some of the fluoride in the surface layer of the fluoridated samples could eventually be removed by soaking in the acid buffer – but only after a delay. This was confirmed by an analysis of the surface concentrations of Ca, P, O and F using X-ray photoelectron spectroscopy (XPS) – see below:

Thickness of the fluoridated surface layer

The authors recall:

“In a former study, we revealed that the thickness of the HAp layer that can be loaded with fluoride is in the range of only a few nanometers (24, 25), even if loaded under optimal conditions (25). “

So – a very thin layer. One that some anti-fluoridation commenters claimed insufficient to give any protection. As the authors say

” the question arose whether such a thin layer would actually be capable of protecting the surface against acid attacks. “

But, their results definitely show that this thin layer does offer protection. I am sure critics will quickly point to the fact that the experimental study showed the removal of some of the fluoride after about 400 seconds. But this removal should be seen in the light of the dynamic system in the oral cavity where the pH of saliva is changing, dropping due to sugar decomposition and then rising again. The presence of fluoride, together with phosphate and calcium in saliva also leads to repair of areas where acid attack has occurred.

Conclusions

This experimental work confirms the protective role of fluoride in saliva for existing teeth – despite the fact that the fluoridated layer may be extremely thin – of the order of a few nanometers. While some of the fluoride in the surface layers is eventually removed the presence of fluoride in saliva helps replenish these layers and repair areas of acid attack.

The authors conclude their results provide:

“evidence that already thin and low concentrated fluoridated layers have a large effect on the acid resistance of HAp [hydroxyapatite]”

They combine these finding with results from a previous study of theirs showing fluoridation reduced adhesion forces of bacteria on hydroxyapatite (HAp) to finally conclude:

“the caries-preventive effect of fluoride is an interplay of at least two mechanisms: a reduction of the solubility and a reduction of the bacterial adhesion force.”

Hence the figure at the top of this article.

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Fluoridation and ADHD: A new round of statistical straw clutching

“To clutch at straws – the act of reaching for a solution no matter how irrational or inconsequential.” Source: Advanced Vocabulary for English Language Learners

Anti-fluoridation activists are promoting a number of new scientific papers they argue support their campaigns. But one has only to critically read these papers to see they are clutching at straws. Their promotion relies on an unsophisticated understanding of statistics and confirmation bias.

I will look at one paper here – that of Bashash et al., (2018) which reports an association between maternal prenatal urinary fluoride and prevalence of child ADHD.

The paper is:

Bashash, M., Marchand, M., Hu, H., Till, C., Martinez-Mier, E. A., Sanchez, B. N., … Téllez-Rojo, M. M. (2018). Prenatal fluoride exposure and attention deficit hyperactivity disorder (ADHD) symptoms in children at 6–12 years of age in Mexico City. Environment International, 121(August), 658–666.

I discussed an earlier paper  by these authors – Bashash et al., (2016) which reported an association between maternal neonatal IQ fluoride and child IQ – (also heavily promoted by anti-fluoride activists) in a number of articles:

Promotion of the new paper by anti-fluoride activists suffers from the same problems I pointed out for their promotion of the earlier paper. In particular it ignores the fact that the reported relationships (between maternal neonatal urinary fluoride and cognitive measure for children in Bashash et al., 2016, and prevalence of child  attention deficit hyperactivity disorder – ADHD – in Bashash et al., 2018) were very weak and explain only a very small amount of the variation. This raises the possibility that the reported weak relationships would disappear if significant risk-modifying factors were included in the statistical analyses.

Bashash, et al., (2018)

Whereas the earlier paper considered measures of cognitive deficits in the children the current paper considers various measurements related to ADHD prevalence among the children. These include parent rating scales (CRS-R). Three were ADHD-related scales from the Diagnostic and Statistical Manual of Mental Disorders (DSM) (Inattention Index, Hyperactivity-Impulsive Index and Total Index [inattentive and hyperactivity-impulse behaviours combined]). They also include several other indexes related to ADHD.

A number of computer-assisted indexes (CPT-II) were also determined.

Most indices were not significantly associated with maternal prenatal urinary fluoride. However, the authors reported statistically significant (p<0.05) relationships for indices of Cognitive Problems + Inattention, ADHD Index, DSM Inattention and DSM ADHD Total.

The data and the relationships were provided in graphical form – see figure below – taken from their Figure 2:

There is obviously a wide scatter of data points indicating that the observed relationships, although statistically significant, explain only a small part of the variation in the indices.

So, just how good are the relationships reported by Bashash et al., (2018) in explaining the variation in these ADHD-related indices? I checked this out by digitally extracting the data from the figures and using linear regression analysis.

Index

% Variance explained

Cognitive problems + Inattention 2.9%
ADHD Index 3.1%
DSM Inattention 3.6%
DSM ADHD Total 3.2%

In fact, these relationships are extremely weak – explaining only a few per cent of the observed variation in the ADHD related indices. This repeats the situation for the cognition-related indices reported on the Bashash et al., (2016) paper (see Maternal urinary fluoride/IQ study – an update).

The fact these relationships were so weak has two consequences:

  1. Drawing any conclusions that maternal neonatal fluoride intake influences child ADHD prevalence is not justified. There are obviously much more important factors involved that have not been considered in the statistical analysis.
  2. Inclusion of relevant risk-modifying factors in the statistical analysis will possibly remove any statistical significance of the relationship with maternal urinary fluoride.

Credible risk-modifying factors not considered

Bashash et al., (2108) do list a number of possible confounding factors they considered. These did not markedly influence their results. however, other important factors were not included.

Nutrition is an important factor. Malin et al., (2108) reported a signficant effect of nutrition on cognitive indices for a subsample of the mother-child pairs in this study (see A more convincing take on prenatal maternal dietary effects on child IQ).

Their statistical analyses show that nutrition could explain over 11% of the variation in child cognitive indices indicating that nutrition should have been included as a possible risk-modifying factor in the statistical analyses of Bashash et al., (2016) and Bashash et al., (2018). I can appreciate that nutrition data was not available for all the mother-child pairs considered in the Bashash et al., papers. However, I look forward to a new statistical analysis of the subset used by Malin et al., (2108) which includes prenatal maternal urinary fluoride as a risk-modifying factor and tests for relationships with child ADHD prevalence.

Could the reported weak relationship disappear?

Possibly. After all, it is very weak.

