Next month on Tuesday, May 5, 2015, the Town of Rockport is going to vote on whether to retain fluoride in their water system. Because I sound like I know what I am talking about when it comes to science I have been asked by several groups to voice my opinion, debate in public, discuss the finer points of a paper or papers pointing out something good or bad about fluoride.
But I won’t. I am not a biochemist or public health scientist. I can tell you the myriad ways you can analyze the expression level of thousands of genes from one human cell, (my current interest is single-cell genomics), but fluoridation is not something I study in detail.
So what do I do and how am I going to vote? I do what I always do when I have a scientific question that I am fuzzy on. I ask the scientific experts in the relevant field. I look at the consensus of the National Academy of Sciences which is charged with the responsibility of advising the President on scientific matters. (Dana-Farber Cancer Institute has some NAS members on faculty so sometimes this is as easy as walking down the hall.) In this case I also check the consensus science from the World Health Organization, the Center for Disease Control, the American Dental Association, and other experts who have studied the question and written reviews. Since we have been adding fluoride to water for 65 years these reviews are extensive. They study the hundreds and hundreds of peer reviewed papers on the subject; there are old reviews and new reviews, they all say the same thing.
The one thing I will not do is google for the answer. That would lead to the Fluoride Action Network, or Dr Mercola, or Dr Oz, or the Food Babe, or Mike Adams of Natural News, or god forbid Alex Jones of Infowars. All of those sites are anti-science full of pseudoscientific mumbo jumbo that cherry picks when it cites papers, some of them even from Harvard and MIT. The problem is that all those sites have an axe to grind. They want you to fear something so they can sell you the filter or the cure or a book. The worst thing to do is to google for the information you want that supports your preconceived notion. This is called confirmation bias. This is something even the best scientists have to watch out for because it is an easy trap to fall into. That is why scientists double blind their experiments so that their own bias does not invalidate the results.
So if you go with consensus science; fluoride is in the top five for awesome public health achievements in the past century. It saves your teeth, young and old, and there is no downside to one part per million fluoride added to your town water system.
If you go with the websites I mentioned, fluoride is a poisonous toxic waste that is being dumped into the water because Big Chemical does not know where else to put it. Big Government lets them because everyone is making money and why not medicate our citizens to make them more compliant? On most of those websites it is a big conspiracy along with vaccines and chemtrails.
To me it is simple. On the one side is anti-science. Global warming denialists, anti-vaxxers, anti-evolutionists, and anti-fluoride groups. On the other side there is real science.
You can vote to keep the fluoride in the water, or you can vote against all consensus scientific opinion and vote to take it out.
– Paul T Morrison
Principal Scientist, Dana-Farber Cancer Institute
Principal Associate in Biological Chemistry and Molecular Pharmacology, Harvard Medical School
Good Morning Gloucester 
Well said Paul…
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The author has not done his homework: FACT: The fluoridation of drinking water began during the Cold War era when a group of companies including Alcoa, Reynolds and U.S. Steel found a way to dump their industrial waste and banded together to sell their refuse to a gullible public, backed by stupid politicians and greedy manufacturers. Today, our fluoride comes from China—a country, like so many others, that refuses to pollute their drinking water with fluoride. Most of Europe and Asia DO NOT put fluoride in their drinking water. I have not seen one credible, independent study that can prove the alleged benefits of fluoridation. I have found no scientific evidence that fluoride has ever strengthened a tooth or prevented a cavity. Not one whit, not one scintilla of trustworthy, independent, documented proof.
Slowly, America is waking up to the terrible truth. Fluoride is being quietly removed from mouthwashes and toothpastes. I myself suffered for years from severe gum pocketing. Over a year ago, I stopped using fluoride topically altogether by using non-fluoride toothpaste and mouthwash, and my condition has improved dramatically. Americans remain willfully naïve, gullibility that led us into Vietnam and Iraq, and an enduring belief in Santa Claus, the Easter Bunny and the Tooth Fairy.
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I think NS Johnson didn’t get a chocolate bunny for Easter because he was too busy reading Alex Johnson and Infowars to bother with Easter.
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I don’t think the author of this feedback read the author above first…Lol…. Now we go to war on the tooth fairy??? NOOOO!!!
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You didn’t know it was the tooth fairy that got us into Iraq? CHEMTRAILS!!!
And George Bush.
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A common complaint of pro-fluoridationists is that opponents are not qualified to speak. They claim scientific consensus is in their favor. However, more and more medical doctors, dentists and scientists are now opposing fluoridation as scientifically insupportable – neither safe nor effective.
I’ve compiled 12 pages of quotes from highly credentialed individuals opposed to fluoridation, including Nobel Laureates. Some were at one time staunch proponents, but changed their minds after careful study. I’ll share just a few, as 12 pages would be too much for this forum.
William Douglass, MD: “Fluoride makes your body absorb extra aluminum. And where does the aluminum go? Your brain. And what metal shows up alarmingly in Alzheimer’s victims? You guessed it.”
Charles Gordon Heyd, MD, former President of the AMA: “I am apalled at the prospect of using water as a vehicle for drugs. Fluoride is a corrosive poison that will produce serious effects on a long range basis. Any attempt to use water this way is deplorable.”
Robert Atkins, MD: “Fluoride not only hinders normal formation of healthy new bone, but by creating crystals of calcium fluoride, produces new bone of inferior quality.”
J. J. Rae, PhD in Biochemistry: “It is a known scientific fact that fluoride is a deadly poison to enzymes, upon which all life depends.”
Douglas Styne, MD: “Long-continued ingestion of minute quantitites of fluorine causes disease of the thyroid gland.”
Robert Mick, DDS, dentist and former fluoridation promoter: “As a result of experiments with animals, we learned that bones, teeth, kidneys, livers, and spleens had accumulated up to 500 percent more fluoride than controlled animals. Cripples were born to the third generation.”
Albert Schatz, PhD, Biochemist, microbiologist and discoverer of streptomycin: “Artificial fluoridation of drinking water may well dwarf the thalidomide tragedy.”
Dean Burk, PhD, former Chief of Cytochemistry, National Cancer Institute: “In point of fact, fluoride causes more cancer death, and causes it faster, than any other chemical.”
Phyllis Mullenix, PhD, former Head Toxicologist at Forsyth Dental Center: “The evidence against the safety of this public health policy will keep mounting and never disappear again. My ignorance of fluoride in the beginning was a matter of chance. If you ignore this evidence today, it will be a matter of choice.”
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Barbara, awesome that you did not post all twelve pages. With 7 billion souls on this planet I am sure, with proper diligence, you could create a mile long list in 12 point font of accredited doctors and dentists who think fluoride is awful. The numbers are in your favor. You have only found 0.0000025% of the world population. It is still an awful way to do science. Go around collecting people who have one idea.
I could easily collect a list of doctors and lawyers and even quite a few noble laureates who believe space aliens have communicated with them. Or believe in homeopathy (a really large list of doctors) or that Vitamin C cures the common cold (tons of doctors and noble laureates.)
It does not make it true. The closest thing we can come to truth, is the consensus of expert scientific opinion. The theory of gravity is only a theory and many doctors dispute it but the theory holds water and we do not float from the earth. Immunology is a much disputed field with many many doctors refuting vaccines and yet we have wiped small pox from the earth and we should also wipe polio and measles from our civilization except for a small cult of insane people who now threaten that progress.
Consensus science protects us from crazy people. When we make big decisions about policy pertaining to towns or even a country we should not listen to singular people but a true consensus made up of experts in the field in question.
To do otherwise and we end up with no vaccines, no fluoride, no adjustment to our national energy needs to slow global warming. We would end up with the Secretary of Homeopathy. The Defense Secretary of Chemtrails. (There is a longer list than yours of people who believe in Chemtrails.)
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So, okay, let’s look at this list of “up-to-date scientists”, plucked from “FAN” by Barbara:
1. “William Campbell Douglass II is a doctor, alternative medicine promoter, and conspiracy theorist. As a conspiracy theorist, he believes that the World Health Organization developed AIDS as part of the New World Order’s nefarious plan to take over the world by depopulating the Earth. As a CAM supporter, he believes, among other things:”
“A little tobacco smoking is both good and bad (apparently he hasn’t made up his mind)
Exercise is overrated
Vegetarianism is bad
Raw milk is good
Pasteurized milk is bad
Fluoride is bad
Vaccines are bad
Sunlight doesn’t cause melanoma, but prevents it
Aspartame is bad
Homebirths are good”
—–http://rationalwiki.org/wiki/William_Campbell_Douglass
2. Charles Gordon Heyd was President of the AMA in 1936.
3. Robert Atkins, MD
Alternative Medicine, Nutritionist, promoter of diet books, and nutrition supplements
Goss’ out-of-context quote she attributed to Atkins:
“Fluoride not only hinders normal formation of healthy new bone, but by creating crystals of calcium fluoride, produces new bone of inferior quality.”
The complete quote including the complete first sentence:
“Bone specialists I’ve talked to assure me that fluoride not only hinders normal formation of healthy new bone, but by creating crystals of calcium fluoride, actually produces new bone of inferior quality. My advice to you is that if your water isn’t fluoridated and your government comes along and wants to fluoridate it, you should yell like hell.”
—–http://www.cafan.net/flashdrive/Articles/Proffesional%20Quotations.doc
4,. JJ Rae- a biochemist in the 1940s
5. Robert Mick – a general dentist in the 1930s
6. Albert Schatz – a microbiologist in the 1940s
7. Dean Burk
“Anti-fluoridation activists love to cite Dr. Burk, who has gone so far as to say that “fluoridation is a form of public mass murder.” As the past head of the National Cancer Institute’s Cytochemistry Sector² from 1938 to 1974, Burk is often cited as an unquestionable expert. However, Dr. Burk is an outlier on this issue in the scientific community. While Dr. Burk had a long scientific career and was notable as a co-discoverer of both biotin and a MRI prototype, a closer look at his career raises serious questions about his credibility. Burk’s approach to fluoridation was one of an activist more than a scientist. The self-correcting model of science advances on the basis of new evidence, yet Burk was never able to accept the mounting evidence against his favored hypothesis”.
