A Few Things Ill Considered

The case against fluoride

i-f9a82a1b0a206a91e01b3866d8c02997-flouride.jpgAlthough I just play the role of a scientist on the internet, my father actually is one. As well as being a medical doctor, he is a retired professor of biophysics. I am telling you this because he has recently co-authored a book on a subject that might interest readers of ScienceBlogs: fluoridation of human water supplies. The book is entitled "The Case Against Fluoride: How Hazardous Waste Ended Up in Our Drinking Water and the Bad Science and Powerful Politics That Keep It There" and you can read a detailed review of that book here [PDF].

At my request, he has written up a guest post outlining the arguments he and his co-authors make in much greater detail in "The Case against Fluoride" and says he will be checking the comments in case there are questions. So, without further ado, take it away Dad!


Guest post by James S. Beck

Participants in this blog will be familiar with at least one struggle between science and science-deniers in the context of a man-made disaster, where material interests and greed and reluctance to face responsibility and fear of legal liability all lie in the background. That’s the drama of climate change. Well, here’s another one for us: fluoridation of public water supplies. The science is perhaps simpler and the solution certainly is easier but the parallels are nevertheless striking.


This drama got its start in North America in the 1940′s after a big effort on the part of industries that were faced with costly law suits over illness and death, things apparently caused by their industrial use of fluorine-containing chemicals. The government of the United States was also involved in fluorine use in its enrichment of uranium for fission bombs. The public became involved unknowingly in 1945 with the beginnings of trials of fluoride as a preventive of dental caries (cavities). These trials were imposed on large cities in Canada, the US and New Zealand without consent of their inhabitants. The goal of some of the actors was prevention of cavities. The goal of the pushers seems to have been to make fluoride look harmless and beneficial, thus making legal challenges hopeless of success. But these trials were imposed without prior tests for safety or effectiveness and fluoridation of public water supplies was approved and promoted by the US Public Health Service in 1950 – half-way through these ill-conceived and incompetently executed trials. After that other government agencies and some professional associations quickly got on the bandwagon. Currently about two-thirds of the population of the United States is using fluoridated water. In Canada usage varies with province but overall less than 40% of the population has it. In Europe the practice has been refused and stopped to the extent that over 90% of the people do not have it.

A brief review of three critical questions about fluoridation follows.

Is fluoridation effective in reducing the incidence of dental caries (cavities)?

Fluoridation of public water supplies has been in effect somewhere in the world for seven decades now. Over that time the prevalence of dental caries has fallen in industrialized countries. This has been taken by many to indicate efficacy. But research has consistently shown that the decrease has occurred in countries without fluoridation to the same or greater degree as in those with fluoridation. Furthermore it is observed that in jurisdictions where fluoridation has been discontinued the incidence of caries has not risen. And studies comparing caries experience of cities fluoridated with cities not fluoridated have shown no difference, except where the nonfluoridated cities do better.

The answer to this first question is clearly no.

Is fluoridation safe?

The most obvious toxic effect has been dental fluorosis. In mild cases it appears as mottling discoloration of tooth surfaces. In moderate and severe cases it involves discoloration, pitting and weakening of the enamel and has serious consequences. The treatment of this condition costs tens of thousands of dollars per patient. Even if this effect were only cosmetic, it would have serious negative effects on a child’s or teenager’s life. Aside from dental fluorosis, evidence uncovered over the last two decades has shown an association of fluoride in drinking water with lower IQ in children. There are over twenty published studies showing this association. In laboratory studies of animals and of aborted human fetuses an association with abnormalities of cells of the brain has been found. Also it has been shown that fluoridation is associated with high levels of lead, a known neurotoxin, in the blood of children.

And there’s more, including, but not limited to, the following:

  • Fluoride intake is a cause of impaired thyroid function. Indeed fluoride was once used medically to suppress thyroid function.
  • Deleterious effects on reproductive systems in humans have been found to be associated with fluoridation: in girls, early onset of menstruation; in men, low sperm counts.
  • We now have strong evidence of the association of osteosarcoma in boys and young adult males with fluoridation. Osteosarcoma is a bone cancer which is often fatal.
  • The possible incidence of bone fracture with fluoridation has been studied with mixed results. One of the strongest studies is presented in a paper by Li et al. published in 2001 which shows a rising prevalence of hip fracture correlated with a rising intake of fluoride starting with concentrations comparable with those used in fluoridation in North America. And this is just one example that suggests that hip fracture is caused by fluoridated water.
  • Fluoride adversely affects kidneys.
  • Two recent studies have shown adverse effects on the heart and the aorta.

Ironically, this multiplicity of demonstrated and possible toxicities has actually been cited by some proponents of fluoridation as discrediting the arguments of opponents. That tactic appears as an assertion that opponents are scaremongers, that nothing would cause so much trouble for so many body systems. But these effects of fluoride are not so surprising to anyone who recognizes that the element fluorine is the most reactive chemical element and that it reacts with many components of the human body. For example, fluoride has been used in thousands of laboratory investigations as an inhibitor of enzymes, the proteins that catalyze (facilitate) biochemical reactions. It is also well known that fluoride, in combination with other elements such as aluminum and with components of cell membranes, disrupts the normal signalling across the membanes of hormones and other messengers that activate or moderate cellular functions. Really, the multiple toxicities are to be expected rather than dismissed because there are so many.

All of this is backed up by scientific reports in peer-reviewed journals. I recognize that there are well educated proponents of fluoridation including scientists, physicians and dentists, but in my experience they have never offered evidence of safety or efficacy that stands up to careful scrutiny.

So the answer to the second question, "Is it safe?", is clearly no.

Is fluoridation ethical?

Given the evidence that fluoridation is ineffective and that it is unsafe, the question of ethicality is easily answered in the negative. But even if it were effective, it would not be acceptable for the following reasons.

It is unethical to administer a substance or procedure to a person without the consent of that person, consent informed by a qualified professional who must answer questions from that person and who must inform the recipient of the reasons for the administration and of possible side effects. Such consent has never been sought from, much less given by, those whose tap water is fluoridated.

It is unethical to administer a substance or procedure that has not been approved by a qualified body. Dosage and/or intensity must be monitored and controlled and the effects on individuals must be monitored by a qualified professional (control of concentration in water does not control amount per unit body weight consumed by an individual). The recipient must be able to stop the administration at will. These are simple precepts of medical ethics, precepts clearly not adhered to in the case of fluoridation.

In short the substances used to fluoridate drinking water (mostly hexafluorosilicic acid) have not been tested or approved for use in humans; the dosage is not controlled; individual consent has not been obtained; the effects on individuals are not monitored; individuals can not stop the administration.

Fluoridation of public water supplies fails on all these ethical requirements.

For more information on this issue, such as which city water supplies are fluoridated and how you can get involved can be found at the Fluoride Action Network.

[Update: references for this book can be found here: http://fluoridealert.org/caseagainstfluoride.refs.html, sorry this was not offered initially]

Comments

  1. #1 Marco
    November 30, 2010

    OK, the language police just arrived. Please could you change all the “flour***” to “fluor***” ?

    Anyway, I’m not a big fan of people referring to fluorine as one of the most reactive elements, when discussing fluoride. The two simply are not the same, chemically and reactively speaking. Moreover, the argument would be more complete if it did not only contain the claim that fluoride inhibits enzymes, but also notes that other enzymes may become more active.

    I’m not in favor of fluoridation, let that be clear, but some points sound a bit too activist to me (i.e, not sciency enough).

  2. #2 Emil Karlsson
    November 30, 2010

    Coby, you have been taken in by pseudoscientific conspiracy theories regarding water fluoridation. I consider you to be a valuable resource for combating global warming denialism. Please do not fall into the same conspiracy mongering when it comes to water fluoridation that you so steadfastly resist in other areas.

  3. #3 Nathan D. Johnson
    November 30, 2010

    Unsubscribed.

  4. #4 Didactylos
    November 30, 2010

    Okay, I was originally going to write a very different comment.

    But I started reading a few review paper abstracts. Then I looked at more papers. And more.

    There’s loads! And most of them say nothing like what Dr. Beck suggests.

    This isn’t a case of the “real science” being overlooked. There is a lot of evidence that fluoride has a small positive health benefit, at the cost of a small aesthetic downside.

    And the research into the fine detail is continuing.

    Remember that a study comes out every week saying “X” is harmful, or “Y” is beneficial. It is ludicrously trivial to scrape together quite a few perfectly good if not particularly significant peer-reviewed papers to support virtually any health argument.

    I’m sure it’s a very noble cause and everything: putting stuff in water without asking is very rude (even if it is naturally occurring in some places). But let’s be quite clear – this isn’t something people should worry about, or campaign about. There are some seriously higher priorities.

    It’s kind of sad. Saying stuff like “In moderate and severe cases” when water fluoridation causes very mild fluorosis – this makes me think you just want to sell books.

  5. #5 J
    November 30, 2010

    Surely I’m not the only one to be amused by the juxtaposition of today’s and yesterday’s posts….

  6. #6 john smith
    November 30, 2010

    First, PLEASE fix the spelling: there are many of us (call us shallow) who assume someone who can’t spell a term is less likely to have something worthwhile to say about it.

    Second, the dose makes the poison. It’s a commonplace cliche, but even water, oxygen, and sugar can be toxic in large amounts. So when antifluoridationists say “F is toxic” and refer to harm caused by orders of magnitude larger doses, it tends to suggest intellectual dishonesty or incompetence. I think some of the comments in the snippet above are likely examples.

    Third, now that we have decades of F use in some areas and not others, some epidemiologic studies should quickly settle the main two questions: (1) How much different are caries rates in comparable cities when you look at the right target groups? and (2) Do any people in the fluoridated cities have higher rates of anything bad? All the other arguments are insignificant in comparison to accurate and honest ascertainment of these two sets of evidence. Too much harping on less relevant evidence implies that the answers to these two questions do not support the position argued. If you have accumulated a book worth of evidence and have to boil it down to a one page synopsis, then use it to accurately list the answers to those two questions with pointers to the independent data.

    I have not read the book, but the above presentation does not persuade me that these authors are honest or compelling evidence presenters.

  7. #7 Just Sayin'
    November 30, 2010

    Second, the dose makes the poison. It’s a commonplace cliche, but even water, oxygen, and sugar can be toxic in large amounts. So when antifluoridationists say “F is toxic” and refer to harm caused by orders of magnitude larger doses, it tends to suggest intellectual dishonesty or incompetence.

    I guess Dr. Beck has never prescribed Koumadin as a blood thinner. It is rat poison, after all.

  8. #8 Dappledwater
    November 30, 2010

    This topic is one of those guaranteed to generate knee-jerk reactions. Neither my water (own supply) nor toothpaste has fluoride. I just apply the precautionary approach.

    Humans in developed societies are exposed on a a daily basis to dangerous chemicals, whether it be in the food supply, cosmetics or pharmaceuticals. Unless the effects are acute, few regulating authorities seem to care.

  9. #9 Alan
    November 30, 2010

    Tell us when your father and his co-authors to submit a paper about the epidemiology of fluoride to a peer-reviewed journal.

  10. #10 Zahnarzt
    November 30, 2010

    The one scientific article mentioned actually shows that hip fracture rates are LOWEST in the areas with ideal fluoridation (1ppm) and the rate only increases once you have pathologic levels, i.e. 4.5+. This kind of obfuscation is typical, expected and should be a bright flashy warning sign against the authenticity of the info in this book.

    The Li article:
    http://www.ncbi.nlm.nih.gov/pubmed/11341339

  11. #11 Chad
    November 30, 2010

    A few things ill-considered indeed.

  12. #12 M
    November 30, 2010

    I’m a little dubious about anti-fluoride activists – they often have rhetoric that sounds similar to anti-vaccine activists – but digging into it suggests they have a better (if not air-tight) case. I think I prefer the rhetoric at the Green Grok on the controversy, however:

    http://www.nicholas.duke.edu/thegreengrok/fluoride

    -M

  13. #13 Lynxreign
    November 30, 2010

    I have a question, how come in this long post you make claims, list details, but never bother to post links to any published articles in reputable journals that would back up these claims? Every single statement following your sentence “And there’s more, including, but not limited to, the following:” should be a link to at least one article.

    As it stands, it reads like so many crank articles that make outlandish claims with nothing to back them up. The article reads enough like a crank article that I wouldn’t be surprised to see approving comments by the author about homeopathy or how vaccines are bad for you. If you do respond to any questions here, I’m really hoping you leave out the references to our “precious bodily fluids”.

  14. #14 Doug Mackie
    November 30, 2010

    We ping denialists for infomercialing with empty ‘but wait, there’s more’ crap. Gimme links to (peer reviewed) papers.

  15. #15 GGMcGready
    November 30, 2010

    @ #11:
    LOL!!
    Had to read your post twice before I got the joke on the *flour*ide. Think of the yeast indeed!

    By the way, tough audience for Coby’s Dad.

  16. #16 Leel
    November 30, 2010

    This is awesome – the comments are more sceptical, rational and grounded in real science than the blog post itself. Which, I have to say, closely resembles woo.

  17. #17 J
    November 30, 2010

    Recall the first sentence of yesterday’s post titled Medicinal Mavericks: “Consensus is a dirty word when it comes to climate change experts, but put in just about any other context, expert consensus is what we all would want.”

    Well, that didn’t last long, did it? This must be some new meaning of “just about any other context”, which happens to exclude “the context I’m about to raise in my next post, where my Dad and I freely reject the expert consensus”.

  18. #18 Art
    November 30, 2010

    Illconsidered … indeed.

  19. #19 Ex-drone
    November 30, 2010

    I was hoping that this article was a joke, but if it is, it’s too subtle for me. It just reiterates the claims of the many conspiracy theory websites that are devoted to anti-fluoridation, anti-vaccination and anti-pharmaceuticals. It’s funny that over 90 professional health organizations around the world, such as the WHO, US FDA and Health Canada, promote the use of fluoridation for the safe prevention of dental cavities. I thought that represented medical concensus, but I guess that they are all part of the conspiracy. Seriously though, I thought this was “Science” Blogs. Oh well, I await your anti-vax post next.

  20. #20 coby
    November 30, 2010

    Wow, quite the reaction! I picked a bad morning (Australian time zone) to get up a little late.

    Firstly, the spelling is fixed. All instances of “flouride” were my fault, so the impression of unfamiliarity with a topic given by such an egregious misspelling can only be correctly reflected on me. The URL will remain to shame me for the duration of the Internets.

    Secondly, I acknowledge that when one wishes to buck the consensus the onus is on them to provide good evidence. I hope my Dad will still pop in with the links some have asked for and have always assumed that they are available.

    That said, when a well spoken climate sceptic shows up at my door, I have plenty of evidence in the form of links to research etc to provide to bolster my arguments against theirs. I would like to see some of that from some of the posters here with such strong opinions.

    Lastly, though not intimate with the medical details of this controversy myself, I do find the third pillar of my father’s argument pretty solid. I have thus far only seen pretty knee-jerk reactions to the whole package and would be interested in any substantive defences of FLUORidation that can at least partially address the ethical concerns.

    If/when my Dad shows up, don’t forget he is not from around these parts (the blogosphere) so he my not be used to the kind of flaming that is second nature to most of us and he may be unaware of some of the online “body language” being sent or received, if you understand what I am getting at.

    Thanks for all the interest.

  21. #21 coby
    November 30, 2010

    I have it on good authority that a substantive reply from the author to the comments above should be here in a couple of hours.

  22. #22 christopher
    November 30, 2010

    so many of u r missing the essential point: that the goverment called it one thing when in fact, it was quite another. i.e. the government, in tandem with industry, put a good name on a bad thing, and thus, made it ‘good’, and thus, saved industry some cash… get it?

  23. #23 nyscof
    November 30, 2010

    If people really want to examine science, please start with the original fluoridation trials which began in 1945. High School biology classes find the flaws easily.

    For example, Newburgh NY was the first city to fluoridate where health effects were looked at. Kingston NY remained the non-fluoridated control city. Meant to last ten years, the experiment was declared a success after only five years when few, if any, permanent teeth had erupted in children born into the experiment.

    Only school children were studied. Excluded were adults, pre-schoolers and anyone sick two weeks before examination – the latter effectively eliminating from study any child sickened by the fluoridated water

    After ten years State University of New York researchers found more bone defects, anemia and early puberty in fluoridated Newburgh children. Today fluoridated Newburgh children have more cavities and fluoride-discolored teeth (dental fluorosis) than never fluoridated Kingston.

    Our government which endorses fluoridation gives out few, if any, grants to study fluoride’s adverse effects. Absence of research doesn’t mean absence of effect.

    However, modern science and reported by the Centers for Disease Control indicates that fluoride hardens outer enamel by topical means and that swallowing fluoride can only cause adverse effects – such as bone and tooth damage.

    Dose does make the poison. However, the amount in water is not the dose. That’s concentration. The dose is the amount of fluoride an individual consumes in a day. Also, fluoride is bioaccumulative. So, even if small amounts of fluoride are consumed daily, fluoride is building up in the bones and can possibly cause problems in later life – especially when coupled with all the fluoride that’s now ubiquitous in our food and beverage supply as well as from dental products and some medicines.

    The references for “The Case Against Fluoride” are here:
    http://fluoridealert.org/caseagainstfluoride.refs.html

  24. #24 kpt
    November 30, 2010

    Coby, you say you want the respondents to post some links with their evidence, but one did. You dad discussed how the article by “Li et al” talked about how Fluoride is bad for hip breaks. But, one your reader tracked down the article. Here it is again:

    http://www.ncbi.nlm.nih.gov/pubmed/11341339

    A little background for you. I used to work as a drinking water chemist, and we targeted a level of 0.8 – 1.2 mg/l of F- in our water. Which is exactly the level the Li paper found associated with the *lowest* level of breaks (it’s also the level recommended by the EPA). If water at 4+ mg/l had left my plant, I’d have had to explain myself to the state Department of Health, and publish a notice in the paper. Because it would have violated the law.

    The fact that your father linked to a paper as evidence for his point of view, when it directly contradicts his point of view, indicates to me one of four things:

    1. A simply typo – he meant to tell us about another paper (but, why no link if so?)
    2. He didn’t read the paper, but copied a reference from someone else.
    3. He doesn’t understand why the contradiction exists.
    4. He understands, but is hoping nobody will actually read the paper to call him on it.

    Only one of those four paints a positive picture of his conclusions (and even then, not very positive). I think the community here could probably find other references to back up the other holes they’ve pointed out. But perhaps they have better things to do.

  25. #25 Cheng
    November 30, 2010

    Wow, I thought I was reading an antivax blog. Half way through reading this blog I forgot this was on scienceblog.

  26. #26 coby
    November 30, 2010

    Hi kpt,

    Dad tells me he and his co-authors are very familiar with that study so I expect some discussion specific to this. So perhaps a fifth explanation is possible: there are other interpretations possible or other findings relevant in there. I will try to find the time to read it myself, though I am at work for the next 5 or 6 hours.

    Given your background, I hope you stick around. Though I discovered my father was not infallible sometime in my early teens, I still find him to be generally a rational and careful person and absolutely anything but dishonest. (Please note, I have been around the internet far too long to take anything personally, so that is not meant to be defensive or offended in tone!)

  27. #27 Ryan
    November 30, 2010

    It really is disheartening to see this kind of uncritical advocacy on a supposedly skeptical science website. Just goes to show, perhaps, that skepticism and science literacy don’t transcend scientific disciplines…

    Anyhow, in response to the first unsupported claim by your father (I understand he’s not a blogger, but you should have tipped him off on the ability to hyperlink to supporting evidence, which is apparently something you require of the other side):

    -The incidence of caries has indeed gone down in both fluoridated and un-fluoridated areas, but a) it has gone down more in fluoridated areas, and b) importantly, the effect is greater when “background fluoridation” is controlled for. In other words, folks living in un-fluoridated areas get some of the benefit through other exposure routes.
    Source: http://www.ncbi.nlm.nih.gov/pubmed/2312893

    -A 2000 metaanalysis concluded: “The range (median) of mean differences in the proportion of children without caries was −5.0% to 64% (14.6%). The range (median) of mean change in decayed, missing, and filled primary/permanent teeth was 0.5 to 4.4 (2.25) teeth.”
    Source: http://www.bmj.com/content/321/7265/855.full

    -A recent metaanalysis concluded: “Among studies published after/during 1980, any fluoride (self- and professionally applied or water fluoridation) annually averted 0.29 (95%CI: 0.16–0.42) carious coronal and 0.22 (95%CI: 0.08–0.37) carious root surfaces. The prevented fraction for water fluoridation was 27% (95%CI: 19%–34%). These findings suggest that fluoride prevents caries among adults of all ages.”

    For a general rebuttal to the first three of the above points, see the CDC’s review of fluoridation as one of the seminal public health achievements of the 20th century. (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4841a1.htm) The ethical debate is an important and interesting one, but it’s hardly appropriate to do so in the face of so much misinformation.

  28. #28 coby
    November 30, 2010

    Thanks for the links Ryan. The first certainly supports your point, though I only had access to the abstract. The second “metaanalysis” did note the following: “214 studies were included. The quality of studies was low to moderate” which advises caution as to its conclusions.

    The last also read like the “uncritical advocacy” you criticized above. I especially note with discomfort the graph of rising fluoridation against dropping caries, while the text did acknowledge that most of the drop in dental caries occurred regardless of fluoridation or not, the picture (worth 1000 words) did not. It also referenced the 1940s-50s clinical trials but not the alledged problems.

    I will continue reading with interest.

  29. #29 Ash
    November 30, 2010

    I’ve looked into the fluoride issue a few times from a toxicology perspective – in general I’ve found the anti-fluoride arguments for toxicity to not hold up under scrutiny. In particular as “john smith” noted, the toxic effects reported don’t generally occur at anything close to the concentrations recommended in drinking water. When I last looked into the issue 2 or 3 years ago (coincidentally in response to an article by James Beck in a local paper) I came away convinced that the health agencies were correct that there was a net benefit from fluoridating water. The ethical questions about involuntary application are obviously a separate issue where they may have more of a case.

    I’ve been meaning to do a write-up on fluoride toxicity on my blog; maybe this will spur me to get it done over the next few days.

  30. #30 coby
    November 30, 2010

    Hi Ash,

    What is your take on the difference between dose and concentration WRT this issue?

  31. #31 locklin
    November 30, 2010

    *Pretending your pet controversy is like climate change -check.
    *Likening yourself to climate scientists fighting denialists (even though you are opposing most of the primary researchers in the field) -check
    *Using emotional words like “Industrial chemicals, fission bombs, uranium” to cover weak arguments -check
    *Copious spelling mistakes -check.

    Scienceblogs, you should be ashamed.

  32. #32 James Beck
    November 30, 2010

    What an initial entry into blogsville! Let me respond to the substantive comments in a lumped reaction.

    On selling books, a disclaimer: I don’t profit from the sale of The Case Against Fluoride; my royalties are donated to the Fluoride Action Network. Nor do I benefit financially in any other form. On this point and for those looking for conspiracy theories, see the meticulously documented book Fluoride Deception by Christopher Bryson.

    On misspelling “fluoride” (did I really?) I plead my aged fingers and my being a serious baker of breads.

    On offering peer-reviewed references: Major points to those who brought this up. Do so with the proponents of fluoridation too. In The Case Against Fluoride references are given in separate sections of the endnotes for each chapter and each chapter deals with a particular issue. So references on any particular point—i.e., efficacy, bone fracture, etc.—can be found quickly. And the references themselves can be found for the most part at http://www.fluoridealert.org and/or slweb.org. Both of these sites keep an updated bibliography, categorized. Also the fluoridealert site has the bibliography from The Case Against.… Another extensive source of references is the report from the National Research Council panel of twelve scientists (some in favor of fluoridation) charged with evaluating the maximum contaminant level for fluoride set by the Environmental Protection Agency (US). 507 pages, 1100 references; conclusion: 4 mg/l (ppm) is not protective of the general population (2006). This is also available through http://www.fluoridealert.org.

    On extreme doses: The observations on toxic effects are often made with concentrations (not the same as dose) higher, some much higher, than in tap-water fluoridation. This is both with laboratory animals and with humans exposed to high concentrations of naturally occurring fluoride. But some are the same or very close to those artificial concentrations. Furthermore in any large population of humans there will be varied sensitivity to any drug or toxin. In the case of fluoride there are groups particularly sensitive such as persons with compromised thyroid function, with kidney disease, young children, diabetics and others. Obviously a drug administered to a whole city should be in low enough dose (different from concentration) to protect everyone.

    On bone fracture: Over the decades there have been varied results. The Li et al. paper is one of the better studies. One commenter has misread it. Li et al. studied six villages with widely varied concentrations of fluoride in drinking water, the lowest quite close to the 1 ppm we see in North America. They looked at two different outcomes: all fractures and hip fractures. And they looked at prevalence as related to dose (not concentration). In the case of all fractures they found a minimum with the lowest-dose group’s prevalence higher than in the group with the next highest dose. Since we were interested in the science and the truth, this result is in The Case Against.… In the case of hip fracture the relationship shows a clear rise of fractures as dose increases.

    On effectiveness: The early studies begun in 1940 (one in New Zealand, one in Canada, two in the United States) are faulty for various reasons, some given by a commenter. The later, more systematic and more competently executed studies show no difference in cavities (except where the nonfluoridated control is better) in comparing cities, show no increase in cavities when fluoridation is discontinued, and show no decrrease in cavities when fluoridation is started. Also the marked and consistent decrease in the incidence of cavities in the industrialized world over the past four decades is the same in fluoridated and nonfluoridated jurisdictions.

    Finally, I assure you that I have not been conspiratorily selective in citing results. Yes, there are many papers on effectiveness and on toxicity. Many of them are so faulted as to be useless to an honest inquiry. Many are done well. And quite a few competently show why some are not reliable. We just have to deal with that as best we can on efficacy and toxicity. On the ethics there is no doubt: it is wrong to force people to take an unapproved drug (by legal definition that’s what it is) by uncontrolled dose without monitoring of its effects and without informed consent of the recipient.

  33. #33 crakar24
    November 30, 2010

    Whats this i see!

    Coby going against the consensus and coping a tirade of abuse, if you wanted to walk in my shoes for a day Coby you could have done it a better way :-)))

    Here in Australia we have had fluoride in our water for many, many years and i remember when i first joined the Air Force i went to the dentist and he said “judging by your teeth and age i would say you are from south eastern Australia” Which of course was correct, i asked him how did he know this and he responded by saying “south eastern Australia was the last place to have fluoride put into the water”.

    Now he might be absolutely correct based on my teeth or he just could have read my file which was sitting on the table before i walked in so who knows. Anyway i am with Coby on this one regardless of what the rest of you say for moral support if anything else.

    For what it is worth.

  34. #34 skip
    November 30, 2010

    “south eastern Australia was the last place to have fluoride put into the water”.

    Ha ha. Let me guess, Crakar: You read the part about fluoride being associated with lower IQ and thought you’d better hitch yourself to the winning team.

    Couldn’t help that one . . .

  35. #35 skip
    November 30, 2010

    The above notwithstanding . . .

    Dr. Beck:

    Thank you for your participation on your excellent son’s excellent blog. You should be proud.

    I confess *fluor*ide and its possible effects are not a huge priority for me when I read/post here, but I want to express my respect for you and your efforts in taking on this issue. Coby is clearly a chip off an impressive block.

    Take care, sir.

  36. #36 crakar24
    November 30, 2010

    Looks like they tipped a whole bucket load into your drinking water Skip.

  37. #37 locklin
    November 30, 2010

    James, you have a wonderful aptitude for taking the exact, nearly word-for-word arguments anti-vaccination quacks spout and replacing the word vaccine with fluoride. You make accusations of conspiracy which include entire medical professions, and many nations’ medical institutions. Referring to lists of references on websites with names like fluoridealert, and making repeated references to toxicity studies without referencing concentrations, and best of all, framing the situation so that it appears that you are advocating a “safe approach” to a controversial health hazard. You are arguing against a scientific consensus that standardised fluoride concentrations lead to reasonable population health benefits with at most marginal risks. Your arguments will work great for the unwashed masses and media, but in scientific and skeptic circles, you need to provide a well reasoned and supported argument. Importantly, your more extraordinary claims require extraordinary support.

    I suggest you read some of the anti-vaccination rhetoric and some of the excellent eviscerations of said rhetoric right here on this website. At worst, you can improve your argument so as to not set off swaths of alarm bells in skeptics who have heard this all before, too many times.

  38. #38 crakar24
    November 30, 2010

    Sorry in my haste i forgot to add.

    Only you Skip could turn a thread about some else’s issues that are obviously very important to them into “its all about me”. What a joke you are.

  39. #39 locklin
    November 30, 2010

    In case anyone wants a reasonable rebuttal to these claims:
    http://www.quackwatch.com/03HealthPromotion/fluoride.html

  40. #40 skip
    November 30, 2010

    Christ, Crakar.

    Can’t I just compliment a man without you being a pill about it?

    Dr. Beck: Put no stock in this interlude between ancient rivals; it need not concern you.

    Again, while I cannot comment intelligently on this particular issue of fluoride, welcome to blog-dom and your son’s world.

    Adieu sir.

    (I wish I could slap you, Crakar . . . )

  41. #41 Peter
    November 30, 2010

    I’m usually just lurking, but decided to jump in … being surprised to see an “alarmist” article in an otherwise great blog.

    I have recently written a report for a client who wished to discontinue water fluoridation and I spent a lot of time digging through the peer-reviewed literature. I came to the conclusion that there is currently no evidence of adverse health effects of *water* fluoridation aside from mild fluorosis. Because of this, the CDC advises now against using fluoridated water for the preparation of infant formula.

    However, I am also convinced that *water* fluoridation has few, if any benefits in preventing tooth decay as evidenced by cessation studies and comparison of dental health among fluoridated and non-fluoridated communities. Nevertheless, it is well understood that fluoride does prevent tooth decay. It is just that drinking water is an ineffective delivery vehicle, which has been recognized by the CDC over 10 years ago when they stated that fluoride’s actions “primarily are topical for both adults and children.”

    There is of course the ethical problem with adding a nutritional supplement to drinking water, which, at doses above the primary MCL, has well known adverse health effects. It is also not possible to control the dose an individual receives. Thus, parts of the population can be exposed to higher than safe fluoride levels, e.g., heavy tea drinkers, infants fed with formula or persons
    with impaired kidney function. As one researcher pointed out “The ADA maintains that fluoride levels administered in water are closely monitored to ensure the safe, optimal level of fluoride to prevent decay. However this claim is problematic since it does not consider cumulative exposures from many other sources … Despite these additional sources of fluoride exposure, the amount added to drinking water continues at the same level as was established in the 1940s.”

    I think given the questionable effectiveness and the ethical issues should be enough reason to stop this practice. No alarmist message needed.

  42. #42 coby
    November 30, 2010

    locklin, with the single exception of it being an argument made against a well accepted practice, I hardly think there are any useful similarities between anti-vaccine controversies and this one.

    You object to references offered from a site called “fluoridealert” and instead point us to “quackwatch”! Very rich.

    I will have a look.

  43. #43 coby
    November 30, 2010

    From your site: “The antifluoridationists’ (“antis”) basic technique is the big lie. Made infamous by Hitler…”

    Yeah, I’ve got time for that…

  44. #44 locklin
    November 30, 2010

    From an ethical perspective, it’s important to recall that fluoridation is a standardisation process. Fluoride is present in varying concentrations in groundwater, and the process of fluoridation involves determining a concentration which yields the best public health outcomes and standardising on that concentration for city production. This is not different from many other substances which are monitored, restricted or “fortified” in water and other food sources (i.e., Iron, Vitamin D, Calcium, etc.).

  45. #45 Didactylos
    November 30, 2010

    I was hopeful that this was just a lesson in healthy scepticism similar to snopes’ Repository of Lost Legends.

    Unfortunately, it seems that the book is real.

    This is usually a question I would pose to tabloid writers: how do you justify causing so much panic and paranoia on the basis of so little evidence?

    I wonder if orac will weigh in on this?

    As to the far more interesting question of “Is fluoridation ethical?” – there are many arguments that can be made here. To me, the most compelling is that there are health risks associated with too high fluoride levels, and with too low fluoride levels. As such, *regulating* the level of fluoride in drinking water seems like the only responsible thing to do.

    In some cases the natural level will be acceptable. In other cases, it must be added or removed.

  46. #46 crakar24
    November 30, 2010

    I have a question for Mr Beck snr, back when fluoride was introduced into Australia the quality of the drinking water was not of the standard we enjoy now. In fact there was an old joke about Adelaides drinking water which was “too thick to drink, too thin too plough”. I remember only 15 years ago if you wanted to drink Adelaide water out of a tap you had to pour it into a pitcher leave it in the fridge over night so all the crap would settle to the bottom as when it was first poured you could not see through it at least with any clarity.

    Is it possible that before the improvement of sanatised water the benefits of fluoride where there to be seen but as the quality of our drinking water improved coupled with government led initiatives to promote better personal dental hygiene fluoride no longer had the benefits it once had?

    Just a thought.

  47. #47 coby
    November 30, 2010

    Please note that complete references for this book can be found here: http://fluoridealert.org/caseagainstfluoride.refs.html

  48. #48 Dappledwater
    December 1, 2010

    Aside from dental fluorosis, evidence uncovered over the last two decades has shown an association of fluoride in drinking water with lower IQ in children.

    Maybe that explains the knee-jerk reactions so far?.

  49. #49 Snowman
    December 1, 2010

    [deleted. let's not bother, shall we?]

  50. #50 nyscof
    December 1, 2010

    Evidence that fluoridation is ineffective:

    New York State Department of Health dentist J. V. Kumar published national statistics in the July 2009 JADA which show similar cavity rates regardless of water fluoride content, However, dental fluorosis rates increased along with water fluoride levels. See analysis “Fluoridation No Benefit; Definite Harm,” by Kathleen M. Thiessen, Ph.D., SENES Oak Ridge, Inc., Center for Risk Analysis here:

    http://www.newmediaexplorer.org/chris/Clinch_2009_No_Benefit_Definite_Harm.pdf

    Researchers reported in the Oct 6 2007 British Medical Journal that fluoridation never was proven safe or effective and may be unethical.

    A study in the Fall 2008 Journal of Public Health Dentistry reveals that cavity-free teeth have little to do with fluoride intake. Researchers report, “The benefits of fluoride are mostly topical…while fluorosis is clearly more dependent on fluoride intake.”

    Pizzo and colleagues reviewed English-language fluoridation studies published from January 2001 to June 2006 and write, “Several epidemiological studies conducted in fluoridated and non-fluoridated communities suggest that [fluoridation] may be unnecessary for caries prevention…”

    They also report that fluoride-damaged teeth spiked upwards to 51% from the 10-12% found over 60 years ago in “optimally” fluoridated communities. Dental fluorosis is white-spotted, yellow, brown-stained and/or pitted teeth.”Community Water Fluoridation and Caries Prevention: A Critical Review,” Clinical Oral Investigations, by Giuseppe Pizzo & Maria R. Piscopo & Ignazio Pizzo & Giovanna Giuliana 2007 Feb 27;

    After over 50 years of water fluoridation, many children in Newburgh, New York have more cavities and more fluoride-caused discolored teeth (dental fluorosis) than children in never-fluoridated Kingston, New York, according to a New York State Department of Health study. (“Recommendations for Fluoride Use in children” NYS Dental Journal, February 1998 NYS Department of Health)

    The National Institutes of Health reviewed tooth decay research (over 560 fluoride studies) and reported in 2001 “… the (NIH) panel was disappointed in the overall quality of the clinical data that it reviewed. According to the panel, far too many studies were small, poorly described, or otherwise methodologically flawed.” (NIH Consensus Development Program panel for the Diagnosis and Management of Dental Caries)
    —-

    Similarly in 2003 a UK medical group reported, “We were unable to discover any reliable good-quality evidence in the fluoridation literature world-wide.” (Centre for Review and Dissemination, “Fluoridation of Drinking Water: a Systematic Review of its Efficacy and Safety” )

  51. #51 Paul Connett
    December 1, 2010

    To date I have found these exchanges most disheartening. I am surprised that people that clearly present themselves as being “scientific” should invest so much vitriol attacking a book that none appear to have actually read. If this controversial issue could have been so easily resolved in favor of the orthodox position, we would not have had to write this book.

    I have spent 14 years of my life researching this issue – first as a professor of chemistry (specializing in environmental chemistry and toxicology)and since retirement in 2006 as director of the Fluoride Action Network.

    14 years ago I did not want to get involved in this issue, largely because I was extremely busy but also because I had succumbed to some of the prevailing attitudes and prejudices shared by some of the commentators above. It was a huge shock to me when I eventually read the literature rather than take the word at face value of the professional bodies and government agencies that promote this practice.

