Category Archives: SciBlogs

If at first you don’t succeed . . . statistical manipulation might help

Anti-fluoride campaigners are promoting yet another new study they claim shows community water fluoridation lowers children’s IQ. For example, the Fluoride Free NZ (FFNZ) press release Ground Breaking Study – Fluoridated Water Lowers Kid’s IQs which claims the study confirms“our worst fears, linking exposure to fluoridated water during pregnancy to lowered IQ for the developing child.”

Yet the study itself shows no significant difference in children whose mothers lived in fluoridated or unfluoridated areas during pregnancy. Here is the relevant data from Table 1 in the paper:

Mean IQ of children whose mothers drank fluoridated or unfluoridated water during pregnancy (SD =  11.9 – 14.7)

Nonfluoridated Fluoridated
All children 108.07 108.21
Boys 106.31 104.78
Girls 109.86 111.47

The differences between fluoridated and nonfluoridated are not statistically significant.

The paper has just been published and is:

Green, R., Lanphear, B., Hornung, R., Flora, D., Martinez-Mier, E. A., Neufeld, R., … Till, C. (2019). Association Between Maternal Fluoride Exposure During Pregnancy and IQ Scores in Offspring in Canada. JAMA Pediatrics, 1–9.

Surprisingly the authors do not discuss the data in the table above. Its as if the data didn’t exist, despite being given in their Table 1. I find this surprising because their discussion is aimed at finding a difference – specifically, a decrease in child IQ due to fluoridation – and surely these mean values must be relevant. Were the authors embarrassed by these figures because they did not show the effect they wanted?

So how did they manage to find an effect they could attribute to fluoride, or fluoridation, despite the mean values above? They basically resort to statistical manipulation – and this has opened up an intense controversy about the paper.

An unprecedented “Editor’s Note”

The journal editor, Dimitri A. Christakis, published a note alongside the paper (see Decision to Publish Study on Maternal Fluoride Exposure During Pregnancy), together with a piece in the Opinion section by David C. Bellinger (see Is Fluoride Potentially Neurotoxic?). This opinion piece is described as an editorial although Bellinger is not an editor of the journal or on the Editorial Board.

This is, in my experience, completely unprecedented. Editor’s don’t comment on the quality of papers or the refereeing process and I can only conclude that within the journal editorial board and those who reviewed the paper there were sharp differences about its quality and whether it should be published. While an editorial may sometimes bring attention to an article, in this case, it is likely that Bellinger was one of the reviewers of the paper and he is expressing his viewpoint on it and supports its publication.

Christakis writes “The decision to publish this article was not easy.” He goes on to imply the journal supports publication “regardless of how contentious the results may be.”  But surely there is no need to defend a good quality paper in this way just because the results may be “contentious.”

Interestingly, FFNZ interpreted the publication of the Editor’s note as making the publication of the paper more “impactful” not realising that the Note is probably not positive for the paper as it reveals controversy over the paper’s quality and whether it was worthy of publication. FFNZ also chose to describe Bellinger’s comments in his opinion piece as representing the views of the authors. However, it would be inappropriate for an editor to make such comments.

I think Bellinger has his own biases and preferences which lead him to advocate for papers like this. I commented on Bellinger’s role in the review of another paper promoting an anti-fluoride perspective in my articles Poor peer-review – a case study and Poor peer review – and its consequences.

A large amount of controversy

I am surprised at the degree of controversy around this paper – and it’s loudness. The fact that it started on the same day the paper was made public reveal various actors have had access to the paper and have been debating it for some time.  This could have been stoked by the unorthodox statistical analysis used and contradictions in the findings.

But it appears this controversy had gone far wider than the journal editors and reviewers of the paper because of the immediate reactions from anti-fluoride organisations like the Fluoride Action Network (see BREAKING: GOVERNMENT-FUNDED STUDY LINKS FLUORIDATED WATER DURING PREGNANCY TO LOWER IQS IN OFFSPRING), some leading Newspapers,  professional bodies (see AADR Comment on Effect of Fluoride Exposure on Children’s IQ Study) and the UK Science Media Centre which published a reaction from experts article (see expert reaction to study looking at maternal exposure to fluoride and IQ in children).

