Fluoridation: “debating” the science?

How the anti-fluoride activist envisages their debate challenge – their hero standing up against the might of the health authorities. Image credit: From the Coliseum to the Cage

New Zealand last week saw another “debate challenge” from anti-fluoride activists. But are their regular challenges serious? And do gladiatorial “debates” before partisan audiences have any value in science anyway?

These people often back away when their bluff is called. Their challenges have more to do with political tactics than any elaboration or clarification of the science. They appeal to the macho and combative attitudes of the intended audience.

One thing for sure, such “debates” do not advance scientific knowledge one iota – nor are they meant to.

The anti-fluoride hero is always victorious in the eyes of the partisan and faithful audience. Image credit: The Real Lives of the Gladiators of Rome – The Unfathomable Sport of Life and Death

Three Wise Men – the anti-fluoride activists Paul Connett, Declan Waugh and Vivyian Howard – visited New Zealand last week. Fluoride Free NZ (FFNZ) advertised these activists as “international experts . . .  “sharing the latest research.” Of course, the implications that these activists actually do any original research on fluoridation or what they were sharing was their own research were completely false.

 

This was just another one of those annual visits from Paul Connett (head of the US Fluoride Action Network) and his mates with the aim of misrepresenting and distorting the science so as to promote the political campaigns of the local anti-fluoridation brigade.

Anti-fluoride campaign puts all its eggs in the IQ basket

New Zealanders are rather tired of this sort of activism but the visit does represent an escalation. This year Three Wise Men, a few years back Two Wise men (Paul Connett and  Bill Hirzy) and before that just one wise man (Paul Connett). Is this a sign of increasing desperation as New Zealand moves ever so slowly to handing over decisions on community water fluoridation to District Health Boards? Or is it a sign of increased funding of the Fluoride Action Network and associated activist groups by the “natural”/alternative health industry? After all, it must cost a bit to send three spokespersons around the globe for just two meetings.

One thing I take from this activity is that the anti-fluoride movement has decided to put all its eggs in one basket – the IQ story. They won’t stop blaming fluoridation for all the ills of the world – from obesity to gender confusion. But they are deliberately making a determined effort to bring their IQ story onto centre stage.

The real experts and all the research indicate the main possible negative health effect which must be considered when planning introduction of fluoridation is mild forms of dental fluorosis. In contrast, anti-fluoride activists in the USA and NZ are attempting to present the main health effect that must be considered is a claimed decline in IQ.

The FFNZ advert shows this is the message the Three Wise Men were promoting in New Zealand. But the “latest research” they were “sharing” was not theirs but that of Basash et al., (2016). Or, rather, they were sharing a misrepresentaion and distortion of that research to fit their scarmongering claims.

I won’t repeat my analysis of the Bashash et al., (2016) paper and its misrepresentation here – readers can refer back to my articles:

• Fluoride, pregnancy and the IQ of offspring, 
• Maternal urinary fluoride/IQ study – an update, 
• Maternal urinary fluoride/IQ study – an update, 
• Maternal urinary fluoride/IQ study – an update, 
• Paul Connett’s misrepresentation of maternal F exposure study debunked,
• Mary Byrne’s criticism is misplaced and avoids the real issues, and
• A conference paper on the maternal neonatal urinary fluoride/child IQ study has problems

A draft of my article critiquing the Bashash et al., (2016) paper, “Predictive accuracy of a model for child IQ based on maternal prenatal urinary fluoride concentration.” is also available online.

The predictable debate challenge

No visit by Paul Connett would be complete without a challenge to debate the science with him. He is frustrated with the fact that his audiences are almost completely faithful anti-fluoride activists. The academics, experts and health authorities did not turn up to his meeting at Otago University so he claims “they don’t feel any obligation whatsoever to debate the science” and ”to simply ignore us is unacceptable” (see Anti-fluoride campaigner invites university debate).

Similarly, he blamed others and claimed his anti-fluoride message was being ignored when only three MPs turned up for his meeting at the NZ Parliament Building last February. That was disingenuous as he had been given plenty of time for a presentation to the Health Committee during the consultations on the Fluoridation Bill last year. And MPs are regularly bombarded with huge amounts of propaganda from anti-fluoride activists. Obviously, MPs feel so inundated with such propaganda that they see no need to attend yet another meeting to hear the same old message.

Connett’s challenges to “debate the science” in front of a partisan audience have more to do with political propaganda and enthusing activists than with science. He knows scientific knowledge does not progress by holding gladiatorial circuses. It progresses by long, careful and detailed research, publication and peer review.

Neither of these Three Wise Men has performed any original research on community water fluoridation but they can still make their input via the peer review process – which include post-publication peer review via critiques of published papers.

To be fair, Connett and other members of the Fluoride Action network have occasionally presented such critiques. Two examples come to mind – the studies of  McLaren et al., (2016) and of Broadbent et al., (2015). These were critiqued in responses published in these same journals by a number of opponents of fluoridation. The original authors responded in the same journals. Arguments and extra data were presented in the responses and the science is better off for those critiques.

But science does not gain one iota from Connett’s attacks on the New Zealander Broadbent and other researchers in the media or in his meetings with the faithful. Such attacks and macho comments, often bordering on ad hominem, only discredit the attacker. They are not the way to discuss science and yet Paul Connett and his supporters challenge genuine scientists to participate in such “debates’ which are nothing more than testostorone-laden slanging matches.

A farcical example of a debate challenge

This time around I got personally involved because I called the bluff of activists making yet another debate challenge. It came out of an online discussion where I was attempting to correct some mistaken claims made by anti-fluoride activists. Here is the challenge:

Screenshot of my invite – just as well a have this as this Facebook page subsequently deleted the invitation and all comments I had made. I am officially a nonperson there.

A game of chicken followed where I attempted to get Fluoride Free NZ (FFNZ) and Paul Connett to formally stand behind the challenge. Chicken because I recognised it was a game. I had a scientific exchange (“debate”) with Paul four years ago – I think it was useful and I believe this is how good faith scientific discussions should take place (see Connett & Perrott, 2014: The Fluoride Debate for the full exchange). But Paul had made clear to me some time ago that he wanted no further contact with me.

Sure enough, FFNZ very quickly retreated from the possibility they had offered of a one on one debate. I emailed FFNZ:

“I think a one on one exchange would be best and as Paul and I have similar expertise he would be the logical discussion partner.”

Their response:

“No we will only agree to two on two.”

Paul confirmed that he would not debate one on one with me. I accepted a two on two “debate” but pointed out it was their responsibility, not mine, to organise the speakers. If they were not prepared to do that I suggested a two on one “debate” (especially as being the only speaker on one side this would give me extra presentation time) but made clear that I would effectively ignore Vyvyan Howard because our expertise did not cross over. (Vivyan agree with me that as he is a pathologist “you are correct that a direct discussion between us would be unbalanced.”)

I also made clear I would not tolerate any attempt to use that format to argue that I was isolated and could not find anyone else in New Zealand to support my arguments (an implication Paul made in our email exchange, and, of course, a claim being parroted by his supporters on social media).

Paul then formally withdrew. A pity as I love Wellington and was looking forward to a visit at someone else’s cost.

So a farce, But wait. there is more. The Facebook page, Rethink Fluoride, deleted their invitation to this “debate.” They then followed by deleting all my comments on their posts. Rather ironic as I had a few days before congratulated them by allowing open comments, and in particular allowing scientific comments – something all other anti-fluoride Facebook pages refused to allow.

Conclusion

Debate challenges by anti-fluoride activists are never genuine. They do not wish to discuss the science – they are simply using the challenges to enthuse their true-believing supporters. It is a form of attack on genuine researchers and health experts.