    In my years exploring this issue I have found that the loudest and most confident proponents of fluoridation are those who have studied very little of the primary literature for themselves. Proponents like the American Dental Association and other professional bodies have done a brilliant job of keeping their members away from the primary literature using two tactics: listing the number of “prestigious” agencies that endorse fluoridation and denigrating opponents of fluoridation as a bunch of “flat-earthers.” With the latter they received major help from the hilarious movie Dr. Strangelove. I was surprised to see both tactics in evidence from several of the commentators above.

    I would be more than happy to respond to scientific arguments and criticism of our painstakingly documented work with those who take the trouble to read it. I am sure those with scientific qualifications will have no trouble obtaining a free copy from the publisher Chelsea Green (see ChelseaGreen.com and search under fluoride) if they would like to write a review of the book either for this blog or some other media outlet.

    Paul Connett

  52. #52 Marco
    December 1, 2010

    Paul Connett,

    I think you will find the prevailing attitude to be in part due to the issue of climate change, the main topic on this blog. Here we are also continuously told by many that they first believed the consensus, but then went into the literature themselves and found that it was all wrong, etc. etc.

    It’s even more problematic that Coby himself, prior to publishing this blogpost, put up this mocking cartoon:
    http://scienceblogs.com/illconsidered/2010/11/medicinal_mavericks.php

    I really don’t think this blog was the right venue, regardless of whether you are right or wrong.

  53. #53 Jim Schultz
    December 1, 2010

    Seemed more like a turf war issue of those self proclaimed as scientific wiz kids. Thought I would see more science and less personal attack. Dr Connett and Beck seem willing to actually present the peer reviewed discussion. I expect this from ADA dentists protecting income as very few dentists actually treat poor kids on medicaid. Cosmetic repairs skyrocket with fluoridation as do dental incomes. Poor inner cities are increasing in cavities but nearly all have been fluoridated for decades. Sadly blacks are known damaged double with even uglier discolored defective enamel only caused by fluoride toxicity. There is still time for actual give and take debate based upon peer reviewed data.

  54. #54 Snowman
    December 1, 2010

    Coby – I was a little disappointed that my mildly satirical observation was deleted when you are content for others to address their opponents as liars, scumbags and worse. But no matter; it is your blog, and you make the rules.

    On a more significant point, I read with interest Mr Connett’s lively defence of his work. I completely share his politely expressed irritation at those who were so quick to denounce the book. As he puts it ‘I am surprised that people that clearly present themselves as being “scientific” should invest so much vitriol attacking a book that none appear to have actually read.’

    When I read his words I had a strong sense of deja vu that I could not immediately account for. Then I remembered: I had in mind the furious attacks here on Prof Plimer’s book ‘Heaven and Earth’ by people who had not read it and had no intention of reading it. In fact, I distinctly recall, Coby, someone describing it as science fiction. No doubt the book contained errors. But to dismiss it unread with a weary wave of the hand struck me at the time, and strikes me still, as difficult to defend.

  55. #55 Paul Connett
    December 1, 2010

    Dear Marco,

    You say that this was the wrong site for this discussion. Really? look at the heading on your mast head – Science Blog: Life Science, Physical Science, Environment, Humanities, Education, politics, Medicine, brain and behavior, technology…

    Seems to me this discussion on fluoridation would fit under several of those headings.

    What one would have hoped was that people on such a site would be able to revisit a controversial issue and debate the issue on its scientific merits rather than rehashing all their pet reasons for not doing so.

    However, I wait patiently for someone when they have read our book to engage with us on a scientific level.

    Paul Connett

  56. #56 coby
    December 1, 2010

    Paul, Marco is referring to the fact that my corner of this website usually deals with climate change issues. Regardless, I don’t feel I have been out of line in introducing a different topic, though I can acknowledge the poor juxtaposition of it with the previous post…oh well.

    Perhaps you can address a couple of specific comments, namely #10 and #28?

  57. #57 Marco
    December 1, 2010

    Paul, I already pointed out that Coby (and likely unwittingly) set a really bad example by first posting a cartoon mocking those going against a medical consensus, and then posting something that…goes against a medical consensus.

    Also, and again, while this does not say much about the strength of your arguments, but on this particular blog, Coby’s blog, there has been a flurry of discussion on climate change; in that field we can find hundreds of probably well-meaning (and less well-meaning) scientists who proclaim they have studied the literature, and find the whole thing (i.e climate change) to be a hoax. People here have been sensitized against such arguments, and at the very least Coby should not be surprised about the apparent kneejerk reaction.

  58. #58 Marco
    December 1, 2010

    snowman:

    I think most people rapidly noted that Ian Plimer, a geologist, said some remarkably stupid things about volcanoes. If he can’t even get the facts right about his own field, who’s going to believe he had anything right about something *outside* his field?

    Combine that with his rehashing of the long-long-long debunked “Mauna Loa is a volcano!”-argument, and his explicit financial involvement in fossil fuel production (through his mining companies), and people don’t feel the need to read the rest.

  59. #59 coby
    December 1, 2010

    WRT climate change parallels, I must say that it is pretty rare to find any “sceptics” that have even glanced at the literature, it is clear from the bibliography that conclusions aside, these authors at least have researched their point of view.

  60. #60 Snowman
    December 1, 2010

    Marco – I don’t doubt that Prof Plimer has said some stupid things in his day. Who hasn’t? Certainly not Rajendra Pachauri. Your argument would suggest that we needn’t read anything produced by the IPCC.

  61. #61 coby
    December 1, 2010

    Snowman, Plimer and the IPCC are off topic here please

  62. #62 Snowman
    December 1, 2010

    Quite right Coby – my apologies.

  63. #63 M
    December 1, 2010

    “When I read his words I had a strong sense of deja vu that I could not immediately account for. Then I remembered: I had in mind the furious attacks here on Prof Plimer’s book ‘Heaven and Earth’ by people who had not read it and had no intention of reading it. In fact, I distinctly recall, Coby, someone describing it as science fiction. No doubt the book contained errors. But to dismiss it unread with a weary wave of the hand struck me at the time, and strikes me still, as difficult to defend.”

    Unfortunately, I did spend a reasonable amount of time reading various sections of Plimer’s book, and found a stunningly high density of stupidity and/or lies. After a while, one gets good at picking up “tells”: signs that one is dealing with a crank who doesn’t know their stuff, and then one can stop wasting time reading Heaven and Earth, G&T, Miskolckzi, Ernst Beck, Slaying the Sky Dragons, Oliver Manuel and the Iron Sun, and numerous other such references (I’ll note that while all the examples that come to my mind are climate relate, my experience started with a guy who would come to physical chemistry seminars and then try and persuade the speaker after the seminar that quantum theory was intrinsically flawed. And the guy had references, math, and all sorts of stuff to back up his quackery. Similar stories come from my reading about intelligent design proponents, anti-vaccination folk, etc).

    Now, just because there are “tells” doesn’t mean that the work is actually wrong… but you have to start somewhere with sifting information. Unfortunately, some of these tells are visible in Coby’s dad’s post, and even more prominent in Paul Connett’s post. Of course, some of the tells may just be correlated with being anti-consensus… I wonder if the “ulcers are bacterial” guy would have given off similar tells… in which case, it becomes very hard to ever know anything with confidence outside one’s area of expertise because there are a lot of quacks out there churning out tremendous amounts of material, and it is really difficult to get a good read of the base literature without an IPCC type assessment document prepared by trustworthy scientists as a guide… which by definition reflects the consensus. (For example, I would have to give the CDC report or the University of York report more credence than a book by a blogger’s father). There does seem to be room in the fluoridation field for better randomized control trials (cf, the University of York report recommendations)

    I would require extremely convincing arguments to persuade me that an entire community of dentists and dental organizations managed to decide that fluoride was beneficial when it had absolutely no benefits (it would perhaps take less to persuade me that extensive use of fluoridated toothpaste leads to reduced benefit of fluoridated water for those individuals). I actually have talked to several dentists about this over the years, including one who kept a close eye to the literature for novel and different treatments, and a nurse practitioner in Utah who looked at my mouth and decided I had clearly grown up outside Utah in an area with fluoridation (yes, plural of anecdotes is not data, but plural of anecdotes plus the consensus of organizations such as the ADA and CDC and so forth does become convincing).

    -M

    ps. No need to plead “aged fingers”: I believe all the original floury misspellings were in Coby’s wrap-text and not in the guest post itself.

  64. #64 skip
    December 1, 2010

    I have a question for you, Snowman, but out of respect for Coby’s wishes I want to ask it on the “There is No Consensus” thread.

    Indulge me?

  65. #65 James Beck
    December 1, 2010

    I’m catching on to the ambience of the blogging world. The pure vitriol (why the anger?!) can be ignored. The quests for information and well-founded challenges should be answered, though that may not always be possible. Some of the mixed, vitriol with substance, merit response.

    #38 from locklin moves me to make two points: 1) Disparaging evidence because it is provided by a mechanism with a naughty name (thinking here of “fluoridealert”) is, frankly, dumb. It is equivalent to dismissing the contents of a letter you receive solely because you don’t like the postman’s name or opinion. 2) Dismissing an argument because it is contrary to a “scientific consensus” is just as mistaken. Medical history is distressingly full of examples of long-honored conclusions and practices ultimately shown to have been wrong, some fatally wrong.

    #45 again from locklin moves me again to make two points: One might call fluoridation a “standardisation process” but it is nevertheless an administration of a drug (medicine). And 2) Rather than “not different” from fortifying with vitamin D, etc. it is very different. Iron, vitamin D, calcium are human nutrients with recognized roles in human pysiology and recognized (in some cases vaguely) limits for safety where there are wide margins between nutritional requirements and toxic exposures. Fluoride is not a natural nutrient for humans; at least there is no substantial evidence that it is.

  66. #66 Orac
    December 1, 2010

    I was hoping that this article was a joke, but if it is, it’s too subtle for me. It just reiterates the claims of the many conspiracy theory websites that are devoted to anti-fluoridation, anti-vaccination and anti-pharmaceuticals. It’s funny that over 90 professional health organizations around the world, such as the WHO, US FDA and Health Canada, promote the use of fluoridation for the safe prevention of dental cavities. I thought that represented medical concensus, but I guess that they are all part of the conspiracy. Seriously though, I thought this was “Science” Blogs. Oh well, I await your anti-vax post next.

    Yep. I can’t believe this got posted on ScienceBlogs. For one thing, my perusal of the Fluoride Action Network website gives me the same feeling I get when I peruse Age of Autism. Even not being as familiar with anti-fluoridation arguments as I am with, say , antivax arguments, I can say that the site gives off serious crank vibes based on my long experience perusing crank sites. In particular the “3,209 Medical, Scientific, and Environmental Professionals Sign Statement Calling for End to Fluoridation Worldwide,” which reminded me very much of Inofe’s list against global warming and various creationist lists against evolution. Particularly hilarious is the breakdown, which includes 458 chiropractors and 138 naturopaths.

    Seriously. let me just put it this way. If you’re going to trumpet that you have all these “medical” and “scientific” professionals allegedly on your side, it sure doesn’t help your credibility to have so many quacks in the list mixed in with the real medical professionals (the vast majority of whom, as is the case for anti-global warming lists, do not have any special expertise in relevant specialties). Make no mistake, naturopathy is a hodge-podge of quackery that includes homeopathy, reiki, traditional Chinese medicine and various detoxification woo, while many chiropractic practices are also highly dubious. In any case, naturopaths and chiropractors are hardly reliable health care professionals who can be counted on to evaluate science and epidemiology. Both CAM specialties tend to be anti-vaccine and anti-pharmaceutical to the core and can be reliably expected to be against fluoridation just on the basis of its not being “natural” or because it’s adding a chemical to water, regardless of what the evidence shows.

    Yes, even though I risk not having this posted because it’s too “strident” or “insulting,” I do have to point out: The list very much resembles the anti-global warming lists and the anti-evolution lists I’ve seen. The analogy to the anti-vaccine movement is also valid.

    You know, you may just have given me blogging material.

  67. #67 Ash
    December 1, 2010

    Coby – sorry for the late response to your question about the difference between dose and concentration. While they’re not the same, they are closely related; if you know the concentration in water you can approximate the dose based on typical water ingestion rates and body weights for a given age group. Typically a “safe” concentration in water would be determined by determining what concentration shows no effect in an animal or epidemiological study, converting it to a dose based on the animal’s water ingestion rate and weight, adding uncertainty factors or animal-human conversions based on pharmacokinetics, and converting back to an expected safe concentration in water for humans.

    That’s a bit of a simplification but describes the general process. There are times when concentration may be more important than dose (for example if the chemical directly affects the point of initial contact with the body), but for systemic toxicity generally dose is more important. Strictly speaking it’s actually the dose that reaches the cells in the organs where the toxic effect occurs that is often most important, but it’s only fairly recently that the science has progressed to the point of looking at that.

    In the case of fluoride the available data are mixed, since there are epidemiological studies based on concentrations in drinking water and laboratory animal studies where safe/unsafe doses would be determined. For effects such as fluorosis concentration may be more important than dose even in animal studies (depending on the mechanism of toxicity), while for other effects such as kidney effects the dose reaching the kidneys may be what is important. Each effect and study really needs to be looked at separately.

    (I’m not totally sure that answers your question – I wasn’t sure what you’re getting at).

    I won’t comment any further on the specific effects mentioned in the original post at this time – I want to take the time to actually look at some of the studies referenced. While the last time I looked into this I came out on the pro-fluoridation side, it’s been 2 or 3 years since I’ve looked at fluoride so I have to allow for the possibility of new information changing my opinion.

  68. #68 GGMcGready
    December 1, 2010

    @ #64:
    “I would have to give the CDC report or the University of York report more credence than a book by **a blogger’s father**” [my emphasis].
    I doubt this is a fair representation of Dr. Beck. He is likely someone more credible than what you are trying to paint him (and his son) as. Whether he is right or wrong in his opinion, it does appear that he and his co-authors deserve respect for their academic qualifications.

    “I would require extremely convincing arguments to persuade me that an entire community of dentists and dental organizations managed to decide that fluoride was beneficial when it had absolutely no benefits”.
    Then perhaps, as Dr. Connett said, be fair to the authors and read the book (while maintaining your skepticism) if this is indeed a topic that fires you up. It’s never a bad idea to keep an open mind. Maybe they have some valid points, maybe they don’t. But you cannot say without giving them a fair hearing.

  69. #69 galilea
    December 1, 2010

    Hi Orac. If you lived in the 16th Century your “feeling” may have been to consider Galileo an anti-science crank. As to the List of Professionals who signed a statement against fluoridation. You say, “Particularly hilarious is the breakdown, which includes 458 chiropractors and 138 naturopaths.” Actually, I hope nearly every chiropractor in the US signs this statement. It is well known that fluoride can adversely affect the bone, and for those chiropractors who love their subject, fluoride should be of great interest them. Why not try reading a landmark 2006 report on the toxicology of fluoride by the National Research Council of the National Academies, whose report features prominently on the Fluoride Action Website. The report is free to read and search at http://www.nap.edu/catalog.php?record_id=11571 (just scroll down a bit).

  70. #70 Paul Connett
    December 1, 2010

    Thank you GGM. It will be interesting to see the comments that come in after these commentators have read the book – though reading between the lines they seem to be mobilizing all the excuses they can for not doing so.

    As far as those magic letters CDC are concerned, that one of the writers finds so impressive, we examine this entity very closely. The CDC stands for the Centers for Disease Control and Prevention based in Atlanta. It is a huge agency with literally thousands of experts in a whole range of medical fields. However, there is only one division at this mighty CDC that oversees fluoridation and that is the Oral Health Division. This is only 30 members strong with the majority only having dental degrees. Their explicit function is to promote fluoridation which they do with some vigor, including sending top level personnel to state legislators to support mandatory statewide fluoridation. To all intents and purposes this Oral Health Division is an adjunct to the American Dental Association (ADA). Tweedledum to tweedledee. Whatever the ADA urges today the CDC OHD will urge tomorrow. It is sad that this enthusiasm for fluoridation which presents a clear conflict of interest when accessing safety issues, is not balanced with another entity at the CDC that could oversee the safety of this practice without such a conflict.

    With regards to the much quoted 1999 statement from the CDC OHD that fluoridation is one of the top ten public health achievements of the Twentieth century, the report was based on the work of just two people: a dentist who had never written on fluoridation before and an economist. Not only were these authors SIX YEARS out of date on the literature they claimed established safety (they cite a review published in 1993 by the National Research Council) but the evidence that they offer for effectiveness was trite. They produced a figure (Figure 1) which showed that tooth decay in 12-year-olds coming down in the US from the 1960′s to the 1990′s while on the same figure they plotted another graph showing that the percentage of Americans drinking fluoridated water had increased by about 15% over the same period. Voila – tooth decay is coming down because the number of people drinking fluoridated water has gone up (so has the sale of bicycles!). Implying simplistically that fluoridation was the cause of this decline could easily have been refuted if they had chosen to look at the figures collated by the World Health Organization. The WHO collects the same data for tooth decay in 12-year-olds in many countries and over the same period selected by the CDC the tooth decay in 12-year-olds has been coming down as fast if not faster in the non-fluoridated industrialized countries as the US and other fluoridated countries. See the graphs presented at http://www.fluoridealert.org/who-dmft.htm and compare with the CDC figure.

    So were these two authors unaware of this WHO data? If they were not aware of this data then one has to question their competence (and anyone else who peer-reviewed this paper) and if they were aware of this WHO data then one has to question their integrity.

    To their credit these two authors did report one important finding and that was that, contrary to assertions made for the previous 50 years about the mechanism of fluoride’s action as far as benefit was concerned, that the predominant benefit appears to be TOPICAL not SYSTEMIC. In other words fluoride works on the outside of the teeth from the inside of the body. This was the graceful point at which the US government should have called a halt to this practice. Why expose every tissue of the body (and the many people who don’t want to be exposed) to a known toxic substance when topical treatment in the form of fluoridated toothpaste is universally available.

    Orac makes fun of some of the 3200 people that have signed the statement calling for an end to fluoridation. However, he ignores those with very solid qualifications that have done so, which includes one Nobel prize winner, three members of the National Research Council panel that reviewed the toxicity of fluoride in 2006 (this 507 page report is accessible online), two former EPA scientists and several other prominent scientists. 15 of these can be viewed online in the videotape “Professional Perspectives on Water fluoridation.” For those unwilling to wait to read the whole of our book before they make up their minds on this matter, perhaps they will spend 28 minutes viewing this tape to see the caliber of the people that are prepared to challenge the “mighty medical and dental consensus” on this issue. A consensus incidentally that has been unable to convince the vast majority of countries worldwide (including nearly the whole of Europe) to participate in this very poor medical practice.

    Paul Connett

  71. #71 Paul Connett
    December 1, 2010

    Dear Marco,

    You asked me to comment specifically on correspondence identified as 10 and 28. I will do these in two separate communications.

    First 10.

    Zahnarzt writes “The one scientific article mentioned actually shows that hip fracture rates are LOWEST in the areas with ideal fluoridation (1ppm) and the rate only increases once you have pathologic levels, i.e. 4.5+. This kind of obfuscation is typical, expected and should be a bright flashy warning sign against the authenticity of the info in this book.

    The Li article:
    http://www.ncbi.nlm.nih.gov/pubmed/11341339

    The citation given is only to the abstract. If Zahnarzt had read the whole article he would have found that while the increase in hip fracture reached statistical significance for the village at 4.3 ppm plus, there was what looked like an increase from the village at 1 ppm through 2.5 ppm and through 3.5 ppm. We carefully discussed how to interpret this data in chapter 17 of our book. Essentially, there are two ways of looking at it. You could ignore the increases in the two villages between 1 ppm and 4.3 ppm, and conclude that there was a threshold at 4.3 ppm where all of a sudden hip fracture rates tripled. Or, you could argue that a better fit of the data is an approximately linear increase in hip fractures as the water concentration increased above 1 ppm. In other words statistical significance may not tell the whole story. If our interpretation is correct the data for villages between villages at 1 ppm and 4.3 ppm are actually “real” data and should not be ignored. We cite other evidence that suggests an increase in hip fractures above 1.5 ppm. We also cite evidence from Mexico which showed a liner increase in bone fractures in both children and adults with the increased severity of dental fluorosis (the severity of dental fluorois is a powerful non-invasive biomarker of fluoride exposure for the permanent teeth have erupted). Sadly this valuable tool has seldom been used in fluoridating countries to probe the many health effects that are suspected of being caused by fluoride. Perhaps further discussion on this should await those who have had a chance to read the whole of chapter 17 as well as our discussion of the bad science that underpins the promotion of this practice (see chapter 22).

    Paul Connett

  72. #72 Didactylos
    December 1, 2010

    Paul Connett says, “buy the book buy the book buy the book.” (I paraphrase.)

    Whether the authors are motivated by genuine concern, scientific evidence, gullibility or sheer fraud, isn’t that exactly what the authors are going to say anyway?

    As an argument, it’s really less compelling than I’m sure you imagine it is.

    No, I will not buy your junk science book. If you can’t convince me that there is even anything worth looking at in this debate, then what use is the book?

    The most compelling point for me is that Dr Beck makes a great deal of absolute, unequivocal statements that are simply false. He says there is no evidence, when there is bucketloads of evidence. Now, I’m sure that *in the book* all this evidence mountain is shunted aside and pooh-poohed (justified or not) – but here in this blog, he simply tried to mislead us.

    So no, I will not buy your junk science book.

  73. #73 Didactylos
    December 1, 2010

    I was going to leave it there, but I saw Paul Connett’s comments on Li et al.

    We are able to read, you know.

    Please don’t insult us.

    You harp on about a “linear increase”, cunningly implying that reducing fluoridation to zero will have the same effect on fracture rates. But that’s not the case, and presumably you know it.

    Nothing raises my ire more than people trying to twist scientific studies to mean what they want.

    Disagree with the study if you want. But for heaven’s sake stop misrepresenting it. Li et al (abstract): “A U-shaped pattern was detected for the relationship between the prevalence of bone fracture and water fluoride level. The prevalence of overall bone fracture was lowest in the population of 1.00-1.06 ppm fluoride in drinking water”

  74. #74 M
    December 1, 2010

    I looked at the graph http://www.fluoridealert.org/who-dmft.htm. I like how you mention the _rate_ of decrease (which depends mostly on oral health starting out really bad), when the key factor is the actual level of caries where the fluoridated nations seem to do better than average.

    However, even more interesting is that I went to the webpage that those numbers were pulled from: http://www.whocollab.od.mah.se/sicdata.html and http://www.whocollab.od.mah.se/euro.html. There, I found that there were two countries who reported fluoridated counties separately from non-fluoridated counties (Brazil and Ireland). At every single time point and population division reported, the fluoridated counties had lower cavity prevalence than the non-fluoridated counties. Rebuttal?

    (of course, I do acknowledge that the non-fluoridation improvement in hygiene over time is larger than the difference between fluoridated and non-fluoridated, showing that fluoridation is not the be-all and end-all oral health method… though it is possible fluoride toothpaste is a contributor there. However, this still goes to show that “The answer to this first question is clearly no” is a rather misleading statement – a number of studies, plus the York and CDC assessments, have shown benefits, so the best that could apparently be said is “There remains controversy over the benefits of fluoridation, with more studies showing benefits than not, but no studies have been done to date with top-of-the-line methodology” or whatever)

    -M

  75. #75 Paul Connett
    December 1, 2010

    Boy it is hard to keep up with all this vitriol and insulting language. I don’t think I am asking too much from people who claim to be scientists to actually read what we wrote before you condemn us. If you don’t want to buy the book then get yourself a free review copy.

    We were finally forced to write this book after many years of trying to argue these points. But they can’t be resolved a la Fox News or MSNBC with venomous rhetoric.

    The book is there – the arguments are transparent and thoroughly documented. It really does not do anyone credit to condemn everything we wrote based on your assumptions about who we are and to challenge our integrity to boot..

    Some of you probably don’t want another issue to examine. Fine. But be honest about it. But for those for whom science matters – and all three of us have spent our professional careers pursuing science and have no axe to grind peddling falsehoods – it is a very painful to be accused otherwise. It does not give skeptics a good name if they won’t even read what you have spent a long time studying, writing and documenting before they scream abuse.

    I am prepared to discuss all the details on our work with any one once they have read the book. And as for the implication that we are doing this to sell books – give me a break! Check out our careers before you make such a ridiculous comment.

    I was going to answer point 28 – but I have had it. Ryan read chapters 6-8 of our book then get back to me.

    And Didactylos how can you possibly say we are misrepresenting Li et al. 2001 before you have actually read chapter 17? We go into both the U-shaped curve on all bone fractures and the curve on hip fractures in some detail.

    Paul Connett

  76. #76 Treppenwitz
    December 1, 2010

    And Didactylos how can you possibly say we are misrepresenting Li et al. 2001 before you have actually read chapter 17? We go into both the U-shaped curve on all bone fractures and the curve on hip fractures in some detail.

    How about you give us a taste in the meantime, then?

  77. #78 Chris S.
    December 1, 2010

    Sorry, meant to add a quote: “The reality is that anybody making any confident statement about fluoride – positive or negative – is speaking way beyond the evidence. In 1999 the Department of Health commissioned the Centre for Reviews and Dissemination at York University to do a systematic review of the evidence on the benefits of fluoridation on dental health and to look for evidence of harm. Little new work has been done since.”

    That was 2008…

  78. #79 Didactylos
    December 1, 2010

    Paul Connett, you are misrepresenting Li et al *here*.

    A book with a subtitle like yours is either a groundbreaking, conspiracy-busting, whistle-blowing exposé – or it is junk science.

    The middle ground of a rational and well-reasoned weighing of the scientific evidence simply isn’t an option you left open.

    Stop trying to shill the book! It looks bad.

    I don’t care what the book says. I care about what you say *here*, and that is *why* I’m never going to buy the book. Because you value accuracy so very little.

    I’m struggling not to call you a liar, here. You aren’t making it easy.

    If this were an important issue, I might hold my nose and actually read the book, to see exactly when and where you go wrong – but it just isn’t.

  79. #80 Brant D
    December 1, 2010

    Didactylos, a linear relationship does not necessarily mean the trend line passes through the origin. If you are going to criticize people about twisting scientific studies, please at least keep your basic mathematics straight.

  80. #81 LindaRosaRN
    December 1, 2010

    There is NOTHING new in Beck’s arguments. I’ve worked on three fluoridation ballot issues in Colorado. What Beck writes here are all the old falsehoods and misrepresentations against community water fluoridation that are meant to invoke the precautionary principle in the public at large; these points have all been *thoroughly* refuted. There is probably nothing more settled than the safety and efficacy of water fluoridation.

  81. #82 Kevin
    December 1, 2010

    To the authors,

    You imply that forces were at work decades ago that biased researchers into concluding that fluoridation of the water system was a “good thing”. However, surely you cannot deny that your own research might be subject to bias: there would be much fame associated with undermining a widely held scientific consensus and much glory attained at averting a major public health hazard (not to mention the simple wonderful feeling you might get from just knowing that you personally have averted great suffering). Others have pointed out the proceeds of your book as an additional source of bias, and there may be a *little* something to that, but I think maverick scientists are rarely in it for the money.

    Consider, for example, the forces at work which convinced both laypersons and professional scientists across the country to conclude that a real and dangerous link existed between powerline proximity and cancer rates in the 80s.

    My question: do you think these forces could have influenced and biased you, perhaps interfering with your own ability to pull *all* studies about the benefits and risks of water fluoridation, and to weigh each based on merits alone (casting a blind eye to whether the studies support your conclusions)? I’d like to hear what steps, explicitly, you took to ensure that no confirmation bias could have crept into your own meta-analysis of these mountains of studies over the past several decades; or into your own research and data collection.

  82. #83 nyscof
    December 1, 2010

    Fluoridation Opposition is Scientific, Respectable & Growing

    More than 3,200 professionals (including over 290 dentists) urge the US Congress to stop water fluoridation citing scientific evidence that fluoridation, long promoted to fight tooth decay, is ineffective and has serious health risks. See statement: http://www.fluorideaction.org/statement.august.2007.html

    Also, eleven Environmental Protection Agency employee unions representing over 7000 environmental and public health professionals called for a moratorium on drinking water fluoridation programs across the country, and have asked EPA management to recognize fluoride as posing a serious risk of causing cancer in people.

    Approximately, 80 US communities rejected fluoridation since 2008. The CDC reports that 225 less communities adjusted for fluoride between 2006 and 2008.

    – On April 12, 2010, Time magazine listed fluoride as one of the “Top Ten Common Household Toxins” and described fluoride as both “neurotoxic and potentially tumorigenic if swallowed.”

    – Water fluoride chemicals boosts lead absorption in lab animals’ bones, teeth and blood, was reported by Sawan, et al. (Toxicology 2/2010). Earlier studies already show children’s blood-lead-levels are higher in fluoridated communities, reports Sawan’s research team.

    – State University of New York researchers found more premature births in fluoridated than non-fluoridated upstate New York communities, according to a presentation made at the American Public Health Association’s annual meeting on November 9, 2009 in Philadelphia.

    – The Canadian Association of Physicians for the Environment, Canada’s leading voice on environmental health issues, released a statement opposing fluoridation.

    – May 2009, Great Lakes United (GLU) supports the end of water fluoridation. GLU is made up organizations representing environmentalists, conservationists, hunters and anglers, labor unions, community groups, and citizens of the United States, Canada, and First Nations and Tribes. (13)

    – The Green Party of Canada passed a resolution to work towards the elimination of artificially fluoridated water. (August 2010)

    – The National Kidney Foundation dropped its fluoridation support replacing it with this caution: “Individuals with CKD [Chronic Kidney Disease] should be notified of the potential risk of fluoride exposure.”

    – “A qualitative review of …studies found a consistent and strong association between the exposure to fluoride and low IQ,” concluded Tang el al., in “Fluoride and Children’s Intelligence: A Meta-analysis” in Biological Trace Element Research (5)

    – Scientific American editors wrote in January 2008, “Some recent studies suggest that over-consumption of fluoride can raise the risks of disorders affecting teeth, bones, the brain and the thyroid gland”

    – Research published in Biological Trace Element Research (April 2009). indicates that blood fluoride levels were significantly higher in patients with osteosarcoma than in control groups. (13) Osteosarcoma, a rare bone cancer, occurs mostly in children and young adults

    – A Tennessee State legislator, Joey Hensley, who is also an MD is urging all Tennessee Water Districts to stop fluoridation, reported a Tennessee newspaper on 11/29/08. At least 30 Tennessee water districts have already complied with his request.

    – Fluoride avoidance reduced anemia in pregnant women, decreased pre-term births and enhanced babies birth-weight, concludes leading fluoride expert, AK Susheela and colleagues, in a study published in Current Science (May 2010)

    On 1/5/09, the Burlington Board of Health recommended that Burlington cease fluoridation because fluoridation can harm some people.

    On 1/6/09, a Canadian town, Drayton, stopped fluoridation, not to save money, but because it was in the best interests of residents, said the Mayor.

    Nobel Prize winner in Medicine, Dr. Arvid Carlsson, says, “Fluoridation is against all principles of modern pharmacology. It’s really obsolete.”

    Fluoride jeopardizes health – even at low levels deliberately added to public water supplies, according to data presented in a 2006 National Academy of Sciences’ (NAS) National Research Council (NRC) report. Fluoride poses risks to the thyroid gland, diabetics, kidney patients, high water drinkers and others and can severely damage children’s teeth. At least three panel members advise avoiding fluoridated water.

  83. #84 nyscof
    December 1, 2010

    Kevin – You can get the book from your library, through interlibrary loan if necessary, and find the answers you ask for yourself.

    Why do you think fluoridation is safe and effective? Did you study it or are you just taking someone’s else’s word for it?

  84. #85 Jeremy
    December 1, 2010

    Wow, pseudo-science on this blog. How disappointing. Unsubscribed. What’s interesting is that opposition to fluoride in water supplies began under the claim that it was a Communist plot during the cold war, which demonstrates the strength of the case against it.

  85. #86 Neil Gottel
    December 1, 2010

    Comment 1: Crying about people being vitriolic and insulting and then declaring yourself above such pettiness and refusing to answer questions is such a classic woo-woo argument.

    Comment 2: I think this has almost been hammered home enough, but the authors are misrepresenting the Li et al. study. They are focusing on only hip fractures which have very low values in all categories, and crappy p-values. At the same time they ignore the data on the total fracture rate because it doesn’t jive with their hypothesis. Its an obvious U-shape in fracture rates when moving from low ppm to high ppm.

    The thing not mentioned regarding the hip fractures is how few there are in the entire study. The hip fracture numbers (from low ppm to high ppm) are as follows: 5, 6, 5, 14, 8, 18 (corresponding to ppm averages of 0.25-0.34, 0.58-0.73, 1.00-1.06, 1.45-2.19, 2.62-3.56, 4.32-7.97). Number of people surveyed was 1363, 1407, 1370, 1574, 1051, 1501.

    The important thing obviously is the relative rates for each group, which are .37%, .43%, .37%, .89%, .76%, 1.2%.

    There’s *probably* significance between the .37% and 1.2% values (the groups with .25-.34ppm and 4.32-7.97ppm), but I don’t think anyone would argue that 8ppm is a good thing. This is why levels are kept between .7 and 1.2 ppm in the United States.

    Anyways, I’m sure Orac can bring the beat-down, so I’ll look forward to reading that. Sorry about my post getting jumbley, Its hard to convey science results in a word pad format :(

  86. #87 coby
    December 1, 2010

    Jeremy, if that’s your idea of a scientific look at an issue then you are hardly qualified to judge science from pseudo-science. A proponent of fluoridation offered a link to this article which stated under the heading “How poisonmongers work” this: “The antifluoridationists’ (“antis”) basic technique is the big lie. Made infamous by Hitler, it is simple to use, yet surprisingly effective.”

    Gee whiz, now how will you know who is right? I guess you have to choose between being a communist or afascist.

  87. #88 coby
    December 1, 2010

    Didactylos,

    You claim the authors are misrepresenting Li et al and you do so on the basis of reading the abstract only. You further use this as a springboard to accusations of dishonesty. In the same breath you acknowledge you aren’t even that interested in the issue. If you don’t want to do any real work, then I suggest you STFU.

    We don’t know what the authors have written about Li et al in the book but it is clearly more nuanced than a quick read of the abstract. Here in this post, James Beck said the study “shows a rising prevalence of hip fracture correlated with a rising intake of fluoride starting with concentrations comparable with those used in fluoridation in North America”. Another commenter noted that 1 ppm was shown to be lowest incidence of fractures rising from there. This does not strike me as inconsistent, and considering the EPA has approved fluoride up to 4.5 ppm (going from recollection here) it is pretty fair game. Again, Dr Beck has indicated there is much more to this study than is in the abstract, not unusual that.

    Regardless, the best accusation supportable by the facts would be that of oversimplification which is inevitable in a summary of a book length argument. And if you can not be bothered to read that argument, you are hardly in a place to pass judgement on it.

  88. #89 coby
    December 1, 2010

    M in #75,

    You say “Clearly no” is not justifiable. Hmmm, well I agree that there is enough evidence on both sides that the answer does not seem clear. But given the fact that the authors have spent alot of time researching the details it is not impossible that the answer has become clear. I think literary license allows us to say things like “clearly” with caveats like “to me after extensive investigation” reasonably implied.

  89. #90 coby
    December 1, 2010

    Neil,

    “I think this has almost been hammered home enough, but the authors are misrepresenting the Li et al. study. They are focusing on only hip fractures which have very low values in all categories, and crappy p-values. At the same time they ignore the data on the total fracture rate because it doesn’t jive with their hypothesis.”

    Is this based on your reading of the relevant chapter in the book? Otherwise, I think your conclusions are premature.

  90. #91 coby
    December 1, 2010

    “Crying about people being vitriolic and insulting and then declaring yourself above such pettiness and refusing to answer questions is such a classic woo-woo argument.”

    Yes, this is how we judge people on the blogosphere, and when those we are judging are experience in that sphere it is usually an accurate indicator. However, if you are not accustomed to what passes as mild antogonism here this is perhaps an inevitable reaction.

    Would any of you speak to a stranger you have just met in this way? And if you did, would you expect to end up in a reasoned and amicable dialogue?

    Normal people do not find this kind of stuff okay, it is really just us bloggers who do.

  91. #92 Treppenwitz
    December 1, 2010

    Since you know we don’t (or don’t yet) have the book, repeating “it’s in the book” is pretty unsatisfying. If that’s to be the reply in every case, why not just close commenting?

  92. #93 coby
    December 1, 2010

    I must hasten to add that I have to take full responsibility for putting them in this situation. I swear to god I did not know this was such a hot button issue.

  93. #94 coby
    December 1, 2010

    Treppenwitz, understood. But my problem is with people
    jumping from not enough information to the harshest accusations of dishonesty. I too would like to see Paul or Dad provide more detail on this particular study though we may have driven them off already.

