Tag Archives: Connett

Debunking a “classic” fluoride-IQ paper by leading anti-fluoride propagandists

epa-meeting-sept5-2014

Three of the paper’s authors – Quanyong Xiang (1st Left), Paul Connett (2nd Left) and Bill Hirzy (far right) – preparing to bother the EPA.

Anti-fluoride groups and “natural”/alternative health groups and websites are currently promoting a new paper by several leading anti-fluoride propagandists. For two reasons:

  1. It’s about fluoride and IQ. The anti-fluoride movement recently decided to give priority to this issue in an attempt to get recognition of possible cognitive deficits, rather than dental fluorosis,  as the main negative health effect of community water fluoridation. They want to use the shonky sort of risk analysis presented in this paper to argue that harmful effects occur at much lower concentrations than currently accepted scientifically. Anti-fluoride guru, Paul Connett, has confidently predicted that this tactic will cause the end of community water fluoridation very soon!
  2. The authors are anti-fluoride luminaries – often described (by anti-fluoride activists) as world experts on community water fluoridation and world-class scientists. However, the scientific publication record for most of them is sparse and this often self-declared expertise is not actually recognised in the scientific community.

This is the paper – it is available to download as a pdf:

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.

bruce-spittle

Co-author Bruce Spittle – Chief Editor of Fluoride – the journal of the International Society for Fluoride Research

I have been expecting publication of this paper for some time – Paul Connett indicated he was writing this paper during our debate in 2013/2014. FAN newsletters have from time to time lamented at the difficulty he and Bill Hirzy were having getting a journal to accept the paper. Connett felt reviewers’ feedback from these journals was biased. In the end, he has lumped for publication in Fluoride – which has a poor reputation because of its anti-fluoride bias and poor peer review. But, at last Connett and Hirzy have got their paper published and we can do our own evaluation of it.

The authors are:

david-c-kennedy

Co-author David C. Kennedy – past president of the International Academy of Oral Medicine and Toxicology – an alternative dentist’s group.

Bill Hirzy, Paul Connett and Bruce Spittle are involved with the Fluoride Action Network (FAN), a political activist group which receives financial backing from the “natural”/alternative health industry. Bruce Spittle is also the  Chief Editor of Fluoride – the journal of the International Society for Fluoride Research Inc. (ISFR). David Kennedy is a Past President of the International Academy of Oral Medicine and Toxicology which is opposed to community water fluoridation.

Quanyong Xiang is a Chinese researcher who has published a number of papers on endemic fluorosis in China. He participated in the 2014 FAN conference where he spoke on endemic fluorosis in China.

xiang-Endemic fluorosis

Much of the anti-fluoridation propaganda used by activists relies on studies done in areas of endemic fluorosis. Slide from a presentation by Q. Xiang to an anti-fluoride meeting organised by Paul Connett’s Fluoride Action Network in 2014.

Critique of the paper

I have submitted a critique of this paper to the journal involved. Publication obviously takes some time (and, of course, it may be rejected).

However, if you want to read a draft of my submitted critique you can download a copy from Researchgate – Critique of a risk analysis aimed at establishing a safe dose of fluoride for children.  I am always interested in feedback – even (or especially) negative feedback – and you can give that in the comments section here or at Researchgate.

(Please note – uploading a document to Researchgate does not mean publication. It is simply an online place where documents can be stored. I try to keep copies of my documents there – unpublished as well as published. It is very convenient).

In my critique I deal with the following issues:

The authors have not established that fluoride is a cause of the cognitive deficits reported. What is the point in doing this sort of risk analysis if you don’t actually show that drinking water F is the major cause of cognitive deficits? Such an analysis is meaningless – even dangerous, as it diverts attention away from the real causes we should be concerned about.

All the reports of cognitive deficits cited by the authors are from areas of endemic fluorosis where drinking water fluoride concentrations are higher than where community water fluoridation is used. There are a whole range of health problems associated with dental and skeletal fluorosis of the severity found in areas of endemic fluorosis. These authors are simply extrapolating data from endemic areas without any justification.

The only report of negative health effects they cite from an area of community water fluoridation relates to attention deficit hyperactivity disorder (ADHD) and that paper does not consider important confounders. When these are considered the paper’s conclusions are found to be wrong – see ADHD linked to elevation not fluoridation, and ADHD link to fluoridation claim undermined again.

The data used by the Hirzy et al. (2016) are very poor. Although they claim that a single study from an area of endemic fluorosis shows a statistically significant correlation between IQ and drinking water fluoride that is not supported by any statistical analysis.

The statistically significant correlation of IQ with urinary fluoride they cite from that study explains only a very small fraction of the variability in IQ values (about 3%) suggesting that fluoride is not the major, or maybe not even a significant, factor for IQ. It is very likely that the correlation between IQ and water F would be any better.

Confounders like iodine, arsenic, lead, child age, parental income and parental education have not been properly considered – despite the claims made by Hirzy et al. (2016)

The authors base their analysis on manipulated data which disguises the poor relations of IQ to water fluoride. I have discussed this further in Connett fiddles the data on fluorideConnett & Hirzy do a shonky risk assessment for fluoride, and Connett misrepresents the fluoride and IQ data yet again.

Hirzy et al. (2016) devote a large part of their paper to critiquing Broadbent et al (2014) which showed no evidence of fluoride causing a decrease in IQ  using data from the Dunedin Multidisciplinary Health and Development Study. They obviously see it as a key obstacle to their analysis. Hirzy et al (2016) argue that dietary fluoride intake differences between the fluoridated and unfluoridated areas were too small to show an IQ effect. However, Hirzy et al (2016) rely on a motivated and speculative estimate of dietary intakes for their argument. And they ignore the fact the differences were large enough to show a beneficial effect of fluoride on oral health.

Conclusion

I conclude the authors did not provide sufficient evidence to warrant their calculation of a “safe dose.” They relied on manipulated data which disguised the poor relationship between drinking water fluoride and IQ. Their arguments for their “safe dose,” and against a major study showing no effect of community water fluoridation on IQ, are highly speculative and motivated.

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Rejection of scientific studies in online discussions

giphy

Sometimes the on-line discussion of scientific issues  looks like a citation battle. People take sides, battle lines are drawn and struggle commences. Each side fires barrages of citations “proving” their own argument.

The battle progresses in real-time – the proferred citations are immediately rejected and alternatives offered. One would think the other side would take time out to actually read the offered citations – but no they are usually quickly rejected as unreliable.  I also get the impression that in many cases the side offering the citation  has also not bothered to read it – usually relying on its use by an ally or its coverage in a friendly on-line magazine.

OK, it natural to be lazy but wouldn’t we all learn a lot more by actually reading the citations being thrown around. And doesn’t it discredit one’s position to reject a citation out of hand for unjustified reasons?

The Logic of Science recently posted an analysis of the bad reasons people use for rejecting citations – 12 bad reasons for rejecting scientific studies. It is well worth a read – we will recognise these 12 reasons and hopefully learn not to use them ourselves in future.

Here are the 12 bad reasons:

Bad reason #1: Galileo/Columbus

“When faced with results that they don’t like, many people will invoke Galileo or Columbus and claim that they defied the mainstream view and people thought that they were crazy, but they turned out to be right. . . [However] no one thought that Galileo was crazy. He presented facts and careful observations, not conspiracies and conjecture. He did not blindly reject the science of his day, rather he made meticulous observations and presented data that discredited the common views. That is not in any way shape or form the same as arrogantly and ignorantly rejecting a paper just because you disagree with it.”

