Category Archives: science

An anti-fluoride trick: Impressing the naive with citations

One way to make an article look impressive is to use citations – the more you use, the more impressive. Well, so some people think.

citations

Some of the over 140 references in Geoff Pain’s article. These references impress some people but are irrelevant to Pain’s arguments.

Again and again I find anti-fluoridation campaigners refer to the number of references in an article or book as a sign of scientific credibility. Paul Connett often promotes his anti-fluoride book by referring to its 80 pages of references. And in a recent on-line discussion where I criticised an article by the anti-fluoride campaigner Geoff Pain I was told that it contained over 140 references, as if that was the end of the story – his article must be valid!

Pain’s article is Fluoride causes heart disease, stroke and sudden death.” It’s one of series of propagandist articles which he has placed on the Researchgate we site. That website also impresses the anti-fluoride people as they think it gives the articles the scientific credibility of publication in a scientific journal. But anyone can belong to Researchgate and upload their articles. There is no peer review or any other form of quality control.

Geoff Pain has uploaded a screed of anti-fluoride propagandist articles with titles like :

  • Fluoridation Causes Cancer, so does the Fluoride content of Tea
  • Fluoride causes Death and Disease
  • Toxicity of Fluoride
  • What do you know about Fluoride?/
  • Impact of Fluoride on Women, the Unborn and Your Children
  • Fluoride is a bio-accumulative, endocrine disrupting, neurotoxic carcinogen – not a nutrient
  • Plumbosolvency exacerbated by Water Fluoridation
  • Fluoride Causes Diabetes
  • NHMRC = Politics, Not Science. Australians – Victims of Tragic Fluoridation Experiments
  • Fluoride doped hydroxyapatite in soft tissues and cancer. A literature review.

So you get the idea. With titles like this you will not be surprised to find his Twitter tag is @FluoridePoison. Although he describes some of these articles as “conference papers” they are, of course, talks given to anti-fluoride meetings. He describes the other articles as “technical reports.”

He is a consultant with a science degree and claims to specialise in analytical chemistry. But there is no credible science in his “technical reports” and “conference papers” on fluoride.

Literature trawling

Pain uses the technique of literature trawling that Declan Waugh has made famous in his anti-fluoride articles. This involves searching the scientific literature for any reference to fluoride and possible toxic effects. A technique which produces mostly irrelevant articles – but so what. They just bung the citations into their articles and make unjustified claims. They rely on their readers never to check the references anyway The committed anti-fluoridation person is only impressed by the number of references  – not their relevance.

No-one has the time or interest to completely debunk such articles by going through every single claim and checking every single citation. Nor are such articles worthy of such attention.

So let’s settle for a “partial debunking.” Here I will just take a single central claim in Pain’s article linked to above and check the relevance of his supporting citations. This should be sufficient to show how he misuses citations and misrepresents the science. Readers can draw their own conclusions about the rest of this article and about his other articles.

The claim

He claims a literature search shows “numerous examples of evidence relevant to cardiovascular damage by Fluoride” and cites “[Houtman 1996, Tyagi 1996, Artru 1997, Johnson 1998, Maheswaran 1999, Jehle
2000, Kousa 2004, Bogatchera 2006 and references therein].” So let’s see how relevant those citations are and if they actually support his claim.

Let’s see how relevant those citations are and if they actually support his claim.

Houtman 1996 reported:

” In general, the elements selenium, copper, zinc, chromium, and manganese seem to counteract the development of cardiovascular diseases, whereas cadmium and may be lead seem to stimulate it. Effects of arsenic, silicon and fluorine are unclear and for cobalt absent.”

So no evidence of fluoride causing cardiovascular damage there.

PMSF

The organic phenyl methyl sulfonyl fluoride does not contain fluoride.

Tyagi et al., 1996 (Post-transcriptional Regulation of Extracellular Matrix Metalloproteinase in Human Heart End-stage Failure Secondary to Ischemic Cardiomyopathy“) used the metal chelators  phenanthroline and phenyl methyl sulfonyl fluoride in laboratory identification of bands identified in immunoblot analysis of proteinases extracted from heart tissue. This has absolutely nothing to do with fluoridation or the fluoride anion. Phenyl methyl sulfonyl fluoride is an organic compound and does not contain the fluoride anion.

 

Artru et al 1997 investigated use of anaesthetics sevoflurane and isoflurane and their effect on intracranial pressure, middle cerebral artery flow velocity, and plasma inorganic fluoride concentrations in neurosurgical patients. There was no investigation of cardiovascular damage. The plasma fluoride was derived from breakdown of the anaesthetics – there was no fluoridation involved.

4 ami

4-amidinophenylmethanesulfonyl fluoride

Johnson et al., 1998 does deal with heart-related matters – atherosclerosis, infarction and stroke. But there is no mention of fluoride or fluoridation. Pain has picked up this article in his literature trawling purely because the study used the protease inhibitor 4-amidinophenylmethanesulfonyl fluoride as a reagent. Again, this is an organic chemical – it does not contain the inorganic fluoride species. The study has no relevance to fluoridation.

Maheswaran 1999 (“Magnesium in drinking water supplies and mortality from acute myocardial infarction in north west England“) investigated the relationship between magnesium and cardiovascular problems and found none. Yes, fluoride and other ions were considered as possible confounders but the paper specifically states:

“Calcium and fluoride appeared to have no significant association with mortality from acute myocardial infarction.”

So Pain’s literature trawling has found  a paper mentioning fluoride and cardiovascular problems but it does not support his claim they are related.

Jehle 2000 did research the human coronary artery but again it was produced by Pain’;s literature trawling simply because the investigation used the protease inhibitor reagent phenylmethylsulfonyl fluoride (see comments on Tyagi 1996). Nothing here to do with fluoridation or the inorganic fluoride species used in community water fluoridation.

Kousa 2004 (“Geochemistry of ground water and the incidence of acute myocardial infarction in Finland“) obviously is related to cardiovascular problems and, yes, fluoride was one of the chemical species in water considered. But what do the authors say:

“Fluoride concentrations of around one mg/l in household water may be beneficial . . . In this study one mg/l increment in the fluoride concentration in the drinking water was associated with a 3% decrease in the risk of AMI [acute myocardial infarction ]. “

And they concluded that their findings suggested fluoride played a protective role.

So a success for Pain’s literature trawling – a reported relation between fluoride and cardiovascular problems – but the opposite to what Pain claim. And he didn’t bother mentioning  this, did he? How honest is that?

Bogatchera 2006 does not seem to relate at all to cardiovascular issues, but sodium fluoride was used to stimulate bovine cells. The concentration of sodium fluoride used was 20mM – equivalent to 380 ppm fluoride. Well above concentrations found in drinking water and the recommended optimum level of 0.7 ppm. Not at all relevant to community water fluoridation and it simply does not support Pain’s claim.

Well, that’s enough. I am not going to search Pain’s “references therin.” Nor will I bother with any of his other claims or cited references. I think you get the picture.