  94. #95 coby
    December 1, 2010

    Just to summarize what the authors have said about Li et al so far:

    in #33:
    “On bone fracture: Over the decades there have been varied results. The Li et al. paper is one of the better studies. One commenter has misread it. Li et al. studied six villages with widely varied concentrations of fluoride in drinking water, the lowest quite close to the 1 ppm we see in North America. They looked at two different outcomes: all fractures and hip fractures. And they looked at prevalence as related to dose (not concentration). In the case of all fractures they found a minimum with the lowest-dose group’s prevalence higher than in the group with the next highest dose. Since we were interested in the science and the truth, this result is in The Case Against.… In the case of hip fracture the relationship shows a clear rise of fractures as dose increases.”

    In #72:
    “If Zahnarzt had read the whole article he would have found that while the increase in hip fracture reached statistical significance for the village at 4.3 ppm plus, there was what looked like an increase from the village at 1 ppm through 2.5 ppm and through 3.5 ppm. We carefully discussed how to interpret this data in chapter 17 of our book. Essentially, there are two ways of looking at it. You could ignore the increases in the two villages between 1 ppm and 4.3 ppm, and conclude that there was a threshold at 4.3 ppm where all of a sudden hip fracture rates tripled. Or, you could argue that a better fit of the data is an approximately linear increase in hip fractures as the water concentration increased above 1 ppm. In other words statistical significance may not tell the whole story. If our interpretation is correct the data for villages between villages at 1 ppm and 4.3 ppm are actually “real” data and should not be ignored.”

    I’ll leave to the reader to judge if this is reasonable and correct or reasonable but mistaken. But I have great difficulty understanding why some are implying it is dishonest.

  95. #96 DrC
    December 1, 2010

    You have lost all credit as a skeptic with this one – get out your tinfoil hat.

    It’s funny. A few months back I moved this blog from the science list to the advocacy list because the science content was so low. I think I’ll move it to the tab that has CA and WUWT.

  96. #97 Ian Forrester
    December 1, 2010

    Here is a link to the full paper by Li et al.:

    http://onlinelibrary.wiley.com/doi/10.1359/jbmr.2001.16.5.932/full

  97. #98 mandas
    December 1, 2010

    coby

    I won’t even attempt to comment on this issue, because I know absolutely nothing about it.

    But I will say a big hearty congratulations to your father for pushing Dick off the front page and from completely dominating the blog.

  98. #99 coby
    December 1, 2010

    Thanks for that Ian.

    Just about the abstract still, I will note that people are confusing two aspects of the study: hip fractures and overall fractures. The U shaped curve people have noted is regarding overall fractures whereas the text in the main post refers to the findings about hip fractures.

  99. #100 Neil Gottel
    December 1, 2010

    @ Coby: I know it sounds like it seems that some commentators are “attacking” your father and his collaborator, but this is pretty much par for the course when it comes to scientific discussion. I’ve been in lab meetings where people are harsher than this with their own colleagues, but everyone understands (usually) that it is nothing personal (also usually). Arguments about “tone” simply come down to personal taste, so I’ll say nothing more on that.

    Re: your response to my post: no, I have not read the book. Please stop saying the book explains everything, I don’t need my hand held while reading a paper as easy to understand as the Li et al. article.

    “Essentially, there are two ways of looking at it. You could ignore the increases in the two villages between 1 ppm and 4.3 ppm, and conclude that there was a threshold at 4.3 ppm where all of a sudden hip fracture rates tripled. Or, you could argue that a better fit of the data is an approximately linear increase in hip fractures as the water concentration increased above 1 ppm.” from post #72

    The above statement is a false dichotomy. A third choice is to agree that high fluoride concentrations are bad, while also realizing that a little bit of fluoride is good. The sudden tripling view is a strawman, and the linear increase view is bad stats.

  100. #101 coby
    December 1, 2010

    Neil, the U shaped curve was found for all fractures, the comment you quote from Paul is about hip fractures. The paper may indeed be easy to understand, but I question whether or not you have.

    Regardless, reality is rarely revealed in a single study and conclusion about these kinds of things really do require balancing all the evidence.

  101. #102 J. J. Ramsey
    December 1, 2010

    Coby, Quackwatch is on the up-and-up and even listed on the sidebar of the Science-Based Medicine blog. Don’t be too quick to trash it.

  102. #103 coby
    December 1, 2010

    Noted, but I can’t say the particular page cited was impressive, and not just because of the “big lie” and “they are like Hitler” crap.

    As sometimes happens, legitimate sides of a debate can end up being saddled with ludicrous or extreme factions and you end up with friends worse than your enemies. I think the ridiculous “mind control” nuttery related to fluoridation is one such example. Just because some crackpots out there think commies put it in our water to weaken our resolve does not mean there is not real evidence of real problems.

    The quackwatch page about fluoridation seemed to be arguing at a level meant for people who just heard about the issue on the “Alex Jones” show and it did not exhibit many signs of a careful assessment.

    Which BTW can be said about the majority of reactions here.

  103. #104 Greenman
    December 1, 2010

    Does fluoride cause hip fractures?

    Some comments on the Li et al 2001 bone fracture study which Didactylos, Paul Connett, and others have been discussing.

    The Li study is important. The 2006 US National Research Council report on fluoride identified it as one of the strongest studies on the question of bone fractures.

    Didactylos is selectively quoting from the abstract of the paper, and it is not clear whether he/she has read the paper itself. The full paper is available online for free at this URL:

    http://onlinelibrary.wiley.com/doi/10.1359/jbmr.2001.16.5.932/pdf

    I won’t go into all the strengths and weaknesses of the Li study, but I will try to clarify it so people will understand why Connett and Beck senior have concluded it contains evidence that fluoride levels in drinking water which occur during artificial fluoridation may lead to higher rates of ***hip fractures*** in the elderly.

    Li studied more than 8000 rural Chinese people, age 50 or older, who lived in six nearby villages. The villages were very similar in most characteristics, but their wells had different levels of fluoride. The subjects were asked whether they had ever broken any bones, at what age, and the bone broken. Interview responses for broken bones were checked against their medical records and X-rays, and generally the self-reporting proved reliable.

    It is critical to understand that Li had two main analyses: One was for ***all types of bone fractures*** which he called “overall bone fractures” and the other analysis looked only at ***hip fractures***. There was a good reason for looking at hip fractures separately from all bone fractures. Hip fractures are very common in the elderly and often have poor prognosis. In the US, complications from hip fractures in the elderly often lead to long convalescence and death. Contrast that to a broken arm in a 25 year old. The 25 year old gets a cast and after several weeks or months the arm is usually as good as new. Another reason hip fractures were singled out for special consideration was because fluoride accumulates in bones over time, with most people having steadily higher bone F concentrations the older they get. So, there is special concern that the elderly will have the highest levels of F in their bones and would be most at risk for any weakening effect it might have.

    The Li study found, in its analysis of ***all types of bone fractures*** that there was a roughly “U-shaped” relationship between water F level and rates of fracture. The village with about 1 mg/L fluoride had the lowest rate, while the villages with less than 1 mg/L had somewhat higher rates and the villages with levels above 1 mg/L also had higher rates of all bone fractures.

    But, the analysis of ***hip fractures*** showed a different picture. There was no “U-shaped” curve. Instead, the villages with water F at or below 1 mg/L all had similar rates of hip fracture, but as the water F concentration increased above 1 mg/L the hip fracture rates also increased. Here is how Li describes these results in the paper:

    “After adjusting for age and BMI, the risk of hip fracture was significantly higher in the highest fluoride group (4.32–7.97) than the population with 1.00 –1.06 ppm of water fluoride, which had the lowest prevalence. In general, the hip fracture prevalence was stable up to 1.06 ppm of fluoride and then appeared to rise, although it did not attain statistical significance until the water fluoride concentration reached 4.32–7.97 ppm (Fig. 3).”

    Li summarizes this information in his Figure 3. But as a scientist, my “suspicion antennae” are raised when I notice that the X axis of this graph, which appears to be a scatterplot, is not a continuous scale but is actually a category scale. Thus, the lines drawn connecting the points do not show the true quantitative relationship between the F concentrations and the hip fracture rates. Li’s graph makes the three lowest F villages appear to all have equal sized increments of F between them, when in fact they are closely bunched together. Therefore, the fact that they have similar hip fracture rates can be explained by the fact that they have similar F rates. There may not be any threshold at 1 mg/L F.

    Of course, even if such a threshold existed, artificial fluoridation typically adds F to yield a concentration of 1 mg/L so we are right at the hinge of the threshold. Furthermore, in the US population there is roughly a 10 fold range in how much water people drink. So, some people drinking 1 mg/L F water will get doses of F four times higher than the person who drinks the average quantity of water. There is another way of comparing the Li study to people’s F exposure in the US. Li estimated not only the concentration of F in the drinking water, but also the quantity of water people drank, and then calculated the actual doses. Li’s Figure 1 shows these values and reveals that the Chinese villagers with 1 mg/L F water were ingesting about 3.4 mg/day of F. The NRC 2006 report included detailed estimates of the range of total F exposure for various sub-groups in the US, including for those who drank greater than average amounts of water. It found many adults in the US ingest more than 3.4 mg/day of F. Based on the Li study findings, these people might have an increased risk of hip fractures. Notice from Li’s Figure 3 that the village with about 2 mg/L F had about twice the rates of hip fractures as the village with 1 mg/L F. That is a very steep rise which provides zero margin of safety for artificial fluoridation. When fluoridation defenders say that adverse effects only occur at exposures much higher than can occur to people drinking water with 1 mg/L, they are directly contradicted by the findings of this Li study.

    Incidentally, the Connett, Beck, Micklem book takes the data from Li’s Table 4 and graphs them as a true scatterplot with the X axis a continuous variable, rather than as 6 categories. This graph gives a more accurate visual understanding of the data. For those who would like to read the book, but don’t want to pay for it, just go to your local library. It is amazing what you can find for free in a library which is not available for free online.

    Sorry if this was too detailed and technical for some. It is intended for those who want to discuss the scientific evidence, rather than for those who wish to debate the “extra-scientific” issues.

  104. #105 Orac
    December 1, 2010

    Thank you GGM. It will be interesting to see the comments that come in after these commentators have read the book

    Send me a review copy and I might read it. I don’t pay money for a book that appears highly unlikely to provide me with education or interesting reading.

  105. #106 Orac
    December 1, 2010

    You have lost all credit as a skeptic with this one – get out your tinfoil hat.

    As harsh as I’ve been on this execrable post (look to my blog tomorrow for a more detailed deconstruction), even I wouldn’t go that far. Clearly Coby has a blind spot. If similar cherry-picked arguments about AGW were made, he’d demolish them. I get it. It’s his dad. I also get that he will react very negatively to attacks on his dad.

    The funny thing is that a not-unreasonable argument that a one-size-fits-all approach to water fluoridation is probably necessary anymore can be made. Dr. Beck’s argument is, however, not such an argument. In fact, it’s anything but a good argument. It’s as simplistic as he claims fluoridation boosters are and histrionic, and it appears to cherry pick studies. Worse, Dr. Beck consorts with people who appear to be true cranks. Connett is bad, from what I’ve been able to discern from my Googling. Really bad. The guy shows up videos with conspiracy nut Alex Jones, the uber-quack Joe Mercola, and even quackery booster Mike Adams. (Search for any of them on my blog if you want to get an idea of how loony they are.) I’ve also found him working with Dr. Russell Blaylock, who is anti-vaccine to the core, pushes all manner of quackery, etc.

    If Dr. Connett and Dr. Beck want to be credible, having Dr. Connett hang out with a guy who wrote a glowing review of Dr. Tullio Simoncini, a guy who believes that all cancer is caused by fungus and that the way to cure it is to inject sodium bicarbonate into it. I wish I were kidding, but I’m not. The guy who promoted Simoncini? Joe Mercola.

  106. #107 Orac
    December 1, 2010

    You object to references offered from a site called “fluoridealert” and instead point us to “quackwatch”! Very rich.

    Oh, geez, I can’t take it anymore.

    This time, you’re showing extreme ignorance. Quackwatch is an excellent resource targeted at the educated lay person for science-based reviews of dubious health claims. It is well-respected in the skeptic community, and it deserves that respect. I regularly consult it when examining dubious health claims that I haven’t encountered before, and I refer my patients there, among other websites. Is it perfect? No.

    The quackwatch page about fluoridation seemed to be arguing at a level meant for people who just heard about the issue on the “Alex Jones” show and it did not exhibit many signs of a careful assessment.

    Funny you should say that, given that Dr. Connett was interviewed about his book by Alex Jones. But I’m interested. Just what, specifically, do you find lacking in the Quackwatch analysis? On the other hand, if you didn’t like that one, maybe you’ll like this one better:

    http://www.quackwatch.org/03HealthPromotion/fluoridelincoln.html

  107. #108 Sid Offit
    December 1, 2010

    Orac, you know even less about fluoridation than you do about vacciantion. Amazing.

  108. #109 Neil Gottel
    December 1, 2010

    Cody! Thanks for completely misunderstanding my post, AND insulting my reading ability! So, I’ll give up on the friendly approach, and just let you know that you’ve gotta stop sucking up to your old man, and realize you’ve fallen for some serious pseudoscience bullshit.

    Sid, I think you’ve finally found a friendly blog to post on in SB, you’ll fit right in!

  109. #110 coby
    December 1, 2010

    Orac, I can appreciate that quackwatch may be a fine resource. My comment passing judgement on it due soley to its name was intended as an ironic mocking of the person who offered it simultaneous with dismissing the slew of references on fluoridactionalert because of…the name.

    I dutifully went to that page but stopped reading after the author said anti-fluoridation people are like Hitler, and what I had read up to that point was not indicative of a fair assessment IMO anyway.

    The page from quackwatch you are now offering is 60 years old and my understanding is that the objections raised in the book, subject of the post, are largely based on subsequent research.

    I do not have a considered opinion of my own on this issue, this is my first focused exposure to the controversy, so my Dad or not I intend to be open minded about it. I will say though that the volume and pitch of the objections thus far simply does not match the substance.

  110. #111 coby
    December 1, 2010

    Neil #110, would this be an example of “Crying about people being vitriolic and insulting and then declaring yourself above such pettiness and refusing to answer questions?”

    If so, b’bye, thanks for playing. Otherwise perhaps you would like to answer #105?

  111. #112 coby
    December 1, 2010

    “Funny you should say that, given that Dr. Connett was interviewed about his book by Alex Jones. ”

    I mentioned Alex Jones because I just saw this page in a list of links including Alex Jones. So I guess I’m a 911 truther!?

    That is a little too much guilt by association for my taste. If Paul Connett cites Alex Jones, then you have a point. I noted above that just because quacks are on “your side” does not necessarily make you wrong (#104)

    I would also add that it is not implausible that Paul Connett has no idea who Alex Jones even is. I have been contacted for interviews by small radio stations or the like and, though one might argue I shouldn’t, I usually consent to participating without much vetting.

  112. #113 Sid Offit
    December 1, 2010

    Unfortunately, fluoridated water is not the only source of exposure. Toothpaste adds substantially to the burden. It is very often swallowed, especially by vulnerable, younger children. And even when used by children with good control of swallowing, it adds as much fluoride to the “diet” as do all other sources—including fluoridated water. Add to that high levels in foods such as mechanically separated chicken (bone fragments) found in chicken mcnuggets and the white grape juice (fluoride pesticide) of which so many vulnerable babies are enamored. So much for the carefully calibrated level of 0.8 – 1.2 mg/l of F about which kpt speaks. And gosh who wouldn’t want a mouthful of fluorosis damaged teeth in exchange for an easily filled cavity? And a cavity compleatly controlable not by illusory public health miracles but abstention from lolly pops, candy and soda. Ahh but where’s the miracle in that?

  113. #114 Dappledwater
    December 2, 2010

    Greenman @ 105 – Awesome summary of Li et al 2001. Thanks.

    All I’ve read so far from the pro-fluoride camp, are insults, mudslinging and a lack of supporting evidence. It’s like I’ve stumbled into WUWT or Faux News.

    I’m still waiting for some rational discussion on the topic, because there’s no way I’m going to start dredging through the peer-reviewed literature.

  114. #115 Sid Offit
    December 2, 2010

    @Neil Gottel

    Anyways, I’m sure Orac can bring the beat-down

    As readers of Respectful Insolence can attest, when the subject is vaccination and the adversary Sid Offit, Orac assumes the role of beat-down experient. Fluoridation is and will be no different.

  115. #116 Sid Offit
    December 2, 2010

    @ The Unsubscribed.

    My mommy says I can’t play with kids who try to make me think. She says my brain hurts when I do.

  116. #117 Didactylos
    December 2, 2010

    coby: lying by omission is still lying.

    Presenting only one side of an argument is misrepresentation.

    Saying “It’s all in the book” is just feeble. The denier’s clarion call. “Buy my book! It explains everything, including why I keep contradicting myself, making stuff up and omitting important details!” …Sure.

    I know you don’t want disharmony around the Christmas dinnertable, but you really need to start by applying your excellent bad science detection skills, and apply them close to home. Or at least, keep the junk science away from the rest of your life.

    But as I said earlier: this whole topic doesn’t interest me. It doesn’t bother me if these authors believe any sort of nonsense. I have my fluoride toothpaste, and I don’t even know if my water is fluoridated. There is nothing terribly bad going on here, even in the totally fantastic, fictitious worst-case. But there are countless far more serious issues out there deserving our attention. Issues that cause serious harm. I am confident that there are plenty of people skilled and interested enough to debunk the book without my help.

  117. #118 Didactylos
    December 2, 2010

    Oh, and if I seem angry – it is because you have wasted my time.

    When you think something is this important, I respect you enough to look into it. What was most annoying was how very little digging I needed to do.

  118. #119 coby
    December 2, 2010

    Didactylos, the issue has nothing to do with topical fluoride use. Your passion is matched only by your ignorance.

  119. #120 Marco
    December 2, 2010

    Coby, let me put Didactylos’ comments in a slightly more constructive manner:

    While the basic argument that there is no distinct positive health effect of fluoridation may be correct, the packaging of the message is rather poor, and mimicks that of several crackpot areas. Orac already pointed out that he had several red flags raised, and I had the same thing from just reading your father’s blogpost (even when I forgot the spelling error).

    You may, for example, talk to your father and tell him how bad it looks when you use an Appeal to Authority where the list contains a significant group of non-authorities. Heck, the FAN even proudly notes Pete Seeger signed on that list of “professionals”. Red flag 1.

    It also looks bad when your president lets himself be interviewed by many people who are known crackpots (see Orac’s comment on his own blog). Note that Connett already had an interview with Alex Jones already in 2003. Your president associated with questionable people? Red flag 2.

    And then there’s the apparent overinterpretation of various papers (such as the Li et al paper). Now, this may be understandable from the activist point-of-view, but on scienceblogs such overinterpretation is not taken so lightly. Again, Orac has some examples on his blog. Red flag 3.

    There are some more of such red flags that, in the skeptical mind (and I mean skeptical, not ‘skeptical’), cause some significant instant dismissals of your father’s book. Perhaps inappropriately so, but that’s life…

  120. #121 Sid Offit
    December 2, 2010

    @Marco

    It also looks bad when your president lets himself be interviewed by many people who are known crackpots

    I think you have to evaluate a work based on its merits rather than the outlets in which its marketed. Unlike scientific entities such as the NIH which operate on “Obama money” authors have to sell books to those with an interest in the subject matter.

  121. #122 Ralph Kramden
    December 2, 2010

    Hey, if I used the Interwebs to post strong evidence that my father was a crackpot, I might be tempted to reply in the same aggressive manner. Sounds to me like some serious self-analysis might be useful…

  122. #123 coby
    December 2, 2010

    Marco in #121

    About red flags, sure, I raise flags in my mind all the time as well. But I do try to keep in mind that they are flags, not final judgements. I don’t expect every reader to bother investigating when faced with too many red flags, life is short and the internet is deep. But I do object to people who jump from “that smells fishy” to “liar and crank” without a second thought. I wouldn’t do it.

    About the specifc flags you listed:
    - appeal to authority:

    this post did not bring up any list of supporters, nor did any comment from the authors. Orac found the list on the advocacy site and raised the subject himself. So there is no appeal to authority in the post and if such a lost is mentioned in the book I am sure it is not a main pillar of their argument. I’m sure if you go to any environmental advocacy website and look in the climate change section you will find appeals to authority. Enough said.

    - association with demonstrable cranks:

    this would raise my hackles for sure. But again it is a very poor substitute for considering a person’s argument. Connett does not cite Alex Jones, he is cited by Alex Jones. It kind of reminds me of an outrageous add for bottled water I once saw that juxtaposed a glass of drinking water filling up with a toilet flushing and said “do you want to drink the same water that goes into your toilet?” Do I have to explain further the irrationality of that kind of associative reasoning?

    - over interpretation of a single paper:

    this is not a fair criticism. In the post it says: “The possible incidence of bone fracture with fluoridation has been studied with mixed results. One of the strongest studies is presented in a paper by Li et al. published in 2001 which shows a rising prevalence of hip fracture correlated with a rising intake of fluoride starting with concentrations comparable with those used in fluoridation in North America. And this is just one example that suggests that hip fracture is caused by fluoridated water.” Later in a comment, James Beck says “On bone fracture: Over the decades there have been varied results. The Li et al. paper is one of the better studies. One commenter has misread it. Li et al. studied six villages with widely varied concentrations of fluoride in drinking water, the lowest quite close to the 1 ppm we see in North America. They looked at two different outcomes: all fractures and hip fractures. And they looked at prevalence as related to dose (not concentration). In the case of all fractures they found a minimum with the lowest-dose group?s prevalence higher than in the group with the next highest dose. Since we were interested in the science and the truth, this result is in The Case Against.? In the case of hip fracture the relationship shows a clear rise of fractures as dose increases.”

    There is nothing in there to justify an accusation of cherry picking a single study, it is clearly stated that the literature shows mixed results and this is one of many and reading the paper supports their characterization of it. The criticisms have been incorrect in confusing the hip only part of the study with the all fractures part and ignoring the distinctions between dosage and concentration. See the useful comment here.

    So out of your mentioned red flags, in my view we are left only with the distaste that Alex Jones leaves in any sane person’s mouth. This is not strong enough evidence to justify the tone and content of comments like those Didactylos has left here.

    Yes that’s life, and don’t worry I will not be losing sleep over apparently poorly formed opinions of strangers like him, but I feel that having brought my Dad into this kind of venue I should defend him.

  123. #124 Dappledwater
    December 2, 2010

    Coby, let me put Didactylos’ comments in a slightly more constructive manner

    Yes, he recently melted down at Real Climate. Rational, constructive discussion is not his forte.

  124. #125 Sigmund
    December 2, 2010

    Shame on (pseudo-)Scienceblogs.

  125. #126 Marco
    December 2, 2010

    Coby, allow me a rebuttal. First, I fully understand your wish to defend your father, especially against those that go directly to “liar and crank”. That’s fully acceptable and correct.

    Having said that, red flag 1 may not be part of the book, but it IS part of the methodology of FAN to get its message out. Note also that your father specifically mentions the FAN website. It is in my opinion therefore fair game to point out that FAN uses questionable marketing. Moreover, remember that there are many similar examples, and sadly all from the fringe sites of the debate. The Perth Group has a list on its site with signatures from “professionals”. You will find such lists on anti-vax homepages. And we all know the OISM petition.

    Point 2 is better understood if you read Orac’s recent post and go through some of his links. It won’t be nice reading, but you will find that Paul Connett has gotten himself into contact with quite a few crackpots, Alex Jones just being one. I’m not sure how I should take Sid Offit’s remark, but are these really the type of people one wants to convince and have as allies? I just listened to how Connett approved of Teri Arranga linking the fluoridation issue with the vaccine-autism issue. Not a good way to start making friends with Orac there!

    Point 3 is more problematic. You quote your father as saying “In the case of hip fracture the relationship shows a clear rise of fractures as dose increases”. You might want to look at the graph on Orac’s blog to see that “clear trend”. I doubt the trend is statistically significant, but more importantly, is it *relevant*? Greenman seems to think it is, but the number of people enrolled is rather limited, so the occurrence of certain events is at levels that make drawing conclusions very, very difficult. Ben Goldacre has discussed similar issues once (can’t find the link, though). But we also still have the possibility of confounding factors: villages are compared to villages. As evidence it is highly questionable.

    Note also that your father stated in the blogpost that fluoridation *causes* hip fractures, something that is inaccurate (and I hope he knows that and will ask you to change it).

  126. #127 Typical
    December 2, 2010

    Dear Coby, James Beck, Paul Connett, etc….

    Just so you are aware, this same sort of madness happens in the vaccination controversy as well. People have very good evidence of a connection between vaccines and autoimmune and neurological problems and yet this evidence is often met (by the “skeptics, such as Orac), as crank, silliness, nonsense, etc. etc… Just keep that in mind now as you are getting a taste for this behavior. Hopefully, it will make you more interested in reading more on that topic as well.

  127. #128 Jen
    December 2, 2010

    I’m both anti-vax and anti-fluoridation. While there is alot of research that fluoridation is dangerous, the research that vaccines are dangerous is even greater. Wakfield’s monkey study is completely incontestable. If you need some links Coby, I got some great resources about vaccines too.

  128. #129 SteveF
    December 2, 2010

    Coby, does the fact that you are now attracting anti-vaccination cranks not give you pause for thought?

  129. #130 getoffmyscienceblogs
    December 2, 2010

    Is scienceblogs lowering its standards because it’s hard to find intelligent people? Seriously, this tells me everything I need to know about you:

    “You object to references offered from a site called “fluoridealert” and instead point us to “quackwatch”! Very rich.”

    Guess who I found cited by the site fluoridealert?

    “September 24. Dr. Mercola says Don’t Ever Drink This During Pregnancy…”

    That’s right – you’re citing as evidence (against a site as reputable and proven to be firmly on the side of science as Quackwatch is) a website that uses Joseph Fucking “I have a goddamn quack miranda warning on my website and I used the money to buy a house with a private island” Mercola. You useless imbecile.

    I hope scienceblogs drops you like a hot rock.

  130. #131 Cedric Katesby
    December 2, 2010

    Fluoride?
    You are peddling a coffee-table book on fluoride pseudo-science crap?
    Eeeeeww.
    How the hell am I supposed to link to your excellent articles on climate denialism now?
    The deniers are going to just howl with laughter over this one.

    Someone’s got a skepticism blind-spot the size of Jupiter.
    Go ahead and embrace your inner woo.

    (…walks away in disgust…)

  131. #132 getoffmyscienceblogs
    December 2, 2010

    Oh, and don’t believe me about Joseph Mercola’s house? Go ahead, look up this address on Google maps:

    60 Watergate Drive, South Barrington, IL, United States

    Yeah, he has a massive four car garage, pool, patio, private island (with a beach), two full baths,
    four half baths (commode and sink), two fire places, full finished basement, den, rec room and is over 5000 square feet. You can even look up his public tax records to see that it’s worth roughly 2 million.

    Not only is he anti-fluoride, but he’s also an anti-vaxxer, and his products all have “not approved by the FDA, not intended to treat or prevent disease” disclaimers at the bottom of each page. He’s a con-man, plain and simple, and by citing websites that use quacks like him for evidence, you have lost all credibility, Coby. You seriously need to take a long break from blogging until you can distinguish solid sources of evidence from pure bullshit being peddled by pseudoscience morons.

  132. #133 alwsdad
    December 2, 2010

    Ignoring the scientific questions for a moment, I see few commenters have addressed the second paragraph, which describes the alleged conspiracy behind fluoridation. Are we to believe that all these water utilities all across the country are in collusion with industries that use flourine-containing chemicals, in an effort to make fluoride seem “harmless”, so they escape regulation? Are HF and other F-containing hazardous compounds unregulated relative to other halogenated compounds? No, they are not. Are legal challenges to an HF release “hopeless of success”? Hardly. That entire paragraph is completely unsupported by any evidence.

    The general public doesn’t understand the difference between chlorine and chloride very well, so I doubt they understand fluorine vs. fluoride. And yet, somehow, chlorinated chemicals are well regulated, labelled as hazardous under RCRA and CERCLA and lots of other regulations. The same goes for fluoride- or fluorine-containing compounds. Municipal water utilities get no benefit from these nefarious fluorine industries by adding fluoride to water. So their motive must be something else.

  133. #134 Kevin
    December 2, 2010

    Let’s get something out in the open:

    Dr. Paul Connell, based solely on what you know of the subject, would you recommend the current apa vaccine schedule to chilren ages 0 – 6?

    http://aapredbook.aappublications.org/resources/IZSchedule0-6yrs.pdf

    Dr. James Beck, based solely on what you know of the subject, would you recommend the current apa vaccine schedule to chilren ages 0 – 6?

    http://aapredbook.aappublications.org/resources/IZSchedule0-6yrs.pdf

  134. #135 Zahnarzt
    December 2, 2010

    “…our results on hip
    fractures support previous findings that fluoride around 1
    ppm in drinking water does not increase the risk of hip
    fracture.”
    Li et al.

    This does not seem to jive with: “And this is just one example that suggests that hip fracture is caused by fluoridated water”, or indeed the entirety of the article’s characterization proffered by the book’s author.

    If the one article you cite is at best “mixed results”, then I find it hard to see how it can fall on the Case Against side. Am I still misreading it?

  135. #136 Clam
    December 2, 2010

    Coby, I know how you feel. My father still cannot be weaned off his Edwardian ideas that if he does not evacuate his bowels every day at 7 a.m. precisely, his blood will be poisoned and the next stop is the graveyard. I said they were Edwardian ideas, as they are. He was born in 1909.
    Wait. Er… Maybe he’s got something?

  136. #137 tonylurker
    December 2, 2010

    “Is this based on your reading of the relevant chapter in the book? Otherwise, I think your conclusions are premature.”

    This is just piss poor argumentation. Who cares what they say in the book. The claim was made on this blog, and the claim should be defendable within this blog post. They cherry-pick one tiny portion of the paper and discount the rest of the results. Who cares if they spend an entire chapter rationalizing it. The paper speaks for itself, the Hip fracture part is taken from a small subgoup of the study. And, since the standard for “statistical significance” is 95%, if you look at enough subgroups you are guaranteed to find a “statistical significance” by pure chance. Basically, the reading of the study defended in this post is equivalent to ignoring Global Temperature and focusing on the temperature in one specific location over a sufficiently narrow time window.

  137. #138 Adam_Y
    December 2, 2010

    The general public doesn’t understand the difference between chlorine and chloride very well, so I doubt they understand fluorine vs. fluoride. And yet, somehow, chlorinated chemicals are well regulated, labelled as hazardous under RCRA and CERCLA and lots of other regulations. The same goes for fluoride- or fluorine-containing compounds. Municipal water utilities get no benefit from these nefarious fluorine industries by adding fluoride to water. So their motive must be something else.

    Yeah because its primairly conspiracy mongering. What this blog post left out is that fluoride is naturally occuring. I forget exactly which mineral it is but it occurs in enough concentration that a lot of water that has never been touched by municipalities actually has fluoride in it. In fact in some municipalities they physically have to remove the fluoride in it because there is too much of it.

  138. #139 Dappledwater
    December 2, 2010

    James Beck,

    Are there any recent meta-analysis in the peer-reviewed literature on this subject?. I started reading some of those old studies by Frederick McKay on Colorado brown tooth etc, but I soon realized it would take some time to research the subject.

    I will eventually get around to reading your book. All the nutty comments from the pro-fluoride supporters, have piqued my curiosity.

  139. #140 ujtr
    December 2, 2010

    “they physically have to remove the fluoride in it because there is too much of it.”

    It’s interesting how many people fail to realize that water fluoridation refers to not only adding fluoride to water, but also removing natural fluoride if it exceeds sage limits. Of course, logic goes right out the window when dealing with hardcore anti-fluoridists.

  140. #141 Lynxreign
    December 2, 2010

    People have been focusing on the Li study, but what really got me was the number of varied problems being blamed on flouridation. The first 3 seem particularly devoid of actual information.
    Fluoride intake is a cause of impaired thyroid function. Indeed fluoride was once used medically to suppress thyroid function.

    At what dose? Nitroglycerine is used both as an orally taken medicine to help people with heart problems and to blow up mountains.

    Deleterious effects on reproductive systems in humans have been found to be associated with fluoridation: in girls, early onset of menstruation; in men, low sperm counts.

    This one strikes me as the “crankiest” of the bunch. I’d want to see lots of maps correlating the two. I’ve read articles lamenting both of these problems, but never seen any linking them to flouridation nor any implying that the levels of girls experiencing early onset menstruation are regionally correlated with men’s low sperm counts. Both of these problems are sensationalized enough in the media that I can’t believe either of these associations, either with flouridation or with each other, would be ignored.

    We now have strong evidence of the association of osteosarcoma in boys and young adult males with fluoridation. Osteosarcoma is a bone cancer which is often fatal.

    Really? What is it?

    Then there are the three questions, each of which the author answers with an emphatic “no”, for example “The answer to this first question is clearly no.” And yet, all three have been easily questioned if not refuted in the comments. At the very least, it isn’t so clear.

    Some general footnotes have been posted in the comments, but a much clearer defense would be to post links for each of the claims made near the claims themselves. To post them in comments in such a sloppy way suggests the authors are trying to get away with something.

    One of the authors keeps using the comments to squack, Jay Sherman-like “Buy My Book! Buy My Book!”, but if I read through the sloppy footnotes, I’ll have no need to. You have to give a compelling reason to buy the book, not just leaving evidence out of a blog post.

    And Coby seems annoyed over in the Orac post about the Dr. Strangelove reference. I think the ranting about “precious bodily fluids” quite apt. And you should be happy, at least he didn’t use Frank Burns.

  141. #142 Beaker
    December 2, 2010

    @dappledwater
    The most recent review I could find is this one from 2009:
    http://www.ncbi.nlm.nih.gov/pubmed/19772843
    Though I can’t get the full text. It concluded that the current evidence indicates that water fluoridation is effective in preventing tooth decay and that there is no good evidence to conclude adverse health effects, other than light to moderate fluorosis (which I would consider more an aesthetic effect, rather than a health effect).

  142. #143 Travis
    December 2, 2010

    Lynxreign, glad I am not the only person who immediately thought of The Critic and Jay Sherman when the topic of the book comes up. Asking people to buy your book to learn your secrets is a piss poor excuse for not wanting to explain yourself.

  143. #144 John Birch Blues
    December 2, 2010

    Thank you for this important post.
    I am going to start looking for fluoride everywhere.
    Not just in my sink, but underneath my chair
    I’ll look way up my chimney hole
    I’ll even look deep down inside my toilet bowl.

  144. #145 Pareidolius
    December 2, 2010

    I’m no scientist, so all the meta-whatevers and acronyms being bandied about by much more educated folk are of no use to me. Where I am an expert is magical-thinking. As a non-scientist and former magical-thinker, I was often swayed by the writings of “maverick” scientists, including their Lord God King, Peter Duesberg (to my eternal shame). I would eagerly lap up their twisted science, their interpretation of studies and their elaborate, sciency-sounding theories (after all, they were scientists). There was, however, one thing that always made me stick my fingers in my ears and yell “La, La, La, La”, and that was troubling issue of conspiracy. It was the red flag I tried mightily to ignore. How can all the water agencies, all the dental and medical sciences and governments around the world be wrong on what has been settled science for sixty years? How can this conspiracy be maintained in the age of Wikileaks? What’s in it for the purveyors of this nefarious plot to . . . break old ladies hips?

    Maybe fluoride really is useless, I really don’t know the science well enough to comment intelligently, but as someone working really hard on improving my critical thinking skills, the whole “everybody in the world is wrong except me” thing gives me pause.

  145. #146 Scientizzle
    December 2, 2010

    The Li et al study absolutely does not support the implicit and explicit claims within this statement from the post: …a paper by Li et al. published in 2001 which shows a rising prevalence of hip fracture correlated with a rising intake of fluoride starting with concentrations comparable with those used in fluoridation in North America. And this is just one example that suggests that hip fracture is caused by fluoridated water.

    To quote directly from the paper:

    The prevalence of overall bone fractures is the lowest for populations living in areas of approximately 1 ppm of fluoride (Table 2), indicating that the fluoride concentrations used for cariostatic purposes also may be beneficial in reducing the risk of overall bone fractures…This finding is in agreement with the results reported by a study in Germany, which found that 1 ppm of fluoride in drinking water did not influence peak bone density but may reduce the incidence of osteoporotic hip fractures in older individuals.

    Regarding the increased number of hip fractures found in the highest fluoride exposure group, the authors state:

    …it may not be appropriate to conclude that the risk of hip fracture is more sensitive to the water fluoride concentration as compared with overall fractures, because the number of hip fractures in the present study is relatively small.