“Burk’s quackery did not end at his anti-fluoridation activities however, he was also known for his support of the now disproven and potentially dangerous cancer “cure” laetrile. While in initial in vitro experiments Burk claimed to see “cancer cells dying off like flies“, these results are now understood to be very misleading and subsequent in vivo experimentation did not support the claims made for laetrile. A 2011 Cochrane Review of over 63 papers found “no reliable evidence for the alleged effects of laetrile or amygdalin for curative effects in cancer patients.” A common theme of Burk’s career was an over-confidence in preliminary data, while having a lack of respect for peer review and scientific criticism³.”
—-Fluoride & Cancer Quackery
http://skepticalvegan.com/2012/07/11/fluoride-cancer-quackery/
8. Phyllis Mullinex
Close “FAN” and Connett affiliate, long-time antifluoridationist Mullinex’ paper on fluoridation was completely refuted by Ross, Daston, and Whitford in 1995
“A seven-year study compared the health and behavior of children from birth through six years of age in communities with optimally fluoridated water with those of children the same age without exposure to optimally fluoridated water. Medical records were reviewed yearly during the study. At age six and seven, child behavior was measured using both maternal and teacher ratings. The results suggested that there was no evidence to indicate that exposure to optimally fluoridated water had any detectable effect on children’s health or behavior. These results did not differ even when data was controlled for family social background.”
“The research conducted by Mullenix et al discussed in this question has not been replicated by other researchers.”
—-Ross JF, Daston GP. Neurotoxicology and Teratology 1995;17(6):685-6
—-Whitford GM. The metabolism and toxicity of fluoride, 2nd rev. ed. Monographs in oral science, Vol. 16. Basel, Switzerland: Karger;1996.
“We do not believe the study by Mullinex, et al. can be interpreted in any way as indicating the potential for NaF to be a neurotoxicant”
Dr. Joseph F. Ross, DVM, PhD
Dr. George P. Daston, PhD
Neurotoxicology and Teratology, Vol 17, No. 6, pp 685-686 1995
Steven D. Slott, DDS
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Good grief, with a population of 7 billion on earth I would think she could have come up with at least a few that were not dead or crazy.
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Dead or crazy are the only two pools they have from which to draw.
A frequent commenter, “Nyscof” aka Carol Kopf, the “Media Relations Director” for FAN, often boasts of a list of professionals, worldwide, who oppose fluoridation, “including 368 dentists and 550 MDs”, obviously oblivious to the fact that there are 175,000 dentists and 850,000 MDs in the US alone, in spite of my having reminded her of this fact on a hundred or so occasions……
Steven D. Slott, DDS
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These cherry-picked quotes are actually pretty intriguing. To take at random the last quoted, Phyllis Mullenix; why the Forsythe Dental Center; why does it not yet have a single Google review; why did it have a Head of Toxicology anyway; and why is she only the former head?
Thanks to the miracle of Google we can find the answer to the last question in about 0.2 seconds. According to her former boss, “Mullenix was dismissed because of problems with the quality of her work.”
If I wanted to quote people who supported my point of view, I think I’d be a bit more diligent in screening ’em. But perhaps I’m picky.
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Here you go, Tim. If you’re bored and in need of some entertainment, here’s a link to the court documents of Mullinex’s Forsyth fiasco. Contrary to FAN BS, She was not persecuted for her fluoridation opposition.
MULLENIX v. FORSYTH DENTAL INFIRMARY FOR CHILDREN
CIV. A. NO. 94-10449-PBS.
http://www.leagle.com/decision/19961085965FSupp120_11059
Steven D. Slott, DDS
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I from England ad I live in Rockport. I have no idea when the UK started fluoridation, but it was a long time ago and it changed the landscape of childhood dental care for ever. I have several fillings as everyone of my generation does. And despite the conventional (and btw tedious) American jokes in this regard, my 55-year old teeth are healthy and straight. But kids of my kids’ generation have very few cavities or fillings by comparison. 1ppm fluoride in drinking water almost wiped them out with no measurable negative impact. As a geologist and crystal scientist, I am familiar with the ion substitution (of Fl- for OH- in a solid solution called apatite) that makes fluoridation effective, so I have no reason to fear it. But as understanding as I might be that not everyone is a scientist, I do not intend to be dragged backward by ignorance proudly proclaimed.
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Tim, as a geologist you should fully appreciate the irony of the fact that a large amount of “naturally occurring fluoride” which antis proclaim to be different from the “toxic waste fluoride” from “artificial” fluorosilicates, comes from fluorosilicates in igneous rock…..
Steven D. Slott, DDS
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Sounds good, nothing against science, but does it seem right to have a town, state or country decide what goes into a “source of life” essential intake for our bodies? We can get flouride, if we wish to from other sources. The question here is freedom to choose (or lack of it). Water is something we can’t just decide not to use/drink, unless we want to pay for it, which many people do because of fluoride or other reasons. Also, how many times have we heard many years/decades later that something scientists/we once thought was good for us is bad, or vice versa?
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If there was evidence that harm was caused by one part per million fluoride in the water system to even a small segment of the populace then yes, a choice would be the way to go. It’s not like we are talking vaccines here where a choice of not being vaccinated can cause great harm to many more people than the person not being vaccinated.
But there is no valid evidence of harm by one part per million fluoride. All consensus science shows overwhelming evidence that adding fluoride up to one part per million so that it would match communities that benefit from naturally occurring fluoride is beneficial with no downside.
Those pseudoscience websites I mentioned will rant about studies in China and India where the fluoride levels are much higher and extrapolate harm. But it doesn’t work that way.
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Excellent, Paul. In general, there is a common format of a web page you quickly run into when searching medical related items. Some of them are filled with lots of information and is very easy to read. They show up at the top of the list, and it catches your eye. But it often leads to selling you something. On Flouride, I haven’t done the research. But I think its healthy to question everything. Good post!
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Rich B, you bring up an interesting point. If you google for health related advice you are swamped with web pages trying to sell you something, mostly bullshit. These snake oil salesmen are good at their trade. They know and retain experts in SEO, Search Engine Optimization.
That is why, when you google fluoride the first hundred hits are scary fear mongering websites trying to sell you a water filter. Unfortunately the real science websites, the CDC, AAAS, NAS, ADA are not allowed to commit trickery and use SEO to load their sites to get the highest hits. So people searching think fluoride must be awful if that is all that is pulled up in a google search.
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Simply stated this is a toxic waste product scraped from Chinese smokestacks, shipped to us in bags marked poison…and poured into our public water. How does that make any sense? The water you drink, cook with , bathe -in is toxic. And you have no choice in the matter, you have no choice as to whether or not you want to be medicated.
You want your fluoride? Feel free to enjoy your fluoridated toothpaste which is labeled with serious health warnings and take your fluoride pills. The list of illnesses attributed to fluoridated water is lengthy and totally unnecessary. It’s addition to our drinking water in this day and age is irresponsible.
The people should have a choice as to whether or not they want poison added to their water supply.
“Beneficial with no downside”? You obviously have not done your homework.
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If by doing my homework I am supposed to be memorizing and believing talking points from Fluoride Action Network then you are correct. I did not memorize it. I did read it, but mostly just to keep myself up at night reading fictional horror stories.
You have to ask yourself, why would the consensus of scientific experts agree that fluoride is beneficial but instead the Chinese are sending us poisons scraped from their smokestacks and shipped in bags marked poison? Why would we allow this and what is the reason?
It must be a vast conspiracy since so many would have to be involved. Or it might be that Paul Connnett is selling fear. He has made a very good living for decades now selling this fear. Flies first class, nice house, all paid for by the fear he is selling.
You have to ask yourself why these government employees are poisoning you? What is their reason? Are the members of the National Academy of Sciences making money selling this poison? It makes no sense. It is the same nonsensical attack on vaccines. You may as well believe in chemtrails.
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Thanks, Paul. I think you have established your bona fides. So has Rockport’s Dr. Sydney Wedmore. And Dr. Jonas Gavelis. These are educated, trustworthy men, and they all support the continued use of fluoride in our public water supply.
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You point out the fact that dentists support fluoride. It is the simple truth that Joey pointed out when he brought this topic up a few months ago. He had a question, he asked his dentist, and his dentist said fluoride was awesome.
The evil conspiracy kind of breaks down right there because a) you would need to pay off a pant load of dentists to keep them all in line in the conspiracy, and b) wouldn’t a dentist be against fluoride if he or she was some kind of nincompoop? Dentists make a ton of money filling cavities and pulling rotten teeth. Shouldn’t they be on Paul Connett’s website denouncing fluoride?
But as you point out, dentists are educated, honorable professionals who have their patient’s health and well being as the most important job they have. It isn’t to sell them a book or a filter.
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Thank you, Paul, for your calm, rational and informed voice. I’m a part-time Rockporter so I can’t vote on this, but I’m glad there is fluoride in the water here as in the majority of communities in this country.
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My daughter has been drinking fluoridated water all of her 38 years and has no cavities, nor, inexplicably, does she suffer symptoms of industrial poisoning or any other vast conspiracy. Just to see if Paul is talking straight, I googled fluoride and found some wacko sites. The first hit, though, is Wikipedia, from which I learned (since in general I trust Wikipedia) several things, among them that yes, it’s good for your teeth, but also that too much of the stuff can be dangerous. However, you are far more likely to ingest too much of it from processed food than from your drinking water. The impression I got was that if you drink un-fluoridated water, you will still get plenty from other sources, for instance, breakfast tea.
Does someone really think we import bags of Chinese coal-plant ash marked “Poison” and then put it into our reservoirs? Whatever they’re smoking, include me out.
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Wikipedia, although people can abuse it, is an excellent source of information. One can easily see in “history” if there has been any vandalism. I have been a wikipedia editor since 2006 with several thousand edits. I watch 155 pages and none of them have had vandalism that lasts more than an hour.
Another excellent source in the same vein is Rational Wiki at http://rationalwiki.org/wiki/
It identifies pseudo science pages and rips them apart. It does a nice thorough job of pretty much every anti-fluoride web page out there.
If a loved one starts believing that a vaccination is deadly or that the government is dousing us with chemtrails that would be my first stop for info.