There is a time and place for good faith scientific exchange – post-publication peer review, for example, can give a genuine avenue for any real critiques to appear and be considered. Testosterone-laden gladiatorial debates before partisan audiences do not.

Anti-fluoride activists are disingenuously using these “debate challenges” to imply that experts and researchers have no confidence in their science and are afraid. It’s simply a macho tactic which often descends into ad hominem attacks.

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An anti-fluoride trick: Impressing the naive with citations

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

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

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

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

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

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

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

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

Literature trawling

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

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

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

The claim

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

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

Houtman 1996 reported:

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

So no evidence of fluoride causing cardiovascular damage there.

The organic phenyl methyl sulfonyl fluoride does not contain fluoride.

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

 

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

4-amidinophenylmethanesulfonyl fluoride

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

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

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

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

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

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

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

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

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

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

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

Conclusions

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

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

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

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

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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 activists, ADHD 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).

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.

 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.

Declan Waugh pushes another anti-fluoride myth

Declan Waugh – Champion cherry-picker

Declan Waugh seems a bit of a late developer. He has only just got around  to finding those papers that anti-fluoride propagandists like to cite as evidence that oral health does not decline when community water fluoridation is stopped. Of course, he cherry-picks the appropriate papers and is then careful not to give the full evidence.

But he has whipped up a Letter to the Editor promoting his new “discovery” – and encourages his fans to use the same information for their own letters to the editor.

Here’s Waugh’s claim in his letter to the editor (which he encourages his fan’s to duplicate).

Dear Sir.

In recent decades in four seperate countries notably Finland, the Netherlands, Germany and Cuba dental health professionals warned of the grave dangers to public health from discontinuation of water fluoridation. Yet ironically peer reviewed published scientific research demonstrated that dental health significantly improved among children when fluoridation of water ended. Scientific evidence proved in every case that the views and opinions of profluoridationalists among dental health professionals were misguided and errorneous. So why are we still listening to them?

Yours sincerely

• Seppa L, Karkkainen S, Hausen H. Caries frequency in permanent teeth before and after discontinuation of water fluoridation in Kuopio, Finland. Commuity Dent Oral Epidemiol 1998;26:256 – 262.
• Seppa L, Karkkainen S, Hausen H. Caries trends 1992 – 1998 in two low-fluoride Finnish towns formerly with and without fluoridation. Caries Res 2000;346:462 – 468.
• Künzel W, Fischer T. Caries prevalence after cessation of water fluoridation in La Salud, Cuba. Caries Res. 2000 Jan-Feb;341:20-5.
• Künzel W, Fischer T, Lorenz R, Brühmann S. Decline of caries prevalence after the cessation of water fluoridation in the former East Germany. Community Dent Oral Epidemiol. 2000 Oct;285:382-9.
• Kalsbeek H, Kwant GW, Groeneveld A, Dirks OB, van Eck AA, Theuns HM. Caries experience of 15-year-old children in The Netherlands after discontinuation of water fluoridation. Caries Res. 1993;273:201-5

What these papers really say

I refered to this little myth in my article What happens when fluoridation is stopped? and will briefly repeat the information these propagandists always omit here.

L. Seppä, S. Kärkkäinen, and H. Hausen, “Caries Trends 1992–1998 in Two Low-Fluoride Finnish Towns Formerly with and without Fluoridation.” Caries Research 34, no. 6 (2000): 462–68. The abstract for this paper concluded:

“The fact that no increase in caries was found in Kuopio despite discontinuation of water fluoridation and decrease in preventive procedures suggests that not all of these measures were necessary for each child.”

The authors commented further on this research in Seppa et al (2002). They found their “longitudinal approach did not reveal a lower caries occurrence in the fluoridated than in the low-fluoride reference community.” But commented:

“The main reason for the modest effect of water fluoridation in Finnish circumstances is probably the widespread use of other measures for caries prevention. The children have been exposed to such intense efforts to increase tooth resistance that the effect of water fluoridation does not show up any more. The results must not be extrapolated to countries with less intensive preventive dental care.”

W. Künzel and T. Fischer, “Caries Prevalence after Cessation of Water Fluoridation in La Salud, Cuba.  Caries Research 34, no. 1 (2000): 20–25. Again this study found no increase in caries after stopping fluoridation but the authors suggested why:

“A possible explanation for this unexpected finding and for the good oral health status of the children in La Salud is the effect of the school mouthrinsing programme, which has involved fortnightly mouthrinses with 0.2% NaF solutions (i.e. 15 times/year) since 1990.”

W. Künzel, T. Fischer, R. Lorenz, and S. Brühmann, “Decline of caries prevalence after the cessation of water fluoridation in the former East Germany Community Dentistry and Oral Epidemiology 28, no. 5 (2000): 382–89. These authors found no increase of caries in two German cities after fluoridation of water was stopped. But again the authors suggest why:

“The causes for the changed caries trend were seen on the one hand in improvements in attitudes towards oral health behaviour and, on the other hand, to the broader availability and application of preventive measures (F-salt, F-toothpastes, fissure sealants etc.).”

Kalsbeek, H., Kwant, G. W., Groeneveld, A., Dirks, B., van Eck, A. A. M. J., & Theuns, H. M. (1993). “Caries Experience of 15-Year-Old Children in The Netherlands after Discontinuation of Water Fluoridation.“ Caries Research, 27(3), 201–205. Tooth decay continued to decline after discontinutation of fluoridation in both the areas previously not fluoridated and fluoridated. But the authors say:

“The question as to whether water fluoridation would have had an additional effect if it had been continued (presuming the application of existing preventive measures) cannot be answered, as there are no remaining communities with fluoridated water in The Netherlands.”

Tooth decay is complex because it involves several factors. Improvements in public health, especially dental health availability, and alternative fluoridation options have produced a general improvement irrespective of the availability of community water fluoridation (CWF). However, where comparisons are made between fluoridated and unfluoridated areas in the absence of other differences the benefits are seen.

Studies do show increase in tooth decay when fluoridation stopped

Of course there are other studies which Declan Waugh and his anti-fluoride mates will refuse to cite because they do not support their claims. In Fluoride debate: Ken Perrott’s closing response to Paul Connett? I discussed a paper which did show an increase in tooth decay –  Attwood and Blinkhorn (1991), “Dental health in schoolchildren 5 years after water fluoridation ceased in South-west Scotland.”  They measured dmft and DMFT – decayed, missing and filled teeth in primary and permanent teeth respectively.

The figures below illustrate the data from this paper which compared changes in oral health of two Scottish towns  in both 1980 and 1988. One town, Annan, had never had fluoridated water while the other, Stranraer, had it until 1983. This enabled the effects of both cessation of fluoridation and the generally observed improvement in oral health due to other factors to be compared and considered. The graphics show the results for 5 year old and 10 year old children.

Decayed missing and filled deciduous teeth for 5 year olds. Stranraer fluoridated until 1983. Annan not fluoridated.

Decayed missing and filled teeth for 10 year olds. Stranraer fluoridated until 1983. Annan not fluoridated.

The plots indicate aspects of the complexity of these sort of studies. Because 2 neighbouring towns were compared it was possible to measure the decline in oral health after discontinuation of fluoridation against a background of the general improvement in oral health, even in a non-fluoridated situation.

The moral here is don’t accept at face value the claims made by anti-fluoridation propagandists – even if they, like Declan Waugh, carry a self-endorsement of “scientist and fluoride researcher.”

