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Archived Comments for: When public action undermines public health: a critical examination of antifluoridationist literature

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  1. response to Jason Armfield's article on anti-fluoridationists

    Paul Connett, Fluoride Action Network

    21 December 2007

    Dear Editor,

    In the article on fluoridation, Jason Armfield uses precisely the same techniques that he accuses opponents of using, namely misinformation, and selective use of the literature, as well as relying on outdated material (Consumers Reports, withdrew the comment he cited years ago) and unqualified "experts" (e.g. Michael Easely). I hope to find the time to provide a thorough critique of this paper, meanwhile, as he mentions me by name, let me provide this rapid response so that your readers are not misled by Armfield’s tirade against me or other opponents of fluoridation.

    During my 11 years of experience researching the literature on this issue I have made my arguments against fluoridation clear and transparent and have documented them with the appropriate scientific references. Moreover, I am more than willing to engage any promoter of fluoridation in open public debate. I did this recently in the Isle of Man where I debated Professor Michael Lennon, chairman of the British Fluoridation Society and an influential member of a WHO committee on oral health. Those interested in examining the caliber of the arguments on both sides of this issue might wish to listen to the radio broadcast of this debate, or examine the power presentations points of each speaker. I would be happy to forward my power presentation to those interested (contact me at paul@fluoridealert.org) and I am sure Professor Lennon (contact bfs@bfsweb.org ) would do the same.

    It is incredible to me that Armfield, while accusing opponents of being highly selective, failed to mention the existence of the report by the National Research Council (2006): a 507-page review of the harmful effects of fluoride. Despite contrary claims by promoters of fluoridation like the American Dental Association (ADA) and the Centers for Disease Control and Prevention (CDC) this report was highly significant for examining the safety, or otherwise, of fluoridation. For the first time in the 60 year history of this practice, the issue of fluoride’s toxicity was addressed by a truly balanced panel.

    It took the panel over 3 years to complete this study. I was the only scientist opposed to fluoridation who was invited to give a presentation in person and I am happy to say that most of my concerns were vindicated in the NRC’s final report.

    The panel concluded that the current safe drinking water standard for fluoride in the US (4 ppm) needed to be lowered and that the US EPA should do a formal risk assessment to determine a new maximum contaminant level goal (MCLG). If the US EPA avails itself of the information on several health end points in this report, as well as the exposure analysis presented in Chapter 2, and applies an appropriate margin of safety to protect ALL members of the population (which includes the very young, the very old, those with poor kidney function, those with poor diet, especially those who are borderline iodine deficient, and above average water consumers) from these end points a new MCLG would have to be set well below 1 ppm which will force the end of fluoridation in the US, and probably worldwide.

    Here are some other criticisms of Armfield’s piece:

    He fails to discuss the concession by leading proponents of fluoridation (CDC, 1999, 2001, ADA, 2000) that the benefits of fluoride are largely topical, not systemic. Thus systemic exposure of every man, woman and child through the water supply makes little sense, when topically applied fluoridated toothpaste is universally available.

    He fails to acknowledge the critical difference between adding known nutrients to salt and food and adding a NON NUTRIENT, which is pharmaceutically active, to the water supply. For the former there is a considerable margin of safety, for the latter there is practically none.

    While emphasizing the natural occurrence of fluoride in many water supplies, Armfield fails to recognize the important fact that the level of fluoride naturally occurring in mothers milk is 0.004 ppm, which is some 250 times lower than the level added to water in water fluoridation schemes.

    Armfield fails to discuss the advice given to its members by the American Dental Association on November 9, 2006 that fluoridated water not be used to make up baby formula. How would Armfield propose to undertake the massive educational program that would be required to inform parents on this matter as well as provide the funding for alternative water sources for those who could not afford to purchase non-fluoridated water for this purpose?

    How does Armfield explain or rationalize why in over 40 years Australian health authorities have never funded studies to examine the possible relationship between exposure to fluoride and any harmful effect on any tissue other than the teeth? Or does he feel it is acceptable to simply fly blind on these matters? Needless to say, “if you don’t look, you don’t find” but that is hardly a sound basis for concluding that fluoridation is not causing any harm to Australians. Based on the findings of the NRC (2006) review such harm might well include lowered thyroid function, lowered IQ, arthritic like symptoms and brittle bones over a lifetime of exposure.

