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Re: Fluoride - Demand AARP Take Action

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Message 41 of 1,448

CarryAnne, Love the quote from Betrand Russell. Sums up my whole approach. Facts, data, evidence are what should ground us.

As you will notice this has been my whole approach in this and other discussions. I have approached my analysis of the Green et al. paper by looking at, and dealing with, the data. I am not influenced by authority statements - either from the author, coauthors, editor or those who had early access to the paper and set out to promote it.

An Editorial note is unprecedented, as this editor specifically said. it is not something I have come across before in my extensive research and publication experience. 

I have written in detail about the handling of the data - I obviously do not agree with your unsupported claim this was "impeccable." But then again I deal with the facts, evidence, data - not personal "authority" assurances. And the fact that the editorial review was contentious (and the editor specifically mentioned contentious statistical review) surely supports my point.

Yes, the mean IQ values provided in Table 1 are not "adjusted" - how could they be. They are plain means, not the result of a regression model.

Yes, in the regression model adjustment for other confounders did influence the association or coefficient - it reduced it (from -2.6 to -1.95 for all children, from -5.01 to -4.49 for boys and about the same 2.23 to 2.40 for girls).

This is quite normal. When a model includes a range of risk-modifying factors that influence the outcome the correlation coefficients for a particular factor is reduced compared for unadjusted regressions. Sometimes, as in the case of the Malin & Till (2015) ADHD paper, adjustment actually removes an association completely. (In this case, their reported association of ADHD with fluoridation disappeared completely when the altitude was included in the adjustment - see Perrott, K. W. (2018). Fluoridation and attention deficit hyperactivity disorder a critique of Malin and Till (2015). British Dental Journal, 223(11), 819–822).

Apart from the fact that reference to adjustment is irrelevant to simple mean values it is surely straw grasping to talk about adjustment in the vain hope of converting a non-significant difference into a large difference. But I notice a few anti-fluoride campaigners are now starting to attempt this with a vague reference to "adjustment."

More worrying to me is the fact that the authors did not even refer to that specific data in their discussion. If there was an argument based on "adjustments" that would have been the place for it to be made.

But another, more political, point. There is nothing in the Green et al study to justify the claims of anti-fluoride campaigners in New Zealand that the study shows that "Fluoridated water lowers kid's IQ."  Quite the opposite. That claim is completely wrong and will probably lead to action from our advertising authority. It is false scaremongering - probably why several local authorities have ordered the offending billboards be taken down.

Your claim that I have only concentrated on the mean values form the papers Table 1 is completely wrong. I have spent some time showing that the regression analysis used by Green et al produces a best-fit line explaining only 1.3% of the variance in IQ. This is a fundamental and important point. This, together with the suspect nature of the regression (the data was not normally distributed so probably violated an inherent assumption) means that the much-touted value of the regression coefficient is meaningless. A simple look at the figures published in the paper confirms that assessment (see below). How could the much-touted coefficient of 4.49 predict the real values?


CarryAnne, I do not see you engage properly with any data. You instead rely almost exclusively on "authority" statements. While that is normal for anti-fluoride campaigners it is extremely poor behavior for any scientists. In fact, it is not at all scientific.

I leave you with this graph from the Green et al. (2109) paper which surely shows that the claims based on the best-fit line have absolutely no predictive power. They are meaningless. It is surely significant that the anti-fluoride campaigners promoting and misinterpreting this paper never show this data.

Canada 1.jpg

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Re: Fluoride - Demand AARP Take Action

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Message 42 of 1,448

CarryAnne and Ken,

 

Your comment is both respecful and accurate, gentle and firm.  

 

KenP has confirmational bias to the extreme.  

 

Ken asked me to debate him on his blog and I agreed, but I chose the topic "excess fluoride exposure."  First he dodged claiming his computer had problems.  I sent him my side of the first debate and he has refused to respond.  The simple answer is too many are ingesting too much fluoride as reported by several streams of evidence.  Excess fluoride does not confim KenP's bias so he refuses to investigate and comment.

 

Instead, KenP is refusing to look at the "weight of evidence" and "streams of evidence" and his research limitations.

 

For example, Ken P should consider the JAMA Editor noted regarding the Green et al study.  Remember, this Journal has promoted fluoride, most of their members promote fluoride.  I have had them speak publicly in favor of fluoridation when I spoke opposed.   JAMA is a pro fluoride Journal.  

 

To speak up against what they have promoted did not come lightly.  In effect, they are admitting they may have been wrong.  Not easy for anyone.

