New study touted by anti-fluoridation campaigners actually indicates fluoridation is safe

Children used in this study were from Lintingkou town (a normal-fluoride/control area) and Dakoutun town (a high-fluoride area) in Baodi district of Tianjin, China. The towns are 25 km apart.

Anti-fluoridation activists on social media seem to cite any scientific article about fluoride which they think will show it harmful. They usually rely only on information in the article title or abstract. This means they are often wrong as the articles may not be at all relevant to the low fluoride concentrations used in water fluoridation. Perhaps they should stop for a minute and actually read the articles they cite.

The other day @NYSCOF, the twitter account for the New York State Coalition Opposed to Fluoridation, Inc (a small antifluoridation activist group in New York) promoted a new Chinese study as part of its campaign against community water fluoridation (CWF). It claimed: “Children’s IQ was lower when water and urinary fluoride levels were high compared to a low fluoride group.” But the fact this is a Chinese study should have warned the honest reader that the “high” fluoride group lived in an area of endemic fluorosis and data for them is irrelevant to CWF.

In fact, some of the data in their paper are relevant to CWF – the data for the “low fluoride” control group where children were exposed to drinking water concentrations less than 1 mg/L (CWF aims to maintain a drinking water fluoride concentration of about 0.7 or 0.8 mg/L). It’s worth looking at that data to see if child IQ is related to fluoride exposure at that level.

The take-home message is that it isn’t.

Here is the citation for the new study:

Zhao, Q., Tian, Z., Zhou, G., Niu, Q., Chen, J., Li, P., … Wang, A. (2020). SIRT1-dependent mitochondrial biogenesis supports therapeutic effects of resveratrol against neurodevelopment damage by fluoride. Theranostics, 10(11), 4822–4838.

Two different communities

The children (8-12 year-olds) in this study came from two different communities in the Baodi district of Tianjin, China – see the map above. They are Lintingkou town, where drinking water fluoride concentrations were “normal,” and Dakoutun town, which is in an area of endemic fluorosis and the drinking water fluoride concentrations are high (about 1 to 3.5 mg/L). The towns are about 25 km apart and will clearly have a number of differences which could be relevant to the IQ of children. Possible confounders like this were not considered in the study.

People living in areas of endemic fluorosis suffer a range of health and socioeconomic effects which could influence child IQ

The figure below from the paper illustrates the ranges of drinking water F and urinary F for the children studied (30 in each of the “low” and “high” fluoride groups).

Only the data for the “control” group are relevant to CWF. Unfortunately, the authors chose to plot the IQ data for the two groups on the same graph and concluded that this showed a “fluoride-caused intellectual loss in children” – see their graph below.

But, their conclusion is wrong. When we look at the data for the “control” and “high fluoride” groups separately that simple conclusion is clearly unwarranted.  In fact, there is no statistically significant relationship (p<0.05) of child IQ with urinary F for either the “low” or the “high” group – see the graph below which uses digitally extracted data from the above figure. Data points for the”low” fluoride group are green and those for the “high” fluoride group are red.

This shows how statistical analyses like regression analyses can produce misleading results if the data is not considered properly. It is simply misleading to include two separate populations like this in a regression analysis without considering the whole range of possible confounders.

There is no relationship between child IQ and urinary fluoride in either population. All the regression analysis shows is that there is a difference between the two towns – and that is simply shown by the average values of IQ in those towns. The average child IQ in Lintingkou town is 112.4 while in Dakoutun town it is 98.5.

While these IQ values seem pretty good (usually the average IQ for a population is 100) the lower value for Dakoutun town is not surprising considering that the population living in areas of endemic fluorosis suffer a whole range of health and social problems.

The biochemical data has the same problem

The paper itself is a real hodgepodge of separate studies involving child IQ, levels of mitochondrial biogenesis signalling molecules, experiments with rats and with in vitro cell cultures. I do not have the expertise to critique the biochemical, cell culture and rat behavioural techniques used. However, the presentation of the biochemical data for the children suffers the same problems as the presentation of the IQ data.

The authors claim that there is a significant positive relationship between the silent information regulator 1 (SIRT1) and child urinary F, and significant negative relationships of peroxisome proliferator-activated receptor γ coactivator-1α (PGC-1α) and mitochondrial transcription factor A (TFAM) with child urinary F. But they simply lumped the data for the two towns together. When the data for the two groups are considered separately there are no statistically significant relationships for these biochemical measures in either of the two groups – see figures below. Again, data points for the “low” fluoride group are green and those for the “high” fluoride group are red.

Conclusions

Yet against anti-fluoride campaigners are promoting a study that they probably haven’t even bothered reading. They are using results for an area of endemic fluorosis to argue against CWF. Worse, they are completely ignoring the data in this and similar studies which show no relationship between child IQ and fluoride exposure at fluoride levels relevant to CWF.