Yes, the Galileo claim always come across to me as very arrogant and crazy – yet it’s a common excuse. An Australian climate change denial group even incorporated Galileo into its title – poor old Galileo must be turning in his grave.

Bad reason #2: science has been wrong in the past

“[P]eople often make the broad claim that science shouldn’t be trusted because it has been wrong before. . . . . First, it is true that science has been wrong, but it has always been other scientists who have figured out that it was wrong. Further, it is logically invalid to blindly assume that it is wrong just because it has been wrong before.

Additionally, although there have been plenty of minor hypotheses which have been discredited, there have been very few core ideas that have been rejected in the past century. In other words, ideas which are supported by thousands of studies have rarely been rejected, and very few central ideas have been overthrown in recent decades.

Finally, attacking science by asserting that it has been wrong before is utterly absurd because science is inherently a process of modifying our understanding of the world. In other words, science is self correcting. This is one of it’s greatest strengths. . . . . It constantly replaces erroneous ideas as new evidence comes to light (the same can’t be said for anti-science views which rigidly cling to their positions no matter how much evidence opposes them). Therefore, the fact that science has been wrong is actually a good thing, because if there were no instances where we had discovered that a previous idea was wrong, that would mean that science hadn’t advanced.”

Scientific knowledge is always incomplete – with time it becomes more and more correct in its description of reality, but there is always room for improvement, for deepening of specific knowledge and refinement of theories.

It seems to me very crass to use this inherent property of good science against science itself.

Bad reason #3: it’s all about the money

Ironically, this excuse is commonly used by people allied with movements funded by big business who are campaigning against scientific findings they feel challenged by.

“This is probably the most common response to papers on climate change, vaccines, GMOs, etc., and it’s often simply untrue. The scientific community is massive, and there are thousands of independent scientists doing research. Further, all scientific publications require authors to declare any conflicts of interest, so you can actually check and see if a paper was paid for by a major company, and if you did that, you would find that many of the papers supporting GMOs, vaccines, etc. have no conflicts of interest. Anti-scientists, of course, have no interest in actually looking at the paper. They would rather just assume that it was paid off because that fits with their world-view.

. . . even if a paper does have a conflict of interest, that doesn’t give you carte blanche to ignore it. The fact that someone works for a pharmaceutical company, for example, does not automatically mean that they biased or falsified their data. If a paper has a conflict of interest, then you should certainly give it extra scrutiny, and you should be suspicious if it disagrees with other papers or has questionable statistics, but you cannot automatically assume that it is flawed.”

Wise words. We should always read scientific papers critically and intelligently – especially when there may be a conflict of interest. But it is neither critical or intelligent to reject them out of hand in this way.

Bad reason #4: there are other results that I disagree with

Someone will say, “I reject the science of X because science also says Y and I disagree with Y.” We can rephrase this as, “I reject science because I reject science.” I would not, for example, accept water fluoridation as evidence that it’s ok to reject the science of vaccines unless I had already rejected the science of fluoridation. In other words, you have to justify your rejection of the science of Y before you can use it as evidence that we shouldn’t trust the science of X. Further, even if you could demonstrate that the science of Y (in this example fluoridation) was wrong, that still would not in any way shape or form prove that the science of X (in this example vaccines) is wrong. In fact, this entire line of reasoning is just a special case of the logical fallacy known as guilt by association. If are going to say that a scientific result is incorrect, you have to provide actual evidence that the specific result that you are talking about is incorrect.”

Yes, this tactic is a red-herring, often used as a diversionary device, and very lazy as it shows an unwillingness to consider properly the issue at hand.

Bad reason #5: gut feelings/parental instincts

know I am right

” . . . .  show someone the scientific evidence for vaccines, and they respond with, “well as a parent only I know what is best for my child.” Similarly, when I show people the evidence for GMOs, they often respond with something like, “well I just have a gut feeling that manipulating genes is bad.” I do not give a flying crap about your instincts or gut feelings. The entire reason that we do science is because instincts and feelings are unreliable. When someone presents you with a carefully conducted, properly controlled study, you absolutely cannot reject it just because you have a gut feeling that it’s wrong. Doing that makes no sense whatsoever. It is the most blatant form of willful ignorance imaginable. Don’t get me wrong, intuition is a good thing, and gut feelings can certainly help you in many situations, but they are not an accurate way to determine scientific facts.”

Our feelings and instincts are very strong and will often divert our attempts at rational considerations. I think such factors are  often behind the rejection of scientific studies – even when this reason is not given. But:

“Gut feelings simply aren’t reliable. That’s why we do science.”

Bad reason #6: I’m entitled to my opinion/belief

“This is another very common response, and it is very similar to #5. Science deals with facts, not opinions or beliefs. When multiple scientific studies all agree that X is correct, it is no longer a matter of opinion. If you think that X is incorrect, that’s not your opinion, you’re just wrong. Think about the relationship between smoking and lung cancer again. What if someone said, “well everyone is entitled to their opinion, and my opinion is that it’s safe.” Do you see the problem? Scientists don’t have an opinion or belief that smoking is dangerous; rather, it is a scientific fact that it is dangerous, and if you think that it is safe, you are simply in denial. Similarly, you don’t get to have an “opinion” that the earth is young, or vaccines don’t work, or climate change isn’t true, or GMOs are dangerous, etc. All of those topics have been rigorously tested and the tests have yielded consistent results. It is a fact that we are changing the climate, a fact that vaccines work, a fact that the earth is old, etc. If you reject those, you are expressing willful ignorance, not an opinion or belief.”

Hear, hear!

Bad reason #7: I’ve done my research/an expert agrees with me

” . . . . . if your “research” disagrees with properly conducted, carefully controlled studies, then your research is wrong (or at the very least, must be rejected pending future data). There, it’s that simple. The only exception would be if your research is actually a large set of properly controlled studies which have directly refuted the study in question (e.g., if you have a meta-analysis vs. a single study, then, all else being equal, go with the meta-analysis). It’s also worth pointing out that having a few people with advanced degrees on your side does not justify your position (that’s a logically fallacy known as an appeal to authority). No matter what crackpot position you believe, you can find someone somewhere with an advanced degree who thinks you’re right.”

This appeal to authority is commonly used – nothing seems to offend an anti-fluoride campaigner more than to refer to their ideological leader, Paul Connett, without reference to his degree of former university title! Such people also often show the converse – refusing to use titles when referring to the work of someone they disagree with.

Bad reason #8: scientific dogma

“This response basically states that all scientists are forced to follow the “dogma” of their fields, and anyone who dares to question that dogma is quickly ridiculed and silenced. . . . .  In short, that’s simply not how science works. Nothing makes a scientist happier than discovering that something that we thought was true is actually false. In fact, that is how you make a name for yourself in science. No one was ever considered a great scientist for simply agreeing with everything that we already knew. Rather, the great scientists are the ones who have shown that our current understanding is wrong and a different paradigm provides a better understanding of the universe. To be clear, if you are going to defeat a well established idea, you are going to have to have some very strong evidence.”

A related claim is that the “scientific establishment” prevents publication -often used to explain why many of the authorities used by people rejecting scientific studies do not have a credible publication record.

I would be the last person to deny human jealousies and defense of peer-reviewers and scientific editors can be a problem with specific journals – but there is many alternative journals willing to accept papers.

