Tag Archives: Paul Connett

Why is it so difficult to get an open discussion on fluoridation?

Yes, I know – everyone’s mind is already made up so participants just talk past each other. People’s positions on this and similar issues have become a matter of identity – people are driven by emotions, not information.

But, the information is there – and while I agree many people are driven by emotions they often attempt to use that information to support their positions. In a sense, the information acts as a proxy for their real driving force – their emotions.

Nevertheless, I have always considered a good-faith scientific exchange on issues like this is possible. I believe the exchange I had with Paul Connett, a US anti-fluoride campaigner, four years ago was a good example of what is possible (see Fluoride Debate or download Connett & Perrott (2014) – the pdf document of the exchange).

So, I always look for the chance to repeat that discussion – and I thought that might happen with my recent articles discussing the Mexican maternal prenatal urinary F/child IQ study. Why, because my recent article Paul Connett’s misrepresentation of maternal F exposure study debunked got a response from Mary Byrne, National Coordinator of Fluoride Free New Zealand. I posted her article as Anti-fluoride group coordinator responds to my article.

I responded to that with Mary Byrne’s criticism is misplaced and avoids the real issues and again I offered her a right of reply.

But no response. In fact, she refuses to answer any of my emails.

OK, I can take a hint – but then I see her claiming on Facebook (see image above) that SciBlogs would not allow this discussion! Would not allow “exposure to both sides!” This is patently untrue and she is completely misrepresenting SciBlogs and me.

Note: SciBlogs is a collection of New Zealand science bloggers. My science-oriented blogs usually appear there by syndication.

The email exchange

So it is worth actually looking at the email exchange where Mary requested publication of her article and we responded. Please note the dates and times and excuse the low magnifications. Here are the emails in sequence:

11 March, 12:51 pm: Mary Byrne requests SciBlogs publish her response to my article.
11 March, 1:06pm: After internal passing on the email, Peter Griffin sends it to me.

Pretty quick service. Remember this was a Sunday.

My response was also pretty quick (considering I usually have my daily power nap at that time). I didn’t have to do much thinking about the issue (please excuse my verbosity).

11 March, 2.11 pm

Mary Byrne did not reply so I went ahead anyway and interpreted the original request to mean that a right of reply post on my blog was acceptable. Her article was posted on Tuesday, March 13 (I already posted on Monday and like to spread posts throughout the week) – Anti-fluoride group coordinator responds to my article. I emailed Mary to let her know her article was posted and I would respond to it.

I posted my promised response to her article on Wednesday, March 14th – Mary Byrne’s criticism is misplaced and avoids the real issues and sent Mary an email to let her know – once again offering her another right of reply.

So, Mary’s claim of SciBlogs not allowing exposure from both sides is completely false.

Incidentally, I have emailed Mary asking her to correct that misrepresentation. She has ignored my email, as she ignored all the other emails I have sent her about this issue. The misrepresentation is still on the Fluoride Free NZ Facebook page.

So, I do not expect Mary to continue this exchange, unfortunately. And I do regret she has chosen to misrepresent the situation in the way she has.

But I guess it is just another case of misrepresentation by an anti-fluoridation activist.

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Paul Connett’s misrepresentation of maternal F exposure study debunked

Title slide for Paul Connett’s presentation to parliament

Anti-fluoride campaigners are misrepresenting a recent Mexican study claiming its findings should cause governments around the world to abandon community water fluoridation (CWF). Their claims are unwarranted because the study has a high degree of uncertainty. Activists are misrepresenting the accuracy of the studies findings. Because Mexico has areas of endemic fluorosis the study itself is not relevant to CWF.

Misrepresentation of the Mexican study was a central argument used by US anti-fluoride activist Paul Connett in his recent New Zealand speaking tour. This is shown in the Powerpoint presentation he prepared for his meeting at parliament buildings last month (see Anti-fluoride activist commits “Death by PowerPoint”).

It may have not been used in the end as only 3 MPs turned up. But, given his status in the anti-fluoride movement, this presentation will present the current strongest arguments against CWF. It is therefore worth critiquing his presentation whether it was given or not.

In this article, I will concentrate on Paul’s presentation of the Mexican study and may deal with other arguments used in the presentation in later articles. The paper reporting the study is:

Bashash, M., Thomas, D., Hu, H., Martinez-mier, E. A., Sanchez, B. N., Basu, N., … Hernández-avila, M. (2016). Prenatal Fluoride Exposure and Cognitive Outcomes in Children at 4 and 6 – 12 Years of Age in Mexico.Environmental Health Perspectives, 1, 1–12.

In Connett’s mind, the study’s results are so overwhelming we should immediately stop fluoridation throughout the world! This was the first and main argument he presented. His title slide and slide no. 10 introducing the study demonstrates the importance to him.

Slide No. 10 introducing Connett’s presentation of the Bashash et al (2017) study.

I have critiqued this study in previous articles – readers can find them at:

Fluoride, pregnancy and the IQ of offspring,
Maternal urinary fluoride/IQ study – an update,
Anti-fluoridation campaigners often use statistical significance to confirm bias and
Paul Connett “updates” NZ MPs about fluoride?

Paul is clearly aware of these articles because he included a note in his presentation about them. I am honoured (it is the only comment in the presentation) and pleased he has made an effort to engage with my critique.

This is what he says:

“Ken Perrott and those who follow him will claim that the wide degree of scatter in the data means the findings of this study are unreliable.  That is an incorrect interpretation of this graph and the study.  The effect size is very large (decrease by 5-6 IQ points per 1 mg/L increase in urine F) and is highly statistically significant.  The fact that urine F can only explain a small amount of the variation of IQ does not invalidate the finding.  Rather, it is a reflection that there are many other factors that affect IQ, most of which are essentially random with respect to F exposure.  For example, individual genetics plays a huge role in IQ (it explains 80% or more of variation in IQ), therefore it would not be possible for F to explain more than the small remaining portion of variation in IQ.  Most studies of other developmental neurotoxins like Pb and Hg find very similar low correlation coefficients, yet there is no debate that their findings are valid.”

This comment provides me with a basis for a more detailed discussion of his use of the study.

The small amount of variance explained

Connett acknowledges my point that the observed relationship with urinary fluoride can explain only a very small amount of the variation in IQ – only 3%. A bit hard to deny considering the high degree of scatter in the data which is obvious even in the slides Connett uses:

Slide 20 where Connett reproduces Fig 2 from the Bashash et al. paper.

But he claims that this:

“does not invalidate the finding. Rather, it is a reflection that there are many other factors that affect IQ, most of which are essentially random with respect to F exposure.”

Here he is, of course, referring to his own “finding” or conclusion – not the authors.

Notice his assumptions:

  • Other factors will be “essentially random with respect to F exposure,” and
  • The observed relationship will not be changed by the inclusion of these other factors.

Those are huge assumptions. And they are wrong.

Here is a relevant example illustrating the danger of such assumptions – the association between ADHD prevalence and extent of fluoridation observed by Malin & Till (2015). Their association was able to explain between 22% and 31% of the variance in ADHD, depending on the specific data used. Far more than the 3% for the Bashash et al., (2017) study.

Yet, when other risk-modifying factors were included, in this case, mainly altitude, the significant association with fluoridation disappeared. A model including altitude, but not fluoridation, explained 46% of the variability in ADHD (see Perrott 2017 and a number of articles in this blog).

In this case, the incidence of fluoridation was correlated with altitude – fluoridation was simply acting as a proxy for altitude in the Malin & Till (2015) association. So much for Connett’s assurance that other factors “are essentially random with respect to F exposure.”

Other studies have found an association between symptoms of fluorosis and cognitive deficiencies. Choi et al., (2015), for example, reported an association of child cognitive deficits with severe dental fluorosis, but not with water F concentration. But there is a relationship between fluoride exposure and fluorosis prevalence – ie. fluorosis is not random with respect to F exposure. If the health effects resulting from fluorosis are the prime cause of the cognitive deficiency, the inclusion of fluorosis incidence in the multiple regression could produce a model where there is a statistically significant association with fluorosis but not with fluoride expose. That is, the urinary fluoride values could be simply acting as a proxy of fluorosis incidence.

A similar non-random association of premature births and low birth weight could occur because these problems do occur in areas of endemic fluorosis. These could be two of the health issues related to fluorosis but fluoride intake may not be the prime cause (see Premature births a factor in cognitive deficits observed in areas of endemic fluorosis?).

Connett is completely wrong to assume that other risk-modifying factors not considered in the Bashash study would necessarily be random with respect to fluoride exposure. And he is wrong to assume that inclusion of these factors would not change the association of child IQ with mothers’ urinary fluoride reported in the paper.