    Armfield offers some of his own explanations as to why the vast majority of countries in Europe do not fluoridate their water but he ignores the actual explanations given by several officials from these countries as to why they don’t do so, see http://fluoridealert.org/govt-statements.htm

    Armfield provides a reference to the response from the Irish authorities to my “50 Reasons to Oppose Fluoridation” but fails to cite my documented response to their self-serving critique. My 50 reasons, the Irish critique and my detailed response are easily accessed on the left hand side of the our home page at http://www.fluoridealert.org

    While, I am sure Armfield would like to characterize opponents of fluoridation as either dim-witted or dishonest, he has overlooked the fact that over 1200 professionals (see http://www.FluorideALERT.org) have signed a statement calling for an end to fluoridation worldwide. Analyzing the credentials of this list of signers would be a good way of testing his thesis on our “lack of credibility.” Were Armfield to do so he would find that it has been signed by many leading fluoride researchers from China, India, Poland and several other countries, a Nobel prize winner who led the successful fight to halt fluoridation in Sweden, a pediatrician who did the same in the Netherlands, 3 members of the NRC (2006) review panel (discussed above), an Austrian scientist who has exposed the scientific weaknesses in the studies used to prove fluoridation’s effectiveness, two advisory board members for the York Review, three officers in the Union which represents EPA professionals in the EPA’s DC headquarters, the newly elected President of the International Society of Doctors for the Environment (ISDE), the Executive Board of the American Association for Environmental Medicine (AAEM), the former President of Canadian Association for Dental Research, the former President of the South Australian branch of the Australian Dental Association, the current President and five former Presidents of the International Academy of Oral Medicine and Toxicology (IAOMT), many prominent environmental writers and literally hundreds of doctors, dentists, PhDs, and other highly qualified people from over 40 countries.

    Finally, I would be more than happy during my next trip to Australia to publicly debate him on this matter. I am sure that we would be able to get a venue and a moderator who would make sure that this debate – as in the Isle of Man – is conducted in a scrupulously fair manner.

    The full citations of all the references cited above can be found at http://www.fluoridealert.org/health/biblio.html

    Dr. Paul Connett,

    Professor of Chemistry,

    St. Lawrence University,

    Canton, NY 13617

    And

    Executive Director,

    Fluoride Action Network,

    Http//www.FluorideALERT.org

    paul@fluorideALERT.org

    315-379-9200

    Competing interests

    None declared

  2. A response to Connett

    Jason Armfield, School of Dentistry, University of Adelaide

    3 January 2008

    Dear Editor,

    I am somewhat surprised, but very much validated, by the Comment by Paul Connett, titled ‘response to Jason Armfield's article on anti-fluoridationists’ in reaction to my article on anti-fluoridation literature. Given the nature of this response to my article, I believe it warranted that I provide a brief reply. At the outset I would suggest to all water fluoridation opponents that if they are upset at being called out over their misleading claims and manipulative rhetorical practices then they should abandon these in favour of a rational and systematic approach to examining and reporting on the scientific literature.

    I would also like to point out to all those who read this article, Connett included, that the article is related to the exceedingly suspect practices of a high percentage of active anti-fluoridationists. I have documented some examples of each of these from the extensive anti-fluoride literature. That Connett would find it “incredible” that I do not mention this report, or do not comment on that study, or do not discuss the argument over whether fluoride has a topical or systemic effect, can only indicate that either he is unaware of the intention of the debate piece or has no relevant reply to the fundamental raison d’être of the article. To spell this out a bit more clearly, the article is not about the alleged benefits or dangers of water fluoridation, nor a review of recent studies looking at water fluoridation – it is about the misleading practices of many of those people who actively oppose water fluoridation. This can be gleaned quite easily by reading the title of the article or, indeed, by actually reading the article. To criticise me and feign astonishment that I did not include things in the article that are unrelated to the article is a Mastermind achievement in ‘missing-the-point’.

    It is unfortunate, but not altogether unsurprising, that Connett regards my article on anti-fluoride literature as a “tirade” against him and as being misleading. I have cited actual examples used by anti-fluoridationists and he has raised no objections over these. Indeed, none can be raised. Instead, he criticises me simply for not mentioning issues that he would have liked me to mention and for being selective in my use of the literature. In the first instance, the paper was not intended to be a mouthpiece for the objections of anti-fluoridationists. In the second, I can assure readers that I did extensively examine large swathes of anti-fluoridationist material and it was, almost without exception, deceptive and misleading. While not every article or pseudo-study used every example of rhetorical practice identified in my article they were all commonly employed across the body of the literature. I would encourage those active opponents of water fluoridation to have a look at the way they convey their message and to cease relying on their manipulative and Machiavellian practices to achieve their goals.