But this does raise another issue to be wary of – there are some journals which have incredibly poor peer review and often accept papers because of the authors’ willingness to pay a publication fee. Publication in such journals should definitely be seen as a warning sign – but as in all other cases judgment should be based on a critical and sensible analysis of the paper  itself.

Bad reason #9: distrust of governments/media

” Many people, however, take it even a step further. On numerous occasions, I have shown someone a study which was not in anyway affiliated with a government agency, yet they still responded with a lengthy rant about corrupt governments or the media. The basic idea of their argument seems to boil down to, “the government/media agree with these results, therefore they must be false.” This line of reasoning is, however, clearly fallacious (in fact it’s a logical fallacy known as guilt by association). Governments and the media will lie to push their own agendas, I’m certainly not denying that, but that fact does not automatically mean that everything that they say is a lie. . . . . . . It’s fine to be skeptical of what you are told by the government/media. In fact it is a good thing, but when you are presented with scientific evidence, then it’s not a matter of trusting the government/media. Rather, it is a matter of whether or not you accept science. In other words, I don’t need to trust the government or media in order to accept the results of a carefully controlled study.”

A related reason is to imply that any scientific study is not independent because the researcher are paid. Rather silly, considering we all have to live and researchers are no different. These people will instead cite articles written by activists or journalists working for magazines financed by an industry like the “natural”/alternative health industry. Or claim the financing of activist organisation is by “donation” so it doesn’t count

Bad reason #10: it’s a conspiracy

“This one is very closely related to #8 and 9, but it takes things a step further. It proposes that there is a massive conspiracy and scientists are being paid by governments/big companies to falsify results. . . . . the scope of this conspiracy would be impossibly huge. The scientific community consists of millions of people from all over the world working out of thousands of universities, institutes, non-profits, corporations, agencies, etc. It includes people from countless religions, cultures, political ideologies, etc. There is no way that you could possibly get that many people to agree on a massive deception like this. Just think about what is being proposed here. Do you honestly think that nearly all of the world’s climate scientists have been bought off? . . . . . .  Do you honestly think that all of those different organizations (many of whom compete with each other and have different goals and purposes) have all managed to come together to make one unified conspiracy? That’s just nuts. The same problems exist for governments. . . . . Honestly ask yourself the following question: which is more plausible, that countless governments, companies, non-profits, etc. have all come together to create the world’s largest conspiracy and buy off virtually every scientist on the planet, or that the thousands of independent scientists who have devoted their lives to science are actually doing real research?”

Personally I think this reason should be considered as an immediate acceptance that the commenter has lost or that they have disqualified themselves – like Godwin’s law for the first person to bring up Hitler or the Nazis.

godwins-law1

Bad reason #11: anecdotes

“Anecdotes do not matter in science, because anecdotes don’t allow us to establish causation. Let me give an example. Suppose that someone takes treatment X and has a heart attack 5 minutes later. Can we conclude from that anecdote that treatment X causes heart attacks? NO! It is entirely possible that the heart attack was totally unrelated to the treatment and they just happened to coincide with one another. Indeed, I once heard a doctor describe a time where he was preparing to vaccinate a child, and while preparing the vaccine, the child began having a seizure (to be clear, he hadn’t vaccinate the child yet). He realized that if he had given the vaccine just 60 seconds earlier, it would have looked for all the world like the vaccine had caused the seizure when in fact the kid just happened to have a seizure at the same time that a vaccine was being administered.

. . . . it should be clear that anecdotes are worthless because they cannot establish causal relationships (in technical terms, using them to establish causation is a logical fallacy known as post hoc ergo propter hoc fallacies [i.e., A happened before B, therefore A caused B]). Properly controlled studies, however, do allow us to establish causation.”

Yet commenters again and again fall back on anecdotes – even after launching a citation attack the anecdotal evidence seems to have much more relevance than anything reported in scientific studies.

Bad reason #12: a scientific study found that most scientific studies are wrong

“This argument is fascinatingly ironic because it uses a scientific paper to say that we shouldn’t trust scientific papers, but let’s look closer because this argument actually has some merit. The paper being references is, “Why most published research findings are false” by John Ioannidis, and it is actually a very useful and informative work, but it often gets misused.”

The Ioannidis paper describes several reasons why individual papers may be wrong. Issues like small sample size and publication bias in its many forms.

Researcher who often search the literature are aware of these problems and they are aware of the advice to approach all papers critically and intelligently – even the ones which present results you find favourable.

But as the article points out:

“. . .all of that may sound very bleak, but it should not make you lose all confidence in the scientific process because of a very important component of scientific inquiry: replication. Ioannidis’s work applies mostly to single paper studies. . . . .  So, this paper shouldn’t make you question the safety of vaccines, the effects we are having on the climate, etc. It should, however, make you skeptical of the one or two anti-vaccine papers that you occasionally see, or the one paper supporting some “miracle cure,” or the occasional paper on homeopathy, acupuncture, etc. Those studies almost always have tiny sample sizes and countless other studies have failed to replicate their results. This is why it is so important to look at the entire body of literature not just a single study.”

Conclusion

The Logic of Science article concludes:

” . . . no matter how you cut it, many of you wouldn’t be alive today if it wasn’t for science. Science clearly works and you need an extremely strong justification for rejecting scientific results.

To be fair, some scientists are corrupt and bad science does occasionally get published, but bad research tends to be identified and discredited by other researchers. In other words, there may be a high probability of a single paper being wrong, but when lots of different studies have all arrived at the same conclusion, you can be very confident in that conclusion. Perhaps most importantly, you cannot simply assume that a paper is bad just because you disagree with its results. You need to present actual evidence that it is flawed or biased before you can reject it.”

Good advice. When you enter a discussion you should actually read the citations you use – and insist you discussion partner readers theirs. And read them critically and intelligently.

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Alternative reality of anti-fluoride “science”

Paul Connett made many unsupported claims in his presentation against community water fluoridation (CWF) to Denver Water. Here I debunk a claim where he rejects most scientific studies on the cost-effectiveness of CWF.

Different grades of dental fluorosis

Connett asserted two things in his presentation:

  1. Previous research showing the cost effectiveness of community water fluoridation (CWF) has been made obsolete by a single new paper.
  2. Something about this new paper (Ko & Theissen, 2014) makes it more acceptable to him than previous research – and he implies you

Plenty of research shows CWF is cost-effective

Connett has cherry-picked just one paper, refused to say why and, by implication, denigrated any other research results. And there are quite a few studies around.

Here are a just a few readers could consult:

Of course, the actual figures vary from study to study, and various figures are used by health authorities. But generally CWF is found cost-effective over a large spectrum of water treatment plant sizes and social situation.

Connett relies on a flawed study

Connett relies, without justification,  on a single cherry-picked study:

Ko, L., & Thiessen, K. M. (2014). A critique of recent economic evaluations of community water fluoridation. International Journal of Occupational and Environmental Health, 37(1), 91–120.

This is a very long paper which might impress the uninitiated. To give it credit, it does make lengthy critiques of previous studies on cost effectiveness. But it has a huge flaw – its treatment of the cost of dental fluorosis.