Notably, the Bashash et al (2017)study did not include any measure of fluorosis as a risk-modifying factor – despite the fact that Mexico has areas of endemic fluorosis. I believe its consideration of gestation period <39 weeks or >39 weeks was inadequate (the normal average period is 40 weeks). The cutoff point for birth weight (3.5 kg) was also high.

The size of the IQ effect

We only have the data in the Bashash et al., (2017) study to go with here and the associations they report are valid for that data. But what about the calculations Connett makes from the reported association.

For example, Connett declares:

” The effect size is very large (decrease by 5-6 IQ points per 1 mg/L increase in urine F) and is highly statistically significant.”

Let’s test this claim – using the association represented in Fig 2 from Bashash, which is the figure Connett and other anti-fluoride activists are using (his slide 20 above).

Firstly, we need to calculate prediction intervals from the data (see Confidence and prediction intervals for forecasted values). The shaded region in the figure used by Connett (Fig 2 in Bashash et al., 2017) represents the confidence interval – the region where there is a 95% probability that a best-fit line for the data lies. The region for the prediction intervals is much larger and Connett may be confused because he has interpreted the confidence interval wrongly. Yet, the prediction intervals are the important measure when considering the effect size.

Here are my graphs for the confidence interval and the prediction interval using data I digitally extracted from the paper (see Maternal urinary fluoride/IQ study – an update).

Let’s consider the predicted values of “child IQ” for urinary F concentrations of 0.5 and 1.5 mg/L.

Urine F (mg/L) Predicted value Lower Higher
0.5 99.8 74.4 125.2
1.5 93.0 67.5 118.4

The prediction intervals are very large. This means the real value for “child IQ” at a urine F value of 0.5 mg/L has a 95% probability of being in the range 74.4 – 125.2. The corresponding range for a urine F concentration of 1.5 mg/L is 67.5 – 118.4. When Connett claims that an increase of 1 mg/mL in mother’s urinary F produces a drop of 5 – 6 IQ points he actually means a drop of 5 – 6 ± 26 IQ points which is not statistically significantly different to zero.

The best-fit line for the data may be statistically significant – but Connett is wrong to say this about his predicted effect of urinary F on child IQ. In fact, over the whole range of urinary F measured there is a 95% probability that IQ remains at 100.

Connett’s claim of a “highly statistically significant” effect size is completely false. If he had simply and objectively looked at the scatter in the data points he would not have made that mistake.

Comparing maternal urinary F levels to other countries

Connett makes an issue of the similarity of maternal urinary F levels found in this Mexcian study to levels found elsewhere. One is tempted to say – so what? After all, I showed above that his claim of a “highly statistically significant” drop in child IQ with increases in maternal urinary F is completely wrong.

He does compare the urine F levels reported by Bashash et al., (2017) with some New Zealand data (Brough et al., 2015) and finds them to be very similar. Interestingly, Brough et al., (2015) reported their urinary F values as indicating fluoride intakes were inadequate for the women concerned. They certainly did not indicate toxicity.

The comparison does highlight for me one of the inadequacies in the Bashash (2017) paper – the inadequate measurements of urinary F. Whereas Borough et al., (2015) used the recommended 24-hr urine collection technique, the data used by Bashash et al (2017) relied on spot rather than 24 hr measurements. These spot measurements were only made once or twice during the pregnancy of these women.

Yes, these were the only F exposure measurements Bashash et al., (2017) had to work with but they are far from adequate.

Conclusions

Paul Connett, as a leader of the anti-fluoridation movement, is completely wrong about the Bashash et al., (2017) study. It will not lead to the end of community water fluoridation throughout the world – nor should it.

He has attempted to ignore, or downplay, the high scatter in the data and the low explanatory power of the relationship between children’s IQ and maternal F exposure found in the study (only 3%). His denial that this relationship may disappear when other more important risk-modifying factors are included is also wrong – as other examples clearly show.

Connett’s presentation of a size effect (5-6 IQ points with a 1 mg/L increase in F exposure) as “highly statistically significant” is also completely wrong. In fact, this size effect is more like 5 – 6 ± 26 IQ points which is not significantly different to zero.

The misrepresentation of this study by Paul Connett and other anti-fluoridation activists demonstrates, once again, that their claims should never be accepted uncritically. This is just one more example of the way their ideological and commercial interests drive them to misrepresent scientific finding.

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Paul Connett “updates” NZ MPs about fluoride?

Data from Bashash et al., (2017). Despite a statistically significant relationship of child IQ with mothers prenatal urinary fluoride, this explains only about 3% of the huge scatter in the data.

I haven’t followed the latest speaking tour of Paul Connett – organised by the local Fluoride Free NZ organisation. But I watched a TV interview with him this morning and came away thinking he is skating on very thin ice – scientifically. He has put all his eggs in one basket – promoting a Mexican study as the be-all and end-all of scientific research which should lead to the immediate ceasing of community water fluoridation.

Paul is a leader of the anti-fluoride activist group the Fluoride Action Network and appears to love visiting New Zealand during our summer (and his winter). Local campaigners seem to idolise him – and rely heavily on him as a self-declared  “world expert on fluoridation.” But this idol has feet of clay (don’t they all?).

In fact, Paul has no original research on fluoride and is simply presenting a biased picture of the scientific literature on the subject., He relies heavily on his academic status and qualifications to give his biased views respectability.

But back to the Mexican study. Paul is referring to this paper:

Bashash, M., Thomas, D., Hu, H., Martinez-mier, E. A., Sanchez, B. N., Basu, N., … Hernández-avila, M. (2016). Prenatal Fluoride Exposure and Cognitive Outcomes in Children at 4 and 6 – 12 Years of Age in Mexico.Environmental Health Perspectives, 1, 1–12.

I have written about this study in some detail in my articles:

Here I will simply return to the poor explanatory power of fluoride for the children’s IQ measured in the study.

The graph above is a plot of the data from the paper – child IQ compared with the pre-natal urinary fluoride levels of the mothers.

Now, Paul describes this study as “rigorous” and relies heavily on it. But despite a statistically significant relationship, the huge scatter in the data really stands out.

In fact, this relationship explains only about 3% of this scatter! It probably only appears because the researchers did not include any proper risk-modifying factors in their regression analysis.

Well, Paul is making a big thing of speaking to New Zealand MPs tonight to “update” them on this latest research. Rather smug because it implies the research is his – when it isn’t.

But this research does not “prove” what Connett implies. It is not as rigorous as he claims. And it is certainly not an argument to stop community water fluoridation in New Zealand.


Note: Paul Connett and I had a scientific exchange on the fluoridation issue four years ago. Interested readers can download the full text from Researchgate –  The fluoride debate.

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Anti-fluoridation activist Paul Connett has a senior moment about our debate

Paul Connett, from  the US anti-fluoride group, the Fluoride Action network, was interviewed today on the Radio new Zealand’s Jesse Mulligan programme. You can listen to the interview at Complaints against anti-fluoride ads not upheld.

jesse

Jesse Mulligan interviewed Paul Connett about his anti-fluoride views

Unsurprisingly, Paul presented the same  tired old arguments against community water fluoridation. And I can understand why he should once again promote his own anti-fluoride book. After all, it has 80 pages of references (most of them broken links to Fluoride Action Network web pages)! And it is surely natural for an author to be proud of their book.

But he seems to suffer from senior moments, or at least memory blocks, when he claims that the arguments in his book have never been confronted. That people refuse to debate with him about these arguments.

Has he really managed to eradicate all memory of our rather long on-line debate about those very arguments? He specifically required that our debate have the format of him advancing arguments from his book and that I would respond to them.

The full debate is available here (see Fluoride Debate) or it can be downloaded as a pdf document (see The fluoride debate). It’s a useful document – about 212 pages long – fully referenced and Paul’s arguments are presented completely unedited – just as he presented them.

I know Paul was unhappy at how the debate went. Since then he has asked me never to contact him again and I was immediately banned from commenting on all the local anti-fluoride websites and Facebook pages. I have also been blocked from commenting on the US Fluoride Action Network’s Facebook page.

OK, I can understand Paul may have felt disappointed with his response to my debunking of his claims – but to pretend the debate never happened?

Interestingly, this is not an isolated behaviour by anti-fluoride activists. Local anti-fluoride people have also made similar claims that no one will debate with them. However, they seem to run quickly in the opposite direction when they do get a response to their offer to debate. Stan Litras is one example where time and time again I have critiqued his anti-fluoride claims and offered him a right of reply. He always refuses but still publicly claims that no one will debate with him.

Paul lost it a bit in his interview today when Jesse mentioned the NZ fluoridation review carried out by the Royal Society of NZ and the office of the Prime mInister’s Chief Science Advisor. He made a few ill-advised disparaging comments which came across as shrill when compared with the explanations from Sir Peter Gluckman, the Prime Ministers Chief Science Advisor, who was given the opportunity to respond to Paul’s criticisms.