    Competing interests

    I have no competing interests.

  3. Comment on article by Jason Armfield

    Bruce Spittle, Private practice

    3 January 2008

    In his paper, submitted on 24 June 2007, Jason Armfield made no reference to the 2006 NRC report, Fluoride in drinking water, published on 22 March 2006. The NRC report gave credibility to the observations of George Waldbott on chronic fluoride toxicity and listed two of his publications as references. Armfield states that almost all major dental and health organizations either support water fluoridation or have found no association between it and adverse health effects. The lack of evidence for the existence of a chronic fluoride toxicity syndrome, as described by Waldbott and affecting about 1-5% of those drinking fluoridated water, in the 2007 NHMRC report, A systematic review of the efficacy and safety of fluoridation, the 2006 WHO report, Fluoride in drinking water, the 2002 MRC report, Water fluoridation and health, and the 2000 University of York report 18, A systematic review of water fluoridation, is a result of the inclusion criteria for those reviews being set in such a manner as to exclude all of the 142 publications by Waldbott on fluoride (Fluoride 1998;31:21-5). Thus the assurances of safety for fluoridation given by Armfield do not carry weight as the evidence, that has been published detailing adverse effects, has not examined.

    It is not remarkable that if the term "water fluoridation dangers" is entered in a search engine that the resulting information will show fluoridation in an unfavourable light. If one looks for dangers they will be in the results.

    Competing interests

    The commenter is the Managing Editor of Fluoride, the quarterly journal of the International Society for Fluoride Research (www.fluorideresearch.org), but is expressing his personal view rather than that of the Society which does not take a position on fluoridation.

  4. Response to Armfiled's response to my critique of his article

    Paul Connett, Fluoride Action Network

    7 January 2008

    Dear Editor,

    In his response to my criticism of his article, Jason Armfield skillfully sidesteps the vast majority of the specific arguments I made. He claims that his article was not meant to be about:

    “the alleged benefits or dangers of water fluoridation, nor a review of recent studies looking at water fluoridation – it is about the misleading practices of many of those people who actively oppose water fluoridation. This can be gleaned quite easily by reading the title of the article or, indeed, by actually reading the article. To criticise me and feign astonishment that I did not include things in the article that are unrelated to the article is a Mastermind achievement in ‘missing-the-point’.”

    Well I have read his article several times – painful as it is to see hollow rhetoric substituted for genuine scientific argument – and I have also read the title of his piece. I didn’t miss the point. His full title reads: “When public action undermines public health: a critical examination of antifluoridationist literature.”

    With such a title in place one would have felt that Armfield had the obligation to actually demonstrate that water fluoridation was a contribution to public health, and not as I believe, after researching the literature for 11 years, a threat to public health – and an unnecessary threat because it does not deliver what it claims to deliver.

    Armfield like many unscientific promoters of this practice tries to win the debate by “assertion” what he cannot win by careful “argument.”

    He asserts that the “actual scientific debate over water fluoridation” was “resolved years ago.” How convenient! But no true scientist ever puts a scientific matter beyond debate. An ugly fact can always destroy a beautiful theory.

    Armfield supports his dubious claim by citing a comment from Consumer Reports from 40 years ago. In the 1990s lawyers from this organization asked Michael Easley and others not to use this quote because it did not represent their current position on the matter.

    Neither Armfield’s article, nor his response to my critique, offer any real science to support his pro-fluoridation stance. Instead, he rails over the perceived “sins” of opponents. He especially cites the use of the internet by citizens and critics for the source of the “evidence” they use to support their health concerns – the “ugly facts” as it were. However, several of the web pages, especially our own, use a very extensive data base of peer-reviewed and published scientific literature to support our case. Does a peer-reviewed, published article lose its validity because it is cited on a web page? (See http://www.fluoridealert.org/health/ )

    The important review by the National Research Council (NRC) which I cited as being a serious omission in Armfield’s article, is not just “anti-fluoridationist” or a “pseudo-study,” as Armfield claims about any opponents’ support material, but the most thorough review of fluoride’s toxicity ever carried out – and carried out by the first truly balanced panel that has ever looked at the toxicity of fluoride in water.