It rejects warranted assumptions made by most studies that the adverse effects of CWF on dental fluorosis are negligible: They say:

“It is inexplicable that neither Griffin et al. nor other similar studies mention dental fluorosis, defective enamel in permanent teeth due to childhood overexposure to fluoride. Community water fluoridation, in the absence of other fluoride sources, was expected to result in a prevalence of mild-to-very mild (cosmetic) dental fluorosis in about 10% of the population and almost no cases of moderate or severe dental fluorosis. However, in the 1999–2004 NHANES survey, 41% of U.S. children ages 12–15 years were found to have dental fluorosis, including 3.6% with moderate or severe fluorosis.”

Two problems with that statement:

  1. The prevalence of “cosmetic” dental fluorosis may be about 10% but this cannot be attributed to CWF as non-fluoridated areas have a similar prevalence. For example, in the recent Cochrane estimates show “cosmetic” dental fluorosis was about 12% in  fluoridated areas but 10% in non-fluoridated areas (see Cochrane fluoridation review. III: Misleading section on dental fluorosis).This is a common, probably intentional, mistake made by anti-fluoride campaigners – to attribute the whole prevalence to CWF and ignore the prevalence in non-fluoridated areas. This highly exaggerates the small effect of CWF on the prevalence of “cosmetic” dental fluorosis – which in  any case does not need treatment. “Cosmetic” dental fluorosis is often considered positively by children and parents.
  2. The small numbers of children with moderate and severe dental fluorosis (due to high natural fluoride levels, industrial contamination or excessive consumption of fluoridated toothpaste) is irrelevant as CWF does not cause these forms. Their prevalence is not influenced by CWF.

So Ko and Theissen (2014) produce a different cost anlaysis because :

“. . . the primary cost-benefit analysis used to support CWF in the U.S. assumes negligible adverse effects from CWF and omits the costs of treating dental fluorosis, of accidents and overfeeds, of occupational exposures to fluoride, of promoting CWF, and of avoiding fluoridated water.”

We could debate all the other factors, which they acknowledge have minimal effects, but they rely mainly on the dental expenses of treating dental fluorosis:

“Minimal correction of methodological problems in this primary analysis of CWF gives results showing substantially lower benefits than typically claimed. Accounting for the expense of treating dental fluorosis eliminates any remaining benefit.”

They managed to produce this big reduction in cost-effectiveness by estimating costs for treating children with moderate and severe dental fluorosis – finding:

“the lifetime cost of veneers for a child with moderate or severe fluorosis would be at least $4,434.”

And:

“For our calculations, we have assumed that 5% of children in fluoridated areas have moderate or severe fluorosis.”

See the  trick?

They attribute all the moderate and severe forms of dental fluorosis to CWF. Despite the fact that research shows this is not caused by CWF and their prevalence would be the same in non-fluoridated areas!

The authors’ major effect – which they rely on to reduce the estimated benefits of CWF – is not caused by CWF.

Connett is promoting an alternative “scientific” reality

The Ko & Theissen (2014) paper is one of a list of papers anti-fluoridation propagandists have come to rely on in their claims that the science is opposed to CWF. In effect, this means they exclude, or downplay, the majority of research reports on the subject – treating them like the former Index Librorum Prohibitorum, or “Index of Forbidden Books,” an official list of books which Catholics were not permitted to read.

The Ko & Theissen (2014) paper is firmly on the list of the approved studies for the anti-fluoride faithful. A few others are Peckham & Awofeso (2014), Peckham et al., (2015)Sauerheber (2013) and, of course, Choi et al., (2012) and Grandjean & Landrigan (2014).  You will see these papers cited and linked to on many anti-fluoride social media posts – as if they were gospel – while all other studies are ignored.

These papers make claims that contradict the findings of many other studies. They are all oriented towards an anti-fluoridation bias. And most of them are written by well-known anti-fluoride activists or scientists.

In effect, by considering and using studies from their own approved list and ignoring or denigrating studies that don’t fit their biases, they are operating in an alternative reality. A reality which may be more comfortable for them – but a reality which exposes their scientific weaknesses.

Lessons for Connett

I know Paul Connett is now a lost cause – he will continue to cite these papers from his approved list and make these claims no matter how many times they are debunked. But, in the hope of perhaps helping others who are susceptible to his claims, here are some lessons from this exercise. If anti-fluoride activists wish to support their claims by citing scientific studies they should take them on board.

Lesson 1: Make an intelligent assessment of all the relevant papers – don’t uncritically rely on just one.

Lesson 2: Don’t just accept the findings of each paper – interpret the results critically and intelligently. How else can one make a sensible choice of relevant research and draw the best conclusions.

Lesson 3: Beware of occupying an alternative reality where credence is given only to your own mates and everyone else is disparaged. That amounts to wearing blinkers and is a sure way of coming to incorrect conclusions. It also means your conclusions have a flimsy basis and you are easily exposed.

Lessons for everyone susceptible to confirmation bias.

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Fluoridation: Connett’s criticism of New Zealand research debunked

Community-Water-Fluoridation-and-Intelligence-Prospective-Study-in-New-Zealand-quote

Paul Connett, Executive Director of the Fluoride Action Network recently made a presentation to Dever Water opposing community Water Fluoridation (CWF). Many of his claims were just wrong – he seriously distorted the science and used this to misinform the board members.

I am posting a series of articles debunking his claims. But Daniel Ryan from Making Sense of Fluoride has also entered the fray with his article Dr Connett distorts the Dunedin IQ fluoride study. I urge readers to check out the article.

Daniel is debunking claims made by Connett about the New Zealand research paper:

Broadbent, J. M., Thomson, W. M., Ramrakha, S., Moffitt, T. E., Zeng, J., Foster Page, L. A., & Poulton, R. (2014). Community Water Fluoridation and Intelligence: Prospective Study in New Zealand. American Journal of Public Health, 105(1), 72–76.

That study is a thorn in Connett’s side because it completely refutes his claims that CWF causes a drop in IQ. It is an excellent paper (as well as being a New Zealand one) – which is another thorn in Connett’s side as he relies on poor quality studies made in areas of endemic fluorosis for his claims.

Daniel goes through Connett’s assertions about the New Zealand study and debunks each of them in turn.

The Broadbent et al. (2014) study investigated a situation where low fluoride concentrations were used. It is the only in-depth study of IQ at these low concentrations. However, I did make a brief investigation of the situation in the USA comparing the average IQ for each state with the percentage fluoridation coverage of the population in each state. I reported that in IQ not influenced by water fluoridation.

The figure below shows the data – and there is no statistically significant correlation of IQ with CWF (the dotted lines show the 95% confidence boundaries)..

Connett debunked once again.

See also:

Connett misrepresents the fluoride and IQ data yet again
Fluoridation: Connett’s naive use of WHO data debunked

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Fluoridation: Connett’s naive use of WHO data debunked

Paul Connett is the Executive Director of the anti-fluoride propagandists group, the Fluoridation Action Network (FAN). His recent presentation to the Denver Water Board’s fluoridation forum was full of scientific misrepresentations and distortions.

I debunked his claims on fluoridation and IQ in the article Connett misrepresents the fluoride and IQ data yet again. Here I debunk his claim that WHO data shows community water fluoridation (CWF) is not effective.

This video clip shows his claim:

1: Is there a difference between fluoridated and unfluoridated countries?

Connett waves around graphs showing declines in tooth decay in  some countries but does nothing to support his claim that there is no input from fluoridation to this improvement in oral health. After all, oral health depends on a number of factors so any serious claim needs adjustment for these factors and a proper quantitative comparison.