This suggests to me a large degree of lobbying. Not only from activists and anti-fluoride scientists or reviewers. But also from authors and their institute. I am not really surprised as I have often seen how politics, activism, commercial interests, and scientific ambitions will coordinate in these situations.

How to discover an effect from a nonsignificant difference

So how do we get from the data in the table above – showing no statistically significant difference between fluoridated and unfluoridated areas – to a situation where the authors (who don’t refer to that data in their discussion) say:

“higher levels of fluoride exposure during pregnancy were associated with lower IQ scores in children measured at age 3 to 4 years. These findings were observed at fluoride levels typically found in white North American women. This indicates the possible need to reduce fluoride intake during pregnancy.”

In their press releases and statements to media, where they are not constrained by a journal’s need for evidence and objectivity, they come out even more vocally against community water fluoridation.

Well, it appears to me, by statistical manipulation. One of the Science Media experts referred to above, Prof Thom Baguley, wrote:

“First, the claim that maternal fluoride exposure is associated with a decrease in IQ of children is false. This finding was non-significant (but not reported in the abstract). They did observe a decrease for male children and a slight increase in IQ (but non-significant) for girls. This is an example of subgroup analysis – which is frowned upon in these kinds of studies because it is nearly always possible to identify some subgroup which shows an effect if the data are noisy. Here the data are very noisy.”

It appears the authors found a significant effect of child sex on IQ so made a decision to do a subgroup analysis – of boys and girls – and this produced a significant association of IQ with maternal urinary fluoride for the boys. This resort to subgroup analysis may have, in itself, produced a misleading significant relationship.

Adam Krutchen, Biostatistics PhD student at the University of Pittsburgh, also illustrates how the relationship with child sex has confused the analysis. He comments on the data that he managed to extract from the paper’s Figure 3:

“There were drastic sex-specific IQ differences in the children, which is of course strange. We shouldn’t expect anything like that to happen. This difference is very significant. There’s also some outlier extremely low IQ values among the male children.”

He is saying that his regression analysis showed a strong effect of child sex on IQ. This is quite irrespective of maternal urinary F or drinking water F. However, once that effect of child sex is taken into account he found no relationship of child IQ with maternal urinary F. He says:

“with such a significant effect of sex on IQ, does fluoride have any remaining relationship? The answer is a resounding no in the digitized data.”

It appears that including child sex difference in the regression analysis produces the finding that there is no significant relationship of fluoride to child IQ after taking into account the significant relationship of IQ with child sex. But when the data is divided into subgroups and analysed separately (a technique statisticians “frown on” “because it is nearly always possible to identify some subgroup which shows an effect if the data are noisy”) a significant relationship of IQ with maternal urinary fluoride can be produced for boys (but not girls).

Interestingly, a second part of the Green et al., (2019) study investigated a relationship of child IQ with unverified estimated fluoride intake by the pregnant mothers. The estimation method was not verified so may be questionable). No sex difference appeared in that data set.

How strong are the reported relationships

Perhaps it is not necessary to go any further. Perhaps the data for mean IQ in the table above is sufficient to show there is no effect of fluoride on IQ. Or perhaps the critique of the analysis of subgroups used is sufficient to make the reported conclusions suspect.

However, perhaps a comment on the weakness of the relationships reported by Green et al is useful – if only because I took the trouble to digitally extract the data from the figures in the paper and do my own regression analyses on the data.

Of course, digital extraction does not get all the data – even if only because the points may merge. In this case, I managed to extract 410 data points from Figure 3A which showed the relationships of child IQ with the maternal urinary F concentrations during pregnancy. This is quite a bit smaller than the 512 data pairs the authors reported in their Table 1 and suggests to me they had not plotted all their data. However, the values for means and coefficients obtained by my own regression were very similar to those reported by Green et al., (2019).

The authors reported a significant (p=0.02) negative relationship of boy’s IQ with maternal urinary F. They do not discuss how strong that relationship is – although the wide scatter of data points in the figures suggest it is not strong. My regression analysis showed the relationship explained only 1.3% of the variance in IQ. I do not think that is worth much. With such low explanatory power, I think the authors overstate their conclusions.

I think this is another case of placing far too much reliance on p-values and ignoring other results of the statistical analysis. I discussed this in a previous article – see Anti-fluoride activists misrepresent a new kidney/liver study).