    The explicit claim that Li et al. “suggests that hip fracture is caused by fluoridated water” is not tenable as the study notes only a highly-confounded correlation between fluoride exposure 4-8 times greater than that recommended for cariostatic purposes. It also neglects the (inconvenient?) finding that low fluoride exposure was associated with a greater incidence of bone breaks. The implication that current municipal fluoridation levels are associated with a potentially increased risk of bone breaks, hip or otherwise, is completely unsupported–the 1.00–1.06ppm exposure level (most comparable to municipal concentrations) was associated with the lowest risk for hip fractures and all fractures.

    I know this is only one study; it’s only one point made in the broader piece presented here. But it’s presented wrongly and seemingly dishonestly. Until this is rectified within the presented argument, it casts doubts upon the veracity of all presented claims.

  146. #147 Paul Connett
    December 2, 2010

    Is it possible for people on this blog to address some of the key issues on water fluoridation that we discuss in our book without ranting, raving,accusing,insulting and otherwise denigrating those who have spent many years researching the issue and have had the temerity to challenge this practice?

    So let’s forget all the mudslinging above and try a different exercise. For those who have accepted the orthodox US position that water fluoridation is a sound practice here are a few questions to ponder?
    1) Why is it if it is a sensible practice to use the public water supply to deliver medicine, it has never been used again for this purpose for any other drug or nutrient (there is no evidence that fluoride is a nutrient)?
    2) Why is it if the arguments are so overwhelmingly in favor of fluoridation, such that there is no room for debate on the issue, that so few countries actually use water fluoridation? Only eight countries in the world have more than 50% of their population drinking fluoridated water (Australia, Colombia, Ireland, Israel, Malaysia, New Zealand, Singapore and the US).
    3) The level of fluoride in mothers’ milk ranges from 0.04 to 0.004 ppm. This means a bottle fed baby in a fluoridated community can get up to 250 times the amount of fluoride that a breast fed baby gets; is that wise?
    4) Why does the CDC Oral Health Division continue to push water fluoridation even though it admits the predominant benefits of fluoride are TOPICAL not SYSTEMIC (CDC, 1999)? In other words fluoride works largely on the outside of the teeth not from inside the body. Why expose every tissue in the body to a known toxic substance when you can brush it on the teeth and then spit it out?
    5) The CDC has reported (CDC, 2005) that overall 32% of all American children now have a condition caused by swallowing fluoride called dental fluorosis (a permanent mottling and/or discoloration of the tooth enamel) and that for 12-15 year olds the percentage is 41% (CDC, 2010). What is the most convincing evidence that while fluoride is causing this condition by some biochemical mechanism a similar mechanism is not impacting other developing tissues in the child’s body which do have such visible signs of damage? These tissues include the brain, the bone and the endocrine system.
    6) Both the ADA and the CDC actually recommend that parents not use fluoridated tap water to make up baby formula for children under one year of age. Why are they not taking aggressive steps to inform parents about this? What steps could be taken to help low-income families get an alternative source of water for this purpose?
    7) The ADA and the CDC are concerned about dental fluorosis but opponents of fluoridation have other concerns. The baby’s blood brain barrier is not fully developed at birth (that doesn’t occur to about 6 months of age). Is it wise to expose a bottle-fed baby’s brain to fluoride at levels 250 times higher than would occur for a baby receiving mothers’ milk?
    There have now been over 100 animal brain studies, 3 fetal brain studies and 23 human IQ studies that fluoride can interfere with brain development (see all the references on the brain at http://fluoridealert.org/caseagainstfluoride.appendices.html ) The lowest level of fluoride in water estimated to lower IQ is 1.9 ppm (Xiang et al., 2003 a,b). Bearing in mind that this result was obtained in a relatively small study group of several hundred children is there an adequate margin of safety to protect ALL children from this potential damage when drinking uncontrolled amounts of water at 1 ppm? Bear in mind one normally uses a safety margin of 10 to take into account the full range of sensitivity in a human population and sometimes an extra margin when protecting children.
    8) The National Research Council, at the request of the US EPA Water Division, appointed a 12-membered panel to review the toxicology of fluoride in water and thereby ascertain the safety of its current safe drinking water standard for fluoride. Both the Maximum Contaminant Level [MCL]– the federally enforceable standard – and the Maximum Contaminant Level Goal [MCLG] the level deemed safe to protect the whole population from “known and reasonably anticipated adverse effects” were set at 4 ppm in 1986. In March 2006, after a three-year review, the panel produced a 507-page report, which concluded that the 4 ppm was not protective of health and recommended that EPA determine a new MCLG.
    a) Why after four and half years has the US EPA not done this?
    b) Why did the ADA dismiss the relevance of this review to water fluoridation on the day it was published?
    c) Why did the CDC follow suit 6 days later?
    d) Did either the ADA or the CDC determine what a new MCLG should be in 1 day and 6 days respectively and if they did where is their analysis?
    e) Why has every fluoridating country either ignored or downplayed this landmark review?
    9) Why has the FDA never been asked by the Department of Health and Human Services to regulate the ingestion of fluoride? Here is a clue: the FDA does regulate fluoride when used in toothpaste and requires this label on the back of the tube: “WARNING: Keep out of reach of children under 6 years of age. If you accidentally swallow more than used for brushing, seek professional help or contact a poison control center immediately.”
    The recommended amount is a pea size. A pea size of toothpaste at 1000 ppm fluoride contains approximately one quarter of milligram of fluoride which is the same amount of fluoride in a quarter of a liter at 1ppm, i.e. one glass of water. If that reflects the FDA’s concern about the toxicity of fluoride what do you think it would say about 180 million American drinking unregulated amounts of this substance on a daily basis? No wonder they are not asked!
    10) Sometimes promoters of fluoridation cite the largest study of tooth decay in the US as evidence that fluoridation is effective. This study was conducted by the National Institute of Dental Research (NIDR) in 1986-87 and involved examining the teeth of about 39,000 children in 84 communities. When comparing children that had lived all their lives in a fluoridated community with those who lived all their lives in a non-fluoridated community, they found an average saving in tooth decay for 5-17-years old of 18% in decayed tooth surfaces. However, this 18% saving was not shown to be statistically significant and amounted to a difference of 0.6 of one tooth surface (see Table VI, Brunelle and Carlos, 1990). By the time all the child’s teeth have erupted there are 128 tooth surfaces – so we are talking about a saving that amounts to less than 1% of the tooth surfaces in a child’s mouth. Question: could this saving – if real- justify taking the risks with the baby’s developing brain and other tissues? In actual fact, Brunelle and Carlos did not take into account the delayed eruption of teeth that may be caused by fluoride, which has been reported by several researchers (see Komarek et al, 2005). A delayed eruption of the teeth by one year would account for this difference of 0.6 of one tooth surface. 9All references cited above can be found at http://fluoridealert.org/caseagainstfluoride.refs.html )

    Paul Connett, co-author “The Case Against Fluoride.”

  147. #148 Sid Offit
    December 2, 2010

    @ujtr

    It’s interesting how many people fail to realize that water fluoridation refers to not only adding fluoride to water, but also removing natural fluoride if it exceeds sage limits

    Errr, not really.

    Fluoridated drinking water contains a fluoride concentration effective for preventing dental caries; this concentration can occur naturally or be reached through water fluoridation, which is the controlled addition of fluoride to a public water supply.
    CDC

    and…

    Water fluoridation is the controlled addition of fluoride to a public water supply to reduce tooth decay.
    WIKI

  148. #149 Marco
    December 2, 2010

    Paul, your arguments would be stronger íf you did not associate yourself with crackpots like Mercola, Alex Jones, and Terri Arranga. Yes, may sound unscientific, but appearance does matter.

    Perhaps you can tell us *why* you associated with those people?

  149. #150 John
    December 2, 2010

    Perhaps the hip fracture incidence increases are caused by old folks distracted by better quality smiles.

  150. #151 Typical
    December 2, 2010

    “I regularly consult it when examining dubious health claims that I haven’t encountered before, and I refer my patients there, among other websites. Is it perfect? No”.

    Orac refers his patients to Quackwatch????? Wow, just wow. That’s the best you’ve got? Quackwatch? LOL!

  151. #152 Scientizzle
    December 2, 2010

    I’m logging off shortly, but I’ll at leat offer short answers to Paul Connett’s giant-list-’o'-”just askin’ questions”

    1) Why is it if it is a sensible practice to use the public water supply to deliver medicine, it has never been used again for this purpose for any other drug or nutrient (there is no evidence that fluoride is a nutrient)?

    Because, the most recent set of reasonable figures I’ve seen suggests that approximately half of Americans don’t have access to acceptable levels of professional dental care. Fluoridation, though clearly imperfect, has been demonstrated to provide a tangible health benefit in this regard for citizens across social strata.

    Chemical manipulation of the water supply is done in many municipalities for many different aims. Bulk administration of “medicine” via water supplies is a facepalm-level stupid idea on many levels that do not justify discussion; bulk administration of simple salt ions, such as chloride, that provide a tangible protection of public health are feasible and plausibly beneficial.

    2) Why is it if the arguments are so overwhelmingly in favor of fluoridation, such that there is no room for debate on the issue, that so few countries actually use water fluoridation? Only eight countries in the world have more than 50% of their population drinking fluoridated water (Australia, Colombia, Ireland, Israel, Malaysia, New Zealand, Singapore and the US).

    There’s clearly room for debate. We’re doing it right now.

    The debate should be honest though. Both sides have an obligation to present appropriate data completely. This post has failed to do so in at least one obvious case. See my comment @ 147.

    Whether another country fluoridates its water or not is only relevant insofar because we can evaluate the data upon which they made (and continue to make) their decisions. Whether Dublin or Aukland fluoridates, it has no impact on whether such a decision by American municipalities is a good one or a poor one.

    3) The level of fluoride in mothers’ milk ranges from 0.04 to 0.004 ppm. This means a bottle fed baby in a fluoridated community can get up to 250 times the amount of fluoride that a breast fed baby gets; is that wise?

    The professional recommendations in the relevant literature I’ve read today do, in fact, recommend against using fluoridated tap water to make formula. This seems sensible.

    So sensible that in Q6 you complain that “the ADA and the CDC actually recommend that parents not use fluoridated tap water to make up baby formula for children under one year of age” but complain they’re not vocal enough.

    Whether the ADA & CDC aren’t publicizing their recommendations enough is an important, but rather separate, argument…It’s quite a stretch to really argue against broad fluoridation based on this transient concern. Certainly it can be part of a larger argument, but it’s remarkably weak on its own.

    Okay, that’s 3+ I’ve responded to. Maybe you can respond to some legitimate concerns directed in your direction?

  152. #153 Sid Offit
    December 2, 2010

    @Becker

    other than light to moderate fluorosis (which I would consider more an aesthetic effect, rather than a health effect).

    I’m glad that it’s up to you to decide what other people’s teeth should look like.

    Anyway, I think this paper give a view more inline with reality:

    Currently, the benefits of water fluoridation are exaggerated by the use of misleading measures of effect such as percent reductions. The risks are minimized by the characterization of dental fluorosis as a “cosmetic” problem. Yet a study of the psychosocial impact of fluorosis found that “10 to 17 year olds were able to recognize very mild and mild fluorosis and register changes in satisfaction with the colour and appearance of the teeth.”18 The investigators also stated, “The most dramatic finding was that the strength of association of [fluorosis] score with psycho-behavioural impact was similar to that of overcrowding and overbite, both considered key occlusal traits driving the demand for orthodontic care.”.

  153. #154 A note of interest
    December 2, 2010

    I love that the Sid Offit that blithely dismisses concerns about the impacts of mumps or measles infection will get his or her undies in a bunch over teenagers fretting about tooth color.

    Quite amusing!

  154. #155 Seamus Ruah
    December 2, 2010

    “I swear to god I did not know this was such a hot button issue.”
    Posted by: coby | December 1, 2010 3:42 PM

    I find this rather difficult to believe.

  155. #156 Orac
    December 2, 2010

    Is it possible for people on this blog to address some of the key issues on water fluoridation that we discuss in our book without ranting, raving,accusing,insulting and otherwise denigrating those who have spent many years researching the issue and have had the temerity to challenge this practice?

    Uh, people on the blog have been addressing the key issues regarding water fluoridation. Coby and you have been ignoring, poo-pooing, or sidestepping those legitimate criticisms.

    Given your questions, though, Dr. Connett, perhaps you could tell us: Why do you appear on Joe Mercola’s video show? Ditto Mike Adams. Ditto Alex Jones. Ditto Autism One Radio. These are not sources that are what anyone would consider to be reliable or even respected. In fact, if you search for these names on my blog you’ll see ample evidence that they all promote pseudoscience and even anti-science. Seriously, if you want to be taken seriously in your complaints, it would really help you if you would avoid people like this and stick to reputable media outlets.

  156. #157 Orac
    December 2, 2010

    “I swear to god I did not know this was such a hot button issue.”
    Posted by: coby | December 1, 2010 3:42 PM

    I find this rather difficult to believe.

    Me too, particularly if his father has ever discussed his work on his book with him.

  157. #158 Philip
    December 2, 2010

    Interesting write-up at the Health Journal Club on the CDC’s latest estimate of dental fluorosis prevalence

    http://healthjournalclub.blogspot.com/2010/12/cdc-update-on-dental-fluorosis.html

    Over 40% of 12-15 year olds now have signs of dental fluorosis, at least according to the CDC.

  158. #159 Sid Offit
    December 2, 2010

    @Paul
    Congratulations on the book. I’ll have to order it. Keep up the good work

    Why after four and half years has the US EPA not done this?
    b) Why did the ADA dismiss the relevance of this review to water fluoridation on the day it was published?

    Becasue they want to preserve the illusion that they’ve performed some type of miracle saving America’s teeth – and they don’t want to be embarrassed for their ill-advised inititatives.

    ————————-

    @Scientizzle

    approximately half of Americans don’t have access to acceptable levels of professional dental care.

    Ah, how sweet, social equity. I’m beginning to tear up. Just make all the kids suffer so you can indulge your egalitarian fantasies

    transient concern

    Water’s too dangerous for babies to drink is a transiet concern? Funny.

  159. #160 Lynxreign
    December 2, 2010

    Coby, you said way back in @21

    That said, when a well spoken climate sceptic shows up at my door, I have plenty of evidence in the form of links to research etc to provide to bolster my arguments against theirs. I would like to see some of that from some of the posters here with such strong opinions.

    Which is all well and good for those people that are arguing that flouride isn’t what the book says it is. However, many of the commenters aren’t arguing that at all. For example, I’m stating that this post is incomplete, seems misleading, is written in a way that reminds me of other crank-science psots and fails to give evidence for statements made, not just links, but even simple explanations. It is making several claims that are at odds with generally accepted knowledge and are trying to sell a book. They are trying to convince me and should show the evidence to back it up. I’m not trying to convince them of anything more than the fact that so far, based on what they’re showing me, how they write and other factors I think they’re barking into their hat and will be telling others my opinion that they’re cranks.

  160. #161 mandas
    December 2, 2010

    coby

    I said earlier that I would keep right away from this one because I don’t know anything about the subject, but from reading all the posts and most of the links, I am going to throw my two cents worth in, not from a purely scientific perspective, but more from a ‘rational’ review of what has been said and from a purely opined position.

    It would appear that – at least a few decades ago – there was a perfectly good reason to add fluoride to drinking water to reduce dental decay etc. I don’t buy the informed consent argument – lots of things are added to drinking water and other things we consume without our knowledge or consent (and yes, chlorine is a perfect case in point that people may wish to argue about).

    However, given other improvements in public health, such as better toothpaste, the ‘need’ to use fluoride has probably diminished somewhat in recent years. We still use it because we still use it, not because we have sat down and systematically reviewed the objective cost vs benefits (I am sure some will dispute this though). There are plenty of cases of the continued use of things long after their effective ‘use by dates’, so it is not an argument to suggest that public health authorities only use it because it is necessary.

    On the other hand, I tend to see a lot of the ‘anti’ arguments as being rather overstated and hysterical. Apart from the really minor problem associated with tooth staining (which I would suggest is far worse from smoking, drinking coffee and red wine – amongst other things), the arguments about fractures and ‘lower IQ’ etc are so statistically insignificant that they appear to be more a search for something – anything – to prove a case rather than being an obvious problem (does that remind anyone of anything?). The arguments about ‘industrial waste’ and ‘toxic poison’ etc are idiotic nonsense, and have no place in a rational discussion. And the case of Dr Beck and Paul Connett are somewhat undermined (at least in front of people who very wary of dealing with psuedo scientific bullshit) by their association with the usual cranks who support every ‘anti’ cause. I patently ignore everything published or supported by crazy people and organisations like the SPPI, jonova, monckton and wattsupmybutt. As soon as you associate with them, you alienate a lot of rational people (but you do gain the new age crystal, denialist crowd – is that what you want?).

    So for what its worth, it would appear from my analysis of this argument – which I have to admit is my first real look at the issue – that the cases both for and against fluoride are rather minor. It almost certainly was of benefit in the past, but those benefits have reduced over time. On the other hand, it appears to be doing virtually no harm at all. So on an objective cost vs benefit analysis, I would suggest there is little in it either way. So to be frank, I am at a loss to understand why people are so passionate about it.

    I would have thought there were far more important things to worry about.

  161. #162 Beaker
    December 2, 2010

    @Paul Connett:
    I’ll go through your arguments. I’ll see how far I get today, but have little time, so others will follow tomorrow and in the weekend:
    1) Fluoride is added to the water and other substances are not because fluoride is a simple and cost effective measure that benefits the health of the whole population and that can actually be practically executed. It benefits everyone who has teeth, other than for example folic acid, which only benefits expectant mothers. It can be administered through water, other than vaccinations, for example. Governments have considered adding other substances to water or food, but this can be done with very few.

    2) Bad argument (Coby, please teach your father and Paul Connett a little bit about argumentation). Different countries will take different decisions, not necessarily because the science is different but because the circumstances in the countries are different. The Netherlands does not add fluoride to the water, but chooses other ways to deliver fluoride, either through tablets, tooth paste and other means. When I was a kid I ate two fluoride tablets every day, on top of brushing my teeth with fluoride tooth paste. Fluoride treatment at the dentist was also very common.

    3) You answered your own question in 6).

    4) The CDC recommends adding fluoride to the water, because brushing teeth with fluoride tooth paste and drinking fluorided water has an added preventive effect above using fluoridated water alone (http://www.cdc.gov/mmwr/PDF/rr/rr5014.pdf).

    5) While the evidence that more children have dental fluorosis in areas with fluoridated water is strong (note that in areas with low fluoride concentrations in drinking water the percentage is still between 10 – 20%, against around 40% in areas with fluoridated drinking water), no such evidence exists for other conditions. Where evidence of adverse health effects exists due to chronic fluoride exposure, concentrations are much higher than allowed in the US. Could it have adverse health effects in the concentrations in the US? Possibly. Have such effects been shown? No.

    6) I cannot make a judgement on what the CDC could do if they are concerned on the intake of fluoride by babies, given that I don’t know how the US helps new mothers. One thing the CDC has done is convincing industries producing formula to lower fluoride concentrations in their products.

    7) This’ll have to wait.

    8) A review recommended lowering the safety limit to levels lower than the current 4ppm.
    a) I don’t know why the EPA hasn’t followed up on this. They may just be slow. Perhaps the new maximum levels do not occur in the population, removing the urgency. Note that what is under concern here will be the removal of natural occurring fluoride, since if fluoride is added the recommended level is 1 ppm, which from the studies I have seen would be above the newly recommended safety levels.
    b) I don’t know why the ADA dismissed the relevance to water fluoridation, but if I have to guess, what I wrote under a) would be the reason. Ie, the recommendations are relevant for the levels in areas where natural occurring fluoride in the water is high, not for the parts where water is fluoridated, since those levels are far below the limits.
    c) Ditto for the CDC.
    d) From what I know of the CDC and ADA, they don’t determine Maximum Contaminant Level Goals, that is the job for the EPA. All the reviews I have seen so far indicates that levels of 1ppm are low enough so no chronic toxicity will occur (except for dental fluorosis), which is also the position of the CDC (for example http://www.york.ac.uk/inst/crd/fluores.htm).
    e) Fluoridating countries have not acted upon the review of the NRC (not the EPA) recommending lowering of the MCLG, because the levels talked about in the NRC study are twice as high as those common with fluoridation (2.0 mg/l). Hence, these limits are only relevant for areas where the natural occurrence of fluoride is high, not for areas where drinking water is fluoridated.

    Note by the way that the 10-fold uncertainty factor you talk about applies to animal studies. If human data is available, the factor is often 1. How can you not know that if you have studied the issue for many years? And if you knew it, why didn’t you mention it in your questions?

    9) The FDA has not been asked to regulate the ingestion of fluoride, because that is not the job of the FDA. Monitoring ingestion of tap water and setting limits there would be the task of the EPA. What do you expect the FDA to do? Put a warning label on water taps “WARNING, DO NOT SWALLOW 5 LITERS OF WATER. KEEP OUT OF REACH OF CHILDREN. IF YOU ACCIDENTALLY SWALLOW 5 LITERS OF TAP WATER, SEEK PROFESSIONAL HELP OR CONTACT A PHYSICIAN IMMEDIATELY.
    Furthermore, FDA is mainly concerned with acute toxicity. Safety limits in that are often much lower than they have to be.

    10) I’ll save this one for next time.

  162. #163 Beaker
    December 2, 2010

    Sid Offit:
    “I’m glad that it’s up to you to decide what other people’s teeth should look like.”
    I never said it was up to my to decide what other people’s teeth should look like. What I said was that what a tooth looks like is a cosmetic issue, not a health issue.

    Yes, such issues may have pscyhosocial effects, but than, so do cavities.

  163. #164 Kris Rhodes
    December 2, 2010

    @148

    3) The level of fluoride in mothers’ milk ranges from 0.04 to 0.004 ppm. This means a bottle fed baby in a fluoridated community can get up to 250 times the amount of fluoride that a breast fed baby gets; is that wise?

    I’m with the others that say you sound like a crank. That’s not a real question, that’s scary hand waving. If there’s a problem, present the problem. If you can’t… SCARY HAND WAVING! Boo!

    Let me try:

    The level of mothers’ milk in mothers’ milk is 1 million ppm. This means that a formula fed baby gets infinitely smaller doses of mothers’ milk that a breast fed baby gets; is that wise?

    Just as valid as your question.

    I don’t know enough about the topic to really assess fluoridation, but you sure do a good job of looking like a fear monger.

  164. #165 M
    December 2, 2010

    “I don’t know why the EPA hasn’t followed up on this. They may just be slow.”

    In fact. For example, the EPA was sued in 1999 to regulate GHGs. In 2007, the Supreme Court told them they needed to figure out if GHGs endangered human health and welfare. It wasn’t until the end of 2009 that an Endangerment Finding was made, and the first cars produced under the new standards based on the Finding will be made in 2011.

    The wheels of the government turn very very slowly. But I imagine that if the NRC made the recommendation, then it is on the EPA’s radar. http://www.cdc.gov/fluoridation/safety/nrc_report.htm

    Also, perhaps the right way to go about this is to actually encourage or fund the higher quality studies that were suggested by the York review.

  165. #166 crakar24
    December 2, 2010

    Well here in Australia they started putting fluoride into bottled water.

    http://www.smh.com.au/environment/water-issues/bottled-water-companies-win-fluoride-battle-20090716-dmjg.html

    Off topic, outspoken anti fluoride advocate Mr Oakley is a resident of Geelong. Just so happens to be my home town, two outspoken advoctes from one place? Surely just a coincedence.

    I wonder what his thoughts are on AGW?

  166. #167 Scientizzle
    December 2, 2010

    @Scientizzle

    approximately half of Americans don’t have access to acceptable levels of professional dental care.

    Ah, how sweet, social equity. I’m beginning to tear up. Just make all the kids suffer so you can indulge your egalitarian fantasies

    And the evidence that anyone has been made to suffer because of fluoridation is…what now? Are you tearing up at the tweens with tooth spots?

    Give it another shot, sport. I’m sure you can do better than this. Usually your dribble has the merest glimmer of something useful.

  167. #168 Paul Connett
    December 2, 2010

    Several of you have asked why I have accepted to do interviews on programs that do not pass your litmus test of acceptability. The simple fact is that in 14 years I do not think I have refused one request for an interview whether it be from the mainstream, left or right wing or further afield. We are trying to educate everyone we can on this issue.

    Surely the point that should concern you is not to whom I give interviews but rather what I say in them. The interviews I have given to several of the interviewers who offend you are readily available on the internet so by now you must have had a chance to watch them. Have I said anything in any of these that strays from your sense of scientific correctness? In actual fact I have used several of these opportunities to reject the wilder conspiracy theories. We know just how these conspiracy theories distract from the solid scientific and ethical reasons for rejecting this practice.

    For those of you who have received much of your information on this issue from the movie Dr. Strangelove (if you knew how many times we have to put up with people making “clever” jokes about this movie at our expense you would be embarrassed to repeat them) you will probably find it difficult to believe that in the 1950s and 1960s there were highly reputable scientists opposing fluoridation such as Dr. Fred Exner (a prominent radiologist), Dr. George Waldbott (one of the world’s leading allergists) and the Nobel laureate Dr. Fred Sumner (one of the world’s leading experts on enzyme chemistry) but proponents managed to drown out their powerful and rational arguments by using similar distractions that some of you are using today.

    As I mentioned before the two major tactics used by promoters to keep the media, the public, and professionals away from the scientific literature is to claim that they have “authority” on their side, while opponents are “scientific illiterates.” Before my wife forced my hand on this matter I too had been duped by the same all-pervasive view of fluoridation opponents.

    The “authority” proponents’ claim on this matter stems largely from a list of endorsements that they cite ad nauseam. However, when you check into the history of these endorsements (as we do in our book) you find that the all-important pivotal endorsement came from the US Public Health Service (US PHS) in 1950. All the rest fell like a series of dominoes.

    However, when the US PHS endorsed fluoridation in 1950 not one single fluoridation trial had been completed and practically no health studies of any significance had been published. Whatever the motivations for this reckless endorsement it cannot be claimed to have been as result of scientific inquiry because the science was simply was not on the table. Not much science has been added since. Much of the investigation on health has taken place in countries that have moderate to high natural levels of fluoride in their water like areas of India, China, Mexico and parts of Africa.

    There is absolutely no question that fluoride damages health the only question to be resolved is whether there is an adequate margin of safety between the doses found to cause harm and the doses received among a population drinking uncontrolled amounts of fluoridated water and fluoride from many other sources.

    Proponents seldom discuss the concept of margin of safety and continue to obfuscate the key difference between concentration and dose (as several correspondents have done on this blog. Someone drinking 4 liters of water at 1 ppm would get as much fluoride as someone drinking one liter at 4 ppm). Worse still they have failed to do the most basic health studies in fluoridated communities that cry out for investigation, e.g. a possible association between living in a fluoridated community and arthritis (the first symptoms of fluoride’s damage to the bone is identical to arthritis); lowered IQ (Xiang et al. 2003 a,b estimate that IQ is lowered at 1.9 ppm) and lowered thyroid function (doctors used to use fluoride tablets to lower thyroid function among patients with hyperthyroidism Galleti and Joyet, 1958 and one Ukranian study found increased thyroid pathology among people drinking water at 2.3 ppm fluoride, Bachinskii et al, 1985). Nor have researchers in pro-fluoridation countries (except for one small study by Morgan et al. 1998) used the obvious non-invasive biomarker of the severity of dental fluorosis (which is linearly related to the amount of fluoride a child is exposed to before their permanent teeth have erupted) to investigate a number of childhood conditions that maybe plausibly be related to fluoride exposure as has been done elsewhere (e.g. Alarcon-Herrera et al., 2001).

    If you don’t look you don’t find. But the absence of study does not mean the absence of harm.

    Today, those of us who have studied this issue and believe that fluoridation is an unnecessary and reckless medical practice and needs to be stopped, find ourselves with the formidable task of educating the public against enormous odds. We are up against the mighty power and influence of the Centers for Disease Control and Prevention (the most visible promoting agency in the Department of Health and Human Services empire) and the financial power of the American Dental Association (ADA) that raises over $100 million a year and maintains a 20 person-lobby in Washington, DC. Both have the ability to mobilize two huge chains of command all the way down to local dental associations and local health officials and both have reputations and possible liabilities to protect. Meanwhile, we have very few investigative journalists prepared to do a decent job on this and we have a public that puts their trust in the “white coats” who tell them with complete assurance that the practice is “safe and effective” even they have not usually had the time to study the literature!

    Over the last few years we have set out to educate as many people as we can with our website; with videotaped interviews of leading scientists opposed to fluoridation and now this book.

    I do not pretend that fluoridation is the most important issue confronting our planet, but I hope that you would agree that it is very serious when public health policy is not informed by the best science. Our book indicates that this is the case with fluoridation. Moreover, unlike many other environmental and health concerns, if we could only secure the political will this issue is as easy to end as turning off a spigot at the water works. The trouble is getting that political will. We need many more people educated and involved.

    In particular, we need more serious scientists to delve into this issue and I hope that they will. Our book was meant to reach them. However, if serious scientists do not get involved – even to the point of refusing to read the book – do they have the right to complain about those that fill the vacuum?

  168. #169 k
    December 2, 2010

    [offensive and gratuitious insult deleted]

  169. #170 Anonymous
    December 2, 2010

    [deleted]

  170. #171 Anonymous
    December 2, 2010

    [deleted]

    [k, aka Anonymous, you have lost the right to post here. Unless you have something very useful to say your comments will be deleted as soon as I see them - coby]

  171. #172 Orac
    December 2, 2010

    Several of you have asked why I have accepted to do interviews on programs that do not pass your litmus test of acceptability. The simple fact is that in 14 years I do not think I have refused one request for an interview whether it be from the mainstream, left or right wing or further afield. We are trying to educate everyone we can on this issue.

    No, several of us have asked why you do interviews with utter conspiracy mongering cranks like Alex Jones and quacks–yes, quacks–like Joe Mercola and Mike Adams.

  172. #173 mandas
    December 2, 2010

    Paul and coby

    I think post #170 says volumes:

    “……today, those of us who have studied this issue and believe that fluoridation is an unnecessary and reckless medical practice and needs to be stopped, find ourselves with the formidable task of educating the public against enormous odds. We are up against the mighty power and influence of the Centers for Disease Control and Prevention (the most visible promoting agency in the Department of Health and Human Services empire) and the financial power of the American Dental Association (ADA)…”

    So can I get this straight? Fluoridation of the water supply is reckless and unnecessary because you say so. And we should go along with what you say rather than the CDC, Department of Health and the ADA?

    Not only that:

    “….Meanwhile, we have very few investigative journalists prepared to do a decent job on this and we have a public that puts their trust in the “white coats” who tell them with complete assurance that the practice is “safe and effective” even they have not usually had the time to study the literature!….”

    Yeah. We should trust those journalists rather than putting our faith in ‘white coats’ (ie scientists).

    “….There is absolutely no question that fluoride damages health….”

    Well yeah, yes there is!

    I’m going to admit – once again – that I am not an expert in this subject and my knowledge is strictly limited to reading everything that has been posted on this thread. As coby well knows, I am a fairly prolific poster here, and my posts (I believe anyway) are generally very rational and I stick to the science and rational debate (although I can be rather abrasive in my opinions). That being said, I am going to ask coby to take a long hard look at what is being opined here.

    If this was an anti-AGW post, coby would have hauled the posters over the coals ages ago. But not in this case. I understand there are obviously emotive connections, but they really have no place in a scientific debate.

    Dr Beck and Paul Connett may be right. As I said, I am not an expert. But unfortunately, you are both coming across as tin-foil hat wearing conspiracy theorists, who have conducted an Excel spreadsheet analysis of a small corner of the USA and extrapolated that to the rest of the world and determined that the consensus is wrong and you are the white knights setting out to save the world and expose the conspiracy.

    I – for one – can be convinced. But if you can’t convince me, you aren’t going to convince others here. And you have failed utterly to convince me so far. I am going to stick to my earlier view that this is so unimportant that I am at a loss to explain why it has gone on for so long. The case either way is not strong.

  173. #174 coby
    December 2, 2010

    mandas, I do find you to be a generally fair and rational contributor here, contributions I greatly appreciate, but I have to object to this:

    “….There is absolutely no question that fluoride damages health….”

    Well yeah, yes there is!

    The full quote is: “There is absolutely no question that fluoride damages health the only question to be resolved is whether there is an adequate margin of safety between the doses found to cause harm and the doses received among a population drinking uncontrolled amounts of fluoridated water and fluoride from many other sources.”

    This does not strike me as at all unreasonable.

  174. #175 Dappledwater
    December 2, 2010

    But unfortunately, you are both coming across as tin-foil hat wearing conspiracy theorists

    Aw, c’mon Mandas, I expected better of you. I’m willing to defer judgement until I’ve read the book and supporting literature, but I don’t have time to do so at the moment. I was kind of hoping to see some reasoned to and fro here (save me some of the effort) , but the pro-fluoride brigade have only insults to offer so far (see above).

  175. #176 Marco
    December 3, 2010

    Good, Paul Connett, it is about what you say. Then let’s take that:

    In your interview with Teri Arranga from Autism One you supported her linking of fluoridation with the vaccine-autism ‘debate’.

    Care to expand on that? to me it sounded like someone (that’ll be you) was supporting the claim that vaccines are causing autism.

    Or take the Alex Jones interview, where you linked lower IQ to fluoridation, despite the fact that each and every one of those studies used much higher fluoride levels, and were generally highly statistically questionable. I’ve seen FAN promote the Xiang et al study, in which the link was mainly due to 8, yes eight, children. This should abhor anyone who knows even the slightest about epidemiology.

  176. #177 Beaker
    December 3, 2010

    @Coby:
    Could I ask you a serious question. If you look at post 170, does it really strike you as anything different than the average global warming denier?

  177. #178 skip
    December 3, 2010

    This should abhor anyone who knows even the slightest about epidemiology.

    Sorry, Marco. But having nothing of substance to contribute to this thread, Skip the Grammar Nanny will just ding your improper use of “abhor” in this sentence, which should have been worded, “should be abhorrent to” or replaced with a suitable substitute, such as “appall”.

  178. #179 Marco
    December 3, 2010

    Thanks, Skip…I was just so abhorred (*grin*) by this little incident that my non-native English speaking background surfaced.

  179. #180 skip
    December 3, 2010

    my non-native English speaking background surfaced.

    Oh, forgot about that . . . I am abhorrent.

  180. #181 Lynxreign
    December 3, 2010

    Coby @176

    mandas, I do find you to be a generally fair and rational contributor here, contributions I greatly appreciate, but I have to object to this:

    “….There is absolutely no question that fluoride damages health….”
    Well yeah, yes there is!

    The full quote is: “There is absolutely no question that fluoride damages health the only question to be resolved is whether there is an adequate margin of safety between the doses found to cause harm and the doses received among a population drinking uncontrolled amounts of fluoridated water and fluoride from many other sources.”

    This does not strike me as at all unreasonable.

    Seriously? The full quote adds nothing to the part mandas quoted. There are absolutely questions as to whether flouride damages health and to state otherwise is unreasonable. You have an entire comment thread here of people posting rebuttals to the idea that flouride damages heath, Orac wrote an entire post about it, they’ve included links to papers and other sites all of which question the idea that flouride damages health.

    If there really was no question, they wouldn’t need to have written this book. There are many questions, they’ve failed utterly to convince people here so they make statements like that one.

  181. #182 GGMcGready
    December 3, 2010

    @ #183
    I knew nothing of this debate before this thread started. Indeed I didn’t even know this was a contentious matter. Hence, I have been reading the comments as a neutral. I am becoming suspicious of the level of vitriol being expressed by the pro-fluoride posters here. I have to say, that while I know next to nothing of the science behind the arguments (though I have been reading the links provided with interest), the authors of the book are coming across as far more reasoned than their detractors. In particular, I am deeply suspicious as to why you would purposefully misconstrue the full quote that you highlighted in your Post #183. Even when I read Dr. Connett’s originally-posted statement that you subsequently referred to, I took from it the following: “fluoride is damaging to health at known *high* concentrations, hence the argument boils down to whether we have supplied a sufficient safety factor in its use as a systemic agent in water supplies”. This seems a totally reasonable argument, and would be my own starting point if I were fired up about this issue enough to want to research it in detail.
    So why were you at such pains to misrepresent what appears to me an entirely fair statement by Dr. Connett? Sounds like you are suffering from as much bias and dogma as you accuse the authors of.

  182. #183 Lynxreign
    December 3, 2010

    GGMcGready @184

    I’m not sure what you’re talking about. I quoted exactly what Coby posted in its entirety. He’s referring to a statement referenced in Paul Connett’s post @170. I went back and read it and that’s an accurate quote. Where are you getting the quote you refer to?