The data in these graphs is just not suitable for this – but lets humour people like Connett who place so much faith in the graphs. I took this graph from Connett’s book The Case against Fluoride (Chapter 6, page 38).

Connett-F-cf-NF

It is easy enough to do a ballpark comparison of the average rate of decline of dental decay  for the four nonfluoridated countries and compare that to the average rate for the four fluoridated countries. I did this and found the average decline in dmft (decayed, missing and filled teeth) for non-fluoridated countries was 1.4/decade and for fluoridated countries 1.6/decade. On the face of it the decline in tooth decay was more rapid in the fluoridated countries – the opposite to Connett’s claim.

Of course, Connett would laugh at such a comparison and claim the data is just not good enough to make such comparisons.  And I agree – but isn’t that exactly what he was trying to do?

He was simply waiving around a poor set of data which he thinks supports his claim that CWF is ineffective – it doesn’t. He should know that, and he should be ashamed, as someone with scientific training, to make these claims using such evidence.

The huge influence of inter-country differences on these data, irrespective of fluoridation, surely sticks out like a sore thumb in Connett’s graphs. That doesn’t require a scientific training to see. These differences introduce so much noise into the data that no conclusion is possible about the influence on fluoridation.

Robyn Whyman pointed this out in his report for the National Fluoridation Information Service – Does delayed tooth eruption negate the effect of water fluoridation?:

“Studies that appropriately compare the effectiveness of water fluoridation do not compare poorly controlled inter-country population samples. They generally compare age, sex, and where possible ethnicity matched groups from similar areas. 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.”

2: Comparison within countries

The WHO data includes New Zealand and Ireland where there are fluoridated and unfluoridated areas. Cornett’s graphs do not differentiate – the just use the averages for these two countries.  Yet, even that sparse WHO data set  shows clear benefits of community water fluoridation on oral health. Consider the differences in tooth decay between fluoridated and unfluoridated areas of  Ireland.

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!

The data in the graphs below shows a similar situation for New Zealand – this time using data from the NZ Ministry of Health (which is much more extensive than the WHO data).dmft

3: CWF still effective when fluoridated toothpaste used.

Paul Connett’s claim that CWF is unnecessary when fluoridated toothpaste is used was based on a naive interpretation of the graphs he was waving around. The data above for Ireland and New Zealand show that, even where the use of fluoridated toothpaste is widespread, there is still a difference in the oral health of children living in fluoridated and unfluoridated areas of a country.

Other research also shows CWF is still effective, even though its effectiveness may, these days, be less than observed in the past when fluoridated toothpaste was not used. But, in contrast to what Connett appears to think, fluoridated toothpaste in not the only factor involved. There is the general improvement in dental health treatments and diet in recent years. Rugg-Gunn & Do (2012)  also refer to the “halo” effect – a diffusion of beneficial fluoride from fluoridated area into unfluoridated areas via food and beverages and consumption of water away from the place of residence.

The recent data can also be influenced by differences in residence and place of dental treatment. For example, dental treatment and record taking may occur at a school or dental clinic in a non-fluoridated area but the child may live in a fluoridated area. This effect could explain the apparent reduction of differences for New Zealand children from fluoridated and non-fluoridated areas after 2006 in the above graph. In 2004 a “hub and spoke” dental clinics system was introduced where one school dental clinic could serve several areas – both fluoridated and non-fluoridated.

 

Conclusion

Paul Connett’s use of the graphs showing improvement in oral health in countries independent of fluoridation, is on the surface, naive because no conclusion about the effectiveness of CWF can be drawn from this sparse data involving comparison between countries with so many political, social and environmental differences. Connett is presumably aware of this, and of the fact the same WHO data shows a beneficial effect for Ireland and New Zealand.

This is another case of Connett using a scientific academic title (his PhD), to give “authority” to his misrepresentation and distortion of the science to local body politicians.

References

Connett, P., Beck, J., & Micklem, H. S. (2010). The Case against Fluoride: How Hazardous Waste Ended Up in Our Drinking Water and the Bad Science and Powerful Politics That Keep It There.

Ministry of Health (2014) Age 5 and Year 8 oral health data from the Community Oral Health Service.

National Fluoridation Information Service (2011): Does Delayed Tooth Eruption Negate The Effect of Water Fluoridation? National Fluoridation Information Service Advisory June 2011, Wellington, New Zealand.

Rugg-Gunn, A. J., & Do, L. (2012). Effectiveness of water fluoridation in caries prevention. Community Dentistry and Oral Epidemiology, 40, 55–64.

Connett misrepresents the fluoride and IQ data yet again

The video clip below shows how local body politicians can be fooled by people misrepresenting the science. The culprit (unsurprisingly for the fluoride issue) is Paul Connett, Executive Director of the anti-fluoride propagandist group Fluoride Action Network (FAN). He relies on his PhD to provide authority – and the fact that few people in his audiences have the time or background to check out his claims.

At the moment, Connett is putting a lot of effort into promoting the myth that fluoridation causes a decrease in IQ. In this very short video clip (just over 1 minute) of a recent presentation to the Denver Water Board Connett massages data reported by Xiang et al., (2003a) to pull the wool of the Board’s eyes..

The innocent victims in his audience, including the Denver Water Board members, were no doubt impressed by this graph Connet used.

It looks pretty convincing, doesn’t it? There appears to be a statistically very significant decrease in IQ with an increase in drinking water fluoride above about 1 ppm F? (Community water fluoridation [CWF] usually uses a concentration of about 0.7 ppm). All the data points are lined up in a row.

That is until you look at the original data.

This figure is from Xiang et al., (2003a).  Not so convincing, eh? Clearly, with such a wide scatter of the data,  fluoride is only part of the story – if it has any effect at all. But this is the sort of graph one needs to consider when looking at correlations. Connett obtained his figure by breaking the data up into ranges. It looks prettier – but is misleading.

One should always look at the original data.*

Although the correlation is statistically significant, urinary fluoride explains only 3% of the variance in IQ! This tells us that fluoride has very little effect on IQ and it is very likely that it would have no explanatory role at all once other factors were considered in the statistical analysis!

I think it is inhumane to make the claims Connett does on such a flimsy correlation. His biased advocacy is, in effect, denying any efforts to find the real causes of the IQ variation.

What about confounding factors?

Connett’s claim that data was “controlled for” confounding factors is just not true. Xiang did not include any of these other factors in the statistical analysis of the data in Figure 2.

He only compared average values of these factors for the two villages in the study. There were no proper correlations across all the data. Xiang reported no differences between villages for urinary iodine, family income, and parent’s education level. However, there was an average age difference between the villages and he reported that IQ was influenced by age. The drinking water arsenic concentrations were higher in the low fluoride village than the high fluoride village (Xiang et al., 2013).

Incidentally, in a later paper (Xiang et al., 2003b) presents data for blood lead. This time he did check for a correlation across all samples and found there was no statistically significant correlation with IQ. But this was separate and not incorporated into a statistical analysis together with fluoride concentrations.

There was no real checking for the effect of confounding factors on the correlation of IQ with fluoride.

Connett asks a silly question

Connett goes on to make an emotional appeal for scientists to produce convincing data showing that fluoride does not decrease IQ:

This question is disingenuous as science can never prove something can never happen – it can only consider the evidence for it happening. Evidence of the sort presented by Xiang et al. (2003a). Scientific reviews look at the evidence, consider its reliability, compare it with evidence from other studies and draw conclusions.