Conclusions

I think this paper has been overblown. It has problems with its statistical analyses as well as other limitations referred to in the paper. I do not think it should have been published in its present form – surely reviewers should have picked up on these problems. I can only conclude that intense arguments occurred within the journal’s editorial board and amongst reviewers – and most probably more widely amongst institutes and activist groups. In the end, the publication decision was most likely political.

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Chemical watchdog confirms suppressed report but justifies the suppression

Director-General of OPCW Fernando Arias Gonzales admits Douma engineers report was legit and he was part of the FFM – but attempts to justify suppression of the report.

France 24 reports that the head of the Organisation for the Prohibition of Chemical Weapons (OPCW) “has ordered a probe into the leak of an internal paper which queried the body’s findings into a 2018 attack in the Syrian town of Douma” (see Chemical weapons body probes leaked document on Syrian attack). This is yet another confirmation of the authenticity of the leaked document I discussed in Does international chemical watchdog cherry-pick evidence to confirm a bias? Recent documents form the OPCW also confirm that Ian Henderson, the head of the engineering subteam that prepared the suppressed document, was employed by the OPCW (see Remarks of the Director-General at the Briefing for States Parties on Syrian Arab Republic: Update on IIT-FFM-SSRC-DAT).

This should put to rest claims made by some corporate media journalists that the leaked document was fake and manufactured to discredit OPCW findings. Even so, these same journalists are not exactly rushing to repor the issue.

I guess no one who has worked for a large organisation, whether corporate or state owned, can be surprised at the way the OPCW is reacting to the leaked document. Or surprised that an important analysis was supressed leading to questions about the reliability of the final reports.

But the fact this is an international organisation bearing responsibility for monitory and eliminating a whole class of dangerous weapons makes the behaviour very serious. Even worse, the apparent bias in the final report about an incident which supposedly lead to the deaths of so many civilians raises questions about the ethical behaviour of the OPCW. It is very likely a war crime was committed and the OPCW has not only failed in its role to objectively elucidate the evidence of this crime but actively worked to prevent attributing blame to the likely instigators of the crime. Instead the OPCW appears to have succumbed to political pressure from NATO-aligned countries to blame an innocent party.

Alleged victims of chemcial attack in Douma, Syria. Who was responsible for these deaths? Image credit: New York Times – Most Chemical Attacks in Syria Get Little Attention. Here Are 34 Confirmed Cases.

Given the seriousness of this matter, it is pleasing to see that the media is starting to provide some coverage of the document suppression – although very belatedly and in a very limited matter in the case of the corporate mainstream media. I hope the truth comes out and I hope, as a result, steps are taken to reform OPCW procedures to limit this sort of political interference.

However, in this post, I will just deal with an attitude expressed by the OPCW which displays a very unscientific attitude to their work. The idea that evidence should be selected to support a conclusion – rather than the conclusion be based on all the evidence.

Director-General of OPCW admits the legitimacy of engineers’ report

The video above shows Fernando Arias Gonzales, the Director-General of OPCW, admitting to the legitimacy of the engineers’ report and attempting to justify the fact its findings were excluded from the final report. I described the findings of the suppressed report in Does international chemical watchdog cherry-pick evidence to confirm a bias?

Briefly, whereas the final OPCW report provided evidence for the finding that the chlorine cylinders had been dropped from the air, the suppressed engineers’ report found it far more probable that the cylinders had been placed manually.  Considerations of the sizes of the ceiling holes, the possible velocities of the cylinders and damage to them, and surrounding damage were considered in the suppressed report.

Whereas other external engineers were later consulted by the OPCW and provided arguments justifying air-delivery I would expect an objective report would include all the analyses and information available. On those grounds alone the Director-General’s arguments for suppression are very suspect and do nothing to alleviate the subsequent loss of credibility of his organisation.

But to me it is worse – his comments are scientifically unethical.

“But sometimes it does not fit to the conclusion”

How can a report be considered credible if evidence contradicting its conclusion is omitted? Fernando Arias Gonzales does nothing to preserve the integrity of his organisation when he says of evidence – “But sometimes it does not fit to the conclusion.”