  183. #184 SteveF
    December 3, 2010

    “Hence, I have been reading the comments as a neutral.”

    lol

  184. #185 Beaker
    December 3, 2010

    @GGMcGready
    “I am becoming suspicious of the level of vitriol being expressed by the pro-fluoride posters here.”

    I think I haven’t been particularly vitriolic here, but let me explain my own apprehension at the anti-fluoride posters, specifically James Beck and Paul Connett.

    I have been following all kinds of quackery for several years now. Homeopathy, chiropraxy, second-hand smoke denialism, reiki, anti-vaccination woo etc etc. And the general writing style and style of argumentation of both authors are so reminiscent of these forms of bunk, that they raise a whole lot of red flags for me, to the point where I had dismissed them instantly. Seriously, if you cannot put up a decent argument in an OP, your underlying premises are most likely to be false and not worth my consideration.

    Let me give one example of this. James Beck asserts (he doesn’t provide valid reasoning) that fluoride is not (note the certainty) effective in reducing caries incidence. Meanwhile, he asserts (again without valid reasoning) that fluoride is the cause of a whole plethora of diseases (note again the certainty, not may be, it is the cause).

    However, even a cursory look at the literature shows that the evidence for efficacy is actually quite positive. There are quite a few studies showing this efficacy, and while none are top of the class, I’d say the weight of the evidence comes down favorably on being effective. Moreover, the studies are actually applicable to levels of fluoride in the US.
    Meanwhile, the number of studies on adverse health effects is much smaller, the studies are generally of much worse quality and the exposure levels generally not applicable to the levels in the US. So when looking at the literature, the situation is actually quite reversed to the one described by James Beck. Look at the criticism on the Li study that has been pointed out here and on Orac’s blog for an example of this.

    Also, look at post 148 and think through the answers to the questions. Are they really valid questions? I answered quite a few of them already in 164. Others have responded to parts of that post as well. Needless to say, I’m underwhelmed.

    For me, that is enough to show that the red flags I had when reading the posts by James Beck and Paul Connett were once again correct. While I thought the responses harsh to begin with, I actually think they were well-deserved.

    That doesn’t mean there isn’t a rational debate to be had on the merits of adding fluoride to the water versus other means of caries prevention. It just means that James Beck and Paul Connett fail to provide this rational debate.

  185. #186 GGMcGready
    December 3, 2010

    @ SteveF:
    “lol”
    A stunning argument, sir. However did you find the time to make it. The cogency – remarkable.

    @ Beaker:
    Thank you for your considered response. Vitriol is a red flag for me – I will be fair and accept that you have shown little or none of it. I fully accept that there are those strongly for and strongly against this argument and I also accept that there are several contributors who know this subject well, and I am not one. It seems there is evidence that a concentration of fluoride is efficacious. It also seems reasonable to me that there will be a concentration (and particularly a dose) of fluoride that is adverse to good health, although such a concentration (or dose) may be many times more than that normally applied to drinking water. My simple point is that vitriol is not argumentation, and I oppose it. I fully accept your right to raise what you see as valid red flags and I commend that you can do so in a considered manner.

    @Lynxreign (#185):
    “The full quote is: “There is absolutely no question that fluoride damages health the only question to be resolved is whether there is an adequate margin of safety between the doses found to cause harm and the doses received among a population drinking uncontrolled amounts of fluoridated water and fluoride from many other sources.”"
    And my interpretation of that quote is: “fluoride is damaging to health at known *high* concentrations, hence the argument boils down to whether we have supplied a sufficient safety factor in its use as a systemic agent in water supplies”.
    My understanding of your post #183 is that you are claiming that it *is* controversial that fluoride can be damaging to health at any concentration. Since it seems to me that fluoride can be damaging to health, then your position in the remainder of your Post #183 posits a misrepresentation of what the full quote from Dr. Connett is actually expressing. Such misrepresentation may be unintentional, but it may show bias on your part. That does not at all mean that you are not correct, or at least that you are not more correct than Beck, Connett, et al. Your bias may be well-founded in fact – I have to learn more to find out. Do you feel with hindsight that you may be misrepresenting or misinterpreting the intention of Dr. Connett’s full quotation?

  186. #187 Orac
    December 3, 2010

    I have been following all kinds of quackery for several years now. Homeopathy, chiropraxy, second-hand smoke denialism, reiki, anti-vaccination woo etc etc. And the general writing style and style of argumentation of both authors are so reminiscent of these forms of bunk, that they raise a whole lot of red flags for me, to the point where I had dismissed them instantly. Seriously, if you cannot put up a decent argument in an OP, your underlying premises are most likely to be false and not worth my consideration.

    Indeed. It’s actually quite possible, without even knowing much about a topic, to at least get a feel for whether you’re dealing with a crank or not. These websites share a lot of the same characteristics, both in design and the types of arguments used (such as the aforementioned “3,209 scientists against fluoride” gambit). Study enough crank websites, and you can develop a “Spider sense” that I now officially dub “crank-dar.” I have it, for sure, having spent so much time on so many different crank and denialist websites. The website cited by Dr. Beck as a good source for more information (the Fluoride Action Network webiste) screams crank website to me. True, it’s not (quite) as bad as Whale.to, Mercola.com, or NaturalNews.com, but it’s definitely got a lot of elements of a typical crank website. It immediately screamed “crank” at me the very first time I saw it.

    Now, of course, it’s possible that my crank-dar can be wrong, just as gay-dar can be wrong. Maybe the website designers are bad. Maybe they’re just fond of histrionic arguments. Maybe they’re on the side of science but don’t recognize logical fallacies and don’t know how to make a good scientific argument. However, in the case of the Fluoride Action Network website, the more I delve into it the less I think I’m mistaken in concluding that it’s a crank site.

    That doesn’t mean there isn’t a rational debate to be had on the merits of adding fluoride to the water versus other means of caries prevention. It just means that James Beck and Paul Connett fail to provide this rational debate.

    Exactly.

  187. #188 Lynxreign
    December 3, 2010

    GGMcGready @188

    So you’re taking me to task and claiming I’m going out of my way to misrepresent him by using his actual quote instead of the way you interpret it?

    Your interpretation is not my interpretation and I do not believe I am misrepresenting what is being said at all. The statement is an attempt to mislead the reader. The following statements are equally true:
    There is absolutely no question that water damages health the only question to be resolved is whether there is an adequate margin of safety between the doses found to cause harm and the doses received among a population drinking uncontrolled amounts of water and water from many other sources.
    There is absolutely no question that chlorine damages health the only question to be resolved is whether there is an adequate margin of safety between the doses found to cause harm and the doses received among a population drinking uncontrolled amounts of chlorinated water and chlorine from many other sources.
    There is absolutely no question that salt damages health the only question to be resolved is whether there is an adequate margin of safety between the doses found to cause harm and the doses received among a population eating uncontrolled amounts of salted food and salt from many other sources.

    One big part of the problem is that they imply dangerous amounts can be had simply by drinking more water and consuming it from vague “other sources”. They don’t state the levels that are dangerous, they don’t show how much water you’d have to drink to get that dose, they don’t show how likely it is that the dose would have that effect even when accompanied by so much water, flushing much from the body or if it would still be a problem over the amount of time it would take for a person to reasonably consume that quantity.

    Every one of those statements is a reason to question whether fluoride “damanges health” in any meaningful context.

  188. #189 GGMcGready
    December 3, 2010

    @ #190
    Lynxreign:
    “The statement is an attempt to mislead the reader.”
    I think this is where we disagree. I did not feel misled by the quotation we are referring to. I believe that I gained the exact context intended. Should Dr. Connett come back to this thread and claim otherwise, I will immediately retract my criticism of you.
    No doubt you will correct me if I am wrong, but I believe the quotation can be summarized as the following: “I am consuming ‘X’ amount of a substance. I have evidence that (many) times ‘X’ is harmful to health – hence I wish to know if ‘X’ itself is totally safe”.
    Why is this not a reasonable position from which to start an enquiry? [NOTE! It does not necessarily mean that the *end position* of that enquiry will be reasonable!]

    “They don’t state the levels that are dangerous, they don’t show how much water you’d have to drink to get that dose, they don’t show how likely it is that the dose would have that effect even when accompanied by so much water, flushing much from the body or if it would still be a problem over the amount of time it would take for a person to reasonably consume that quantity”.
    In the context of that quotation, I believe you. However is it not possible that they have done so in the book itself, and we should be less hasty in condemning them until there is a similar level of exposition as would be gained from reading the book?
    Do you actually expect a complete dissection of all arguments that they (and you) can make to be fought over on a blog?
    Do you think that disrespectful and vitriolic language promotes considered debate?
    Do you think that the authors are not actively involved in this thread because they are “cranks” running scared or because they believe that it is not possible to have reasoned discourse in this forum?

  189. #190 Ash
    December 3, 2010

    At the risk of generating more hostile comments than I normally get I have put up the post on fluoride toxicity I mentioned earlier: http://ashartus.wordpress.com/2010/12/03/fluoride-toxicity/

  190. #191 Lynxreign
    December 3, 2010

    GGMcGready @191

    No doubt you will correct me if I am wrong, but I believe the quotation can be summarized as the following: “I am consuming ‘X’ amount of a substance. I have evidence that (many) times ‘X’ is harmful to health – hence I wish to know if ‘X’ itself is totally safe”.
    Why is this not a reasonable position from which to start an enquiry? [NOTE! It does not necessarily mean that the *end position* of that enquiry will be reasonable!]

    Because it applies to every substance on earth that you ingest in any quantity whatsoever. There isn’t a single thing you can consume that won’t kill you at some dose. When the Many Times X that you’re investigating is on the order of ounces and you’re consuming 1 ppm, you’re wasting your time and the statement that Many Times X can kill you is misleading as you’re unlikely to ever actually consume that. Couple this with 40 to 50 years of large populations consuming 1 ppm with no easily discernable or readily evident deliterious side-effects and you’re wasting your time.

    In this case, you also have to remember that communities with higher concentrations than around 1ppm ocurring in their water supply take action to reduce it and that’s part of the flurodation debate as well.

    If scientists were to investigate and find there is a correlation, I’d expect the demonstration to be much more solid and focused than the diatribe given here.

    In the context of that quotation, I believe you. However is it not possible that they have done so in the book itself, and we should be less hasty in condemning them until there is a similar level of exposition as would be gained from reading the book?

    They’ve had plenty of opportunity to provide that level of exposition, but all they’ve said is “buy the book!” Surely they could focus on one of the claims above, demonstrate it reasonably with studies and data and convince those there through this method that they should purchase the book which would contain further information of a similarly robust scientific inquiry? Instead, they’ve thrown out a bunch of wildly disparate claims, absolute statements about their conclusion and no real supporting data. Much of the data they have provided is just a data dump, not bothering to associate articles with studies and leaving readers to wade through all their endnotes to figure out what they’re talking about.

    They’re the ones challenging the common assumptions, they should make the effort to at least convince people there’s something worth looking into. When approaching a community of scientists and scientifically thinking people, you need to provide some hard evidence or your not going to have much chance of success. As it stands, my most charitable expectation for their book is that all the data could be correct, but the writing and presentation are going to be terrible, making it hard for the reader to accept their conclusions. More likely, the data is crap, cherry-picked or mis-interpreted and the writing is still no good.

  191. #192 Sid Offit
    December 3, 2010

    I see a bunch of Oracians here.

    Which one are ewe?

  192. #193 Sid Offit
    December 3, 2010

    Should read:

    @mandas

    rather than the CDC, Department of Health and the ADA?

    Baaaaaa!

    I see a bunch of Oracians here.

    Which one are ewe?

  193. #194 Lynxreign
    December 3, 2010

    Oh Sid. Keep trying. I’m sure someday you’ll manage to say something clever. You haven’t yet, but keep trying! Perhaps you should practice to yourself quietly for awhile.

  194. #195 t34whryw734gvy87w34y
    December 3, 2010

    “From [Quackwatch]: “The antifluoridationists’ (“antis”) basic technique is the big lie. Made infamous by Hitler…”

    Yeah, I’ve got time for that…”

    Um, Coby? This isn’t a case of Godwin’s Law. It actually is a propaganda technique whose name was coined by Hitler.

    http://en.wikipedia.org/wiki/Big_Lie

    By dismissing Quackwatch, you’re being a complete idiot, Coby.

  195. #196 Todthegod
    December 3, 2010
  196. #197 James Beck
    December 3, 2010

    Dappledwater, your comment in #140

    I am not aware of any meta-analysis, recent or old, on efficacy. There is a recent meta-analysis on fracture the URL to which was given in an earlier comment. I looked at it and found it unintelligible. If that is my failing, I apologize; I was out of contact for a day and quite rushed. It is the only meta-analysis I recall on the possible toxicities. We have to add a caution to the usual ones in evaluating a meta-analysis. That is the difficulty in lumping data from different investigations in which different techniques, criteria, etc. may have been applied.

    Lynxreign, #142

    You ask what dose of fluoride was used to treat hyperthyroidism. Doses as low as 0.9–4.2 mg fluoride per day were enough to reduce the basal metabolic rate (BMR) of hyperthyroid patients and allevi­ate their condition. This corresponds to the range of fluoride ingested by many people living in fluoridated areas. The U.S. Department of Health and Human Services estimated that an adult in a fluoridated community ingests between 1.6 and 6.6 mg of fluoride a day from all sources combined.

    You ask about effects on the reproductive system in humans. In a 1956 report on the Newburgh-Kingston trial from 1945 to 1955 it is said that girls in fluoridated Newburgh reached menarche (onset of menstruation) five months earlier than girls in the control city Kingston.

    You ask for the evidence of association of fluoridation with osteosarcoma. There have been several investigations of a possible association over the decades, with mixed results. The paper by Bassin et al. in Cancer Causes and Control (May 2006) is probably the best, in part because the methodology exposes the association that has been unrecognized because of lumping age groups and times of exposure. These investigators found in a matched case-control study that young boys exposed to fluoride in their sixth to eighth years (which corresponds to the mid-childhood growth spurt) had a fivefold-to sevenfold increased risk of contracting osteosarcoma by the age of twenty.

    Beaker to Dapplewater in 143

    From the abstract you read: “RESULTS: Of the 59 publications identified, 3 systematic reviews and 3 guidelines were included in this review. While the reviews themselves were of good methodological quality, the studies included in the reviews were generally of moderate to low quality. The results of the three reviews showed that water fluoridation is effective at reducing caries in children and adults. With the exception of dental fluorosis, no association between adverse effects and water fluoridation has been established. Water fluoridation reduces caries for all social classes, and there is some evidence that it may reduce the oral health gap between social classes.
    CONCLUSION: Water fluoridation, where technically feasible and culturally acceptable, remains a relevant and valid choice as a population measure for the prevention of dental caries.” The authors have found a good review of three reviews of moderate to low quality selected from 59 publications. Can you justify their conclusion?
    By the way, they have embedded a conclusion of their own into their Results. The results showed what the reviews claim to have shown. They themselves didn’t study efficacy or harm in their review.
    And as another poster has pointed out, it may well be satisfactory for you to conclude that dental fluorosis is an esthetic rather than a health effect in your own mouth but not in another person’s mouth.

  197. #198 Kieran
    December 3, 2010

    I’m a biostatistician and I’ve had a look at the paper by Li et al.
    Before I comment on it, let me make a few general comments about medical/clinical research, since there will be many people who read this blog who are not in this area of research.
    Most medical/clinical research is done by people with little or no research training: clinicians in other words. When a paper is submitted to a medical journal it is generally peer-reviewed by people with little or no research training (clinicians again). From time-to-time, the literature in a particular area of medical/clinical research will be reviewed and summarized and these reviews are generally conducted by people who believe that because a study has been published in a peer-reviewed journal, its conclusions are sound (clinicians again).
    Now these comments don’t apply to all clinicians, but it’s my opinion that they apply to most clinicians doing research.
    Similarly, my comments don’t apply to all medical journals, just the vast majority. The exceptions would be the major general medical journals (N Eng J Med, JAMA, Lancet, BMJ, etc) which generally provide a fairly rigorous peer-review, as do the major epidemiological journals (Am J Epidemiol, Epidemiology) and the major cancer and cardiovascular journals.
    What these journals have in common is that they employ a statistical reviewer in the peer-review process. The vast majority of medical journals do not.
    There have been numerous reviews of the quality of statistical analyses in published peer-reviewed medical research. These date back over the past 30 years or so and they don’t paint a particularly pretty picture. See, for example, Altman DG and Bland JM (1991). Improving Doctors’ Understanding of Statistics. J R Stat Soc A 154(2): 223-267.
    These reviews had some impact – the incorporation by some journals of statistical reviewers into the peer-review process, for example – but for most medical journals, little has changed. What has changed over the past 30 years is the complexity of the statistical analyses being reported. You now have people who don’t even have a clear idea of what a p-value is (Small is good, right?), performing quite complex regressions on their data with no clear modelling strategy (Don’t you just click on “stepwise”?).
    The difference between journals that do and don’t employ statistical reviewers is most obvious, as you might expect, when you submit a paper and look at the reviewer’s comments that you receive back in return. If reviewers know that a statistician is reviewing the paper, they tend to restrict their comments to other aspects of the paper; they stay within their area of expertise, in other words. If, on the other hand, a journal does not employ a statistical reviewer, then the clinical reviewers feel free to provide comments on the statistical analysis and, believe me, the level of ignorance is simply breathtaking.
    A recent paper that I was co-author on was submitted to a journal that uses statistical reviewers where it received fairly intense statistical critiquing. Around the same time, a paper submitted to another (no statistical reviewer) came back with comments that could only be described as utter, utter bullshit.
    You know, they say that if you gave a chimpanzee a typewriter and enough time, it could produce the works of Shakespeare. It turns out that “enough time” would be more that the age of the Universe. But why wait that long, I’m pretty sure they could be knocking out peer-reviews for the Journal of Clinical Endocrinology & Metabolism after only a week or two.

    Anyway, here is may take on the Li et al paper.

    First and foremost, there seems to be no one with any significant statistical expertise involved in this study. I can tell this by the use of terms such as “correlated” when what they mean is “associated”. Similarly, reference is made to “fracture rates” when in fact no fracture rates are estimated in the study nir could they be given the way the study is designed.
    Second, the aim of the study is to estimate the prevalence of fractures, but this is not what is estimated in the study. If you wanted to estimate the prevalence of fractures you would ask “Do you have a fracture (Yes or no)?” to obtain the point prevalence or you could ask about fractures over a defined period of time: the last year or the last five years, for example, to obtain an estimate of period prevalence.
    One could argue that by asking about fractures since age 20 years, that the authors are estimating the cumulative risk of fracture during adult life, but this cannot be determined retrospectively since it excludes those who have died since age 20.
    It is difficult to interpret exactly what is being estimated in the study, but it is not a risk.
    The study is a cross-sectional survey conducted in six communities, but we are not told anything about where these communities are.
    The authors state that participants were recruited randomly from within these communities, but we are not told how. It is very difficult to draw a sample from a community at random and I would be immediately suspicious of a study that blandly stated that the sample was drawn randomly without providing any details what so ever.
    I’m not nit-picking here. The authors clearly do not understand sampling. I can tell that the data are at the very least from a stratified random sample because the samples have been drawn from within the communities and not one sample from across the communities. Given this, any results presented for the communities overall are incorrect because the data would need to be weighted to reflect the stratified sampling. So, for example, the estimated overall fracture prevalence of 6.42% is incorrect.
    Failure to weight the data will not affect the results presented for comparisons between the communities as long as we are prepared to accept that sampling was done at random within the communities. I’m not prepared to accept that.
    If the samples were drawn by, for example, selecting households at random, and then selecting individuals within these households then this would affect the whole analysis. Such a sampling design is often employed when sampling populations because it is convenient. It’s called cluster sampling and as long as the probability of selecting a household and the probability of selecting an individual within a households are known, the data can be weighted to provide unbiased estimates of population characteristics.
    So how the sample is drawn affects how it will be analysed and there is simply no information provided in the paper that describes this other that the statement that they were drawn randomly. A random sample would require a list of all residents. Such a list may exist, but we need to be told that. We also need to be told the population totals for each of these communities so we can determine the sampling fractions for each community.
    The multivariate analysis using logistic regression has clearly been conducted by someone who has no idea. The aim of this analysis should be to remove the influence of any confounding variables. In this study, the authors are interested the relationship between reporting of a fracture (that’s their outcome) and the communities that a participant lives in (that’s their exposure). A confounding variable is one that is associated with both exposure and outcome.
    In their analysis, the authors are selecting variables for inclusion into the logistic regression based on the variable’s “statistical significance”; in other words, based on its association with the outcome only. This is not what you do. Confounding causes bias. To determine if a variable is confounding the association between exposure and outcome you simply look to see if the association changes after you adjust for the variable. If the odds ratios after adjusting look markedly different from the odds ratios before adjusting then that is an indication that the variable may be a confounder. There is no significance testing involved, all you need is some criterion for determining how much the odds ratios have to change in order for you to decide that the variable should be retained in the model.
    I’m simplifying this modelling strategy to a large degree, but the point is that it’s not based on statistical significance.
    Overall, when modelling data you need to be sure of what you are modelling and I’m not sure exactly what that is in this study. It’s certainly not the risk of fracture; it’s the risk of reporting a fracture that occurred sometime in the past. What exactly is that?
    The risk of a fracture is not the same as the risk of reporting a fracture that occurred sometime in the past. Hip fracture is associated with mortality, but reporting a hip fracture that occurred in the past can only be done by people who survive.
    Given this, age would seem to me to be an important factor in the analysis, but there is no description of age provided at all, apart from mean ages. What use are the mean ages? Everyone had to be at least 50 years old to get into the study, so I could make a rough guess that the mean is going to be around 65, but it’s hardly a summary measure that’s very informative. How many old people are there in the samples drawn from these communities? Furthermore, there are many ways of modelling age in a logistic regression. You could enter it a linear effect or a non-linear effect, or you could model it as a categorical variable. How was it done in this study?
    One last point on the logistic regression modelling. If the authors wish to report the statistical significance of associations between the six communities and the risk of reporting a fracture (Tables 2, 4, and 5) then that is first done by one overall test. A Wald’s Chi-square on 5 degrees of freedom from which you would get one p-value. The individual p-values reported in these tables are of no particular use unless the overall p-value is significant.

    James Beck described this as “one of the better studies”. Maybe it is, but it’s a crap study.

  198. #199 Lynxreign
    December 3, 2010

    James Beck @199

    You ask what dose of fluoride was used to treat hyperthyroidism. Doses as low as 0.9–4.2 mg fluoride per day were enough to reduce the basal metabolic rate (BMR) of hyperthyroid patients and allevi­ate their condition. This corresponds to the range of fluoride ingested by many people living in fluoridated areas. The U.S. Department of Health and Human Services estimated that an adult in a fluoridated community ingests between 1.6 and 6.6 mg of fluoride a day from all sources combined.

    If this is true (and really, you need to start linking to the sources) then a reasonable conclusion would be that ingesting flouride from “all sources combined” over the period of a day does not affect people the way concentrated tablets do as there’d be an epidemic of people with thyroid conditions. That or flouride only brings the thyroid to a certain point and then ceases to have any affect. There are others as well, but if those numbers are correct, despite the huge ranges for each, then flouride doesn’t seem to be a problem in this area.

    Then again, as I mentioned, those are huge ranges for those numbers. Large enough to almost render them meaningless. If 90% of people needed the 4.2 mg for it to be effective in tablet form and if 95% of the adults in a flouridated community only get the 1.6 mg level from all sources combined (which still seems high to me), then you could see why we wouldn’t have seen a problem with it in the general community. Then again, it wouldn’t be a problem with the general community if that were the case. I’d love to see %s associated with the dosages in each of those cases. I’d also like to know dates that the information is for and the sample size for the people receiving the tablets and more information on what their conditions were that the flouride was intended to correct.

    You ask about effects on the reproductive system in humans. In a 1956 report on the Newburgh-Kingston trial from 1945 to 1955 it is said that girls in fluoridated Newburgh reached menarche (onset of menstruation) five months earlier than girls in the control city Kingston.

    You’re basing the statement that this is the cause on a single 50+ year old study? And the similar study about low sperm count is from when? Is there just one of those as well? What % of girls had the earlier onset? What were the ranges of ages for each group?

    You ask for the evidence of association of fluoridation with osteosarcoma. There have been several investigations of a possible association over the decades, with mixed results.

    You have mixed results, with one paper you consider the best, but you stated it as strong evidence in your original post. Are there more papers than this one that show this same result? Why do you dismiss the mixed results and call it “strong evidence”?

  199. #200 Dappledwater
    December 3, 2010

    James Beck @ 199 – thanks.

  200. #201 coby
    December 3, 2010

    Lynxreign:

    @183
    “Seriously? The full quote adds nothing to the part mandas quoted. There are absolutely questions as to whether flouride damages health and to state otherwise is unreasonable. You have an entire comment thread here of people posting rebuttals to the idea that flouride damages heath, Orac wrote an entire post about it, they’ve included links to papers and other sites all of which question the idea that flouride damages health.”

    I don’t think this is correct. The major criticisms I have seen wrt the toxicity of fluoride are not that it does not exist (maybe you can support your statement here with some quotes?) but that it does not occur at dosages typical at water concentrations of 1ppm. My impression is that the toxicity of fluoride at dosages typical at several times higher concentration levels, or at least many times higher, is not controversial.

    @201
    If this is true (and really, you need to start linking to the sources) then a reasonable conclusion would be that ingesting flouride from “all sources combined” over the period of a day does not affect people the way concentrated tablets do as there’d be an epidemic of people with thyroid conditions. That or flouride only brings the thyroid to a certain point and then ceases to have any affect. There are others as well, but if those numbers are correct, despite the huge ranges for each, then flouride doesn’t seem to be a problem in this area.

    I agree, Dad should provide more direct citations, I have asked him to try to do this. But I don’t think you have arrived at a reasonable conclusion from your charitable assumption the numbers provided are correct, at least not without some additional knowledge specific to thyroid functions you may not be sharing. Your conclusion depends on the range of normal BMR levels, the range of abnormal BMR levels and the degree to which fluoride affects them.

    Your comment about how if it were true then there would be an epidemic relies on a general and very common misunderstanding of these kinds of medical statistics. I could tell you if you do X, your chance of Y are 20 times greater. You look around at everyone doing X, apparently without suffering from Y and say I must be wrong. Not necessarily, it really depends on the background rates involved. If the background rate is one chance in 1 million of getting Y, 20 times greater is one chance in 50,000. You will still look around and very likely see no one with Y, but in a city of 5 million people, all doing X, there will be on average 95 individuals who now have Y and who otherwise would not have. [update: which I would like to add is both not an epidemic and a number worth considering.]

    In the case of X = fluoridation, the legitimate questions are what are the “Y” effects and fluoride’s affect on background levels, and are they favorably balanced by any benefits to dental health. But to address that rationally, the above point must be understood.

  201. #202 Beaker
    December 3, 2010

    @James Beck
    “By the way, they have embedded a conclusion of their own into their Results. The results showed what the reviews claim to have shown. They themselves didn’t study efficacy or harm in their review. ”
    James, I’m posting this specifically because it shows one of your misunderstandings. And those misunderstandings illustrate why you are are, in my honest opininion, completely unfit to makea judgement on this data.

    First off all, the results section is correct. Reviews have shown a beneficial effect of fluoridation. You may not like this, but that is what every single scientifically valid review has found so far, and thus that is what should be presented in the results section.
    Reviews aren’t meant to parrot other articles. They are meant to summarize the currently available literature show their conclusions based on that. And those conclusions are sound. Based on the available literature, there is very little to no indication that exposure beneath 1 mg/l fluoride has any side effects, aside from an increased incidence of mild fluoridosis. You have offered nothing, and I mean exactly nothing, against that.

    But it shows something more abhorrent (that is the right word, skip? :) ). You have elevated studies showing negative effects of fluoride to “good studies”, while lowering studies showing efficacy of fluoride to “bad studies”. This leads you to opposite conclusions as the literature actually warrant. If you would be consistent, you conclusion would be exactly the opposite from the opening post.

  202. #203 Beaker
    December 3, 2010

    @Coby
    “I don’t think this is correct. The major criticisms I have seen wrt the toxicity of fluoride are not that it does not exist (maybe you can support your statement here with some quotes?) but that it does not occur at dosages typical at water concentrations of 1ppm. My impression is that the toxicity of fluoride at dosages typical at several times higher concentration levels, or at least many times higher, is not controversial.”
    But that wouldn’t be my impression if I read only post #170. Through the set-up of the post, if I would read only that, my impression would be that levels of fluoridation used in the US are close to those for negative health effects. I mean, if not, why write a book about it?

    And that is one of the problems I have with Beck’s and Connet’s argumentation right there. They hardly ever mention dosage, when this is important. They overstate negative effects, while understating positive effects.

  203. #204 Lynxreign
    December 3, 2010

    Coby @203

    See, that’s exactly what I’m getting at. There was no specificity in the post that would allow readers to judge the data, the claims or the issue. My comment is more about how they haven’t provided enough information for anyone to make sense of their comments or the sparse numbers they have provided.

  204. #205 Steve L
    December 3, 2010

    Holy cow — over 200 comments? Welcome to the internet Dr Beck. I grew up in Edmonton where we had fluoridated water. I was ticked when my dentist insisted for health reasons that I should not drink anything for a half hour after my fluoride treatment — where was the warning on toothpaste I used to eat? Anyway, I look forward to hearing more about this. But I’ve got to save the world first, so I won’t get to reading these comments any time soon. Best wishes.

  205. #206 coby
    December 3, 2010

    I believe some have asked about the lower IQ claims presented in the OP. Over at Orac’s thread about this post a commenter offered this:

    Biol Trace Elem Res. 2008 Winter;126(1-3):115-20. Epub 2008 Aug 10.
    Fluoride and children’s intelligence: a meta-analysis.

    Tang QQ, Du J, Ma HH, Jiang SJ, Zhou XJ.

    Department of Pathology, Nanjing University School of Medicine, Nanjing Jinling Hospital, Nanjing, Jiangsu 210002, People’s Republic of China.
    Abstract

    This paper presents a systematic review of the literature concerning fluoride that was carried out to investigate whether fluoride exposure increases the risk of low intelligence quotient (IQ) in China over the past 20 years. MEDLINE, SCI, and CNKI search were organized for all documents published, in English and Chinese, between 1988 and 2008 using the following keywords: fluorosis, fluoride, intelligence, and IQ. Further search was undertaken in the website http://www.fluorideresearch.org because this is a professional website concerning research on fluoride. Sixteen case-control studies that assessed the development of low IQ in children who had been exposed to fluoride earlier in their life were included in this review. A qualitative review of the studies found a consistent and strong association between the exposure to fluoride and low IQ. The meta-analyses of the case-control studies estimated that the odds ratio of IQ in endemic fluoride areas compared with nonfluoride areas or slight fluoride areas. The summarized weighted mean difference is -4.97 (95%confidence interval [CI] = -5.58 to -4.36; p

    PMID: 18695947 [PubMed - indexed for MEDLINE]

    I have not verified this to be accurate, nor can I offer an expert analysis of it. Two main questions come to mind: what dosage and concentrations of fluoride are we talking about here, and two, are these dosages possible/probable to recieve from 1ppm fluoride in drinking water?

  206. #207 Chris Ho-Stuart
    December 3, 2010

    The meta-analysusis paper mentioned by coby in #208 does not ever define dosages. The terms in the paper are all qualitative, not quantitative; speaking of “severe” and “slight” fluoridation. What this means is never defined.

    However, in chasing references, it seems that the problem arises with higher levels of fluoride than used in fluoridated drinking water. Coby, my guess is that you have been sucked in badly on this one. Asking questions is good, but you’ve learned this very late in the game.

    If I find more, I’ll let you know. Gotta run for now, sorry.

  207. #208 Dappledwater
    December 3, 2010

    The meta-analysusis paper mentioned by coby in #208 does not ever define dosages. The terms in the paper are all qualitative, not quantitative; speaking of “severe” and “slight” fluoridation

    Huh?. The paper doesn’t refer to fluoridation but fluorosis, presumably dental (staining, pitting of teeth) which normally occurs during childhood in areas where there are high levels of fluoride in the drinking water. The Deans Index describes levels of fluorosis – severe/moderate/mild etc according to the staining/pitting evident from visual inspection.

    And what do you mean by dosages?. Do parents typically record the water intake of their children for their first 8 years of life?.

    The paper, although short on detail , merely establishes a link between high levels of fluoride in drinking water (as evidenced by fluorosis) and low IQ. Nothing more. It does not follow from this paper, that levels in fluoridated water have the same effect, although I’m beginning to wonder.

  208. #209 Snowman
    December 3, 2010

    Coby should begin to think in damage limitation terms and put an end to this thread. Whatever I may think about the AGW hypothesis I have always found his blog to be a lively and interesting place. I regret the way its credibility and reputation have been shot to pieces by this foray into crankery.

    No doubt Coby will believe I am being disingenuous. But I am not. We are witnessing an example of how a reputation that has been built up over several years can be destroyed almost overnight.

    Coby, it was a serious error of judgment to have promoted this anti-fluoridation book. I think that much is obvious by now. Even your most ardent supporters have lapsed into embarrassed silence. The sooner you can put this episode behind you the better.

  209. #210 Rainborowe Spence
    December 4, 2010

    Cross-posted from Orac’s blog:

    Coby, you might want to read this if you want to understand why subgroup analysis is a problem:

    http://www.badscience.net/2009/04/a-frankly-thin-contrivance-for-writing-on-the-fascinating-issue-of-subgroup-analysis/

  210. #211 Dappledwater
    December 4, 2010

    by this foray into crankery

    You disappoint yet again Snowman. Given your climate crankery I thought you’d be better equipped to assess the situation. Tell me, how many studies on fluoridation have you read, and which ones really convinced you?.

  211. #212 Snowman
    December 4, 2010

    Dapplewater, your capacity to miss the point never fails to astound me.

  212. #213 Jack Savage
    December 4, 2010

    Just goes to show… we all have a little bit of the tin foil milliner in us.
    Next…Coby’s nephew from Alabama will post on Intelligent Design.
    Oh dear oh dear.

  213. #214 Jack Savage
    December 4, 2010

    Women sense my power…..

    http://www.youtube.com/watch?v=N1KvgtEnABY&feature=related

    Am I the only one old enough here to remember this?

  214. #215 Dappledwater
    December 4, 2010

    Snowman – Dapplewater, your capacity to miss the point never fails to astound me.

    So you haven’t read any studies on fluoridation?. Figures.

  215. #216 Beaker
    December 4, 2010

    @Coby:
    “I have not verified this to be accurate, nor can I offer an expert analysis of it. Two main questions come to mind: what dosage and concentrations of fluoride are we talking about here, and two, are these dosages possible/probable to recieve from 1ppm fluoride in drinking water?”
    I’ll repeat my comment I left at Orac’s blog here. I could not get the article, only look at the abstract. But from the abstract it becomes clear they looked at places with exposure to naturally occurring fluoride. What I’ve of such studies, the reference group generally has an exposure of 1 mg/l, while the moderate to how exposure ranges would be 4 to 8 mg/l, way above the levels used anywhere for fluoridation and probably not applicable to the levels people are exposed to here.

    @Dappledwater:
    “Huh?. The paper doesn’t refer to fluoridation but fluorosis, presumably dental (staining, pitting of teeth) which normally occurs during childhood in areas where there are high levels of fluoride in the drinking water. The Deans Index describes levels of fluorosis – severe/moderate/mild etc according to the staining/pitting evident from visual inspection.”
    I don’t think they looked at fluorosis, although it is hard to tell. Reading the abstract, it seems they used fluorosis when they meant fluoride a couple of times, given the way they use the terms. If they would have used fluorosis as a measure by some kind of index, that would have been mentioned more clearly (also, the categorization they use does not match any fluorosis indexes I’m aware of). Unless you actually had access to the paper?

    “And what do you mean by dosages?. Do parents typically record the water intake of their children for their first 8 years of life?.”
    That is one of the reasons why concentrations are often used. Otherwise you’ll have to guesstimate backwards.

    “The paper, although short on detail , merely establishes a link between high levels of fluoride in drinking water (as evidenced by fluorosis) and low IQ. Nothing more. It does not follow from this paper, that levels in fluoridated water have the same effect, although I’m beginning to wonder.”
    Why?

  216. #217 Chris Ho-Stuart
    December 4, 2010

    Replying to @210 by Dappledwater:
    Huh?. The paper doesn’t refer to fluoridation but fluorosis, presumably dental (staining, pitting of teeth) which normally occurs during childhood in areas where there are high levels of fluoride in the drinking water. The Deans Index describes levels of fluorosis – severe/moderate/mild etc according to the staining/pitting evident from visual inspection.