The Interview and Sir Peter’s response is worth listening to. You can download it or listen to it at Jesse Mulligan, 1–4pm.

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Misrepresenting fluoride science – an open letter to Paul Connett

Connett Blenheim

A poster for Connett’s Blenheim meeting – scaremongering because there is no proposal for mandatory fluoridation in New Zealand.

A new year and a new speaking tour of New Zealand by US anti-fluoride campaigner Paul Connett. Looking over the presentation he is giving at his New Zealand meetings I find he has absolutely nothing new to say. It’s all been said before – and all his claims have been debunked before.

His visit this year is slightly unusual – the first time I am aware he has visited in winter. Perhaps the local anti-fluoride movement has decided they need to get him early because of the impending introduction of new legislation on community water fluoridation (CWF).

In this open letter to Paul, I respond briefly to the points he makes in his current presentation and will link to a fuller discussion of each point in earlier posts. Many of these links will be to my debate with Paul Connett 3 years ago. You can download the full debate (Connett & Perrott, The Fluoride debate – 2014) or find the individual posts at Fluoride Debate.

Finally, I have offered Paul the right of reply here. I believe that participation in a good-faith discussion is the most scientifically ethical response to my open letter.


Dear Paul,

I wish to challenge claims you made in your 2016 New Zealand speaking tour. Most of these claims were refuted in our 2013/2014 debate but it is worth itemising some of them here because you are continuing to rely on them.

I, of course, offer you the right of reply and access to an open good faith discussion here if you feel I have misrepresented you in any way.

Fraudulent charges of scientific fraud

Fraud claim

From Connett’s 2016 New Zealand presentation

Scientific fraud is an extremely serious offence and accusations should not be made lightly. Yet you have accused New Zealand scientists involved in the Hastings trial of scientific fraud without even citing the study’s reports or publications. You have relied simply on an out-of-context sentence in a letter from a departmental official and unsubstantiated claims about changes in methodology. I pointed this out to you in our 2013/2014 debate  yet you are persisting in this defamation of researchers who are no longer here to defend themselves. You have even gone as far as producing an internationally distributed newsletter entitled “New Zealand Fluoridation Fraud” which was promoted by Fluoride Free NZ activists in this country.

You base your charge of “fraud'” on:

  1. An out of context quote from an internal letter by a director,
  2. Abandonment of Napier as the planned control city at the beginning of the study, and
  3. Alleged changes in the diagnostic procedures used during the course of the trial.

1: A letter from a divisional director expressing his frustration at developing a description “with meaning to a layman” is not evidence of “fraud,” or an attempt to distort the evidence. Scientists are always being urged by officials to make their findings more accessible and understandable to the public.   Your presentation of it as such is equivalent to the 2009/2010 “climategate” misinformation campaign launched by climate change deniers using out-of-context quotes from scientists emails. In that case, we know the real fraud was carried out by those attempting to deny the science and discredit the scientists.

2: Yes, the original plan was to use Napier as a control non-fluoridated city alongside the fluoridated city of Hastings. This was abandoned when data showed a lower incidence of tooth decay in Napier and it was judged unsuitable as a control because of differing soil chemistry which would have introduced an extra confounding factor. While this reduced the Hastings experiment to a longitudinal study, comparisons were made with other non-fluoridated New Zealand cities.

Surely this was a sensible solution to a problem? – and these are always occurring in long-term studies as any researcher familiar with such studies will confirm. Yet, in our debate, you irresponsibly described these reasons as “bogus.” As I said in our debate:

“That is the problem with conspiracy theories – they paint the world black and white which is very unrealistic. I expected far more professionalism from Paul than this.”

This is not the sort of rational assessment expected from a scientific review but sounds more like the declaration of a biased political campaigner.

3:  The diagnostic procedure used in the Hastings experiment were described in the first paper of the series reporting results (Ludwig 1958). Subsequent papers (Ludwig and Ludwig, et al., 1959, 1962, 1963, 1965, 1971) refer to this description and confirm it continued to be used. So where is the evidence for a change in diagnostic procedure?

Yes, there were changes in tooth filling procedures used by New Zealand dental nurses around the time this trial started. But even the anti-fluoride  Colquhoun & Wilson (1999) confirm attempts were made to use a consistent filling procedure in the trial – quoting from a file they received from their Official Information Act request:

“At the commencement of the Hastings fluoridation project steps were taken to ensure that the practice of preparing prophylactic type fillings by dental nurses was discontinued.

Of course, longer term trial like this always have a possibility of technician (or dental nurse) differences and good trial managers attempt to reduced such differences.

Perhaps one way to confirm that such “teething problems” (pardon the pun) did not have an overriding effect is to see that the improvements in oral health measured as differences from the 1954 start were also observed if 1957 was taken as the start (and also for later dates). In our debate I showed this to be a fact using the graphs below.

Hastings data shows similar improvement in oral health even if the project had started in 1957. Plots are for different ages.

Paul, you description of honest research, no matter what its limitations, as fraudulent is irresponsible. Considering your motives for this description and the way you have distorted the situation I would even describe your behavior itself as fraudulent.

Misrepresenting WHO data.

You repeat the same misleading interpretation of the World Health Organisation (WHO) data that we discussed in our debate where you attempted to avoid my criticisms and in the end did not have a sensible response. Despite the refutation, you continue to promote the following misleading graph every chance you get (see also Fluoridation: Connett’s naive use of WHO data debunked):

WHO data

Slide from Connett’s 2016 New Zealand presentation

These data do not support your claim of no difference between the rates of improvement of oral health in fluoridated and unfluoridated countries because there is no attempt to account for all the different factors influencing dental health. Robyn Whyman pointed this out in his report for the National Fluoridation Information Service – Does delayed tooth eruption negate the effect of water fluoridation?:

“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.”

It is far more rational to compare regions within countries and you have purposely omitted the WHO data where fluoridated and unfluoridated areas within individual countries were compared.

Here is that WHO data for Ireland which shows a clear benefit in fluoridated areas.

As I said in my post Fluoridation: Connett’s naive use of WHO data debunked:

“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!”

Isn’t it about time you stopped promoting this invalid and misleading use of the WHO data?

Nexo and ChildSmile are complimentary to CWF – not alternatives

Nex and CS

From Paul Connett’s 2016 New Zealand presentation.

You are being disingenuous in promoting oral health programmes like the Danish Nexo and Scottish ChildSmile programmes, as “alternatives” to community water fluoridation (CWF). Health authorities do not see them as alternatives – more as possible complimentary social programmes. The British Dental Association supports both the Scottish ChildSmile programme and CWF. In Scotland it has come out publicly called for communities to move towards introducing water fluoridation. In the absence of CWF, UK health professionals see ChildSmile as “the next best thing – a rather expensive substitute for the fluoridation schemes that have never been introduced.”

I discussed the ChildSmile programme in my article ChildSmile dental health – its pros and cons and in our debate (see Fluoride debate: Ken Perrott’s closing response to Paul Connett?). It, and the Nexo programme, use approaches of child and parent education, toothbrushing supervision and programmes, and  health education initiatives based principally on public health nurses and health visitors attaching themselves to particular schools in order to give oral health advice to children and parents. Subject to parental consent, they also arrange for children who are not registered with a dentist to undergo check-ups and, if necessary, treatment.

Both programmes also provide regular fluoride varnishes for children’s teeth (so much for being an alternative to fluoride).

The point is that elements of these programmes are probably already incorporated into the social health policies of many countries. They certainly are in New Zealand. The introduction of a social health policy like CWF does not mean that programmes like the Nexo and Childsmile, or elements of them, are abandoned by health authorities. The research still shows that CWF reduces tooth decay even when other programmes like this, the use of fluoridated toothpaste and restriction of sugar consumption are practiced (see for example Blinkhiorn et al., 2015).

Interestingly, though, because sometimes programmes like tooth varnishes are targeted at the more vulnerable children in non-fluoridated areas these may lead to difficulties in drawing conclusions from simple comparison of fluoridated and unfluoridated areas. I discussed this in my article on mistakes in one of John Colquhoun’s  papers – Fluoridation: what about reports it is ineffective? – where children from non-fluoridated areas received preferential fluoride varnishing.

There is no single “silver bullet,” for solving the problem of tooth decay so why not use programmes like CWF and Childsmile/Nexo, or elements of the these, together?

In fact, that is exactly what is happening in New Zealand.

Asserting CWF out of step with the science

You claim:

“A better guide as to what nature thinks about the safety of fluoride is the level found in mother’s milk.”

This is simply weird, a naive example of the naturalistic fallacy.

Nature doesn’t think – such an arguments could be used against everything humanity has done to ensure that we have a better quality and length of life than “offered by nature.” As I pointed out in our debate, we are used to other elements being deficient in mothers milk and therefore requiring supplementation (see also Iron and fluoride in human milk for discussion of an evolutionary perspective vs a naive appeal to nature).

