It is a false balance to equate the advocacy of scientific and medical experts concerned with truth and child health to the advocacy of ideologically-motivated anti-fluoride and anti-vaccination activists known for their misrepresentation of science. Credit: World Congress for freedom of scientific research
I thank Dr Ghali for taking up my offer of a right of reply to my article Scientific integrity requires critical investigation – not blind acceptance. This sort of discussion is important and I am pleased he took the time to read my article.
Unfortunately, he did not respond to my point about the need to critically examine research findings and claims. Or my point that he seemed to be attempting to “sweep aside” critical reviews which are inherently part of the scientific process. His characterisation of the letter sent by 30 academic and health experts to the US National Institute of Environmental Health Science (NIEHS) about the Green et al (2019) study (see Experts complain to funding body about quality of fluoride-IQ research) was unjust and simply avoided the necessary discussion.
However, in his reply, he raises a new issue that is worth discussion. That of how scientists should respond to “advocacy positions.”
Equating political and scientific/health advocacy
“. . we tried in our presentations to shed some light on the controversy, and to show how advocacy positions have focused on attacking both the evidence on benefits of fluoride (e.g., the multi-pronged attacks on Lindsay McLaren’s study on CWF), and the more recent evidence on potential negative cognitive effects in developing brains.”
This characterisation falls into the trap of equating the advocacy of anti-fluoride activists, organisations like the Fluoride Action Network (FAN) and Fluoride Free NZ (FFNZ), who are well known for distorting and misrepresenting the science, with scientific and medical experts who are attempting to present a good faith expert scientific interpretation and critique of current research.
I believe this is a dangerous position because it comes across to policymakers as saying the scientists disagree with each other, that there is not a majority consensus, and equates the standard of science presented by both sides. This impression is, of course, very much favoured by political activists because it is an easy way of discrediting scientific information, of avoiding the need to properly and objectively consider the information.
I saw this myself when the fluoridation issue was being considered by the local Hamilton City Council in 2013. Councillors were clearly not up to the job of considering the science (and why should they be) so reacted to any attempt to present scientific details by arguing that “scientists disagree with each other,” that there are “two sides to the science.” In the end, they even based their decision on things like the number of submissions as the deciding factor instead of on the science.
Incidentally, the voters in Hamilton did not let the council get away with such a sloppy disregard for the science and of their own previously expressed majority support for fluoridation. A new referendum was demanded and the result confirmed that of the previous referendum showing 70% support for community water fluoridation.
I cannot understand why Dr Ghali promotes this understanding – even to the extent of appearing to favour those who misrepresent the science above those who are attempting a good scientific critique. For example, he describes the anti-fluoride activist attacks on the science merely as “strong” and “rooted in positional anti-fluoride advocacy,” while he refers to “the unusually vigorous attacks on the fluoride cognition studies” and argues these are “seemingly rooted in the challenging findings of those studies. “
Interpreting normal scientific critique as an “attack”
Dr Ghali specifically mentions the fluoridation cessations study of McLaren et al (2016) as being strongly attacked. Part of that “strong attack” was a published critique of FAN members – Neurath et al (2017) – the sort of critique fully acceptable and expected in the scientific community. McLaren et al., (2017) in turn responded to that critique. Again a normal and necessary process in science. In fact, the opening sentence in this response was:
“Thank you for the opportunity to respond. We are pleased to see thoughtful debate in the peer‐reviewed literature and agree that careful consideration of study limitations can stimulate improvement.”
That is how such critiques should be dealt with – welcomed and responded to. That should have been the way to respond to the critique of the 30 scientific and medical experts who responded to the Green at al (2019) study in their letter (see Experts complain to funding body about quality of fluoride-IQ research).
Yet Dr Ghali’s response to that letter was:
- He described it as “The notion that you can just talk away 10 years of research.”
- He leapt to an emotional defence of the authors of the Green study, saying: “I respect the doers of the research and the deliverers of the evidence and don’t think they should be shot for tough messages.”
- He uses phrases like “once published it can’t be unpublished” and refers to this critique as “sweeping aside because one disagrees.”
- And in his response here (see Scientific integrity & fluoridation – Dr Ghali responds) he reverts to this emotional rejection of the normal scientific critique saying he could not “pretend that the new studies do not even exist or that they are fatally flawed with irrelevant results.”
Ignoring the real political attacks on the science
But where is his emotional response to the way anti-fluoride activists have resorted to disgusting personal attacks on Lindsay McLaren for her work? That is surely unacceptable in any scientific discussion
Or to the way that these activists have misrepresented and distorted the findings of the Green et al (2019) study?
This sort of scaremongering advertising has appeared quite widely in newspapers and public billboards in New Zealand and caused a lot of concern among health professionals and their patients.
Who is advocating for what?
The political position of the anti-fluoride activists is clear – they advocate to end fluoridation or prevent it where it is being considered. This advocacy comes from ideological positions as can be seen with their alliance with anti-vaccination activists in Health Liberty and their funding by the “natural”/alternative health industry (eg., Mercola.com and the NZ Health Trust and see Big business funding of anti-science propaganda on health).