Conclusions

Geoff Pain

Anti-fluoride campaigners always promote people like Paul Connett and Pain as “renowned” or “world experts.” They aren’t

People like Geoff Pain promote themselves as “renowned” experts on community water fluoridation – but they simply aren’t. Surely the dishonest way Pain has used citations in the article considered here illustrates this. And we can be sure that he has approached his other fluoride articles in the same way.

So there is a warning. Just don’t be impressed by large numbers of references. Check them out – or at least check some of them out. If you find the references you check do not support the claims being made, or are maybe even completely unrelated to the claims, then draw the obvious conclusions.

NOTE: I am contacting Geoff pain to offer him the right of reply here and a chance to enter into any discussion.

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Does community water fluoridation reduce diabetes prevalence?

diabetes

Maybe community water fluoridation reduces the prevalence of diabetes?

You will be seeing headlines claiming a link between community water fluoridation (CWF) and diabetes. Or even that fluoridation can predict an increase in the prevalence of diabetes. But they are misleading

These articles report results from a recently published study indicating that in the majority of situations CWF is linked to a decrease in diabetes prevalence. But many of these articles, and especially those from anti-fluoride activists are making opposite claims.

Why the confusion? Well, the study used modelling to relate a number of factors to the prevalence of diabetes. According to the model’s prediction CWF using fluorosilicic acid and sodium fluorosilicate is related to a decrease in diabetes prevalence. However, the saving clause for anti-fluoride activists is that the model predicts an increase in diabetes prevalence when the least common fluoridation chemical, sodium fluoride, is used.

A 1992 survey found that only 9% of the US population received water fluoridated with sodium fluoride – compared with 63% for fluorosilicic acid and 28% for sodium fluorosilicate. I got the latest figures from a fluoridation engineer at the US Center for Disease Control. The current figures are 75% for fluorosilicic acid, 13% for sodium fluorosilicate and 7% for sodium fluoride.

In New Zealand only on water treatment plant for a small community uses sodium fluoride.

So this subheading by the Fluoride Action Network (FAN) is completely  misleading – “Regression analyses suggest association between increases in consumption of fluoridated water and type 2 diabetes.” The only way anti-fluoride propagandists can make mileage out of this study is by deliberately ignoring the results indicated for over 90% of the population!

Perhaps supporters of CWF should be the ones reporting and promoting this study – arguing that CWF could reduce diabetes prevalence! However, I would not push that idea on the basis of a single report. This study has a number of deficiencies – and recommendations should not be based on individual cherry-picked studies anyway.

This is the paper reporting the study:

Fluegge, K. (2016). Community water fluoridation predicts increase in age-adjusted incidence and prevalence of diabetes in 22 states from 2005 and 2010. Journal of Water and Health.

Here are some of the problems I see with it.

Insufficient consideration of confounders

It is a modelling study looking for correlations between selected parameters. Such studies often suffer from little or no consideration of important confounders. Statistically significant correlations can disappear when such confounders are later included. For example, consider my criticism of the Malin and Till (2015) ADHD study – see ADHD linked to elevation not fluoridation and ADHD link to fluoridation claim undermined again.

Fluegge included obesity prevalence and leisure time physical inactivity as confounders but more could have been considered.  One that sticks out like a sore thumb to me is the community size. It could be that the sodium fluoride data he used could be acting as a proxy for community size as these days sodium fluoride is usually only considered for small water treatment plants.

Adjustment of fluoride exposure data

Fluegge compared his model prediction for diabetes prevalence using two different measurements of fluoride exposure – drinking water fluoride concentration (ppm) and an adjusted estimate of fluoride intake (mg/day). His estimation was made from per capita domestic water deliveries per county. I find this questionable as the proportion of water consumed will vary by location where there are different requirements for things like lawn and garden watering, car washing, swimming pools etc.

Whereas the drinking water fluoride concentration showed a negative correlation with diabetes prevalence (the prevalence decreased with increasing fluoride concentration), the adjusted exposure values showed a positive correlation (the prevalence increased with increasing fluoride concentration). He declared the second correlation more “robust” but his reasons seem more related to confirmation bias than any proper analysis.

Confused discussion

Fluegge seems completely unaware that sodium fluoride is now only rarely used as a fluoridating chemical. He even suggests a possible policy outcome of his research could be switching from sodium fluoride to fluorosilicic acid!

He refers to Hirzy et al. (2013) claiming it showed cost savings from using sodium fluoride but critiques Hirzy for not including consideration of effects on diabetes prevalence. He seems completely unaware that Hirzy’s paper was discredited and he had to withdraw its claims about cost savings.

This suggests to me that Fluegge is not familiar with fluoridation research. In fact, his very brief publication history indicates his interest is more associated with cherry-picking various health measures to find fault with by using statistics and modelling.

How reliable is the modelling?

I have drawn attention to possible problems with poor selection of confounders and lack of familiarity with the fluoridation literature. But there may also be problems with the modelling methods used.

I do not have the modelling skills or time to delve into his model in any depth but note there has been some controversy about another modelling paper he was involved in.

He co-authored a paper with his brother claiming a link between glyphosate and ADHD. This created some controversy because it was rejected by the journal and then published by mistake. So the journal had to retract the paper. You can read about it at Retraction Watch – A mess: PLOS mistakenly publishes rejected ADHD-herbicide paper, retracts it.

The paper was rejected because it did not satisfy the standards of experimental and statistical analysis required, or describe these in enough detail. Also because the conclusions were not presented in an proper way or supported by the data.

OK, we should not discredit future work because an earlier paper was rejected, even for the given reasons. Authors can learn from their mistakes. But it does ring warning bells. With this history, I would prefer a deeper critique of the methods used and the reliability of his conclusions.

These questions just underline my warning that one should never base policies, or final interpretations, on single papers – especially cherry-picked ones. Conclusions should be based on a more complete reading of the scientific literature.

Conclusions

So, always take headlines with a grain of salt. In this case they will be completely misleading – especially if promoted by anti-fluoride activists.

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“Filtering” out fluoride

filter TWBTFLPB1

Systems for removing fluoide from tap water can cost less than $300

Many anti-fluoride campaigners and their sympathisers use “filters” to remove fluoride from their tap water. Despite this, they will often claim the procedure is “too expensive” for the ordinary person – or that it is ineffective.

Fluoride Free Nelson (FFN) combined both reasons in this exchange on their Facebook page.

fluoride size

But she is wrong on both counts. Suitable water filters can be relatively cheap (just do an on-line search  to check this out) and they just do not work by filtering out particles. The argument that fluoride “is so small most filters do not remove it at all” is naive. FFN does not understand how these systems work and her advice is completely unreliable.

Firstly, The word “filter” is commonly used but is technically not correct for “filters” that remove fluoride. Filtration is usually understood to involve removing particulate matter, and not soluble ions. The actual mechanism of fluoride removal is not by filtration of particles.

Yes, some “filters” do not work with fluoride – because they are not intended to. Activated charcoal is great for removing organic matter and tastes – but is not mean to remove anions like fluoride.

