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Antifluoridation Bad Science

There is a movement in the US to oppose a public health measure that is backed by impressive evidence showing it is safe and effective, as well as highly cost effective. For as long as the government has supported this health measure, there have been those opposed to it, claiming (against the evidence) that it is unsafe, ineffective, and represents a violation of personal freedom and the right to refuse an unwanted medical intervention. I could be talking about vaccines and the anti-vaccine movement, but in this case I am talking about the fluoridation of public water supplies and the antifluoridation movement.

This social debate (there isn’t much of a scientific debate) crops up in the news every now and then – mostly prompted by an antifluoridation activist or group making noise, or by a local referendum to block fluoridation in a community. Recently there has been a Harvard study making the rounds of social media, Developmental Fluoride Neurotoxicity: A Systematic Review and Meta-Analysis. The actual findings of the study do not show that there is any risk to public water fluoridation (if anything, they show that it is safe), but the study was seized upon by antifluoridation activists and distorted for their propaganda purposes. Unfortunately, the internet is now fertile ground for the spreading of propaganda.

The NYS Coalition Opposed to Fluoridation put out a press release distorting the findings of the study. Their press release (“Harvard Study Finds Fluoride Lowers IQ – Published in Federal Gov’t Journal”) was then printed as a science news item by many online news outlets. Reprinting press releases, without any editorial filter, is a cheap and easy way to add news-like content to your website. The Sacramento Bee, for example, published the press release under their “News” tab. Near the top of the page, in small print, they did put a disclaimer (which is better than most sites):

This section contains unedited press releases distributed by PR Newswire. These releases reflect the views of the issuing entity and are not reviewed or edited by the Sacramento Bee staff. More information on PR Newswire can be found on their web site.

That’s better than nothing, but I wonder how many people reading the press release will notice and read the disclaimer. In my opinion, a news outlet should not reprint press releases sent out from advocacy organizations clearly intended to promote an agenda. They especially should not print them under the banner of “News.” The disclaimer is not adequate. The spreading of this “news item” around Facebook and other social media demonstrates this.

Some Background

Before I get to the study itself, let me review the basic facts surrounding fluoridation of public water supplies. In the 1940s and 50s in the US there were major studies looking at the role of fluoride in the health of teeth. It was first noticed that too much fluoride, which occurs naturally in many water supplies, can cause a darkening and pitting of the teeth, now called fluorosis. However, smaller amounts of fluoride are necessary for tooth health and can help reduce tooth decay. Fluoride can help remineralize the enamel of teeth, to reduce or even reverse destruction by acid-producing bacteria.

The turning point in terms of evidence came with the publication of a study in 1950 – Dr. H. Trendley Dean, head of the Dental Hygiene Unit at the National Institute of Health published the results of a study in Grand Rapids, Michigan in which fluoride was added to the drinking water of one community and not another. The study revealed a 50% decrease in dental cavities in the fluoridated community compared to the control. This and other evidence led to the recommendation to adjust the fluoride levels of local water supplies to about 1 mg/L (or 1 part per million, ppm). Some communities have natural levels of fluoride in the water at higher levels, and these are often reduced. The decision on whether and how to adjust fluoride is made at the municipal and local governmental level – not the Federal level. Therefore, some communities add fluoride while others do not.

Immediately after the recommendation was made and some communities started adding fluoride, the antifluoridation movement started. The primary motivation seems to be objecting to the imposition on personal freedom, seeing fluoridation as involuntary medication. Groups that oppose fluoridation, however, are typically not content to make the freedom argument, but rather also distort the evidence to argue that fluoridation is not safe or effective, despite the actual evidence. At the fringe there are also those who believe that the fluoridation of water is part of a dark government conspiracy to make us all into mindless slaves. (These conspiracy theories were famously lampooned in the brilliant movie Dr. Stranglove, when the character General Jack Ripper talks about the violation of his “precious bodily fluids.”)

The last 50 years of scientific research has only confirmed the safety and efficacy of fluoridation. A 2008 systematic review of this research concluded:

Fluoridation of drinking water remains the most effective and socially equitable means of achieving community-wide exposure to the caries prevention effects of fluoride. It is recommended that water be fluoridated in the target range of 0.6-1.1 mg/l, depending on the climate, to balance reduction of dental caries and occurrence of dental fluorosis.

For further background see the policy statement on fluoridation by the Institute for Science in Medicine (of which I and other SBM authors are members).

The Harvard Study

The Harvard study is actually not a new study, but a review of prior research. Further, the studies reviewed did not involve water fluoridation programs.  The review concludes:

“The results support the possibility of an adverse effect of high fluoride exposure on children’s neurodevelopment. Future research should include detailed individual-level information on prenatal exposure, neurobehavioral performance, and covariates for adjustment.”

“The possibility” of an effect justifying future research is not the same as concluding that there is an effect. But the problems with the way this review is being presented go far deeper. The implication being implied by anti-fluoride groups is that the fluoridation program in the US and elsewhere is putting children’s IQs at risk. This data, however, cannot be used to support that conclusion.