But it is simply wrong to put the advocacy of scientific and medical experts as operating at the same level. This is made clear in the letter from the 30 experts (that Dr Ghali dislikes) which says in its summary:
“The aim of science is to gain a better understanding of our natural world and to build a shared knowledge base for the benefit of all. Every scientist is interested in the truth. If fluoride at common levels of maternal exposure does lead to lower IQ scores, we would certainly want to know. This is why transparency related to the Green article is crucial.”
To be clear – the scientific and medical experts are advocating for good science and the health of the public, especially children. That is what drives their legitimate demand for transparency in the science.
So, I think Dr Ghali is disingenuous to present a false balance between the arguments of scientific and medical experts and the ideologically-driven anti-fluoride activists. He is wrong to treat scientific and medical experts as just another “advocacy group” like FAN. And he is especially wrong to use this false balance to ignore or discredit normal scientific critique which is so essential to good science.
Dr Ghali’s characterisation of the new fluoride cognitive studies
I also find the way Dr Ghali’s presentation of both the recent cognitive studies and the expert discussion of them disturbing. he says:
“The new cognition studies (led, interestingly, by two Canadian public health research teams) and the ensuing NTP draft report from the US are now such that it would have been absurd for us to pretend that the new studies do not even exist or that they are fatally flawed with irrelevant results.”
Who the hell is pretending that these studies do not exist? How is a rational, good-faith scientific critique of these studies pretending they “do not even exist?”
As for the question of the possibility these studies “are fatally flawed with irrelevant results,” how can anyone ever decide that question if the scientific critique of the studies is not permitted – or thoughtlessly, even emotively, disregarded?
Even Dr Ghali admits these studies have limitations (although I am unaware of any discussion by him of those limitations). Surely an honest scientific discussion of the is work requires a discussion of these limitations – and that is exactly what the letter from the 30 experts did. It listed ten important limitations – yet Dr Ghali wishes to dismiss the letter. He has certainly shown no interest in considering the specific limitations of the study.
These limitations may well mean the results are irrelevant to the question of community water fluoridation. I have argued that in several articles. I think the conflicting and contradictory results from the different papers and different databases (ELEMENT in Mexico City, MIREC in Canada, INMA in Spain, and NHANES in the USA) do suggest the quality of the results mean they should not directly influence health policy. I have also raised the issue of naive presentation of statistical analysis, reliance only on p-values with no discussion of the small size of the effects as indicated by the inability of the relationships to explain more than a few per cent of the variance in cognitive factors. There is also the problem of using a large number of factors with the inevitable p-hacking – a problem which, I believe, is actually quite widespread in science and needs to be countered.
Dr Ghali appears to argue that these new studies are not fatally flawed despite acknowledging they have “limitations” and that the results of the studies are relevant to CWF. But how can he come to that conclusion without making an objective analysis of the study’s methodology, considering the weak nature of the relationships reported? He is certainly not performing a proper scientific review by simply taking the authors’ claims as fact.
Dr Ghali appears to argue that these new cognition studies be given a free pass – that they not be subjected to the normal scientific process of proper peer-review and critical analysis. He appears to be turning a blind eye to the way these studies have been misrepresented and their finding distorted in scaremongering advertising by anti-fluoride organisations. Does he not realise his attitude plays directly into the hands of the ideologically motivated anti-fluoride and anti-vaccination activists? Can he not draw an appropriate conclusion from the fact that his arguments are being promoted by ideologically motivated activists known for their misrepresentation and distortion of science?
If readers think I have been too harsh in my discussion here they should consider that Dr Ghali’s response did not in any way deal with the points I raised about the need for ongoing scientific discussion. In fact, he went further suggesting that I, or others, may be pretending “that the new studies do not even exist or that they are fatally flawed with irrelevant results.”
That is patently not true as I have critiqued and discussed these studies in a number of articles here – there is no pretence in my position or the position of others who have participated in a principled discussion of the limitations and faults in this work.
I also did not appreciate Dr Ghali’s suggestion that we could “have a chat some time.” In my experience invitations to private chats as a substitute for participation in a good-faith open scientific discussion are simply a bureaucratic attempt to close down that discussion – or to silence a participant.
Another important factor is that while Dr Ghali attempts to discredit those who honestly critique these new cognitive studies from a scientific perspective he is apparently unwilling to criticise anti-fluoride activists who misrepresent the work and use that misrepresentation in scaremongering claims and advertising campaigns. I specifically asked Dr Ghali if he could point me to any video content where he was critical of the anti-fluoride campaigners – so that I could use it in this post as a balance to the video in my article Scientific integrity requires critical investigation – not blind acceptance where he strongly criticises those participating in a scientific critique. He did not respond which make me think he is unable to find anything where he has subjected anti-fluoride activists to the same emotive attack as he leveled at those critiquing the Green et al (2019) paper.
It is sad to see such partisanship in one who has had the responsibility of reviewing the research in this area.