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Re: Evidence & Ethics
Yes, Richard, sometimes the majority does not prevail. That is wrong, but it happens. It happened in my city when the council ignored a referendum and several opinion polls they had commissioned to follow the non-scientific claims of an ideologically motivated group - with help from the Connett crowd.
But, sometimes democracy has to be fought for. That is what happened in our community and the people, in the end, won.
But local body politics is pathetic. Driven by all sorts of egos, commercial interests, and political infighting.
I think we have discussed the issue of the fluoride concentration of saliva. You ignore completely that this is determined by things like the F content of food and beverages or water - directly. As well as by regular toothbrushing.
You are relying on a figure for freshly excreted saliva and ignoring completely the direct effects of food, beverage, and toothpaste.
As for dental fluorosis of concern. Research shows this to be due to ingested fluoride, mainly from toothpaste and not from fluoridated water.
Re: Stop Fluoridation
Bill, you confuse the issue when you say of Broadbent's study - "Most of the subjects (if they were drinking the public water) were on fluoride supplements." From the figures, you then cite this is patently untrue.
But the basic problem in your approach is that you do not understand that this is a multivariate study - not a simplistic bivariate study of the sort reported in the poor quality Chinese studies you rely on which compared two villages - one in an area of endemic fluorosis and one not.
Put simply - there are no "controls" - there are treatments." - multiple "treatments."
Yes, the overlap of treatments influence the confidence intervals of the result of the multiple regression. This is inevitable. That I why I have said that the main flaw is that the size of the CIs influences the sensitivity of the detection. Or, in other words, the IQ effect (which you assume without evidence occurs) is so small that it is not detected by the regression analysis.
One can drive that argument to infinitely small effects, as for example with the Swedish study which had very large sample numbers.
You assume that only the residents of the nonfluoridated area (and then all the residents of that area) received supplements. The numbers show that is patently untrue and again you completely ignore the results of the statistical analysis which teases this sort of theing out in the size of the resultoing CIs.
The fact that you keep talking about "controls" shows your lack of understanding. You do not understand that this was not like the studies with what Broadbent et al refer to as "simplistic methodological design" that you put so much faith in.
Search through the paper and you will see Broadbent do not use the noun "control" in the way you do.
You go on to claim that Broadbent ignored other sources of F intake. The authors responded to this claim in the paper replying to the critique form the Connett crowd. (By the way, I wish that, in your consideration of this study, you would actually refer to both papers. The fact that you don't often means you are attempting to break through open doors - arguing a point the authors have already dealt with).
It is interesting that Connett and Hirzy seem to give up on the supplement argument to instead argue, vias motivated reasoning and poorly-based calculation, that the major F intake in fluoridated communities does not from the water but from other sources. They effectively say that scientific investigation of communities like New Zeland would not pick up a fluoridation effect on IQ.
Of course, this is wild speculation on their part (and partially explains why they could not get their paper published in a reputable journal so had to fall back on "Fluoride." And I think they do not believe it themselves - if they did they would stop campaigning against community water fluoridation but instead would campaign against all the other sources of fluoride which the had argued were more important.
Broadbent 2015, "Community Water Fluoridation and Intelligence: Prospective Study in New Zealand."
Consider Table 1.
CWF = 891 cohorts.
Never lived in CWF = 99 controls.
Fluoride tablets = 139 participants.
Stick with me Ken, this is something that for years you have failed to grasp about the Broadbent study.
Seldom do doctors prescribe fluoride in fluoridated communities. Double dose is not recommended. Therefore, we can assume, most of the 139 on pills were in the "Never lived in CWF" group of 99.
Slow down, calm down, read that again. The purpose of a doctor prescribing fluoride tablets is because the patient is not on fluoridated water. Therefore, from a clinician's point of view, most of the 139 on fluoride tablets were part of the 99 non-CWF controls. Broadbent does not address this huge problem which makes the study incapable of determinging an IQ difference.
The methods state, " Residence in a CWF area, use of fluoride dentifrice and intake of 0.5-milligram fluoride tablets were assessed in early life (prior to age 5 years); we assessed IQ repeatedly between ages 7 to 13 years and at age 38 years."