 

The Editor wrote:

"This decision to publish this article was not easy. Given the nature of the findings and their potential implications, we subjected it to additional scrutiny for its methods and the presentation of its findings. The mission of the journal is to ensure that child health is optimized by bringing the best available evidence to the fore. Publishing it serves as testament to the fact that JAMA Pediatrics is committed to disseminating the best science based entirely on the rigor of the methods and the soundness of the hypotheses tested, regardless of how contentious the results may be. That said, scientific inquiry is an iterative process. It is rare that a single study provides definitive evidence. This study is neither the first, nor will it be the last, to test the association between prenatal fluoride exposure and cognitive development. We hope that purveyors and consumers of these findings are mindful of that as the implications of this study are debated in the public arena."
 
The Editor also included a pod cast, short and informative.  https://edhub.ama-assn.org/jn-learning/audio-player/17802991
 
Harvard Professor Dr. David Bellinger provided an editorial piece (JAMA August 19, 2019) noting:
"The hypothesis that fluoride is a neurodevelopmental toxicant must now be given serious consideration…It is instructive to recall that the hypothesis that subclinical lead exposures pose a neurodevelopmental hazard was bitterly contested in the 1980s and 1990s, and it was only the weight of evidence that eventually accumulated that led to the now widely held consensus that no level of lead exposure is safe…If the hypothesis is true, the implications are worrisome. Exposure to fluoride has increased substantially in recent decades…If the effect sizes reported by Green et al and others are valid, the total cognitive loss at the population level that might be associated with children’s prenatal exposure to fluoride could be substantial."
 
The problem I think Ken has is considering the "weight of evidence and combining that with the "streams of evidence."   
 
When it comes to risk, harm, researchers cannot knowinging cause harm to evaluate safety.  Therefore, judgment must be used on the weight of evidence from all streams of evidence.  
 
Some streams which must be included, are:
 
1.  Too many ingesting too much fluoride. (EPA, NRC, CDC, etc)
 
2.  Research on efficacy is incomplete, low to moderate quality.  Percentages are used as gee whiz marketing rather than absolute numbers.
 
3.  Fluoridation may not reduce dental expenses.  No high quality studies.
 
4.  Fluoride, according to many studies, is a known carcinogen.  Yes, more research would be good, but the low to moderate studies have weight.
 
5.  Fluoride makes teeth harder, delays diagnosis of caries, increases bone fracture.  Yes, more research would be good, but the low to moderate studies have weight.
 
6.  Fluoride reduces IQ.  Yes, more research would be good, but the more than 50 low to moderate studies are over 90% consistent which adds weight.
 
7.  Supplementation of fluoride without consent, without knowing whether the patient has dental fluorosis, swallows toothpaste, has high levels of fluoride in their urine or is chemically sensitive is ignored. . . the motto is "give everyone more fluoride regardless of whether they are ingesting too much."
 
The weight of evidence from all streams makes the issue of fluoridation mute.  Fluoridation of public water must stop, at least until quality research confirms safety for all.  Fluoridation is not the only source of fluoride and an individual can ingest more fluoride from other sources if they want.    
 
Fluoridation is the worst case of big government thinking they know what is best for everyone and individuals are too stupid to make health care decisions on their own.
 
Ken, look at all streams of evidence.  Look at the weight of evidence.  Consider Green et al is one of many studies and goes against the JAMA past bias.  Consider your evaluation of Green just might be incomplete.
 
Bill Osmunson DDS MPH

 

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Re: What? Read tbe post. I said fluoridation promoters. Of co...

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Message 43 of 1,448

The trustworthy well controlled caged mammalian studies are the most reliable,, proving beyond doubt that fluoridated water ingestion in newborn offspring leads to damaged brain function. There is no debate about this. The blood levels used for F were comoparable to that for humans ingesting fluoridated water.  The case is closed for me. It does not need to be proven in humans who cannot be caged anyway and for whom it is difficult to obtain a good control.

The data are what they are, and if F causes brain dysfunction in childhood as rpeortedin manyhuman publications, then the small increase in urinary F here in the JAMA article that the authors claimed may be responsible for the corresponding expected small lowering of IQ is consistent with the known toxic effects F is known to have.