The problem is that urinary fluoride data could simply be a proxy for a more important risk-modifying factor. That is, urinary fluoride could be related to other risk modifying factors (eg. nutrition) so that the relationship with urinary fluoride could disappear when these other factors are included.

I illustrated this for a earlier reported relationship of child ADHD prevalence with extent of fluoridation in US states (see Perrott 2017 – Fluoridation and attention deficit hyperactivity disorder – a critique of Malin and Till (2015)). In  that case the relationship was much better than those reported by Bashash et al., (2016) and Bashash et al., (2018) – explaining 24%, 22% and 31% of the variance in ADHD prevalence for the years 2003, 2007 and 2011 respectively. The relationships are illustrated in their figure:

Relationships between water fluoridation (%) and child ADHD prevalence for 20013 (red triangles), 2007 (blue diamonds) and 2011 (purple circles). Malin & Till (2105)

Yet, when other risk-modifying factors (particularly mean state elevation) not considered by Malin & Till (2015) were included in the regression analyses there was no statistically significant influence from fluoridation prevalence. In this case fluoridation prevalence was related to altitude and was simply acting as a proxy for altitude in the Malin & Till (2015) regression.

Conclusion

As the authors admit, this study:

“was not initially designed to study fluoride exposure and so we are missing some aspects of fluoride exposure assessments (e.g., detailed assessments of diet, water, etc.).”

However, they do say these “are now underway” so I look forward with interest to the publication of a more complete statistical analysis in the future.

There are other problems with the data (for example the paucity and nature of the urinary fluoride measurements) and these are the sort of issues inevitably confronting researchers wishing to explore existing data rather than design experimental protocols at the beginning.

Readers should therefore always be hesitant in their interpretations of the results and the credibility or faith that they put on the conclusions of such studies. The attitude should be: “that is interesting – now let’s design an experiment to test these hypothetical conclusions.”

The problem is confirmation bias – the willingness to give more credibility to the findings than is warranted. Scientists are only human and easily succumb to such biases in interpreting their own work. But this is even more true of political activists.

The reported relationships are weak. Important risk-modifying factors were probably not included in the statistical analyses. The observed relationships may simply mean that urinary fluoride is acting as a proxy for a more important risk-modifying factor (like nutrition) and the weak relationship may disappear when these are considered.

So scientific assessment of this study will be extremely hesitant – interpreting it, at best, as indicating need for more work and better designed research protocols.

But, of course, political activists will lap it up. It confirms their biases. Political activist organisations like the Fluoride Action Network are heavily promoting this paper – as they did with the earlier Bashash et al., (2016) paper.

But they are simply clutching at straws – as they often are when using science (or more correctly  misrepresenting and distorting the science) to support their political demands.

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A more convincing take on prenatal maternal dietary effects on child IQ

Image credit: Nutrition and Pregnancy: Choline For Baby’s Development

Prenatal maternal nutrition is more likely to influence child cognitive abilities than fluoride. A new paper shows this by considering the effects of good or bad prenatal nutrition for the women in the Basash et al., (2016)  study that anti-fluoride campaigners promote. The new data shows that nutrition is more important than fluoride.

The Bashash et al. (2016) reported a weak relationship between prenatal maternal urinary fluoride and child cognitive outcomes or IQ (see Fluoridation: “debating” the science?). Anti-fluoride campaigners latched on to the paper because it seems to offer critical “evidence” for their claims that community water fluoridation lowers IQ. They argue that IQ, rather than the risk of dental fluorosis, should be the main consideration when considering community water fluoridation.

But a new study shows that prenatal maternal nutrition is a better predictor of neurodevelopmental outcomes for children than is urinary fluoride. This study used data from the same set of Mexican women/child pairs as Bashash et al., (2016).

Here is the citation for the new study:

Malin, A. J., Busgang, S. A., Cantoral, A. J., Svensson, K., Orjuela, M. A., Pantic, I., … Gennings, C. (2018). Quality of Prenatal and Childhood Diet Predicts Neurodevelopmental Outcomes among Children in Mexico City. Nutrients, 10(8), 1093.

Misrepresentation  of the Bashash et al., (2016) study

I have dealt with this in a number of articles. Basically my argument was not with the study itself (although it obviously lacks consideration of important risk-factors in it statistical analysis) but with the way anti-fluoride activists use it to draw unwarranted conclusions.

A key problem they ignore is that the relationships reported by Bashash et al., 2016 can explain only about 3% of the variation in the cognitive measurements. This strongly suggests that the relationship with prenatal urinary fluoride would probably disappear if more important risk-modifying factors were included in the statistical analysis. My article “Predictive accuracy of a model for child IQ based on maternal prenatal urinary fluoride concentration.”  explains this and is available online.

The new Malin et al., (2108) study now provides some risk-modifying factors, specifically diet, which explains the data better than does urinary fluoride.

Readers wishing to refer back to my earlier posts on misrepresentation of the Bashash et al., (2106) study can read:

Diet as a predictor of neurodevelopmental outcomes

The statistical analyses in this new paper are quite complex because the authors considered nutrient mixture and not simply each nutrient in isolation. Their argument for this is that we consume nutrients as mixtures and that interactions between nutrients is always possible.

The study, therefore, looked at the relationship of different neurodevelopmental outcomes in the children with prenatal maternal diet. Initially the authors considered the predictive ability of nutrition by considering “good” or “bad” diets based on U.S. dietary guidelines.

A bad diet during pregnancy may harm your future child’s neurodevelopment. Credit: © ivanmateev / Fotolia

Good maternal prenatal nutrition had a significantly positive effect on all the neurodevelopmental outcomes measured. In contrast, poor nutrition had a significantly negative effect on all the outcomes (see table below). Weighted Quartile Sums (WQS) were used to create indices for the individual diets.

I compared the predictive ability of prenatal maternal nutrition used here with the prenatal maternal urinary F approach used by Bashash et al., (2016) using data digitally extracted from their supplemental figures (S1 and S2 – see below). This was for the verbal development score of the children. Unfortunately, this was the only individual data presented.

Clearly, there is a lot of scatter in the data – to be expected where a number of risk-modifying factors are involved. However, the data showing a positive effect of good maternal prenatal nutrition on the verbal score of the children explains 7.1% of the variation. The data for poor prenatal nutrition explains 11.2% of the variation.