First it should be noted that almost all of the studies reviewed were conducted in China (one was conducted in Iran) – not in the US. China had a limited fluoridation program for a time, and has had no fluoridation of drinking water since 2002. So why, then, are most of the studies from China?

There are many rural areas of China that have naturally high levels of fluoride in the well water. The studies were largely looking at this exposure. Two studies looked at fluoride exposure from inhaling smoke from coal burning. So the question is – how do these levels of exposure relate to the amount of fluoride being added to water in the US (because toxicity is always all about dose)? There was a lot of variability across the studies, but generally the high fluoride groups were in the 2-10 mg/L range, while the reference low fluoride groups were in the 0.5-1.0 mg/L range (not including the coal burning studies, which had much higher fluoride levels).

The recommended fluoride level for fluoridated drinking water is 0.5-1.0 mg/L (similar in most countries – Australia, for example, uses 0.6-1.1 mg/L). The EPA set the upper safe limit at 4.0, with a secondary (voluntary) recommendation of 2.0. Areas with high natural fluoride actually have some of the fluoride removed from the drinking water.

In other words – fluoridated water in the US has the same level of fluoride as the control or low fluoride groups in the China studies reviewed in the recent article, and the negative association with IQ was only found where fluoride levels were much higher – generally above EPA limits.

Also – these studies were mostly epidemiological or ecological – they were not experimental studies (like the Grand Rapids study) in which variables were controlled in any way. It is possible, and even likely, that the high levels of fluoride exposure from natural or industrial sources (not deliberate fluoridation) also correlate with exposure to other contaminants, such as arsenic.

 Conclusion

There are many weaknesses to the epidemiological studies reviewed in the recent article – high heterogeneity, poor controlling for other variables, no indication of blinding of IQ assessments, and many others. But even taken at face value they do not indicate any association between lower IQ and the fluoride levels added to drinking water in the US. In fact, those levels of fluoride were used as the controls in these studies showing higher IQ. (There was a lot of variance of the effect size, but the net effect size on IQ in the meta-analysis was -0.45 standard deviations). Therefore, if anything, this review adds to the body of evidence for the safety of fluoridation.

This fact has not stopped anti-fluoridation groups from exploiting the review for their own propaganda purposes. Otherwise respectable news outlets are unwittingly collaborating in this anti-scientific propaganda campaign by lazily reprinting these press releases in their news sections – without any editorial filter.

The “fluoride wars” are likely to continue as long there is a fluoridation program. This is evidence that there is no public safety measure that is so effective, safe, and cost effective that there will not be those who vigorously oppose its implementation.

Posted in: Public Health

Leave a Comment (39) ↓

39 thoughts on “Antifluoridation Bad Science

  1. windriven says:

    “when the character Captain Jack Ripper”

    General Jack D Ripper, played by Sterling Hayden.

  2. jt512 says:

    Steve, you misinterpreted the meta-analysis’s pooled effect estimate. It is a standardized mean difference (SMD). So, the pooled estimate is a difference of –0.45 standard deviations, not IQ points.

    Meta-analyses use the SMD in order to be able to combine results reported on disparate scales. If we assume that the results can be applied to a conventional IQ test, which is designed to have a standard deviation of 15 IQ points, then the results suggest that high fluoride exposure would lower IQ by 0.45 × 15 = 7 IQ points.

    Jay

  3. ZeGuimaraes says:

    Maybe there is a correlation between being part of an anti fluoridation group and IQ levels.

  4. Janet Camp says:

    Some issues just never seem to die.

    Is putting various chemicals in the public water supply to make it drinkable/safe also a violation of our “freedom”? Has any word been as twisted, undefined, and overused as “freedom” in the US?

  5. nicmart says:

    In 1999, the Chief Medical Officer of England’s Department of Health commissioned what became known as the York Study of the efficacy and harm of fluoridation. It was conducted Centre for Reviews and Dissemination, part of the National Institute for Health Research (NIHR) and is a department of the University of York.

    In 2003, in response to what the authors considered misrepresentation of their study, they released this statement:

    What the ‘York Review’ on the fluoridation of drinking water really found
    Originally released : 28 October 2003

    A statement from the Centre for Reviews and Dissemination (CRD).

    In 1999, the Department of Health commissioned CRD to conduct a systematic review into the efficacy and safety of the fluoridation of drinking water. The review specifically looked at the effects on dental caries/decay, social inequalities and any harmful effects. The review was published on the CRD Fluoridation Review website and in the BMJ in October 2000.

    We are concerned about the continuing misinterpretations of the evidence and think it is important that decision makers are aware of what the review really found. As such, we urge interested parties to read the review conclusions in full.

    We were unable to discover any reliable good-quality evidence in the fluoridation literature world-wide.