As far as those who oppose fluoridation in advertising claims, vs those who promote the industrial fluoridation of people, I side with those who are rational and oppose fluoridation of people with a known toxic substance, regardless of whether the effect can be easily detected or not, where humans cannot be caged like animals can. For example, the formation of bone of poor quality begins with the first sip of F'd water. But can we detect with current methods any observable effect from it in such people? Of course not. Does this mean you should continue to incorporate fluoride into your bones by drinking fluoridated water because it appears nothing is wrong with it? Of course not. Just like smoking, the longer you do it, the more toxic effects accumulate. All toxic effects of fluoride ingestion have their own intrinsic diffiuclty in assessing in man. I do not condemn as "liars" those who repeat what the JAMA authors claim is real. Sorry.

Richard Sauerheber, Ph.D.
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Re: Fluoride - Demand AARP Take Action

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Message 44 of 1,448

Hello everyone,

 

Whilst we welcome robust debate, we ask that everyone abides by the guidelines.

 

Please be respectful and refrain from making hateful and/or incendiary comments. You are free to express your opinions, but you must do so in a way that respects the opinions of others.

https://community.aarp.org/t5/custom/page/page-id/Guidelines

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Re: Fluoride - Demand AARP Take Action

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Message 45 of 1,448
“When studying any matter, ask yourself two things: what are the facts and what is the truth that the facts bear out. Never let yourself be diverted by what you wish to believe, or what you think would have beneficent social effects if it were believed. Look only and solely at what are the facts.” -  Bertrand Arthur William Russell, logician and Nobel laureate on evidence and data analysis (1959)
 
KenP - So after several comments attacking my veracitiy, even claiming I'm generating fake news despite my repeatedly providing the link to my source, you admit you hadn't followed the link before making your false claim. Your latest responses after finally checking the source aren't exactly word salad because they are coherent, but they so misrepresent the material with your "assumptions" that it's hard to see how you could rationally arrive at your claims. 
 
First, there is nothing "unprecedented" or exceptional about either the fact that there was a podcast or editorial meetings associated with the MIREC study by Green et al. The editors do a monthly podcast on 1 or 2 articles in JAMA Pediatrics. Moreover, mentioning the several statistical reviews in that podcast was not an offhand remark - the stated intent of this 12 minute podcast which was entirely devoted to the MIREC study was to explain the behind the scenes due diligence to ensure that the quality of the study was up to JAMA Pediatrics standards - which it was. Despite your claims that no one at JAMA Pediatrics or even the researchers who conducted the study were competent, the handling of the data was impeccable. 
 
As far as your personal armchair analysis of the study data, any analysis that relies on unadjusted estimates is meaningless because adjusted estimates from the regression model that control for all the factors that can influence IQ is what reveals significant patterns. Consideration of how many potential confounders were controlled is standard in review methods, such as the Cochrane reviews. Cochrane rates the quality of studies and their analyses.
 
KenP, that you rely totally on unadjusted data in your critique of this MIREC study is either a major blunder or overt manipulation, especially in this study that had several confounders such as higher maternal education in the fluoridated group. Confounders like this would obscure loss in IQ. Green et al., on the other hand, did it right.  Given the stature of the JAMA Network, I'm sure the "several" independent and professional statistical analyses that JAMA contracted did it right, too. 
 
But even without that fatal flaw in your critique, KenP, any analysis that controlled for zero potential confounders like yours, KenP, would be rated at very “high risk of bias” by Cochrane or any other competent reviewer and would less likely be published by any competent journal. It  certainly would not be published by a high quality journal like JAMA Pediatrics.  
 
I like data, but I am very aware of the data manipulation by biased players and so pay close attention to both the data and language used. I suggest your choice of language in social media and your quick criticisms of any comment that disagrees with you without even checking sources, as well as your non-standard handling of data confirms your pro-fluoridation bias as fact and suggests that you are afraid  the truth in the science published by both the MIREC and ELEMENT projects will not reflect well on your hobby of championing fluoridation policy by throwing stones at people and studies that disagree with your point of view. 
 
For more on truth revealed by the high-quality MIREC and ELEMENT studies relevant to fluoridation policy, see:  https://www.greenmedinfo.com/blog/wetoo-medical-assault-and-battery 
 
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Re: What? Read tbe post. I said fluoridation promoters. Of co...

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Message 46 of 1,448

Richard - read my post and stop diverting. In fact, the anti-fluoride campaigners are telling lies about the Green et al paper as my photo of their local billboard shows. It is likely they will be asked by the advertising authority to remove these billboards - several local authorities have already ordered them down. And the local media is very critical of the scaremongering involved in their advertising.