Compare this with the predictive ability of the data present by Bashash et al., (2016) where maternal prenatal urinary fluoride could only explain 3% of the variation of the child cognitive scores (see Maternal urinary fluoride/IQ study – an update).

Malin et al., (2018) were able to show which nutrients contributed most to the positive or negative neurodevelopmental outcomes of the children. They concluded:

“mothers who consumed more nutritious diets during pregnancy tended to have children with more favorable neurodevelopmental outcomes, while mothers who consumed less nutritious diets and/or higher levels of sodium, saturated fat, and/or sugar during pregnancy tended to have children with poorer neurodevelopmental outcomes. This suggests that the consumption of more comprehensively nutritious prenatal diets favorably affects child  neurodevelopment, while the consumption of less comprehensively nutritious prenatal diets may hinder it.”

Individual nutrients affected specific neurodevelopmental factors but they reported that prenatal dietary thiamine, vitamin B6, monounsaturated fats, fibre and calcium had beneficial effects. In contrast, lower monounsaturated fat, lower thiamine, lower fibre and higher saturated fat were associated with lower neurodevelopmental scores for the children.

Conclusions

If anti-fluoride activists are really concerned about child IQ and other aspects of child neurodevelopment then they should be campaigning on the importance of nutrition during pregnancy and stop diverting us by scaremongering about community water fluoridation.

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Fluoridation: “debating” the science?

How the anti-fluoride activist envisages their debate challenge – their hero standing up against the might of the health authorities. Image credit: From the Coliseum to the Cage

New Zealand last week saw another “debate challenge” from anti-fluoride activists. But are their regular challenges serious? And do gladiatorial “debates” before partisan audiences have any value in science anyway?

These people often back away when their bluff is called. Their challenges have more to do with political tactics than any elaboration or clarification of the science. They appeal to the macho and combative attitudes of the intended audience.

One thing for sure, such “debates” do not advance scientific knowledge one iota – nor are they meant to.

The anti-fluoride hero is always victorious in the eyes of the partisan and faithful audience. Image credit: The Real Lives of the Gladiators of Rome – The Unfathomable Sport of Life and Death

Three Wise Men – the anti-fluoride activists Paul Connett, Declan Waugh and Vivyian Howard – visited New Zealand last week. Fluoride Free NZ (FFNZ) advertised these activists as “international experts . . .  “sharing the latest research.” Of course, the implications that these activists actually do any original research on fluoridation or what they were sharing was their own research were completely false.

 

This was just another one of those annual visits from Paul Connett (head of the US Fluoride Action Network) and his mates with the aim of misrepresenting and distorting the science so as to promote the political campaigns of the local anti-fluoridation brigade.

Anti-fluoride campaign puts all its eggs in the IQ basket

New Zealanders are rather tired of this sort of activism but the visit does represent an escalation. This year Three Wise Men, a few years back Two Wise men (Paul Connett and  Bill Hirzy) and before that just one wise man (Paul Connett). Is this a sign of increasing desperation as New Zealand moves ever so slowly to handing over decisions on community water fluoridation to District Health Boards? Or is it a sign of increased funding of the Fluoride Action Network and associated activist groups by the “natural”/alternative health industry? After all, it must cost a bit to send three spokespersons around the globe for just two meetings.

One thing I take from this activity is that the anti-fluoride movement has decided to put all its eggs in one basket – the IQ story. They won’t stop blaming fluoridation for all the ills of the world – from obesity to gender confusion. But they are deliberately making a determined effort to bring their IQ story onto centre stage.

The real experts and all the research indicate the main possible negative health effect which must be considered when planning introduction of fluoridation is mild forms of dental fluorosis. In contrast, anti-fluoride activists in the USA and NZ are attempting to present the main health effect that must be considered is a claimed decline in IQ.

The FFNZ advert shows this is the message the Three Wise Men were promoting in New Zealand. But the “latest research” they were “sharing” was not theirs but that of Basash et al., (2016). Or, rather, they were sharing a misrepresentaion and distortion of that research to fit their scarmongering claims.

I won’t repeat my analysis of the Bashash et al., (2016) paper and its misrepresentation here – readers can refer back to my articles:

A draft of my article critiquing the Bashash et al., (2016) paper, “Predictive accuracy of a model for child IQ based on maternal prenatal urinary fluoride concentration.” is also available online.

The predictable debate challenge

No visit by Paul Connett would be complete without a challenge to debate the science with him. He is frustrated with the fact that his audiences are almost completely faithful anti-fluoride activists. The academics, experts and health authorities did not turn up to his meeting at Otago University so he claims “they don’t feel any obligation whatsoever to debate the science” and ”to simply ignore us is unacceptable” (see Anti-fluoride campaigner invites university debate).

Similarly, he blamed others and claimed his anti-fluoride message was being ignored when only three MPs turned up for his meeting at the NZ Parliament Building last February. That was disingenuous as he had been given plenty of time for a presentation to the Health Committee during the consultations on the Fluoridation Bill last year. And MPs are regularly bombarded with huge amounts of propaganda from anti-fluoride activists. Obviously, MPs feel so inundated with such propaganda that they see no need to attend yet another meeting to hear the same old message.

Connett’s challenges to “debate the science” in front of a partisan audience have more to do with political propaganda and enthusing activists than with science. He knows scientific knowledge does not progress by holding gladiatorial circuses. It progresses by long, careful and detailed research, publication and peer review.

Neither of these Three Wise Men has performed any original research on community water fluoridation but they can still make their input via the peer review process – which include post-publication peer review via critiques of published papers.

To be fair, Connett and other members of the Fluoride Action network have occasionally presented such critiques. Two examples come to mind – the studies of  McLaren et al., (2016) and of Broadbent et al., (2015). These were critiqued in responses published in these same journals by a number of opponents of fluoridation. The original authors responded in the same journals. Arguments and extra data were presented in the responses and the science is better off for those critiques.

But science does not gain one iota from Connett’s attacks on the New Zealander Broadbent and other researchers in the media or in his meetings with the faithful. Such attacks and macho comments, often bordering on ad hominem, only discredit the attacker. They are not the way to discuss science and yet Paul Connett and his supporters challenge genuine scientists to participate in such “debates’ which are nothing more than testostorone-laden slanging matches.

A farcical example of a debate challenge

This time around I got personally involved because I called the bluff of activists making yet another debate challenge. It came out of an online discussion where I was attempting to correct some mistaken claims made by anti-fluoride activists. Here is the challenge:

Screenshot of my invite – just as well a have this as this Facebook page subsequently deleted the invitation and all comments I had made. I am officially a nonperson there.