Apart from distillation, there are three ways for the ordinary consumer to remove fluoride and similar anions from tap water – anion exchange, surface adsorption and reverse osmosis. Here is a brief description of each method but readers can also refer to a useful local report:

National Fluoride Information Service (2012). Household water treatment systems for fluoride removal.

Anion exchange

This involves attraction of negatively charged anions like fluoride by positively charged surfaces. Water is passed through a bed of anion exchange material which has positive charges on its surface balanced by negatively charged anions like chloride (Cl) or hydroxide (OH).

Anion exchanger

Anion exchange particle. Positive surface charges are balanced by negatively charged ions.

Anions like fluoride in the tap water replace the existing charge-balancing anions on the exchanger. For example:

Exchange

Fluoride anion in tap water replace chloride anions on the surface of the anion exchanger.

Of course, these anion exchange cartridges eventually become saturated with fluoride or other anions being removed, and their efficiency drops. They are then replaced or recharged by flushing with the proper salt solution.

Surface adsorption

Interaction of fluoride anions and anion exchangers is basically a physical electrostatic one. But some filters rely on a chemical interaction where the fluoride anion reacts with the surface to form a chemical bond. Absorbents like bone char and alumina are common.

Bone char is made from cow bones and is a high surface area, porous calcium phosphate (apatite) providing active calcium for reaction with fluoride. Alumina provides a surface containing active aluminium which reacts with fluoride.

The chemical reactions occurring at the surface of these materials are of the form:

surface reaction

 

alumina F

Schematic of a water filter using alumina. Source: National Fluoridation Information Service.

The efficiency of both the anion exchange and surface adsorption methods can be improved by the way the filter is set up, the use of pre-filters, etc. And by regular recharging or replacement of cartridges.

Reverse osmosis

This relies on the ability of certain semi-permeable membranes to allow transport of water molecules but not ions like fluoride. So much for the naive concept that fluoride anions are too small to be filtered out of water.

It gets its name from the phenomena of osmosis which is probably familiar to most school children. Remember the experiment where pure water would pass through a membrane into a solution of sugar or salt – but water from the sugar or salt solution could not pass through into the pure water.

reverse osmosis 1

A semi-permeable membrane is a membrane that only allows through molecules of a certain size or smaller. The cell membranes of plants and animals are semi-permeable membranes, they let water molecules pass through while keeping out salts. Image credit: Solar-Powered Desalination Plants.

That creates an osmotic pressure. Reverse osmosis involves applying pressure to the sugar or salt solution (or whatever solution needs purifying). This causes pure water to flow through the membrane and the contaminants to stay behind providing a way of removing ions and molecules from the original water.

This schematic animation shows how reverse osmosis works in practice – although the membranes are rolled into cylinders to provide a greater surface area and increased efficiency.

reverse-osmosis-info-anim

Image credit: Reverse Osmosis Works

Consumers can use either of these methods to remove fluoride from tap water if they choose. While the equipment varies in price and sophistication, like any household appliance, relatively cheap systems are available.

These do work – just beware of claims made about low efficiency as often measurements are made with inappropriate “filters” like activated charcoal, or on systems that have been used for a time and need recharging.

That “freedom of choice” we keep hearing about is available and it is relatively cheap.

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Is water fluoridation better than salt fluoridation?

Salt

Discussion of fluoridation here concentrates on community water fluoridation. But some countries (parts of Europe, and Latin America, for example) fluoridate their salt instead of their water.  This could be for a number of reasons – the state of the water reticulation system, or political opposition to water fluoridation, etc.

The effectiveness of community water fluoridation in reducing tooth decay is well established by research, but there has been far less research on the effectiveness of salt fluoridation. Evidence suggests the effectiveness of the two fluoridation methods is similar but new research from Latin  America found water fluoridation significantly better than salt fluoridation.

It’s a very good study, large numbers of subjects and good consideration of possible confounders. But the authors themselves suggest their findings are more relevant to developing countries than developed countries with better oral health systems.

The paper is:

Fabruccini, A., Alves, L. S., Alvarez, L., Alvarez, R., Susin, C., & Maltz, M. (2016). Comparative effectiveness of water and salt community-based fluoridation methods in preventing dental caries among schoolchildren. Community Dentistry and Oral Epidemiology.

The researchers used data from survey of the oral health of 1528 twelve-year-olds in Porto Alegro, South Brazil  (water fluoridated) and 1154 twelve-year-olds in Montevideo, Uruguay (salt fluoridated). Diagnostic procedures were standardised and the data adjusted for gender, maternal education, school type, brushing frequency, use of dentifrice, professional fluoride application, access to dental services and consumption of soft drinks.

Caries prevalence and decayed missing and filled teeth (DMFT) were measured using standard WHO procedures, and modified WHO procedures (which also included noncavitated lesions).

The graphs below show the adjusted data for caries prevalence (%) and DMFT.
Caries water salt

DMFT water salt

Both caries prevalence and DMFT were significantly higher for children from salt-fluoridated Montevideo than similar children from water-fluoridated Porto Alegro.

Apparently this is the first study showing a statistically significant difference between water and salt fluoridated areas. Similar studies in Freiberg, Germany and Dublin, Ireland had shown no signficant differences. The larger sample sizes of the current study may have contributed to the difference. However, the authors also warn that the different situations may also be a factor.

Developing countries have higher prevalence of caries and poorer access to others sources of fluoride than developed countries. Whereas water fluoridation reaches the whole population fluoridated salt may not have such a regular use. In Uruguay the salt fluoridation programme is limited to salt for domestic use. It does not cover public and private canteens, restaurants and bakeries (which the WHO recommends).

So, an interesting study with a clear result – but one that should not be cherry picked to confirm a bias. It indicates community water fluoridation will probably be more effective than salt fluoridation in developing countries – especially if a salt fluoridation programme is not complete. But this should not be used to argue against a good salt fluoridation programme in developed countries.

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Ethics and the doping scandal – a response to Guest Work

Rodchenkov

Grigory Rodchenkov, Russia’s sacked anti-doping lab director. Considered a criminal in Russia and a “whistle blower” in USA. Credit: Emily Berl for The New York Times

International Olympic Committee (IOC) decisions about participation of athletes from the Russian Federation in the Rio Olympics have brought both criticism and support – from the political as well as the sporting communities.

The issues of sports doping, the responsibilities and actions of sporting bodies and the political context and factors all need discussing. So I am pleased to see a Guest Work blog post at SciBlogs from Ian Culpan discussing the ethical questions involved (see Ethics, Doping the Olympics and Russia).

But I think the article missed important ethical considerations and I do not think the issue can properly be discussed without these. To me the following ethical and legal principles, which Ian did not discuss, are central:

  1. Proper testing of claims and evidence;
  2. Presumption of innocence until proven guilty;
  3. Inadmissibility of collective punishment
  4. Avoiding direct or implied political direction in decision-making.