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Declan Waugh claims it’s “clear as day”

Declan Waugh is an anti-fluoride propagandist who specialises in naively distorting scientific and medical information to “prove” community water fluoridation (CWF) is dangerous. A common tactic of his is to select, really cherry-pick, medical data to show the mortality or disease prevalence is greater in the Republic of Ireland – and other countries with CWF, than the rest of the world.

Similarly, he often cherry-picks data to “prove” a sudden increase in disease or deaths in Ireland after the introduction of CWF in the late 1960s. He has recently pulled this trick with Irish data for vascular diseases. It’s a simple (and naive) recipe. He has found data in a report and selected parts of it to fit his message – ignoring everything else and specifically discussion of the trends in the data by the specialists.

So he has produced this graph:

You can see the point he is trying to drive home – but lets look at all the data in that table Waugh used from the cited “50 years of Heart Disease in Ireland“:

Looking at all the data

Perhaps we should consider the death rate – deaths/100,000 to correct for changes in total population

Another factor is changes of coding and diagnostic criteria used for reporting causes of death and details of vascular disease. The report lists a number of changes occurring in the periods 1958-1967, 1968 – 1978 and 1979 – 1999. It also refers to “the lack of specification of diagnoses during the early years covered by this review.” What this means is that some of the changes, especially the apparently sudden changes, may represent nothing more than changes in diagnostic criteria.

Waugh also simplifies the date that fluoridation commenced in Ireland – claiming 1965. The Irish “Forum on fluoridation 2002“ reported that CWF started in Dublin in 1974, in Cork in 1965 and over the next 5 years in other areas. This suggests another reason to be careful about interpreting sudden changes in data during 1964 – 1970 as due solely to introduction of CWF.

So things are nowhere as simple as Declan Waugh presents it. Of course they never are. The intelligent reader should read the report and not just rely on cherry-picked data and motivated rationalisation resulting from confirmation bias.

A more rational understanding

The report itself  states that Ireland does have a high mortality rate from cardiovascular disease, particularly compared with Europe. The report says:

“One way or another, the data from the 1950’s and 1960’s point to an ongoing epidemic of heart disease in Ireland for at least half a century. This is evidenced by the fact that in 1950, 31% of all deaths were due to vascular diseases.”

Although:

“The low rates of IHD mortality in the 1950’s and 1960’s is almost certainly a reflection of difficulties encountered in accurately diagnosing cardiac conditions at that time. Thus, many IHD deaths may have been coded to the ‘catch all’ category of ‘Other Myocardial Degeneration’ (ICD 422).”

And the decline in death rates since 1985:

“is the consequence of a multifaceted approach to the problem. Specifically it has been suggested that a proportion of the decline, ranging from 25% to 50%, may be due to primary prevention. A proportion of the decline (40% to 50%) may be related to early intervention and treatment of acute cardiovascular events and a proportion is due to secondary prevention among those with established disease (13-16). Data from the WHO MONICA project in 37 countries further suggested that a proportion of the decline in mortality may be related to economic
success (17).”

Another complicating factor has been “changes in the demographic structure of the population.”

So there you go. One can understand these fluctuations in death rate from cardiovascular disease using the normal factors related to changes in diagnosis, diet and health care, and treatment of cardiovascular events. No need to drag in the “universal demon” of fluoride.

Only one example

This is only one example of the sort of tricks Declan Waugh uses in his reports. He pretends to be a “scientist and fluoride researcher” and this, together with extensive scientific citation and dogmatic claims does fool some people. It fooled the Hamilton City Council in their consideration of CWF last year (see When politicians and bureaucrats decide the science).

He is dishonest – but his tactics are difficult to counter. It takes far less effort to present a naively “sciency” looking lie than to reasearch and communicate the facts. As they say, a lie can get half way around the world before truth can get its boots on.

And that’s what Declan Waugh relies on. That is why he does not allow peer review of any of his reports. That is why he will not engage in an exchange with critics of his reports.

He knows he has critics. Just the other day on his Facebook page he moaned:

“There are some sick people out there in twitter land who joke about the graphics I produce. . . .they will present any possible excuse to try and discredit the association while point blankly refusing to even consider the biological mechanisms by which fluoride contributes to disease.”

Well, Declan, it is part of the scientific ethos to engage with your critics. Respond to their criticisms – show where and why you think they are wrong – or acknowledge your mistakes. You refuse to do that because you “point blankly” refuse to “even consider” the discussion and evidence of the experts who write the papers and reports you cherry pick from.

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Another fluoridation whopper from Declan Waugh

Declan Waugh is a self-proclaimed “scientist and fluoride researcher” who seems to spend all his time misrepresenting and distorting  scientific literature and health data to promote his anti-fluoride cause. Waugh has an avid following, among fellow anti-fluoride activists and propagandists. The sad thing is that he “reports” do manage to fool some gullible people. The Hamilton City Council staff listed one of his reports at the top of the “list of scientific information” they relied on when they stopped fluoridation last year (see When politicians and bureaucrats decide the science). And the “Physicians and Scientists for Global responsibility, NZ” also relied heavily on this report in their anti-fluoridation submission to councils.

But Declan Waugh’s latest “scientific” gem is a real whopper. He has extracted data from a 1997 Finnish paper to produce “evidence” fluoridation causes all a sorts of ailments. In the process he surely can’t have missed the fact the authors found the same level of expressed symptoms from people who were drinking unfluoridated water but believed it was fluoridated. That is, the symptoms seem to have a psychological cause, the belief threat drinking water was fluoridated, and not a physical cause – fluoride in the water.

The paper is Lamberg, M., Hausen, H., & Vartiainen, T. (1997). Symptoms experienced during periods of actual and supposed water fluoridation. Community Dentistry and Oral Epidemiology, 25(4), 291–5. Or see the full text.

Here is the image Waugh is promoting, and which is being repeated by anti-fluoride propagandist. For example fluoride Girl tweeted this:

@FluorideGirl: In Finland they Removed #fluoride in the tap water…Look at the reductions in diseases in just 3 months or 12 weeks! http://t.co/Lofb16ucnC

And this links to Waugh’s Facebook image:

Seriously? Waugh’s bar graph will be interpreted by many as evidence 72% or more of people drinking fluoridated water report “nausea and vomiting” which disappear when fluoridation is stopped!

Intentionally dishonest!

Trouble is, that image is extremely dishonest and intentionally so. Waugh could not have extracted that data from the paper without seeing and understanding the data alongside it for people who were not drinking fluoridated water but believed they were. He has made 3 outrageous distortions to produce his data:

1. He has ignored that actual data (in the same table) for % reduction of reported symptoms for both the group that had originally drunk fluoridated water, and the group who had originally drunk unfluoridated water in the mistaken belief it was fluoridated.
2. He took his data from the information for all respondents, combining both groups in the final survey but ignored the column for people drinking unfluoridated water but believing it was fluoridated.
3. He then took a “percentage of a percentage” so that, for example, although the percentage of respondents reported “Nausea and vomiting” when drinking fluoridated water was 3.8% (and 2.3% for the group who wrongly assumed they were drinking fluoridated water)  had dropped to 1.1% when knowingly drinking  unfluoridated water (a decline of 2.7% which was not statistically significant) his calculation produced a decline of 72%!

What a whopper!

An honest depiction of the data would have included both sets as below:

Very different to his figure.

Lamberg et al (1997) concluded:

“Since the occurrence and mean number of symptoms were fairly similar during actual and supposed fluoridation, the results do not support the theory that the symptoms considered in this study are caused by the physical effect of fluoridated water. On the other hand, the significant reduction in the number of symptoms only after the respondents had become aware of the discontinuation of fluoridation reveals that fluoridation may have psychological effects which present as perceived symptoms.”