    What evidence we found suggested that water fluoridation was likely to have a beneficial effect, but that the range could be anywhere from a substantial benefit to a slight disbenefit to children’s teeth.
    This beneficial effect comes at the expense of an increase in the prevalence of fluorosis (mottled teeth). The quality of this evidence was poor.

    An association with water fluoride and other adverse effects such as cancer, bone fracture and Down’s syndrome was not found. However, we felt that not enough was known because the quality of the evidence was poor.
    The evidence about reducing inequalities in dental health was of poor quality, contradictory and unreliable.

    Since the report was published in October 2000 there has been no other scientifically defensible review that would alter the findings of the York review. As emphasised in the report, only high-quality studies can fill in the gaps in knowledge about these and other aspects of fluoridation. Recourse to other evidence of a similar or lower level than that included in the York review, no matter how copious, cannot do this.

    ———-

    The full study is found here:

    http://www.york.ac.uk/inst/crd/fluores.htm

  6. cervantes says:

    I’m afraid I have to agree that the safety of fluoridating water supplies is not really well established. There isn’t any good evidence of harm, but there really haven’t been any quality studies that provide affirmative evidence of long-term safety. It is plausible that very low concentrations of fluorinated hydrocarbons can form in drinking water — there is organic material in reservoirs, obviously. The diversity of these compounds is practically infinite, but they can have all sorts of biological effects. Of course one can speculate about unknown harms from just about any exposure.

    More to the point, there are many which we already know cause serious harm that nobody seems worried about, such as ultra-fine particle exposure from motor vehicle exhaust, which is known to cause thousands of premature deaths every year, particularly in people who live near highways. Yet there is no public outcry about it, because we love our cars too much.

    So this is not something I would lose any sleep over. Still, to make an affirmative assertion that there are no long-term ill effects — I don’t think you can do that.

  7. ossumsoss says:

    My city recently ended fluoridation, not on the grounds that it is harmful, but that it’s unnecessary given that almost everyone is getting fluoride in their toothpaste these days.
    I agreed with this measure as it seems wasteful to fluoridate a water supply which is mostly being used to water lawns and wash things, the proportion of tap water which people actually drink is very small.
    I stopped drinking tap water years ago, not because of fluoride but because of the pool-water taste from the chlorine which I find highly unpleasant. I don’t even boil rice in tap water anymore because of the taste.

    I realize fluoridation made sense in the days when few people practiced good, regular oral hygeine, but now it seems like a waste of money.
    Does fluoridation help a person who is already brushing regularly with fluoride toothpaste?

  8. Jay and Windriven – thanks, Ill make the corrections.

  9. Harriet Hall says:

    Countries that don’t fluoridate their water supplies try to provide fluoride by other means: toothpaste, applications by dentists, etc. In areas of the US that don’t fluoridate, doctors uniformly recommend fluoride supplements for children. The existing research will always be open to criticism by anti-fluoridationists, but there is a strong evidence-based consensus among dentists and other scientists that fluoride is beneficial. Once that is accepted, it boils down to how to best provide the benefits to children, so those who reject water fluoridation will have to come up with ways to help the poor and the uninformed.

  10. BobbyG says:

    “freedom”? Has any word been as twisted, undefined, and overused as “freedom” in the US?
    __

    No. The Epistemic Hairball All Star Shoe Band comments musically:

    http://www.youtube.com/watch?v=gR-w9LLpieM

  11. Alia says:

    In my country there is no water fluoridation. But when I was a kid in primary school, we had to bring our toothbrushes to school on a designated day and then we would stand in the washroom, brushing our teeth with a foul-tasting liquid. And this was called “fluoridation”.

  12. nicmart says:

    Harriet wrote, “there is a strong evidence-based consensus among dentists and other scientists that fluoride is beneficial.”

    No, there is a pack mentality and dentists take for granted that fluoridated water is justified by sound science. Not one dentist to whom I’ve ever spoken about it in the past 10 years had heard of the York study, and all were taken aback by the results when I have them copies to them. Did the author of this blog know of the York study?

    Essentially all physicians formerly believed that gastric ulcers were caused by “stress” until a rebel researcher defied the common wisdom by proving that the major cause was H. pylori. Decades of research “proved” that stress caused ulcers, but all of that research was bogus. Once H. pylori was established as the causative agent, it took years for most physicians to leave behind the discredited “stress” diagnosis.

    Consensus in science is meaningless, and the truth is that most practicing physicians and dentists do a poor job of keeping up with the latest research.

    “Science is the belief in the ignorance of experts.” — Richard Feynman.

  13. Harriet Hall says:

    There is a difference between pack mentality and the consensus of experts who are familiar with all the literature. While individual dentists may not be well informed, the dentists who prepared the ADA policy statements were. Despite the fact that the literature is far from ideal, the existing evidence is persuasive.

  14. nicmart says:

    Why are the conclusions of the York team incorrect, Harriet? Has there been a more thorough survey of the evidence than that done by York? What was it? The fact that you refer to experts rather than to research is good reason to be suspicious of your bias.