His statement implies that in this case the writers of the report started with a conclusion and then selected only that evidence which could support their pet conclusion.

That is scientifically unethical and displays probable political pressure.

Hiding behind possible attribution

In a formal statement from the OPCW the Director-General provides yet another justification for the report’s suppression:

“The document produced by this staff member pointed at possible attribution, which is outside of the mandate of the FFM with regard to the formulation of its findings. Therefore, I instructed that, beyond the copy that would exclusively be kept by the FFM, the staff member be advised to submit his assessment to the IIT*, which he did, so that this document could later be used by the IIT.”

But this is just incredulous. The final report presented only the evidence supporting air delivery of the two chlorine cylinders. The suppressed report presented evidence which did not support air delivery but was consistent with the cylinders being placed manually.

Neither the engineer’s report nor the final report mentioned any attribution – although of course attribution could be inferred. By arguing for air-delivery the final report can be seen as possible laying the blame on the Syrian state forces which used helicopters in the area.  Manual placement provides for possible attribution to the jihadist forces and a staged event. But neither of these are stated directly and it is disingenuous for the Director-General to claim, the suppressed report “pointed at possible attribution” but the final report didn’t.

Really, the Director-General’s statement has only dug a deeper hole and further reduced the credibility of the origination and its past and future reports.

*IIT –Investigation and Identification Team. This has been set up by the OPCW Secretariat to identify “the perpetrators of the use of chemical weapons in the Syrian Arab Republic.” However, it does not have full support from OPCW members and its establishment is controversial.

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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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Novichock detection and the Salisbury tourists

Image credit: EU Today.

The Salisbury novichok poisonings are a real can of worms. Media coverage is obviously politically, rather than scientifically, driven. Social and mass media reporting is highly partisan and the scientific components and reports (which are mostly classified) can become slaves to the particular political masters. I find the whole drama a mystery and certainly do not want to tie myself to any of the conspiracy theories, official or otherwise, that are floating around. It’s probably a subject to keep well away from.

However, one aspect intrigues me – the claimed identification of novichock residues in the London hotel room used by the Russian duo, Alexander Petrov and Ruslan Boshirov. In particular, is the identification of the material reliable and, further, is the reporting of this identification factual and reliable?

Media reporting: This generally assumes a positive identification, although at trace levels. The Sun, for example, reported:

“Petrov and Boshirov stayed in the City Stay Hotel in Bow, East London, during their time in the UK.

Cops searching their room two months later on May 4 are said to have discovered minute traces of Novichok, a high-grade military nerve agent created by Soviet scientists.”

And later:

“police found traces of Novichok in the hotel room in which the pair stayed for two nights.”

Similarly, the Independent reported:

“Investigators later found traces of novichok in their room at the City Stay Hotel.

They said the amount was too low to present a health risk but are appealing for any hotel guests who stayed there between 4 March and 4 May to contact investigators.”

Since Petrov and Boshirov surfaced and were interviewed the media coverage has become even more partisan and the discovery of these traces of novichock is being portrayed as even more definite.

The police reportIn the absence of an official scientific report of the analyses this is the best we have to go on:

“On 4 May 2018, tests were carried out in the hotel room where the suspects had stayed. A number of samples were tested at DSTL at Porton Down. Two swabs showed contamination of Novichok at levels below that which would cause concern for public health. A decision was made to take further samples from the room as a precautionary measure, including in the same areas originally tested, and all results came back negative. We believe the first process of taking swabs removed the contamination, so low were the traces of Novichok in the room.

Following these tests, experts deemed the room was safe and that it posed no risk to the public.”

This raises more questions, for the scientifically inclined, than the answers, seemingly, provided:

  • How many samples were taken – 2 positives is probably a low proportion of the total measurements?
  • Where were the sample sites located in the room
  • How do the low levels reported compare with the detection limits for the methods used?
  • Was the decision to take further samples based on lack of confidence in the results form the first sampling?
  • Again, how many further samples were taken and from what sites in the room?

I suspect that the two positive detections were probably false positives which the analyst had low confidence in. It is likely many samples were taken from the room so that two positives near, or at, the level of detection is not a good result. I suspect experts would challenge this evidence in court.