Your assertion:

“in mammals not one single biochemical process has been shown to need fluoride to function properly”

is simply deceptive – knowingly so. Fluoride may not play a biochemical role but it does play a chemical one. It is a normal and natural component of bioapatites – bones and teeth. And when present in optimum amounts confers strength and low solubility. Surely as a chemist you are familiar with the fact that minerals like apatite usually do not occur in the ideal form, as end members of a chemical series. In practice, no bioapatites are “fluoride-free.”

I demonstrated the difference between real world apatites and the ideal end members in our 2013/2014 debate using this figure. As a chemist this should be obvious to you.

apatite-2

In the real world bioapatites like bones and teeth always contain fluoride as a normal and natural constituent. The end members hydroxylapatite and fluoroapatite are not real models for natural bioapatites.

You claim that:

“With fluoridation: the chemicals used are not pharmaceutical grade but contaminated waste products from the phosphate fertilizer industry.”

But none of the chemicals used in water treatment, or the water itself, are of  “pharmaceutical grade.” Water plants and water treatment have their own grading system for the chemicals used.

In fact, comparing the certificated concentrations of contaminant elements in fluoridating chemicals used with the same contaminants already in the source water, we find that fluoridating chemicals are not a real source of contamination. We should be more concerned about the source water itself. I presented data to show this in my article Chemophobic scaremongering: Much ado about absolutely nothing. In most cases contamination from the fluoridating chemical is less than 1% of the contaminant concentration already in the source water.

Your reference to “contaminated waste products” is simply naive (or dishonest since you have chemical training) chemophobic scaremongering

Misrepresenting facts on dental fluorosis

dental fluorosis

Paul Connett cites an irrelevant figure in his 2016 New Zealand presentation.

Your claims regarding dental fluorosis are presented as an argument against CWF and in that context are very misleading:

1: The deceit of not identifying contribution from CWF.

Your slide refers to all forms of dental fluorosis and to all areas – fluoridated and fluoridated. It is very misleading to infer that CWF is responsible for a dental fluorosis prevalence of 41%  of dental fluorosis. In fact, CWF makes only a small contribution – often not detectable as was the case with the New Zealand Oral Health survey illustrated below (see Dental fluorosis: badly misrepresented by FANNZ).

Unfortunately, even the recent Cochrane Fluoridation Review (Iheozor-Ejiofor et al., 2015) mistakenly presented the dental fluorosis data without differentiation between fluoridated and non-fluoridated areas. My calculations from their data indicated tyhe prevalence of dental fluorosis due to CWF is more like 7% – much less than your 41% (see  Cochrane fluoridation review. III: Misleading section on dental fluorosis).

2:  Scaremongering by not differentiating between mild and severe forms.

Your 41% sounds scary – especially with the implication it is caused by CWF. But at least your acknowledge that the prevalence of more severe forms is much less. That is obvious from my figure above and from your later slide acknowledging a 3.6% prevalence of moderate and severe dental fluorosis in American teens.

This figure from the National Research Council review shows that CWF (which usually uses a concentration of 0.7 ppm) does not contribute at all to severe dental fluorosis.

Severe-dental-fluorosis

Usually only the moderate and severe forms of dental fluorosis are considered of aesthetic concern – and the milder forms are often judged favourably by parents and teenagers.

What you did not say is that CWF does not contribute at all to moderate and severe forms. These forms are completely irrelevant to the discussion of CWF and it is dishonest to use it as an argument against CWF. Again, my calculation from the Cochrane data indicates the contribution of CWF to dental fluorosis of aesthetic concern was within the measurement error.

If you are really concerned about dental fluorosis, and especially the more severe forms of aesthetic concern, you should be paying attention to high natural sources of fluoride in some regions, industrial pollution and the possibility of obsessive consumption of toothpaste by children.

Brain damage?

Brain

Wild claim by Connett in 2016 New Zealand presentation. There is absolutely no evidence that CWF is harmful to the brain.

Paul, you have been uncritically dredging the scientific literature for articles you can use to imply fluoride is toxic or a neurotoxicant. Of course you will find studies supporting your bias that you can cherry-pick. A similar uncritical dredging will produce far more articles showing water is toxic! Such confirmation bias is scientifically unethical. We should always read the scientific literature intelligently and critically.

Applying a bit of objectivity we see that almost all the studies you rely on use exposure levels far greater than the recommended levels for CWF. Many of the animal studies considered exposure 50 to 100 times those levels or more. The quality of many of the research reports you rely on is not good – a point I think you have acknowledged in the past.  The human studies you rely on have, almost without exception, involved regions of endemic fluorosis quite unrepresentative of regions where CWF is used (I discuss the two exceptions below). None of them properly considered relevant confounding factors.

The exceptions

You promote Malin and Till (2015) as evidence that CWF causes attention deficit hyperactivity disorder (ADHD). You have made no critical assessment of that study. If you had you would have found that when relevant confounders like altitude, poverty and home ownership are included there is not statistically significiant relation of ADHD prevalence with CWF. I demonstrated this in my article ADHD linked to elevation not fluoridation. Coincidentally, the importance of altitude was confirmed in another study which you completely ignore. That study is:

Huber, R. S., Kim, T.-S., Kim, N., Kuykendall, M. D., Sherwood, S. N., Renshaw, P. F., & Kondo, D. G. (2015). Association Between Altitude and Regional Variation of ADHD in Youth. Journal of Attention Disorders.

Unfortunately, the scientific literature is full os such inadequate studies where confounding factors are ignored. Great for confirming biases but, by themselves, absolutely useless if we want to get to the truth.

Peckham et al., (2015) is another example you use. They claimed a relationship of hypothyroidism with CWF but refused to include iodine deficiency (a well established cause of hypothyroidism) in their statistical analysis.

Studies from areas of endemic fluorosis

You extract a lot of mileage out of the studies by Xiang and his coauthors (eg Xiang et al., 2003) – and they are probably the better studies in your collection. But even here your confirmation bias leads you to draw unwarranted conclusions. I showed this in my articles Connett fiddles the data on fluorideConnett & Hirzy do a shonky risk assesment for fluoride and Connett misrepresents the fluoride and IQ data yet again.

For example you claim (correctly) that Xiang found a statistically significant correlation of IQ with urinary fluoride. But a dispassionate consideration of the data shows this relationship explains only 3% of the variance in IQ. I suggest to you that inclusion of some relevant confounders in the statistical analysis would probably cause the correlation with urinary fluoride to be non-significant. This parallels the situation reported by Malin and Till (2015) for ADHD (and here they were able to explain over 20% of the variance in prevalence of ADHD by fluoride – before inclusion of confounders like elevation when the explanatory power of fluoride disappeared).

You have from time to time acknowledged the poor quality of the reports you rely on regarding fluoride and IQ but have said that “there must be something in it” because there are so many reports. There may well “be something in it” but you will not make progress by jumping to your ideologically motivated conclusions favouring chemical toxicity. Just think about it. Those studies occurred in areas of endemic fluorosis – where skeletal fluorosis and severe dental fluorosis are common. It is reasonable to expect such disfiguring and disabling diseases may impact the quality of life, learning ability and IQ of inhabitants. I suggested this mechanism for explaining the data in my article Severe dental fluorosis and cognitive deficits.

CWF is never used in areas of endemic fluorosis so such an effect on cognitive abilities would not occur. And that is consistent with the existing studies which do not show and IQ deficits resulting from CWF (see, for example, Broadbent et al., 2014 and my article IQ not influenced by water fluoridation).

Paul, you are disingenuous to pose the question in your presentations:

“What primary studies (not self-serving government reviews) can you cite that allow you to confidently ignore or dismiss all the evidence of fluoride’s potential to damage the brain?”

We must remember that this is posed in the context of your campaign against CWF and there is no primary study, or review, indicating “potential damage to the brain” from CWF. When you assert “Over 300 studies have found that fluoride is a neurotoxin” you are relying on animal studies where high concentrations of fluoride were used and poor quality studies from areas of endemic fluorosis. None of the studies you rely on are relevant to CWF. It is simply unprofessional scaremongering to promote these sort of political messages:

neurotoxin

Scaremongering slide from Connett’s 2016 New Zealand presentation

I demonstrated in my article Approaching scientific literature sensibly how such uncritical dredging of the literature is meaningless. A Google Scholar search for  produced 2,190,000 results for water toxicity but only 234,000 for fluoride toxicity. So let’s paraphrase your question:

“What primary studies (not self-serving government reviews) can you cite that allow you to confidently ignore or dismiss all the evidence of  water’s potential to damage the body?”