    You ignored my analogy with “stress ulcers,” which were uniformly supported by “experts who [were] familiar with all the literature.” You also passed by Richard Feynman’s quote.

    One could provide dozens of similar examples of the failure of medical experts and the disvalue of consensus. Epilepsy is a paradigmatic example. In biological sciences the experts are probably wrong more often than they are right.

  15. Jimmylegs says:

    @nicmart:

    Perhaps you can provide a link or reference to the York study, when I keep trying to find it I get “alertiest” and propaganda sites that talk about it, but get a 404 error when trying to view the PDF file. And the stuff I do find I can’t really read or understand. I might not be looking hard enough or in the right areas, but you could help shed some light on this matter.

    Just because someone, in this case HH, doesn’t comment on every single point a person makes does not automatically make them guilty of dodging a question or quote.

    The experts people refer to tend to also be researchers in that field, so when asking an expert in something they have studied and done research to BE an expert. These experts on boards and advisory committees are not “arm-chair” experts. They have dedicated their lives to this (or a better part of).

    And for your quote, Richard Feynman was a brilliant physicist but I guess he didn’t know the definition of science. I don’t know the context in which he said this, but all I can gain from this quote is he was saying that “science is believing what experts don’t know.” I have no idea what the hell that is suppose to mean or what relevance it has here, again perhaps you could clear this up for me for I am a layman in my early age.

  16. Jimmylegs says:

    Oh and I forgot to include, just because someone was very smart or held in a high position does not make everything they say or do correct, rational, or logical. I believe here on SBM there was talk about the “Nobel Syndrome,” which is when a Nobel Prize is awarded to a scientist they fall into pseudoscience for some reason (not all do, but some).

    When that happens you don’t throw away what they have done, but you do question what they are doing now.

  17. Harriet Hall says:

    @nicmart,

    “Why are the conclusions of the York team incorrect, Harriet?”

    They aren’t incorrect. Did you even read them?

    The full pdf of the York study is available at: http://www.york.ac.uk/inst/crd/fluores.htm
    It concludes that there is evidence supporting fluoridation and the risk of fluorosis. It says “The research evidence is of insufficient quality to allow confident statements about other potential harms or whether there is an impact on
    social inequalities. This evidence on benefits and harms needs to be considered along with
    the ethical, environmental, ecological, costs and legal issues that surround any decisions
    about water fluoridation. All of these issues fell outside the scope of this review.” It recommends that the quality of studies be considered and that future studies use better methodology.

    As for stress and ulcers, science worked exactly as intended, and standard practices changed in a very short time. Science can only go by the available evidence, and when the evidence changes, the conclusion changes. Science is far from perfect, but it’s the best method we have. It approaches truth ever more closely over time. There is no new evidence about fluoride that would merit a change in consensus.

    Richard Feynman’s quote was about the logical fallacy of appeal to authority just because it is authority. It means we should go by the evidence, and we can’t all be well versed in the evidence for every field. It is reasonable to provisionally accept the conclusions of experts in that field who have evaluated the evidence more reliably than we can individually hope to do.

  18. weing says:

    ““Science is the belief in the ignorance of experts.” — Richard Feynman.”

    For another take on this quote, I suggest checking out the book by Stuart Firestein “Ignorance – How it Drives Science”.

  19. DugganSC says:

    Commenting on ossumsosson’s and Harriet Hall’s comments on flouridation via drinking water versus other means:

    Funnily enough, I always took it the other direction. I grew up drinking a lot of tap water, so my family and I always kind of looked askance on the insistence of our dentist that all of us needed extra fluoridation when we came in four our annual check-ups. And yes, the water there was fluoridated. It was just the assumption of the times that kids needed extra fluoride, so we had to bite down for several minutes on a foam jaw insert that contained foul-tasting gel.

    On a side note, the other item I’ve often heard in anti-fluoridation literature is that fluoridation didn’t become a mandated thing by the government until the rat poison and pesticide industry (I’ve also seen fertilizer pointed out here) started looking for ways to get rid of their stocks of fluoride-containing chemical waste. Honestly, I’d be more inclined to believe that fluoride has a source of industrial necessity than a more sinister conspiracy involving it being a slow poison.

  20. daedalus2u says:

    I want to correct a misinterpretation that cervantes suggested.

    The fluoride that is added to drinking water is ionic fluoride, usually sodium fluorosilicate. fluorosilicic acid or sodium fluoride. This type of fluoride does not spontaneously form organic fluorine compounds.

    Another beverage that has a high fluoride content is tea. Instant tea can have fluoride levels above where the EPA would recommend treatment if it was drinking water.

    http://www.thenhf.com/old/skeletal_flourosis_and_instant_tea_study.htm

  21. I linked to a 2008 systematic review in the article itself. The review was extremely thorough. They concluded that fluoridation is safe and effective.

  22. nicmart says:

    @ Harriet

    “As for stress and ulcers, science worked exactly as intended, and standard practices changed in a very short time.”