A game of chicken followed where I attempted to get Fluoride Free NZ (FFNZ) and Paul Connett to formally stand behind the challenge. Chicken because I recognised it was a game. I had a scientific exchange (“debate”) with Paul four years ago – I think it was useful and I believe this is how good faith scientific discussions should take place (see Connett & Perrott, 2014: The Fluoride Debate for the full exchange). But Paul had made clear to me some time ago that he wanted no further contact with me.

Sure enough, FFNZ very quickly retreated from the possibility they had offered of a one on one debate. I emailed FFNZ:

“I think a one on one exchange would be best and as Paul and I have similar expertise he would be the logical discussion partner.”

Their response:

“No we will only agree to two on two.”

Paul confirmed that he would not debate one on one with me. I accepted a two on two “debate” but pointed out it was their responsibility, not mine, to organise the speakers. If they were not prepared to do that I suggested a two on one “debate” (especially as being the only speaker on one side this would give me extra presentation time) but made clear that I would effectively ignore Vyvyan Howard because our expertise did not cross over. (Vivyan agree with me that as he is a pathologist “you are correct that a direct discussion between us would be unbalanced.”)

I also made clear I would not tolerate any attempt to use that format to argue that I was isolated and could not find anyone else in New Zealand to support my arguments (an implication Paul made in our email exchange, and, of course, a claim being parroted by his supporters on social media).

Paul then formally withdrew. A pity as I love Wellington and was looking forward to a visit at someone else’s cost.

So a farce, But wait. there is more. The Facebook page, Rethink Fluoride, deleted their invitation to this “debate.” They then followed by deleting all my comments on their posts. Rather ironic as I had a few days before congratulated them by allowing open comments, and in particular allowing scientific comments – something all other anti-fluoride Facebook pages refused to allow.

Conclusion

Debate challenges by anti-fluoride activists are never genuine. They do not wish to discuss the science – they are simply using the challenges to enthuse their true-believing supporters. It is a form of attack on genuine researchers and health experts.

There is a time and place for good faith scientific exchange – post-publication peer review, for example, can give a genuine avenue for any real critiques to appear and be considered. Testosterone-laden gladiatorial debates before partisan audiences do not.

Anti-fluoride activists are disingenuously using these “debate challenges” to imply that experts and researchers have no confidence in their science and are afraid. It’s simply a macho tactic which often descends into ad hominem attacks.

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Who is weaponising the vaccination debate?

Image credit: How To Win a Vaccination Debate

The  media are promoting a new scientific paper on the vaccination debate. Their interest is undoubtedly driven by the study’s conclusion that “Russian trolls” (and by implication the Russian state) are amplifying this debate to promote discord in the US. The title describes this as “Weaponization of Health Communication.”

I am very cynical. After all, the media loves to dramatise these matters – and scientists are not immune to the temptation of taking advantage of this and the current political environment. The data the authors present is weak and has a far more reasonable explanation than the one they assume.

Yes, I may well be called a “Russian troll” or one of “Putin’s Useful Idiots” (and it wouldn’t be the first time) for expressing these doubts. But I have read the paper and this was helpful as it provides sources enabling me to do my own checking.

The paper is:

Broniatowski, D. A., Jamison, A. M., Qi, S., AlKulaib, L., Chen, T., Benton, A., … Dredze, M. (2018). Weaponized Health Communication: Twitter Bots and Russian Trolls Amplify the Vaccine Debate. American Journal of Public Health.

That’s just the abstract but here is a link to the full text.

The paper summarises its main claim about “Russian trolls” as:

“Russian trolls and sophisticated Twitter bots post content about vaccination at significantly higher rates than does the average user. Content from these sources gives equal attention to pro- and antivaccination arguments. This is consistent with a strategy of promoting discord across a range of controversial topics—a known tactic employed by Russian troll accounts. Such strategies may undermine the public health: normalizing these debates may lead the public to question long-standing scientific consensus regarding vaccine efficacy.”

The sources

The analysis relies on subjective judgment for defining a twitter account as a bot, but it does use two publicly available lists of twitter accounts (and tweets from these accounts) defined as inauthentic or false “Russian trolls.”

These sources are:

  1. “Russian troll accounts identified by NBC news” which allegedly documented “Russian interference in the US political system” (see Twitter deleted 200,000 Russian troll tweets. Read them here), and
  2. “Accounts the US Congress identifies as Russian trolls” (see Twitter’s list of 2,752 Russian trolls).

The evidence supporting their main claim is given in their Figure 1: Bots’ Likelihood of Tweeting About Vaccines Compared With Average Twitter Users: July 14, 2014–September 26, 2017. See below:

Tweets from the “NBC Russian Trolls” contain a higher incidence of vaccination keywords than tweets from the average twitter user. To be clear – this is not evidence of promotion of an anti-vaccine message (“Content from these sources gives equal attention to pro- and antivaccination arguments”). It simply shows these collection of tweets contained a higher than average reference to this polarizing subject.

I suspect a similar analysis of this collection of tweets would also show a higher than average incidence for other polarizing subjects in this collection. It is the nature of the tweet selection not evidence of a specific motive.

In fact this claim of “promoting discord” is so commonly used nowadays that it seems to have lost any meaning. Politicians now attribute this motive to much of the Russian social media – and to Russian mainstream media (eg., RT and Sputnik) news reports.

We should note that the authors did not attempt to justify the highly political allegation. They simply aligned themselves with the political message, but the senior author Broniatoski admits “we cannot say that with 100% certainty, because we’re not inside their head.”

Unfortunately, they did not consider for one moment other possible explanations for their results (that is highly unscientific and reveals a bias). I think this illustrates the power of the controlling or prominent political narrative. Anti-Russian hysteria is widespread in the US at the moment.

But there are more innocent motives for such tweets which a more objective analysis would have considered (see below).

The “guilty” tweets

I have looked through the database listing the tweets identified as from“Russian troll accounts identified by NBC news.” The incidence of reference to vaccination in the tweets from“Accounts the US Congress identifies as Russian trolls” was not much different to that for the “average user” so I did not consider them.