Misrepresentation of evidence supporting CWF

Randomised control trials

Again you raise the red herring of the lack of randomised controlled trials (RTCs) showing CWF effective. As I pointed out to you in our 2013/21014 debate  there is also a lack of RTCs showing CWF not effective – and that must surely tell you something. Simply there are no RTCFs on the subject (although there are on other forms of fluoride delivery like fluoridated milk – see Stephen et al., 1984).

The fact is that such trials are practically impossible with social health measures like CWF. The American Academy of Pediatrics comments in their article on the Cochrane Fluoridation Review:

“it would be a logistical nightmare to try creating a public water system that pumps fluoridated water to the first house on the block, delivers non-fluoridated water to the following two houses and then provides fluoridated water to the 4th and final house on that block.”

This was acknowledged by the Cochrane Reviewers in their discussion. Your mate, and fellow member of the Fluoride Action Network leading body, Bill Osmunson, argues that such an RTC is possible. But his description of how it would be setup shows he is not really serious. He suggests that housing developments be built with several different water reticulation systems and houses be attached to these different systems by flipping coins!

There are some areas of investigation, such as drug efficacy, where RTCs are possible and ethical – but social health measures like CWF is not one of them. That does not prevent an objective analysis of all others sorts of investigation and data which enables health authorities and decision makers to make reliable decisions on such issues.

The Cochrane Fluoridation Review

Paul, I am shocked that with your scientific training you resort to a complete misrepresentation of the recent Cochrane Fluoridation Review (Iheozor-Ejiofor et al., 2015):

Cochrane 1

Connett misrepresented the findings of the Cochrane Fluoridation Review in his 2016 New Zealand presentations

Surely you are not that naive? The reviewers had selection criteria for inclusion of studies in their calculations. This excluded most modern cross-sectional  studies – on the basis of unavailability of data before CWF was started – not quality as you imply. Those restrictions meant they were unable to draw conclusions on the factors  in your slide – but they were discussed, and the studies cited, in the discussion section of the review. These non-selected studies do show that CWF is beneficial to adults (Griffin et al., 2007Slade et al., 2013), provides benefits even when fluoridated toothpaste is considered (see Water fluoridation effective – new study and Blinkhorn et al., 2015) and reduces social inequalities (Riley et al., 1999). The research also shows tooth decay increases when CWF is stopped (see Fluoridation cessation studies reviewed – overall increase in tooth decay noted and Mclaren & Singhal 2016).

How is it that you ignore the language in the review referring to limitations imposed by its selection criteria and then present their qualified conclusions as if they were facts. Can you not understand sentences like?:

“Around 70% of these studies were conducted before 1975. Other, more recent studies comparing fluoridated and non-fluoridated communities have been conducted.We excluded them from our review because they did not carry out initial surveys of tooth decay levels around the time fluoridation started so were unable to evaluate changes in those levels since then.”

Why did you persistently ignore the qualifications in their conclusions imposed by their selection criteria expressed in the common phrase?

“We found insufficient information . . . “

And, why did you purposely ignore the specific conclusion:

“Our review found that water fluoridation is effective at reducing levels of tooth decay among children. The introduction of water fluoridation resulted in children having 35% fewer decayed, missing and filled baby teeth and 26% fewer decayed, missing and filled permanent teeth.We also found that fluoridation led to a 15%increase in children with no decay in their baby teeth and a 14%increase in children with no decay in their permanent teeth.”

Yes, that was followed by the disclaimer “These results are based predominantly on old studies and may not be applicable today.” But that only means the reviewers could not draw specific conclusions about today because they had excluded modern studies.

You have purposely ignored the issues around study selection and presented their inability to draw conclusions as evidence that there is no effect. That is not a scientific assessment of the review – it is a blatantly propagandist exercise in cherry picking motivated by an ideological position. An exercise in public relations, not proper scientific assessment.

Topical vs systemic

I think one change that did come out of our debate is that you now tend to qualify you claims about the systemic and topical roles of fluoride in preventing tooth decay. You use words like “primary” and “predominantly.” But you still confuse the issue by arguing that topical action is quite separate from ingestion when you ask”

“If fluoride works primarily on the outside of the tooth why swallow it?”

The fact is that fluoride, calcium and phosphorus in dental plaque and saliva (to which the CDC attributes the topical action of decay prevention) occur through ingestion of these nutrients in food and water. It is naive to separate the reaction at the tooth surface from ingestion of food and beverage.

You also ignore completely the evidence that ingested fluoride plays a beneficial systemic role with developing and so far unerupted teeth (see Ingested fluoride is beneficial to dental health and Cho et al., 2014).

And let’s not forget about our bones which benefits from appropriate amounts of fluoride in our diet (see Is fluoride an essential dietary mineral? and  Yiming Li et al., 2001)

Use of PR techniques – You are the guilty party

I have shown here how you have distorted and misrepresented the science around CWF. In doing so you are behaving as an ideologically driven lobbyist – not an objective scientist. You are not intelligently and critically assessing the scientific literature – you are cherry-picking and selectively quoting to promote your own agenda.

Personally, I think this sort of behaviour is unethical for a scientist. Sure, we all have our biases and beliefs and this can influence our interpretation of the literature. But you are consistently misrepresenting the science – and continue to do so even after you have been shown wrong.

Perhaps this is unsurprising considering you are essentially a political lobbyist campaigning against a social health policy. You lead a lobby organisation – the Fluoride Action Network. This organisation receives finance from the “natural”/alternative health industry – most publicly from Mercola. According to tax returns you and other members of your family, personally receive monthly payments from these funds.

It hypocritical for you, then, to disparage honest scientists and their publications in the way you have done regarding the Hastings project. Your bias (and refusal to deal with the science) comes out in your description of scientific reviews and papers as “dummy reviews,” “bogus,” “self-serving government reviews,” etc.

In one of your final slides you claim the alleged PR tactics by scientists:

“Would not be necessary if science was on the promoters’ side – but it is not.”

In fact, it is you that are on the wrong side of the science and that is why you resort to misrepresentation, distortion, fear mongering and slander.

You also claim:

“After 6 years there has been no detailed or documented response to our book The Case Against Fluoride.”

And

“Proponents will very seldom agree to publicly debate either myself or other leading opponents of fluoridation.”

Yet, isn’t that exactly what I did in our Fluoride Debate of 2013/2014? And didn’t I give a platform on my blog for you to make all your points and to present the arguments from your book?

And isn’t it a fact that in most forums where your lobby against CWF you, in fact, lose because the scientific arguments against you prevail? You make a big thing of every single victory you achieve against CWF but are silent about the larger number of losses.

As we are discussing the refusal to debate let’s be honest. Your organisations, internationally and locally, attempt to prevent supporters of science from involvement in their discussion forums. I personally have been banned from all local anti-fluoride forums and from the Fluoride Action Networks Facebook forum.

This suggests to me that neither you nor your supporters are willing to take part in a good-faith discussion of the science around CWF. You are simply behaving like a political and commercial lobbyist – not a scientist for whom such discussion should be welcome.

Nevertheless, once again I offer you a right of reply to my comments in this article. In fact, I would happily welcome such a reply as this would be in the best traditions and interests of the science.

References

I have included only citations where links were not available.

Ludwig, T. G. (1958). The Hastings Fluoridation project I. Dental effects between 1954 and 1957. New Zealand Dental Journal, 54, 165–172.

Ludwig, T. G. (1959). The Hastings fluoridation project: II. Dental effects between 1954 and 1959. New Zealand Dental Journal, 55, 176–179.

Ludwig, T. G. (1962). The Hastings fluoridation project III-Dental effects between 1954 and 1961. New Zealand Dental Journal, 58, 22–24.

Ludwig, T. . (1963). Recent marine soils and resistance to dental caries . Australian Dental Journal, 109–113.

Ludwig, T. G. (1965). The Hastings fluoridation project V- Dental effects between 1954 and 1964. New Zealand Dental Journal, 61, 175–179.

Ludwig, T. G. (1971). Hastings fluoridation project VI-Dental effects between 1954 and 1970. New Zealand Dental Journal, 67, 155–160.

Ludwig, T. G.; Healy, W. B.; Losee, F. L. (1960). An association between dental caries and certain soil conditions in New Zealand. Nature, 4726, 695–696.

Ludwig, T.G.; Healy, W. B. (1962). The production and composition of vegetables in home gardens at Napier and Hastings. New Zealand Dental Journal, 58, 229–233.

Ludwig, T.G.; Pearce, E. I. F. (1963). The Hastings fluoridation project IV – Dental effects between 1954 and 1963. New Zealand Dental Journal, 59, 298–301.

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

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The farce of a “sciency” anti-fluoride report

F network

Click for a larger image

I came up with the image above after a quick glance at a “report” promoted by the local Fluoride Free groups and Paul Connett’s Fluoride Alert organisation. (Scientific and Critical Analysis of the 2014 New Zealand Fluoridation Report). It illustrates the incestuous network of authors and “peer reviewers” involved in producing the “report.” I have also illustrated connections of these people to a number of anti fluoride organisations and 2 publications.