Absence of evidence is not proof of innocence

I should stress that in questioning the results I am not trying to argue for the innocence of the two guys. After all, a true professional would not have contaminated the hotel room. If the evidence is genuine, though, it may be more suggestive of a non-professional or non-state actor than a professional hitman.

The problem, though, at this stage is that all the other evidence made public is circumstantial and unlikely to stand up in court. The claimed positive detection of novichock-type compounds in the hotel room could be the key to a successful conviction so any doubts should be removed.

Novichock compounds

The following presents my views on the problems of detecting novichock compounds at low levels and why I think we should not accept the current media reports as positive evidence. A court would have to look very critically at the actual data and detection methods used. At the moment the political and police statements could be expressing far more confidence in the reported findings than is actually warranted by the real evidence.

An Iranian paper from two years ago, Hosseini et al., (2016) provides information on the synthesis, structure and detection of novichock-type compounds. It is probably the most up-to-date information publicly available and its citation is

Hosseini, S. E., Saeidian, H., Amozadeh, A., Naseri, M. T., & Babri, M. (2016). Fragmentation pathways and structural characterization of organophosphorus compounds related to the Chemical Weapons Convention by electron ionization and electrospray ionization tandem mass spectrometry. Rapid Communications in Mass Spectrometry, 30(24), 2585–2593.

The paper describes the micro-synthesis of two compounds that are listed under Schedule 2.B.04 of the Chemical Weapons Convention. These are:

  • Compound 3: N-[Bis(dimethylamino)methylidene]-P-methylphosphonamidic fluoride, and
  • Compound 4: O-alkyl N-[bis(dimethylamino)-
    methylidene]-P-methylphosphonamidate Novichok derivatives

The figure shows the chemical structures of these compounds.

The F atom in compound 3 is replaced by an organic group (R) to form the novichok derivative. As this can be either of a wide range of organic groups (the authors list nine different groups for derivatives they synthesised) the novichock-type compounds include a range of different chemicals with differing levels of toxicity.

This is why more official reports on the Salisbury poisonings refer to novichock-type nerve agents and not just novichock.

Before any clever reader decides to use this paper to synthesize their own samples of these or similar compounds I must stress the warning provided by the authors:

“It should be noted that, due to the extreme toxicity of these materials, the separation and purification of CWC-related chemical are very difficult and therefore should be carried out only by a trained professional in an efficient fume cupboard equipped with an active charcoal filtration system.”

Detection of novichok-type compounds

Mass spectrometry methods are used for detection. This involves breaking up the molecules into fragments using an electron ionizer (EI). These molecular fragments are then separated according to mass and charge and the amounts of each detected in a mass spectrometer (MS) to produce an EI-MS spectrum.

Each compound has its own “fingerprint” – a pattern of peaks defined by the mass/charge (m/z) of each molecular fragment and the relative intensity of each peak. The figure below shows the EI-MS “fingerprints” for compound 3 and the O-ethyl derivative of compound 4.

We can see why the detection of a compound relies not only on a single peak but also other characteristic peaks and their relative sizes.

For example, the largest peak (H) at m/z = 71 occurs in both compounds. This is because the molecular fragment (see the chemical structure to the right) responsible for it is produced by ionization of both compounds. So that peak cannot be used alone to differentiate between the two compounds. Identification of a specific compound requires locating all the major characteristic peaks and ensuring their relative intensities are correct.

This is straightforward where the compounds are available at relatively high concentrations and the combination of mass spectroscopy with gas or liquid chromatography helps to remove some of the background chemicals. The ability of UK experts to conclude that the type of novichok used to poison the Skripals is the same as that in the fake scent bottle used by the second victims (Dawn Sturgess and Charlie Rowley) means that they were able to recover samples containing the nerve agent at sufficiently high concentrations.

But, at low concentrations one may simply not be able to find all the characteristic peaks, and identification using just the most intense peaks is not so reliable. For example, compounds 3 and 4 could not have been differentiated at low concentrations if all that could be detected were very small peaks at m/z =  71, 135 and 150. Yet that is the situation when searching for trace levels and one is always conscious that the peaks that are detected could be due to low levels of a completely different compound.