Keep in mind:
"In childhood, no statistically significant difference in IQ existed between participants who had or had not resided in areas with CWF, used fluoride toothpaste, or used fluoride tablets, both before (Table 1) and after (Table 2) adjusting for potential confounding variables."
Apparently, IF fluoride affects IQ, the source of fluoride did not appear to make a difference.
Breastfeeding showed higher IQ irrespective of 0.3 or 1.0 fluoride in water or fluoride supplements.
Did the cohorts actually drink the water or bottled water? No mention.
In other studies, water district claims for fluoridation of each house were not accurate by about 10%. Did the cohorts actually drink the water and how much water? Broadbent says, "A limitation is that we did not ask how much water study members drank. Individual water-intake level was not directly measured, meaning that the CWF exposure variable is an ecological one."
What percentage of fluoride exposure comes from public water? "Other sources of fluoride are also important in assessment of total intake. Prior to age 5 years, water intake is thought to account for less than half of total fluoride intake among children."
Ken, digest the statistics. The study is comparing about half the fluoride exposure for CWF.
Broadbent states: "Dietary fluoride was not considered, although we did consider exposure to fluoride from dentifrices and fluoride tablets."
Urban/rural was not considered, although most without CWF were in satellite suburbs.
Broadbent did not report the calcium or other mineral concentrations in the water which also affects dental caries.
Broadbent had no controls and compared fluoridation exposure with fluoride tablet exposure.
Bill Osmunson DDS MPH
Re: Evidence & Ethics
But the majority does not prevail. Citizens in San Diego voted twice in two separate elections (before I got involved) to ban fluoridation chemicals from their water supply. And yet the city council ignored that and fluoridated anyway.
The entire L.A. basin is fluoridated even though hundreds of people came to protest at the time designated for public input by the water disrrict. Only one person favored it, the man who wrote the CA fluoridation mandate against the statutes of the Safe Drinking Water Act..
When it comes to fluoridation, money talks, Democracy and truth have nothing to do with it.
For example fluoride in salive in a fluoridated city is only 0.016 ppm, completely useless in affecting calcium phosphate preciptation and the structure of teeth enamel, at 96,000 times less concentrated than in fluoridated toothpaste.. It;'s a scam that makes money for cities and in CA muich of the money comes from Delta Dental who never reimburses a member with more funds than what the member pays into it in the first place The extra money is given to cities to fluoridate. For San Diego it was First Five money from collected tobacco taxes that was supposed to be used for childrens' health programs. Again, money talks, and Democracy and truth walk.
Dental fluorosis is now endemic in the U.S. because of water fluoridation. it is not because of toothpaste fluoride in most cases, as claimed recently by the CDC who are protecting their longheld view that fluoridation is harmless. The original observations were reported by Dean in the 1930's that water fluoride at 1 ppm was causing substantial dental fluorosis in kids at the time, long before fluoridated toothpaste was ever invented.
If I tell you the data on Broadbent, you will not spend the time to read the study again and evaluate the the flaws.
How many cohorts were subjects on fluoridated water?
How many were controls?
How many of the controls were on fluoride supplements?
What was the difference in the polution in the water between the two areas?
My point is,
Most of the subjects (if they were drinking the public water) were on fluoride supplements dispensed as fluoridation.
Most of the controls were on fluoride supplements dispensed as pills/liquid (if they took the pills).
The difference in dosage of fluoride between the two groups was too small to detect IQ loss.
This is probably the 4th time in the last few years I have repeated that the Broadbent study was incapable of determining IQ loss and is certainly not evidence ingesting fluoride is safe. . . Broadbent compared two sources of fluoride and found both to be about the same.
Bill Osmunson DDS MPH
Re: Evidence & Ethics
Ross, re the Hamilton city debacle - biased activists are biased activists even if they have degrees. Yes, I know Bob Mann too - and he is an extremist on this issue.
I interacted with many councillors after their initial decision and it was clear to me that they did not understand the science at all - what they understood is that there were two different stories coming from people they thought were experts. They were incapable of discussing the science and they had no idea of criteria to use to judge if a submitter was a real or a fake expert.