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My son is 44 years old and i believe he has had maybe one cavity in his life thanks to fluoride,brushing and flossing.
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“Because I sound like I know what I am talking about when it comes to science… ”
Actually, my friend, you don’t. You sound more like a coward who hides behind a delete button when the website boss is trying to sleep.
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Sorry Michael, I did delete your post, I was watching the Bruins and the Red Sox lose at the same time in one screen and I had written a lovely reply to your six page screed but deleted it instead of the damn Sox. Please repost.
Basically my response to your rehash of FAN talking points was, “It comes down to believing the respected scientists of our nation and in fact the world, the consensus opinion of the efficacy of fluoride, or believing a small minority with an axe to grind trying to create fear.”
Fear sucks, I prefer science.
ps. Could you shorten the copy paste diatribe down to maybe two pages? A simple link to the FAN website will cover pretty much everything you wrote.
Here, let me help you out: http://rationalwiki.org/wiki/Water_fluoridation
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LMFAO
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Paul, I like your style! Just before I read your last post, I was getting ready to comment that anytime a fluoridation comment begins with “You haven’t done your homework” ….duck quickly! The “FAN” BS is about to be unleashed!!
Fluoridation provides nothing in the water but a few more fluoride ions, identical those which humans, and antifluoridationists as well, have been ingesting their entire lifetimes, and trace contaminants in barely detectable amounts that fall so far short of EPA mandated maximum levels of safety that it is not even a certainty that they aren’t those which exist in water naturally. Optimal level fluoride is colorless, odorless, tasteless, and causes no adverse effects. Countless peer-reviewed studies through the decades have clearly demonstrated its effectiveness in preventing dental decay in entire populations. The dental and medical costs to taxpayer-borne public assistance programs, such as Medicaid and HealthChoice, incurred as a direct result of untreated dental decay, completely dwarf the less than $1 per person, per year cost of fluoridation.
There is no good reason not to have it in the water. Thanks for your article!
Steven D. Slott, DDS
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Excellent points.
I tried to keep the science to a minimum but you point out a major FAN issue. A fluoride ion in solution from China or from the pristine hills of Nova Scotia are absolutely identical. There are no Chinese characters written on the side of the asian fluoride ion. That fluoride ion will incorporate into the enamel in our teeth just like any other fluoride ion.
I’m starting to think the FAN opinion is elitist. “Our fluoride ions are better then these fluoride ions from a foreign country.” Or does it all stem from Dr Strangelove and the purity of our bodily fluids?
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As you well know, the “imported from China” is just more of Connett’s fear-mongering nonsense. It doesn’t matter if the fluoridating compounds come from the moon. Water at the tap meets EPA mandated safety certification requirements under Standard 60 of the NSF, or it isn’t allowed, period. The fluorosilicates are gone as soon as they hit the neutral pH of drinking water, and don’t exist at the tap. Arsenic is the most prevelent contaminant in fluoridated water at the tap, due to its high prevalence in nature in general. It takes 10X the manufacturer recommended single dose amount of HFA for the NSF to detect any arsenic, and that’s only in less than 50% of the random samples. The maximum arsenic detected is 0.6 ppb, only 60% of the maximum allowed under standard 60, which is only 10% of the EPA MCL for arsenic, 10 ppb. The average detected is only 0.12 ppb. Any other contaminants detected are even less than arsenic and farther below allowable maximums. If anything, HFA is remarkably pure.
Steven D. Slott, DDS
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Thanks Paul…. I began looking at the drinking water fluoridation about a year ago, after a person I respect greatly suggested to me that it was neither “safe nor effective”. It seemed ridiculous that something which I’d been part of for 62 years might not be true. So, like the good little retired engineer, I went looking for data and analyses. The organizations which support fluoridation, I found, alluded to “numerous studies”, but never referenced any on their websites. So I looked elsewhere and found a great deal of study had been done. The initial studies in the US and Canada, upon which the practice was based, were deeply flawed with omissions, statistical errors and data selection bias to the point that valid conclusions can be drawn from none of them. ( http://cof-cof.ca/wp-content/uploads/2012/08/Sutton-Fluoridation-Errors-And-Omissions-In-Experimental-Trials-Melbourne-University-Press-1959-1960.pdf ) Since that time, numerous studies HAVE been done, the overwhelming majority of which do not support the adage that fluoridation is “safe and effective”.
But I tend to agree with Ms. Williams on this one, that the primary question here is freedom of choice, something which the practice of drinking water fluoridation disallows. And yes, I do realize that those who cannot tolerate fluoridated water can purchase their own fluoride-free water in addition to the fluoridated water for which they have already paid. At the same time, those who live in non-fluoridated communities are also free to get a prescription for fluoride supplements if they so desire. One of these things is considerably more expensive than the other….can you guess which?
I also tend to agree with N.S. Johnson that the author hasn’t done his homework (although he has a lot of company) It is easy, even comforting, to believe the things our consumer protective groups tell us, but sad that intelligent and educated people would do this without doing their own fact checking.
I also tend to agree with you, Paul, about asking the scientific experts in the relevant field. So, rather than simply believing organizations dedicated to fluoridation endorsement, your homework assignment is to follow these links and to do some reading which goes well beyond the pronouncements of the American Dental Association:
2005 in Journal of American Physicians and Surgeons: http://www.jpands.org/vol10no2/kauffman.pdf
2014 in Scientific World Journal: http://www.hindawi.com/journals/tswj/2014/293019/
2014 in Journal of Occupational and Environmental Public Health: http://www.ncbi.nlm.nih.gov/pubmed/24999851
2013 in Journal of Environmental Public Health: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3690253/
1996 Confronting the Experts: http://www.bmartin.cc/pubs/96ce/3_Diesendorf.pdf
And for extra credit, you may consider going to the following link which, will provide you with numerous scientific studies which raise a great deal of doubt about the organizations who claim fluoridation is “safe and effective” or “one of the top ten public health achievements of the 20th century.”
http://www.cafan.net/links/
And yes, I do realize that would be a lot of reading, but then homework isn’t always easy.
Please know that if you can provide links to recent studies demonstrating safety and/or effectiveness, I would be glad to read them. But if you post Brunelle and Carlos, I’ll be forced to reference Yiamouyianous, and I might not buy that coffee I owe you.
(BTW…It appears that the ADA website has recently taken down their list of fluoridation endorsing organizations. This had been a source of pride for them, even after several withdrew their names in recent years. Makes you wonder.)
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Much better Michael you got your comment under two pages. Some comments.
1) “I started looking at fluoride a year ago.”
And now you are an expert much more qualified to dissect why a fluoride ion added to water is horrible because you have memorized Paul Connett’s FAN website? More qualified than the National Academy of Sciences? Really? In your retirement as an engineer I suggest cracking a chemistry textbook.
I started thinking of fluoride as a teenager in September of 1970 when I first moved from Indianapolis to Woods Hole and I was in the dentist’s chair of Dr Wolf, the Woods Hole dentist. One look in my mouth and he said, “You’re not from around here are you?” Using a mirror Dr Wolf showed me how my teeth were very white were they ground together. He then gave me the news that the white would disappear since Woods Hole (actually it was the John Birch Society in Falmouth) did not allow fluoride in the water because it was a commie plot. Since then as I became a scientist I always kept up on the “fluoride controversy” because I thought it so strange that a minority of luddites could keep a safe and effective way to keep your teeth into old age out of the water system.
2) “I also tend to agree with N.S. Johnson that the author hasn’t done his homework”
Really? You had to do the “Do your homework” schtick? I should make this a drinking game but I would be shit faced in no time. No, I will not read your cherry picked reasoning from the Fluoride Action Network because I have read it all before. In reviewing scientific papers I get to read a lot of sciencey sounding bullshit. Is sciencey a word? It should be. Definition: Bullshit pretending to be science which can fool nonscientists into thinking it actually might be true. Sort of like Stephen Colbert’s “truthiness”. But truthiness fits your comment even better. Dozens of links saying the same thing. Repeat the same bullshit over and over again and some people actually think it might be true.
3) You ignore scientific findings because “your extensive searching” find nothing.
You ignore scientific findings because your searching cannot find studies showing fluoride efficacy. You even bet your favorite granite sculpture that no one could find a five year blinded study of fluoride efficacy. But it took James Dowd about fifteen minutes to google find one. Even though it was pointed out to you that James had won your sculpture because he had found a paper which actually cited five other papers with even longer blinded studies you somehow changed the rules and reneged on your bet. You call me a coward. I would not describe you as a coward just misinformed but weaseling out of a bet like that comes close.
In the 65 years of water fluoridation there have been something like one hundred reasons that luddites have come up with to decry fluoridation. I ran into the John Birch “commie plot” when I was a kid. The reasons change over time because actual scientists shoot down each reason and the luddite says, “Oh yeah, but what about …” and they think of the new reason. Cosmetic dental fluorosis (only if fluoride is at high concentrations like in China where breathing coal smoke is loaded with fluoride is a problem) is the new one.
Your oft stated position opposing vaccines makes you a confirmed luddite who should get off his soapbox or at least move it to the Park Street Subway Station. 🙂
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Still waiting for my sculpture.
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And I am still busting Mr. Foley’s balls about your lack of sculpture. Writing has consequences. To advocate absurd conspiracy theories about fluoride is a bad joke. To advocate anti-vaccination conspiracies; that is actually killing people today. Small babies dying of whooping cough. Completely preventable if not for a small sect of the population who are ignorant, elitist, or they just really don’t give two shits about the common health of all of us.
But to make a bet and then make up sorry excuses and move the goal posts, that’s just plain old lame.
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Paul, allow me to address Foley’s list of study titles copy/pasted from “FAN” just as I have numerous times before when he and his cohort Karen Spencer have pasted them, with obviously, neither one of them having read, much less understood, any of the studies attached to these titles.
1. 2005 in Journal of American Physicians and Surgeons: http://www.jpands.org/vol10no2/kauffman.pdf
The “Journal of American Academy of Physicians and Surgeons” is a fringe group with 3,000 or so, out of 850,000 MDs in the US. The journal of this group is yet another “open access” which is not even recognized by respected scientific databases. The article you reference relies heavily on an another fringe activist group. The “International Academy of Oral Medicine and Toxicology”.