Connett is disparaging about scientific reviews of the fluoride literature because he does not understand that such literature requires critical and intelligent analysis. Things like the high concentrations and doses used in animals studies he refers to. And looking below surface claims to see what the data really says – as I have done here. This is what reviewers of the scientific literature do all the time.

All Connett has relied on here is his own confirmation bias – and his emotions. Policy makers should beware of such advocacy.

See also:

Connett fiddles the data on fluoride
Connett & Hirzy do a shonky risk assessment for fluoride

*Note: Observant readers might note the second figure compares IQ with urine fluoride concentration. Unfortunately, he did not give a similar figure for fluoride concentration in drinking water. However, this is well correlated with urine fluoride. And, as urine concentration is a better indicator of fluoride intake that drinking water concentration, this figure does give a useful picture of the variance in the data Xiang used.

Incidentally, I have made several attempts without success, to get the original water fluoride concentrations from Xiang (who has so far not replied to several emails) and Connett (who told me that he does not want me contacting him again!).

References

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

Xiang, Q.; Liang, Y.; Zhou, M. . and Z. H. (2003b). BLOOD LEAD OF CHILDREN IN WAMIAO–XINHUAI INTELLIGENCE STUDY. Fluoride, 36(3), 198–199.

Xiang, Q., Wang, Y., Yang, M., Zhang, M., & Xu, Y. (2013). Level of fluoride and arsenic in household shallow well water in wamiao and xinhuai villages in jiangsu province, china. Fluoride 46(December), 192–197.

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Connett & Hirzy do a shonky risk assesment for fluoride

Paul Connett, executive director of the Fluoridation Action Network (FAN), told me, during our fluoride debate, that he was writing a scientific paper defining a lower safety limit for fluoride than currently accepted. Nothing has been published yet – although a recent FAN newsletter did refer to a risk assessment paper by him and Bill Hirzy currently under review. I look forward to reading this paper, but I am not holding my breath as neither author has an impressive publication record.

Connett described his risk assessment for fluoride in the debate (see Fluoride debate: Paul Connett’s Closing statement) and he and Hirzy have also made comments on this lately. They are rejecting the current risk assessment, based on the incidence of severe dental fluorosis, and using the incidence of IQ deficits instead. To this end, they are heavily promoting the work of Choi et al., (2012) and Xiang et al., (2003) (which reported IQ deficits in areas where fluorosis is endemic). They are also attempting to rubbish published research (such as Broadbent et al., 2014) which show no significant IQ deficits at fluoride concentrations used in community water fluoridation.

Connett and Hirzy have also organised campaigns to congressional representatives in their effort to force a downward revision of the Environmental Protection Agency’s (EPA) standards for fluoridation.

Connett’s approach is a desk study – these guys are not going  to dirty their hands by doing their own research to get useful data. They are taking a value which they claim represent the lowest concentration of fluoride in drinking water below which no IQ deficit was found. They then apply “safety factors” to effectively conclude the only safe concentration is zero (see Scientist says EPA safe water fluoride levels must be zero)!

I will be a bit surprised if they manage to squeeze their paper though a decent review process because their approach is shonky. Look at the way they use the data from Xiang et al., (2003). (I have used the presentations by Connett and Hirzy at last February’s Sydney anti-fluoride conference as sources here). As I pointed out in Connett fiddles the data on fluoride, this data actually does not show a strong relationship between IQ and fluoride. The figure (from Xiang et al., 2003) shows the relationship between IQ and urinary fluoride and, in this case, the fluoride explains only about 3% of the variance in IQ.

Despite being statistically significant (p=0.003) this is certainly not evidence for a causative relationship. Clearly other, unconsidered, factors contribute to the variance and if these were considered the relationship with fluoride may be non-significant.

(Readers may notice the figure uses data for urinary not drinking water fluoride. Unfortunately, Xiang did not give a similar figure for fluoride concentration in drinking water. I have contacted him requesting the similar data for drinking water but so far have not had a meaningful response. Xiang did report drinking water fluoride is well correlated with urine fluoride so the above figure probably gives a good idea of the variability in drinking water fluoride as well).

Connett and Hirzy effectively ignore the high variability in the data and rely on a trick to get this  second graph. By splitting the concentration range into groups and taking the mean IQ for each group they make the situation look a lot more respectable. Who would guess from this trick that fluoride only explained about 3% of the IQ variance?

Connett illustrates his next step with this slide.

Sydney-Feb-21-key-step

He then claims that IQ deficits occur at a fluoride concentration of 1.26 ppm – he appears to have simply subtracted the value of one standard deviation from the mean of the lowest concentration group associated with a significantly different mean IQ to that of Xiang’s “control” group – Xinhaui village. That is strange because surely the first figure indicates  that low IQ values occur even for children with very low urinary fluoride, and most probably drinking water fluoride.

Connett then uses a safety factor of 10 (“to account for the wide range of sensitivity expected for any toxic substance in a large population”). Of course, this produces a maximum “safe” concentration of 0.13 ppm – which rules out all fluoridated water – and most natural water sources!

Sydney Feb 21 B Australia,  2015Connett goes on to promise his offsider, Bill Hirzy, will elaborate on the method they issued. Hirzy’s presentation did mention fluoride intake from other sources besides water. He then presents his conclusion on what the “safe daily dose” is fluoride – but no explanation of why! All the preceding slides in his presentation where self-justifying descriptions of his qualifications, employment history and how great his organisation, FAN, is.

IQ-Risk-Assessment-02.26.15

Conclusions

Connett and Hirzy are claiming IQ deficits are more important than dental fluorosis for setting of maximum fluoridation levels in drinking water. They are campaigning to get this accepted by legislators and the EPA.

Connett has been promising publication in a scientific journal for several years and recently implied that a paper is under review. If their publication efforts are successful a more critical assessment of their approach will be possible.

Available information indicates Connett and Hirzy have no original data but are relying on data from a study of children in an area of endemic fluorosis in China. They are refusing to accept published information from areas where community water fluoridation exists.

Their analysis also appears to rely on a tricky processing of the data to obscure the fact that fluoride probably only explains about 3% of the variance in IQ measured by the Chinese researchers! Legislators and policy makers would be foolish indeed to make changes to fluoridation standards on the basis of such data and poor analysis.

I could, of course, be wrong so eagerly await the Connett & Hirzy (2016?) paper.

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Connett fiddles the data on fluoride

I am always suspicious when activists present simple figures to confirm their bias and fool their audience. I think anti-fluoride activists do this a lot. Here is an example in Paul Connett’s presentation to the recent Sydney anti-fluoride conference.

Connett uses data from Xiang et al (2003) and some of Xiang’s other papers and presentation to push his claim that fluoridation is bad for your IQ. Apparently he and Bill Hirzy (currently described as Fluoride Action Networks “chemist in residence”) are working on a paper attempting to justify a case that the maximum permissible level of fluoride in drinking water should be reduced to practically zero! They use a simplification of data from Xiang’s paper for this.

Xiang-2003

First of all the figure shows what Xiang’s data is like. It compares IQ with urine fluoride concentration – unfortunately he did not give a similar figure for fluoride concentration in drinking water. However, this is well correlated with urine fluoride.

There is certainly a lot of scatter, but Xiang (2003) reports a “Pearson correlation coefficient of 0.174, p=0.003.” So a statistically significant relationship (helped by having a large number of samples) but it still only explains about 3% of the variance!