    I was not “feigning astonishment” at Armfield’s failure to address this important review. If Armfield wants to convince people that there are no health concerns with fluoridation the place to start is by carefully reviewing this report. His refusal to do so speaks volumes. Attacking the techniques of anti-fluoridationists is simply a diversionary tactic and a lazy one at that. To understand what he is doing I urge him to read Henrik Ibsen’s play, “The Enemy of the People.”

    I will now respond to one very specific criticism Armfield makes of my public presentations. He is wrong when he claims that I do not indicate to listeners that the doubling of hip fractures in the elderly in a Chinese study in a village at 1.5 ppm in their water, compared to a village at 1 ppm, was not statistically significant. I do point this out to audiences but I also point out that there appears to be a trend in increased hip fracture rates as we move from the village at 1 ppm to the village at 4.3 ppm which does show a statistically significant increase (actually a tripling) in hip fractures. This trend is better explained by linear increase across these villages with increasing fluoride concentration than by the alternative theory that there is a threshold at 4.3 ppm. This suggests that the doubling in villages with 1.5 ppm and 3 ppm is a real result, even though the study did not show that these results to be statistically significant. Armfield may wish to interpret this differently, but it hardly warrants the inflammatory charge that I am distorting the findings of this study (Li et al., 2001).

    If Armfield wants to discredit me, rather than nitpicking my commentary on one article, he should debate me in public as I challenged him to do in my response to his article. That way an audience would have a better way of judging who has a better grasp on the total argument on whether fluoridation is a benefit to public health, as he claims, or a threat to public health, as I claim. He simply cannot assert that his case is ‘proved’ without bothering to examine the evidence scientifically.

    Since the Armfield article was published in December, an 8-page article has appeared in the January 2008 issue of the highly respected journal Scientific American entitled, “Second Thought About Fluoride” and it cites the chairman of the NRC panel, Dr. John Doull as follows:

    "What the committee found is that we've gone with the status quo regarding fluoride for many years—for too long, really—and now we need to take a fresh look," Doull says. "In the scientific community, people tend to think this is settled. I mean, when the U.S. surgeon general comes out and says this is one of the 10 greatest achievements of the 20th century, that's a hard hurdle to get over. But when we looked at the studies that have been done, we found that many of these questions are unsettled and we have much less information than we should, considering how long this [fluoridation] has been going on. I think that's why fluoridation is still being challenged so many years after it began. In the face of ignorance, controversy is rampant."

    Meanwhile, in his response to my criticism of his article, Jason Armfield continues to throw more mud on this debate than light.

    Paul Connett

    Dr. Paul Connett,

    Professor of Chemistry,

    St. Lawrence University,

    Canton, NY 13617

    And

    Executive Director,

    Fluoride Action Network,

    Http//www.FluorideALERT.org

    paul@fluorideALERT.org

    315-379-9200

    Competing interests

    None declared

  5. Further and final rejoinder to Paul Connett

    Jason Armfield, University of Adelaide

    17 January 2008

    Paul Connett has attempted to argue in his second Comment published here that my article is "hollow rhetoric substituted for genuine scientific argument". Of course, the irony of this statement is that it is just one more example of the hollow rhetoric used by many anti-fluoridationists.

    Connett again ignores that my article is not and was not intended to be a systematic review of the literature on water fluoridation. To suggest that I had an "obligation to actually demonstrate that water fluoridation was a contribution to public health" is patently absurd. Systematic reviews have already established this and my paper never had any pretension to be a systematic review. He further claims that I am trying "to win the debate by 'assertion'", which is somewhat bizarre because I was not trying to 'win' a debate. Similarly, Connett's criticism that my article does not "offer any real science to support his [i.e. my] pro-fluoridation stance" falls flat, because I was not taking a pro-fluoridation stance - I was instead taking a stance against the misleading and deceitful literature produced by anti-fluoridationists and used to derail public health efforts to introduce water fluoridation. I am unsure how much more simply I can state this fact.

    In answer to Connett's question as to whether or not "a peer-reviewed, published article lose[s] its validity because it is cited on a web page" the answer is that when the study is selectively or misleadingly or incorrectly quoted it is not the article itself which loses its validity but the interpretation of the results of the study. It is the same with reporting the results of one study but ignoring the results of a dozen others - the individual study might not be misinterpreted, but the overall scientific knowledge surely has been.