In regard to the American Academy of Physicians and Surgeons:
“The AAPS motto, “omnia pro aegroto” is Latin for “all for the patient.” AAPS also publishes the Journal of American Physicians and Surgeons (formerly known as the Medical Sentinel). The Journal is not indexed by mainstream scientific databases such as the Web of Science or MEDLINE. The quality and scientific validity of articles published in the Journal has been widely criticized, and many of the political and scientific viewpoints advocated by AAPS are considered extreme or dubious by mainstream scientists and medical groups.”
—–http://en.m.wikipedia.org/wiki/Association_of_American_Physicians_and_Surgeons
2. 2014 in Scientific World Journal: http://www.hindawi.com/journals/tswj/2014/293019/
This is nothing more than an opinion piece by longtime antifluoridationists Hiyi Awofeso, and Stephen Peckham, Peckham being the former chair of the British antifluoridationist faction “Hampshire Against Fluoridation”. This article was published in an “open access” journal which charges a hefty fee to those which wish to have their work published. A & P’s opinions are in complete contradiction to the overwhelming consensus opinion of the worldwide body of respected science and healthcare.
3. 2014 in Journal of Occupational and Environmental Public Health: http://www.ncbi.nlm.nih.gov/pubmed/24999851
This paper by long time antifluoridationist, Phyllis Mullinex, is an obvious stretch to attempt to discredit fluoridation by providing entirely irrelevant information on the contents of raw, undiluted fluoridation substances. It makes no difference, whatsoever, as to what are the contents of water additives prior to their reaching the tap. Drinking water quality standards begin with water at the tap. This is the water that we ingest and/or otherwise utilize. All water at the tap must meet stringent EPA mandated certification requirements under Standard 60 of the NSF. There must not be any contaminants present in this water that are in excess of these EPA mandated maximums. If there are, the water is not allowed. It’s that simple.
4. 2013 in Journal of Environmental Public Health: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3690253/
This article is by Richard Sauerheber, the “Scientific Consultant” for attorney James Deal. Deal maintains a website for the apparent sole purpose of attempting to scare up lawsuits against fluoridation, with which he has, obviously, had no success. Sauerheber’s article is published in yet another “open access journal” which charged him $800 to publish it. Sauerheber’s “argument” is in regard to neutralization of fluoride by calcium, and reformation of HF in the human gut. Neither argument has any merit for fluoride at the minuscule optimal at which water is fluoridated. There is no valid, peer-reviewed proof, whatsoever, of any adverse effects of HF reformation in the human gut, from optimal level fluoride.
5. 1996 Confronting the Experts: http://www.bmartin.cc/pubs/96ce/3_Diesendorf.pdf
This is nothing but yet another piece by a long-time antifluoridationist, this one being Mark Diesendorf. This biased, rambling junk is just more of the same conspiracy nonsense, false statements, and misinformation characteristic of the overwhelming majority of the “science” which antifluoridationists put forth as evidence.
Steven D. Slott, DDS
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Thanks Steven, I think Michael Foley will be sending you a token of appreciation in the form of a granite sculpture for pointing out how wrong he is in stoking irrational fears about fluoride.
Not.
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In the spooky, murky, conspiracy laden world of antifluoridationists, Foley, Spencer, and Goss are lightweights who have posted enough garbled nonsense all over the internet to fill a warehouse.
Steven D. Slott, DDS
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Thanks for your refreshing voice of reason.
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A YES vote on May 5th gives every Rockport Resident the freedom of choice.
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I vote Megan Fox for President of Everything.
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Thank you Craig for restoring my faith in humanity and the American Way. But twelve hours before there is a comment on Megan Fox? We really are slipping as a nation of red blooded Americans.
I was expecting at least a few, “Hey Megan you need any help with applying your fluoride ions because I could help you out there.”
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Well Ol’ Buddy….Sex has been used to sell used cars, Brylcreme and booze. Your choice of this approach is consistent with American marketing history, and better than endorsements, omissions and deception.
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If I had a choice between Megan Fox and your mug O’l Buddy I think I gotta go with Megan unless I was going door to door selling crazy.
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HEH! We’re both too long in the tooth to sell ANYTHING via mug shots!
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Oh…And I would be remiss in not introducing Dr. Steven Slott to those on this forum. Dr. Slott is a sometimes dentist (check out his patient ratings!) from Burlington, NC, and a leading member of the ADA fluoridation “Rapid Response” team. In any place in the English speaking online world where fluoridation is threatened, you will find “Doc” Slott’s “personal” perspectives, which are accessed skillfully from the ADA response database. “Doc” refuses to reveal his rate of pay per post, but there are those who believe it runs as high as $25. Since fluoridation is being questioned in many communities now, there are many opportunities for a man like him to do much better than he could as a dentist. but clearly, it isn’t about money, but a true love for internet trolling.
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Thanks Michael, Steven Slott is obviously an expert since every word he has posted is backed by 65 years of scientific research. His calling out the Fluoride Action Network for the complete BS about the foreign fluoride being a poison was clearly explained. With simple high school chemistry one can easily follow along with his explanation that the fluoride ion, once it is in solution, is identical to all other fluoride ions in solution.
To think that the fluoride ion is different would mean that the rules of chemistry do not apply. That homeopathy actually works. That the Food Babe is correct when she states that microwaving or yelling at water will reconfigure the water molecules into an unhealthful arrangement. (Food Babe is antifluoride big time). Voo-doo like that is clearly used when one is fear mongering to scare the crap out of someone. Like what the FAN is doing with an element that has been added to our water system for decades.
ps. You haven’t delivered Dowd’s reward yet?
https://goodmorninggloucester.wordpress.com/2014/07/19/reward-offered-by-m-s-foley-stoneworks-of-gloucester-ma/
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Ahhhh, Michael! You messed me up! I had estimated that it would be farther into this discussion before you would throw in the towel, and resort to your fallback of ridiculous and patently false claims. To your credit, I did find find one true statement in your comment. I am a dentist from Burlington, NC. So, congratulations! That’s one more than you usually post.
Paul, thank you for the compliment, but I am not an expert on fluoridation other than would be considered of any dentist. I am simply a general dentist who has spent the overwhelming majority of his 33 career providing dental treatment for low-income and indigent populations. I have spent decades seeing and dealing with, first hand, the devastating effects of lifetimes of untreated dental disease…..while feeling the frustrating futility of trying to make a dent in it by putting out one raging fire at a time. My knowledge of fluoridation comes from performing simple research from respected, reliable sources, as can anyone with a modicum of intelligence, along with knowing where to turn to find accurate answers to any questions I might have, or for information I might need. Given that I have hardly charged for the majority of my dental services through the years, it is always comical when antis claim that I am being paid by this group or that for my part in this “vast conspiracy”.
Steven D. Slott, DDS
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Well Michael has played the last of his cards. Let me see,
1) Need to do your homework, done and done.
2) Dentists don’t have time to study this but I have been researching it for a year. (This must be the most galling for a dentist to hear.)
3) And the ace card for dealing with an expert whether for fluoride, vaccines, or GMOs, you are a paid shill. $25 bucks a post! That is so much more than filling a cavity so obviously you would roll over and become a paid shill for the ADA!
“There are those that believe”!! Yes, there are those that believe in ancient aliens walked the earth thousands of years ago and are still leaving crop circles and Chemtrails. Hopefully, “those that believe” do not influence public policy outside of their fear mongering circle.
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I’ve learned two things about conspiracy fabulusts: 1. I’m unaware of any conspiracy that any of them has actually shown to be fact, and 2. You can’t possibly change their minds. Empirical evidence means little or nothing. The definition of delusion is: the persistent belief in something that is against what is accepted as reality or generally accepted as truth. Just as with people we call paranoid, they tend to think those who don’t agree with them are really the delusional ones. I think there are people who are not in this category, but who sometimes think where there is smoke there must be fire. In the case of fluoride, I think it ain’t smoke; it is just hot air. Science has this one right. If you really think fluoride is a gigantic Chinese/industrial/dental/medical conspiracy, eschew chlorine, too, as well as those godawful filters, and go back to drinking creek water and let your teeth and body do what they may.
Occasionally, there is wisdom in the crowd.
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This is an interesting thread. I’m a preschool teacher and as the years go by and kids drink more bottled water and more “fruit snacks”, the difficulty with their teeth problems has appeared to increase from a very early age. Who wouldn’t appreciate a smart public health initiative?
As for vaccines…I’m sure any father out there who googles an image of “adult male with mumps” and sees the very unfortunate swelling everywhere that occurs would never refuse a vaccine offered to his child!
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I really wish toxic waste pushing ignoramuses would stop associating climate science with fluoridationist nonsense. Climate change is extremely serious, and the science credible, unlike fluoridationist “science”. Thinking that everything which has had the label “science” slapped onto it is all the same is about as dumb as it gets. Fluoridation and the reckless burning of fossil fuels are both examples of grossly irresponsible pollution carried out to further corporate interests at the expense of the public, and in defiance of the best scientific knowledge and the precautionary principle. It is unlikely to just be a coincidence that America and Australia are especially guilty in relation to both. When a dentist supports industrial silicofluoride toxic waste pollution, it is similar to a geologist supporting carbon pollution, because they are both speaking outside their area of expertise. Whenever anyone speaks in favour of forced-fluoridation they are just blowing hot air, because there is no good quality evidence they can cite, and because the whole idea of using public water supplies to medicate populations is ridiculous to everyone with at least a little common sense.
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This is an interesting post. It promotes the premise that there is good science behind global warming but that there is not good science behind fluoridation.
It simply is not true any way you look at it. The very same organizations that back global warming also back fluoridation with consensus science. The National Academy of Sciences, AAAS, The World Health Organization, the Royal Academy, all the heavy hitters.
You simply cannot pick and choose when you listen to scientists and when you believe they are paid shills. It is about as cut and dried as you get.
Science is not a religion, good science is not political, it is not left wing or right wing. It is the systematic analysis of data to try to find out how stuff actually works. It has no other agenda because it is not really a “thing”, but a process. You cannot yell at it when you think it is wrong and agree with it only when it agrees with your “common sense”.