They are simply scare-mongering, in the worst possible way targeting children and pregnant woman, and they are simply lying. The study says nothing of the sort - in fact, the data shows no effect of fluoridation - as you admit. The local anti-fluoride peop[le have really misjudged the situation this time and will find it very difficult to recover from this.

Who says it must be linear - not me and I found a more normal distribution of the data using partial log transformation. The authors acknowledge the data was not perfectly normal but judged they should not transform the data (they say because of difficulty in interpreting a model but more probably because the transformed data was unlikely to show a relationship).

A low R-squared value shows that the relationship is incapable of explaining much of the variance - in this case only 1% which is extremely weak. It is telling the authors did not discuss the R-squared values and relied simply on p-values which can be very misleading.

I have not commented on the correlation coefficient, low or high is immaterial. The relationship is so weak and the regression so questionable I do not believe we can extract any meaning from that coefficient.


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What? Read tbe post. I said fluoridation promoters. Of co...

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Message 47 of 1,448

What? Read the post. I said fluoridation promoters. Of course those opposed to fluoridation make no such claim.

A small effect is noticed with a small F increase. So what? F levels in controls, from drinking tea, or whatever, predict a small effect from a small additional increase in F from fluoridation above that level  And a low r^2 does not disprove its reality. Who says it must be linear? And any small effect can have a low correlatiom coefficienr even wben the effect is real. 

As stated before the controlled mammal studies prove F'd water incduces brain abnormality. You can't get a perfect study like those in humans who cannot be caged.

Stop changing what i state to suit your own needs.

.

 

Richard Sauerheber, Ph.D.
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Re: Fluoride - Demand AARP Take Action

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Message 48 of 1,448

Richard, you are playing with words. The anti-fluoride people are NOT claiming "that the urinary fluoride study proves that water fluoridation does not decrease IQ." They are claiming the exact opposite.

The point is that there is absolutely no evidence in this study that fluoridated water lowers kid's IQ" as they are specifically claiming about the study. The billboard is presenting a lie.

I noticed you refused to answer my questions relating to your attempt to draw conclusions from the urinary F data relevant to fluoridation. And you avoid the extremely weak nature of the association involved. (You will recall I called out Malin & Till for the association they reported (and they had R-squared values of about 22 to 34%. Even so, their claimed relationship of ADHD with fluoridation disappeared when better risk-modifying factors were included).

The statistical analysis indicates that the data in the Green et al paper was not distributed normally, the variance was too high for that according to the probability distribution. This, together with the extremely weak nature of the association (R-squared around 1%) means the result is really meaningless and will be seen as such by the experts.

You are busily avoiding the elephant in the room - the weak nature of the reported relationship and the questionable regression used to obtain it.

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Re: Fluoride - Demand AARP Take Action

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Message 49 of 1,448

There is no basis upon which to make the claim that has been made by fluoridation promoters, that the urinary fluoride study proves that water fluoridation does not decrease IQ. This is inane. The study did not include people who had systemic fluoride levels and urine fluoride levels reflective of normal controls in more typical nonfluoridated areas. Therefore the claim that "fluoridation" does not decrease IQ is, as I said, nuts.

The difference in urine fluoride is far more reliable as a chemical measurement even though it is criticized in the previous post.

Also I think the readers are perfecxtly clear that I do NOT disagree with the authors of the study, that is, that a 1 ppm increase in maternal urine fluoride is associated with a significant several point drop in IQ in male offspring.  The authors are far more in tune with their data and trustworthy than the critic.

Finally, if a larger urine fluoride difference had been present, all previously published well controlled studies indicate even a larger IQ drop would have been found.

Clear?

Richard Sauerheber, Ph.D.
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Re: Fluoride - Demand AARP Take Action

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Message 50 of 1,448

Richard, you are not being clear nbut I gather you do agree with me.

In this study, THERE IS NO EVIDENCE THAT CHILDREN'S IQ IS INFLUENCED BY THEIR MOTHER'S RESIDENCY IN FLULODIATED VS UNFLUODIUATED AREAS.

Do you agree with that? After all the figures are clear nonfluoridated mean IQ = 108.1, fluoridated mean IQ = 108.2. Nothing to do with urinary F.

So the billboards used in NZ are wrong? Their claim is completely fake.

As for the rest - you are speculating. Urinary F data is so rare and the methodology used in this paper so inexact that one just cannot extrapolate.

But even so, considering this study alone, would you consider the difference between the 25th and 75th percentiles to be realistic for the effect of fluoridation. From the data what do you expect the IQ difference to be? What do you expect the CIs to be? Do you think that is at all significant?

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