Conclusions

I suspect the description of the two possibly positive samples in the London Hotel as trace levels or “at levels below that which would cause concern for public health” were interpretations driven by “wishful thinking” and exaggerated confidence and not surety. After all, scientists often face such pressures when their political masters are looking for results to fit a preconceived narrative. It is easy to be persuaded in such situations. And it is tempting for both scientists and police to describe their findings in a more confident way when presenting to the media than they would during peer discussions in the laboratory or office.

My suspicions are supported by the fact that the total number samples taken from this hotel room must have been quite large so that makes the reliability of the positive values at such low levels for only two samples quite suspect (although information on locations of sampling sites would help this interpretation).

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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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Blatant misreporting of latest OPCW report on chemical weapons in Syria

BBC caught out promoting fake news about OPCW report

The Organisation for Prohibition of Chemical Weapons (OPCW) reports no evidence of banned chemical weapons use by the Syrian government in Douma last April. This conflicts with the strong claims of NATO states and most of the mainstream media at the time. It also shows that the illegal missile attacks by France, UK and USA (FUKUS) on Syria at the time (see The “heart of the Syrian chemical weapons programme” destroyed?) were completely unjustified.

While the NATO governments involved have yet to respond to the OPCW report (let alone make apologies for their actions) many mainstream media outlets seem determined to continue promoting fake news when it comes to Syria. Some major news outlets have completely misrepresented the OPCW findings.

OPCW has problems but got this one right

I have commented on some earlier OPCW reports on Syria and have found them unconvincing, biased or relying only on terrorist sources (see Another shonky OPCW chemical incident report on Syria and Chemical weapons use in Syria UN report flawed by political bias).

However, this one is a bit different. It is an interim report on the alleged chemical weapons attack in Douma, Syria, last April. This incident got a lot of publicity with France, UK and USA declaring they had evidence which proved there had been an attack using sarin. This alliance (FUKUS) was sufficiently confident with their “intelligence” to order an illegal missile attack on several sites in Syria. (see The “heart of the Syrian chemical weapons programme” destroyed?)

This interim report is also different because the area of alleged attack was soon liberated by Syria and Syria, together with Russian Military Police and the UN Office for Project Services, was able to stabilise the area and enable inspectors from the OPCW to take samples and interview people in the buildings which had allegedly been attacked. A big difference to earlier reports which had relied only on “open sources,” and the testimony and samples provided by the White Helmets – a group affiliated with the jihadists and which actively campaigns against the Syrian states and has a history of false reporting.

While this is only an interim report some conclusions are clear (paragraph 2.5 in Summary):

“No organophosphorus nerve agents or their degradation products were detected, either in the environmental samples or in plasma samples from the alleged casualties.”

Media coverage

I have yet to see any response from NATO governments, particularly those comprising the FUKUS attack group. A sharp contrast to their vociferous accusations at the time of the alleged incident.

However, it appears that much of the mainstream media, and some of the sources it relies on, will draw unwarranted conclusions from this interim report to support their narrative.  For example, Al Jazeera claims Interim OPCW report finds proof of chlorine used in Syria’s Douma.

That is an outright lie. It did not give any such proof or even make that claim.

There is also this from the BBC:

Again an outright lie – the report found nothing of the sort.

Reuters are going with Chemical weapons agency finds ‘chlorinated’ chemicals in Syria’s Douma. Mind you this headline is a “correction” – “(Corrects to “various chlorinated organic chemicals” instead of chlorine).” Technically correct but misleading.

Sky news is claiming Chemical attack confirmed in deadly Douma strikes, but OPCW finds no evidence of sarin. Again wrong. No evidence of sarin but also no evidence presented of any chemical attack at all.

ABC also misrepresented the OPCW report claiming Chlorine used in Syria’s Douma, no trace of nerve agent, Interim OPCW report finds.

The NZ Herald was more neutral in their report Watchdog reports on alleged Syria attack behind airstrikes.

On the other hand the Xinhua Chinese news agency correctly reported Various chlorinated organic chemicals found in samples from Douma attack sites: OPCW, and RT correctly reported Nerve agents not found in samples from Syria’s Douma – interim OPCW report saying (in its second sentence ““Various chlorinated organic chemicals were found in samples” from two locations in the Damascus suburb of Douma.”