[edit] Dan Germouse has flooded this thread with many more posts like his first finally crossing over into ad hominem attacks pointing out my obvious dementia because I do not know what confirmation bias is and I think that only Harvard scientists like myself could possibly know the correct answer.
I am not posting them. Not because I have a thin skin, they are amusing, but because they muddy the water and someone reading this thread from start to finish might get turned off and not read the whole thing because the train has left the tracks. I can post them somewhere else if someone cares to read all the details.
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On May 5, 2015, in a lopsided vote, Rockport voters decided to keep fluoride in their water. Gloucester has a chance to vote this fall.
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Whew! It’s a good thing, Paul. It would have been a shame to alter the content of water which Megan so obviously enjoys.
Hopefully Gloucester citizens will vote as responsibly as did Rockport.
Steven D. Slott, DDS
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Hi Paul, never met you and likely won’t, but I have been reading GMG a long time. I enjoy your posts. You bring a unique perspective to the blog, staff scientist etc. if you will. Keep it up. I like this occasional Fenway lunch time shots to! Good luck in this summer’s Challenge from an old Gloucester “coastie” and paddler—pete
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I stated earlier that I had deleted multiple posts by Dan Germouse because they were mostly copy paste of what others had posted from the Fluoride Action Network. But he has posted all of his posts and much more on something called the Fluoridation Freedom Fighters website. I would post a link but that might drive a lot of clicks to a website that really is not worth it.
But if you do want to read his posts just google: “PAUL T MORRISON OF HARVARD UNIVERSITY IS AN INCOMPETENT, DISHONEST HUMAN RIGHTS ABUSER”
or
“if Paul T Morrison bothered to have a look at it, and his brain hasn’t been completely lost to dementia, he might discover that for himself. In the meantime, he should do the honourable thing and resign.”
If you cannot find it because the website took it down I have a copy. Just email me if it vanishes or the descriptions of me change.
I read it all so you don’t have to. You’re welcome. In lay language, his posts are a sciencey (sic) sounding word salad. Or maybe hummus, left in the Cuisinart too long.
He also included a recent photo of me:
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Wear it like a badge of honor, Paul. When the antifluoridationist clowns begin posting nonsense about you on other websites, it means you’ve struck a nerve. Some antifluoridationist lawyer has a whole page of nonsense about me posted on his website. I can’t remember the link or I’d post it. It is truly hysterical. Even moreso is when the antis post the link in lame attempts to discredit me. The hyenas have also posted nonsense about me on some website that supposedly rates healthcare providers. They then post links to that site, as if anyone but they take any of that junk seriously. The infantile mindset of these people is remarkable.
Germouse is a real piece of work. He trashes the respected sources of information on fluoridation because they debunk his claims……then he expects intelligent people to accept “information” posted on his website “forcedfluoridationfreedomfighters”, as if anyone with more than a quarter of a brain would care what is on such a ridiculous little site.
Steven D. Slott, DDS
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I am sure you have received much worse than this. I am only an amateur when it comes to pointing out pseudo-science. But this mixture of almost sounding logical for a second and just plain loopy is just weird. It does lay bare most of the arguments that anti-fluoride uses. Because crazy.
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Germouse is an odd one to figure. His abusiveness and rage are are a constant, but there are times when he can make a halfway intelligent argument. Not necessarily a valid one, but at least showing some thought process beyond the normal “fluoridealert” copy/pastes that 99% of them mindlessly post. But then he’ll follow that with inane junk such as his list of “good sources”…i.e. fluoridealert, Declan Waugh, Connett’s and Bryson’s books, and other antifluoridationist websites, and insane nonsense like what he’s posted on his site about you. He seems to read original literature instead of just the filtered and edited versions located on the anti websites. In view of this, I’ve questioned him more than a few times as to why he ruins what credibility he might have by listing those “good sources”, but no answer.
Strange character.
Steven D. Slott, DDS
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Last night, November 4, 2015, Gloucester voted 2 to 1 against removing fluoride. Cape Ann believes in science!
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File this next comment under, “I’m not as bright as I think I am.” :-O
I commented at lab meeting yesterday about SEO, getting our lab website listed and mentioned this post about fluoride. I said out loud, “This guy Dan Germouse is a real nutball …” and several of my staff pointed out that the name “Dan Germouse” had to be a fictitious name equivalent to Phil McCracken or Ben Dover.
No, I insisted Dan Germouse is …, and as soon as I said it I realized how stupid I sounded. Doh.
Where is that “You are an Idiot” website? I need to go click it.
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Don’t feel alone, Paul. In spite of the hundreds of times I’ve gone back and forth with that Australian moron, until I read your post here and thought about it, “danger mouse” had not occurred to me, either. I guess I’ve just become inured to the pseudonyms of antifluoridationists.
Steven D. Slott, DDS
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Happy Anniversary Megan Fox. Seems a lot longer than three years since crazy left town.
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Exactly four years later and crazy is back in town. For some reason the Town of Rockport will be discussing the dangers of fluoride at town meeting. I think I will be hiding under my mattress.
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I could not have put it better, Paul. It always amazes me to see the CDC, ADA, AAP. WHO, etc., disparaged by antifluoridationists, who urge us to instead trust little activist groups, fanatics, their books, and YouTube videos……
Steven D. Slott, DDS
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There are a lot of words here but what I’m getting out of the article is that the author has no concept of “Regulatory Capture” and doesn’t understand that Appeal to Authority is a logical fallacy. Then when anyone brings up actual science about fluoridation, or quotes contradictory authorities, he uses childish idiotic comebacks. “I think NS Johnson didn’t get a chocolate bunny for Easter because he was too busy reading Alex Johnson and Infowars to bother with Easter.” “You didn’t know it was the tooth fairy that got us into Iraq? CHEMTRAILS!!!” N.S. never mentioned any of those things. Legitimate health science discussion looks nothing like this.
Also, “Alex Johnson and Infowars”?? Well, water fluoridation is known to reduce IQ (I’m sure he meant “Alex Jones and InfoWars”).
Predictably, along comes Steve Slott who claims to not be a shill for companies with fluoride waste to dispose of but somehow has time to comment repeatedly and persistently on any article anywhere on the internet about fluoridation.
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You point out I do not understand Appeal to Authority logical fallacies. Is that because as a scientist who is not an expert in fluoridation I read consensus reviews of the science and follow those recomendations?
Look up this logical fallacy in Wikipedia. I wrote the page. It is funny that this fluoridation subject, really a very dead horse we keep beating comes up in my mailbox the same hour I get a review of another stupid paper pushing the fluoridation conspiracy. This paper shows that women who brush their teeth with fluoridated toothpaste give birth to low IQ children.
I tack on here a letter showing why that is shamefully ridiculous. I study p-hacking in my day job. I have to so that my collaborators do not fall into the trap since I hand them a lot of genomic data which are then used in non-hypothesis driven hunts for interesting correlations.
I do read fluoride studies because virtually every single one is an example of p-hacking. A terrible way to science.
Green paper retort follows, an easy read except for the formatting. One can find it on the internet in a few days well formatted or I can send you the pdf that was sent to me.
ps. I did end up posting snarky comments about chocolate bunnies. I toned down what I really wanted to post since I do not suffer fools gladly.
October 23, 2019 Rick Woychik, PhD
Acting Director, National Institute of Environmental Health Sciences P.O. Box 12233
Mail Drop B2-01
Durham, NC 27709
Gwen W. Collman, Ph.D.
Acting Deputy Director, National Institute of Environmental Health Sciences P.O. Box 12233
Mail Drop B2-01
Durham, NC 27709
Dear Drs. Woychik and Collman,
Research supported by the National Institute of Environmental Health Sciences (NIEHS) has tremendous potential to expand scientific knowledge about human health and positively inform health and
environmental policies. We write this letter regarding the NIEHS-funded Green et al study about maternal fluoride exposure; the article about this study was recently published by JAMA Pediatrics. have a variety of concerns about the Green article related to methodological transparency and analytical rigor. We wish to share these concerns with you and request that NIEHS formally ask the Green authors to release the HIPAA-compliant, Research Identifiable File (RIF) data sets from their study, as well as a complete explanation of their methods and the computer program/codes used in their data management and analysis.
In recent weeks, at least two of the Green authors have declined to respond affirmatively to requests from other researchers for access to the data and analytical methods they used. Growing concerns about the replicability of scientific research makes transparency more critical than ever. Recently, the editor-in- chief of the Journal of Neuroscience Research and nine other research experts wrote an article whose abstract opened with this observation: “Progress in basic and clinical research is slowed when researchers fail to provide a complete and accurate report of how a study was designed, executed, and the results analyzed.”2
By releasing their raw data and a detailed explanation of their statistical methods, the Green authors
1
We could satisfy incongruities and ensure the scientific record is accurate. Given the potential policy implications of the Green article, we believe the authors should be more transparent, as this could provide clarity amid the concerns their article has raised. In recent weeks, a number of experts in epidemiology, psychology, statistical methodology and other fields have raised numerous concerns about the Green article, including the following:
1. Focusing on a subgroup analysis amid “noisy data”: The Green authors focused a significant portion of their narrative on the one subgroup (boys) where a lower IQ association was observed, but only in the performance part of the IQ test. Thom Baguley, professor of experimental psychology at Nottingham Trent University, is one of several experts who have raised concern about this aspect of the article. “This is an example of subgroup analysis — which is frowned upon in these kinds of studies
because it is nearly always possible to identify some subgroup which shows an effect if the data are noisy,” he wrote. “Here the data are very noisy.”3 Part of the reason why the data are noisy is that the
Green authors included in their analysis IQ scores that fell within 2.5 standard deviations from the mean. In other words, only a very small number of scores could have been excluded, which explains why the study includes scores in the 50s, indicating profound delays, as well as scores in the 130s, which indicate giftedness. Not excluding extreme values or outliers may have skewed the regression analysis, the impact
of which could be better understood with review of the raw data used by the Green authors.