A brief background

The Russian Federation does have a problem with sports doping. It should be in everyone’s interests for this to be dealt with. Interestingly, the Russian national officials and politicians do appear to be cooperating with international sports bodies. They have transferred testing of athletes to non-Russian laboratories. Officials (including the deputy Minister of Sport) implicated by Richard McLaren’s World Anti-Doping Authority (WADA) commissioned report have been suspended pending investigation. The President himself has urged officials not to react defensively but to deal with the problem.

Grigory Rodchenkov, the former head of Moscow’s anti-doping laboratory, was a key figure in the current scandal. He was taking bribes to supply illegal drugs to athletes and (apparently) to enable falsification of test results. When he was sacked and criminal proceeding taken against him he fled to the US. Now treated as a “whistle blower” instead of a criminal he made charges implicating higher officials in the doping scandal. His claims made in a May New York Times article (see Russian Doctor Explains How He Helped Beat Doping Tests at the Sochi Olympics) sparked the decision of the WADA to commission the McLaren report.

Richard McLaren’s report effectively supports Rodchenkov’s claims and found Rodchenkov to be trustworthy. But this appears to be McLaren’s opinion, rather than a conclusion based on testing of claims and evidence. There was no attempt to interview officials in the Russian Federation which is surely required for a proper evaluation. And results of the “forensic testing” commissioned by McLaren (DNA data and testing the methods for removing and replacing seals on sample vials and scratches on the vials) are not even included in the report. We are asked simply to accept his judgment on these.

I agree, the time limit of 57 days may well be to blame but in the absence of presentation of the forensic evidence, relying on the claims of an obvious criminal and lack of any consideration of evidence from Russian officials I think Culpan’s judgment the report “seems to contain irrefutable evidence” is just not valid. To interpret a situation where there had been no opportunity given to refute as meaning the evidence was “irrefutable” is hardly fair. Or ethical.

The reliability of the McLaren report and the information he gathered appears to be unravelling – according to articles in The Australian (unfortunately behind a pay wall but see WADA ‘sexed up’ anti-Russia case, implicated clean athletes – Australian media, citing officials). These claim the president of the Australian Olympic Committee, John Coates, who is also an IOC vice president, wrote to Australia’s Health Minister Susan Ley, saying that the IOC had a “lack of confidence in WADA.” There are also problems with the list of “implicated” Russian athletes not named in McLaren’s report but provided to the sporting federations by McLaren. The Australian cites a senior sports official as saying “We were asked to make a judgment about Russian competitors based on McLaren’s report but without having any of the detail to understand the significance of them being named.”

For Richard McLaren’s description and defence of his work see ‘No time to ask Russia’s opinion, I had enough evidence anyway’ – WADA doping report author to RT

Unwarranted judgments are easily made in the context of the current geopolitical struggle and the resulting information war. They can have consequences which are hardly ethical and I think Richard McLaren himself is concerned about this. He said recently:

“The focus has been completely lost and the discussion is not about the Russian labs and Sochi Olympic Games, which was under the direction of the IOC.”

“But what is going on is a hunt for people supposed to be doping but that was never part of my work, although it is starting to (become) so.’’

“My reporting on the state-based system has turned into a pursuit of individual athletes.’’

This treatment of individual Russian athletes, which was described as being like a “Stalinist witch hunt” by one commentator, is what concerns me. I think this raises ethical issues.

Presumption of innocence

This seems so fundamental to our legal (and ethical) system I just cannot see why critics of the IOC have been so prepared to ignore it – or worse, knowingly violate the principle.

Many Russian athletes who have never had a positive drug test have been denied the opportunity to participate in the Rio Olympics. The criteria applied to other Russian athletes has been much harsher than for other nations with sometimes impossible demands being made to prove a long history of clean test results. While athletes from other nations who have been found guilty in the past of doping and “served their time” in suspension are able to compete this is not the case for Russian athletes.

These clean athletes justifiably ask “Why me?” Russian sports fans may well be thoroughly disappointed by this scandal and particularly with athletes and officials who have found to be guilty of doping. But you can understand they are also angry at the unfairness of such discriminatory and unethical judgments made against their clean athletes.

Collective punishment

Punishing clean athletes for the crimes of those who used doping is simply collective punishment. It brings to mind the actions of Nazi occupiers in Eastern Europe who killed innocent villagers (or in some cases killed entire villages) as collective punishment for the actions of partisans. For the life of me, I cannot see how those critics who believe that the entire Russian Olympic Team should have been punished for the (as yet unproven) crimes of some officials consider they occupy the “moral high ground” as Culpan appears to argue.

Not that collective punishment is anything new when it comes the history of staging important international events by the Russian Federation (and the previous USSR). In the 1980s we saw boycotts of the Moscow and San Francisco Olympics. Attempts at collective punishment of entire nations because of disagreements in the international political arena.

There were attempts to inject political issues into the Sochi Olympics, and even promoting the idea of boycotts,  and who seriously doubts that there will be political attempts to harm, or even prevent, the 2018 World Football Cup in the Russian Federation.

Yet, international sporting and cultural events offer great opportunities to encourage goodwill and understanding between nations. They should not be used as weapons in the geopolitical struggle – because that, in turn, only enhances that struggle and harms peace.

Political motivations can prevent a solution

Fortunately, the IOC avoided a blanket ban on athletes from the Russian Federation, despite coming under political pressure to do so. The consequences of such an unprecedented and radical step may have been unpredictable but include a possible break-up of the Olympic movement. This would not have solved the sports doping problem.

As things stand there is now room for progress in a proper investigation of the charges made by Rodchenkov – particularly those suggesting the involvement of state officials. Such serious charges, made by someone facing criminal action, should not be left as they are without a proper balanced investigation. And this investigation must involve officials and legal bodies from the Russian Federation. It is hardly surprising that McLaren’s report is now being described as unfinished. The Australian articles reported IOC spokesman Mark Adams as saying:

“To have someone who didn’t (commit) a competition doping offence but was counted as such is a very dangerous thing. We encourage a full report by Professor McLaren before we make any full and frank ­decisions.’’”

Surely such a proper investigation will have more chance of eliminating Russian sports doping and corruption than external allegations primarily based on claims made by someone fleeing criminal proceedings.

Finally, we should not allow the current concentration on Russian sports doping to fool us into thinking it is only, or even primarily, a Russian problem. The fact is that sports doping is world-wide and there is plenty of evidence that international sporting bodies themselves are not free from corruption.

I presented the most recent official data from WADA n my article Quantifying the problem of international sports doping. This showed that the proportion of positive doping tests for Russian athletes was just less than average for the whole world. More importantly, there are a number of nations with a higher proportion of positive doping tests than the Russian Federation – including India, France, Belgium, Mexico and Turkey.

proportion

Yes, the data was for 2014. It did not (could not) cover the current Russian doping scandal or the McLaren report. But let’s not rely on an unethical presumption of guilt to discredit the data.

Let’s not allow geopolitical differences and prejudices get in the way of battling the sports doping problem.

And let’s not allow such differences to lead us to ignore important ethical principles.