The first column lists the authors in red, and their claimed peer reviewers in green. The third column lists the anti-fluoride organisations and several publications these people are connected to.

The middle column lists some other people who are also connected to these organisations and publications. I have already reviewed Kathleen Theissen’s article (see Peer review of an anti-fluoride “peer review”) and will get around to reviewing the other 2 articles (by H.S. Miclen and Stan Litras) later.

Meanwhile, lets just consider the connections between these authors, “peer reviewers” and anti-fluoride organisations.

Taking in each other’s laundry

Most of these names are familiar to anyone who has followed the anti-fluoride movement. That fact in itself shows how this report can in no way be seen as “expert,” “independent” or at all credible. Some details on the illustrated people, organisations and publications.

NRC Review minority: There were several disagreements on the 12 member panel which produce the 2006 NRC report “Fluoride in drinking water. A scientific review of EPA’s standards” because 3 members were anti-fluoride. They were Robert Issacson, Hardy Limeback and Kathleen Theissen. Hardy Limeback is involved in several anti-fluoride activist groups.

Kathleen Theissen appears not to be organisationally involved but regularly makes anti-fluoridation submissions when the issue is debated.

UPDATE: Steve Slott has reminded me of this example of Theissen’s lack of credibility as a peer reviewer of fluoridation-related papers:

“In July 2013, Douglas Main, that freelance reporter and bastion of “objectivity”, interviewed Thiessen to get her opinion on Hirzy’s study on which he based his petition to the EPA.

From the article:

“Experts not involved with Hirzy’s study agreed with its findings.”

“I think this is a reasonable study, and that they haven’t inflated anything,” said Kathleen Thiessen, a senior scientist at SENES Oak Ridge Inc., a health and environmental risk assessment company.”

When the EPA reviewers looked at Hirzy’s study they found that he had made a 70-fold miscalculation in his study. When corrected for that error, the EPA reviewers found that Hirzy’s data actually demonstrated the exact opposite of what he had concluded.

Seems Thiessen either didn’t bother to read Hirzy”s study prior to commenting on it, or she overlooked his glaring error, too.”

Fluoride/ISFR: The International Society for Fluoride Reasearch (ISFR) publishes the journal Fluoride and organises regular conferences. They provide an avenue for authors to publish anti-fluoride articles, and generally poor quality research from areas where endemic fluorosis is common which may not be acceptable in the normal scientific journal.

The Society is based in New Zealand and is registered here as a charity. Bruce Spittle is the treasurer and journal managing editor.

FTRC/Second look: The anti-fluoride organisation and web site Second Look as set up the Fluoride Toxicity Research Collaborative (FTRC). It appears to be a weak attempt to provide a front “scientific institute” for anti-fluoride activists who want to present themselves as scientific experts.

This reminds me of the creationist Biologic Institute set up by the intelligent design creationists at the Discovery Institute. Actually, the Intelligent Design “pretend” scientific journal Bio-complexity also reminds me of the anti-fluoride journal Fluoride.

The FTRC lists the following staff:

  • Russell Blaylock, M.D., FTRC Medical Director
  • Hardy Limeback, Ph.D., D.D.S, FTRC Principle Investigator
  • Phyllis J. Mullenix, PhD., FTRC Research Program Director
  • Aliss Terpstra, RNCP, FTRC Research Coordinator

So far they claim to have sponsored (financed?) 2 research papers only by Phyllis Mullinex. Have a read of them and make up your own mind about their quality.

Case Against Fluoride: This is Paul Connett’s book The Case against Fluoride: How Hazardous Waste Ended Up in Our Drinking Water and the Bad Science and Powerful Politics That Keep It There. It is usually treated as a holy scripture in the anti-fluoridation movement. His co-authors were H. S. Micklen and James Beck.

Connett is very proud of this book and relies on it to support his claim to be a “world expert” on fluoridation.

Fluorine in Medicine: This is the sole scientific paper that Paul Connett can claim authorship (actually co-authorship) to:

Strunecká, A. ., & Patočka, J.; Connett, P. (2004). Fluorine in medicine. Journal of Applied Biomedicine, 2, 141–150.

The senior author Anna Strunecká is also part of the anti-fluoride network illustrated above. I am personally very suspicious of the quality of the journal which published this paper – anti-fluoride people have a history of placing poor quality papers in suspect journals purely to attain some sort of scientific credibility. DonQuixoteJune2011

FIND: The Fluoride Information Network for Dentists is one of the local Fluoride Free’s astroturf organisations claiming about 8 members but only Stan Litras is active. Stan uses his FIND hat for his anti-fluoride press releases – such as the one promoting the “report” considered here.

NZ Tour of Don Quixote & Sancho Panza: Sorry, can’t help thinking of these two when the upcoming NZ tour of Paul Connett and Bill Hirzy is mentioned. They do seem to be charging local fluoridation windmills with meetings in Taupo and Auckland.

William Hirzy: He is Paul Connett’s wingman on the Don Quixote & Sancho Panza Tour. Unlike Paul’s sole co-authorship he actually has 2 published scientific papers related to fluoridation where he appears as senior author. (See Comparison of hydrofluorosilicic acid and pharmaceutical sodium fluoride as fluoridating agents—A cost–benefit analysis and Corrigendum to “Comparison of hydrofluorosilicic acid and pharmaceutical sodium fluoride as fluoridating agents—A cost–benefit analysis” [Environ. Sci. Policy 29 (2013) 81–86]“)

The “credibility” of his “expertise” on the subject is shown by the fact his second paper was necessary to correct the huge arithmetic mistake he made in the first paper!

Perhaps you can see why the Connett/Hirzy act brings Done Quixote and Sancho Panza to my mind.

Conclusion

The “report” is discredited even before addressing the arguments presented – simply because of the well-known anti-fluoride stance of all the authors and “peer-reviewers.” The diagrammatic network shows just how incestuous the “report” is. It is simply an attempt to put a “sciency” face on their political stand and their attack on the Royal Society Review.

As a scientific presentation it is a farce.

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Wishart misrepresents fluoride science to advance his extreme ideology

Seems if there is an anti-scientific bandwagon to climb on New Zealand’s own self-described “investigative journalist” just can’t help himself. Having self-published books on climate change (he denies the science) and evolution (he supports creationism) it shouldn’t be long before he will be producing a book on fluoridation. And, yes, he is agin it.

Investigate

Until then we will have to make do with an article by him, in the April/May 2014 issue of his self-published magazine “Investigate.”  It’s called “Brushing up on the science” (and no, it doesn’t contain any reliable science at all – what did you expect?). Bloody hell – he is going to have to find more material if he is to write a book. This is nothing more than extensive quotes from Paul Connett (remember him?), a Mickey Mouse alternative dentistry group  (the International academy of Oral Medicine and Toxicology) and Justice Hansen’s judgement on the New Health NZ vs South Taranaki District Council High Court case (it’s worth downloading and reading this 43 page judgement).

Mind you, in the past I have found Wishart’s “investigative” journalism to rely heavily on quotes from newspapers and unreliable sources rather than any objective material or reasoning. In my review of his book on climate change Air Con, for example, I noted that 43% of the book was straight out quotes – with 75% of one chapter straight quotes (see Alarmist con)!

IAOMT – an authority??

The first of Wishart’s sole 2 authorities on fluoridation is the  International Academy of Oral Medicine and Toxicology (IAOMT). Yes – they are also agin it – claiming in Wishart’s quote:

“There is no discernible health benefit derived from ingested fluoride and . . . the preponderance of evidence shows that ingested fluoride in dosages now prevalent in public exposures aggravates existing illnesses, and causes a greater incidence of adverse health effects.”

But IAOMT are neither authoritative or reliable.

Wishart describes them as “a major North American dental professional association.” Others are not as impressed (or as willing to pull the wool over readers’ eyes). RationalWiki informs us that the IAOMT:

“is a quack organization based in Canada that promotes dental woo. They were responsible for the “smoking tooth” video that frequently gets passed around in altie circles. Their main issue is mercury amalgam fillings, which they claim can cause all sorts of neurological illnesses such as Parkinson’s and autism. They sell filling removal kits for “dentists” along with various other nature woo, mostly vitamin supplements. The organization also opposes water fluoridation, claims to put out peer-reviewed “research,” and supports “health freedom.””

So, another “alternative” organisation one can sign up to and use for letters after your name. Hardly a mainstream or respected organisation – it has only 2 affiliated members in New Zealand! One of these is Lawrence Brett from Whangarei. Brett  often fronts for the anti-fluoride activist group Fluoride Action network of NZ (FANNZ). For example in his submission to the Hamilton City Council Fluoride Tribunal he gave his affiliation as the International Academy of Oral Medicine and Toxicology. I guess some councillors who knew no better thought this meant he was an internationally recognised expert – he isn’t. (In fact, according to FANNZ sopkesperson Mark Atkin, Brett was denied a graduate degree from Otago University because his thesis was unacceptable).