Additionally, the Green article’s focus on the subgroup analysis ignores the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations, which were issued more than a decade ago. The STROBE committee cited several reasons for these recommendations, including its view that “there is too great a tendency to look for evidence of subgroup-specific associations, or effect measure modification, when overall results appear to suggest little or no effect.”4
2. Modeling and variable anomalies: As you know, a p-value indicates the probability that the results observed are by chance. In its Statistical Analyses section, the Green authors reported that they “retained a covariate in the model if its p-value was less than .20 or its inclusion changed the regression coefficient of the variable associated factor by more than 10% in any of the models.” This could potentially be an example of p-hacking, meaning that variables are left in the model (or excluded) to achieve some sort of
5
Typically, when a researcher is testing associations between potential confounders and an outcome of interest, they set the significance level at p<0.20; however, for retaining them in the final model, they typically select only those with a significance of p<0.05. It is unclear if the Green researchers carried out this step. The more covariates that are included in the final model, the more likely it is that researchers will find a significant association.
One approach to account for the effects of including variables in the model as the Green authors did is to use Bonferroni’s correction, something they do not appear to have done. Bonferroni’s correction allows for the p-values of multiple comparisons to be performed at the same time in one model. Usually, this correction decreases the acceptable p-value at which a variable is considered to be statistically significant in its contribution to the observed statistic.
Further, the Green analysis failed to account for the influence of multi-level effects on the association between the independent and dependent variables or the multi-level effects such variables would have on the outcome of interest. Moreover, selecting the covariates in a stepwise manner has the potential to bias
statistical significance in the final p-values.
.20 instead of .10 or .15 so readers of the article have no basis for deciding whether this decision was warranted or not.
In this regard, the authors did not explain why they chose
6
3. Lacking data on relevant factors: In recent decades, studies have revealed numerous factors that can
impact children’s intelligence and cognitive ability. Parental behaviors and traits are among these factors;
for example, research shows children’s intelligence is linked to fathers’ social class8 and mothers’ IQ
9
regression coefficients. Biostatisticians have discouraged the use of stepwise selection for this reason. The American Statistical Association has established six principles on the use and analysis of p-values, one of which states: “Proper inference requires full reporting and transparency.”7 By releasing the data and a detailed explanation of their analytical methods, the Green authors would enable the scientific community to better assess whether their choice of p-value was appropriate.
Indeed, a 2013 study supported by the Centers for Disease Control and Prevention noted that
scores.
these factors are “major predictors of IQ and should be included routinely in studies of cognitive development.”9 Unfortunately, the cohort on which the Green authors relied lacks data on maternal IQs
and paternal social class. Although the Green authors had access to data on maternal lead exposure, the cohort provided no data on lead exposure for children during the 3-4 years between birth and their IQ
tests. This could be another confounder. The authors themselves acknowledge that “this observational study design could not address the possibility of other unmeasured residual confounding.”1 This is more than a minor concern, and it demonstrates why the Green findings should be interpreted with significant caution.
4. Omitting crucial findings: In the Key Points section of their article, the Green authors summarize the question their study sought to answer: “Is maternal fluoride exposure during pregnancy associated with childhood IQ in a Canadian cohort receiving optimally fluoridated water?” Nonetheless, the authors downplayed the lack of a statistically significant difference between children’s mean IQ scores in fluoridated and non-fluoridated communities of Canada. Nowhere within the narrative of their article do they share the two mean IQ scores for the Full Scale IQ (FSIQ) —108.21 among children in fluoridated communities and 108.07 among children in non-fluoridated areas. These nearly identical scores could easily be missed unless readers carefully scan the 29 rows of data within Table 1. Instead, the Green article focused on the subgroup analysis where an association was observed. Contrast how the Green
article reported its findings with how the authors of a 2018 article on lead exposures10 presented their
11
findings. Data for both articles was sourced from the same Canadian maternal-child cohort.
The authors
of the 2018 article included three of the Green authors, and they summarized the results in their abstract in Environment International (EI) by leading with their primary objective:
“Median blood lead concentrations for the mother at 1st trimester and 3rd trimester of pregnancy, and for cord and child blood were 0.60 μg/dL, 0.58 μg/dL, 0.79 μg/dL and 0.67 μg/dL, respectively. We found no association between cord blood lead concentrations and WPPSI-III scores in multivariable analyses. However, cord blood lead concentrations showed a negative association with Performance IQ in boys but not in girls (B = 3.44; SE = 1.62; 95% CI: 0.82, 5.98). No associations were found between WPPSI-III scores and prenatal maternal blood or concurrent child blood lead concentrations.”
By stark contrast, the Green authors proceeded to their subgroup analyses without mentioning the full- scale IQ scores for fluoridated and non-fluoridated areas. Additionally, they did not report the main
12
effect result for maternal urinary fluoride (MUF) and IQ.
effect result, it would have shown the association between MUF and IQ was non-significant—both with and without covariates. STROBE guidelines indicate that all main effect results should be reported
4
5. Using invalid measures to determine individual exposures: According to an article coauthored by
(Guideline #16), in addition to any interactions and sensitivity analyses (Guideline #17).
Had the Green authors reported the main
the director of Columbia University’s Applied Statistics Center, the most important assumption in linear
13
regression is that the independent and dependent variables map to one’s research question and are valid. In this case, relying on MUF and a twice-administered beverage recall question estimating types of fluid consumption are not reliable ways to determine fetal fluoride exposure. Moreover, relying on these measures could threaten construct validity, a limitation which is not adequately discussed by the authors. This issue is compounded by the fact that MUF was gathered by spot urine samples rather than 24-hour samples. Alastair Hay, professor emeritus of environmental toxicology at the University of Leeds, reviewed the Green article and raised this concern: “For a substance with a short half-life, such as fluoride, urine concentrations vary hugely and are really only representative of the last drink. Validation of intake is something you must do before looking at associations.”3
Researchers have noted the limitations of extrapolation from urine samples, observing that “daily urinary fluoride excretion is suitable for predicting fluoride intake for groups of people, but not for individuals.”
In their assessment: “Thus, it can be concluded that, at this time, urinary fluoride excretion has a very limited value as a biomarker of individual fluoride exposure.”14 Dr. F. Perry Wilson, a nephrologist at the Yale School of Medicine, criticized the Green article for relying on urine samples “because urine fluoride is not a perfect proxy for blood fluoride.” Moreover, Dr. Wilson identified a new variable that the
authors introduced:
“… more dilute urine will have a lower fluoride concentration, and they ‘correct’ this problem by dividing urinary fluoride by urine specific gravity. But this introduces a new variable. Assuming that fluoride has no effect on a child’s IQ, you could get results that look like this if moms with more dilute urine tend to have kids with lower IQs.”
Dr. Wilson also noted that the article’s results could have been skewed because women with a higher
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6. Defining the final study group: The Green study is not representative of all mothers and their
children in Canada, and, therefore, not generalizable. This is clear from Figure 1 in the Green article,
1
urinary pH (due to diet or other factors) tend to have higher urinary fluoride levels.
indicating that a significant number of mother-child pairs were excluded from the final study group.
The
cohort was drawn from six cities, and the authors did not account for clusters of sampled pregnant women or consider multilevel models. It is not entirely clear from the Figure 1 schematic or the article’s narrative why all of these pairs were excluded, and it is important to learn the authors’ reasons for exclusion to understand fully the actual fluoride exposure and its effects on IQ scores. What we do know is that some of the pairs were excluded because they did not drink tap water or lived outside a water treatment zone.
This kind of exclusion would make sense only if the authors were specifically seeking to compare IQ scores based on water fluoridation status, but they did not present their results in this way. The authors should have been more explicit as to the reasons for excluding the mother-child pairs that they removed from the final study group. The fact that the association was observed only in boys could be an artifact of who was left out of the study and how the Green authors modeled sex in the regression.
7. Assessing the impact of fluoride exposure: Several questions arise because the details of the regression model used by the Green authors are not provided. Further, the authors assessed daily fluoride intake in mothers using a non-validated questionnaire, and their estimates of fluoride intake based on water and tea consumption appear to be crude. The narrow focus on tea-drinkers could have biased the results by overlooking other sources of fluoride intake. In this regard, the EI article (cited previously) on prenatal lead concentrations and IQs in this same cohort are instructive. The EI article demonstrated that
cord blood lead level was associated with IQ in boys in this cohort (but not girls). While the
supplemental table eTable 2 of JAMA Pediatrics shows that controlling for lead does not alter the
predictor or its standard error, it does raise questions about the role of environmental lead in this cohort.
Additional information concerning the measure of lead exposure in the Green study’s sensitivity analysis
is needed, especially given research showing that blood lead levels are higher in those who drink tap
8. Reporting anomalies: The authors reported that a 1 mg/L increase in the adjusted MUF concentration was associated with a 4.49-point lower IQ score in boys, but there was no statistically significant association with IQ scores in girls (B = 2.40; 95% CI, -2.53 to 7.33). And a 1 mg/L higher daily intake of
16
would be valuable for clarifying the relationship among these variables.
water.
Release of the RIF data and a detailed explanation of the modeling used by the Green authors
maternal fluoride was associated with a 3.66 lower IQ score in boys and girls. The Green authors did not discuss the magnitude of change in the sex differences for IQ observed in the MUF-adjusted regression.
This difference includes an actual sign change between boys and girls (from – to +) that poses a significant threat to the validity of their results. Instead, the authors stressed the results for boys while ignoring the disconnect between boys’ performance IQ and verbal IQ scores. Also unmentioned in the Green article is the overlapping confidence intervals throughout for boys and girls (see Table 2), which
means there is a greater than 5% probability that the IQ measurements for boys and girls are actually not different from each other.
In addition, while several covariates have been found in the past to be significant determinants of IQ score and are not included in the Green study, the reported 95% confidence interval (CI) in boys (−8.38 to −0.60) is too wide to be statistically acceptable. The ordinary multivariable statistical methodology (e.g. regression analysis adjustment) used in this study, which is indeed widely known and used in
17
epidemiology, focuses on the association with the outcome.
adequately address complicated problems, where measured and unmeasured confounding is involved. Alternatively, novel methodological approaches (e.g. propensity scores and Inverse Probability Weighting) are being used in the medical, epidemiological and biostatistical research to infer causal
20,21,22
study for boys’ IQs reveals that this score can have a value of .6, which is almost 15 times smaller than
effects with less potential bias and to provide narrow and more precise CIs.