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Misrepresenting fluoride science – an open letter to Paul Connett

Connett Blenheim

A poster for Connett’s Blenheim meeting – scaremongering because there is no proposal for mandatory fluoridation in New Zealand.

A new year and a new speaking tour of New Zealand by US anti-fluoride campaigner Paul Connett. Looking over the presentation he is giving at his New Zealand meetings I find he has absolutely nothing new to say. It’s all been said before – and all his claims have been debunked before.

His visit this year is slightly unusual – the first time I am aware he has visited in winter. Perhaps the local anti-fluoride movement has decided they need to get him early because of the impending introduction of new legislation on community water fluoridation (CWF).

In this open letter to Paul, I respond briefly to the points he makes in his current presentation and will link to a fuller discussion of each point in earlier posts. Many of these links will be to my debate with Paul Connett 3 years ago. You can download the full debate (Connett & Perrott, The Fluoride debate – 2014) or find the individual posts at Fluoride Debate.

Finally, I have offered Paul the right of reply here. I believe that participation in a good-faith discussion is the most scientifically ethical response to my open letter.


Dear Paul,

I wish to challenge claims you made in your 2016 New Zealand speaking tour. Most of these claims were refuted in our 2013/2014 debate but it is worth itemising some of them here because you are continuing to rely on them.

I, of course, offer you the right of reply and access to an open good faith discussion here if you feel I have misrepresented you in any way.

Fraudulent charges of scientific fraud

Fraud claim

From Connett’s 2016 New Zealand presentation

Scientific fraud is an extremely serious offence and accusations should not be made lightly. Yet you have accused New Zealand scientists involved in the Hastings trial of scientific fraud without even citing the study’s reports or publications. You have relied simply on an out-of-context sentence in a letter from a departmental official and unsubstantiated claims about changes in methodology. I pointed this out to you in our 2013/2014 debate  yet you are persisting in this defamation of researchers who are no longer here to defend themselves. You have even gone as far as producing an internationally distributed newsletter entitled “New Zealand Fluoridation Fraud” which was promoted by Fluoride Free NZ activists in this country.

You base your charge of “fraud'” on:

  1. An out of context quote from an internal letter by a director,
  2. Abandonment of Napier as the planned control city at the beginning of the study, and
  3. Alleged changes in the diagnostic procedures used during the course of the trial.

1: A letter from a divisional director expressing his frustration at developing a description “with meaning to a layman” is not evidence of “fraud,” or an attempt to distort the evidence. Scientists are always being urged by officials to make their findings more accessible and understandable to the public.   Your presentation of it as such is equivalent to the 2009/2010 “climategate” misinformation campaign launched by climate change deniers using out-of-context quotes from scientists emails. In that case, we know the real fraud was carried out by those attempting to deny the science and discredit the scientists.

2: Yes, the original plan was to use Napier as a control non-fluoridated city alongside the fluoridated city of Hastings. This was abandoned when data showed a lower incidence of tooth decay in Napier and it was judged unsuitable as a control because of differing soil chemistry which would have introduced an extra confounding factor. While this reduced the Hastings experiment to a longitudinal study, comparisons were made with other non-fluoridated New Zealand cities.

Surely this was a sensible solution to a problem? – and these are always occurring in long-term studies as any researcher familiar with such studies will confirm. Yet, in our debate, you irresponsibly described these reasons as “bogus.” As I said in our debate:

“That is the problem with conspiracy theories – they paint the world black and white which is very unrealistic. I expected far more professionalism from Paul than this.”

This is not the sort of rational assessment expected from a scientific review but sounds more like the declaration of a biased political campaigner.

3:  The diagnostic procedure used in the Hastings experiment were described in the first paper of the series reporting results (Ludwig 1958). Subsequent papers (Ludwig and Ludwig, et al., 1959, 1962, 1963, 1965, 1971) refer to this description and confirm it continued to be used. So where is the evidence for a change in diagnostic procedure?

Yes, there were changes in tooth filling procedures used by New Zealand dental nurses around the time this trial started. But even the anti-fluoride  Colquhoun & Wilson (1999) confirm attempts were made to use a consistent filling procedure in the trial – quoting from a file they received from their Official Information Act request:

“At the commencement of the Hastings fluoridation project steps were taken to ensure that the practice of preparing prophylactic type fillings by dental nurses was discontinued.

Of course, longer term trial like this always have a possibility of technician (or dental nurse) differences and good trial managers attempt to reduced such differences.

Perhaps one way to confirm that such “teething problems” (pardon the pun) did not have an overriding effect is to see that the improvements in oral health measured as differences from the 1954 start were also observed if 1957 was taken as the start (and also for later dates). In our debate I showed this to be a fact using the graphs below.

Hastings data shows similar improvement in oral health even if the project had started in 1957. Plots are for different ages.

Paul, you description of honest research, no matter what its limitations, as fraudulent is irresponsible. Considering your motives for this description and the way you have distorted the situation I would even describe your behavior itself as fraudulent.

Misrepresenting WHO data.

You repeat the same misleading interpretation of the World Health Organisation (WHO) data that we discussed in our debate where you attempted to avoid my criticisms and in the end did not have a sensible response. Despite the refutation, you continue to promote the following misleading graph every chance you get (see also Fluoridation: Connett’s naive use of WHO data debunked):

WHO data

Slide from Connett’s 2016 New Zealand presentation

These data do not support your claim of no difference between the rates of improvement of oral health in fluoridated and unfluoridated countries because there is no attempt to account for all the different factors influencing dental health. Robyn Whyman pointed this out in his report for the National Fluoridation Information Service – Does delayed tooth eruption negate the effect of water fluoridation?:

“Inter-country comparisons of health status, including oral health status, are notoriously difficult to interpret for cause and effect, because there are so many environmental, social and contextual differences that need to be considered.”

It is far more rational to compare regions within countries and you have purposely omitted the WHO data where fluoridated and unfluoridated areas within individual countries were compared.

Here is that WHO data for Ireland which shows a clear benefit in fluoridated areas.

As I said in my post Fluoridation: Connett’s naive use of WHO data debunked:

“I showed this graph to Connett at the beginning of our debate on fluoridation. throughout the next few months he continued to confuse the issue and I kept coming back to it. Finally, he said in his closing statement, “My apologies. I should have checked back.”

An acknowledgment, of sorts, that his use of the WHO data is wrong in his graphs – but he continues to misrepresent it in this way!”

Isn’t it about time you stopped promoting this invalid and misleading use of the WHO data?

Nexo and ChildSmile are complimentary to CWF – not alternatives

Nex and CS

From Paul Connett’s 2016 New Zealand presentation.

You are being disingenuous in promoting oral health programmes like the Danish Nexo and Scottish ChildSmile programmes, as “alternatives” to community water fluoridation (CWF). Health authorities do not see them as alternatives – more as possible complimentary social programmes. The British Dental Association supports both the Scottish ChildSmile programme and CWF. In Scotland it has come out publicly called for communities to move towards introducing water fluoridation. In the absence of CWF, UK health professionals see ChildSmile as “the next best thing – a rather expensive substitute for the fluoridation schemes that have never been introduced.”