    The diagnosis of “stress” is not science at all; it is simply the sort of psychiatric voodoo that physicians apply to almost any idiopathic illness. It’s akin to what got epileptics locked up in “colonies.” It is the abdication of science. There was not a shred a proof that ulcers were caused by emotional stress, and how could there have been since they were not? What is “a very short time,” and what evidence can you provide showing the percentage of physicians who treated ulcers as a bacterial infection in a given period of time after causation was proven? Evidence, please.

    The trees must seem very imposing since you cannot see the forest. York concluded, as I already posted:

    “We were unable to discover any reliable good-quality evidence in the fluoridation literature world-wide.

    “What evidence we found suggested that water fluoridation was likely to have a beneficial effect, but that the range could be anywhere from a substantial benefit to a slight disbenefit to children’s teeth.”

    On that basis it is reasonable to conclude that those who support mass fluoridation are unscientific, not those who oppose it.

    @ Steven

    Why link to the 2008 review, published in a minor journal, but ignore the 2000 review published in the BMJ? The latter doesn’t serve your ideology? Was the York review not “extremely thorough”? York had 10 reviewers and the review you linked had three. York included 214 studies and the review you chose included 77.

    No evidence has been supplied by fluoridation proponents in this discussion that they even knew of the York study, or that now knowing of it they have bothered to read it. They are persuaded by the “consensus,” as if truth is the outcome of majoritarianism.

  23. nicmart says:

    It would be darned near impossible to find a dentist who is not a flossing enthusiast, yet here is what Cochrane concludes about the evidence supporting flossing:

    “Overall there is weak, very unreliable evidence which suggests that flossing plus toothbrushing may be associated with a small reduction in plaque at 1 or 3 months.

    “None of the included trials reported data for the outcomes of caries, calculus, clinical attachment loss, or quality of life. There was some inconsistent reporting of adverse effects…

    “There is some evidence from twelve studies that flossing in addition to toothbrushing reduces gingivitis compared to toothbrushing alone. There is weak, very unreliable evidence from 10 studies that flossing plus toothbrushing may be associated with a small reduction in plaque at 1 and 3 months. No studies reported the effectiveness of flossing plus toothbrushing for preventing dental caries.”

    Such is the level of commitment by dentists to proving their beliefs and recommendations. Oh, but there is a consensus! (That magical word.)

    Chiropractors must envy dentists for the awe they inspire based on such meager evidence.

  24. windriven says:

    @nicmart

    I have followed the exchange between you and Dr. Hall but am not able to define in my mind your actual point. Are you arguing that fluoridation is ineffective in reducing dental caries (there seems to be reasonable evidence that it is somewhat effective) or that it is dangerous (and there seems to be reasonable evidence that it isn’t). I haven’t time this evening to read the York study in its entirety but have digested the executive summary and it, in fact, seems to support fluoridation as generally effective and safe.

    As to your first post and the York study you quoted the authors as warning, “This beneficial effect comes at the expense of an increase in the prevalence of fluorosis (mottled teeth).” We have be fluoridating water in this country for many decades but I can’t think of a single friend or even acquaintance with mottled teeth. That may not be scientifically rigorous but it is empirically relevant.

  25. Harriet Hall says:

    @nicmart,

    The story of H. pylori and its path to acceptance is told here:
    http://www.csicop.org/si/show/bacteria_ulcers_and_ostracism_h._pylori_and_the_making_of_a_myth/
    I don’t know of any reference to show the actual number of doctors treating ulcers with antibiotics in each year, but I followed the story in the journals at the time, and the standard recommendations for treatment certainly did change promptly.

    Stress causes the stomach to increase acid production, contributing to the development of ulcers. There is even a syndrome of stress ulcers in patients with burns and severe illness.

    I don’t know about the forest and the trees, but it appears that the glass of evidence looks half empty or half full depending on one’s prior prejudices. I’m getting a hint that you might be prejudiced: you successively criticize fluoridation, experts, scientific consensus, ulcer treatment, physicians, and now flossing. What is your agenda?

  26. weing says:

    @nicmart,

    “On that basis it is reasonable to conclude that those who support mass fluoridation are unscientific, not those who oppose it.”

    So, you are scientific because you oppose mass fluoridation. You use the York paper to support your scientific stance when they indicated that the evidence for benefit vs harm is tilted toward benefit; but it is imperfect and more studies are needed. So we should oppose fluoridation because the evidence is for benefit? If the conclusions were reversed, with the imperfect evidence favoring harm, would you then be supporting fluoridation? And you would be calling us unscientific for opposing it?

  27. True_Q says:

    An interesting discussion. Unfortunately I’m unable to add anything substantial about fluoridation. Though I think that H. pylori may have an undeserved “bad press”, since there are some studies showing that for most people it’s beneficial protecting against asthma and allergy, helping in regulation of stomach acids and maybe even regulating hunger. There are though those unlucky ones for whom it’s harmful. It’s possible that by eradicating H. pylroi we do more harm than good. Any insight on that?