This is important because, although Xiang did consider some confounding factors he could well have missed a factor which explains more of the variance which, when considered, may make the relationship with serum fluoride concentration non-significant. For example, I would be interested to see a statistical analysis which included incidence of moderate and severe dental fluorosis as this may be more important than the drinking water fluoride concentration itself).

Connett-sydneyBut have a look at how Paul Connett present this data (or the equivalent data for drinking water fluoride concentration) in his Sydney anti-fluoride conference presentation.

The “trick” has been to divide the data into “categories” based on inclusion in a separate water fluoride concentration ranges and then presenting only the averages within each category. I can see the point of sometimes using such categories, but this figure conveys a very misleading message.

The Sydney audience could have been excused for thinking that Xiang’s data showed a very strong connection between IQ and drinking water fluoride – a relationship explaining almost all the variance. Completely misleading as this relationship probably only explains only about 3% of the variance in the original data.

Paul Connett and William Hirzy are currently campaigning to make IQ the key factor for determining the maximum permissible levels of fluoride in drinking water. They might confuse a few politicians with these sort of distortions but hopefully the real decision-makers will be awake to such tricks.It really is

It really is a matter of “the reader beware.” Never take on trust what these political activists are saying. Always go to the original sources and consider them critically and intelligently.

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Is comfirmation bias essential to anti-fluoride “research?”

Anti-fluoride propagandists like Declan Waugh and Paul Connett avidly scan the scientific literature looking for anything they can present as evidence for harmful effects of community water fluoridation (CWF). Sometimes they will even do their own “research”  using published and on-line health data looking for any correlations with CWF, or even just with fluoride levels in drinking water.

Several years ago an activist going under the nom de plume “Fugio” posted images showing correlations of mental retardation, adult tooth loss and ADHD with the incidence of CWF in the US. These images are simply the result of “research” driven by confirmation bias and data dredging.They prove nothing. Correlation is not proof of a cause. And no effort was made to see if other factors could give better correlations.

I go through Fugio’s examples below – partly because I noticed one of their images surfacing recently on an anti-fluoridation Facebook page as “proof” that CWF causes tooth loss. But also because they are just more examples of the type of limited exploratory analysis used in two recently published papers – Peckham et al., (2015) (discussed in my article Paper claiming water fluoridation linked to hypothyroidism slammed by experts) and Malin and Till (2015) (discussed in my articles More poor-quality research promoted by anti-fluoride activistsADHD linked to elevation not fluoridation and Poor peer-review – a case study).

ADHD

This figure is essentially the same as that reported by Malin & Till (2015). In fact, I wonder if Fugio (who posted December 2012) is the unattributed source of Malin & Till’s hypothesis. Fugio chose the ADHD data for 2007 and fluoridation data for 2006 whereas Malin and Till (2015) concentrated mainly on fluoridation data for 1992 which had the highest correlation with ADHD figures.

I won’t discuss this further here – my earlier article ADHD linked to elevation not fluoridation shows there are a number of other factors which correlate with ADHD prevalence just as well or better than CWF incidence does and should have at least been considered as confounding if not the main factors. I found a model using mean elevation, home ownership and poverty only (no CWF included) explained about 48% of the variation whereas their model using CWF and mean income explained only 22-31% of the variation. And when these confounder factors were considered the correlation of ADHD with CWF was not statistically significant.

In other words we could do a far better job of predicting ADHD prevalence without involving CWF.

Water Fluoridation and Adult Tooth Loss

Fugio posted a figure showing a correlation of adult tooth loss with CWF incidence in 2008. It was statistically significant explaining 11% of the variation. But quite a few other factors display better correlations with adult tooth loss. For example, the data for smoking by itself explains 66% of the variation (see figures below).

Teeth-smoke

Checking out correlations with a range of factors I found a model involving only smoking and longitude  explaining  about 74% of the variation. The contribution from CWF was not significant statistically – it added nothing to this model.

Water Fluoridation and Mental Retardation

Fugio found a better relationship between CWF in 1992 and mental retardation in 1993 – a correlation explaining 19% of the variation. Apparently the concept of “mental retardation” was later abandoned as there do not appear to be any more recent statistics.

But again, if Fugio had not stopped there he/she would have found a number of other factors with better correlations. I give an example in the figure where state educational level (% Bachelors Degree in 1993) explained 50% if the variation. This correlation is negative as we might expect.

mental

 Again I used multiple regression analysis to derive a model involving educational level (% with Bachelors degree in 1993), poverty in 1993 and mean state elevation which explained 69% of the variation. No statistically significant contribution from CWF occurred.

Conclusions

I am not suggesting here that the factors I identified have a causal effect. Simply that they give better correlations  than CWF. These and similar confounding factors should have been considered by Fugio and Malin and Till (2015).

My purpose is to show that this sort of exploratory analysis of easily available data can easily produce results for anti-fluoride activists who are searching for some “sciency” looking arguments to back up  their position. Provided they don’t look too deeply, stop while they are ahead and refuse to consider the influence of other factors.

Unfortunately poor peer review by some journals is allowing publication of work that is no better than this. Peckham et al (2015) did nothing to check out other factors except gender in their correlations of hypothyroidism with CWF. The glaring omission was of course dietary iodine which is known to have a causative link with hypothyroidism. (I could not find US data for hypothyroidism so was unable to check out Peckham et al’s hypothesis for the US.) Malin and Till (2015) included only socioeconomic status (as indicated by income) in their analysis despite the fact that ADHD is known to be related to a number of factors like smoking and alcohol intake.

As I keep saying, when it comes to understanding the scientific literature it really is a matter of “reader beware.” It’s easy to find papers supporting one’s pet obsession if you are not critical and sensible with your literature searches. And it is important not to take at face value the claims of activists who clearly rely on confirmation bias when they explore the literature.

Fluoride debate: Response to Daniel Ryan’s critique – Rita Bartlett-Rose

Rita F. Barnett

Rita Barnett-Rose, author of Compulsory water fluoridation: Justifiable public health benefit or human experimental research without informed consent” has replied to Daniel Ryan’s critique of her paper. Daniel’s critique was posted yesterday at Fluoride debate: A response to Rita Barnett-Rose – Daniel Ryan.

Rita’s reply is available to download as a pdf


RE: CWF Working Paper Article

Dear Daniel,
I have now had a chance to consider your comments to my draft article. In some respects, I am flattered that you have devoted so much time to an unpublished working paper, and I thank you for giving me some of your opinions. I absolutely want to make sure that I have cited to sources accurately and have not mischaracterized any particular study I reviewed. To that end, I have now engaged independent review of my article from several highly-qualified scientists/researchers with the specific request that they review my article for scientific accuracy. After I have received their comments, I will revise my draft accordingly.

Unfortunately (or fortunately for me), I did not find in your review any specific places where I actually mischaracterized any cited study. Instead, your primary points of contention seem to be twofold: (1) you object to my use of Fluoride Action Network’s (“FAN”) website as a cited source; and (2) you object to my failure to include contrary studies that reaffirm the (English-speaking countries’) public health agencies’/dental lobby positions on the safety and benefits of compulsory water fluoridation.