The 95% CI in this
However, this kind of analysis does not
18,19
the higher value (8.38) estimated in this interval. The study’s omission of significant predictors/confounders (see #3) for IQ scores resulted in this wide interval, limiting the validity of the results.
9. Internal inconsistency of outcomes: The Green authors reported the overall effect result for fluoride intake (FI) in this way: “A 1-mg higher daily intake of fluoride among pregnant women was associated with a 3.66 lower IQ score (95%CI, −7.16 to −0.15; P = .04) in boys and girls.”1 An attentive reader would recall that the association found in the MUF regression was not all children; rather, boys showed an associated decline on one part of the IQ test, but girls did not. (In fact, girls had an observed increase in IQ.) Here, the authors attempted to demonstrate internal consistency of analysis outcomes for both FI and MUF. In summary, they observed the FI intake effect when they combined boys and girls (overall effect), but they found the effect of MUF only in boys. Additionally, Green did not find an effect with FI
23
association in the JAMA Pediatrics article, it would have been strong evidence of internal inconsistency.
Upon closer comparison, the Green thesis states they excluded city as a covariate to achieve statistical significance for the FI analysis. As the Green thesis explained (p. 34): “Holding all covariates constant, FI significantly predicted [Full-Scale IQ] scores without city in the model (B = -4.03, 95% CI: -6.82 to – 1.25, p = .005*) (Figure 6). With city in the model, FI just missed significance (B = -3.82, 95% CI: -7.65
in her thesis when she included the same covariates.
Had the Green authors reported this lack of
to 0.02, p = .05). In both models, there were no significant interactions between FI and any of the
23
covariates” (emphasis added).
adjusted “for city, HOME score, maternal education, race/ethnicity, child sex, and prenatal secondhand smoke exposure.”1 However, these two model outputs, 3.82 in the thesis versus 3.66 in the article, are different. Allowing the raw data to be reviewed and analyzed might reveal exactly how the researchers managed to find a model with significant effect with city for inclusion in the article. Accordingly, Dr. Stuart Ritchie of the Institute of Psychiatry, Psychology and Neuroscience at King’s College London, reinforced this point in his recent comments about the second analysis, which was FI:
By contrast, in the JAMA Pediatrics article, Table 2 reported that FI was
“For the second analysis, where there’s an overall effect, the p-value is .04—that is, it’s JUST below the standard threshold used for declaring something to be significant
(0.05). Given that they ran lots of other hypothesis tests in the paper, and didn’t correct
for how many times they did so, I wouldn’t have much confidence in this finding being
3
robust or replicable” (capitalization in original).
It could be that the authors were able to achieve a significant effect in the FI analysis with city in the FI
model because they included secondhand smoke as another covariate. This possibility presents a significant problem because the number of smokers in the Green sample of 400 is only 11. In the EI article that studied the same cohort, the authors specifically stated that they excluded the secondhand
10
smoke exposure variable from the analysis because of the lack of variance.
the secondhand smoke variable in the FI model, the two main effect models MUF-IQ and FI-IQ would show no association. This undermines the main discussion point in the Green article that there is a “converging” of the two analyses. In fact, the two models might be remarkably similar in showing no effect of fluoride on IQ. To clarify these discrepancies, the scientific community needs to have access to the Green data sets so they can be reanalyzed using a multi-level model—or, at the least, a principled accounting for the design effect arising from cluster sampling, and adjusting the p value for multiple hypothesis testing. Such an independent analysis could help us determine whether fluoride exposure at common levels has an effect on IQ in this cohort.
It is possible that without
10. Overlooking research that conflicts with the authors’ conclusions: Typically, when researchers identify their study’s limitations in the Discussion section, they acknowledge other research that reached different conclusions and perhaps consider possible explanations for these differences. Yet the Green authors do not acknowledge or cite several studies about fluoride and cognitive development, including
24,25
26
publication that has been described as not applying a high degree of rigor when publishing studies. Altogether, these concerns suggest the Green authors may have conducted a selective literature search that could reflect a predetermined conclusion.
Summary and Requests
We believe the Green authors should have taken additional steps to address or at least fully acknowledge potential confounders. Moreover, they should have presented their findings in a more transparent,
one that (unlike their study) tested IQs multiple times over a 30-year period.
studies did not focus on maternal exposures, one such study, co-led by researchers at the National Toxicology Program (NTP), examined animal exposures to fluoride during the gestational period and
observed no exposure-related differences in learning skills or memory.
was cited in the Green article, the authors did not mention the NTP study’s conclusions. Of related concern, the Green article’s citations are limited in scope and include three articles from Fluoride, a
27
Although most of these
Although the NTP-led study
qualified way that reflects STROBE guidelines. Given that the NIEHS funding award was an R21 exploratory grant, the authors should have exercised more caution in the interpretation of the results.
The publication of this article in a mainstream, peer-reviewed medical journal has generated a tremendous amount of media coverage. If the Green authors had merely called for more research, our focus would be directed toward ensuring that future research in this area is more methodologically robust and reflective of STROBE guidelines. However, the article’s release was followed by statements to major media by the journal’s editor28 and at least one author that are creating confusion, shaping individual behaviors and influencing public policy. For instance, the corresponding author of the Green article told Time magazine that instructing pregnant women to reduce their fluoride intake is “a no- brainer.”29 The fallout from the Green article is currently most visible in the Canadian city of Calgary, where the article is being cited as a reason not to resume water fluoridation after eight years of cessation
and significant increases in tooth decay.
30
The aim of science is to gain a better understanding of our natural world and to build a shared knowledge base for the benefit of all. Every scientist is interested in the truth. If fluoride at common levels of maternal exposure does lead to lower IQ scores, we would certainly want to know. This is why transparency related to the Green article is crucial. Given the concerns outlined herein:
▪ We urge NIEHS to ask the Green authors to release their RIF data set and provide a thorough explanation of their analytical methods. Doing so could enable an independent review that would bring clarity and ensure the scientific record is accurate.
▪ Should the Green researchers not voluntarily release their data, please advise us on what the process would be to have the data set released so an independent analysis of the Green data can be conducted.
Without greater transparency of its data and analytical methods, the Green article could generate unjustified fear that undermines evidence-based clinical and public health practices. So much is at stake. Hundreds of millions of people around the globe—from Brazil to Australia—live in homes that receive fluoridated drinking water. Hundreds of millions of people use toothpaste or other products with fluoride.
Many millions of children receive topical fluoride treatments in clinical or other settings. Tooth decay remains one of the most common chronic diseases for children and teens, and fluoride is a crucial weapon against this disease. Decay prevalence could increase if a journal article unnecessarily frightens people to avoid water, toothpaste or other products fortified with fluoride.
Please let us know if you have any questions about our request or the issues raised in this letter. Please consider Dr. Scott Tomar (stomar@dental.ufl.edu) as the individual to whom you can direct your response. We greatly appreciate your time and consideration.
Sincerely,
Raman Bedi, BDS, MSc, DDS, DSc, FDSRCS
Chair, World Federation of Public Health Associations, Oral Health Group
Chair, Global Child Dental Fund
Former Chief Dental Officer for England
Nigel Carter, OBE, BDS, LDS(RCS)
CEO, Oral Health Foundation,
Chair, Platform for Better Oral Health in Europe Chair of the Royal Society for Public Health
Timothy Caulfield, BSc, LLB
Canada Research Chair in Health Law
& Policy Professor
Faculty of Law & School of Public Health University of Alberta
Denice Curtis, DDS, MPH, DHS Assistant Professor
Master of Public Health Program Usha Kundu, MD College of Health University of West Florida
Gail Douglas, BMSc, BDS, PhD, MPH, FDS RCS(Ed), FDS(DPH), RCS
President of the British Association for the Study of Community Dentistry
University of Leeds, U.K.
Kenneth A. Eaton, PhD, MSc, FFPH, BDS Visiting Professor
University College London, U.K.
Michael Foley, BDSc, MPH, MEpi
Jonathan E. Howard, MD
Assistant Professor, Department of Neurology Assistant Professor, Department of Psychiatry NYU School of Medicine
Dushanka V. Kleinman, DDS, MScD
Director, Research and Advocacy
Metro North Oral Health Services,
Queensland Health, Australia
Ruby L. Fried, PhD
Assistant Professor
Department of Population Health Studies
University of Alaska, Anchorage
Institute for Circumpolar Health Studies
Mairead Harding, BDS, MFGDP (UK), MDPH, PhD, FDS
Senior Lecturer
Deputy Director, Oral Health Services Research Centre
Cork University Dental School and Hospital Ireland
Associate Dean for Research
Univ. of Maryland, School of Public Health
Michael A. Lennon, OBE, MDS, DPD,
FDSRCS(Ed)
John Furness, MBBS, DCH, FRCPCH
Professor Emeritus in Dental Public Health
Consultant Paediatrician
University of Sheffield (U.K.)
Darlington, England (U.K.)