  28. BillyJoe says:

    True_Q,

    The solution is staring you in the face.

    Treat only those whose H.Pylori is causing ulcers or reflux – because ulcers can haemorrahge and perforate and thereby harm and kill; and reflux can, over time, result in esophageal strictures and esophageal cancer which is almost inevitably fatal.

    Do not treat those whose H.Pylori is harmless or beneficial – in any case, their H.Pylori status would never be known because, being symptomless, they would not even be investigated for its presence.

    (Actually it is news to me that H.Pylori can be beneficial)

  29. Earthman says:

    The context of the Richard Feynman quote is a talk he gave to the fifteenth annual meeting of the National Science Teachers Association, 1966 in New York City, and the section below is a short excerpt:-

    “Another of the qualities of science is that it teaches the value of rational thought as well as the importance of freedom of thought; the positive results that come from doubting that the lessons are all true. You must here distinguish–especially in teaching–the science from the forms or procedures that are sometimes used in developing science. It is easy to say, “We write, experiment, and observe, and do this or that.” You can copy that form exactly. But great religions are dissipated by following form without remembering the direct content of the teaching of the great leaders. In the same way, it is possible to follow form and call it science, but that is pseudo-science. In this way, we all suffer from the kind of tyranny we have today in the many institutions that have come under the influence of pseudoscientific advisers.

    We have many studies in teaching, for example, in which people make observations, make lists, do statistics, and so on, but these do not thereby become established science, established knowledge. They are merely an imitative form of science analogous to the South Sea Islanders’ airfields–radio towers, etc., made out of wood. The islanders expect a great airplane to arrive. They even build wooden airplanes of the same shape as they see in the foreigners’ airfields around them, but strangely enough, their wood planes do not fly. The result of this pseudoscientific imitation is to produce experts, which many of you are. [But] you teachers, who are really teaching children at the bottom of the heap, can maybe doubt the experts. As a matter of fact, I can also define science another way: Science is the belief in the ignorance of experts.

    When someone says, “Science teaches such and such,” he is using the word incorrectly. Science doesn’t teach anything; experience teaches it. If they say to you, “Science has shown such and such,” you might ask, “How does science show it? How did the scientists find out? How? What? Where?”

    It should not be “science has shown” but “this experiment, this effect, has shown.” And you have as much right as anyone else, upon hearing about the experiments–but be patient and listen to all the evidence–to judge whether a sensible conclusion has been arrived at.

    In a field which is so complicated [as education] that true science is not yet able to get anywhere, we have to rely on a kind of old-fashioned wisdom, a kind of definite straightforwardness. I am trying to inspire the teacher at the bottom to have some hope and some self-confidence in common sense and natural intelligence. The experts who are leading you may be wrong.”

    The gist I gather from this quote, and the rest of the piece, is that pseudo-science can look like science, but may be rot. And that we should all question the ‘experts’ ‘cos they may be wrong i.e. they may know the name for something but not understand anything else about it.

  30. True_Q says:

    BillyJoe,
    You’re complitelly right. When I wrote about erradicating H.p. what I meant was global erradication, not the one in patients it does harm. If I remember correctly before the Great War ca. 70-90% of people had H.p. in their stomachs, nowdays in industrialised countries it’s around 10% (and that’s what I meant by erradication). Here’s an article about H. pylori and asthma/alergy: http://www.med.nyu.edu/medicine/labs/blaserlab/PDFs/Blaser%20Gut%2057%20561%2008.pdf
    For me it is a bit of a news, too. I found out about these new research just about a month ago. I still consider them kinda “preliminary results” despite they’re not new at all. Most certainly we need more research on the subject.

  31. BillyJoe says:

    True_Q,

    I am also unaware of any push to eradicate H.Pylori globally. It would surely fail. Few asymptomatic persons would subject themselves to gastroscopy followed by eradication therapy followed by breath test to confrim eradication. Also governments are unlikely to finance the enormous cost of this futile endeavour.

  32. True_Q says:

    BillyJoe,

    I didn’t mean a concious campaign to erradicate H.p. ’cause there’s no one. Nevertheless the data are there. I believe that what’s responsible for the change is irresponsible antibiotic use but for sure the notoriety of H.p. does not help it.

  33. WilliamLawrenceUtridge says:

    Ah, fluoridation – brings out the crazies like few other topics.

    Essentially all physicians formerly believed that gastric ulcers were caused by “stress” until a rebel researcher defied the common wisdom by proving that the major cause was H. pylori. Decades of research “proved” that stress caused ulcers, but all of that research was bogus. Once H. pylori was established as the causative agent, it took years for most physicians to leave behind the discredited “stress” diagnosis.

    The fact that Warren and Marshall discovered peptic ulcers were caused by a mechanism other than what was previously thought only demonstrates that such an outcome is possible; it does not mean that everybody proposing a new mechanism or interpretation is always right. And the reality of peptic ulcers is <a href = "http://www.sciencebasedmedicine.org/index.php/h-pylori-plausibility-and-greek-tragedy-the-case-of-dr-john-lykoudis/"a little more complicated than a "brave maverick doctor. But the ultimate point here is that the cause of peptic ulcers has no relation to whether fluoridation has adverse effects. Bringing up the former serves only to make rhetorical points when discussing the latter.

