Tag Archives: Connett

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.

Similar articles

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

Similar articles

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.

Similar articles

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.

Similar articles

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.

Similar articles

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.

Similar articles

Crude dredging of the scientific literature

I am always amazed at how some people will crudely misrepresent the scientific literature in their efforts to pretend their particular political agenda is scientifically valid. The way they will dredge the scientific literature searching for studies they can quote and misrepresent seems an extreme form of cherry picking and confirmation bias. Surely those indulging in such crude literature dredging are fully aware of what they are doing.

Here is an example of literature dredging I picked up recently. The offender is Michael Connett, Special Projects Director for Paul Connett’s Fluoride Action network (yes – a bit of nepotism there. Son Michael and Wife Ellen are on the payroll). Michael has a legal qualification, but no scientific qualification. Nevertheless, one of his special projects is a litrerature database anti-fluoride activists can use in their propaganda.

Any and every scientific publication that can be quoted, misquoted or misrepresented in arguments against fluoridation.

Here are a couple of slides from Michael’s talk at recent anti-fluoride get-together organised by the Connetts. It’s about “Fluoride and  IQ Studies” and the section was meant to show that recent research confirms community water fluoridation is bad for our brain. So he found 4 studies from on rats from 2014.

I have extracted from each cited paper details from the conclusions and the fluoride concentrations of the drinking water given to the rats.

Keep in mind that in New Zealand the recommended optimum concentration for community fluoridated water is 0.7 – 1.0 mg/L.


1-connett-m.fan-conference

“We found that NaF treatment-impaired learning and memory in these rats.” The NaF treatments were 25, 50 and 100 mg/L!


4-connett-m.fan-conference

“these results indicated that long-term fluoride administration can enhance the excitement of male mice, impair recognition memory, . . ” The NaF treatments were 25, 50 and 100 mg/L!


3-connett-m.fan-conference

“exploration preference in the novel object recognition test was significantly altered in mice treated with 5 and 10 mg/L NaF compared with the water-treated control animals.”


2-connett-m.fan-conference

“These data indicate that fluoride and arsenic, either alone or combined, can decrease learning and memory ability in rats.” “The rats in the F, As, and F+As groups had access to drinking water with a 120 mg/L NaF solution, 70 mg/L NaAsO2 solution, and combined 120 mg/ L NaF and 70 mg/L NaAsO2 solution for 3 months, respectively.


It’s the old story. Find evidence for adverse effects at concentration much higher the optimum and pretend the results apply to the optimum.

Beware of political activists who claim their agenda has scientific support. There is a good chance they are manipulating the science.

Update

Surpise, suprise. FAN has used young Michael’s talk at their get-together to launch a press release – Fluoride’s Brain Damage Studies Mounting. This will be sent through their usual social media merry-go-round in the hope that the MSM picks it up somehwere.

Just what one expects from a political activist organisation.

Similar articles

Making money out of fanatics

bad science

Click on image to enlarge

This looks like a Xcd cartoon. I picked it up from a new Facebook page The Girl Against Fluoride Lies. Good to see more and more Facebook pages like this.

Speaking of fluoride – the cartoon sort of reminds me of Paul Connett’s book – The case against fluoride?