It is this confusion caused by activists pressuring councils which lead to the councils requesting, and partially financing, the authoritative NZ Fluoridation Review (https://royalsociety.org.nz/assets/documents/Health-effects-of-water-fluoridation-Aug-2014-corrected... and eventually pressure for legislation to take such decisions away from councils (as councils pointed out - they do not have the skills to make scientific evaluations and they considered the whole issue a "poisoned chalice" for councils). That legislation is still waiting for its second reading in parliament.
The numbers you quote are a symptom of the problem councils saw - cynical form letters and copies of letters given as submissions simply to get numbers. It’s an old activist trick.
Scientific issues should not be considered by councils, but by relevant experts. It's up to democratic bodies to consult such experts for advice - not replace them.
You list issues you claim swung the council (rather a naive understanding considering the stupid politics involved in that council at that time with competition to replace the Mayor). Let’s look at these:
1: Yes, the surface reaction of phosphate, calcium and fluoride at the tooth surface is considered the main mechanism of preventing decay and recovering from acid attack. This results from the presence of these chemical species in saliva, plaque and the oral cavity in general. Fluoridated water and food help provide these and help maintain saliva F, P and Ca concentrations during the day (saliva F from toothpaste drops relatively quickly so restoration of concentrations during the day is important.
2: Your argument for "wasted" treated water is simply an argument for a double reticulation system - one for drinking and one for all other uses. That is extremely wasteful financially and that is why such an approach is only considered for very small reticulation systems.
3: Each country approaches the involvement of F in oral health according to their own situation. CWF is not suitable for many systems (it's not suitable for many systems in NZ) and alternatives like school fluoride rinses, fluoridated salts, natural fluoride levels, etc., come in to play. In the end, each country and region make its own decision according to its situation.
4: Use of fluoridated water is not considered a risk to bottle-fed infants by health professionals - but parents who do have a concern are recommended to sometimes used alternative water sources - simply a "peace of mind" issue. Anti-fluoride propagandists always misrepresent that situation.
While there has been some concern that bottle-fed infants exceed the recommended maximum intake for F the lack of prevalence of moderate or severe dental fluorosis caused experts in NZ and Australia to reconsider the calculations. They found a flaw and there are now new recommendations showing that bottle-fed infants do not exceed the recommended F intake. See:
5 & 6: You don’t explain. However, I have written several articles about the way that anti-fluoride activists distort the evidence and use statistical analyses incorrectly. See for example:
I could say that I find it bizarre that you think my attitude to democratic processes is bizarre. It is simply a matter of democracy for resolution of differences based on values or ethical issues. Yes, the minority "loses" but nothing is "forced" on them. When CWF was stopped in my city I used a mouth rinse. When it was restored many anti-fluoride activists used filters and alternative sources (2 of these provided by the council). This is what sensible people do when they feel the democratic decision doesn’t suit them - they use alternatives.
I think democracy is a win-win situation for this reason. It is simply dishonest to claim that either side is forced into anything. They aren’t
Think about free hospitals or secular education. People who object to these have alternatives and use them - at far more cost than the $250 for a filter or similar amount for a year’s supply of mouth rinse.
You say of my attitude to democracy:
"Intellectual consistency would surely force him to state that those opposing fluoridation had got it wrong.
Referendums are by far the wrong ways to resolve fluoridation disputes."
Of course, I think those opposing fluoridation have got it wrong - just as I believe those voting for certain political parties have got it wrong. But democracy means the majority decision prevails - I accept that and take alternative action if necessary.
No, referenda cannot solve scientific issues - they are not meant to. But they do resolve the values differences - providing decisions suiting most people. And as I say, usually there are alternative actions available for the minority (not for the elected government, though, and we all accept that.
You say, "Local governments face ethical issues with fluoridation." Yes, but isn't it disgusting for ideologically motivated activists to use science (and distorted science at that) as a proxy for their own ethical views. They should be honest - face up to the ethical issues and attempt to win a political decision on those grounds and not distorted scientific claims - recognising there are no black and white, facts or correct decision when it comes to values. Except that the majority should prevail.
