Fluoridation: Connett’s naive use of WHO data debunked

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

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

This video clip shows his claim:

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

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

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

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

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

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

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

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

“Studies that appropriately compare the effectiveness of water fluoridation do not compare poorly controlled inter-country population samples. They generally compare age, sex, and where possible ethnicity matched groups from similar areas. Inter-country comparisons of health status, including oral health status, are notoriously difficult to interpret for cause and effect, because there are so many environmental, social and contextual differences that need to be considered.”

2: Comparison within countries

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

I showed this graph to Connett at the beginning of our debate on fluoridation. throughout the next few months he continued to confuse the issue and I kept coming back to it. Finally, he said in his closing statement, “My apologies. I should have checked back.”

An acknowledgment, of sorts, that his use of the WHO data is wrong in his graphs – but he continues to misrepresent it in this way!

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

3: CWF still effective when fluoridated toothpaste used.

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

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

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

 

Conclusion

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

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

References

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

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

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

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

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.

Similar articles

 

 

 

 

Remove support for child abuse

This doesn’t affect me directly, being a horrible heathen, but some readers might be interested. Some might even want to take action.

The article  Absolve This: Put The Catholic Church Out Of Its Misery appeared recently. It’s written by a “lapsed” Catholic disgusted by recent revelations of child abuse by the church in Ireland. It makes the point that one still gets counted by the church as a member – thus inflating the statistics. That to actually stop this it’s no good just being “lapsed” – one has to make it official. One has to actually defect.

The writer is encouraging this course for other Catholics who are “lapsed” or otherwise disgusted with the church. Here’s his advice:

“The genius’s at Count Me Out have compiled all the information you’ll need to complete this easy process on one website. Not Irish but still want to defect? No problem, the form is universal, so just fill this out and send it to the parochial house or bishop’s office of the diocese in which you were baptised. If you haven’t defected yet, then the church is using your membership to show that they have support. . .

Any other organisation would have been torn down after the first evidence of child abuse came to light. How many more horror stories do we need before the Church is put out of its evil misery?”

So – for all you “lapsed” Catholics out there. Here’s a practical step you can take to end this abuse.

Religion in the public square

Or do I mean irreligion in the public square? Same thing really.

I refer to the open discussion of religious ideas in the “public square.” That means ideas can be put up for consideration and subjected to open support or criticism. The same as our ideas on politics and sport. I am using the dictionary, not literal, definition of “public square” as “relating to or concerning the people at large or all members of a community.”

Don’t we already do that? Yes, I agree. But some people are unhappy about it. There is an idea around that religion doesn’t get a fair go. That it should be able to promote its claims and ideas without being subjected to criticism. The United Nations has passed a resolution against the “defamation of religion”. Ireland has reintroduced a blasphemy law. You get the picture.