Category Archives: science

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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Flight MH17 tragedy in Ukraine – new evidence

New evidence presented at Russian Ministry of Defence press conference, 17 September 2018.

In July 2014 the Malaysian Airline Flight MH17 was shot down over eastern Ukraine. All 283 passengers and 15 crew died. A Dutch-led international Joint Investigation Team (JIT) has been investigating the tragedy with the aim of determining criminal blame.

Update: Facebook took it upon themselves to censor my timeline and remove the Facebook post of my article. It seems their fact-checkers at the Atlantic Council have judged this information as “not following community standards”

Bit of a lesson there.

 

The JIT produced a preliminary report in 2016 (see But will it stand up in court?) and updated this with new evidence at a press conference last May 24. At the conference they revealed the serial number of the missile which shot down the plane and made a general appeal for people who might have information on this to come forward. At a Press Conference this week the Ministry of Defence (MOD) of the Russian Federation has responded with information from the manufacturer’s log books about this specific missile.

This appears to be the most concrete evidence to date which could be used to lay credible blame for the tragedy.

The JIT reveals serial numbers of the missile and appeals to the public for information about it.

While the JIT May 24 statement laid the blame on the Russian Federation, their evidence was rather subjective – relying on subjective interpretation of markings on vehicles in videos available online. “Open source” evidence. In contrast, the Russian MOD was specific and taken from archived information from the missile manufacturer.

In a way, this is rather unique because this information was understandably classified. Presumably, Russian officials have been active in the period between May and September locating the log books, interviewing relevant staff members from the time of production and going through the bureaucratic procedures required to declassify the material.

The new evidence

The video of the Russian MOD press conference above summarises three pieces of evidence the Russians have made available:

1: The most convincing evidence is the date of manufacture of the specific missile (December 1986) and its transport to the military unit where it was deployed. The records show it was deployed to a unit based near Lvov in the then Ukrainian Socialist Republic. It had never been returned to Russian territory.

I think that evidence is solid. The MOD spokesperson said the information has been passed onto the JIT and if they ask to inspect the archives they will be invited to Moscow to do so. He also made the point that the Russian side has asked the JIT to request the log books of the Ukrainian military unit which has been in possession of that missile and reveal its movements and location during July 2014.

2: Analysis of the video material the JIT had relied on to support their conclusion that the missile came from the Russian 53rd Anti Aircraft Missile Brigade based near Kursk in the Russian Federation. That video material had initially been compiled by Bellingcat, a suspect internet group now allied with NATO. The JIT conclusion relied on subjective tracking of markings on a BUK unit and its transporter and claimed to track it through its journey.

JIT open source video evidence supporting their conclusion that the BUK unit came from Russia

Russian experts have analysed these videos and shown problems with lighting and perspective indicating they have been faked. Something as simple as placing an image of a BUK unit into an existing video.

Their analysis seems credible, but obviously, this is the sort of thing which could be debated between experts in a court.

3: A recording of a telephone conversation made in 21016 where Ukrainian Armed Forces Col. Ruslan Grinchak refers to the tragedy in a way that implied it was caused by the Ukrainian armed forces. This person was in charge of airspace over the Donetsk region at the time of the tragedy.

This evidence relies on interpretation so is less convincing by itself.

Conclusion

The new evidence resulting from the discovery of the missile serial numbers by the JIT looks conclusive. As Russian Lieutenant General Nikolai Parshin told reporters the archives show:

“the missile was assembled on December 24, 1986, and delivered by rail to the military unit number 20/152, officially named the 223rd Air Defense Missile Brigade. It was deployed to the Ukrainian Soviet Socialist Republic’s Ternopol Region, which was part of the Subcarpathian Military District.”

Unless archive evidence in the possession of the Ukrainian armed forces can show that the missile was subsequently exported back to the Russian Federation there seems no doubt that Flight MH17 was shot down by a Ukrainian missile.

However, much more has to be done to apportion blame. There is still the possibility that this particular BUK unit was in the hands of the separatist forces in the Donetsk or Lugansk regions (although Dutch Intelligence reports at the time indicated any BUK units in the hands of separatists were not functioning -see Flight MH17 in Ukraine – what do intelligence services know?).

What is clear is that the ball is now back in the hands of the JIT, and more specifically, the Ukrainian armed forces. The JIT should now demand archived information on the locations, servicing and possession of this specific missile in the period between 2086 and July 2014.

Of course, as in other aspects of this investigation, the Ukrainian side may claim that records do not exist or have been destroyed. I do not think that is good enough and such lack of cooperation has already damaged the reputation and reliability of the JIT. Ukraine, as possibly one of the suspects, should never have been given membership of the JIT where it can influence the investigation and exert veto power over the dissemination of findings.

Perhaps reporters should now be asking the Ukrainian military to go away and find this specific missile and hold their own press conference where they can expose the serial number of the one they have in their possession.

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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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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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