There were 203,451 tweets in this collection and I found about 100 (about 0.05%) included a vaccine keyword (vacc*). The paper gives examples of both pro and anti-vaccine tweets from this collection and mine were similar. These were hardly remarkable – indeed most of them were retweets. For example:

  • RT @HealthRanger: Don’t miss this: #autism-vaccine link explained by doctors!   https://t.co/L9ziemow6o  #antivax #vaccines #adhd
  • RT @ActivistPost: States are rushing to pass vaccine mandates before everyone realizes that they’re completely unnecessary at best, harmful…
  • RT @HealthRanger: Danish #documentary exposes widespread damage caused by HPV vaccine https://t.co/nuQqQ1u0XZ  #health #vaccines #antivax #…
  • RT @HealthRanger: Never inject them. #antivax #vaccines #natural #health https://t.co/oY0XLqRkdH
  • RT @pakalert: The Scary TRUTH About Vaccines (Satanic illuminati Vaccines Agenda Exposed Full Documentary) https://t.co/fxs8zOwVnV
  • RT @WorldTruthTV: Robert De Niro To Produce Film Proving Vaccines Cause Autism | World https://t.co/telXZBWPRi https://t.co/VrApvqn62s
  • RT @CobraCommans: Canadian scientists to test promising HIV vaccine on 600 volunteers @ANCParliament @My_AfricanUnion @AfricaHealthFor
  • RT @GStein269: Perry talking about Drugs and Vaccines? https://t.co/lsxJN2Udcy
  • RT @SanJosePost: #politics California’s vaccine bill passes Assembly, next hurdle: Gov. Jerry Brown
  • RT @varadmehta: Having a vaccine truther chair a commission on vaccine safety is something that merits actual outrage. But media only has o…
  • RT @blicqer: Major HIV Vaccine Trial Set to Begin in South Africa  https://t.co/fPkW3XYV32 @TheRoot https://t.co/I5iRgU42Yn

The #VaccinateUS hashtag

The paper describes the #VaccinateUS hashtag as:

“designed to promote discord using vaccination as a political wedge issue. #VaccinateUS tweets were uniquely identified with Russian troll accounts linked to the Internet Research Agency—a company backed by the Russian government specializing in online influence operations.”

Again, it did not provide any evidence to support this allegation.

The authors claim these tweets “contain a combination of grammatical errors, unnatural word choices, and irregular phrasing.” I did not see this myself – the grammar in these tweets appeared to me to be far better than the average tweets I see. The authors did acknowledge that these “messages contain fewer spelling and punctuation errors than do comparable tweets from the general vaccine stream.”

Tweets with this hashtag are about evenly divided between pro- and anti-vaccination potions (“43% were provaccine, 38% were anti vaccine, and the remaining 19% were neutral”). It occurred rarely in the quarter million tweets.

While they appear to have been specifically written by the account holders or staff at the organisation behind them, rather than simple retweets, they hardly provide evidence for a motive of “sowing discord.”

Here are some examples:

  • what will you fill when you get a disease that you could’ve been protected from? #VaccinateUS
  • if we don’t have regular chek ups and get #vaccines-what’s the point of doctors’ work? #VaccinateUS
  • open your eyes, people! It’s all government conspiracy plan  #VaccinateUS
  • our government cares only about money so it’s profitable for them to say that #vaccination is necessary #VaccinateUS
  • the production of a #vaccine is disgusting #VaccinateUS
  • #VaccinateUS FDA  state that #vaccines are safe
  • #VaccinateUS For sure #vaccines work!
  • God bless big pharma. You fools #VaccinateUS

Amplification of the anti-Russian hysteria

Ironically the charge laid at the supposed “Russian trolls” (that they seek to sow discord by amplifying existing electoral or polarizing debates) is actually typical of much of the reaction in our media to stories like this. In fact these media reports are aimed at sowing discord and promoting Russophobia. And, unfortunately, such anti-Russian amplification, or weaponization to use the language of the paper, comes from people I would have thought should know better.

This example from March for Science – a social media group formed after Trump’s election and aimed at mobilising scientists against anti-science policies of the new administration.

They are reposting an article from the Guardian (which these days leaps onto any anti-Russian argument they find). But in doing so they add their own claim:
” Study finds that 93% of tweets about vaccines between 2014 and 2017 were planted by bots and Russian trolls with the aim of sowing division.”

The 93% is the invention of March for Science as neither the paper or The Guardian provided this figure. And the study did not “find” that Russian trolls were sowing divisions – that was the prevailing assumption they started with. March for Science is simply crudely (very crudely considering their invention of 93%) amplifying the anti-Russian narrative and contributing to weaponization of social media against the Russian Federation.

Bringing this home, the NZ Facebook page Science Community New Zealand reposted the March for Science claim. Here we have social media accounts claiming to be pro-science amplifying an outright lie on social media.

Update: Science Community New Zealand has now removed the offending post – a good sign perhaps.

I am disappointed at such a naively political falsification from organisations which is meant to be promoting science. It does show how persuasive the current anti-Russian hysteria is – but it is especially disappointing to see people who should know better succumbing to it. Or, perhaps, I have been fooled and the real motives of March for Science and Science Community New Zealand have been far more questionable right from the start.

A more realistic motive for these tweets

The motive given by the study’s authors, and usually promoted in the current mainstream media narrative (sowing discord to weaken US society), really does not hold water. That strategy could more legitimately be attributed to ordinary US twitter users who indulge in tweeting on controversial subjects in far larger numbers. Anything  added by these Russian trolls is minuscule. If the Kremlin genuinely has such a strategy it should be judged a pitiful failure.

But what about this shady company Internet Research Agency based in St Petersburg? I have no doubt it exists and that it is planting material in social media like Facebook and Twitter. Presumably it is also setting up non-authentic or fake accounts for this purpose.

However, the paper’s claim that it is “a company backed by the Russian government” is not supported by any evidence at all and is typical of the way our media continually falsely claims that Russian individuals and entities are connected to the Kremlin or “close to Putin” – simply because of their ethnicity.

While the company (and many similar companies indulged in similar activity) have no credible results in “sowing discord” (compared with the ordinary, authenticated users of Twitter and Facebook in the US) they do seem to be doing this for commercial purposes. These appear to be similar to the activity of the Cambridge Analytica company which acquired personal data from social media users which they then marketed to political users.

Using fake or inauthentic accounts to retweet messages, or plant original messages, in a polarizing political or health debates is one way of mining personal data. Authentic users who retweet, “like” or repost such messages reveal a preference or bias which is of interest to companies involved in marketing products and ideas. Even seeding social media with pictures and videos of cats and dogs which attract likes, retweets and reposts can help obtain information of use to commercial and political entities.