I discussed the ChildSmile programme in my article ChildSmile dental health – its pros and cons and in our debate (see Fluoride debate: Ken Perrott’s closing response to Paul Connett?). It, and the Nexo programme, use approaches of child and parent education, toothbrushing supervision and programmes, and  health education initiatives based principally on public health nurses and health visitors attaching themselves to particular schools in order to give oral health advice to children and parents. Subject to parental consent, they also arrange for children who are not registered with a dentist to undergo check-ups and, if necessary, treatment.

Both programmes also provide regular fluoride varnishes for children’s teeth (so much for being an alternative to fluoride).

The point is that elements of these programmes are probably already incorporated into the social health policies of many countries. They certainly are in New Zealand. The introduction of a social health policy like CWF does not mean that programmes like the Nexo and Childsmile, or elements of them, are abandoned by health authorities. The research still shows that CWF reduces tooth decay even when other programmes like this, the use of fluoridated toothpaste and restriction of sugar consumption are practiced (see for example Blinkhiorn et al., 2015).

Interestingly, though, because sometimes programmes like tooth varnishes are targeted at the more vulnerable children in non-fluoridated areas these may lead to difficulties in drawing conclusions from simple comparison of fluoridated and unfluoridated areas. I discussed this in my article on mistakes in one of John Colquhoun’s  papers – Fluoridation: what about reports it is ineffective? – where children from non-fluoridated areas received preferential fluoride varnishing.

There is no single “silver bullet,” for solving the problem of tooth decay so why not use programmes like CWF and Childsmile/Nexo, or elements of the these, together?

In fact, that is exactly what is happening in New Zealand.

Asserting CWF out of step with the science

You claim:

“A better guide as to what nature thinks about the safety of fluoride is the level found in mother’s milk.”

This is simply weird, a naive example of the naturalistic fallacy.

Nature doesn’t think – such an arguments could be used against everything humanity has done to ensure that we have a better quality and length of life than “offered by nature.” As I pointed out in our debate, we are used to other elements being deficient in mothers milk and therefore requiring supplementation (see also Iron and fluoride in human milk for discussion of an evolutionary perspective vs a naive appeal to nature).

Your assertion:

“in mammals not one single biochemical process has been shown to need fluoride to function properly”

is simply deceptive – knowingly so. Fluoride may not play a biochemical role but it does play a chemical one. It is a normal and natural component of bioapatites – bones and teeth. And when present in optimum amounts confers strength and low solubility. Surely as a chemist you are familiar with the fact that minerals like apatite usually do not occur in the ideal form, as end members of a chemical series. In practice, no bioapatites are “fluoride-free.”

I demonstrated the difference between real world apatites and the ideal end members in our 2013/2014 debate using this figure. As a chemist this should be obvious to you.

apatite-2

In the real world bioapatites like bones and teeth always contain fluoride as a normal and natural constituent. The end members hydroxylapatite and fluoroapatite are not real models for natural bioapatites.

You claim that:

“With fluoridation: the chemicals used are not pharmaceutical grade but contaminated waste products from the phosphate fertilizer industry.”

But none of the chemicals used in water treatment, or the water itself, are of  “pharmaceutical grade.” Water plants and water treatment have their own grading system for the chemicals used.

In fact, comparing the certificated concentrations of contaminant elements in fluoridating chemicals used with the same contaminants already in the source water, we find that fluoridating chemicals are not a real source of contamination. We should be more concerned about the source water itself. I presented data to show this in my article Chemophobic scaremongering: Much ado about absolutely nothing. In most cases contamination from the fluoridating chemical is less than 1% of the contaminant concentration already in the source water.

Your reference to “contaminated waste products” is simply naive (or dishonest since you have chemical training) chemophobic scaremongering

Misrepresenting facts on dental fluorosis

dental fluorosis

Paul Connett cites an irrelevant figure in his 2016 New Zealand presentation.

Your claims regarding dental fluorosis are presented as an argument against CWF and in that context are very misleading:

1: The deceit of not identifying contribution from CWF.

Your slide refers to all forms of dental fluorosis and to all areas – fluoridated and fluoridated. It is very misleading to infer that CWF is responsible for a dental fluorosis prevalence of 41%  of dental fluorosis. In fact, CWF makes only a small contribution – often not detectable as was the case with the New Zealand Oral Health survey illustrated below (see Dental fluorosis: badly misrepresented by FANNZ).

Unfortunately, even the recent Cochrane Fluoridation Review (Iheozor-Ejiofor et al., 2015) mistakenly presented the dental fluorosis data without differentiation between fluoridated and non-fluoridated areas. My calculations from their data indicated tyhe prevalence of dental fluorosis due to CWF is more like 7% – much less than your 41% (see  Cochrane fluoridation review. III: Misleading section on dental fluorosis).

2:  Scaremongering by not differentiating between mild and severe forms.

Your 41% sounds scary – especially with the implication it is caused by CWF. But at least your acknowledge that the prevalence of more severe forms is much less. That is obvious from my figure above and from your later slide acknowledging a 3.6% prevalence of moderate and severe dental fluorosis in American teens.

This figure from the National Research Council review shows that CWF (which usually uses a concentration of 0.7 ppm) does not contribute at all to severe dental fluorosis.

Severe-dental-fluorosis

Usually only the moderate and severe forms of dental fluorosis are considered of aesthetic concern – and the milder forms are often judged favourably by parents and teenagers.

What you did not say is that CWF does not contribute at all to moderate and severe forms. These forms are completely irrelevant to the discussion of CWF and it is dishonest to use it as an argument against CWF. Again, my calculation from the Cochrane data indicates the contribution of CWF to dental fluorosis of aesthetic concern was within the measurement error.

If you are really concerned about dental fluorosis, and especially the more severe forms of aesthetic concern, you should be paying attention to high natural sources of fluoride in some regions, industrial pollution and the possibility of obsessive consumption of toothpaste by children.

Brain damage?

Brain

Wild claim by Connett in 2016 New Zealand presentation. There is absolutely no evidence that CWF is harmful to the brain.

Paul, you have been uncritically dredging the scientific literature for articles you can use to imply fluoride is toxic or a neurotoxicant. Of course you will find studies supporting your bias that you can cherry-pick. A similar uncritical dredging will produce far more articles showing water is toxic! Such confirmation bias is scientifically unethical. We should always read the scientific literature intelligently and critically.

Applying a bit of objectivity we see that almost all the studies you rely on use exposure levels far greater than the recommended levels for CWF. Many of the animal studies considered exposure 50 to 100 times those levels or more. The quality of many of the research reports you rely on is not good – a point I think you have acknowledged in the past.  The human studies you rely on have, almost without exception, involved regions of endemic fluorosis quite unrepresentative of regions where CWF is used (I discuss the two exceptions below). None of them properly considered relevant confounding factors.