    I am referring to the paper mentioned in the thread: Fluoride and Children’s Intelligence: A Meta-analysis, by Tang et al, in Biol Trace Elem Res (2008), 126(1-3):115-20. The abstract is in @208, and a pdf preprint can be found at this link. (It’s in a collection of documents used in some commission or other; normally it is behind a paywall.)

    This paper is looking to “assess the strength of the association between the level of fluoride in water and IQ” (quoting from introduction).

    Your suggestion makes good sense… it appears to identify areas as “severe fluorosis” or “slight fluorosis” rather than by quantifying levels of fluoride in water directly. By this measure, areas with fluoridated water would be in the slight fluorosis area; not in the areas of severe fluorosis where a small drop in IQ levels is indicated.

    Hence this appears to be yet another case in which the Connett, Beck and Micklem are misusing references.

    Dappledwater continues: The paper, although short on detail , merely establishes a link between high levels of fluoride in drinking water (as evidenced by fluorosis) and low IQ. Nothing more. It does not follow from this paper, that levels in fluoridated water have the same effect, although I’m beginning to wonder.

    IMO the paper would suggest that levels of fluoride in fluoridated water would not have the low IQ effect which is discussed; they would be in the slight or non fluorosis areas.

    Questions are fine; but here as in other topics like AGW or vaccination or evolutionary biology, real scientific skepticism is being turned on its head and cherry picked or distorted information is used to manufacture doubt in a way that is far from reasonable.

    It’s been very interesting to look at this topic and I’ll be checking out further; as I have a longstanding interest in subjects like this where there are popular movements to object to conventional scientific conclusions.

    It sure looks at this point that the book being touted in this post is a poor guide, and belongs in the same category as books “raising questions” about AGW or vaccination or other topics which seem to attract this kind of pseudo-skepticism.

  217. #218 Paul Connett
    December 4, 2010

    Thank you Beaker for attempting to address the 10 questions I posed and doing it with the minimum of aggression. There are several mistakes and misunderstandings in your responses and I will be addressing these shortly. Meanwhile, have you yet prepared answers to questions 6 and 10, which you said you would get back to?

  218. #219 Militant Agnostic
    December 4, 2010

    I noticed the environmentalist dog-whistle “Hazardous Waste” in the subtitle of the book. It is not a good sign when the intellectually dishonest arguments start right on the cover.

  219. #220 Militant Agnostic
    December 4, 2010

    Coby, I just notice what your post previous to the anti-fluoride fiasco was.

    My irony meter just melted.

    You are definitely Hard on Equipment

  220. #221 Kieran McCaul
    December 4, 2010

    I’ve just had a look at the Tang et al. paper (Fluoride and Children’s Intelligence: A Meta-analysis, Biol Trace Elem Res (2008), 126(1-3):115-20).

    It’s supposed to be a meta-analysis of 18 case-control studies, but it’s not immediately clear to me after looking at Table 1 that any of the papers are case-control studies.

    A study that employed a case-control design would be evaluating the association between exposure (flouride) and disease (low IQ).

    So a case would be defined on the basis of IQ, but the way that the results are summarised in Table 1, suggests that in some of these studies the samples were drawn based on exposure.

  221. #222 Paul Connett
    December 4, 2010

    Beaker here I will comment on your responses to the 10 questions I posed to supporters of fluoridation on this list. Again I thank you for taking the time to do this.

    Beaker: I’ll go through your arguments. I’ll see how far I get today, but have little time, so others will follow tomorrow and in the weekend:

    Question 1) Why is it if it is a sensible practice to use the public water supply to deliver medicine, it has never been used again for this purpose for any other drug or nutrient (there is no evidence that fluoride is a nutrient)?

    Beaker 1) Fluoride is added to the water and other substances are not because fluoride is a simple and cost effective measure that benefits the health of the whole population and that can actually be practically executed. It benefits everyone who has teeth, other than for example folic acid, which only benefits expectant mothers. It can be administered through water, other than vaccinations, for example. Governments have considered adding other substances to water or food, but this can be done with very few.

    Paul: In actual fact it has not been done with any other medicine since fluoridation began, has it? In other words this delivery system – regardless of the purported benefits of the medicine – has not been used for any substance. Why is that? I think the answers are fairly obvious. 1) Once you add a drug to the water supply you cannot control the dose people get because people drink vastly different amounts of water. 2) You can’t control who gets it. Everyone who drinks water will get it, including the very young, the very old, the very sick those with a poor diet and who are nutritionally deficient. In the case of fluoride it was also include people with poor kidney function. These people will have a greater uptake of fluoride into their bodies than the average person. 3) There is no individual supervision by a doctor, which means that there is no one tracking any side effects. 4) It also violates the individual’s important right to informed consent to medication. The AMA defines this right pretty carefully on their web site.

    QUESTION 2) Why is it if the arguments are so overwhelmingly in favor of fluoridation, such that there is no room for debate on the issue, that so few countries actually use water fluoridation? Only eight countries in the world have more than 50% of their population drinking fluoridated water (Australia, Colombia, Ireland, Israel, Malaysia, New Zealand, Singapore and the US).

    Beaker 2) Bad argument (Coby, please teach your father and Paul Connett a little bit about argumentation). Different countries will take different decisions, not necessarily because the science is different but because the circumstances in the countries are different. The Netherlands does not add fluoride to the water, but chooses other ways to deliver fluoride, either through tablets, tooth paste and other means. When I was a kid I ate two fluoride tablets every day, on top of brushing my teeth with fluoride tooth paste. Fluoride treatment at the dentist was also very common.

    PAUL: Beaker I think you miss the point here. If this practice was as good as those who promote it in the US say it is why did so few countries follow America’s lead? Waldbott et al. (1978) document some of the efforts undertaken by fluoridation promoters in the US to get other countries to do so, but the vast majority resisted these efforts. On our web page we have listed a number of statements by countries that were convinced NOT to go ahead with this practice. (see http://www.fluoridealert.org/govt-statements.htm )The usual reasons offered, were that a) they didn’t feel all the health questions had been resolved and b) they were not willing to force this practice on citizens who didn’t want it. Yes you are correct that other countries have been able to fight tooth decay without putting this toxic substance in their drinking water, the Netherlands being one (although they did start). The vast majority of European countries neither fluoridate their salt nor their water and yet their teeth appear to be no worse than ours.

    Question 3) The level of fluoride in mothers’ milk ranges from 0.04 to 0.004 ppm. This means a bottle fed baby in a fluoridated community can get up to 250 times the amount of fluoride that a breast fed baby gets; is that wise?

    BEAKER: 3) You answered your own question in 6).

    PAUL: Not quite Beaker. In question 3) I raise the question as a general matter. When you have found out that the levels of fluoride in mothers’ milk are so extremely low doesn’t that raise a question about whether or not a) the baby actually needs fluoride (in other words if it does need it then clearly nature screwed up on baby’s first meal. Meanwhile, we know that no one has been able to show that there is a nutritional requirement for fluoride) and b) that there may be some exclusion mechanism operating here. Whether the latter is the case or not it would appear to be very lucky that fluoride levels are low in mothers milk because that clearly minimizes the baby’s risk of dental fluorosis and if you go to my question 7) even more lucky if it is serving to keep fluoride away from the baby’s developing brain.

    QUESTION 4) Why does the CDC Oral Health Division continue to push water fluoridation even though it admits the predominant benefits of fluoride are TOPICAL not SYSTEMIC (CDC, 1999)? In other words fluoride works largely on the outside of the teeth not from inside the body. Why expose every tissue in the body to a known toxic substance when you can brush it on the teeth and then spit it out?

    BEAKER: 4) The CDC recommends adding fluoride to the water, because brushing teeth with fluoride tooth paste and drinking fluorided (sic) water has an added preventive effect above using fluoridated water alone (http://www.cdc.gov/mmwr/PDF/rr/rr5014.pdf).

    PAUL: I would argue about how great that actual benefit is from ingesting fluoride (see chapters 6-8 in our book) however, be that as it may, doesn’t the CDC’s admitting this fact greatly undermine the case for forcing fluoride on people in their drinking water when if people want to be exposed to it they can do so by using the universally available fluoridated toothpaste to get the PREDOMINANT benefit? I think it would be useful to see exactly what the CDC said on this matter in their 1999 paper:

    “Fluoride’s caries-preventive properties initially were attributed to changes in enamel during tooth development because of the association between fluoride and cosmetic changes in enamel and a belief that fluoride incorporated into enamel during tooth development would result in a more acid-resistant mineral. However, laboratory and epidemiologic research suggests that fluoride prevents dental caries predominantly after eruption of the tooth into the mouth, and its actions primarily are topical for both adults and children.” (CDC, 1999).

    QUESTION: 5) The CDC has reported (CDC, 2005) that overall 32% of all American children now have a condition caused by swallowing fluoride called dental fluorosis (a permanent mottling and/or discoloration of the tooth enamel) and that for 12-15 year olds the percentage is 41% (CDC, 2010). What is the most convincing evidence that while fluoride is causing this condition by some biochemical mechanism a similar mechanism is not impacting other developing tissues in the child’s body which do have such visible signs of damage? These tissues include the brain, the bone and the endocrine system.

    BEAKER: 5) While the evidence that more children have dental fluorosis in areas with fluoridated water is strong (note that in areas with low fluoride concentrations in drinking water the percentage is still between 10 – 20%, against around 40% in areas with fluoridated drinking water), no such evidence exists for other conditions.

    PAUL: To state that NO such evidence exists is incorrect. An important study on osteosarcoma was carried out by Elise Bassin at Harvard as part of her doctoral thesis (Bassin, 2001). This was later published in 2006 (Bassin et al., 2006). She found in matched case-control study that young boys exposed who were exposed to fluoridated water in their 6th-8th years had a 5-7 fold increased risk of succumbing to osteosarcoma by the age of 20. Osteosarcoma is a fairly rare bone cancer but it often proves fatal in young men. This issue has a long history stretching back to observations of the bones of children in the Newburgh-Kingston fluoridation trial (1945-55); animals studies conducted by the National Toxicology Program (NTP, 1990) and a number of epidemiological studies with mixed results (see chapter 18 in our book for a listing and discussion.) While only a few hundred young men maybe affected by this condition how many amputations or even deaths would one accept in order to save a very small if any (see Question 10 below) amount of tooth decay? To date no one has published a refutation of Bassin’s work, although her thesis adviser Chester Douglass promised that he would do so in the Summer of 2006 and we are still waiting! Meanwhile, promoters of fluoridation are using this “promise” of an un-peer-reviewed and unpublished study as if it had actually occurred! (again see chapter 18 for an account of these shenanigans).

    As far as other health effects are concerned Beaker your argument here would be forceful if good faith efforts had been made in fluoridated countries to investigate a possible relationship between both short-term and long-term health effects that are PLAUSIBLY related to exposure to fluoride. Sadly many important health studies have not been attempted. For example:

    • Lowered IQ in children, even though twenty-three studies published in four different countries have now found an association between moderate and high fluoride exposure and lowered IQ in children (see chapter 15 in our book and question 7 below)
    • Alzheimer’s disease in adults, even though one study showed that rats given water containing 1 ppm of fluoride for one year had a greater uptake of aluminum into their brains and the formation of beta amyloid deposits, which are associated with Alzheimer’s disease (Varner et al., 1998)
    • Lowered thyroid function, even though doctors used to give fluoride to patients to lower thyroid activity (Galleti and Joyet, 1958), and millions of Americans today suffer from hypothyroidism or subclinical hypothyroidism, in which there occurs an abnormally low level of thyroid hormone without clinical symptoms or signs (see chapter 16 in our book)
    • Increased arthritis rates in adults, even though an estimated 46 million Americans have arthritis, and the first symptoms of poisoning of the bones by fluoride are identical to the first symptoms of arthritis (see chapter 17 in our book for a list of references)
    • Bone fractures in children, even though the first health study of children exposed to fluoridation (Schelsinger et al., 1956) showed an increase in cortical bone defects and a study from Mexico (Alarcon-Herrera et al., 2001) showed a positive linear correlation between the severity of dental fluorosis (a biomarker of fluoride exposure before the permanent teeth have erupted) and the frequency of bone fractures in children (see chapter 17 in our book; although the Mexican study had methodological weaknesses, its approach of using dental fluorosis as a simple and noninvasive biomarker was sound (see the comment below), and authorities in fluoridating countries should have attempted to repeat at least that aspect of the study)
    • Lowered melatonin levels and earlier onset of puberty, even though it has been shown that fluoride accumulates in the human pineal gland, (Luke, 1997, 2001) and lowered melatonin levels commensurate with earlier onset of puberty have been observed in animals exposed to fluoride from birth (Luke, 1997) (see chapter 16 in our book)
    • Irritable bowel syndrome, and the many other common complaints that, in some individuals, apparently are triggered by fluoride exposure (see chapter 13 in our book). Here governments that practice fluoridaiton have been unwilling to test these many anecdotal reports with carefully designed double-blind studies. Why not?

    BEAKER: “Where evidence of adverse health effects exists due to chronic fluoride exposure, concentrations are much higher than allowed in the US.”

    PAUL: Hardly Beaker. Xiang estimates that IQ is lowered at 1.9 ppm. To state the obvious a child drinking two liters of water at 1 ppm would get more fluoride than a child drinking one liter of water at 1.9 ppm. You like many other commentators on this constantly confuse concentration and dose (and dosage). Bachinskii et al. (1985) estimate that thyroid function is affected at 2.3 ppm. Li’s data (already cited many times) indicates that hip fractures MAY increase above 3 mg/day. Freni (1994) reported an association between lowered fertility among people in US counties with fluoride at 3 ppm or more. In the context of a situation where you cannot control how much water people drink or the fluoride they get from other sources, none of these levels could be described as “much higher” than allowed in the US. These levels are too close for comfort.

    BEAKER: Could it have adverse health effects in the concentrations in the US? Possibly. Have such effects been shown? No.

    PAUL: Again see my comment above. There is not much effort in fluoridated countries to investigate health effects. The absence of study does not mean the absence of harm.

    We review the poor science that has underpinned this practice since it first began in 1945, and endorsed in 1950 by the US PHS, in chapter 22. In addition to not attempting to investigate the many possible and plausible conditions that may be related to fluoridation two other crucial aspects of the bad science need to be highlighted.
    1) Researchers and government agencies in fluoridated communities are not tracking the fluoride levels in our bones, blood or urine. Why not? Isn’t exposure the first thing you want data on?
    2) Nor are they using the most OBVIOUS (and non-invasive) biomarker of exposure to investigate conditions in children: the severity of dental fluorosis. The severity of this condition is well-established to be linearly related to the amount of fluoride a child is exposed to prior to the eruption of their permanent teeth. We literally have millions of children in at least four categories of dental fluorosis (very mild, mild, and moderate) and thousands in the severe category. That’s lots of kids to look at for many, many conditions that may be related to fluoridation. Apart from one small study by Morgan et al., 1998, this has not been done. Why not?

    Critics have every right to hack away at the epi studies which are waving red flags about some of these conditions, however, in my view the greater problem is that these same critics are not insisting that fluoridating governments go about doing studies of their own, with the best methodologies that the critics can devise. Moreover, when these critiques come from government agencies themselves, they do so without feeling obliged to do studies of their own It looks very much like that they are more interested in protecting this practice than protecting the health of their citizens.

    QUESTION 6) Both the ADA and the CDC actually recommend that parents not use fluoridated tap water to make up baby formula for children under one year of age. Why are they not taking aggressive steps to inform parents about this? What steps could be taken to help low-income families get an alternative source of water for this purpose?

    BEAKER: 6) I cannot make a judgement on what the CDC could do if they are concerned on the intake of fluoride by babies, given that I don’t know how the US helps new mothers. One thing the CDC has done is convincing industries producing formula to lower fluoride concentrations in their products.

    PAUL: Beaker this is weak. This is THEIR practice that they promote from one end of the country to the other and are prepared to force on people whether they want it or not. If they now know that drinking fluoridated water is causing harm to babies (even if they feel that it is acceptable harm) at the very least they should feel obliged to make sure these warnings get to parents. Neither the ADA nor the CDC is taking aggressive steps to do this. That is simply not acceptable. There are simple things they could do. They could request that water departments put warnings in water bills. They could get this advice to WIC clinics. They could take steps to stop bottled water companies selling “nursery water” with added fluoride.

    QUESTION: 7) The ADA and the CDC are concerned about dental fluorosis but opponents of fluoridation have other concerns. The baby’s blood brain barrier is not fully developed at birth (that doesn’t occur to about 6 months of age). Is it wise to expose a bottle-fed baby’s brain to fluoride at levels 250 times higher than would occur for a baby receiving mothers’ milk?

    There have now been over 100 animal brain studies, 3 fetal brain studies and 23 human IQ studies that fluoride can interfere with brain development (see all the references on the brain at http://fluoridealert.org/caseagainstfluoride.appendices.html )

    The lowest level of fluoride in water estimated to lower IQ is 1.9 ppm (Xiang et al., 2003 a,b). Bearing in mind that this result was obtained in a relatively small study group of several hundred children is there an adequate margin of safety to protect ALL children from this potential damage when drinking uncontrolled amounts of water at 1 ppm? Bear in mind one normally uses a safety margin of 10 to take into account the full range of sensitivity in a human population and sometimes an extra margin when protecting children.

    BEAKER: 7) This’ll have to wait.

    PAUL: I will handle your response when I receive it Beaker.

    QUESTION: 8) The National Research Council, at the request of the US EPA Water Division, appointed a 12-membered panel to review the toxicology of fluoride in water and thereby ascertain the safety of its current safe drinking water standard for fluoride. Both the Maximum Contaminant Level [MCL]– the federally enforceable standard – and the Maximum Contaminant Level Goal [MCLG] the level deemed safe to protect the whole population from “known and reasonably anticipated adverse effects” were set at 4 ppm in 1986. In March 2006, after a three-year review, the panel produced a 507-page report, which concluded that the 4 ppm was not protective of health and recommended that EPA determine a new MCLG.
    a) Why after four and half years has the US EPA not done this?
    b) Why did the ADA dismiss the relevance of this review to water fluoridation on the day it was published?
    c) Why did the CDC follow suit 6 days later?
    d) Did either the ADA or the CDC determine what a new MCLG should be in 1 day and 6 days respectively and if they did where is their analysis?
    e) Why has every fluoridating country either ignored or downplayed this landmark review?

    BEAKER: 8) A review recommended lowering the safety limit to levels lower than the current 4ppm.

    QUESTION 8 CONTINUED: a) Why after four and half years has the US EPA not done this?

    BEAKER: a) I don’t know why the EPA hasn’t followed up on this. They may just be slow.

    PAUL: The calculations necessary to correct the old 1986 determination of the MCLG can be done very quickly. After all The NRC did all the work for them as far as end points are concerned. In a few hours to a few days the EPA would have at least found out that a new MCLG would have to be set less than 1 ppm, which would end fluoridation overnight. Dr. Robert Carton, a former risk assessment specialist at the US EPA published his own risk assessment of this and concluded a new MCLG should be zero (Carton, 2006). A more likely explanation for this extraordinary delay is perhaps the EPA not wishing to cross swords with the Department of Health and Human Services on their long-standing support for fluoridation.

    For those new to this subject it might be helpful for you to know how the EPA determined the 4 ppm MCLG in 1986. It consisted of five simple steps:

    1) They assumed only one health effect to be of concern: crippling skeletal fluorosis.

    2) The estimated dose at which the condition is estimated to occur (the Lowest Observable Adverse Effect level, or LOAEL) was 20 mg/day.

    3) They then applied a safety factor of 2.5 (to account for the full range of sensitivity in a human population) and produced a so-called “safe” daily dose of 8 mg/day.

    4) They then assumed that water represented the only source of fluoride people were exposed to

    5) People drank (on average) two liters of water per day. Thus they concluded that each liter could contain 4 mg, to give a daily dose of 8 mg/day (two liters/day x 4 mg/liter = 8 mg/day).

    Each of these five steps (or assumptions) is inadequate and when simple adjustments are made based on NRC recommendations and common sense (see chapter 20 in our book) a new MCLG would have to be set at less than 1 ppm. If people want me to go through these changes I will.

    BEAKER: Perhaps the new maximum levels do not occur in the population, removing the urgency.

    PAUL: Beaker how do you know that if they (or you) haven’t ascertained what the MCLG should be?

    BEAKER: Note that what is under concern here will be the removal of natural occurring fluoride,

    PAUL: That is incorrect Beaker. That concern only comes into play when you are moving from an MCLG to an MCL. The MCLG calculations should not be “tainted” by economic, social or political considerations. Note that the MCLG for arsenic is 0 , but the MCL for arsenic is 10 ppb.

    BEAKER: since if fluoride is added the recommended level is 1 ppm, which from the studies I have seen would be above the newly recommended safety levels.

    PAUL: Right you have hit the nail on head Beaker! 1 ppm would be above “a scientifically based MCLG” if appropriate margins of safety are used to protect everyone drinking tap water. Thus fluoridation should be halted PERIOD.

    QUESTION 8 b) Why did the ADA dismiss the relevance of this review to water fluoridation on the day it was published?

    BEAKER: b) I don’t know why the ADA dismissed the relevance to water fluoridation, but if I have to guess, what I wrote under a) would be the reason. Ie, the recommendations are relevant for the levels in areas where natural occurring fluoride in the water is high, not for the parts where water is fluoridated, since those levels are far below the limits.

    PAUL: A judgment about the relevance of the NRC recommendations and report must hinge on what the new MCLG is found to be. The relevance to water fluoridation cannot be determined until that MCLG is calculated – see the discussion above. The ADA was simply being political here – i.e. protecting the program they so aggressively promote.

    QUESTION: 8c) Why did the CDC follow suit 6 days later?

    BEAKER: c) Ditto for the CDC.

    PAUL: And ditto from me too. I repeat: a judgment about the relevance of the NRC recommendations and report must hinge on what the new MCLG is found to be. The relevance to water fluoridation cannot be determined until that MCLG is calculated – see the discussion above. The CDC was simply being political here – i.e. protecting the program they so aggressively promote.

    QUESTION 8d) Did either the ADA or the CDC determine what a new MCLG should be in 1 day and 6 days respectively and if they did where is their analysis?

    BEAKER: d) From what I know of the CDC and ADA, they don’t determine Maximum Contaminant Level Goals,

    PAUL: But they would have had to have done this determination for their statement to have been scientifically as opposed to politically based…

    BEAKER: that is the job for the EPA.

    PAUL: Yes and after four and half years they have not done that job (and a simple job at that)! So who meanwhile is protecting the American people?

    BEAKER: All the reviews I have seen so far indicates that levels of 1ppm are low enough so no chronic toxicity will occur (except for dental fluorosis), which is also the position of the CDC (for example http://www.york.ac.uk/inst/crd/fluores.htm).

    PAUL: Beaker again you are confusing dose and concentration. The York Review was important (I was actually an invited peer reviewer) but limited in scope. The 507-page National Research Council report of 2006 was a far more comprehensive review of the scientific literature. Moreover, their exposure analysis in chapter 2 indicates that subsets of the population are already exceeding safe reference doses (the IRIS level) consuming water fluoridated at 1 ppm.

    QUESTION 8 e) Why has every fluoridating country either ignored or downplayed this landmark review?

    BEAKER: e) Fluoridating countries have not acted upon the review of the NRC (not the EPA) recommending lowering of the MCLG, because the levels talked about in the NRC study are twice as high as those common with fluoridation (2.0 mg/l). Hence, these limits are only relevant for areas where the natural occurrence of fluoride is high, not for areas where drinking water is fluoridated.

    PAUL: Beaker again you are confusing dose and concentration and ignoring the politics operating here.

    BEAKER: Note by the way that the 10-fold uncertainty factor you talk about applies to animal studies. If human data is available, the factor is often 1. How can you not know that if you have studied the issue for many years? And if you knew it, why didn’t you mention it in your questions?

    PAUL: This refers to a statement in 7. Not yet otherwise addressed by Beaker: (The lowest level of fluoride in water estimated to lower IQ is 1.9 ppm (Xiang et al., 2003 a,b). Bearing in mind that this result was obtained in a relatively small study group of several hundred children is there an adequate margin of safety to protect ALL children from this potential damage when drinking uncontrolled amounts of water at 1 ppm? Bear in mind one normally uses a safety margin of 10 to take into account the full range of sensitivity in a human population and sometimes an extra margin when protecting children.)

    PAUL: No Beaker you are wrong- check your toxicology books again. The default safety factor going from animals to humans – as you rightly state – is 10. This is invoked to allow for “interspecies” variation. ALSO, the default safety factor used going from human studies to protect the whole population is also 10. This is invoked to allow for “intraspecies” variation. Now it is true that when there is a lot of human data that the safety factor may be reduced, from 10, but this would not occur if you were extrapolating from a study of a relatively small population. A safety factor of 1 implies total certainty, meaning that you have so much data that you believe that you have accounted for the the total variation in the whole population. We don’t usually have that amount of data in human studies and certainly not in this case.

    QUESTION: 9) Why has the FDA never been asked by the Department of Health and Human Services to regulate the ingestion of fluoride? Here is a clue: the FDA does regulate fluoride when used in toothpaste and requires this label on the back of the tube: “WARNING: Keep out of reach of children under 6 years of age. If you accidentally swallow more than used for brushing, seek professional help or contact a poison control center immediately.”

    The recommended amount is a pea size. A pea size of toothpaste at 1000 ppm fluoride contains approximately one quarter of milligram of fluoride which is the same amount of fluoride in a quarter of a liter at 1ppm, i.e. one glass of water. If that reflects the FDA’s concern about the toxicity of fluoride what do you think it would say about 180 million American drinking unregulated amounts of this substance on a daily basis? No wonder they are not asked!

    BEAKER: 9) The FDA has not been asked to regulate the ingestion of fluoride, because that is not the job of the FDA.

    PAUL: The FDA regulates drugs. Since fluoride is being used to prevent a disease, by definition it is a drug. Their current classification of fluoride is that it is an “unapproved drug.”

    BEAKER: Monitoring ingestion of tap water and setting limits there would be the task of the EPA. What do you expect the FDA to do? Put a warning label on water taps “WARNING, DO NOT SWALLOW 5 LITERS OF WATER. KEEP OUT OF REACH OF CHILDREN. IF YOU ACCIDENTALLY SWALLOW 5 LITERS OF TAP WATER, SEEK PROFESSIONAL HELP OR CONTACT A PHYSICIAN IMMEDIATELY.

    PAUL: First of all if FDA was consistent with its warning label on toothpaste – it wouldn’t be 5 liters that shouldn’t be drunk, but one glass! And yes that would be preposterous wouldn’t it? But so is knowingly adding this toxic substance to the drinking water, when a) you can’t control the dose; b)you can’t control who gets it and c) you are forcing it on people without giving them the right to informed consent to medication.

    BEAKER: Furthermore, FDA is mainly concerned with acute toxicity.

    PAUL: I am not sure if that is correct.

    BEAKER: Safety limits in that are often much lower than they have to be.

    PAUL: I do not understand the point you are making here?

    QUESTION 10) Sometimes promoters of fluoridation cite the largest study of tooth decay in the US as evidence that fluoridation is effective. This study was conducted by the National Institute of Dental Research (NIDR) in 1986-87 and involved examining the teeth of about 39,000 children in 84 communities. When comparing children that had lived all their lives in a fluoridated community with those who lived all their lives in a non-fluoridated community, they found an average saving in tooth decay for 5-17-years old of 18% in decayed tooth surfaces. However, this 18% saving was not shown to be statistically significant and amounted to a difference of 0.6 of one tooth surface (see Table VI, Brunelle and Carlos, 1990). By the time all the child’s teeth have erupted there are 128 tooth surfaces – so we are talking about a saving that amounts to less than 1% of the tooth surfaces in a child’s mouth. Question: could this saving – if real- justify taking the risks with the baby’s developing brain and other tissues? In actual fact, Brunelle and Carlos did not take into account the delayed eruption of teeth that may be caused by fluoride, which has been reported by several researchers (see Komarek et al, 2005). A delayed eruption of the teeth by one year would account for this difference of 0.6 of one tooth surface. ( All references cited above can be found at http://fluoridealert.org/caseagainstfluoride.refs.html )

    PAUL: I will handle your response to this Beaker when I get it. Meanwhile, thanks for all your input to the above.

    Paul Connett, co-author “The Case Against Fluoride.”

  222. #223 James Beck
    December 4, 2010

    I’m way behind here, but trying. Here are responses to two posts, thoughtful and helpful ones.

    #192 from Ash. Thanks for the careful and nonviolent comment. I am taking seriously your criticisms. Your conclusions are reasonable, though I might disagree on the confidence to be put on, for example, the Li et al. 2001 paper on fractures. And #200 from Kieran. I thank you also. Your (Kieran’s) first several paragraphs on the state of research, particular clinical research are off-topic (I’m picking up the blogosphere jargon) but, I believe, quite correct. My first immersion into the practice of science was in the 1950s. So during my four decades of research in fields that sometimes got close to clinical research and clearly did include biological systems were times of increasing application of inferential statistics in biomedicine. I came to believe, as Kieran does, that those applications were often faulty and were used by people who didn’t understand what they were doing. Beyond that, I felt that statistics—the more elaborate, the better—was often used as window dressing, often required by journal editors appropriate or not, or even something to obscure the low quality of the experimentation. We need Kieran’s expertness but we need to be rational in its application. As he was, by the way. Enough off-topic.

    With respect to both #192 and #200, I suggest that there is merit in Li et al. simply for the reason that, whether or not it is strong evidence of an association, it has used what has been called a “natural experiment”. Nature and human societal development has presented us with villages comparable in life style, occupational history, probable genetic similarity, in groups which have stayed put through many generations. And nature has given very different concentrations of fluoride in the water supplies of those villages. So, though I may have erred in saying that this paper is one of the better ones on fracture, I still think it is one of the more useful ones. And “useful” brings up another point that has not been raised in this blog-drama. There seems to be on the part of proponents of fluoridation of public water supplies and many of the comments here that only absolutely certain demonstration of association—perhaps even causal connections—of fluoridation with harms should cause us to stop fluoridation. I have seen governmental reports that conclude that since that study or those studies are not perfect and don’t prove absolutely that X causes Y then we should continue fluoridating until such proof arises. Now turn that around. Say we don’t have fluoridation and we are considering starting it, but we have some evidence that it may be harmful. Would we start it anyway? Would we propose research and wait for valid assurance that the harm is not related to fluoride? The unions of EPA scientists petitioned Congress in the US to declare a moratorium on fluoridation while its suggested association with cancer was properly investigated. Seems reasonable, given the at best limited benefit of fluoridation. And responsible.

  223. #224 Dappledwater
    December 4, 2010

    Beaker @ 218. I’ve read the study (Tang 2008), not the abstract. Compared to the many hundreds of climate science papers I’ve read, it’s like a post-it note. I agree with you there’s a lot there that isn’t clear.

    also, the categorization they use does not match any fluorosis indexes I’m aware of

    Dean’s Fluorosis Index

    That is one of the reasons why concentrations are often used. Otherwise you’ll have to guesstimate backwards.

    I thought I summarized clearly enough, but apparently not. You don’t appear to understand that quantifying such concentrations is not possible. The extent of fluorosis simply establishes exposure to high levels of fluoride in the drinking water for the first 8 years of childhood (when flourosis develops)

    although I’m beginning to wonder

    Just humour mate. Aimed at some of the more vitriolic commenters.

  224. #225 Dappledwater
    December 4, 2010

    Chris Ho-Stuart @ 219 – IMO the paper would suggest that levels of fluoride in fluoridated water would not have the low IQ effect which is discussed

    See above. Just a smart-alec comment on my part.

  225. #226 R Simmon
    December 5, 2010

    Re: #146, Question 1

    1) Why is it if it is a sensible practice to use the public water supply to deliver medicine, it has never been used again for this purpose for any other drug or nutrient (there is no evidence that fluoride is a nutrient)?

    While no other medicines/nutrients are in the U.S. water supply, there are two close analogs in food: Iodized salt (to prevent thyroid disease), and Vitamin-D fortified milk (to prevent rickets).

  226. #227 Paul Connett
    December 5, 2010

    Thank you R. Simmon.

    I was all set to point out that they had actually tried adding iodine to water supplies in the 1930s but had to stop when they found that a number of people developed hyperthyroidism. When I searched on google to get the details (search under iodination of water) I found that there have been a number of smaller trials of iodination of water in specific areas endemic for iodine deficiency in more recent times (in the 1990s) and they have had some success. Unlike fluoridation these limited programs have been tightly monitored for potential side effects.

    It would be interesting to find out if there had been any discussion of adding vitamin D to water supplies before adding it to milk (perhaps there is a water solubility issue here). The use of milk is a more sensible choice because unlike water there is a smaller range of consumption across the population, allowing a tighter control over dose, as well as individual choice in the matter

    Needless, to say in the case of both iodine and vitamin D – unlike fluoride – we are looking at genuine nutrients with known serious health problems when they are absent or low in the diet.

    Paul Connett

    Paul Connett

  227. #228 Paul Connett
    December 5, 2010

    PS to R.Simmon

    ..nor (unlike fluoride) do we have an industry anxious to get rid of thousands of tons of industrial grade vitamin D, which would otherwise have to be treated as hazardous waste. Pharmaceutical grade vitamin D (or fluoride for that matter) would be far too valuable to have most of it flushed down the toilet or used to wash the dishes!

    Paul Connett

  228. #229 Kieran
    December 5, 2010

    When considering the possible causal role a particular exposure or treatment may have on a disease outcome, summarising the available evidence is a daunting task.
    There will invariably be many studies published which examine the association between the exposure and the disease, they will use different types of study design, and they will vary markedly in quality.
    The best quality evidence will come from randomised controlled trials and the least reliable evidence from ecological studies. In between you’ll find cohort studies, case-control studies, and cross-sectional studies.
    Once the studies are classified by design, you’ll find variation in quality within each of these classifications. Some randomized trials describe how randomization was performed, some don’t. Some will be double-blinded, some single blinded, and some will make no mention of this. To be truly rigorous, you’ll need to contact the authors of some studies to get further information about their study.
    The same sort of thing needs to be done for cohort studies. How were the cohorts defined? How was the exposure assessed? How were the cohorts followed over time? How were disease cases ascertained? And then for case-control studies, etc, etc.
    Once that has been done, the studies can be classified not only by study design, but also graded by quality.
    If you summarize the results of these studies, what you invariably find is that the most robust study designs find smaller effects than the less robust study designs and, within each study classification, the best quality studies will find much smaller effects than the least quality studies.
    Now it is a sad fact that in clinical and epidemiological research the proportion of studies that can be classified as high quality is very small. If this were not the case, we would not need CONSORT guidelines for the reporting of randomized controlled trials or STROBE guidelines for the reporting of epidemiological studies.
    So there will be lots of “evidence” of an effect of fluoride on a whole variety of disease outcomes, but not much good evidence.

    With regard to the meta-analysis performed by Tang et al. I really can’t be too confident in the ability of the authors to conduct a meta-analysis when they can’t even identify the study design of the studies they are reviewing.
    What other things could affect a child’s IQ? Iodine deficiency perhaps? What about lead? Lead-based paint is banned where I live, but what about in China? Kids like to chew lead-based paint: it tastes sweet. What about lead in cooking utensils? Is that a problem in rural China? What about lead in petrol? If you want to tease out the effects of fluoride on IQ, you need to account for other exposures that have known effects. Did the studies reviewed by Tang et al. do this?

    Now as far as the Li paper is concerned, the assertion that the communities chosen were comparable with regard to life style, occupational history, etc, is not something that can be made from the information supplied in that paper. Falls can produce forces that may or may not be sufficient to cause a fracture and, if fluoride is to have any causative role in the occurrence of a fracture, then it is here, at the margin of the forces required to produce a fracture, that you would see the effect of fluoride.
    Therefore, if the comparison between communities is to be valid, the risk of falling must be similar between these communities, but we don’t even know where these communities are, how can we be confident that the risk of falling is similar? China is a big place. What are the weather conditions like in these communities? What about ice on the ground in winter?

  229. #230 Paul Connett
    December 6, 2010

    I have been waiting patiently for Beaker to respond to questions 7) and 10) in my entry #148 above. Readers can see my responses(see entry #224)to Beaker’s responses (see entry #164) to the other eight questions.

    Perhaps someone else on this list could have a go at responding (hopefully abuse free) to either question 7) or question 10) or both.

    Paul Connett

  230. #231 Mike
    December 7, 2010

    Unbelievable. After lurking successfully for so long, enjoying the hard work indicated by your critical thinking skills on AGW and other items, I am flabbergasted at your stepping into a steamin’ pot ‘o woo, and no even noticing that your feet have John Birch all over them. No, no, no!!
    But that is it, isn’t it? Stepping in it, and not even noticing. Doesn’t this _sound_ familiar? Aren’t the woo/conspiracy analogy gears clicking Coby?