Hell, Google, Facebook and Twitter themselves are involved in mining account holder’s personal information and selling it to advertisers.

How else do we end up getting social media messages related to topics we have searched for information on, or have commented  on in social media. On the surface this appears harmless, even useful (although the continual  messages I still get offering travel insurance just because I researched the topic several months ago are rather tiring – and counter-productive as they turn me off the advertiser).

Conclusions

My main objection to this paper is its uncritical and unthinking acceptance of the prevailing political narrative. I think it shocking that a scientific study makes no attempt to question or validate the narrative it relies on.

The data is extremely weak – only someone intoxicated by the political narrative will seriously see the extremely small number of tweets and retweets they found as evidence of a “strategy of sowing discord.”

Finally, the authors make no effort to consider other more reasonable explanations for their data. That is a pity as mining personal data by Google, Facebook, Twitter, Cambridge Analytica, the Internet Research Agency and other commercial companies should concern us all. Targeted advertising is very intrusive and annoying. Targeted political influence is also no doubt occurring and should concern us.

But the old trick of blaming the Russians for these problems is diverting our attention away from the real culprits.

I guess this shows how a bad political climate and destructive prevailing narrative can influence even the most scientific researcher.

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Anti-fluoride campaigners exhaust their legal channels with another loss

NZ Supreme Court Building, Wellington

The NZ Supreme Court has delivered its judgments and local anti-fluoride campaigners (and their big business supporters) seem to have come to the end of the line with their legal actions to prevent community water fluoridation (see Supreme Court rules against Taranaki anti-fluoride campaigners and Supreme Court rules South Taranaki fluoridation allowed).

Specifically, the Supreme Court delivered two judgments rejecting three appeals by NZ Health Inc. These appeals arose from High Court rejection of challenges by New Health NZ to prevent South Taranaki District Council from fluoridating drinking water in Patea and Waverly. While dealing with local situations these legal actions, ongoing since the end of 2012, inhibited other councils throughout New Zealand from making fluoridation decisions for fear of the cost involved in possible legal defences.

In effect, the Supreme Court judgements free up other councils to go ahead with fluoridation decisions, although the impending legislation transferring decision-making to District Health Boards may also cause delays.

The Supreme Court judgements were welcomed by health authorities and many New Zealanders concerned about the time wasting tactics used by anti-fluoride campaigners and their big business supporters.

Nature of the judgments

Court judgements can be complex but the Supreme Court provided a press release to help readers understand this case (see Fluoridation: New Health NZ v South Taranaki DC). This also provides a brief history of the legal actions since 2012.

Several things stand out to me.

The courts cannot rule on the science

The scientific arguments commonly presented by anti-fluoride campaigners are not considered in this judgement – this is as it should be. Courts do not decide the science.

Through this whole procedure lawyers for New Health NZ presented a litany of misrepresentations of the science we have come to expect from anti-fluoride campaigners. Apparently these campaigners are so used to relying on arguments misrepresenting the science they just could not help themselves even though the courts do not arbitrate on scientific matters.

I have always considered this somewhat strange. The strongest arguments that anti-fluoride campaigners can present relate to freedom of choice and the rights of minorities in social decisions. Yet they always seem to lead with misrepresentation and distortion of the science and only fall back to their strongest arguments when these misrepresentations are challenged by actual consideration of the science.

The statutory power of councils

New Health NZ argued that councils do not have the statutory authorisation to add fluoride to drinking water. The Supreme Court majority dismissed this ground for appeal. The dismissal was based on:

“the Council’s general power of competence in s 12 of the Local Government Act and in light of its duty under the Health Act to protect, promote and improve public health in its region. The relevant provisions had to be interpreted against the background that fluoridation had been lawful in New Zealand for decades prior to enactment.”

Claim that fluoridation breaches the NZ Bill of Rights.

On this question the Supreme Court:

“considered that the conferral of a statutory power to fluoridate water to levels prescribed by the drinking water standards was a justified limit on the right protected by s 11 of the Bill of Rights Act”

Or that:

“the Bill of Rights Act meant that local authorities could fluoridate water only where doing so in the particular district would be demonstrably justified in terms of s 5, an assessment which may depend on the local conditions.”

So, although there were subtle differences in the arguments of separate members of the court this claim by New Health NZ was rejected.

Not a unanimous decision

No doubt anti-fluoride activists will make much of the fact that there were differences between members of the Supreme Court on some details. I don’t think such differences are at all surprising or will necessarily give these asctivists the comfort they will attempt to derive from them. One of the judgements (NZSC59.pdf) gives detials of the arguments presented by sperate court members

The issues considered by the Court relate to interpretations of the Health Act and the NZ Bill of Rights. This involves considerations of ethical issues and the practical implementation of democratic procedures. There is no pre-ordained right or wrong answers to such matters and they are normally decided by prevailing procedures, ethical approaches and political matters.

It is possible to argue wither way on such issues. This is why I consider anti-fluoride campaigners make a mistake in their concentration on scientific matters which can easily be decided (and which they misrepresent) . If they put more effort into debating the ethical and political aspects they might have more success in winning people to their arguments and in achieving their political demands.

Who has been financing this legal action?

The Supreme Court press release describes New Health NZ, the anti-fluoride group which fronted the legal action, as a “consumer advocacy group.” This is factually wrong. New Health NZ was formed by the NZ Health trust to front such actions but the NZ Health Trust is, in fact, a lobby group for the “natural”/alternative health industry in New Zealand. It is effectively representing big business and not consumers. (Although, strangely, it has registered itself as a charity – perhaps this should be challenged by someone).

In fact, very few consumer advocacy groups could afford such legal action. The cost of defending against this action was substantial. South Taranaki mayor Ross Dunlop said the legal battle had cost the council at least $300,000-$350,000. The Ministry of Health assisted with funding but one can see how the fear of such legal costs has scared councils from making fluoridation decisions in the six years these issues have been before the High Court and then the Supreme Court. Even in this last case, the Supreme Court ordered New Health NZ to pay the Council only $20,000 towards costs.

The New Zealand Health Trust has funded, through New Health NZ, this legal battle to the tune of about $180,000 per year. I described this in my articles  Who is funding anti-fluoridation High Court action?,  Corporate backers of anti-fluoride movement lose in NZ High Court and Anti-fluoridationists go to Supreme Court – who is paying for this?