And I get the impression most of the “alternative” media sources I see on social media are reporting the OPCW findings correctly. So what was that about “Fake News” and the strong recommendations we get to wear blinkers so that we do not see alternative news sources?

Bellingcat also misrepresents findings

Eliot Higgins, who runs the Bellingcat organisation which provides “open source” information often used by western governments and media, also misrepresents the OPCW report. His organisation is responsible for initiating the story that the MH17 flight was shot down in eastern Ukraine by a Russian BUK unit especially imported for the occasion (and exported immediately afterwards).  Bellingcat is also responsible for many of the claims of chemical weapons used by the Syrian government.

Higgins tweeted:

What is the basis for misleading reports of chlorine use

The OPCW report mentions chlorine only twice – in this paragraph describing the original open source and media reporting of the alleged incident (paragraph 3.1 in Background):

So, no evidence of chlorine use found by the OPCW team. Those making this claim will point, in justification, to the fact that “chlorinated organic chemicals” were found at a few of the examined sites (paragraph 2.5 in Summary):

“Various chlorinated organic chemicals were found in samples from Locations 2 and 4, along with residues of explosive.”

Many of the commenters I have seen on social media who resort to this to prove their claims of chlorine use seem not to understand the chemical differences involved or to argue that traces of any chlorinated organic chemicals must mean chlorine had been present.

Surprisingly, the OPCW did not draw any conclusions from the presence of these chemicals and are still attempting to establish their significance. I would have thought their job was to show if the trace levels found were at all unusual for environmental samples.

As a chemist I do not find the OPCW detection of traces of these chemicals at all surprising. For example, the report mentions the presence of “dichloroacetic acid, trichloroacetic acid” in samples of concrete debris, wood fragments, a water tank wood support, and some clothing.  But these chemicals are common in drinking water and even groundwater (see the Background document for development of WHO Guidelines for Drinking-water Quality, Dichloroacetic Acid in Drinking-water ). Some of the chemicals found are common chlorinated compounds in treated wood (e.g. bornyl chloride and 2,4,6-trichlorophenol as mentioned in a footnote to Annex 3 of the OPCW interim report).

So, in fact, the identified chlorinated organic chemicals are what one may expect from such samples or especially samples taken from areas where explosives have been used.

This OPCW report is still of dubious scientific quality

I find a lot wrong with this OPCW report – but first the positive.

It followed (mostly) the OPCW guidelines for on-site inspection and sampling. This is a sharp contrast with the earlier OPCW reports on Syria where investigators relied on samples and testimony from jihadi affiliated groups like the White Helmets and their associates. This was possible because Douma had just been liberated and the Syrian Government and Russian Armed Forces made an immediate request for the OPCW to send their own observers to check media claims. (Although, given their willingness to trust jihadi-linked groups based in a terrorist-controlled area it does seem strange that the OPCW was unwilling to send their investigators to those areas and rely on terrorist guarantees for security in past investigations. Although, I am being sarcastic. Even in the case of Douma the OPCW team, was concerned about attacks from suicide bombers which seem to operate freely in the terrorist-held areas).

But have they learned?

In paragraph 5.1 describing their activities and timeline the OPCW say:

“Following reports in the media of the alleged incident on 7 April 2018, the Information Cell of the Secretariat immediately informed the FFM team and initiated a search of open-source information to assess the credibility of the allegation. The major sources comprised news media, blogs, and the websites of various non-governmental organisations. The assessment by the Information Cell was that the credibility of the allegation was high. Based on this information, the Director-General initiated an on-site investigation.”

Will the OPCW learn from this specific incident. In  previous reports they stopped at “The assessment by the Information Cell was that the credibility of the allegation was high” – and they would have this time of the Syrian, Russian and UN military had not provided them the security they required for onsite inspections.

The OPCW assessment was that the credibility of the jihadi-connected groups was “high.” Their own inspections showed they were mistaken. Will they be more careful with such claims in the future?

This question is important as NATO countries at the UN Security Council earlier this year effectively prevented adoption of mandatory on site inspections for UN-related chemical weapons investigations. At the OPCW the NATO countries have also pushed through a policy enabling the OPCW to go beyond its investigatory role and carry out a political role of apportioning blame.