    I haven’t read all comments, but I do see many folks have spoken up in support of critical thinking on this subject; that is to say rejecting the conspiracy meisters.

    Now I’ll let others slice and dice most of it, but I just have to make a comment or two. First of all, as a chemical water-quality professional, I observe and review the regulatory side a good bit. I don’t know the exact source of the “let’s just see how we can use these excess hazardous materials we have laying around, …wait! I know, let’s use them in thousands of communities across the country to 1) fund haz waste companies; 2) control minds; 3)sap and impurify all our bodily fluids…they’ll never realize what’s happening” conspiracy, but I gotta tell you it is one of the most mindless, idiotic, suck the brain dry pieces of flabby cranksterism I have ever had the misfortune to encounter.

    I don’t care about any other arguments you want to toss out…it doesn’t matter…if your critical thinking skills have ebbed low enough to argue forcefully for this load of proto-landfill, then may I suggest you have problems that will not be addressed by the removal of 1 ppm fluoride in your water.

    For those interested in reality: The flouride used in the water treatment industry comes from a natural source, the mineral apatite. This mineral is used to produce phosphorous-bearing fertilizers, because it is high in P. Apatite, and an associated mineral, fluoroapatite, contain some low percentage of F (3-6% I think?) And so, a by-product of this P production yields various F compounds. And for those with their conspiracy generators tuned to auto-play, a by-product is not per se bad – really, go ahead, look it up, we’ll wait.

    If you want to be into worrying about by-products, go after one that makes sense: the by-products of the mining industry nice enough to bring you all of the heavy metals and rare earth elements which make your computing fun even possible…look for mining disasters in Africa, South America, and yes, even in America if you are looking for a fight.

    I actually feel a bit bad for the level of snark I am using, but this has seriously pegged my woo meter. And the fact that your meter hasn’t even registered, Coby, is…..interesting? There are so many good materials out there on this…

    I was going to say more, but I need to go read some Carl Sagan or something to wash away the flibber.

  231. #232 Luna_the_cat
    December 7, 2010

    I haven’t read this entire thread (so apologies if I’ve missed something vital), and I’ve only started to read what papers I have access to — and I don’t know that I will necessarily have all the time I would need to go find and read everything in full detail. But, having said that, from skimming a number of papers on flouride effects and reading a few of the ones where I actually have full access, it doesn’t look like a clear evidence of risk. It seems on the face of it to be that the studies on bone brittleness or friability are often contradictory and focused on small effects, but do not show a distinctly elevated risk at the fluoride levels which are recommended for water; and the studies which show, for example, flouride toxicity effects in rats are dealing with flouride concentrations of considerably above the legal limit for drinking water (for example, Basha PM, Rai P, Begum S. “Evaluation of Fluoride-Induced Oxidative Stress in Rat Brain: A Multigeneration Study.” Biological Trace Element Research, DOI: 10.1007/s12011-010-8780-4).

    As for the effectiveness of fluoridation in dental caries, there are a number of papers which you seem to have missed considering, like Stephen KW, Macpherson LM, Gilmour WH, Stuart RA, Merrett MC., “A blind caries and fluorosis prevalence study of school-children in naturally fluoridated and nonfluoridated townships of Morayshire, Scotland.” BMJ. 2000 Oct 7;321(7265):855-9. ( http://www.ncbi.nlm.nih.gov/pubmed/11021861 ) and McDonagh MS, Whiting PF, Wilson PM, Sutton AJ, Chestnutt I, Cooper J, Misso K, Bradley M, Treasure E, Kleijnen J., “Systematic review of water fluoridation.”, BMJ. 2000 Oct 7;321(7265):855-9.( http://www.ncbi.nlm.nih.gov/pmc/articles/PMC27492/?tool=pubmed ).

    Speaking about the comparison of towns in Morayshire in the Stephen, et al. paper — I live in NE Scotland and have family in Morayshire, and am very familiar with Burghead, Findhorn and Buckie (moderately familiar with Kinloss, and not so familiar with Portessie) — for those towns I know, I can tell you that honestly, aside from where the boats pull up the towns themselves are much of a muchness, economically, educationally and culturally (although Burghead has the most amazing Pictish fort, Findhorn has a nearby ex-hippie community, and Kinloss has an RAF station, to distinguish them from each other) — and the only significant dietary difference is the relative quality of the local fish & chips shops. For the purposes of a study like this, however, you would be hard pressed to find better-matched communities overall. And these populations showed a 96% reduction in dental caries with the fluoridation of the water.

    It’s probably safe to say that fluoridation of the water has the largest dental-caries-prevention effects in lower-income populations with low rates of compliance with dental recommendations for toothbrushing and regular cleanings. However, this was a situation as well for much of rural America when fluoridation was first introduced, as I understand it.

    I can address one question, which I think was implicated in “why was the US one of only a few countries to introduce water fluoridation”, which is “why, when there is evidence of benefit, has the UK *not* introduced water fluoridation.” The answer to that is relatively simple: they tried, and the protests matched the burning of GM test crops in their ferocity. It wasn’t so much based on an understanding of the science or assessment of real risk; it was based on a populational primal reaction of ferocious protest against the government “drugging” the water (even though much of the mains water here is heavily chlorinated anyway, because the water has a lot of geosmin).

    I’d just like to point out one thing: it isn’t fair to accuse Paul Connett or any of the authors of “dishonesty”, like I think I saw upthread. One can be intelligent, and very sincerely convinced of a problem, but just wrong, especially if there is a lot of emotional involvement in a concern. I’m sorry, but I don’t see that this is an impossibility here.

    I’ll keep reading as and when I have time, but so far I’m not convinced about the “big, bad fluoride”, I have to admit. Following on from that, though, if anyone has it, would someone be willing to send me a copy of the full Xiang 2003 paper, “Effect of fluoride in drinking water on children’s intelligence.”? I can’t even locate the full paper online, even behind a paywall — all I can find is the abstract being quoted on various anti-fluoridation sites.

  232. #233 Paul Connett
    December 7, 2010

    Unbelievable indeed Mike. If your diatribe is an example of critical thinking God help us. I just don’t understand why people who are so ignorant on the details of a subject are prepared to be so rude, so arrogant and so utterly disdainful with the efforts of people who have spent a very long time studying an issue in depth, and documenting every single argument they make.

    Outbursts like yours Mike do not help rational discourse.They are simply meant to intimidate people and keep them away from relevant facts and arguments. Your argument is about as clinical as a brain surgeon using a monkey wrench. Needless to say you won’t read our book so conveniently you will be able to take your prejudices to the grave. Good luck to you.

  233. #234 Luna_the_cat
    December 7, 2010

    (Oh, I just looked at a map, and realised I *am* familiar with Portessie. I just hadn’t remembered it was so close to Findochty. Yes, those communities are all very well matched.)

  234. #235 Paul Connett
    December 7, 2010

    Luna (comments 234, 236) Thank you for your contribution, which seems to have kept the invective to a minimum. It contains some really good points and I will get back this a little later. But here is a quick comment.

    It is well known that a rat needs to receive a dose 5-10 times as high so as to reach the same plasma levels as a human. There are a number of excellent studies from ZZ Guan and co-workers that have consistently found brain effects at levels of fluoride in water of 30 ppm. This would translate to humans getting 3-6 ppm fluoride in their water.

    One rat study used remarkably low levels of fluoride and found some serious effects. Varner et al (1998) treated rats with 1 ppm fluoride in their water for one year and found both kidney and brain damage visible under a microscope. They also found a great uptake of aluminium into the brain and beta-amyloid deposits. These authors were surprised by these results at these very low levels that they actually repeated their experiment three times.

    Paul Connett

    PS One of co-authors is from Edinburgh and I have asked him for comments on the study from Scotland. However, it was my understanding that Scotland was not fluoridated so was the study village artificially or naturally fluoridated?

  235. #236 Mike
    December 7, 2010

    Interesting, Paul, that you completely side-step the content, and feel the need to go on and on about the messenger. Just because I address this issue rather harshly gets your gander up, but all your defensive posturing will not be lost on people who realize you “forgot” to address the issue in your reply.

    And the core issue listed by me was the full-on, fear- mongering conspiracy touted by you and others stating that the water-quality fluoridation industry uses hazardous waste materials as their source for F compounds for “mind control” or [insert conspiracy here].

    You are simply incorrect, and all your posturing and whining that I am “rude” because I call BS only reaffirms to me that you have no real interest in discussing, but rather remaining entrenched in your shell.

    And if your listing in #148 is in any way indicative of your book, why would I read it?

    The problem I see, frankly Paul, is that the questions in #148 are all comfortably answered by “Conspiracy”!!

    Don’t believe me? Try it out for yourself.

    Why doesn’t the EPA(!)……
    Why don’t the CDC and the ADA(!)…
    Why hasn’t the NRC(!)…
    Why don’t other countries(!)…

    The fact is, there is no conspiracy. There is simply evidence, long held, and under constant review (you can look it up, here’s a hint though: you won’t find it on fluoridealert!)

    The conspiracies you allege against the NRC and the EPA are actually long, legislative slug fests, which are best served by good science, and not woo. And these protracted legislative and regulatory battles are made more and more difficult as anti-vaxers, anti-fluoridians, global warming deniers and other anti-science folks creep into public policy positions as is now happening in our Congress.

    For the damage that you are doing here, we are all going to need some luck going forward.

    Defensive much?

  236. #237 Luna_the_cat
    December 7, 2010

    First — sorry, my link to the Morayshire paper was the wrong one, it’s here:
    http://onlinelibrary.wiley.com/doi/10.1034/j.1600-0528.2002.300110.x/abstract

    And, some water sources changed when new infrastructure was brought online in 1985, which introduced a naturally-fluoridated water supply to the named towns — fluoridation is almost exactly 1ppm, however. It is correct that water supplies are not artificially fluoridated (viz. the protests, as stated above), but there are naturally fluoridated sources in a number of places.

    Second, could I just ask, please — could you at least give paper titles as well as year of publiction when you refer to something as a source of information? I really like to check these things, and some are difficult to find when all I have is one author’s name. Speaking of which, for the Varner et al (1998) study you mention, is it “Chronic administration of aluminum-fluoride or sodium-fluoride to rats in drinking water: alterations in neuronal and cerebrovascular integrity.”? If so, I have access and will read it in detail.

    Again, I have to add a caveat here that I haven’t had a chance to read and analyse the detail of these papers, but I found quite a number of papers by ZZ Guan on fluorosis effects. From skimming them, however, it looks to me as if he is deliberately inducing clinical fluorosis with high doses of fluoridation (30-100ppm in drinking water over a period of 7 months, in one paper, maybe the one you are referring to, 7 months being just over 25% of a normal rat lifespan for lab animals), and it seemed like he was looking for signs of distinct skeletal fluorosis as diagnostic in his test animals. I will say without hesitation that when someone is exposed to enough fluoride to induce skeletal fluorosis that it is perfectly reasonable to look for and at other metabolic damage; but that wouldn’t really be the case for most of the human populations in question.

    In China, of course, there is in places an additional significant danger of fluorosis from the air pollution of coal burning, which I don’t think is reflected much in the current decades of the US and the UK, although it was potentially higher last century.

  237. #238 Luna_the_cat
    December 7, 2010

    @Mike: I’m taking seriously Coby’s warning that Paul Connett is not a normal internet resident, and is unused to the usual level of interaction on forums. There is a normal expectation that people debating on the internet have a certain thickness of skin, but bear in mind that Paul may be genuinely rocked back on his heels by what he may be encountering for the first (or nearly the first) time.

    Of course that doesn’t invalidate the fact that he didn’t answer the content of your post, but cut him a little slack in getting used to these waters. If it were my dad on the internets, I could only imagine what his shock/horror reaction would be to the usual tone of forum posts, however legitimate the content.

  238. #239 Paul Connett
    December 7, 2010

    Sorry Luna. Early on we gave a link to all the references we used in the book. These can be found here:

    http://fluoridealert.org/caseagainstfluoride.refs.html

    The Varner study can be found in Appendix 1, as well as the Xiang paper and follow up letter – for which there are links to the full text.

    It could be of course, that three old professors with PhDs in chemistry, physics (plus an MD) and biology – as well as a historian -have been carried away on this issue and are letting our emotions get the better of us, despite the many years that we have put into investigating the matter. However, not one of us got into this matter with an anti-fluoridation bias. In fact, speaking for myself I wanted to get rid of the issue as quickly as possible. Only the evidence kept me back. This may all be wishful thinking on our part, but the only way this can be fully judged would be for people to read the whole book and make their own judgment on the matter. Of course, every time I mention this sane approach I am accused of just wanting to sell books. What total nonsense. Quite frankly I couldn’t care a tiddly cuss if some of the people on this list read the book or not. They have received most of their education from Dr. Stranglelove and that is where they would like to keep their minds. As such I would rather they spouted their jaundiced tripe on the other side of the debate. They would be embarrassing to have on our side.

    Paul Connett

  239. #240 Luna_the_cat
    December 7, 2010

    …I see you are getting into the spirit of flaming fast enough. ;-D

  240. #241 Mike
    December 7, 2010

    @Luna,
    I appreciate your sentiments on how Paul and others may receive these comments, but as you say that does not invalidate missing the point. I honestly don’t mean to be abrasive, but this really grinds me.

    @Paul #241
    Your bias on the subject is quite evident in the subtitle to your book…”The Hazardous waste industry”… This is fear-mongering 101, and you’ll have a hard time convincing anyone that wasn’t done to sell books or inflame using empty rhetoric.

    And no, I didn’t receive my education from Dr Strangelove (kudos for getting the reference, however), although the overt swipe at the Birchers was spot on, wouldn’t you say?

    Also, my education is every bit as good as yours regarding inorganic water quality and chemistry…hint: such a blatant appeal to authority is a candy-apple red flag.

    Perhaps my educations is even better since I tend to rely on actual peer-reviewed data, as opposed to materials found on quack sites such as fluoridealert, which appears to be the only reference you seem to think anyone needs. This fact alone truly does not inspire confidence that you have researched this material with any objectivity.

  241. #242 paul Connett
    December 7, 2010

    Mike I don’t really have to adopt a defensive posture. We have done everything anyone could possibly want from three scientists who are opposed to this practice. We have written a thoroughly documented text presenting our case – with the minimum of hyperobole. If we are completely wrong – as you suggest – then what we would expect within a year would be an equally transparent text and equally well-documented -” giving “The Case For Fluoride.” If you are correct that should not be difficult for promoters to do. We will wait but won’t hold our breath.

    Meanwhile, no amount of invective is a substitute for this approach.

    You are the one that brought up conspiracy – and some of your cronies – not me.In fact in our text we go out of way to disown some of the wilder conspiracy theories like “dumbing down the American people” and “limiting the world’s population.” Both of which I believe are insulting to those who promote fluoridation in good faith. Moreover, because motivation is such a tricky area we left this discussion to the very last chapter in our book. In my view the only fault I can find with most of the people who promote this practice is that rather than researching the issue for themselves they rely on the second-hand judgments of so-called authorities like the CDC and the ADA. However, since both these entities have been promoting this practice for so long it is difficult to see if their mission now is protecting their credibility or protecting the health of the people. The two questions I posed were meant to tease this out. How was it that the ADA was able to dismiss the 507-page groundbreaking review by the National Research Council on the day it was published – and ditto the CDC six days later – when at this point no one had actually determined the new safe drinking water standard and goal (MCL and MCLG) recommended by the NRC.

    You can’t have it both ways – if this was so easy to do that the ADA and CDC did it in one day and six days respectively – then how do you explain the fact that the EPA has been unable to come up with a new MCLG in four and half years?

    You might call this a “conspiracy theory” I call it plain old politics. The EPA has no desire to cross swords with the Department of Health and Human Services (DHHS) by pulling the rug from under DHHS’s pet practice. As far as the ADA is concerned they have huge liabilities to worry about since they have their seal of approval on so many dental products containing fluoride. Clearly, they have an invested interest in making sure that every paper that finds harm at levels close to the doses someone drinking fluoridated water would receive (by the way what would say is an adequate margin of safety between the doses that cause harm to protect EVERYONE drinking uncontrolled amounts of water?) is dismissed or ignored.

    For those of you who think that this whole business came about because the US government suddenly became obsessed with children’s teeth – I urge them to read the thoroughly documented book by Chris Bryson, “The Fluoride Deception.” I think he gives us some clues as to why it began. What we need now is an equally well-documented text explaining why it continues now despite the fact that promoters admit that fluoride works predominantly TOPICALLY rather than systemically (which they believed for 50 years)and harmful effects are being documented at levels far too close for comfort (see the NRC(2006) review) – to the levels that some people are getting in fluoridated communities. So if the benefits are topical, and the risks are systemic (whatever they are) why force this nonsense on people or yourself for that matter.

    As far as your diatribe on the hazardous nature of the fluoridating chemicals. Here is the history. For over 100 years the phosphate fertilizer industry put two very toxic gases into the environment. They were hydrogen fluoride and silicon tetrafluoride. These gases caused a great deal of damage to vegetation (including citrus groves in Florida) and crippled cattle that ate the grass contaminated by these emissions. This is all thoroughly documented in our book. These gases are generated when the phosphate rock is heated up with sulfuric acid. This acid converts fluoride to hydrogen fluoride which then reacts with silica to produce silicon tetrafluoride. After about 100 years of this pollution, the industry was finally required to put wet scrubbers on their facilities to capture these two gases (plus some other crud). A spray of water converts these two gases to a solution of hexafluosilicic acid (this is not a natural product Mike). This liquid is circulated until it reaches a concentration of 23% ( I assume some kind of eutectic mixture)and then it is removed. This liquor is officially classified as a hazardous waste by the US EPA. It cannot be dumped into the sea by international law, and it cannot be dumped into local waterways because it is too concentrated. This is where it gets fun. If someone buys this waste product from them it is no longer classified as a hazardous waste but as a “product” and can then be used without having to meet the normal regulations governing hazardous waste disposal. This “product” is then used to fluoridate our water. This product also contains other toxic substances including lead and arsenic. As you probably know the MCLG for both arsenic and lead are both set at zero. So whatever the dangers drinking fluoride are concerned, fluoridation inevitably results in knowingly exceeding the MCLG for both of these cancer causing elements.

    Now while this may save/make the phosphate fertilizer industry anywhere from 100 – 200 million dollars a year, I do not believe that it the tail that is wagging the dog of the fluoridation program. It is simply a very convenient way that this industry can save money on disposing of hazardous waste and make a little profit as well.

    Now there is a way our of this silly mess Mike. Let’s assume the best case from your point of view and that you can convince people it makes sense to swallow fluoride (and in the case of the baby at up to 250 times the level in mothers milk) then here is a solution, which would satisfy most rational people (i.e. the ones you have to convince, rather than ones who rabbit on all day long protecting us from conspiracy theorists with their rhetoric). Here is a solution: Make up fluoridated water in one liter bottles and make them freely available in pharmacies and supermarkets (and free for families of low -income). This way you could control the DOSE (people would be told to drink only one liter of this water a day); you could control the purity of the fluoridating agent – you could use pharmaceutical grade AND you wouldn’t have to force it on people who don’t want to drink it, thereby avoiding the violation of the patient’s right to informed consent to medication. It would provide an easy way for parents of low -income to make up baby formula without fluoride in the water (as both the ADA and CDC now rather reluctantly recommend)- they could simply use regular unfluoridated tap water.

    This would be a rational solution IF (an only IF) you could convince people that it was safe and sensible to drink fluoridated water at 1 ppm – and IF you were interested in rational argument, which I very much doubt is the case.

    Paul Connett

  242. #243 Quietmarc
    December 8, 2010

    Delurking here, but, Paul, how are the ADA and the CDC “rather reluctantly” recommending? Do they include a statement like “We don’t really want to say this, but we have to” on their recommendations? Sorry for the snark, but Paul, regardless of the validity of your statements, to THIS relatively unbiased observer, your message comes across as not very substantial.

    I want to add that your “solution” for people who want fluoride in their water seems to raise more problems than it solves, especially on a blog that tends to focus on environmental solutions. Isn’t bottling water kind of a bad thing when you factor in the waste created through the production and shipping processes?

    I’ve followed this discussion (here and at Respectful Insolence), and while I can’t say definitively that fluoride is safe, I have to say that most of your arguments appear to have been rebutted or at least reinterpreted by many of the posters here. I’m NOT a scientist, and am not qualified to assess papers, but I’ve come to trust the scienceblogs community and a lot of the content here disagrees with your conclusions.

    It’ll take a little bit more convincing for me to buy the book or to change my (admittedly unpassionate) opinions about water fluoridation.

  243. #244 (╬ ಠ益ಠ)
    December 9, 2010

    “They would be embarrassing to have on our side.”

    And yet having a quack ‘doctor’ anti-vaxxer who claimed to have cures for cancer and owns a million dollar mansion on your side somehow isn’t?

    http://www.quackwatch.org/11Ind/mercola.html

    Frankly I’m more inclined to listen to what a real doctor says and not someone peddling a book that’s clearly scaremongering (as can be seen on the front cover) who’s been accused of committing the dental equivalent of child abuse.

    http://quackfiles.blogspot.com/2005/06/experts-condemn-anti-fluoride-claims.html

  244. #245 H S Micklem
    December 9, 2010

    Just caught up with all this. There’s some interesting stuff amongst all the playground games (reminds me of Prime Minister’s Question Time in London – lots of fun, but often short on illumination).

    To Quietmarc@245. I guess many people share your reasonable agnostic position, and I’d like to discuss a couple of your points.
    1. It’s what the ADA and CDC don’t do, not anything they do say. They have never attempted to get the message across widely. It’s been a matter of suggesting that dentists advise mums who are worried about fluorosis to use fluoride-free water to make up infant formula concentrate. Here’s the current CDC, fairly well buried in: http://www.cdc.gov/fluoridation/safety/infant_formula.htm
    “Parents and caregivers of infants fed primarily with formula from concentrate who are concerned about the effect that mixing their infant’s formula with fluoridated water may have in developing dental fluorosis can lessen this exposure by mixing formula with low fluoride water most or all of the time.” Not exactly a clarion call; you don’t get this advice unless you can afford to be seeing a dentist.

    2. Your point about disputed evidence. Dental fluorosis is the one harm that both sides of the argument agree can result from drinking fluoridated water. I think it is a significant harm in itself, but others dismiss it as merely cosmetic. All the other possible/probable harms are currently disputed. Any claim made on either side of the argument is likely to evoke some contrary claim (as you observe) and each side will seek to minimize the evidence of the other. We are dealing in probabilities here, not certainties. Taking into account evidence from animal and in-vitro studies and from humans consuming water with higher concentrations of fluoride, it appears that there are several serious risks that may face consumers of artificially fluoridated water, particularly if they drink a lot of water. This conclusion owes much to the findings of a large and well-documented official report by the US National Research Council of 2006 “Fluoride in Drinking Water: A Scientific Review of EPA’s standards”, available online at http://www.nap.edu/catalog.php?record_id=11571
    Others are perfectly entitled to make an opposite case if they can. My view is that while substantial risks may be acceptable to an individual taking a therapeutic drug or other intervention, such risks should contraindicate a program of mass medication for which only small benefits are demonstrable. Proponents of fluoridation seem to see it differently and to believe that if no harm (other than fluorosis) has been proved to be directly attributable to fluoridated drinking water then it is okay to continue and extend the fluoridation program. I think that’s a fair statement of their position. It strikes me as irresponsible and pointless. The McQuacker @246 may call it something else, or perhaps McQuacker’s problem is just mansion envy. Anyway, differing attitudes to risk lie near the core of the fluoridation dispute.

    H S Micklem, third author of the book; you know which one I mean.

  245. #246 Luna_the_cat
    December 9, 2010

    Paul Connett:

    A few(!) quick(!) thoughts.

    1. Colleagues at a nearby mouse lab were unable to confirm your assertion that “It is well known that a rat needs to receive a dose 5-10 times as high so as to reach the same plasma levels as a human” wrt fluoride/NaF. The comment I received was more along the lines of “that doesn’t sound right; animal absorption is about on par with human absorption”, again specifically wrt fluoride/fluoride compounds. A quick search of literature found nothing to support your assertion either. Could you please give a reference for it?

    2. The Varner 1998 paper looks primarily at aluminum toxicity, and they do turn up good evidence that fluoride enables a more ready absorption of aluminum compounds…bearing in mind, too, that the exposure to aluminum in their lab was well above the standard MRL (1 mg aluminum/kg/day, as set by the US Dept. of HHS, a maximum of 0.2 mg/L being allowable in water, and the bulk of exposure being through food). Contrast this to the minimum 0.5mg/L in water being provided to the rats.

    The results are interesting, and certainly to a degree concerning; but as both the paper (the full paper, which I have in .pdf form) and the subsequent papers which cite the Varner paper make clear, Varner et al. are actually looking at levels of exposure far higher than what is allowable under current US/UK environmental law. There are obviously issues where natural occurrences of fluoride and/or aluminium are higher than normal, or where there are unregulated pollution sources (such as in China). Given the levels in the water in the bulk of the US, the case that the current levels of fluoride are dangerous stands as not proven. Worthy of monitoring, absolutely, beyond a doubt. A clear and present danger, maybe not so much. Proven, definitely not.

    As a matter of side interest, you say “These authors were surprised by these results at these very low levels that they actually repeated their experiment three times.” Are you referring to the statement in the paper, “All counts and ratings were conducted by three individuals, two of whom were always blind to the treatment of the rats from whom the tissues came”? I can’t see a reference anywhere in the paper itself to the experiment being repeated three times; it’s possible I’m missing it, but if that’s the case, could you point it out?

    It is undoubtedly worth reviewing dietary and air-pollution exposure levels to fluoride in at-risk populations, and periodically in wider populations, to review policies on fluoridation. That strikes me as being sensible risk assessment, given that we know that there *is* such a thing as fluoride toxicity at high levels. But to eliminate fluoridation entirely, especially where (actually) benefit in dental caries is reasonably well proven, and where there is a disparity of availability of dental care…hmm. I honestly can’t see that as justified, in the light of what is in the literature.

    Now, you had a number of comments on how fluoride is obtained, and how lead, arsenic, and other contaminants were supposedly introduced with it into water supplies.

    For one thing, I learned something that I didn’t know: that although there is no official nation-wide fluoridation policy in the UK, there are individual local councils which fluoridate water supplies, in England and Wales. And the British Fluoridation Society has this to say about supply:

    “The basis of the claims that the aluminium industry promotes fluoridation in order to dispose of its toxic waste seems to be based on a tenuous link more than 40 years ago in the USA. In the 1940s, The Aluminium Company of America (ALCOA) acquired a chemical manufacturing plant which produced fluoride compounds by the method described above (not as a waste product of aluminium production). ALCOA was then using sodium fluoride as a catalyst in the aluminium smelting process, but soon replaced sodium fluoride with less costly fluoride compounds. ALCOA sold the chemical plant in the early 1950s; their last sales of sodium fluoride were in 19522. Nowadays, the aluminium industry is the largest user of fluoride compounds. Thus, the aluminium industry has no interest in promoting water fluoridation whatsoever.”

    http://www.bfsweb.org/facts/tech_aspects/chemsmanufac.htm

    (On a side note, with further regard to your earlier question “it was my understanding that Scotland was not fluoridated so was the study village artificially or naturally fluoridated?” — makes no difference anyway. Reasonably straightforward studies, for example, A. Maguire, F.V. Zohouri, J.C. Mathers, I.N. Steen, P.N. Hindmarch, and P.J. Moynihan, “Bioavailability of Fluoride in Drinking Water: a Human Experimental Study” J Dent Res 84(11):989-993, 2005, have demonstrated that there is simply no effective difference in absorption or bioavailability of natural occurring or artificially added fluorides in water. Just for reference.)

    Finally, in your later response, you say “It could be of course, that three old professors with PhDs in chemistry, physics (plus an MD) and biology – as well as a historian -have been carried away on this issue and are letting our emotions get the better of us, despite the many years that we have put into investigating the matter.

    *ahem* Blatant appeal to authority much? Yes, you’ve got very impressive qualifications. No, that never protected anyone from being mistaken and becoming disconnected from evidence over time, occasionally to the point of being completely OTT. Look at Judith Curry, for example. Linus Pauling and vitamin C. Hoyle and panspermia. Look at Kary Mullis, even; he is certainly educated and qualified, and he has provided the world with a biology tool of absolutely incalculable worth (I love me my taq PCR I do I do), but let’s face it, the man is a complete frootloop. Your education and career can legitimately earn you a hearing; but they aren’t enough to guarantee your rightness, as they don’t ever protect you from getting emotionally involved in something which turns out to be improbable, or from becoming too dedicated to a proposition to evaluate evidence realistically (and I mean that as a generic “you”, not a specific “you”). And they should certainly not make your claims immune to scrutiny.

    There is one thing I really do find profoundly disturbing about this whole situation, however. From your discussion, I would think that you are concerned about the possibility of CNS damage and/or skeletal damage in children because of substances fed them to supposedly increase their health. Yes? No? But then, I saw allegations over at Respectful Insolence that you have voluntarily associated yourself with the likes of Blaylock and Autism One, as well as Mercola (and Mike Adams and other such), and this seems on the face of it to be the case. In other words, you have voluntarily associated yourself with people who advocate frequent chelation for children, when it is well-known that chelation is not risk free — and indeed, there is good evidence that chelation in the absence of confirmed presence of clinically toxic levels of heavy metals in tissues, results in cognitive damage itself, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1831518/ for the most famous example. You have in the past voluntarily associated yourself with people who simply lie about the results of clinical studies and about demonstrable results of conventional medical treatments. And what’s worse, some of these people have also actively advocated for the use of Lupron — Lupron! — at up to 5x the standard clinical dose in adolescents, to “cure” autism! Well, sure, it calms an adolescent boy right down, to have his body stripped of androgens, and I’m sure that improves behaviour. But let’s talk about damage to bones, shall we? With a helping of a 20-30% chance of cardiovascular disease on the side?

    So you are upset about what fluoride is potentially doing to people, on the one hand, and you hang out with people who advocate using treatments which are far more dangerous, on autistic children, on the other?

    I realise that just a day ago I was the one calling for restraint of language here. The irony of this is not lost on me. But I have to say it: Are you out of your fucking mind?!

    If you could provide an explanation for this, I really would appreciate it.

  246. #247 Mike
    December 9, 2010

    @Paul,
    I’m going to try a more settled rebuttal here.

    “We have written a thoroughly documented text presenting our case – with the minimum of hyperobole.”

    The last part of that introduction, my friend, is what is called a laughable statement. Have you even read the subtitle to your book? How is this not fear-mongering? This book screams cranksterism; sorry, I’m sure you don’t want to hear this, but try bringing it to 10 random DDSs in your community, and ask for their opinion. I have no doubt that several will reject in out of hand because of the way you present your message…which is chock-full of hyperbole, fearmongering, making people scared of something…but it sells! You know where the pathos and essence of this book would do well? Two places come immediately to mind. 1) The Glenn Beck show (’nuff said). 2) Gretchen and Doofus on FauxNewz, (’nuff said).

    The trajectory of you message is this: We are going to throw as much spaghetti at the wall as possible in the next XX pages, and if more than some minimum sticks, whoopee! Your post #148 clearly expounds how muddled your message is…you toss out everything hoping someone will believe something, somewhere along the line. Just. Wow.

    The Science:
    Well, this is the big one isn’t it? And I am going to hand wave it away in this fashion. You suggested somewhere that I (we) should write counter paper stating the pro-fluoride side. Well, no, we don’t need to…this is your fight, and you have shown how you are willing to fight it. I’ll leave the dozens of gov’t, health, and water agencies in this and other countries to do the pro- papers (which they have). What I will say, is that the decision for three retired PhDs (I think you said) to take your message to the popular press, rather than publishing a succinct paper in a peer-reviewed journal is a mistake. I know that Environmental Toxicology, or Environmental Health Perspectives, or even Medical Geology would all be willing to publish a well-reasoned paper.

    Science is done at that level, not on blogs, not in the press (popular or otherwise). And shame on you for pretending that you don’t know this, because we all know well that you do.

    Your mixed message:
    It only shows minimal efficacy…oh wait, no, it’s actually ineffective…no, what I mean to say is it’s deliterious, no, no I mean its TOXIC!!!!!

    No, no, no, and no. What a terrible, awful mess, for apparently well educated scientists that is. You cannot have it all four (ok, seven) ways. Gather, analyze, discuss, and report a single message. That is the only correct method for science communication. You and your co-authors do nothing but throw spaghetti here. Your message forces me to look away, seriously.

    And I’m not even going to get into the straw men you create out of the legislative process.

    That’s it. I could go on, but I’ve said my piece. My humble opinion, as a chemical water-quality professional, is that the content appears to be a mishmash of half-truths, poorly thought out stabs at any number of professional organizations, and a whole slew of misunderstanding and quote-mines. That is not to say that you might not have a kernal worth pursuing…you actually might. But I’ll never know, because I won’t read stuff like this.

    best wishes,

  247. #248 Sid Offit
    December 10, 2010

    After following this discussion for a week it’s become obvious the pro-fluoridationists are as immune to reason as they belive fluoridated teeth are from decay. Trying to convince them of the folly of fluoridation is analougs to Rachel Maddow trying to convince David Bahati that there might be something wrong with executing homosexuals.

  248. #249 Sid Offit
    December 10, 2010

    @ Luna

    So you are upset about what fluoride is potentially doing to people, on the one hand, and you hang out with people who advocate using treatments which are far more dangerous, on autistic children, on the other?

    I find it bizarre you believe a books credibility is determined by the harmful ideas espoused by a program used for the promotion of said book. If I’m promoting a book should I avoid avowed socilst Lawrence O’donnels msnbc show even those his socialism has done more damge that even chelation. Should I avoid the progressives on the View as well as uber-liberal Larry King?
    ———————

    It’s probably safe to say that fluoridation of the water has the largest dental-caries-prevention effects in lower-income populations with low rates of compliance with dental recommendations for toothbrushing and regular cleanings

    Yes lets all give our children dental fluorosis so we can help those feeding their kids lolly pops

    PS – Kids don’t get regular cleanings at the dentist

    ——————-

    Results: For 5/6-yr-olds, mean primary caries scores were 96.0% less in fluoridated than nonfluoridated subjects – In 8–12-yr-olds, DMFT values favoured water-fluoridated subjects; their caries-free trend was significant

    I don’t have access to the entire study – only the abstract, but the author makes no mention regarding delayed eruption in the primary dentition (where he/they cite 96% impact) He does mention it having no effect in the permanent dentition but fails to put an efficacy number on the 8-12 year old group. Maybe delayed eruption accounts for such splendid results. Interesting we go from 96% to just “significant”

    —————————

    Colleagues at a nearby mouse lab were unable to confirm your assertion that “It is well known that a rat needs to receive a dose 5-10 times as high so as to reach the same plasma levels as a human”

    The Textbook of Pharmaceutical Medicine By John P. Griffin P132 – goes into some detail on rats vs. humans

    Also google “rats typically require higher doses of drugs than humans to observe an effect” (the web address is quite long)
    ———————–

    I’m sure you don’t want to hear this, but try bringing it to 10 random DDSs in your community,

    Out of those 10 DDSs only 2 would even know how fluoride “worked”

    http://www.ncbi.nlm.nih.gov/pubmed/17899898The majority of dental professionals surveyed were unaware of the current understanding of fluoride’s predominant posteruptive mode of action through remineralization of incipient carious lesions.

  249. #250 Mike
    December 10, 2010

    @Sid Offit

    After following this discussion for a week it’s become obvious the pro-fluoridationists are as immune to reason as they belive fluoridated teeth are from decay.

    I don’t even know what this means.

    Out of those 10 DDSs only 2 would even know how fluoride “worked”

    Ergo, it doesn’t work?? That’s really your argument?

    Trying to convince them of the folly of fluoridation is analougs to Rachel Maddow trying to convince David Bahati that there might be something wrong with executing homosexuals.

    You are correct…you have not convinced me. Hint: try less hyperbole and more science.

  250. #251 Luna_the_cat
    December 10, 2010

    Sid, dear, some of us know enough about rodent biology to understand the fact that they do not have identical responses to every test substance. Sometimes they need more, in order to show a proportional response to humans. Sometimes it is the same. Sometimes it is less, because they have a higher sensitivity to the substance in question, or do not metabolise it well. It is very specific to the substance in question. That is why I said, in my response, that the statement was specifically with regard to fluoride (and common fluoride compounds).

    I will look up the reference to see if you are correct, thank you for the detail. The rest of your post is largely incoherent, but in bits simply wrong. But what do I know, maybe kids don’t get regular dental cleanings at dentists’ offices where you live. Here they do, it is recommended for twice a year. They did when I was living in the US, as well. But hey, like I said, maybe they don’t where you are.


    @Mike: Sid Offit is a dedicated anti-vaccinationist who usually trolls Respectful Insolence. What he just posted here is really very typical.