Re: Evidence & Ethics
KenP, in claiming that a 2013 (non-binding) referendum provided overwhelming support for his local council to reverse a decision to terminate fluoridation is grossly distorting history. He also asserts that the council decision to stop fluoridation was made under pressure from ideologically motivated activists who were distorting and misrepresenting the science, thereby confusing the issue.
A four-day tribunal style hearing had been held by KenP’s city council with one-and-a-half hour primary presentations from both sides of the fluoridation debate with half an hour for questions from councillors after each presentation.
The case against fluoridation and summing up was given by medical doctors, a doctor of dental surgery and the retired biochemist who had supervised John Colquhoun’s doctoral thesis and co-authored with Colquhoun ‘The Hastings fluoridation experiment: science or swindle?’
The case for was given by a large number of district health board, Ministry of Health and New Zealand Dental Association representatives.
1,385 of submissions asked the council to stop fluoridation with 170 submissions supporting continuation. Of the 141 requests to speak at the hearings only 11 wanted fluoridation to continue.
I watched much of the hearings online and also read many submissions on which the council decision was made.
On the weight of evidence presented at the tribunal there were six factors that influenced the council’s post-tribunal decision to stop fluoridation. They were:
1. Application by toothpaste or other means that directly affect the tooth surface are much more effective at reducing tooth decay.
2. Fluoridation is wasteful – of the 224 litres of water used by the average person each day, less than two litres is used for drinking – 99% goes down the drain (i.e. of the $48,000 per year spent on fluoridation only $480 ends up being fit for purpose).
3. Communities around the world are rejecting the practice – most of Europe does not fluoridate.
4. There is strong evidence that fluoride should not be ingested at all by babies under six months old and bottle-fed babies are therefore at greater potential risk.
5. While fluoridation may have some benefits for some, it isn’t good for everyone and fluoridation of the water supply affects personal choice.
6. Statistical evidence that fluoridation potentially causes harm.
Are these not reasonable factors on which to make a rational decision?
One councillor, also a district health board member, had been excluded from council decision making on the issue because of conflict of interest but within weeks had marshalled the local dental fraternity to garner support for a referendum which was eventually held in October 2013 with only around one third of eligible voters participating. Of those voting, 70 per cent voted for fluoridation while 32 per cent voted against.
The 24,635 voting for fluoridation had determined that the 11,768 against were forced, against their best judgement, to accept addition of a neurotoxin and endocrine disruptor to the water delivered through their household taps.
The district health board spent huge taxpayer funds in advertising.
As well as brochures and posters, their campaign included four huge billboards outside their buildings, three full city-wide letter box drops, two-page newspaper advertisements for four weeks in a row and Google and YouTube advertisements.
All emails from the health board and hospital had pro-fluoride messages as part of the signature, a recorded pro-fluoride message was on health board and hospital telephones and even TV screens at the hospital showed pro-fluoridation videos.
Local newspapers were blatantly pro-fluoridation.
Anti-fluoridation groups were unable to afford counterbalancing public information.
I find it quite bizarre that for KenP to admit that if referendums in his community had opposed the return of fluoridation he would have supported the outcomes. So what happens to his ‘safe and effective’ fluoride science?
Intellectual consistency would surely force him to state that those opposing fluoridation had got it wrong.
Referendums are by far the wrong ways to resolve fluoridation disputes.
Local governments face ethical issues with fluoridation.
A clear majority of pro-fluoridation voters in a poll should not be able to determine that the rest are forced against their will to take a health-affecting toxin in their drinking water.
If you are sick you don’t ask a stranger to vote on your medication so why should fluoridation be any different?
Re: Evidence & Ethics
CarryAnne - I agree completely, in the current situation, with your comment that "fluoridation policy should primarily be about ethics."
This is because currently, the science is pretty definite. Community water fluoridation is effective in reducing tooth decay and there is no evidence of harm. However, like all such social interventions, the issue is political. That is why I say that where there is controversy in the community about fluoridation proposals it should be decided democratically, involving the community. Referenda are good for this.
In my own community, it took a second referendum, confirming the first referendum of overwhelming support for fluoridation, for the local council to reverse its decision to terminate fluoridation. A decision made under pressure from ideologically motivated activists who were distorting and misrepresenting the science - thereby confusing the issue.