Lauren Lessard, PhD, MPH
Assistant Professor of Health Science
University of Alaska, Anchorage
Institute for Circumpolar Health Studies
Vasileios Margaritis, PhD, MSc, DDS
Senior Lecturer/Core Faculty
College of Health Sciences
Catherine Hayes, DMD, SM, DMSc
Walden University, College of Health Sciences
Clinical Professor of Health Policy & Health
Services Research
Boston University, Henry M. Goldman
School of Dental Medicine
Jennifer Meyer, PhD, MPH, CPH, RN
Assistant Professor of Health Sciences
University of Alaska, Anchorage
A. John Morris, DDS, MCDH, BDS
Elizabeth A. Hodges, PhD, MPH
Senior Lecturer in Dental Public Health and
Associate Professor of Public Health,
Deputy Senior Tutor
College of Health
School of Dentistry, The University of
University of Alaska, Anchorage
Birmingham, United Kingdom
Alice M. Horowitz, PhD, MA, RDH
Research Associate Professor, Behavioral
Mark E. Moss, DDS, PhD
Associate Professor
and Community Health
ECU School of Dental Medicine
Univ. of Maryland, School of Public Health
East Carolina University
Scott Tomar, DMD, MPH, DrPH
Professor & Director of Institutional Analysis and Evaluation
University of Florida College of Dentistry
Joe Mullen, BDS, BA, BSc, MA, MDPH Former Chairman,
New and Emerging Issues Committee Expert Body on Fluorides & Health, Ireland
René F. Najera, MPH, DrPH
Associate, Department of Epidemiology Bloomberg School of Public Health Johns Hopkins University
H. Grant Ritchey Jr.,
Georgios Tsakos, PhD, FFPH
Professor of Dental Public Health
Department of Epidemiology and Public Health University College London (UCL)
Paula Vassallo, BChD, MSc, DDPH, RCS, MBA, FFPH
Director, Health Promotion and Disease Prevention
Consultant, Dental Public Health President, European Association of Dental Public Health
John J. Warren, DDS, MS
University of Iowa College of Dentistry
DDS, FAGD
Practicing dentist in Kansas, contributor to
Science-Based Medicine blog
DDS, MPH
R. Gary Rozier,
Emeritus Professor
Gillings School of Global Public Health University of North Carolina
Amy Seery,
MD, FAAP
Pediatric Section Chair,
Ascension Via Christi-Wichita Hospitals
Assistant Professor,
University of Kansas School of Medicine
Professor, Department of Preventive &
Community Dentistry
CC: Patrick Breysse, PhD
Director, National Center for Environmental Health (CDC)
Karen Hacker
Director, National Center for Chronic Disease Prevention and Health Promotion (CDC)
Martha J. Somerman, DDS, PhD
Director, National Institute of Dental and Craniofacial Research
References
1 Green R, Lanphear B, Hornung R, et al. (e-published 19 Aug 2019) Association between Maternal Fluoride Exposure during Pregnancy and IQ Scores in Offspring in Canada. JAMA Pediatr. https://doi:10.1001/jamapediatrics.2019.1729.
2 Prager EM, Chambers KE, Plotkin JL, et al. (2019) Improving transparency and scientific rigor in academic publishing. Brain Behav. 9(1): e01141. https://doi.org/10.1002/brb3.1141.
3 Science Media Centre. 19 Aug 2019. Expert reaction to study looking at maternal exposure to fluoride and IQ in children. Accessed in Oct 2019 at https://www.sciencemediacentre.org/expert-reaction-to-study-looking-at-maternal- exposure-to-fluoride-and-iq-in-children/.
4 Vandenbroucke JP, von Elm E, Altman DG, et al. (2007) Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and Elaboration. PLoS Med 4(10): e297.
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8 Lawlor DA, Batty GD, Morton SMB, et al. (2005) Early life predictors of childhood intelligence: evidence from the Aberdeen children of the 1950s study. J Epidemiol Community Health, 59(8): 656–663. http://dx.doi.org/10.1136/jech.2004.030205.
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10 Desrochers-Couturea M, Oulhoteb Y, Arbuckle TE, et al. (2018) Prenatal, concurrent, and sex-specific associations between blood lead concentrations and IQ in preschool Canadian children. Environ Int. Dec 2018; 121(Pt 2): 1235-1242. https://doi.org/10.1016/j.envint.2018.10.043.
11 Government of Canada. (15 Apr 2019) Maternal-Infant Research on Environmental Chemicals (MIREC) Study. Accessed in Oct 2019 at https://www.canada.ca/en/health-canada/services/environmental-workplace- health/environmental-contaminants/human-biomonitoring-environmental-chemicals/maternal-infant-research- environmental-chemicals-mirec-study.html.
12 For the sake of simplicity, our letter uses MUF rather than MUFsg. The latter term was used in the Green et al study to indicate that maternal urinary fluoride was adjusted for specific gravity and averaged across three trimesters.
13 Gelman A, Hill J. (2007) Data analysis using regression and multilevel/hierarchical models. Cambridge, UK: Cambridge University Press.
14 Rugg- Gunn AJ, Villa AE, Buzalaf MRA. (2011) Contemporary Biological Markers of Exposure to Fluoride. Buzalaf MAR (ed): Fluoride and the Oral Environment. Monogr Oral Sci. 22: 37–51. https://doi.org/10.1159/000325137.
15 Wilson FP. (21 Aug 2019) Is Fluoridated Water Affecting Our Kids’ Intelligence? Medscape: Impact Factor. Accessed in Sep 2019 at https://www.medscape.com/viewarticle/916971.
16 Sanders AE, Slade GD. (2018) Blood Lead Levels and Dental Caries in U.S. Children Who Do Not Drink Tap Water. Am J Prev Med. 54(2): 157-163. https://doi.org/10.1016/j.amepre.2017.09.004
17 Margaritis V, Mamai-Homata E, Koletsi-Kounari H. (2011) Novel methods of balancing covariates for the assessment of dental erosion: A contribution to validation of a synthetic scoring system for erosive wear. J Dent. 39(5), 361-367. https://doi.org/10.1016/j.jdent.2011.02.007.
18 Stampf S, Graf E, Schmoor C, Schumacher M. (2010) Estimators and confidence intervals for the marginal odds ratio using logistic regression and propensity score stratification. Stat Med. 29(7-8):760-9. https://doi.org/10.1002/sim.3811.
19 Kurth T, Walker AM, Glynn RJ, et al. (2006) Results of multivariable logistic regression, propensity matching, propensity adjustment, and propensity-based weighting under conditions of nonuniform effect. Am J Epidemiol. 163(3): 262–70. https://doi.org/10.1093/aje/kwj047.
https://doi.org/10.1371/journal.pmed.0040297.
5 Head ML, Holman L, Lanfear R, et al. (2015) The Extent and Consequences of P-Hacking in Science. PLoS Biol 13(3): e1002106. https://doi.org/10.1371/journal.pbio.1002106.
Steyerberg E.W., Eijkemans M.J.C., Habbema J.D.F. (1999) Stepwise selection in small data sets: A simulation study of
bias in logistic regression analysis. J Clin Epidemiol 52(10): 935-942. https://doi.org/10.1016/S0895-4356(99)00103-1.
7 Wasserstein RL, Lazar NA. (2016) The ASA Statement on P-Values: Context, Process, and Purpose, The Amer
Statistician, 70(2): 129-133. https://doi.org/10.1080/00031305.2016.1154108.
Eriksen H-LF, Kesmodel US, Underbjerg M, et al. (2013) Predictors of Intelligence at the Age of 5: Family, Pregnancy
and Birth Characteristics, Postnatal Influences, and Postnatal Growth. PLoS ONE, 8(11): e79200.
https://doi.org/10.1371/journal.pone.0079200.
20 Rosenbaum PR, Rubin DB. (1983) The central role of the propensity score in observational studies for causal effects. Biometrika. https://
21 Robins JM. (1998) Marginal structural models. 1997 Proceedings of the section on Bayesian statistical science. Alexandria, VA: American Statistical Association. 1–10. Accessed in Oct 2019 at https://cdn1.sph.harvard.edu/wp- content/uploads/sites/343/2013/03/msm-web.pdf.
22 Robins JM, Hernan MA, Brumback B. (2000) Marginal structural models and causal inference in epidemiology. Epidemiology. 11(5):550–60. Accessed in Oct 2019 at https://www.ncbi.nlm.nih.gov/pubmed/10955408.
23 Green R. (July 2018) Prenatal Fluoride Exposure and Neurodevelopmental Outcomes in a National Birth Cohort: A Thesis Submitted to the Faculty of Graduate Studies in Partial Fulfillment of the Requirements for the Degree of Master of Arts. York Univ.: Toronto, Canada.
25 Broadbent JM, Thomson, WM, Ramrakha S, et al. (2015) Community Water Fluoridation and Intelligence: Prospective Study in New Zealand. Am J Public Health. 105(1):72-76. https://doi.org/10.2105/AJPH.2013.301857.
26 McPherson CA, Zhang G, Gilliam R, et al. (2018) An Evaluation of Neurotoxicity Following Fluoride Exposure from Gestational Through Adult Ages in Long-Evans Hooded Rats. Neurotox Res. 34(4):781–798. https://doi.org/10.1007/s12640-018-9870-x.
27 Pew Center on the States. (Apr 2012) “Not all studies carry equal weight.” Philadelphia, PA: Pew Charitable Trusts. Accessed in Oct 2019 at https://tapintohealthyteeth.org/wp-content/uploads/2015/07/Not-All-Studies-Carry-Equal- Weight.pdf.
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29 Ducharme J. (21 Aug 2019) Is Fluoride in Drinking Water Safe? A New Study Reignites a Long-Standing Debate. Time. Accessed in Oct 2019 at https://time.com/5656476/is-fluoride-in-water-safe/.
30 McLaren L, Patterson S, Thawer S, et al. (2016) Measuring the short-term impact of fluoridation cessation on dental caries in Grade 2 children using tooth surface indices. Community Dent Oral Epidemiol. 44(3):274-282. https://doi.org/10.1111/cdoe.12215.
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Exactly, Paul. The Green, et al. study is just one more in an increasing list of questionable, agenda-driven studies by many of the same group, seeking to establish non-existing adverse effects of optimally fluoridated water. In addition to the letter to the NIEH, this study has received withering criticism from the scientific community. Until the authors opt for the transparency expected within respected science and release their heretofore hidden data, they have no credible defense against the points made in these critiques, regardless of how many media interviews they give.
The following links are to a three part, reader-friendly critique by a respected biostatistician:
https://epidemiological.net/2019/09/19/the-hijacking-of-fluorine-18-998-part-one/
https://epidemiological.net/2019/09/21/the-hijacking-of-fluorine-18-998-part-two/
https://epidemiological.net/2019/09/23/the-hijacking-of-fluorine-18-998-part-three/
From the American Council on Science and Health:
https://www.acsh.org/news/2019/08/19/no-fluoride-doesnt-lower-iq-it-fails-satisfy-hills-criteria-causality-14229
From the Science Media Centre:
https://www.sciencemediacentre.org/expert-reaction-to-study-looking-at-maternal-exposure-to-fluoride-and-iq-in-children/
Steven D. Slott, DDS
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