Note

The Twitter account @NYSCOF promoting this specific study is very active and is connected with the Fluoride Action Network (FAN) through Carol Kopf –  the media officer for both the New York State Coalition Opposed to Fluoridation, Inc. (NYSCOF) and FAN. Ironically, she uses the slogan “I Am a Force for Science” on her Twitter image.

Sometimes I drop a reply to her posts – in this case pointing out: “And no loss of IQ at F concentrations relevant to community water fluoridation. These studies show CWF safe.”

My comment will not change Carol Kopf’s mind, of course, but others may read it and understand. Mind you, it’s inevitable that other anti-fluoride activists see my comments and react in stupid ways. For example, one of the Fluoride Free NZ leaders, Kane Kitchener, posted this reply:

“Ken, you’ve been exposed too long by Hamilton’s Fluoridated water. Too much reduction in IQ to see it.”

It really is pointless attempting to discuss science with these people.

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EPA comprehensively debunks anti-fluoride claims of a fluoride-IQ effect

FAN propaganda video promoting their petition to the EPA to stop community water fluoridation

The US environmental Protection Agency (EPA) has denied an anti-fluoride petition to ban community water fluoridation. The document outlining its reasons for declining the petition is valuable because it considers all the arguments and evidence presented in the petition and comprehensively shows them to be misleading or even false.

This is a humiliating defeat for the petitioners – the US  Fluoride Action Network (FAN), Food & Water Watch, Organic Consumers Association, American Academy of Environmental Medicine, International Academy of Oral Medicine and Toxicology and Moms Against Fluoridation. FAN, and in particular Michael Connett, had put a lot of work into their petition. The petition is a 76-page document, heavily referenced and, importantly, presenting all the best arguments that FAN could find. FAN did not keep any of their powder dry.

Of course, FAN and their associated international groups, Facebook pages and websites heavily promoted this petition. They had high hopes – Paul Connett himself has argued that their evidence would bring about the complete demise of community water fluoridation within a few years. The local Fluoride Free NZ issued a press release with the heading EPA Petition Could Spell End of Fluoridation claiming “FAN’s assessment provides unequivocal proof that current allowable levels of fluoride are not protective for all members of the population from damage to the brain.” Mary Byrne, their spokesperson asserted:

“Fluoridation belongs to a by-gone era and far too much is now known about adverse health effects for any further consideration on fluoridation to be seriously considered.”

Many anti-fluoridation submissions to the Parliament Health Committee considering changes to fluoridation legislation in New Zealand have relied strongly on the FAN petition – presenting it as the best thing since sliced bread.

Serious consideration

The EPA did give the petitioners arguments serious consideration – as we should expect from such an authoritative organisation. The petition was not rejected out of hand – the EPA’s 50-page document eexaminesthem in detail.

This is what makes the EPA document so available – it considers all the FAN arguments, the scientific papers presented and the evidence claimed. It shows how many of these papers and claimed evidence are misrepresented by the petitioners. It points to the limitations of the studies FAN relies on. It shows how FAN has not even established a case for reconsideration of recommended safe levels for fluoride and explains that the methodology used by FAN, and the recent publication by FAN staff (Herzy et al., 2016 – see Debunking a “classic” fluoride-IQ paper by leading anti-fluoride propagandists), is not valid.

The documents overall assessment of the petition’s arguments is damning:

“The petition has not set forth a scientifically defensible basis to conclude that any persons have suffered neurotoxic harm as a result of exposure to fluoride in the U.S. through the purposeful addition of fluoridation chemicals to drinking water or otherwise from fluoride exposure in the U.S. Still less has the petition set forth a scientifically defensible basis to estimate an aggregate loss of IQ points in the U.S, attributable to this use of fluoridation chemicals. As noted previously, EPA has determined the petition did not establish that fluoridation chemicals present an unreasonable risk of injury to health or the environment, arising from these chemical substances’ use to fluoridate drinking water “

Some specific rejections

The petition argued about 12 points and the EPA responded to all of them. Here are a few extracts.

The central claim of the anti-fluoride petitioners is that  Fluoride is neurotoxic at levels relevant to U.S. population. It cited human studies to support this but the EPA document responded by pointing out “the petition ignores a number of basic data quality issues associated with the human studies it relies upon.”

A central problem is the lack of  consideration of other factors possibly involved in influencing IQ – confounders:

“The petition . . .  does not properly account for the relatively poor quality of the exposure and effects data in the cited human studies (e.g., it appears to give all studies equivalent weight, regardless of their quality). When an association is suggested between an exposure and a disease outcome, the studies need to be assessed to determine whether the effect is truly because of exposure or if alternate explanations are possible. The way to do that is to adjust for potential confounders, such as diet, behavior, and socioeconomic status, in order to appropriately assess the real relationship between the exposures to a specific substance and health effects. In other words, when these confounding factors are potentially present, but not recognized or controlled for, it is not possible to attribute effects to the contaminant of concern (fluoride) as opposed to other factors or exposures. The evidence presented did not enable EPA to determine whether various confounding factors (e.g., nutritional deficiencies) were indeed placing particular subpopulations at a “heightened risk of fluoride .”