The Connett interview

Most of Wishart’s article is just extended quotes from an interview he had with Paul Connett (his second “authority,” during Paul’s last annual visit to New Zealand. Nothing new there at all. The same tired old arguments he used in our exchange (see the Fluoride debate). I’ll just deal here with the dishonest use of quotes by Connett and Wishart on “topical application” of fluoride  and the reduction of tooth decay.

Wishart misattributes this quote to the American Dental Association Journal:

“that the mechanism by which fluoride may have a meaningful impact on the reduction of dental caries is by topical application, not ingestion.”

Anti-fluoride activists are always misrepresenting this issue of topical mechanisms so I searched for the full quote. Only 2 hits – Wishart’s article and an anti-fluoridation site. Couldn’t help wondering if that is Wishart’s real source. Not very professional if it is.

Still, the anti-fluoridation site did attribute their claim (not a quote) to “the cover story of the July 2000 Journal of the American Dental Association (JADA).” And that cover story was a paper by J. D. Featherstone (2000) The science and practice of caries prevention, Journal of the American Dental Association, 131(7), 887–99.  You can get an idea of what Featherstone wrote from the paper’s abstract which reads in part:

Conclusions. Caries progression or reversal is determined by the balance between protective and pathological factors. Fluoride, the key agent in battling caries, works primarily via topical mechanisms: inhibition of demineralization, enhancement of remineralization and inhibition of bacterial enzymes.

Clinical Implications. Fluoride in drinking water and in fluoride-containing products reduces caries via these topical mechanisms.

So the old story of changing “topical mechanism” to “topical application” – hence implying fluoridated toothpaste and not fluoridated water. And removing the word “primarily.” A finer point is that Featherstone is referring to specific mechanisms involved in “caries progression or reversal” and “battling caries.” This does not negate an overall role for fluoride in strengthening the apatites in teeth and reducing wear which can contribute to oral health (see Ingested fluoride is beneficial to dental health).

The Hastings project

Wishart refers to the exchange I had with Connett but misrepresents me when he says:

“Perrott was forced to admit the New Zealand study was certainly “Bad science” but was offended by the allegation of fraud.”

What I wrote is easy enough to check. Referring to possible influence of changes in dental practice Connett relied on for his charge of “fraud” I wrote:

Akers (2008) agrees these changes confounded the experiment:

“The changing of NZSDS [NZ School Dental Service] diagnostic criteria for caries and the cessation of the NZSDS nurses’ practice of prophylactic restoration of fissures further confused interpretations. While later antifluoridationists justifiably claimed that the changed diagnostic criteria contributed to the fall in caries (Colquhoun, 1999), their “science or swindle” questioning of methodology and findings (Colquhoun and Mann, 1986; Colquhoun, 1998; Colquhoun and Wilson, 1999) simplified confounding variables and dismissed international evidence supporting community water fluoridation as one factor in declining community caries incidence (de Liefde, 1998).”

So science, probably bad science, but not the “swindle” Paul wants to believe – and wants us to accept. As an aside, I think changes in dental practice like this will have also contributed to the graphs Paul and other anti-fluoride activists love to use to prove improvement of oral health in the absence of fluoridation – yet they never discuss that sort of detail. It is a potential problem with any longitudinal study and Colquhon was criticised for ignoring it in his own presentation of New Zealand data.

The dotted line in the RH figure is effectively what Cheng et al (2007) used for Ireland in the LH figure. Just because oral health has improved in countries without water fluoridation does not “prove” fluoride is ineffective.

Wishart misquotes my “probably”   as “certainly”. Actually, on reflection it should have been “possibly” as I was really referring to the problems one sees in long-term experiments of this nature when observed in hindsight. I did refer to this later saying:

“I know from experience the complexity of long term trials involving many people doing different jobs. It is easy to take a bureaucratic letter out of context, oversimply or misinterpret problems of personal approaches to methodology and ignore the fact that managers of such trials inevitably face difficulties from factors outside their control. As for reporting findings, the data amassed and details of methodology and their changes can be mind-boggling for an outsider who attempts an understanding.”

As for being “offended” by Connett’s unwarranted allegations of fraud (Connett did not bother checking out the published reports from the project relying only on an out of context bureaucratic letter) – yes I guess I do find that sort of dishonesty offensive. Worse I think it is professionally irresponsible as I wrote:

“I think Paul is irresponsible to make such damning charges of “fraud” without considering all the material. He actually has no evidence at all the project was a “fraud” or that the reasons for dropping Napier as a control were “bogus.” His behaviour is unprofessional.”

The Napier “control”

Wishart’s extensive quote of Connett refers to the dropping of Napier as a “control” region “for reasons that may not have been legitimate.” In our exchange Connett said:

“after about two years the control city of Napier was dropped for bogus reasons.” 

So “bogus” or “not legitimate” – but what reason does he give? – None! I asked him for a justification and his response was simple – avoidance:

“However, whether the control city was dropped for bogus or legitimate reasons the central charge remains the same.”

Again I just think that is professionally irresponsible. Connett makes charges of scientific fraud and illegitimate behaviour by the scientists without any justification at all.

Incidentally, this is how Akers refers to the problem of using Napier as a control city:

“The abandonment of the control city (Napier) because it had a lower initial caries rate than that of Hastings (Ludwig, 1958) implicated soil science as a confounding factor in New Zealand cariology (Ludwig and Healey, 1962; Ludwig, 1963).”

It would have been irresponsible to pretend that Napier was a proper control in these circumstances).

The “Nanny State”

Wishart’s last words are “Roll on Nanny State”. These show his motivations – not only on fluoridation but also his attacks on climate change science. This is his starting and finishing point. His whole reason for distorting the science. A blatant example of what Professor Gluckman described as using science as a proxy for values or political views.

It’s the old “freedom of personal choice” argument in this case Justice Hansen represents the state so anything he decides or recommends becomes simply an expression of “state interests” – “nanny state interests” at that, and should not be considered as a result of evidence or reason.

Well,  everyone is entitled to their own ideology and its political manifestations – we do still live in a free country. Fortunately, because we are a democracy the extremist positions Wishart arrives at from his ideology have very little support. Even if all the Hamilton citizens who voted against fluoridation in the referendum had personal choice as their sole motive (and they certainly didn’t) they amounted to only 30% of the voters. (Or, if I resorted to the silly arguments anti-fluoridation activists have used to explain away the referendum result –  to only 30% of 34% (the proportion who voted – about 10% of the population.)

It is one-sided to see fluoridation as merely a “freedom of choice” issue. It is really an issue of balancing freedom of choice against social good. We often have these discussions in our society because social organisation involves balancing these two apparent extremes. In practice we usually find some procedure enabling a working balance on issues – often in ways that allow actions producing social good while still maintaining a high degree of personal choice.

Consider “social goods” like free secular education and public hospitals. Our society supports these (or something close to them) while at the same time not denying freedom of choice to those members of society who refuse to use them. The fact individuals making that choice to avoid the social good incurs costs to them, sometimes substantial costs like medical insurance and school fees, does not deny the fact they are taking advantage of their freedom of choice. The social goods have not caused a loss of freedom of choice.

Yes, people who wish avoid the advantage of a public health measure like community water fluoridation may incur some costs in purchasing other sources of drinking water or kitchen filters (at far less cost than private education and medical insurance fees). But this does not mean their freedom of choice is being denied. These people may complain about these costs but should remember that freedom of personal choice also involves personal responsibility for the consequences.

There is also the point that the exercise of personal freedom of choice should not take away the freedom of choice of many others who benefit from a public health measure. Justice Hansen made this argument in his  judgment on the fluoridation issue (Hansen 2014);

“Provided it does not have consequences for public health a person has the right to make even the poorest decisions in respect of their own health. But where the state, either directly or through local government, employs public health interventions, the right is not engaged. Were it otherwise, the individual’s right to refuse would become the individual’s right to decide outcomes for others. It would give any person a right of veto over public health measures which it is not only the right but often the responsibility of local authorities to deliver.”

Dr. John Harris of the Department of Ethics and Social Policy at the University of Manchester, UK, made the same point in his article The Ethics of fluoridation:

“We should ask not are we entitled to impose fluoridation on unwilling people, but are the unwilling people entitled to impose the risks, damage & costs of the failure to fluoridate on the community at large? When we compare the freedoms at stake, the most crucial is surely the one which involves liberation from pain and disease.”

Conclusion

Ian Wishart has relied on two bogus authorities to supported his distortion of the science. But at least he has been honest enough to show his extremist ideological reasons for this by attacking the “Nanny State.”.