    Connett makes the claim that the recent National Research Council (NRC) report is regarded by myself as being either "anti-fluoridationist" or a "pseudo-study". Again, Connett's 'facts' are wrong. I do not believe this and have never stated such and to say otherwise can be nothing short of a deliberate and manipulative lie.

    In relation to the NRC report, this was not discussed in my paper because it was, again, not relevant to the topic of the paper which was, rather, a critique of anti-fluoridationist literature. Just saying the NRC report is relevant to my paper does not make it so, in the same way that yelling "the sky is falling" will not send those within earshot running for their bicycle helmets. If I had been writing a paper about the potential benefits and dangers of water fluoridation it may well have been discussed, despite the fact that it looks at higher levels of naturally occurring fluoride in the water than is achieved with artificial water fluoridation. But I wasn't, so I didn't. Simple, I would have thought.

    Connett responds to a criticism of his presentation of information related to a Chinese study of hip fractures by Li et al. (2001) by saying that he does point out a lack of statistical significance between hip fracture rates in Chinese villages with 1ppm and 1.5ppm fluoride in the water. Not surprisingly, and there is a pattern here, the premise of his argument is again wrong, as he accuses me of criticising his "public presentations". The references in my paper are, however, to particular examples of his written work, not to what he may or may not say in an undisclosed meeting or forum somewhere. Indeed, in one of the references cited in my paper he merely states: "One study found a dose-related increase in hip fracture as the concentration of fluoride rose from 1ppm to 8ppm" (Connett, '50 reasons' document). As I state correctly in my paper, he never points out that water fluoridation at about the level used to artificially fluoridate water supplies was actually found to be associated with significantly fewer bone fractures overall and was found to be unrelated to the prevalence of hip fractures. Water fluoridation at about 1ppm actually produced a reduction in bone fractures! In any event, this is just one study and more research is required to show beyond doubt the benefit of water fluoridation in reducing bone fractures.

    Connett's reference to the January 2008 article in the "highly respected journal Scientific American" is an attempt to beat up the credibility of the article. Scientific American is, in fact, a magazine and while it is reportedly the oldest continuously published magazine in the United States and is well respected it is not a peer-reviewed journal, publishing articles and personal opinions predominantly for a lay or amateur audience. Connett's reference is to a personal opinion published within a personal opinion and does not constitute evidence. It is also, again, unrelated to my paper.

    In relation to Connett's chest-beating calls to publicly debate me, I should note that whereas Connett is funded to travel the world and fight the introduction of water fluoridation I am a dental researcher working within a university and I receive no funding to travel and debate issues such as water fluoridation. I am, instead, employed to carry out research into children's oral health. If I was receiving any funding to carry on such activities, from any source, I would have undoubtedly declared this as a conflict of interest in either my paper or in my previous Comment. It should be noted that the policy for Comments in this journal states "Those who post comments should disclose any financial competing interests but also any non-financial competing interests that may cause them embarrassment were they to become public after the publication of the comments."

    It is somewhat ironic that Connett elsewhere views my paper as "scurrilous" and believes here that I am attempting to personally discredit him. Given that he recently attacked me in an anti-fluoride newsletter (Fluoride Action Network Bulletin 902), saying "This man hasn't even got his graduate degree and yet he feels that he can throw his kindergarten knowledge around as if he was in direct contact with God almighty" one might suspect that his abusive and combative approach is being projected onto those he is 'at war with'. While I regard Connett's undignified personal attack on me as a likely indication that he has no substantive issues on which he can successfully argue, this kind of petty personal vilification should be seen as what it really is - one more example of the type of argument favoured by anti-fluoridationists to sway the public and foster anti-fluoride aggression.

    In conclusion, I encourage readers to make up their own mind over the many dubious scientific claims of anti-fluoridationists. If they really are interested, read the systematic reviews, go to the original papers or at least look at their abstracts, and then compare these to the twisted verdict provided by opponents of water fluoridation. It is only right that the public as well as government and public health officials should arm themselves against the deliberately fostered misinformation of anti-fluoridationists. There should be no place for lies, deceit, and manipulation of science in the determination of public health policy.

    Competing interests

    I declare that I have no financial or non-financial competing interests.

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