The authors did toss a small glimmer of hope the hypochondriacs who claim fluoride sensitivity is real. The differences in reported decline in incidence of ailments between the fluoridated and supposed fluoridated groups are statistically insignificant for almost all the tested ailments. The exception was for “skin rashes” and the authors say:

“However, the significant decrease in the number of other skin rashes leaves room for speculation, seeming to favor the view that a small segment of the population may have some kind of intolerance to fluoride. This group of people should be studied further.”

The again, it is not uncommon to get a false positive when considering a large number of ailments in the same study.

“Tasting fluoride” in water

Nearly 10% of the respondent in the Finnish study claimed they could taste the fluoride in fluoridated water – which is known to be impossible for humans.

“However, the respondents made this claim equally often during actual and supposed fluoridation. As expected, the percentage reporting this “fluoride taste” dropped to nearly zero during known discontinuation of fluoridation in March. The psychological aspect is further confirmed by the fact that the illusory tasters seemed to be predisposed to perceived symptoms, as were also those who regarded fluoridation as a bad practice in general.”

No wonder the authors concluded:

“it seems likely that the prevalence of the symptoms
considered in the current study is connected with the psychological rather than with the physical effects of being exposed to fluoridated water.”

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Declan Waugh’s misinformation on fluorosilicic acid

Declan Waugh argued recently that silica species produced when fluorosilicates are hydrolysed in water cause a whole range of health problems and deaths. A new theory for him – silica is the problem, not fluoride! He is wrong, of course (see An open letter to Declan Waugh – new mechanism for fluoride toxicity?).

Declan had previously argued the exact opposite. That fluorosilicates do not hydrolyse completely in water and it is the remaining fluorosilicate species that are toxic and cause all these effects. He summarised his arguments and evidence for this in his 2012 report Hexafluorosilicic Acid, Raw Materials, Manufacture, Toxicity and Public Health Concerns as an Active Ingredient in Drinking Water.

This report is typical of Waugh’s writings. He distorts or misrepresents the literature and makes unwarranted inferences. He is not the only person doing this – it’s a common feature of the confirmation bias and cherry picking endemic to the anti-fluoridation movement. However, for some reason some people consider he is an authority on the subject (perhaps they have been fooled by his own hubristic claims to be an “environmental scientist and fluoride researcher”) so his reports get used as evidence and are something quote. For example, the Hamilton City Council listed one of his reports first in the “scientific evidence” which convinced them to stop fluoridation last year (see When politicians and bureaucrats decide the science ). Mark Atkin, the science and legal spokesperson for the local anti-fluoridation group is also fond of citing Declan Waugh – maybe because Waugh is the only source he can find to support his own confirmation bias.

A poster prepared by Declan Waugh to advertise the decisive effect of his submission to the Hamilton City Council fluoride tribunal

In this article I consider some of the claims Waugh makes in the above report and show how he uses distortions and misrepresentation of the literature he cites to support them.

Exaggerating toxicity of fluoride

This part of Waugh’s report is confused but he quotes the relative toxicities of CaF₂ and H₂SiF₆ (1 to 25) to apparently argue “that 1 ppm of hexafluorosilicic ingested orally is the equivalent of 25 ppm calcium fluoride.”  He then seems to argue that the regulated  concentration limits for fluoride are really for CaF₂ – implying that since we use fluorosilicic acid for water fluoridation we should introduce a factor of 25. He seems to say that the limits should not be 1.5 ppm F (he says is set for CaF₂) but 1.5/25 = 0.06 ppm! He says:

“The drinking water standards were established for the much less toxic calcium fluoride which is listed as a moderately toxic compound compared to hexafluorosilicic acid, which is categorised as extremely toxic.”

All this ignores that the toxic species in CaF₂ is the fluoride anion. This is the same for fluorosilicic acid in drinking water as the fluoride anion is the end product of its hydrolysis when added to water. In fact the relevant species is the fluoride anion whatever the source – NaF, CaF₂ or fluorosilicic acid. So the relative toxicities Waugh quotes for solid CaF₂ and concentrated fluorosilicic acid are irrelevant.

Calcium fluoride is relatively insoluble (about 15 ppm CaF₂ = 7.3 ppm F) so when the solid is ingested there is less dissolved fluoride anion available to exert a toxic effect. That is why it is less toxic than the readily soluble NaF and fluorosilicic acid. But CaF₂ is soluble enough to easily maintain the optimum concentration of fluoride anion required for the beneficial effect (0.7 ppm F). One could use it to fluoridate water – although the mechanics would be difficult as very little dissolves. Whatever the source, NaF, CaF₂ or fluorosilicic acid, the end product in drinking water is the same so introduction of such relative toxicities is misleading.

Claim hydrolysis is incomplete

Waugh says:

“When added to drinking water Hexafluorosilicic acid dissociates into free fluoride ions, it is now accepted that this reaction is not complete with the possibility of some silicofluoride compounds remaining present in drinking water.⁵
It is further known that the following fluorosilicate species may be present in treated water. However current analytical methodologies are not yet available to accurately measure or quantify the level of residual fluorosilicates or fluorosilicon complexes that may be present.”

Strange. He is claiming that we currently do not have the analytical methods to measure or quantify residual fluorosilicates but nevertheless “it is now accepted” and “further known” silica fluoride compounds are present in drinking water. Trouble is neither the table he presents, or the paper he refers to (from which the table is taken) say this. They say the exact opposite!

The table simply lists the different silicofluorides species that have been chemically proposed, reported or inferred in solids, gases or solutions. While some of these may logically exist in water (eg SiF₆^2- and Si(OH)₄) there is certainly no evidence that they all do. His reference 5 (Urbansky, E. T. (2002). Fate of fluorosilicate drinking water additives. Chem. Rev., 102, 2837–2854) concludes:

“that in drinking water supply with a pH of 5 or higher, fluoridated with sodium silicofluoride [hexafluorosilicate] to the extent of 16 ppm or less, all of the silicofluoride is completley hydrolysed to slicic acid, fluoride ion and hydrogen fluoride. There can be no question of toxicity of SiF₄ or SiF₆^2- under these conditions.”

As for rate of hydrolysis Urbansky (2002) clearly says “all the rate data suggest that equilibrium should have been achieved by the time the water reaches the consumer’s tap if not by the time it leaves the waterworks plant.” This “equilibrium” is essentially the complete hydrolysis of the fluorosilicate as Urbansky and Schock (2000) make clear:

“Based on the above information on both the thermodynamics of the hydrolysis reaction and it’s kinetics, we can safely conclude that there is essentially no (<< 1 part in a trillion) hexafluorosilicate remaining in drinking water at equilibrium and that equilibrium is rapidly reached from the combine uncaltalyzed and metal-catalysed reactions.”

Claim reaction of silica with fluoride in stomach and bladder

Waugh claims:

“According to Urbansky, a senior US EPA chemist and expert upon water fluoridation chemicals” such compounds [H₂SiF₆, NaF, Na₂SiF₆ and AlF₃] may exist in artificially fluoridated drinking water as well as in low acidic environments within the human body (i.e. Stomach and bladder) after consumption of fluoridated water.³“

And

“It is also now hypothesized that incomplete dissociated SiF residues may re-associate both at intra-gastric pH and in the bladder which are low ph environments⁹ (thereby exposing the consumer to toxic harm) and during food preparation (low pH soft drinks) producing SiF species including silicon tetrafluoride, (SiF₄), a known toxin. It is also believed that commercial SiFs are likely to be contaminated with fluosiloxanes.”