The exceptions

You promote Malin and Till (2015) as evidence that CWF causes attention deficit hyperactivity disorder (ADHD). You have made no critical assessment of that study. If you had you would have found that when relevant confounders like altitude, poverty and home ownership are included there is not statistically significiant relation of ADHD prevalence with CWF. I demonstrated this in my article ADHD linked to elevation not fluoridation. Coincidentally, the importance of altitude was confirmed in another study which you completely ignore. That study is:

Huber, R. S., Kim, T.-S., Kim, N., Kuykendall, M. D., Sherwood, S. N., Renshaw, P. F., & Kondo, D. G. (2015). Association Between Altitude and Regional Variation of ADHD in Youth. Journal of Attention Disorders.

Unfortunately, the scientific literature is full os such inadequate studies where confounding factors are ignored. Great for confirming biases but, by themselves, absolutely useless if we want to get to the truth.

Peckham et al., (2015) is another example you use. They claimed a relationship of hypothyroidism with CWF but refused to include iodine deficiency (a well established cause of hypothyroidism) in their statistical analysis.

Studies from areas of endemic fluorosis

You extract a lot of mileage out of the studies by Xiang and his coauthors (eg Xiang et al., 2003) – and they are probably the better studies in your collection. But even here your confirmation bias leads you to draw unwarranted conclusions. I showed this in my articles Connett fiddles the data on fluorideConnett & Hirzy do a shonky risk assesment for fluoride and Connett misrepresents the fluoride and IQ data yet again.

For example you claim (correctly) that Xiang found a statistically significant correlation of IQ with urinary fluoride. But a dispassionate consideration of the data shows this relationship explains only 3% of the variance in IQ. I suggest to you that inclusion of some relevant confounders in the statistical analysis would probably cause the correlation with urinary fluoride to be non-significant. This parallels the situation reported by Malin and Till (2015) for ADHD (and here they were able to explain over 20% of the variance in prevalence of ADHD by fluoride – before inclusion of confounders like elevation when the explanatory power of fluoride disappeared).

You have from time to time acknowledged the poor quality of the reports you rely on regarding fluoride and IQ but have said that “there must be something in it” because there are so many reports. There may well “be something in it” but you will not make progress by jumping to your ideologically motivated conclusions favouring chemical toxicity. Just think about it. Those studies occurred in areas of endemic fluorosis – where skeletal fluorosis and severe dental fluorosis are common. It is reasonable to expect such disfiguring and disabling diseases may impact the quality of life, learning ability and IQ of inhabitants. I suggested this mechanism for explaining the data in my article Severe dental fluorosis and cognitive deficits.

CWF is never used in areas of endemic fluorosis so such an effect on cognitive abilities would not occur. And that is consistent with the existing studies which do not show and IQ deficits resulting from CWF (see, for example, Broadbent et al., 2014 and my article IQ not influenced by water fluoridation).

Paul, you are disingenuous to pose the question in your presentations:

“What primary studies (not self-serving government reviews) can you cite that allow you to confidently ignore or dismiss all the evidence of fluoride’s potential to damage the brain?”

We must remember that this is posed in the context of your campaign against CWF and there is no primary study, or review, indicating “potential damage to the brain” from CWF. When you assert “Over 300 studies have found that fluoride is a neurotoxin” you are relying on animal studies where high concentrations of fluoride were used and poor quality studies from areas of endemic fluorosis. None of the studies you rely on are relevant to CWF. It is simply unprofessional scaremongering to promote these sort of political messages:

neurotoxin

Scaremongering slide from Connett’s 2016 New Zealand presentation

I demonstrated in my article Approaching scientific literature sensibly how such uncritical dredging of the literature is meaningless. A Google Scholar search for  produced 2,190,000 results for water toxicity but only 234,000 for fluoride toxicity. So let’s paraphrase your question:

“What primary studies (not self-serving government reviews) can you cite that allow you to confidently ignore or dismiss all the evidence of  water’s potential to damage the body?”

Misrepresentation of evidence supporting CWF

Randomised control trials

Again you raise the red herring of the lack of randomised controlled trials (RTCs) showing CWF effective. As I pointed out to you in our 2013/21014 debate  there is also a lack of RTCs showing CWF not effective – and that must surely tell you something. Simply there are no RTCFs on the subject (although there are on other forms of fluoride delivery like fluoridated milk – see Stephen et al., 1984).

The fact is that such trials are practically impossible with social health measures like CWF. The American Academy of Pediatrics comments in their article on the Cochrane Fluoridation Review:

“it would be a logistical nightmare to try creating a public water system that pumps fluoridated water to the first house on the block, delivers non-fluoridated water to the following two houses and then provides fluoridated water to the 4th and final house on that block.”

This was acknowledged by the Cochrane Reviewers in their discussion. Your mate, and fellow member of the Fluoride Action Network leading body, Bill Osmunson, argues that such an RTC is possible. But his description of how it would be setup shows he is not really serious. He suggests that housing developments be built with several different water reticulation systems and houses be attached to these different systems by flipping coins!

There are some areas of investigation, such as drug efficacy, where RTCs are possible and ethical – but social health measures like CWF is not one of them. That does not prevent an objective analysis of all others sorts of investigation and data which enables health authorities and decision makers to make reliable decisions on such issues.

The Cochrane Fluoridation Review

Paul, I am shocked that with your scientific training you resort to a complete misrepresentation of the recent Cochrane Fluoridation Review (Iheozor-Ejiofor et al., 2015):

Cochrane 1

Connett misrepresented the findings of the Cochrane Fluoridation Review in his 2016 New Zealand presentations

Surely you are not that naive? The reviewers had selection criteria for inclusion of studies in their calculations. This excluded most modern cross-sectional  studies – on the basis of unavailability of data before CWF was started – not quality as you imply. Those restrictions meant they were unable to draw conclusions on the factors  in your slide – but they were discussed, and the studies cited, in the discussion section of the review. These non-selected studies do show that CWF is beneficial to adults (Griffin et al., 2007Slade et al., 2013), provides benefits even when fluoridated toothpaste is considered (see Water fluoridation effective – new study and Blinkhorn et al., 2015) and reduces social inequalities (Riley et al., 1999). The research also shows tooth decay increases when CWF is stopped (see Fluoridation cessation studies reviewed – overall increase in tooth decay noted and Mclaren & Singhal 2016).

How is it that you ignore the language in the review referring to limitations imposed by its selection criteria and then present their qualified conclusions as if they were facts. Can you not understand sentences like?:

“Around 70% of these studies were conducted before 1975. Other, more recent studies comparing fluoridated and non-fluoridated communities have been conducted.We excluded them from our review because they did not carry out initial surveys of tooth decay levels around the time fluoridation started so were unable to evaluate changes in those levels since then.”

Why did you persistently ignore the qualifications in their conclusions imposed by their selection criteria expressed in the common phrase?

“We found insufficient information . . . “

And, why did you purposely ignore the specific conclusion:

“Our review found that water fluoridation is effective at reducing levels of tooth decay among children. The introduction of water fluoridation resulted in children having 35% fewer decayed, missing and filled baby teeth and 26% fewer decayed, missing and filled permanent teeth.We also found that fluoridation led to a 15%increase in children with no decay in their baby teeth and a 14%increase in children with no decay in their permanent teeth.”