    Nicmart, you’ve already made your decision, you don’t care what the evidence is. You can pretend otherwise, but it’s pretty obvious that you’re not motivated by the science.

    May your precious fluids run pure,

    WLU

  34. I have to give it up to the authors of this blog and some of it’s absolutely fantastic commenters (WLU, nyb, etc), because you guys are absolutely tireless in this endless battle with stupidity. You guys face idiots head on and (usually) patiently demonstrate how they are wrong, try to show them the error of their ways, and usually only give up when they become abusive.

    I can’t do that. I don’t have it in me to be endlessly patient with people who are essentially missing part of their brain. I can’t be nice to idiots and hold their hands as I futility attempt to show them the errors of their ways. I know that sometimes opponents can be corrected, but 9/10 they are just immovable lumps on a camel’s scrotum.

    I just… feel exhausted. In the last 24 hours I’ve saved the lives of someone who tried to kill themselves, two people with severe sepsis, one with a severe GI bleed, and I’ve greatly improved the lives of dozens of others. And that’s in a day. And I’m not unique, any hospitalist sees similar pathology on a daily basis and saves equal and greater numbers of lives on a regular basis. And we’re arguing with a-holes who think fluoride in the water is a government conspiracy to mind control us. I just can’t do it anymore. I can’t tolerate the stupidity. Sigh!

    The whole situation is a gigantic Dunning-Kruger. These pieces of crap just don’t realize that what they see and do is absolutely nothing. These retarded chiropractors who come out and say they are smarter than doctors are just f-ing idiots. They can’t even deal with back pain, let alone the hundreds of other things we do daily. It’s just astonishing that they are so completely clueless as to how little they do that they actually convince themselves they do so much.

    I just … hate them. Please, just put them on a boat and ship them all to Antarctica. Let them revel in their own stupidity, isolated away from humanity. They contribute nothing and do nothing besides directly harm their clients.

  35. ConspicuousCarl says:

    Strangely, the h. pylori issue came up recently over on SGU forums, but in a thread about virus-induced cancers. Someone listed the ulcer thing as yet another example of those stubborn scientists not listening to the lone hero. I provided a link to the same Atwood article, but the other guy responded only by saying that he takes the word of a person who won a nobel prize. What a sad response.

  36. Dramaman says:

    Back in the late 90′s, I was taking a college course on the Cold War and thought it would be quite amusing to do my term paper on the movement against fluoridation. While there was a certainly nutty conspiracy element to it, I was surprised to find myself somewhat sympathetic to the health concerns that were voiced and annoyed by the hubris displayed by those backing fluoridation. Don’t get me wrong. I am convinced that fluoridation is safe and good policy, but I think there were a lot of policy mistakes that were made in the process of implementing it that might have prevented it from being more solidly embraced.

    First, those backing it underestimated the seriousness that folks would have over what is essentially medicating the public water supply. The initial tests were so positive that the backers immediately began implementing it elsewhere, leaving themselves open to charges that they never completed their scientific testing. This wouldn’t have been such a big deal, except when it comes to the water supply, this is not voluntary. This was a mistake and although it seemed like a no brainer to immediately begin fluoridating municipal water supplies, it would have probably been better in retrospect to wait, complete the original studies and then begin a phased in adoption.

    When reading policy journals about how how to deal with opponents of fluoridation, one of the key strategies was to belittle and ridicule anyone who had concerns. Sure, some of of the opponents thought it was a communist plot, but I think they were in the minority. Most were simply concerned about the idea of messing with the public water supply and the attitude of the pro-fluoridation advocates toward them was arrogant and hurt their cause. I’d have to go back and look at my paper, but at the time I wrote it, there was still a large percentage of cities and towns int he U.S. who decades later still were not using fluoridation. In the end, I think fluoridation has stood the test of time, but I can’t help think that it might have been more widely adopted if those advocating it had gone more slowly and been more sympathetic and less arrogant in their implementation.

  37. DrBrown says:

    Before I get to this specifics of this article and the Harvard fluoride review, I first want to point out that I personally believe that the topical use of fluoride is beneficial, is safe (unless swallowed), and is a proven way to reduce dental caries. That being said, I personally oppose water fluoridation for a few reasons that I feel are rarely brought up in discussions by fellow practitioners.

    In my state–like all of yours–if I want to provide systemic fluoride supplements then I MUST PRESCRIBE them. Systemic fluoride cannot legally be sold over the counter. By law, prior to prescribing systemic fluoride, I must first develop a patient-physician relationship; meaning that I have reviewed the patient’s medical history, the patients current health, and know what supplements and medications the patient is currently taking. This FACT alone conflicts greatly with the practice of water fluoridation. Systemic fluoride supplementation through the water supply does not require a prescription, does not require medical supervision, or a patient-physican relationship. How can we in good conscience promote something for the entire public that we CANNOT DO IN OUR OWN OFFICE?