His reference 3 is to Urbansky (2002) and 9 is to Ciavatta, L., Iulianno, M., & Porto, R. (1988). Fluorosilicate Equilibria in Acid Solutions. Polyhedron, 7(18), 1773–7779.

The falseness of his claim that Urbansky provided evidence of the existence of fluorosilicates in drinking water was discussed above. Urbansky and Schock (2000) actually put the theoretical proportion of silica present as fluorosilicate in the “most acidic gastric conditions” at less 0.0002%. As for Ciavatta et al (1988) – their work has no relevance to the stomach or bladder. They studied the reaction of silicic acid and fluoride in 3 Molar Lithium perchlorate with an acidity between 0.3 and 3 Molar. An ideal solution for the laboratory investigate of chemical equilibria but more extreme than conditions in our stomach and bladder.

So again, Waugh has misrepresented the literature and distorted its relevance to the situation in drinking water and our body.

Nevertheless, Waugh get cited as evidence for incomplete fluorosilicate hydrolysis and for recombination in the stomach. For example Mark Atkin relied on this report of Waugh’s in defending this erroneous claim before the NZ Advertising Standards Authority (see Anti-fluoridation advertising deceptive).

Finney et al (2006) is also often used by anti-fluoridationists to claim recombination in the stomach because they showed presence of an intermediate SiF species at pH values below 3.5 (SiF₅^–). Again this is a laboratory study with higher F concentrations and no interfering species. In the real world drinking water (and especially the stomach content) has all sorts of chemical species, many of which react with F, Si(OH)₄ or both. These will displace any theoretically derived equilibria. I have not seen any reports of detection of silicofluorides species in the stomach or bladder. Nor have I seen anything to suggest that these would be any more toxic than fluoride itself – or any of the other chemical species present in the stomach.

Conclusion

Readers having read my comments here and those on Waugh’s theory about silica toxicity (An open letter to Declan Waugh – new mechanism for fluoride toxicity?) might see a pattern:

• Citation of scientific literature to given credibility to Waugh’s claims;
• Misrepresentation of the cited literature – often claiming they report the exact opposite of what they in fact do;
• Confirmation and cherry picking which is very clear to any intelligent reader;
• Attempt to establish himself as a “scientific authority” on fluoridation which can be used by anti-fluoridation activists to support their own claims.

I guess you can fool some of the people some of the time. But it does show that  such material should always be approached critically and intelligently.

---

PS: I would of course welcome Declan Waugh’s response to this article. After all, I might be completely wrong – but I won’t know that without some sort of exchange with him.

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An open letter to Declan Waugh – new mechanism for fluoride toxicity?

Dear Declan,

You describe yourself as a scientist and fluoride researcher so I feel the responsibility to bring to your attention what I think are major flaws in a recent presentation of yours. I am sure you understand that research and the scientific ethos requires and encourages constructive criticism, and in fact the debate over ideas and hypotheses is an essential part of the scientific process. I offer my criticisms with this in mind and therefore assume you will receive them in the same open spirit  and give them your honest consideration.

In this presentation to the  Nutritional Therapists of Ireland, Health Impacts of Water Fluoridation May 2014 you make several arguments which I think violate basic chemical principles. You then go on to claim a mechanism for many health complaints you claim results from community water fluoridation.This is a novel mechanism because it attributes health problems not to fluoride but to silica resulting from the hydrolysis of fluorosilicates used as fluoridation chemicals.

Below I list the steps in your argument together with my comments on these:

Slide 16:

You claim “ultra fine silica particles”  form on hydrolysis of fluorosilicates. You cite Finney et al (2006) for this. However, nowhere in  Finney et al (2006) is there a reference  to”ultra fine silica particles.”

What they describe is the well-known hydrolysis reaction:

SiF₆^2-(aq) + 4H₂O(l) ↔ 4H⁺ + 6F^– + Si(OH)₄(aq)

The silica species produce is the monomeric molecule Si(OH)₄. This soluble (“reactive”) silica exists in solution but has a very complex chemistry. Polymerisation occurs and a number of molecular species are possible in solution. The end product of such polymerisation can be solid silica but, on the other hand, solid silica can support a concentration of monomeric silica in solution.

Yes, molecules in solution are extremely small but it is plain  wrong to describe them as if they were just very small, or “ultra fine,” particles of the solid.

Slide 17:

You now go further describing these molecules as “nanoparticles” and cite Napierska et al (2010) to tell viewers that nanoparticles can have negative health effects. They can be toxic. This is a huge leap, on top of the huge leap in the previous slide.

You have gone from a monomolecular species (Si(OH)₄), to a finely divided solid,  to “nanoparticles.”

No way is it legitimate to describe a small molecule like Si(OH)₄ as a “nanoparticle.” One definition of a nanoparticle describes is as a “microscopic particle with at least one dimension less than 100 nm.” Simple molecules like Si(OH)₄ are thousands of times smaller.

Slide 18:

You now put these ideas together to imply that fluoridation can cause a large range of health problems via formation of nanoparticles during hydrolysis of the fluoridation chemical and their toxic reaction in the bloodstream. I believe your arguments here are false, you have not given any evidence to support them, and in fact you have misrepresented the citations you used.

Silica in drinking water

Your wild “theory” introduces a big can of worms which you should have considered but actually ignore. Silica, reactive or monomolecuar silica, exists in all drinking water, fluoridated and unfluoridated. Here are some examples from New Zealand community water supplies. Please note, fluoridation  is irrelevant. In fact the highest levels of reactive silica occur in an unfluoridated supply.

		Fluoride (mg/L)	Reactive silica (mg/L)
Hamilton	Templeview Site 23.08.13	0.16	37
	Hamilton Site 12.02.14	0.19	34
Christchurch	Christchurch	<0.1	16
Wellington	Waterloo	0.78	15.5
	Wainuiomata	0.83	12.55
Auckland	Auckland	0.81	13.23

None of this is surprising as silica will be derived from all sorts of natural, geological, sources the water contacts.

Did you bother comparing natural levels of reactive silica with what could be expected from the hydrolysis of fluorosilicates? My estimates suggest that fluoridation with fluorosilicate at the optimum level (0.7 mg F/L) would produce a reactive silica concentration of 0.37 mg SiO₂/L. Surely you can agree this is miniscule compared with he natural levels of reactive silica in all drinking waters?

Your hypothesis of a toxic role of monomolecular silica in drinking water implies  all drinking water is unhealthy and that, in fact, fluoridation could contribute only an insignificant amount to this toxicity.

A serious charge which most scientists would consider better justification and evidence than you have given so far. Personally I think it would be irresponsible of you not to publicly withdraw these unwarranted claims.

I think there are similar faults in the way you have used statistical health information to imply a link of fluoridation to a whole host of health problems but that is a separate issue. At this stage I look forward to a response to my specific chemical criticisms listed above.

If you wish to defend your hypothesis, or to debate this specific issue and the wider claims you are making, I would be happy to offer you space on the Open Parachute blog for an exchange of articles. This proved a very effective method of scientific discussion in my exchange with Paul Connett (see Fluoride Debate). Many anti-fluoridation activists seem to hold you in the same regard as Paul and rely on your for much of their information. You have also contributed submissions to local body councils in New Zealand considering the fluoridation issue. I am sure you would therefore welcome the opportunity to present your scientific claims to a scientifically literate audience that this exchange can offer.

I look forward to your response.

Kind regards

Ken Perrott.

 

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Declan Waugh scaremongers over fluoride – again

Mary Byrne, the convener of the anti-fluoridation activist group Fluoride Action Network of NZ, is promoting “alarming information” about incidence of neural tube developmental defects like spina bifida with the implication they are caused by community water fluoridation. Her authority for this is Declan Waugh!