The issue of confounders is central to the petitioners claim that recent epidemiological studies corroborate neurotoxic risk in Western populations. The petition cites two studies from Western populations to attempt to corroborate the assertion that exposure to fluoridated water presents unreasonable risks for neurotoxicity. I have discussed these in previous posts – Peckham et al (2015) which claim to show that hypothyroidism is related to fluoridation and Malin & Till (2015) which demonstrated a relationship of ADHD prevalence to extent of fluoridation.

The EPA response says of the Peckham et al (2015) paper that:

“Adjustment for some confounders was considered, including sex and age, but other potential confounders (such as iodine intake) were not assessed. Fluoride from other sources and other factors associated with hypothyroidism were not assessed in this study.”

Iodine deficiency is a well-known factor in hypothyroidism.

The EPA response was relatively kind in its comment on the Malin & Till study:

“Although it is possible that there may be biological plausibility for the hypothesis that water fluoridation may be associated with ADHD, this single epidemiological study is not sufficient to “corroborate” neurotoxic health effects, as stated in the petition. More study would be needed to develop a body of information adequate.”

I showed in my article ADHD linked to elevation not fluoridation that once factors like elevation, poverty, and house ownership were included there was no statically significant relationship between ADHD prevalence and the extent of fluoridation in Malin & Till’s data. That is a clear example how conclusions based on correlations can be completely wrong when confounders are not properly considered.

The petitioners fell back onto their claim that neurotoxic risks of fluoride are supported by animal and cell studies – a common anti-fluoride tactic. However, the EPA document responded by pointing out that the petitioners had misrepresented such studies. It pointed out that these studies had been recently reviewed by the US National Toxicity Program (NTP) and the petitioner’s misrepresentation of the studies:

“do not change EPA’s agreement with the conclusions of the NTP report that their “[r]esults show low-to-moderate level-of-evidence in developmental and adult exposure studies for a pattern of findings suggestive of an effect on learning and memory.”

The petitioners claim susceptible subpopulations at heightened risk from CWF is a common claim of anti-fluoride propagandists. The EPA found this argument unconvincing:

“The data and information provided in the petition do not support the claims that “nutritional status, age, genetics and disease are known to influence an individual’s susceptibility to chronic fluoride toxicity.”“

The petition argued there were no established benefits of CWF to public health. The EPA responded by outlining some of the evidence for CWF benefiting oral health and responded to the petitioners claims with:

EPA does not believe that the petition has presented a well-founded basis to doubt the health benefits of fluoridating drinking water.

Despite not showing that community water fluoridation is linked to IQ losses the petitioners asked that because fluoridation covers a large population any harm would affect a large number of people so drinkign water fluoridation should be stopped on those grounds alone. Incidentally, Hirzy et al (2016) promised a future paper where they estimate economic losses to the USA because of fluoridation. I guess they will just ignore the Swedish work that actually shows drinking water fluoride levels are positively related to increased income and chances of employment (see Large Swedish study finds no effect of fluoride on IQ).

The EPA response to this argument:

As noted previously, EPA has determined the petition did not establish that fluoridation chemicals present an unreasonable risk of injury to health or the environment, arising from these chemical substances’ use to fluoridate drinking water. The fact that a purported risk relates to a large population is not a basis to relax otherwise applicable scientific standards in evaluating the evidence of that purported risk.

I like that bit about “relaxing scientific standards.” Doesn’t it just describe the whole approach of the anti-fluoride propagandists to the science?

What now?

According to the rejection letter the Petitioners, the Fluoride Action Network and their ideological mates can appeal the declining of their petition:

“by commencing a civil action in a U.S. district court to compel initiation of the requested rulemaking proceeding within 60 days of the date of this denial letter.”

The letter was dated February 17 – so they have until mid-April to get this underway. Michael Connett – who did the heavy lifting in the preparation of this 76-page petition – is an attorney so may be more capable with such legal action than he appears to be with the scientific arguments.

At the moment anti-fluoride propagandists appear more concerned with the theological questions related to leprechauns than they are with the EPA’s rejection of their petition.

At the moment the anti-fluoride groups, including those in New Zealand, are silent. It’s as if they did not receive their rejection letter almost 10 days ago. Perhaps they are busy debating their possibilities – and the public stance on this rejection they will eventually have to take.

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Connett & Hirzy do a shonky risk assesment for fluoride

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

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

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

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

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

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

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

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

Connett illustrates his next step with this slide.

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!

Connett 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.

Conclusions

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

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

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

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

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

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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. 

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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

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

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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.

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

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“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!

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“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.”

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“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.

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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.

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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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