If the referenda in my community had opposed the return of fluoridation I would have supported that decision. I support democracy.
In fact, the ethical issue is the best argument anti-fluoridationists have. They discredit themselves when they resort to misrepresenting and distorting the science to make a "sciency" argument - but when they lose at that they resort to the ethical argument. I have seen this sort of behaviour again and again - and now with you. You should start with the ethical argument, stick with it, not attempt to use "science" as a proxy for your ethical or values concerns - and accept the democratic decisions which always decide such ethical questions.
Unlike science - which on the whole deals with factual matters, ethical considerations are based on values. There is no "correct" or factual argument to decide an ethical question. These are decided by the prevailing values - usually, by referenda or simlar democratic decsion.
Anti-fluoridationists will always lose the scientific arguments because it is determined by the facts (that is why you refuse to participate in an honest, good faith scientific exchange) but they can win the ethical one - depending on the previaling ethics of their community.
Finally, you make claims that I have used words that I certainly have no recall of using - and you do not provide any evidence. I am sure I did not use most of those terms - however the charge of describing your claim that in my scientific career I was researching pesticides and developing high fluoride fertilisers I am sure I described as "dishonest" or a "lie" - because it patently was and you admitted it and apologised for making that dishonest claim..
Re: Evidence & Ethics
Yes. An Associated Press article came out last week stating that the CDC now claims that kids are using too much toohtpaste because of the endemic of dental fluorosis. So the followers of the CDC also accept this. But yes water fluoridation began causing dental fluorosis long before fluoride toothpaste was ever invented. The original correlation that attempted to claim fluoride in water reduces caries was in the 1930's where substantial dental fluorosis was observed in communites with fluoride at 1 ppm in water. Toohtpaste with fluoride was not available until the 1950's.
The CDC has a mission to protect the Surgeon General's claim that fluoride ingestion is safe and effective, so obvsiouly it must be that toohtpaste be blamed for what is mostly done by water fluoride..But both now are involved in causing the high incidence of fluorosis enamel hypoplasia.
The bizarre thing is that there is no credible well controlled evidence in man or animals proving that fluoridation even works to lower dental caries. And yet vast effort and funds are put into fluoridating the country. Pretty disgusting and when this is called out, all you will get from fluoridationists is that you are somehow the 'scaremonger.'
Evidence & Ethics
”Fluoride 'science' is corporate 'science'. Fluoride science is DDT 'science'. It's asbestos 'science'. It's tobacco 'science'. It's a racket." - Chris Bryson, investigative reporter and author of 'The Fluoride Deception' (2006)
KenP writes 'when have resolutions at union meetings become a substitute for real science' - yet offers his blog posts to claim that the real science published by world experts is 'dishonest.' This specific to an exchange on dose and the EPA scientists' testimony to EPA management on a scientifically justifiable reference dose for fluoride.
KenP writes in his first three days on AARP that several participants are 'dishonest,' 'deranged,' 'liars,' 'unreliable' and 'so intellectually stubborn as to make rational discussion impossible,’ yet consistently writes things like "Bill, I wish you would back away from the personal attacks."
KenP writes that in optimally fluoridated communities dental fluorosis is caused 'mainly by ingestion of toothpaste.' Yet, when I offer two sources with urls and screen shots documenting dental fluorosis that predated fluoridated toothpaste (a 1956 PHS sponsored controlled dose study documenting 'coppery brown' dental fluorosis & 1962 government report that documented the first generation of children raised on fluoridated water had alarming rates of dental fluorosis, disproportionate by race in the same community), KenP replies that 'truth is your last concern,' that I made 'unwarranted claims' and spread 'propaganda' and 'fake news.' Then he says I refuse to enter into honest conversation about science?!
However - fluoridation policy should primarily be about ethics.
- Is it ethical to use municipal water to mass medicate the public?
- Is it ethical to add a poison to water that is medically contraindicated for many consumers?
- Is it ethical to claim more science is needed before ending a program when dozens of human studies and hundreds of animal studies have validated neurological harm from that program?
- Is it ethical for anyone to dismiss the poisoning of vulnerable populations as a political decision?
- Is it ethical for AARP and other organizations that claim to advocate for a constituency to remain silent?