Declan Waught – promoted as a “leading expert” on fluoride by anti-fluoride movement

Any critical examination of Waugh’s claims on fluoridation (and there are many) would show him to be the last person one should trust on the issue. Unfortunately, though, he does seem to fool some people – using a mixture of extensive, but misleading, citation of scientific papers and claims about the high incidence of many illnesses in the Republic of Ireland. Anti-fluoride activists love to quote him as “scientific proof” for their own extreme claims and, worryingly, the Hamilton City Council was persuaded that he is indeed a reliable “expert” – citing one of his reports in the list of 10 documents which convinced them to stop fluoridation last year (see When politicians and bureaucrats decide the science).

Very often simple checking will show his claims about the incidence of illnesses are actually completely wrong, and the scientific papers he cites don’t actually say what he claims. Completely dishonest but  it seems you can fool some of the people some of the time with fancy sciency-looking reports. Especially if your citations are so intimidatingly extensive few readers have the energy to check them.

Here I will take apart the fear mongering he is currently promoting over spina bifida and similar neural defects.

The incidence of neural defects in Ireland

The “alarming information” on incidence of neural defects in The Republic of Ireland  he relies on is a paper by McDonnell et al (2014), Neural tube defects in the Republic of Ireland in 2009–11.  The authors concluded:

“The incidence of NTDs [neural tube defects] in the Republic of Ireland appears to be increasing. Renewed public health interventions, including mandatory folic acid food fortification, must be considered to reduce the incidence of NTD.”

A press release from the UCD School of Medicine and Medical Science in Dublin put this in context:

“This comprehensive national audit over three years found that the incidence of neural tube defects (NTDs) increased slightly during the period studied, reversing the trend of the previous ten years.

NTD incidence had increased from 0.92/1 000 in 2009 to 1.17/1 000 in 2011. And nowhere was fluoride implicated as a cause of this.

So no basis for Waugh’s fear mongering and implication of community water fluoridation as the cause. However, I imagine the average anti-fluoride activist would be aghast at the idea of a social health policy involving mandatory folic acid food fortification and would campaign against it.

Manufacturing a link to fluoride

Declan Waugh manufactures a link of NTDs to fluoride and community water fluoridation in two ways:

1: The old trick of using a brief report from an area of high dietary fluoride intake. In this case the paper of Gupta et al (1994). This brief 2 page report studied children suffering dental and skeletal fluorosis in India. Drinking water concentration was high (4.5 to 8.5 ppm compared with the recommended 0.7 for community water fluoridation). Fourteen of the 30 children studied showed spinal bifida occulta (the mildest form which usually presents no problems) on X-rays but not on clinical examination.

Although the incidence in this small sample is higher than the 20% normally found in average spines the number of subjects is low so no conclusions are possible. In fact, all the authors did was to propose “a randomised controlled study to evaluate a possible correlation between spina bifida and high fluoride intake.” The also pointed out that they could not find any literature reports correlating spina bifida with fluoride.

So all pretty speculative – but enough for a desperate anti-fluoride “authority” like Declan Waugh to do a bit of scaremongering.

2: Waugh goes out of his way to suggest a mechanism for community water fluoridation causing neural tube defects – fluoride reduces folic acid concentration in the body! And he manages to cite a couple of scientific papers to support his ideas. Problem is – they don’t.

He argues in a 2012 report (which he describes as his “main report”) that “Fluoride is known to be an inhibitor of enzymatic activity and research has identified fluoride as an inhibitor of homocysteine hydrolase³⁶³“ and this causes a decline in folic acid levels.

The cited paper is Mehdi S, Jarvi ET, Koehl JR, McCarthy JR, Bey P. The mechanism of inhibition of S-adenosyl-L-homocysteine hydrolase by fluorine-containing adenosine analogs. J Enzyme Inhib. 1990;4(1):1-13.

Waugh is citing work using “fluoride-containing adenosine analogs” to make the claim about the fluoride anion. Specifically, the compounds (Z)-4,5′-Didehydro-5′-deoxy-5′-fluoroadenosine, 5′-deoxy-5′-difluoroadenosine, and 4′,5′-didehydro-5′-deoxy-5′-fluoroarabinosyl-adenosine  – not fluoride.

Extremely sloppy!

Declan Waugh has just pulled out any old citation referring to fluoride – maybe he hasn’t even read past the title of the paper.

Yet the tame alternative health media make the claim that “amongst the international scientific community, Waugh is now regarded as a leading expert on the subject!”

That reminds me of the local anti-fluoridation activists who continually describe Paul Connett, from the sister activists organisations Fluoride Alert, as a “World expert on fluoridation!”

Actually, Waugh gave the show away in his 2013 report when he said:

“To my knowledge no study has ever been undertaken to examine if fluoride exposure combined with nutritional status may be a contributory factor to the alarming levels of congenital defects in fluoridated compared to non-fluoridated countries.”

But as is often the case with these sorts of admissions, the very lack of evidence appears to be used to infer a cause. He is advancing the fallacy that the lack of evidence really means the evidence is there but just hasn’t been found yet – probably because evil scientists are conspiring to prevent the necessary research.

The old trick of making a wild claims, suggesting something as a possibility and then promoting the idea as some sort of scientifically proven fact in his scaremongering.

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When politicians and bureaucrats decide the science

The current seperation of responsibility for water treatment (local body councils) and community health policy (District Health Boards) is a problem when considering fluoridation. This was illustrated by the Hamilton City Council’s suspension of  fluoridation of the city’s water supply. In the end the City Council neglected its real responsibility (to find out and reflect the views of its citizens) and instead took over the health Board’s responsibility for public health policy.

The council set itself up as a “tribunal” to make judgements on the science – a task they were clearly not equipped for.

The “tribunal” process

Tegan McIntyre, the Hamilton City Council’s Strategy and Research Unit manager, recently revealed a little of the process used by the council in its judgment of the science around fluoridation. She released “a list of the key research papers referenced during the submission and tribunal process.” She also described the “in-house evaluation” of that research. This evaluation appeared to find the research acceptable if it was “validated (peer reviewed) and/or published in an acknowledged peer-reviewed journals.”

You can download Tegan’s list –Scientific research supporting the stopping of fluoridation. The research seems to have been chosen using some sort of popularity index – she says “Please note, this list does not cover all the reports referred as this was extensive but focuses on the ones most frequently cited.”

So, the unrepresentative nature of submissions is a bit of a problem to start with – the summary of submissions says – ”

“Of the 1,557 submissions received 1,385 (89%) seek Council to stop the practise of adding fluoride to the Hamilton water supply. 170 (10.9%) seek Council to continue the practise of adding fluoride and 2 (0.1%) submitters did not indicate a stance.”

This in a city which showed 70% support for fluoridation at its 2006 referendum!

The validity of scientific research determined by this sort of popularity contest. Or by the way the councillors and council bureaucrats kept referring to “experts on both sides” as if it was simply a matter of weighing the submissions without any proper evaluation of the validity of claims made by the “experts.”

This approach is not acceptable for scientists who are used to critical consideration and in depth analysis of published research.

However, maybe it’s a natural way for bureaucrats without the scientific background necessary to make sense of a large number of submissions. I am sure the anti-fluoridation activist organisations realise this and I can understand why they use the approach of swamping such hearings with unrepresentative numbers of submissions, basically repeating the same message.

I will comment below on the documents in the list and the validity of the Council’s assessments. Sorry for the inevitable length of these comments. You can download a pdf to read at your leisure.