The financial returns from the NZ Health Trust and New Health NZ clearly show that money is flowing from the “natural”/alternative health industry (which is big business), via the NZ Health Trust (a lobby group for that industry) into New Health NZ which has then used it to find their anti-fluoridation legal activity to the tune of about $180,000 per year ($340,000 in 2017).

This graph shows the correspondence of grants received by New Health NZ with grants paid by the NZ Health Trust.

The size of the grants received by New Health NZ corresponds to payments for consultancy & professional fees. It is most likely this represents the funding used for the legal campaigns against community water fluoridation.

A clear example of big business funding trying to deny a safe and effective social health programme for New Zealanders

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Anti-fluoridation activists buy scientific credibility using a predatory publisher

A group of well-known anti-fluoride activists have just published some new research. Well, this is what their social media publicity will tell us.

In fact, this is not new research. It is simply the republication of a shonky paper from two years ago as a  chapter in a book produced by a predatory open access publisher.

It is a clear example of anti-fluoride activists attempting to buy scientific credibility. This book chapter cost them GBP £1400!

The “new” paper, or book chapter, anti-fluoride people will be promoting is this:

Hirzy, J. W., Connett, P., Xiang, Q., Spittle, B., & Kennedy, D. (2018). Developmental Neurotoxicity of Fluoride: A Quantitative Risk Analysis Toward Establishing a Safe Dose for Children. In J. E. McDuffie (Ed.), Neurotoxins (pp. 115–131). Rijeka: InTech.

In fact, this is simply a slight rehash of the paper published 2 years ago:

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.

Almost word for word. And the authors acknowledge this at the beginning of the chapter with an introductory statement:

” This work has, in slightly different format, form and content been published in the journal Fluoride, Vol. 49(4 Pt 1):379–400, December 2016.”

I guess that saves me the job of critiquing this new version – my analysis and critique of the original paper was posted as the article  Debunking a “classic” fluoride-IQ paper by leading anti-fluoride propagandists. I also discussed the issues in other articles (see Connett & Hirzy do a shonky risk assessment for fluorideAnti-fluoride authors indulge in data manipulation and statistical porkies, and Anti-fluoridation campaigners often use statistical significance to confirm bias).

I have also submitted for publication a more formal critique of the original Hirzy et al., paper – see Does drinking water fluoride influence IQ? A critique of Hirzy et al. (2016)and  CRITIQUE OF A RISK ANALYSIS AIMED AT ESTABLISHING A SAFE DAILY DOSE OF FLUORIDE FOR CHILDREN.

Perhaps I will just repeat this qualification given by the authors in the first paper (and repeated in the book chapter), as it does call into question the whole campaign against community water fluoridation (CWF). They say:

“However, when comparing a fluoridated area of the USA to an unfluoridated area it would be hard to discern a mean IQ difference, because of the multiple sources of fluoride intake besides drinking water (Table 5). These sources greatly reduce the contrast in total fluoride intake between fluoridated and unfluoridated areas. A very high hurdle is thus created to gaining useful information in the USA, as it was in the New Zealand study [5], via a large, long-range longitudinal epidemiological study of fluoride and IQ.”

They are, in effect, accepting that no study of CWF has shown an IQ effect and argue that such studies will never show an  effect. Because, they argue, there is only a small difference in fluoride dietary intake between children in fluoridated and unfluoridated areas.

The fact that studies show no effect of fluoidation on IQ drives their need to “explain away” these results using dubious estimates of dietary intake. However they are essentially conceding there is no point campaigning against CWF. If they want to stick with their “explaining away” argument then, if anything, they should campaigning against other forms of dietary intake and leave CWF alone.

Scientific credibility

Anti-fluoridationists often argue that they have science on their side – and many of them seem to honestly believe it. Of course, when one is singing to the choir it is easy to delude oneself. The facts are that most claims made by anti-fluoride activists do not stand up to scientific scrutiny and when they cite scientific reports they are usually misrepresenting them.

I just wish these campaigners would sit down and actually read the papers they keep touting – very often they just do not say what is claimed for them.

On the other hand a small number of scientifically dubious papers do make their way into the scientific literature and these get used as “proof” by activists. Usually these are published in poor quality journals (like “Fluoride” where Hirzy et al., originally published their paper) and this is especially true when the authors are known anti-fluoride activists.

So, a combination of misrepresentation of the scientific literature and citation of poor quality papers get churned out again and again by campaigners to give scientific credibility to their arguments.

Shonky publishers

In my article Anti-fluoridation propagandists promoting shonky “review”, I discussed the use of shonky journals by anti-fluoride activists. These are usually open access journals which charge authors for publication and have very poor or non-existent peer review standards. I quoted one commenter as describing these journals as “bottom feeders,” but they, and their publishers, are often simply described as “predatory.”

bottom feeder

Some “peer-reviewed” journals really are “bottom-feeders.”

Predatory because these publishers scam researchers and exploit young or naive scientists, often from third world countries, who are impressed by the ease of publication and apparent distinction. An ease which is lubricated by author payments and little or no proper peer review.

Prospective authors can search lists identifying such predatory publishers and journals. So I did my own search and was not surprised to find that the IntechOpen publishers of the Hirzy et al., (2018) book chapter are on such lists. However, even a search of the IntechOpen website and their information for authors showed the signs typical of such predatory publishers. This is what IntechOpen will give you for your money (GBP – see Open Access Publishing Fees):

  • £1400 gets you a book chapter;
  • £4000 will get you a compact monograph, and
  • £10,000 will give you a long form monograph.

So, it looks like Bill Hirzy, Paul Connett, Quanyong Xiang, Bruce Spittle, and David Kennedy had a whip around (probably digging into the Fluoride Action Network funds) and produced £1400 to buy themselves some apparent “scientific credibility.”

I say apparent because more and more readers of scientific literature are becoming aware of the problem of poor quality journals and predatory open access publishers. Rather than providing scientific credibility, publication in such outlets may in fact leave a bad mark on a scientist’s reputation and credibility.

But I guess the politically motivated activists looking to confirm their biases will not care.

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Not just another rat study

A new high-quality study of the effect of fluoride on the memory and learning behaviour of rats has produced definitive results. Anti-fluoride campaigners had great hopes this study would bring an end to community water fluoridation (CWF) – but their hopes have been dashed.