First, with respect to my reliance on FAN. Of the 209 footnote references in my article, I believe only 17 of them are cites to FAN. Of those 17 cites, I am citing to the FAN website primarily as an easy way to get to the primary source material (e.g., studies or newspaper articles from around the world). For example, in footnotes 85-87, I could have listed the primary source studies, but I have found that many of these studies are hard to get on the internet for those who do not have paid subscriptions to the various science databases. I myself had to order a number of the primary sources from my University intra-library loan system and felt that it would be better to simply provide a link so that the reader could see the names of the studies and determine for himself/herself how to get to those primary sources. Nevertheless, your point is well-taken that I should not give the appearance of relying upon an advocacy group (including yours), and I will review those 17 cites to see if I should instead cite to primary sources.

Second, with respect to your complaint or desire that I cite to contrary (i.e., pro-fluoridation) studies in addition to (or in lieu of) the published studies that I cite that tend to weigh against fluoridation, as I have already indicated to you on two occasions: I am not interested in a battle of the studies debate, and I urge you to conduct such a battle with a more appropriate sparring partner, such as FAN-NZ. Specifically: you complain about FAN not being a legitimate source of credible scientific information, but your organization is also a political advocacy (pro-fluoridation) group, and, from your critique, you are just as guilty of “cherry picking” your sources and your studies as you suggest I am. Moreover, and in stark contrast to you, the section of my article where the studies are discussed is specifically entitled: “Scientific Evidence Against Compulsory Water Fluoridation.” It is not meant to be an exhaustive examination of all studies on fluoridation and is specifically and accurately identified for what it is. I am well aware of many of the pro-fluoridation studies — as well as the criticisms of many of those studies (in terms of who funded them, flaws in methodology, conflicts of interest, etc.) by those opposed to fluoridation. I do not believe either side has definitively proved their case with respect to safety/benefits or lack thereof. However, what I do believe is that the burden of proving safety and effectiveness lies with the pro-fluoridation side, as it is your side that is insisting on imposing this “public health measure” on everyone else, even in the face of substantial objection and despite existing studies suggesting serious risks of harm. It also appears to me that the pro-fluoridation side is playing “whack a mole” with the studies weighing against CWF – often trying to hammer down/marginalize the opposition each time a negative study pops up, rather than trying to consider the evidence objectively. I note throughout your critique that you often refer to studies that weigh against fluoridation as “flawed” or “debatable” or as somehow lacking in proper control mechanisms – while studies that support fluoridation are “quality studies.” (p.8). You also minimize any existing evidence weighing against fluoridation by qualifying it: “there is no quality research” (p. 4) “there is no robust evidence” (p. 4), “there is no strong evidence” (p. 6). However, to me, if even one strong study exists, then the entire compulsory practice must be reevaluated.

Please also note that any and all of your cites to the ADA lobby, or to the CDC (which, though its oral health division, works hand in hand with the ADA promoting fluoridation and thus has a serious conflict of interest/credibility problem) are unpersuasive to me – as they should be to anyone conducting even a minimum level of research into the history of and politics behind fluoridation (some of which is chronicled in my article, including the story of the EPA’s NTEU battle). Incidentally, as someone who did not have a pony in this race before doing the actual research (i.e., I am not a long-time anti-fluoridation advocate), it does not take long to discover how politically motivated many “public health agencies” and “professional dental associations” are — or how willing they are to obscure, minimize, or bury contrary evidence or to marginalize the anti-fluoridation messengers, regardless of the evidence or the credentials of those messengers (e.g., Waldbott, Taylor, Marcus, Mullenix, Bassin, Hirzy).

With respect to the NRC Report, I agree with you that it did not specifically address compulsory water fluoridation. However, I believe that its review of fluoride toxicology is highly relevant to exposures from fluoridated water (and its exposure data itself suggests that some people drinking fluoridated water can, indeed, receive doses that can cause adverse health effects, including severe dental fluorosis and bone fractures). In addition, in a number of health risk areas, the NRC panel concluded that there was not enough data, and/or that more research needed to be conducted, before definitive statements could be made with respect to other potential adverse health effects due to excess exposure to fluoride. This is hardly a ringing endorsement of the safety of fluoride or fluoridation. Nor is the NRC Report irrelevant to the fluoridation debate.

I see no point in going through your critique page by page to point out various flaws in it, as mostly you seem to be trying to persuade me with contrary evidence rather than identifying any mischaracterizations of the studies I did cite. I will, however, point out that your opening accusation on p. 2 that my “paper starts off by saying there is mounting scientific evidence against fluoridation” and that I used an opinion piece by John Colquhoun as my “evidence” to support this statement is outrageously incorrect, and it almost prompted me not to respond to you at all, as I do not appreciate my words being twisted or my cites misused to inflate your argument. This statement about “mounting scientific evidence” at the start of my paper (near fn. 2) actually references an entire section of my article – (“See discussion infra Sec. II-B”) — and not an opinion piece by Colquhoun, which is only referenced – appropriately – at footnote 65 (referring to “formerly avid fluoride proponents” who have changed their minds). I have no desire to engage with insincere zealots, so I hope that you simply made a mistake there.

As I said to you privately, I am more than willing to revise my article where I have misstated any of the cited scientific evidence. However, I disagree with you that a discussion on the legal and ethical aspects of CWF would be “confusing” or “pointless” at this point and I would genuinely be interested in knowing why you feel so strongly that imposing this practice on everyone is ethically justifiable. Data published by the WHO suggests that the decline in dental caries is similar in both fluoridated and unfluoridated countries, and I have heard of no massive outbreak of a worldwide dental carie epidemic that has been attributed to a lack of fluoridated water (rather than to poverty, poor nutrition, or a lack of access to proper dental care). Thus, I am very curious as to why there appears to be such an aggressive campaign on the pro-fluoridation side to impose this practice on the world – and why anyone believes that personal liberties and rights to bodily integrity should be sacrificed for a public health practice addressing a non-contagious disease. I would also be interested in understanding where you personally believe compulsory public health practices should begin and end (e.g., do you believe governments should mandate compulsory flu shots? What about the HPV vaccine that the Governor of Texas tried to mandate for girls? Where should the personal right to bodily integrity begin and end, in your opinion? And how comfortable are you with public health officials mandating what is good for you? Do you contend that they haven’t been wrong on a public health issue before?).

As for me, I remain convinced that CWF is legally and ethically unjustifiable. My article sets forth my reasons, so I won’t repeat those arguments here. These reasons would remain even if compulsory water fluoridation were proven to be entirely safe, which it most definitely has not, despite the presumed “majority” view in the English speaking countries. You will also find many of my reasons articulated by dissenting justices in fluoridation cases over the last 60+ years, when presumably even less “science” was available to support their nevertheless valid legal/ethical objections to CWF. I include some of these cases and dissenting opinions in my article.

Daniel, I thank you for your (heretofore) civilized exchange with me and I do welcome your thoughts if you have any on the legal and ethical justifications of CWF. After this exchange, however, I am only interested in a private discussion with you, which is something you may not be interested in as it may not advance your organization’s agenda. However, your facebook posting has generated some contact to me by a few rude (and seemingly unbalanced) pro-fluoridation folks, and I have no interest in entertaining their rants (which certainly do nothing but convince me that the pro-fluoridation side has something to hide). In any event, I do thank you for reaching out and for your interest in my article. I hope to ensure that my final draft will address any legitimate criticisms/issues.
Sincerely,
Rita


Daniel Ryan’s response to Rita’s reply will be posted tomorrow. See Fluoride debate: Second response to Rita Barnett-Rose – Daniel Ryan.

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