The science is shonky

I find it incredible that the report should simply list identification of traces of chlorinated organic chemicals without either providing some sort of indication of the concentrations involved or comparing levels with measurements from  control samples – taken from areas outside the alleged attack area. This is a basic scientific mistake.

Those who wish to claim that the presence of chlorinated organics “proves” chlorine was used in this area could well be right. But only if the concentrations of these chemicals was much higher than normal for environmental samples.

I really can’t help thinking that this shoddy reporting of the science is a political trick enabling the report to be misrepresented. The OPCW is, after all, an international body and subject to the same sort of political manoeuvring we have come to expect from all such international bodies.

Interviews in country X!

The report states (paragraph 8.17:

“The FFM team interviewed a total of 34 individuals; 13 of these interviews were
conducted in Damascus and the remainder in Country X. Analysis of the testimonies is ongoing.”

Two issues for me here:

1: 13 interviews in Damascus – where most witness could have been found and 21 interviews in “Country x?” What this means is that more people from the defeated jihadi groups and their families were interviewed than those remaining in Douma who may have been less motivated to lie.

2: Country X! really? This is meant to be an intelligent report – not a spy thriller. There is absolutely no reason to be so coy about the location of the people interviewed. This is just childish.

I should note that the defeated “rebels”/terrorists and their families were given the opportunity to be transported to Idlib (still in terrorist hands). This has been a common feature of settlement agreements as areas are liberated. Of course, many choose to stay – even those who had been actively fighting with the militants. There is usually a provision for fighters to formalise their citizenship and even join the Syrian Army.

Many of the “rebel” fighters and members of affiliated organisations travel from Idlib into neighbouring Turkey – and further on. Why is the OPCW afraid to reveal the location of their interviewees in Turkey or other countries? Are they concerned this might reflect on the reliability of their testimony?

The warehouse and chemical production facility.

The Syrian government also asked the OPCW to investigate a chemical production facility and warehouse they had found deign liberation of East Ghouta and Douma. They believe these had been sued by terrorists to manufacture chemical contain weapons. (Similar facilities had been found in East Aleppo where terorists appeared to be adding chemicals to projectiles used in their “hell cannons.”

Only one paragraph was devoted to this inspection – paragraph 8.16: Warehouse and facility suspected of producing chemical weapons:

“At the warehouse and the facility suspected by the authorities of the Syrian Arab Republic of producing chemical weapons in Douma, information was gathered to assess whether these facilities were associated with the production of chemical weapons or toxic chemicals that could be used as weapons. From the information gathered during the two on-site visits to these locations, there was no indication of either facility being involved in the production of chemical warfare agents or toxic chemicals for use as weapons.”

That is all – no details. No inventory of chemicals held at the sites. No sign of what the warehouse and production facility was actually used for.

Now, I can accost the Syrians may have been completely wrong in their suspicions about these sites – after all that assessment was made by military officers on the ground in the heat of battle, not chemical weapons experts. But I find the lack of information frustrating, even suspicious.

Were any cylinders of chlorine present at these sites. After all, if politically motivated commenters and media wish to misinterpret the presence of normal traces of chlorinated organic chemicals in collected samples why should they not also be forced to consider stocks of chlorine held in terrorist controlled areas -even if their declared use was innocent.

Conclusions

At last, and OPCW report on Syria actually based on factual evidence, the samples and interviews collected by the OPCW on site. A great advance over earlier reports based on “evidence” from terrorist-connected sources and social media or “open sources.”

But I wish the OPCW was more serious in reporting their scientific findings. Reporting traces of chlorinated organic chemicals without any indication of concentrations and comparison with normal environmental samples is shoddy work laying their information wide open for misrepresentation and distortion. Given the current geopolitical struggles and the way international organisations can be manipulated, I can’t help feeling this shoddy reporting was possibly intentional.

Despite these weaknesses, I think this report shows what is possible. It does show that the military action taken by FUKUS last April was not only illegal it was either based on poor intelligence and, more likely, based on claims these governments knew to be false. It is always good to see such blatant political and military hypocrisy exposed.

However, the weaknesses in the report show that more must be done to improve the scientific quality of OPCW work and reduce political influence on that work. This aspect is important because the recent changes giving OPCW a role in apportioning blame for alleged attacks open up that organisation to being so politicised it will lose all credibility.

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