The study showed no effect of fluoride on the memory, learning and motor skills of rats thus reinforcing the consensus that CWF is safe

Animal experiments are commonly used to investigate possible health effects of chemicals like fluoride. This enables strict research protocols without the ethical problems faced by human studies. Consequently, there have been a large number of investigations of the effect of fluoride on animals. Some of these have suggested harmful effects. The US anti-fluoride activist organisation, the Fluoride Action Network (FAN) lists 45 studies “where mice or rats treated with fluoride were found to suffer impairments in their learning and/or memory abilities” (see FLUORIDE AFFECTS LEARNING & MEMORY IN ANIMALS).

FAN claims these and similar studies as irrefutable evidence that CWF is harmful – particularly in their major campaign claiming CWF lowers IQ and should be stopped. However, a more scientific assessment is far less dogmatic.

The US National Toxicity Program (NTP) examined published research of potential neurological effects from fluoride exposures in experimental rodent animals in a systematic review published in 2016 (see Systematic literature review on the effects of fluoride on learning and memory in animal studies). They found many of the studies had limitations due to confounding in the learning and memory assessments and there was a lack of discrimination between motor and learning skills. Very few of the studies were made at drinking water concentrations relevant to CWF and the evidence for adverse effects was “low to moderate,” and weakest for animals during their developmental phase.

The NTP concluded further research was needed and undertook laboratory studies with rodents to fill the research gaps it had identified. Those studies are now complete and have been published in a research paper:

McPherson, C. A., Zhang, G., Gilliam, R., Brar, S. S., Wilson, R., Brix, A., … Harry, G. J. (2018). An Evaluation of Neurotoxicity Following Fluoride Exposure from Gestational Through Adult Ages in Long-Evans Hooded Rats. Neurotoxicity Research. Neurotoxicity Research.

The laboratory experiment

The authors used four treatments for the rats:

  • G1: Fed standard rodent chow;
  • G2: Fed low-fluoride chow;
  • G3: Fed low-fluoride chow + drinking water with 10 ppm F;
  • G4 Fed low-fluoride chow + drinking water with 20 ppm F.

Effects of drinking water F were determined by comparing results for G3 and G4 with G2.

The drinking water fluoride concentrations still seem high (compared with the recommended level of 0.75 ppm for CWF) but are lower than used in most earlier studies (often around 100 ppm). However, the basis for these choices was the use of the US secondary drinking water standard (2 ppm) and US UPA maximum contaminant level (4 ppm) and “the conventional wisdom that a 5-fold increase in dose is required to achieve comparable human serum levels.” However, this “wisdom” is debated as blood serum levels fluctuate.

These drinking water concentrations are still far higher than the recommended optimum level for CWF (0.75 ppm) so the results should be seen as more related to the defined upper limits than to CWF itself.

Behavioural assessments

A range of behavioural assessments was made. These included:

“motor, sensory, or learning and memory performance on running wheel, open-field activity, light/dark place preference, elevated plus maze, pre-pulse startle inhibition, passive avoidance, hot-plate latency, Morris water maze acquisition, probe test, reversal learning, and Y-maze.”

The purpose of using such a wide range was to overcome deficiencies of the measurements made in earlier studies and to fill in gaps. Animals at the developmental stage were included as most earlier studies had been made with adult rats.

“No significant differences observed”

One of the most commonly used phrases in this paper as the results are presented and discussed is that there were “no significant differences observed across groups.”

The authors note in their abstract that they “observed no exposure-related differences” in any of the behavioural tests listed above.

This result is important. The study is authoritative. The chosen experimental protocols resulted from an extensive systematic review of the earlier work which identified gaps and deficiencies. A very wide range of behavioural tests was used. And the experimental plans were discussed very widely before the experiments began.

We can conclude, therefore, that rodent experiments are unlikely to show behavioural effects related to fluoride exposure at the concentrations which, the authors argue, are relevant to the recommended maximum drinking water standard (2 ppm) and maximum contaminant level (4 ppm) for humans. The argument that this result is relevant to humans is strengthened by the possibility that ““the conventional wisdom that a 5-fold increase in dose is required” to make results relevant for humans may be inflated.

The argument is further strengthened for humans as the recommended drinking water fluoride concentrations for humans is even lower than the maximum drinking water standard and the maximum contaminant level.

Other assessments

The researchers also analysed thyroid hormones and examined collected tissues. They reported:

“No exposure-related pathology was observed in the heart, liver, kidney, testes, seminal vesicles, or epididymides.”

And:

No evidence of neuronal death or glial activation was observed in the hippocampus at 20 ppm F.”

In fact, the only statistically significant effects they found were a “mild inflammation in the prostate gland” and “evidence of mild fluorosis in adults” at 20 ppm F (treatment G4). Remember this level corresponds to the maximum contaminant level for humans and dental fluorosis has also been reported for humans at that concentration.

The anti-fluoride spin

Several years ago I discussed the planned NTP work and the reaction of anti-fluoride campaigners to it in my article Fluoride and IQ – another study coming up.

These campaigners seemed ecstatic about the planned NTP work, although I did comment:

“You wouldn’t think the anti-fluoride crowd would welcome such a careful analysis of the poor-quality articles they promote”

However, Fluoride Free NZ revealed the spin they placed on the NTP document describing the systematic review and the planned work in their press release at the time (see Fluoride-Brain Studies Set to Expose Fluoridation Damage):

“Results could mean the end to fluoridation world-wide, and definitely should put a halt to any plans to start fluoridation in places not currently fluoridated.

Because it is now well established that fluoride affects the brain, the NTP plans to conduct new animal studies to determine the lowest dose at which this damage occurs. They also plan to do a systematic review of all the existing scientific literature. To date, there have been 314 studies that have investigated fluoride’s effects on the brain and nervous system. These include 181 animal studies, 112 human studies, and 21 cell studies.”

I commented on this:

“The confirmation bias and dogmatic agenda stick out like a sore thumb – don’t expect these people to accurately report this study’s findings.”

Well, it seems that these campaigners are still stuck in dumb shock of the denial phase as they have yet to make any comment on these research results. When they do get around to overcoming their speechlessness they are going to be hard put to reconcile this denial with their earlier hopes for the research findings.

There is no way this study can be used to argue for “the end to fluoridation worldwide” or that there “definitely should” be “a halt to any plans to start fluoridation in places not currently fluoridated.

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