Yes, that was followed by the disclaimer “These results are based predominantly on old studies and may not be applicable today.” But that only means the reviewers could not draw specific conclusions about today because they had excluded modern studies.

You have purposely ignored the issues around study selection and presented their inability to draw conclusions as evidence that there is no effect. That is not a scientific assessment of the review – it is a blatantly propagandist exercise in cherry picking motivated by an ideological position. An exercise in public relations, not proper scientific assessment.

Topical vs systemic

I think one change that did come out of our debate is that you now tend to qualify you claims about the systemic and topical roles of fluoride in preventing tooth decay. You use words like “primary” and “predominantly.” But you still confuse the issue by arguing that topical action is quite separate from ingestion when you ask”

“If fluoride works primarily on the outside of the tooth why swallow it?”

The fact is that fluoride, calcium and phosphorus in dental plaque and saliva (to which the CDC attributes the topical action of decay prevention) occur through ingestion of these nutrients in food and water. It is naive to separate the reaction at the tooth surface from ingestion of food and beverage.

You also ignore completely the evidence that ingested fluoride plays a beneficial systemic role with developing and so far unerupted teeth (see Ingested fluoride is beneficial to dental health and Cho et al., 2014).

And let’s not forget about our bones which benefits from appropriate amounts of fluoride in our diet (see Is fluoride an essential dietary mineral? and  Yiming Li et al., 2001)

Use of PR techniques – You are the guilty party

I have shown here how you have distorted and misrepresented the science around CWF. In doing so you are behaving as an ideologically driven lobbyist – not an objective scientist. You are not intelligently and critically assessing the scientific literature – you are cherry-picking and selectively quoting to promote your own agenda.

Personally, I think this sort of behaviour is unethical for a scientist. Sure, we all have our biases and beliefs and this can influence our interpretation of the literature. But you are consistently misrepresenting the science – and continue to do so even after you have been shown wrong.

Perhaps this is unsurprising considering you are essentially a political lobbyist campaigning against a social health policy. You lead a lobby organisation – the Fluoride Action Network. This organisation receives finance from the “natural”/alternative health industry – most publicly from Mercola. According to tax returns you and other members of your family, personally receive monthly payments from these funds.

It hypocritical for you, then, to disparage honest scientists and their publications in the way you have done regarding the Hastings project. Your bias (and refusal to deal with the science) comes out in your description of scientific reviews and papers as “dummy reviews,” “bogus,” “self-serving government reviews,” etc.

In one of your final slides you claim the alleged PR tactics by scientists:

“Would not be necessary if science was on the promoters’ side – but it is not.”

In fact, it is you that are on the wrong side of the science and that is why you resort to misrepresentation, distortion, fear mongering and slander.

You also claim:

“After 6 years there has been no detailed or documented response to our book The Case Against Fluoride.”

And

“Proponents will very seldom agree to publicly debate either myself or other leading opponents of fluoridation.”

Yet, isn’t that exactly what I did in our Fluoride Debate of 2013/2014? And didn’t I give a platform on my blog for you to make all your points and to present the arguments from your book?

And isn’t it a fact that in most forums where your lobby against CWF you, in fact, lose because the scientific arguments against you prevail? You make a big thing of every single victory you achieve against CWF but are silent about the larger number of losses.

As we are discussing the refusal to debate let’s be honest. Your organisations, internationally and locally, attempt to prevent supporters of science from involvement in their discussion forums. I personally have been banned from all local anti-fluoride forums and from the Fluoride Action Networks Facebook forum.

This suggests to me that neither you nor your supporters are willing to take part in a good-faith discussion of the science around CWF. You are simply behaving like a political and commercial lobbyist – not a scientist for whom such discussion should be welcome.

Nevertheless, once again I offer you a right of reply to my comments in this article. In fact, I would happily welcome such a reply as this would be in the best traditions and interests of the science.

References

I have included only citations where links were not available.

Ludwig, T. G. (1958). The Hastings Fluoridation project I. Dental effects between 1954 and 1957. New Zealand Dental Journal, 54, 165–172.

Ludwig, T. G. (1959). The Hastings fluoridation project: II. Dental effects between 1954 and 1959. New Zealand Dental Journal, 55, 176–179.

Ludwig, T. G. (1962). The Hastings fluoridation project III-Dental effects between 1954 and 1961. New Zealand Dental Journal, 58, 22–24.

Ludwig, T. . (1963). Recent marine soils and resistance to dental caries . Australian Dental Journal, 109–113.

Ludwig, T. G. (1965). The Hastings fluoridation project V- Dental effects between 1954 and 1964. New Zealand Dental Journal, 61, 175–179.

Ludwig, T. G. (1971). Hastings fluoridation project VI-Dental effects between 1954 and 1970. New Zealand Dental Journal, 67, 155–160.

Ludwig, T. G.; Healy, W. B.; Losee, F. L. (1960). An association between dental caries and certain soil conditions in New Zealand. Nature, 4726, 695–696.

Ludwig, T.G.; Healy, W. B. (1962). The production and composition of vegetables in home gardens at Napier and Hastings. New Zealand Dental Journal, 58, 229–233.

Ludwig, T.G.; Pearce, E. I. F. (1963). The Hastings fluoridation project IV – Dental effects between 1954 and 1963. New Zealand Dental Journal, 59, 298–301.

Xiang, Q; Liang, Y; Chen, L; Wang, C; Chen, B; Chen, X; Zhouc, M. (2003). Effect of fluoride in drinking water on children’s intelligence. Fluoride, 36(2), 84–94.

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Are you really right?

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She describes the two different mindsets we have when approaching problems – calling them the “Warrior mindset” and the “Scout mindset. Motivated reasoning which is so widespread is a strong feature of the “Warrior mindset.” While this may spur people to action it is not a good way of solving problems.

I like the way Julia brings out the fundamental role of emotions in determining mindsets – and the way different people approach problems.

So some good advice from her is to encourage emotions related to curiosity, the desire to understand and the ability to be proud about changing one’s mind and not defensive about retaining beliefs.

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Maajid says the West, and particularly the USA, has it all wrong. The policies of intervention, imposing “democracy” and the killing of terrorist leaders and civilians via bombing and drones, will never solve the basic problem – that extremist jihadism appeals to many Muslims, even western born Muslims.

He is advancing the need to counter jihadist ideologies with alternative moderate policies – but points out this is hardly happening. And how can it happen if people are too “politically correct” to discuss and condemn actions like the stoning of women, female genital mutilation, imposed marriages, etc.

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Now he is a co-founder and chairman of Quilliam, a counter-extremism think tank that seeks to challenge the narratives of Islamist extremists.

Maajid wrote about his experiences and changes of thinking in his book Radical: My Journey Out Of Islamist Extremism.


More recently he discussed these problems with the atheist Sam Harris. Their discussion is published in the book Islam and the Future of Tolerance: A Dialogue.

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