  251. #252 Luna_the_cat
    December 10, 2010

    Sid:

    As I suspected. The reference you gave discusses the scaling factor for therapeutic pharmaceuticals where a difference in human/animal response is suspected, but not known or where it is not well understood. It does not refer to fluoride compounds, where it looks to me as if extensive testing of blood sera levels and bone surface and bone interior have all been done in order to assess absorption, and it seems to be the case that absorption of it is much of a muchness in all mammals.

    So. I renew my request to Paul Connett — if he is aware of specific protocols which describe fluoride absorption in rodents, on which he bases his statement that they need 5-10x human dose to reach the same blood serum level, I would really love to know details.

  252. #253 La punaise
    December 10, 2010

    Mike@253. I don’t know how you can advise anyone to talk about science when your posts give no hint that you know anything about science even if you are the top “water quality professional” in Ruritania for all I know. Have you made a single serious scientific statement, quoted one scientific paper? You can’t even understand what Sid Offit meant about DDSs even though he made it clear enough I’d have thought. If you tried the link he gave, maybe you couldn’t figure out why it didn’t work exactly as given (hint: typo). So here it is. It confirms what he said. Enjoy. J Public Health Dent. 2007 Summer;67(3):140-7.
    Knowledge and use of fluoride among Indiana dental professionals.
    Yoder KM, Maupome G, Ofner S, Swigonski NL.

    And you don’t appear to understand that original papers, reviews and books play different necessary roles and don’t always need to be written by the same people.

    Do you ever get around to actually reading any books? It’s simpler to find reasons not to that’s for sure, and you seem to have a lot else to do. Hint: save time, follow the sensible punaise example and go back to lurking.

    La punaise

  253. #254 H S Micklem
    December 10, 2010

    Luna_the_cat @234,236
    Of the two papers you think were missed, McDonagh et al is the famous so-called York report which everyone on both sides of the debate regularly quotes/misquotes to bolster their point of view.

    The Stephen et al paper is a real lemon. I don’t know whether you have had a chance to read the whole paper rather than just the abstract. There are problems.

    1. Beware the percentage scam. The headline 96% reduction in caries has a nice high geewhizz factor. If you unscramble the garbled mess that is Table 3 it turns out that decayed, missing or filled deciduous teeth in 5-6 year olds (the categories are not distinguished) number 3.21+/-3.11 in the control community and 0.13+/-0.35 in the fluoridated three. That is a worthwhile reduction IF (big if, which I’ll come to) it is due to fluoridation. But it hardly has the impact of 96%. Almost all papers quote their caries reductions in percents. It is not exactly a lie, but it is a kind of trickery when you are dealing with small numbers. They also refer to the difference between 0.96 and 0.00 carious tooth surfaces, out of 128 in a child’s mouth, as a reduction of 100%: wow.
    2. Not a problem, but note that differences are smaller and more irregular in the permanent teeth of older children.

    3. Now the real problem and it’s a biggy. They claimed that the fluoride-exposed (F) and control (NF) communities were “socioeconomically similar” in rural Morayshire, without giving any supporting detail. You live nearby and confirm that the communities look similar, though this puzzles me since Buckie+Portessie (Postcode AB56 1) is an industrial town of 8,000 or so people and the other places are small villages with a total population little more than half that. I have been looking at the relative demographic and socioeconomic data for the period of the study and they reveal large differences between the F and NF communities in almost every parameter you can think of: income, life expectancy, social class composition, educational level of workforce, car ownership, proportion of children living in single-parent or welfare-dependent homes, etc, etc. All of these show that the NF control community of Buckie/Portessie was substantially poorer and less privileged than the three F villages and hence, as wide experience has shown and the authors acknowledge, likely to have poorer dental health. So much for the authors’ claim of similarity. Worse still – and the authors must surely have been aware of this – Buckie/Portessie’s children apparently had exceptionally poor dental health even by Scottish standards, as evidenced by one of the highest dental hospital admission rates in the country – 3 times the national average.

    In short, the Buckie/Portessie area provided an absurdly inappropriate baseline for assessing any effect of fluoridation on the wealthier communities and, as a result, no valid conclusions can be drawn from the paper.

    The socioeconomic data are available online from ScotPHO (Public Health Information for Scotland), and demographics (I haven’t said anything about that, but there are also big differences in population make-up) from Scottish Census Results Online. Let me know if you have trouble finding them. The amount of detail is amazing.

    Some very large studies that have been published during the last 20 years or so, mostly by people with a stated pro-fluoridation bias, show little difference in the permanent teeth, some so little that it might reasonably be called trivial.
    You may like to look at some of the following if you aren’t already familiar with them.
    J. A. Brunelle and J. P. Carlos, “Recent Trends in Dental Caries in U.S. Children and the Effect of Water Fluoridation,” Journal of Dental Research 69 (1990): 723–27
    A. J. Spencer, G. D. Slade and M. Davies, “Water Fluoridation in Australia,” Community Dental Health 13, suppl. 2 (1996): 27–37
    D. Locker, Benefits and Risks of Water Fluoridation: An Update of the 1996 Federal-Provincial Sub-committee Report, prepared under contract for Public Health Branch, Ontario Ministry of Health First Nations and Inuit Health Branch, Health Canada (Ottawa: Ontario Ministry of Health and Long Term Care, 1999), http://fluoridealert.org/re/locker.1999.pdf
    H. Cohen and D. Locker, “The Science and Ethics of Water Fluoridation,” Journal of the Canadian Dental Association 67, no. 10 (2001): 578–80 34.
    J. M. Armfield and A. J. Spencer, “Consumption of Nonpublic Water: Implications for Children’s Caries Experience,” Community Dentistry and Oral Epidemiology 32, no. 4 (2004): 283–96.
    A. Komárek, E. Lesaffre, T. Härkänen, et al., “A Bayesian Analysis of Multivariate Doubly-Interval-Censored Dental Data,” Biostatistics 6, no. 1 (2005): 145–55.
    J. J. Warren, S. M. Levy, B. Broffitt, et al., “Considerations on Optimal Fluoride Intake Using Dental Fluorosis and Dental Caries Outcomes—A Longitudinal Study,” Journal of Public Health Dentistry 69, no. 2 (2009): 111–15.

    Can you remind me about the protests you say occurred when fluoridation was mooted for the UK way back? I can’t recall anything about them or even that they existed (Of course I know about the recent circus in Southampton).

Thanks.

  254. #255 Mike
    December 10, 2010

    @punaise

    You can’t even understand what Sid Offit meant about DDSs even though he made it clear enough I’d have thought.

    I understood perfectly, thank you. He inferred that because they are not aware that considerable (and real) discussion regarding topical vs systemic efficacy is occurring…fluoride must be what…bad?

    On which I call bullshit. I’ll leave it to you to sort out the logic.

    Have you made a single serious scientific statement, quoted one scientific paper?

    From @249: “I’ll leave the dozens of gov’t, health, and water agencies in this and other countries to do the pro- papers (which they have).”

    Spewing references is, as we all know, is a time-honored blog tactic. I have read many of them. If you, or anyone else is interested in finding them, teh Google awaits.

    And you don’t appear to understand that original papers, reviews and books play different necessary roles and don’t always need to be written by the same people.

    If they have an original thought, an important addition to the scientific literature, then an advertisement on a relative’s blog, couching a bag of spaghetti-throwing half-truths, is a poor choice for an outlet. These are presumably seasoned scientists. WTF? Is there a reason that a proper paper wasn’t the goal of their interest? I won’t wait on pins and needles for an answer.

    I write a lot, and I read a lot, and I lurk a lot. And when I see content about which I have personal, professional knowledge which comes wrapped in sensationalist, fear-mongering hyperbole, I call bullshit. I would hope that you would do the same.

    best,

  255. #256 John M.
    December 11, 2010

    Oh dear. Just when we thought you were doing a great job of putting down the pseuds, you go and fall for the old “It’s family” scam and get a load of woo dumped on your (mostly) impeccable blog. Why not follow up with a guest post by Christopher Monckton, just to even things up a bit [/sarcasm]

  256. #257 Luna_the_cat
    December 11, 2010

    Micklem: Unfortunately I have a lot of things (real work stuff) that I need to do this weekend, so I need to be brief; but a few quick responses which I would be happy to revisit at leisure.

    Simplest first — there were some very vocal and vitriolic protests at water fluoridation plans in Scotland in 2003 (see, for example, http://scotlandonsunday.scotsman.com/addingfluoridetothewatersupply/Scots-sink-teeth-into-fluoride.2428446.jp ), and I seem to remember the previous protest being around 1990, although I can’t dig up news stories from then and have to admit I wasn’t paying close attention. Perhaps I was extrapolating from Scotland to all of the UK in an unwarranted fashion, but certainly we’ve had that reaction in the public of Scotland, and the Green party have done their best to fan those flames where they can in England, much shame to them.

    Second, re. the Morayshire paper — I have in-laws living in Portknockie (if you aren’t sure where that is, I suggest Google maps) and my husband and I love the north coast and stay at their house whenever we can — I can assure you, I haven’t just “seen” the area, I’ve walked it, shopped it, got to know its local drunks, got to know its local folk music groups (there are some good ones), listened to local whinging about local papers and politicians, etc. etc. As I mentioned, Kinloss is distinguished by its RAF base — which skews education and employment statistics, but does not contribute much at all to the local population of children (it is not a family base) — and Findhorn is distinguished by its famous hippie (now really ex-hippie) community which is very prosperous and skews education and employment statistics, but again not so much the children; outside of these little islands, the communities are indeed very well matched. Burghead, very well matched, except obviously for absolute population and numnber of manufacturing jobs. You point about % being squishable or stretchable is well enough made, but actually, the straight numbers do speak volumes.

    Now, I haven’t time at the moment to read your list of references in every detail, but a quick search amused the heck out of me.

    J. A. Brunelle and J. P. Carlos, “Recent Trends in Dental Caries in U.S. Children and the Effect of Water Fluoridation,” Journal of Dental Research 69 (1990)

    Children who had always been exposed to community water fluoridation had mean DMFS scores about 18% lower than those who had never lived in fluoridated communities. When some of the “background” effect of topical fluoride was controlled, this difference increased to 25%. The results suggest that water fluoridation has played a dominant role in the decline in caries and must continue to be a major prevention methodology.

    A. J. Spencer, G. D. Slade and M. Davies, “Water Fluoridation in Australia,” Community Dental Health 13, suppl. 2 (1996)

    Results from Australian oral epidemiological studies consistently support the accumulated evidence on the effectiveness of water fluoridation. This includes recent evidence that lifetime exposure to fluoridation is associated with average reductions of 2.0 dmfs and between 0.12 and 0.30 DMFS per child compared with non-exposed children. Water fluoridation has been found to reduce socio-economic inequalities in caries, reducing the differential between high and low socio-economic status groups by approximately 1.0 dmfs and 0.2 DMFS per child. … Community water fluoridation continues to be the most effective and socially equitable measure for caries prevention among all ages by achieving community-wide exposure to the caries preventive effects of fluoride.

    Benefits and Risks of Water Fluoridation: An Update of the 1996 Federal-Provincial Sub-committee Report, prepared under contract for Public Health Branch, Ontario Ministry of Health First Nations and Inuit Health Branch
    – A bit more complex than the cherry-picked quotes in the conclusion that are extensively used on fluoridealert and other anti-fluoridation sites. Includes things like

    The quality of the evidence provided by these recent studies of the effectiveness of water
    fluoridation is, in general, rather poor. Nevertheless, in spite of weak designs,
    methodological flaws and the publication of studies showing no significant differences in caries rates between fluoridated and non-fluoridated communities, the balance of the evidence does suggest that in many locations water fluoridation is associated with a reduction in rates of dental decay. This conclusion is strengthened by the findings of the few studies that are more robust in methodological terms.

    and

    However, these studies reported that caries rates are highest of all in children from low socioeconomic groups living in non-fluoridated communities. Moreover, the absolute difference in dmft/s or DMFT/S scores between populations living in fluoridated and non-fluoridated communities is consistently larger in lower SES children than in higher SES children

    (So, better studies needed? Sure. Lack of benefit? Not so much.)

    J. M. Armfield and A. J. Spencer, “Consumption of Nonpublic Water: Implications for Children’s Caries Experience,” Community Dentistry and Oral Epidemiology 32, no. 4 (2004)

    There are concerns that the consumption of unfluoridated bottled and tank water may put children at increased risk of developing caries.

    Multivariate modelling revealed a significant positive relationship between deciduous caries experience and consumption of nonpublic water, even after controlling for the age and sex of the child, SES and residential location.

    CONCLUSION: Recommendations are made for the addition of fluoride to bottled water, especially with regard to the oral health of younger children.

    A. Komárek, E. Lesaffre, T. Härkänen, et al., “A Bayesian Analysis of Multivariate Doubly-Interval-Censored Dental Data,” Biostatistics 6, no. 1 (2005)
    –Came to a firm conclusion that fluoridation doesn’t help with caries, but Jesus wept, you pick on the Morayshire study and then put forward this? Talk about limited, biased and weak! “Our analyses will be limited to the caries experience of the four permanent first molars (teeth number 16, 26, 36, 46 in European dental notation) … it was decided to measure fluoride-intake by the degree of fluorosis on some reference teeth. [that is, not by access to fluoridated water]” Yeesh.

    J. J. Warren, S. M. Levy, B. Broffitt, et al., “Considerations on Optimal Fluoride Intake Using Dental Fluorosis and Dental Caries Outcomes—A Longitudinal Study,” Journal of Public Health Dentistry 69, no. 2 (2009)

    While the present study was longitudinal and went to extensive efforts to account for multiple fluoride sources, it relied on periodic parental reports of fluoride use and ingestion which may not have been completely accurate. In addition, some potential sources of fluoride ingestion, such as fluoride mouthrinses and gels or professional fluoride applications, were not assessed in a way to yield concentrations and amounts of fluoride ingestion. In addition to these limitations, the study was conducted in one area of the United States with a sample that was not representative of any defined population. In part because of the longitudinal study design, those who remained in the study until the dental examinations at age 9 years tended to be from higher income families than those who dropped out of the study. Lastly, there were missing data, so the means reported were based on variable numbers of respondents for each time point. [my emphasis]

    In addition to the study’s limitations, there are a few cautions in interpreting the study results. First, most of the fluorosis was mild or very mild (3 percent of fluorosis cases were “severe” as defined by FRI score 3) and generally not of much esthetic concern. Similarly, most of the children with caries had relatively few decayed or filled surfaces.

    Despite the limitations, the study provides the only recent, outcome-based assessment of the “optimal” fluoride intake, and as such, it appears that while the generally accepted range of 0.05 to 0.07 mg F/kg bw may still be associated with caries prevention, it may not be optimal in preventing fluorosis.

    So, in other words, the groups most likely to have benefited from water fluoridation were likely not a part of this study, but nevertheless the authors believed there to be a benefit to a level of water fluoridation, though they pointed out accurately that setting the optimal level of fluoridation was tricky.

    …And so on, and so forth. Honestly, I have to go do other things now. But I have to wonder: what exactly are you trying to prove, here?

    I renew my request for Paul Connett to answer the questions I asked, please.

    I have to admit, I am becoming less and less impressed with this whole thing.

  257. #258 Luna_the_cat
    December 11, 2010

    There was a blockquote fail on that last paper. All the paragraphs between “While the present study was longitudinal…” and “So, in other words …” were actually from the paper itself.

  258. #259 Sid Offit
    December 11, 2010

    @Luna

    To paraphrase Jerry McGuire, “They had you at social equitability”
    —————-

    and generally not of much esthetic concern.

    I’m glad these clowns feel empowered to judge what is of esthetic concern to others

    ————

    Are you not understanding the concept that fluoride-induced delayed eruption is a confounding variable ignored in the studies you highlight?

  259. #260 Luna_the_cat
    December 11, 2010

    Sid, I very much doubt that you have read these studies, at all. That might be a thing to try before you make assertions about them. Although, given your general level of comprehension, to be honest it probably wouldn’t make much difference.

  260. #261 Robert Murphy
    December 13, 2010

    Finally, a website that practices truth in advertising. “Ill Considered”, indeed.
    I’ll take my fluoride-tainted precious bodily fluids to other climate websites like RC and Open Mind where I can get climate info free from Coast-to-Coast woo. Very disappointing.

  261. #262 Doctor Smart
    December 13, 2010

    Nazis used sodium flouride on prisoners to make them more obedient and less likely to think for themselves. Who knows why our government is doing it.

  262. #263 Luna_the_cat
    December 14, 2010

    Sweet jesus; when both Sid Offitt and “Doctor Smart” show up in a thread on your side, you know you’re in trouble.

    I think this thread is becoming moribund. Let’s let it.

    But, Coby: what you have here is a big steaming pile of opportunity — honestly. I think you should be getting insight out of this.

    You took a position backing someone you like, respect and admire, your father. You obviously consider your father to be an intelligent man. The question is, do you stick with personal loyalty to an idea which obviously means a lot to him, or do you take on board the criticisms, and perhaps do a little reading around of your own to look at what is on PubMed (never a bad idea), and reconsider the possibility that it really is what the mainstream science says it is?

    At this point, I don’t doubt that attacks on this fluoride idea (and against the intelligence of the people who see a malevolent conspiracy here) probably feel like attacks against you, personally, and your dad (in some cases, it does descend to something indistinguishable from that, too). And the thing which feels right to do, in fact the automatic thing that people do under circumstances like this, is to look for evidence to support the position that you had committed to, and to find ways to nitpick, devalue or rationalise away the stuff that looks like it directly contradicts that position. The fact is, as well, the longer you value an idea for the stronger you entrench yourself in its defense, whether you intend to do that or not.

    You’ve had several posts on how on earth Judith Curry could have gone so far off the rails in dealing with the climate ‘debate’, especially given her education and qualifications and background and (one would have thought) intelligence. This ought to give you some insight. Is it any more understandable, now? How incredibly difficult it is to re-evaluate and back down after you’ve committed to something, even if that something ends up contradictory to the bulk of evidence available and rests on what is essentially a conspiracy theory?

  263. #264 H S Micklem
    December 14, 2010

    Luna 259. Thanks for the ‘protests’ ref. I do remember the Scottish discussion. You say that there were “very vocal and vitriolic” protests. Neither the article you cite nor any of the links I followed from it mention anything of the sort, though they mention several thousand written submissions. No doubt there were vocal protests too; what’s wrong with that? Vitriolic? Doubtless a few people yelled and ranted about Hitler, Stalin, concentration camps and the gulag. Overall I’d say it was a reasonably calm democratic process and the proposal failed because there was cross-party opposition to it in the Scottish parliament, not just the Greens. The dental profession was disappointed, but has reacted well, finding other more logical ways to reduce caries in vulnerable populations such as parts of Glasgow. In an earlier post (#234) you stated: “I can address one question, which I think was implicated in ‘why was the US one of only a few countries to introduce water fluoridation’, which is ‘why, when there is evidence of benefit, has the UK *not* introduced water fluoridation.’ The answer to that is relatively simple: they tried, and the protests matched the burning of GM test crops in their ferocity.” So are you now withdrawing this? As far as I am aware, it is a fantasy..

    The Morayshire paper. Easy to understand that you love the north coast of Moray, but what have your cultural and touristic impressions got to do with whether Buckie is a suitable control population?? If it comes to a choice between them and official detailed socioeconomic data relating to the actual period of the study, I have to prefer the latter. Sorry, no disrespect to you.
    You say that the controls are valid; the data say unequivocally that they are not.

    You partly explain the disparity yourself by mentioning the RAF base at Kinloss. (There is another nearby at Lossiemouth.) These two bases dominate the immediate local economy. Just look at the current local anxiety about the impending closure of Kinloss. The official body Highlands and Islands Enterprise has estimated that the base supports 2341 jobs and contributes £68million to the local economy annually; the figures for Lossie are 3370 and £90million http://www.hie.co.uk/highlands-and-islands/economic-reports-and-research/, http://news.scotsman.com/scotland/Jobs-warning-over-RAF-Kinloss.6601753.jp.

    It is just a pity, from the point of view of Stephen et al’s paper, that the fluoridated communities are very close to the bases and hence are wealthier than most other rural communities, while Buckie is much further away and probably benefits less. Irrespective of fluoride, one would expect these places to have better dental health. I don’t want to bad-mouth this small local study or its hard-working authors, but unfortunately all these factors rob it of any significance as it stands. As it happens, they arrived at much the same picture for deciduous teeth as most of the large studies.

    The papers that amused you. Your life must be one big laugh. It would be better to read them rather than jumping to judgement with short quotes from skimmed abstracts. You seem to be trying to score points off me, but I can read too and know perfectly well what is in those abstracts. Perhaps it’s just standard don’t-try-to-fool-me-I’m-far-too-smart forum-speak. Almost all these papers are by avowed supporters of fluoridation and I thought you might be interested to observe the disconnect between the “conclusions’ that praised the fluoridation programme and the actual results, showing very small or absent benefits, that they obtained from thousands of subjects. I won’t waste my time and everyone’s else’s with a lot of details, but:
    1. In Brunelle & Carlos, 18% means a caries reduction of 0.6 of a permanent tooth surface out of 128 in the mouth. The percentage scam again. Big deal innit? They don’t see fit to put that in the abstract, so you probably wouldn’t have known. Yiamouyiannis 1990 (a fluorosceptic) analysed the same data at a whole tooth rather than tooth surface level and you can access that through http://www.fluoridealert.org/health/teeth/caries/nidr-dmft.pdf He found no significant effect on the permanent teeth. The deciduous teeth showed some benefit, but remember that any benefit to the deciduous teeth is bought at a price, since fluorosis of the permanent teeth is induced by ingesting fluoride in the very early years of life.

    2. Look at Spencer et al’s figures: 2.0 less dmfs and 0.12-0.30 less DMFS due to fluoridation. So they were able to report that fluoridation worked. Fine, but ask yourself: is the difference worth the expense, the additional dental fluorosis, a lifetime’s accumulation of F in the skeleton and very possibly other serious problems, albeit let us say unproven? Please tell: I am listening. Later (2006) they called for fluoridated bottled water on even slenderer grounds, including NO significant effect on DMFS.

    3. Locker 1999

    Obviously it’s more complicated than any short quotes can convey! – it’s quite a long report. Why do you object to the quotes on FluorideAlert? They are non-contentious and reflect what the CDC and other other official pro-fluoride organizations say. Also that website offers you access to the entire report, which unsurprisingly is painted not in black and white but various shades of grey. Locker was a proponent of fluoridation, but (unusually) not dogmatically so. He wrote thoughtfully. I wish he were around to update his report, but unfortunately not.

    4. Komarek 2005. LOL. Feel free to read and understand the paper and THEN rubbish it.

    5. Warren et al 2009. Fluorosis. Percentages again. 3% percent of “severe” fluorosis more or less brushed aside: tiny minority… Well, let’s keep it simple and imagine that just 1% have severe (probably includes “moderate” in other classifications) fluorosis. 1%? Who cares about that? Go figure: that’s 10,000 cases of moderate/severe fluorosis for every million people drinking fluoridated water, 50,000 in the UK. Have you ever seen moderate-severe fluorosis? You don’t want it in your mouth. The British Fluoridation Society, which exists to promote fluoridation, agrees that 3% is about right (p.24 of the following pdf}:
    http://www.bfsweb.org/One%20in%20a%20million/3%20dental%20fluorosis.pdf

    H S Micklem

  264. #265 name
    January 7, 2011

    http://www.azcentral.com/news/articles/2011/01/07/20110107water-flouride-levels-too-high-.html

    ATLANTA — Fluoride in drinking water — credited with dramatically cutting cavities and tooth decay — may now be too much of a good thing. Getting too much of it causes spots on some kids’ teeth.

    A reported increase in the spotting problem is one reason the federal government will announce Friday it plans to lower the recommended levels for fluoride in water supplies — the first such change in nearly 50 years.

    About 2 out of 5 adolescents have tooth streaking or spottiness because of too much fluoride, a surprising government study found recently. In some extreme cases, teeth can even be pitted by the mineral — though many cases are so mild only dentists notice it.

    Health officials note that most communities have fluoride in their water supplies, and toothpaste has it too. Some kids are even given fluoride supplements.

    The U.S. Department of Health and Human Services is announcing a proposal to change the recommended fluoride level to 0.7 milligrams per liter of water. And the Environmental Protection Agency will review whether the maximum cutoff of 4 milligrams per liter is too high.

    The standard since 1962 has been a range of 0.7 to 1.2 milligrams per liter.

    The Centers for Disease Control and Prevention reports that the splotchy tooth condition, fluorosis, is unexpectedly common in kids ages 12 through 15. And it appears to have grown much more common since the 1980s.

    “One of the things that we’re most concerned about is exactly that,” said an administration official who was not authorized to speak publicly before the release of the report. The official described the government’s plans in an interview with The Associated Press.

    The government also is expected to release two related EPA studies which look at the ways Americans are exposed to fluoride and the potential health effects. This shift is sure to re-energize groups that still oppose it.

    Read more: http://www.azcentral.com/news/articles/2011/01/07/20110107water-flouride-levels-too-high-.html#ixzz1ANrE2ebG

  265. #266 Skeptic?
    January 7, 2011
  266. #267 ShmienceBlogger
    January 9, 2011

    *crickets*

  267. #268 mike
    January 16, 2011

    it’s glaringly evident from reading this article and the comments below it that the “pro” fluoride camp has been outclassed and out-argued by the authors of the book. every one of their criticisms of the authors’ data and sources has been smashed to pieces just in this comment thread, yet as elsewhere on the internet, media, and in politics, the “pro-” group responds with comeents that make no sense.
    for example, “we acknowledge that fluoridation causes increased fluorosis rates where it has been introduced. but according to the ADA or the CDC,there is no eveidence that it accumulates in human tissue.”

    what??

    they’re so stuck on the idea that anti-consensus arguments equal quackery, that they don’t even realize how much like quacks they sound.

  268. #269 mike2
    January 16, 2011

    #270 not to be confused with the other “mike” several comments above. i’ll be “mike2″, i guess.

    another thing carefully avoided, or “vigorously brushed aside” by the pro-camp is the issue of the source of the fluoride used for water fluoridation- (often) unrefined hydrofluorosilic acid from the wet scrubbers of the smokestacks of phosphate fertilizer plants. a quote from the USGS mineral commodities survey, 2007: (similar numbers quoted in more recent years as well)

    “An estimated 47,000 tons of fluorosilicic acid (equivalent to about 83,000 tons of 92% fluorspar) was recovered from phosphoric acid plants processing phosphate rock. Fluorosilicic acid was used primarily in water fluoridation, either directly or after processing into sodium silicofluoride.”

    that IS a big deal. what would they do with this substance otherwise? i don’t know why more of the pro-folks don’t find this disturbing. and what of the co-incidence of the invention of the fluoride recovery devices (“wet scrubbers”) and the introduction of water fluoridation?

    seems as if before these devices were introduced, the industries emitting waste fluoride into the air were causing a lot of collateral damage to the crops, livestock, and people around them. (or, actually it doesn’t just seem that way, that is what happened).

    and then suddenly with the wet scrubbers, they have all this unrefined waste fluoride, highly toxic, which they would have had to pay a great deal to dispose of, but co-incidentally that was around the same time water fluoridation was introduced?

    that REALLY sounds fishy to me.

  269. #270 mike2
    January 18, 2011

    let’s hear some of the “scientist” bloggers here address that issue, rather than arguing about the banal minutiae of the studies regarding the safety of fluoride(about which the authors of the book have ruined your credibility)…

  270. #271 ShmienceBlogger
    January 21, 2011

    “let’s hear some of the “scientist” bloggers here address that issue”

    No, we don’t need to hear any more Pepsi-science thank-you. Like aspartame, the science-substitute sounds so good, most couldn’t tell the difference in a blind A-B test.

  271. #272 mike2
    January 28, 2011

    just as i thought. push it aside, call me a quack, and presto! the source- issue evaporates! good thing there are people out there like the authors, who are actually changing policy through their work.

  272. #273 blah, blah, blah
    January 29, 2011

    Lead, arsenic and radionuclides are in the hydrofluorosilic acid added to most fluoridated water in the U.S. They are not healthy in any amount. The U.S. Environmental Protection Agency (EPA) has a maximum contaminant level goal of zero for them. A few minutes of research will confirm this. If you want to pollute your brain and body with every glass of water and cup of coffee you drink with lead, arsenic and radionuclides then go ahead but don’t make the rest of us.

  273. #274 Robert G
    December 4, 2011

    It astonishes me that certain individuals, who have commented on this article, do not even have the basic professional courtesy of reading the book in question before criticising both the authors and the book. One of the authors has even offered the book for free, yet there is still a refusal to read it. The authors have asked for nothing more than a professional, referenced, written response to their work – and in turn have been met with a disgraceful barrage of immature, unprofessional sniping. If you are so confident that their work has no merit, then read, review, and front up to debate the authors properly! If you don’t want to read the book, then you have no right to criticise it; and even less right to question the professionalism of the authors! And, for what it’s worth, my doctor – who holds a MBBS(Hons.) degree – has a copy and proudly keeps it on his desk as as a reference work. As a result, he filters all tap water in his clinic and no longer recommends the consumption of fluoridated water. He also met Dr. Connett personally earlier this year, and was highly impressed with Dr. Connett’s professionalism, knowledge and integrity. Dr. Connett’s book changed his position on fluoridation from Pro to Anti.

  274. #275 Humane Sorrows
    December 4, 2011

    Since WHEN did drinking lead, arsenic, mercury, aluminum in ANY amount, along with the industrial waste grade chemicals of sodium fluoride, sodium fluorosilicate, Fluorosilic Acid ever become SAFE?

    Read this: http://sapphireeyesproductions.blogspot.com/

    Then BOTHER to READ Professor Paul Connett’s book.

    You might be considered useful to this debate AFTER doing these two fundamental actions (ie. Actually READ the book, before you spit lies and vitriole). Until then, the ‘Pro Fluoride’ bunch are just regurgitating the same tired old garbage they’ve spouted to keep their personal pockets lined and people fooled.

    Little babies deserve better than a soup of heavy metals pumped into their bloodstream and traversing the blood brain barrier. And everyone else too.

    The vitriole and fear-mongering towards one well written, extremely well referenced book, shows the power the Truth has to shine on the lies of ignorance.

  275. #276 Humane Sorrows
    December 4, 2011

    Favourite comment of the whole blog:

    ” just as i thought. push it aside, call me a quack, and presto! the source- issue evaporates! good thing there are people out there like the authors, who are actually changing policy through their work. “

  276. #277 Anon
    December 4, 2011

    Let’s cut the cackle and get straight to the point which is water fluoridation is alleged to reduce tooth decay; but it doesn’t.

    Research reveals there is no clinically significant benefit from water fluoridation when fluoridated and non-fluoridated communities are compared.

    The differences claimed – that are always expressed as percentages because that makes fluoridation look like it works – are so infintisimally small that they generally represent only a small portion of one tooth surface.

    So if it doesn’t work, why is fluoridation being forced on communities?

    Please Google ‘Osmunson’ at this link http://www.pauapress.com/fluoride/files/1418.pdf and study the graph that shows that good teeth are related to a higher income not water fluoridation.

  277. #278 Robert G
    December 4, 2011

    RE: Water fluoridation chemicals –

    Despite many attempts by researchers to acquire the evidence from health authorities that the industrial-grade silicofluoride chemicals used to fluoridate water supplies have been adequately tested for safety for long-term ingestion by humans, they have been unable to do so. The chemical manufacturers (such as Incitec Pivot Limited) have also failed to provide this data, instead shifting the issue to third parties, who in turn cannot provide the data, thus maintaining a cycle of “oh, we don’t have it, try those guys; maybe they have it… oh, no, we don’t have it; ask these guys… and so on.” Here are some quotes and links below that shed some light on the issue:

    “Hydrofluorosilicic acid is recovered from the smokestack scrubbers during the production of phosphate fertilizer […] Fluorosilicates have never been tested for safety in humans. Furthermore, these industrial-grade chemicals are contaminated with trace amounts of heavy metals such as lead, arsenic and radium that accumulate in humans […] Long-term ingestion of these harmful elements should be avoided altogether.”
    http://www.slweb.org/limeback.html

    The EPA admits to having no studies on the long-term Health Effects of Silicofluorides:
    http://www.fluoridealert.org/images/letters/EPA-Masters.jpg

    Further reading:

    Dr. Connett et al cover the silicofluoride issue in The Case Against Fluoride ( ISBN: 9781603582872 ). See: pp. 16–22
    http://books.google.com.au/books?id=DEqDaoNTo2IC&lpg=PP1&pg=PA16#v=onepage&q&f=false

    Also see:

    http://www.fluoridealert.org/chemicals-in-fluoridate-water.aspx
    http://www.fluoride-journal.com/01-34-3/343-161.pdf
    http://www.nteu280.org/Issues/Fluoride/flouridestatement.htm
    http://dianabuckland.webs.com/nosafetydatafl.htm

    Potential effects of extremely low doses of toxins on the brain:

    http://video.google.com/videoplay?docid=4072416559052593081

  278. #279 Michael
    May 21, 2012

    There’s are two obvious answers…#1. I have a right to determine what goes down the gullet, and into my body, and I don’t want fuoride, which totally invalidates all claims, arguments, conjectures, research papers, rebuttals, theories, abstracts, metaphysical postulations, the end.
    #2, why add to water, for good or Ill, why add to water?

  279. #280 stimoceiver
    Teegeeack
    August 18, 2012

    This thread is full of win. The more I research fluoride, the more I’m exposed to the dogmas and litanies of the pro- and anti- camps, its becoming fairly clear that the benefits of fluoride aren’t nearly as clear cut as has been commonly stated, while there the potential for inadvertent harm to multiple body systems is quite real, before we even get to residual trace lead, arsenic and radium from the industrial grade source.

    In light of the study by Luke relating fluoride to the calcification of the pineal gland, the claims about the Nazi’s and Soviet’s adding fluoride to the water of their prison camps to keep prisoners docile start to seem, not quite as far fetched as one might like.

  280. #281 Vince Whirlwind
    August 22, 2012

    Just out of interest, what problem would be associated with the calcification of the pineal gland? Excessive scepticism about Homeopathy, perhaps? An overwhelming urge to reject irrational beliefs?

  281. #282 Myantipodean
    November 4, 2012

    Vince Whirlwind: You muppet! The pineal gland is a calcifying tissue. It naturally produces calcium hydroxyapatite crystals. Fluoride accumulates in the pineal gland, because fluoride has strong affinity for calcium. Fluoride deposition results in suppression in the function of the pineal gland. One consequence of this is reduced melatonin output, which leads to early onset of puberty.

  282. #283 Our Water
    November 14, 2012

    Announcment of new film “The Great Culling: Our Water” Filmmakers are Chris Maple and Paul Wittenberger. Alex Jones and G. Edward Griffin and selling and promoting this film.

    Dr. Laura Pressley Film did a review of “The Great Culling: Our Water” as well as Gary O. Pittman Film a former phosphate mining supervisor in Florida
    .
    Chris and Paul would really appreciate you checking out their film “The Great Culling: Our Water” and would love to have you promote their film.

    This is a link to the first 33 min of the movie for you to watch “The Great Culling: Our Water”.
    http://thegreatculling.wordpress.com/2012/11/02/the-great-culling-our-water-official-movie-first-33-min/

    Film reviews:
    http://thegreatculling.wordpress.com/film-reviews/

    Link to purchase your copy of “The Great Culling: Our Water”:
    http://www.thegreatculling.bigcartel.com

    More info about “The Great Culling: Our Water”.
    http://www.thegreatculling.net

    Thank you for checking out “The Great Culling: Our Water”!

  283. #284 Andi Eigenmann
    November 28, 2012

    With all these kind of issues and disagreements the only solution to all these talks and rants is to really have a final results on what’ll be the effect of the flouride in our health as the primary user and/or absorber of it. Me and my dentist in Longview,TX actually agreed that as long as there’s no specified and fixed decision regarding the use of flouride we can still manage using it since we are accustomed in using it and as dentist he also thinks that it is also beneficial cause this is one of the substance they are using in cleansing the teeth.

  284. #285 Peter Bach
    Brisbane Australia
    February 28, 2013

    Water is for everyone. Fluoride is not.

    41% of American children have dental fluorosis.

    China stopped fluoridation due to lower IQ in its Children.

    Fluoride is extremely toxic.

    The sooner its discontinued the better.

  285. #286 Paul Cohen
    Helena, MT
    April 8, 2013

    I appreciate the thoroughness and good humor of Dr. Connett and Dr. Beck in their replies on this thread, who absolutely kicked the asses of pompous nitpickers who, lacking the science to rebut their claims and questions, consistently resorted to a puerile smear campaign that backfired in their faces. They sure showed us all what they are made of!