1: Public Health Investigation of Epidemiological data on Disease and Mortality in Ireland related to Water Fluoridation and Fluoride Exposure by Declan Waugh.

Declan Waugh is a darling of the anti-fluoridation movement. He also made presentations (written and by Skype from Ireland) to the “tribunal” so I am not surprised to find it top of the list. Apparently the Council evaluated the document highly because it was a “literature review collated by environmental scientist/consultant.”

I haven’t had time to critically consider this specific document but in the scientific world Declan Waugh’s work is not so highly regarded. The Irish Expert Body on Fluorides and Health evaluated Waugh’s previous report – which he considers his “main Report” – (Human Toxicity, Environment Impact and Legal Implications of Water Fluoridation)  and found it was “not reliable.” That while the “report is expertly produced and is impressive in size and appearance. However, in spite of its presentation, its content is decidedly unscientific” (see Appraisal of Waugh report – May 2012). Among specific points it made are these (see Executive Summary of Appraisal of Waugh report – May 2012):

• “The allegations of ill health effects are based on a misreading of laboratory experiments and human health studies, and also on an unfounded personal theory of the author’s.
• There is an absence of reporting of the bulk of the scientific literature which points to the lack of harmful effects from fluoridation.
• The views of authoritative bodies such as the World Health Organisation, the European Commission and others are significantly misrepresented.
• There is a misunderstanding of the evidence of benefits to oral health and with regards to enamel fluorosis.
• The view that there is a build up of fluoride in the environment is unfounded and not supported by the evidence.”

Anyone willing to spend a little time can make their own evaluation of Declan Waugh’s scientific integrity simply by checking his approach to citations.

Two examples:

On page 74 of his “main report” we find the claim:

“Fluoride is known to be an inhibitor of enzymatic activity and research has identified fluoride as an inhibitor of homocysteine hydrolase.³⁶³“

The cited paper is:

Mehdi S, Jarvi ET, Koehl JR, McCarthy JR, Bey P. The mechanism of inhibition of S-adenosyl-L-homocysteine hydrolase by fluorine-containing adenosine analogs. J Enzyme Inhib. 1990;4(1):1-13.

Waugh is citing work about “fluoride-containing adenosine analogs” to make the claim about the fluoride anion. Extremely sloppy!

On Page 75 he claims:

“Current research has also identified the link between fluoride and atherosclerosis.³⁷⁰“

The cited paper is:

Li Y, Berenji G R, Shaba W F, Tafti B, Yevdayev E, Dadparvar S. Association of vascular fluoride uptake with vascular calcification and coronary artery disease. Nucl Med Commun. 2012 Jan;33(1):14-20.

Those familiar with the claims made by anti-fluoridation propagandists will recognise this paper. It concluded “[18F]fluoride PET/CT might be
useful in the evaluation of the atherosclerotic process in
major arteries, including coronary arteries. “ Fluoride does not cause atherosclerosis but because fluoride is associated with calcium containing products of atherosclerosis – fluoride is only along for the ride – the authors proposed the technique for detecting atherosclerosis.

Waugh uses citations like a drunk uses a lamp post – for support rather than illumination. And this causes him to use the citations dishonestly – as evidence for claims that they actually don’t support. Try checking out a few citations yourself.

2:  Ethics of Artificial Water Fluoridation in Australia by Niyi Awofeso

This appears to be an academic discussion of the ethical issues involved and comes out in opposition to fluoridation. Effectively it balances  health equity against individual autonomy – a values/political judgement. The Council evaluated the document highly because it was “Published in a peer-reviewed international journal.”

I could not get the full text of this document so can’t really comment on it – except to conclude from the abstract that no scientific issues seem to be discussed.

3: Developmental Fluoride Neurotoxicity: A Systematic Review and Meta-Analysis by Anna L. Choi, Guifan Sun, Ying Zhang,and Philippe Grandjean

If you are familiar with the fluoridation debate you will recognise this paper – it is one of the most quoted by anti-fluoridation commenters on the internet.  The Council evaluated the document highly because it was “Published in a peer-reviewed research and news journal published with support from the National Institute of Environmental Health Sciences.”

The study often seems to be quoted alongside outrageous claims like the Nazis used fluoride in the concentration camps to placate inmates. Or the US government adds fluoride to water to keep the population from revolting (see Fluoridation and conspiracy theories).

Because of the study’s misuse to attack fluoridation the authors warned in a press release:

“These results do not allow us to make any judgment regarding possible levels of risk at levels of exposure typical for water fluoridation in the U.S. On the other hand, neither can it be concluded that no risk is present. We therefore recommend further research to clarify what role fluoride exposure levels may play in possible adverse effects on brain development, so that future risk assessments can properly take into regard this possible hazard.”

One problem is that the effects on IQ were seen at high fluoride intakes (studies were of Chinese localities with a range of fluoride in drinking water from both natural and industrial pollution sources). The “control” ‘low fluoride exposure” groups in this study are often exposed to fluoride concentrations comparable to that achieved by community water fluoridation schemes. Andrew Sparrow illustrated this with the following infogram:

Another problem is that no causal link between fluoride and IQ levels was sought or found. The fact that some of the locations suffered from industrial and coal pollution means these IQ effects, if real as social factors were not elimated, could have been caused by any number of pollutants.

This work should not have been considered relevant to the question of fluoridation of Hamilton’s water supply – despite its popularity with anti-fluoridation submitters.

4: Critical review of any new evidence on the hazard profile, health effects, and human exposure to fluoride and the fluoridating agents of drinking water by SCHER

The Council evaluated the document highly because it was “Published by one of the independent non-food Scientific Committees which  provides the European Commission with scientific advice.

This review is often cited by both sides. Reasons for anti-fluoridation citing could include the clear assertion that fluoride “is not an essential element for human growth and devlopment.” But the review does make clear the fluoride is beneficial for oral health. Misunderstandings often revolve around precise usage of words like “essential.”

Another reason could be the vague comparsion between “topical fluoride application” and “systemic” intake of fluoride. This could enable anti-fluoridationists to claim fluoridated water is ineffective. However, the report does refer to the effectiveness of maintianing “a continuous level of fluoride in the oral cavity.” Fluoridated water does do this.

Again this illustrates the need for careful and critical evaluation of the scientific literature and the need to avoid simple claims which may incorrectly cite that literature. I just don’t think politicans and bureaucrats can be relied on for that.

5: Estimated Dietary Fluoride Intake For New Zealanders by Peter Cressey, Dr Sally Gaw and Dr John Love

The Council evaluated the document highly because it “was prepared as part of a Ministry of Health contract for scientific services.”

It is a straightforward desktop study of the “dietary fluoride intakes for a range of age and gender sub-populations based on New Zealand data.” There are no surprises in the data, although the interest for anti-fluoridationists was probably their findings for  formula-fed infants:

“The estimates for a fully formula-fed infant exceeded the UL [upper level of intake] approximately one-third of the time for formula prepared with water at 0.7 mg fluoride/L and greater than 90% of the time for formula prepared with water at 1.0 mg fluoride/L. However, it should be noted that the current fluoride exposure estimates for formula-fed infants are based on scenarios consistent with regulatory guidelines, rather than on actual water fluoride concentrations and observed infant feeding practices.”

They conclude “the very young appear to be the group at greatest risk of exceeding the UL.” However:

“the rarity of moderate dental fluorosis in the Australia or New Zealand populations indicates that current exceedances do not constitute a safety concern, and indicates that the UL may need to be reviewed.”