    When dealing specifically with systemic fluoride drops/supplements, I must first (according to ADA and AAP guidelines) conduct a caries risk assessment. Even the ADA states that “fluoride supplementation is only appropriate for HIGH RISK children. Yet water fluoridation does not discriminate, it gets ingested by ALL CHILDREN. According to these guidelines I must also find out how much fluoride each patient is consuming on a daily basis (from food, water, medications, etc) to ensure they consume too much fluoride. According to the ADA, “If you are unable to make an assessment of the child’s daily fluoride intake, it is better not to prescribe fluoride at all. Inappropriate supplementation carries a high risk of dental fluorosis.” Again, water fluoridation is not supervised to this level. We have no idea how much fluoride each child in a fluoridated town is consuming, and yet practitioners have no problem circumventing what the ADA and AAP guidelines suggest for responsible fluoride supplementation.

    Next, the guidelines require that I monitor periodically (at least every six months). I need to know if they have any adverse reactions to fluoride, if they get dental fluorosis, or if their caries risk is reduced. I must provide medical supervision when giving any prescription, reviewing all of these factors each time the patient steps foot in my office. With water fluoridation there is NO MEDICAL SUPERVISION, no periodic monitoring, and no evaluation of adverse effects of the development of fluorosis.

    Lastly, the ADA and AAP guidelines for prescribing fluoride recommend ZERO fluoride for infants under 6 months of age, 0.25mg/day for children under 3 years of age, 0.5mg/day for children under 6, and only 1.0mg/day for everyone over 6. In a fluoridated community a liter of water has 1mg of fluoride. This is too much fluoride for infants whose formula is reconstituted with fluoridated tap water (200 times more fluoride than a breastfed baby according to the National Research Council), this is too much fluoride for a 3 year old, as well as a 6 year old. Again, water fluoridation ignores the ADA and AAP’s own guidelines and recommendations. YOU CANNOT CONTROL DOSAGE WITH WATER FLUORIDATION. My son plays soccer and drinks at least a liter of water every practice and game, not to mention he gets fluoride in his fruit juice, food, and possibly in the shower through dermal absorption. Luckily we have fluoride-free well water.

    So this debate is really pointless when you consider that water fluoridation directly CONFLICTS with state law, the ADA and AAP guidelines for supplementation, and with what we can and would do in our own offices. This is the primary reason I oppose water fluoridation, and in my opinion these are undebatable facts, not pseudo-science.

    In regard to Dr. Novella’s article, he does fail to mention the York study that showed little or no benefit to fluoridation. He also fails to mention the National Research Council report that showed that there is little proven benefit to fluoridation, that all of the benefit that exists is topical not systemic, and that the current MCL and MCLG is NOT safe enough for the general population, particularly INFANTS and people with thyroid and kidney problems. He also doesn’t mention that most of Europe has taken action to BAN fluoridation as a medical experiment. Or that the EPA’s employee’s union has called for a moratorium on fluoridation due to the risk factors of ingesting the inorganic substances used to fluoridate 98% of the public water supplies.

    Next, Dr. Novella points out that the “low fluoride / control group” in the Chinese studies was consuming a level of fluoride that is found in our fluoridated communities (approx. 1.0ppm). He fails to take into account that our citizens are also ingesting fluoride from soda, beer, tea, juice, processed foods, seafood, dental products, medications, etc. The NRC report found that on a daily basis, citizens consume way more than 1.0mg of fluoride when all of these fluoride sources are taken into account, which then moves some of our citizens into the levels of the “high fluoride groups” from the Chinese studies. Either Dr. Novella has left this out on purpose to make his point, or he simply hasn’t considered the fact that we get fluoride from sources other than our water supply. Either way, his analysis is lacking in this regard.

    Last, Dr. Novella touches briefly on fluorosis, calling it a minor “cosmetic” problem. He fails to mention that the CDC reports that 41% of american adolescents have signs of dental fluorosis. Yes, most of it is mild, but it is a fact that this number is growing exponentially and uncontrollably here in the U.S. I see more and more patients with fluorosis each year. In regard to it only being cosmetic. I would say it is at best cosmetic AND psychologically damaging, since these kids have to go through their school years with less confidence because of stains all over their teeth. Not an easy task in our society that treasures perfection, beauty, and bleached teeth. At worst, you have to realize that fluorosis is a bio-marker of internal damage. What is going on with the teeth is certainly also going on with the bones. If a patient comes to me with their hair falling out, or open sores on the skin, or skin discoloration, I don’t simply say, “don’t worry your problems are simply cosmetic.” Instead, I heed these cosmetic changes as signs of internal damage and a problem that needs resolving immediately. For the sake of fluoride proponents, I hope time will tell that it is merely cosmetic, but I think we all know better.

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