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Fluoride debate Part 1: Connett

Ken Perrott’s response to this article is at Fluoride debate Part 1: Perrott


Connett versus Perrott Internet Debate on Fluoridation.

This is part 1 of a five-part series of internet exchanges on the fluoridation debate between Paul Connett (USA) and Ken Perrott (NZ).

1. Fluoridation is a poor medical practice.

2. The evidence that swallowing fluoride reduces tooth decay is very weak. Better alternatives for fighting tooth decay

3. The large database that indicates that fluoride can impact the brain of animals and humans.

4. Other health concerns and the lack of an adequate margin of safety to protect everyone drinking fluoridated water.

5. Key moments since 1990 that should have forced an end to fluoridation.

Paul Connett is co-author of The Case Against Fluoride (Chelsea Green, 2010) and executive director of the Fluoride Action Network ( www.FluorideALERT.org ) Paul’s cv and list of publications is attached.

Part 1. Fluoridation is a poor medical practice

 

Introduction. Using the public water supply to deliver medical treatment is a very unusual practice. In fact it has only been done only once before and that was a short trial in which iodine was added to the drinking water to help fight hypothyroidism. However this was quickly abandoned when it was found that some people were being over-exposed to iodine. Since then fluoridation has been the only example. The reasons for not using the water to deliver medical treatment are fairly obvious.

1) It is impossible to control the dose people get. Once a chemical is added to the water to treat people (as opposed to treating the water to make it safe or palatable to drink) it is impossible to control the dose people get. People drink very different amounts of water. In short, engineers at the water works can control the concentration added to the water (mg/liter) but no one can control the total dose (mg/day) individuals receive.

2) It is totally indiscriminate. It goes to everyone regardless of age, regardless of health or nutritional status. Of particular concern is that it goes to people with poor kidney function who are unable to clear the fluoride from their bodies via the kidneys as effectively as others. It thus accumulates in their bones more rapidly. It also goes to people with low or borderline iodine intake, which makes them more vulnerable to fluoride’s impact on the thyroid gland. In general, according to studies done in India, people with poor diet (low protein, low calcium and low vitamin intake) are more vulnerable to fluoride’s toxic effects.

3) It violates the individual’s right to informed consent to medical treatment. This is a very important medical ethic which is fully described on the website of the American Medical Association (www.AMA.org). It is very surprising that so many medical doctors standby while the community does to everyone what they are not allowed to do to a single patient.

The above arguments would apply to any medicine added to the drinking water but there are other aspects to the fluoride ion, which makes it particularly unsuitable for addition to the drinking water.

 4) Fluoride is NOT a nutrient. There is not one single biochemical process in the body that has been shown to require fluoride for normal function (we will see later that fluoride’s predominant action on teeth is topical not systemic). However,

5) There are many biochemical processes that are harmed by fluoride (given a sufficient dose). These include the inhibition of many enzymes. This is the reason that some of the earliest opponents of fluoridation were biochemists like Professor James Sumner from Cornell University, who won the Nobel Prize for his work on enzyme chemistry. More recently fluoride has been shown to activate G-proteins and interfere with the cell’s messaging systems. It can also cause oxidative stress. An excellent summary of fluoride’s biochemistry can be found in the article “Molecular Mechanisms of Fluoride Toxicity” by Barbier et al, 2010.

6) The levels of fluoride in mothers’ milk is extremely low. This level, on average for a woman in a non-fluoridated community, is 0.004 ppm (NRC, 2006, p.40). This means that a bottle-fed baby in a fluoridated community (at 1 ppm) will get about 250 times more fluoride than a breast fed baby in a non-fluoridated community. Bearing in mind the fact that life emerged from the sea where the average level of fluoride is about 1.4 ppm, and thus there was no impediment for nature to use fluoride when developing human metabolism, her verdict appears to be that the baby a) does not need fluoride and b) that it may be harmed by fluoride. In my view, it is more likely that nature knows more about what the baby needs than a bunch of dentists from Chicago or public health officials in Washington, DC.

7) Fluoridation has always been a trade-off between lowered tooth decay and dental fluorosis but a key question was never satisfactorily answered. When the fluoridation trials began in 1945 it was known that the trade off was that approximately 10% of the children would develop dental fluorosis in its mildest form (this was a mottling or discoloration of the tooth enamel). While the mechanism whereby fluoride caused this effect was not known it was known to be a systemic effect. In other words it was caused by fluoride interfering with biochemistry during the development of the tooth cells. The question that was not answered before the US Public Health Service endorsed fluoridation in 1950, was: “What other tissues in the body may be interfered with at the same time that fluoride was interfering with the laying down of the tooth enamel?” Were the baby’s bone cells also being impacted? How about brain cells? How about the cells of the glands in the endocrine system? Sadly, very little has been done in fluoridated countries to answer these questions since fluoridated was started. However, proponents do acknowledge that the appearance of dental fluorosis means that a child was over-exposed to fluoride before the permanent teeth have erupted. Meanwhile, in 2010 the CDC reported that 41% of American children aged 12-15 have dental fluorosis, with 8.6% having the mild form (with up to 50% of the enamel impacted) and 3.6% with moderate or severe dental fluorosis (100% of the enamel impacted).  In later arguments in this debate I will be presenting evidence that fluoride is capable of harming other developing tissues.

 8) The fluoridating chemicals used to fluoridate the water supply are not the pharmaceutical grade chemicals as used in dental products. Most of the chemicals used are obtained from the phosphate fertilizer industry’s wet scrubbing systems (see Chapter 3, The Case Against Fluoride). One of the problems with this source is that it is contaminated with a number of other toxic chemicals including arsenic. Arsenic is a known human carcinogen and as such for the US Environmental Protection Agency (EPA) there is no safe level. The EPA’s maximum contaminant level goal (MCLG) for drinking water is thus set at zero. Proponents will argue that after the dilution of these bulk chemicals by about 180,000 to 1, the level of arsenic is negligible. However it is not zero and thus this practice will inevitably increase cancer rates in the population. As there are other delivery systems which are cost-effective and do not involve the use of these industrial grade chemicals, increasing the cancer rate even by a small amount is not acceptable.

9) Worldwide fluoridation is not a common practice. Proponents will often imply that fluoridating the drinking water is a common practice. It is not. Most countries do not fluoridate their water. 97% of the European population is not forced to drink fluoridated water. Four European countries have salt fluoridation (Germany, France, Switzerland and Austria), but the majority of European countries have neither fluoridated water nor fluoridated salt, yet according to World Health Organization (WHO) data available online (measured as DMFT in 12-year-olds) tooth decay rates in 12-year-olds have declined as rapidly over the period 1960 to the present in non-fluoridated countries as fluoridated ones and there is little difference in tooth decay rates today (see Cheng et al, 2007). The reasons that European spokespersons have given for not fluoridating their water are usually twofold: a) they do not want to force fluoride on people who don’t want it and b) there are still many unresolved health issues (see a list of statements by country at http://fluoridealert.org/studies/caries01 ).

10) Typically fluoridation is promoted via endorsements not via sound science. When the US Public Health Service (PHS) endorsed fluoridation in 1950, before a single trial had been completed and before any meaningful health studies had been published, it clearly was not the result of solid scientific research. However the PHS endorsement set off a flood of endorsements from other health agencies and professional bodies (see Chapters 9 and 10 in The Case Against Fluoride). Most of these came between 1950 and 1952. These endorsements were not scientific but simply reflected a subservience of public policy to the US government.  However, promoters of fluoridation for over 60 years have used these endorsements very effectively with the general public as if they were coming from scientific bodies reflecting thorough and comprehensive scientific research. Very seldom is this the case.  Hopefully, in these exchanges with Ken Perrott we will both focus on what the primary science actually says and not what some “authority” has to say about the matter.

References:

Barbier et al., 2010. Molecular Mechanisms of Fluoride Toxicity. Chem Biol Interact. 188(2):319-33 http://www.ncbi.nlm.nih.gov/pubmed/20650267

CDC, 2010.  Beltrán-Aguilar,Prevalence and Severity of Dental Fluorosis in the United States http://www.cdc.gov/nchs/data/databriefs/db53.htm

Cheng et al. 2007.  Adding fluoride to water supplies. BMJ 335:699

http://www.bmj.com/content/335/7622/699?tab=responses

Connett, P., Beck, J and Micklem HS. The Case Against Fluoride. Chelsea Green, White River Junction, Vermont,  2010.

NRC, 2006. Fluoride in Drinking Water: A Scientific Review of EPA’s Standards (2006) http://www.nap.edu/catalog.php?record_id=11571


Anyone wanting to follow the debate and/or check back over previous articles in the debate can find the list of articles at Fluoride Debate.

See also:

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