Anti-fluoridationist have made some mileage out of this, taking advantage of parent’s’ understandable concerns about their children. They (and the Hamilton City Council in their initial advice to ratepayers) advised parent not to use fluoridated water to make up formulae when infants are  fully formula-fed.

While the current expert advice is a little confusing it does take account of the need for review of current UL’s and considers use of fluoridated water safe for fully formula-fed infants. However, they also advise that if parents are concerned they should use non-fluoridated water for part of the feeding – a peace of mind matter.

Again, I question if the “tribunal” really understood the complexity of the situation for fully formula-fed children. Even though health experts had explained the situation during the hearings they apear to have simply accepted the anti-fluoridationist’s interpretation of this research.

Maybe it was the loudest, or more frequently presented, message which prevailed?

6: Fluoride in Drinking Water: A Scientific Review of EPA’s Standards by National Research Council Of  The National Academies Committee on Fluoride in Drinking Water.

The Council evaluated the document highly because the national research council is a “government funded research entity.”

This report usually get cited by both supporters and opponents of fluoridation – however, it actually does not have direct relevance to fluoridation of water supplies at the concentrations used in New Zealand (0.7 – 1.0 ppm) or in the US (0.7 to 1.2 ppm). “The charge to the committee did not include an examination of the benefits and risks that might occur at these lower concentrations of fluoride in drinking water.”

The NRC’s task was to evaluate the scientific evidence to determine if the Environmental Protection Agency’s maximum recommended levels of 4 ppm F should be lowered. They concluded it should be lowered to below 2 ppm to avoid any severe fluorosis. Anti-fluoride activists very often cite this report because of its thorough discussion of the negative effects of fluoride observed at high concentrations. They rarely admit that these effects are not reported for the concentration range used in public water fluoridation. This sort of scare-mongering often comes up in political debate but I would expect a critical evaluation of the report would have recognised that it is not relevant to the Hamilton situation.

But then again, why should we expect politicians and bureaucrats to be capable of such critical consideration.

7: Water Fluoridation: a Review of Recent Research and Actions by Joel M. Kauffman

The Council evaluated the document highly because although the “journal  is not listed as an academic journal but as a professional association journal. [It]Has a double-blind peer-review process.”

This was published in the Journal of American Physicians and Surgeons which really has no scientific standing. Issuepedia says “the journal does not appear to be considered respectable by the scientific establishment“ because:

• It is not listed in the major literature databases ( MEDLINE/PubMed nor the Web of Science).
• The World Health Organization found that a 2003 article on vaccination published in the journal had “a number of limitations which undermine the conclusions drawn by the authors.” 
  
• Quackwatch lists it as an untrustworthy, non-recommended periodical. 
  

Investigative journalist Brian Deer described the journal as the:

“house magazine of a right-wing American fringe group, the Arizona-based Association of American Physicians and Surgeons, which campaigns against US vaccination policies. The association is also vocal in opposing moves to combat fraud by private doctors, and medical professional efforts to reduce deaths from domestic firearms. In 2005, Time Magazine reported that the association had only 4,000 members. Although cited by Private Eye in stories attacking MMR, the association’s journal – recently renamed from the Medical Sentinel, presumably for the purpose of attempting to give its ideologically slanted material the aura of science – is barely credible as an independent forum for such material. No objective medical scientist with important information of any standard would submit it to such a publication, unless they couldn’t get it published anywhere else.”

So much for the Hamilton City Council high evaluation. But the paper itself is not at all convincing. It’s claims are poorly supported. It relies heavily on citation of sources from anti-fluoridation activists. Much of the citation is to just one book Fluoride: Drinking Ourselves to Death by Barry Groves – a staple anti-fluoridationist manual. Kauffman’s ideological motivation are obvious.

8: Prevention and reversal of dental caries: Role of low level fluoride  by J. D. Featherstone.

The Council evaluated the document highly because it was in a “ranking academic journal.”

This paper is often cited by anti-fluoridationists as support for their claim that the “topical mechanism” of protection of existing teeth means that fluoridated water is ineffective. Yet the paper clearly includes “fluoride in drinking water” (as well as in “fluoride-containing products”) as operating via the topical mechanisms. Featherstone has also stressed drinking water in recent descriptions of the “topical mechanism” (Topical Effects of Fluoride in the Reversal and Prevention of Dental Decay). I can only conclude that some people have the wrong impression through superficial reading and their conclusions have been adopted by others without any checking. The Fluoridation Action network NZ (FANNZ) website even claims, incorrectly, that a topical effect of fluoridated water on teeth “is contradicted by Featherstone.”

Again, and again, I find this website very misleading in their use of citations.

The Hamilton City Council repeated this incorrect interpretation of topical mechanisms in their information leaflet for citizens (see Topical confusion persists) – a serious mistake which has been strongly criticised by health professionals. Did Council bureaucrats simple take the anti-fluoridationist use of this citation at their word – without any checking?

9: Why I changed my mind about water fluoridation by J. Colquhoun.

The Council evaluated the document highly because it was in a “Peer-reviewed academic journal published by Johns Hopkins. Author: former dental officer in New Zealand during the 1970s and early 1980s”

This is really a memoir, and not a high quality review. I found that it generally gave a lot of emphasis to longitudinal studies which show improvement in oral health over time for both fluoridated and unfluoridated areas. This may have suprised researchers at the time but is well recognised today and, by itself, is not evidence against the effectiveness of fluoridation. He also seems to be very selective, some would say cherry-picking, in referring to studies where comparison have been made between fluoridated and unfluoridated areas. The all appear to show either no effect, or that oral health was better in the non-fluoridated areas! (Anti-fluoridations regularly do such cherry-picking today).

Colquoun presented the “topical” mechanism as an argument that fluoridated water is ineffective – a suprising interpretation for someone familiar with the literature. However, I guess his committment to the anti-fluoridationist cause when he wrote this memoir might explain the faulty interpretation.

10: The mystery of declining tooth decay by Mark Diesendorf

The Council evaluated the document highly because it was published in “Nature [which] is a prominent interdisciplinary scientific journal. Ranked the world’s most cited. “

Although Diesendorf is an environmental scientist he is also an anti-fluoridation activist. In this paper he relies heavily on longitudinal studies, where oral health was found to improve in both fluoridated and unfluoridated areas over time. This is a well accepted observation, explained by improvements in diet and care of teeth, as well as availability of fluoridated toothpaste. I believe some of this improvement is also due to changes in dental practice involving less fillings.

Such research does not invalidate the also well recorded difference in oral health between fluoridated and unfluoridated areas observed in many good studies. However, the longitude observations still get trotted out as evidence against fluoridation by the anti-fluoridation activists.

Despite the high standing of Nature, this paper does come across as somewhat one-sided, maybe partly because of its age (1986).

Conclusions

The mistaken approach of the Hamilton City Council in its “tribunal” judgement of the science behind fluoridation illustrates the problems of the current situation where councils effectively make decisions about fluoridation because they manage water supplies. This can force them into a role for which they have neither the skills nor the training – making scientific and health judgements. Anti-fluoridation activists have taken advantage of this anomaly with a certain amount of success.

The Medical Association has called the debate on fluoridation to be raised to a national level. “Medical Association chairman Dr Mark Peterson says it’s not ideal for it to be discussed at a regional level and not nationwide.” This could be a way of avoiding the problems illustrated by the actions of some councils – including the Hamilton City Council.

The way scientific research was evaluated by the Hamilton City Council and its bureaucrats shows what can happen when such evaluations are not done critically by people with expertise in research and some understanding of the issues involved. Discussion and decision of the fluoridation issues at the natioanl level could help ensure such evaluations are done by bodies better equipped for the job.

See also:

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