Wednesday, June 12, 2013

Thought of the day: cage match between fluoride opponents and climate deniers

Rules are the fluoride opponents have to start out convinced that the climate deniers are wrong, and vice versa. I'd like to listen to their arguments on why the other group is wrong (not very interested in their arguments as to why their own group is right). So what happens in the end? Anyone gets convinced?

I'm being slightly unfair here to the fluoride people. Even though I've voted consistently at the Water District to fluoridate and might take some heat in my district for doing so, I think the consensus on water fluoridation being safe isn't at the same level of strength as that of the climate consensus. To clarify, the consensus that fluoridating water is better than not as a general matter for the public health seems pretty strong, but it gets more iffy on the issue of potential side effects.


Sou said...

How about a three or four way contest in rounds and add in the anti-vaxxers and anti-GMOers. You'd probably get a good cross section of politic leanings that way.

The prize to the ultimate winner could be a debate with young earthers. :D

Anonymous said...

Will the cage be filled with a 50:50 mixture of CO2 and elemental fluorine?

Anonymous said...

Dr. Lumpus Spookytooth, phd.

Whoa, whoa whoa. Talk about deflection. The tears stream from Brian's and Eli's eyes as long time ally Justin Gillis uttered the satanic verses, "To the contrary, in a climate system still dominated by natural variability, there is every reason to think the warming will proceed in fits and starts."


Brian said...

Are you a fluoride opponent, Lumpus? If so, what makes you one?

Ian Forrester said...

Sou, you do yourself no favours by including those of us who understand and have read about the problems with GMOs with anti-vaxxers and AGW deniers.

There is more and more evidence showing no benefits and lots of problems with GMOs and their associated technologies.

The only places you can find any positives on GMOs are in the PR screeds handed out by the promoters and in papers which are funded by the GMO companies. Does it not worry you that anyone who published papers showing harmful effects is vilified? Many have been fired or had problems with their careers because of their findings. That is atrocious behaviour and it does not shine a bright light on anyone supporting this attack on legitimate scientists.

I am pro-climate science, pro-vaccinations and pro-fluoride addition (at appropriate levels).

Why do some scientists have such a hard time understanding the problems with GMOs as they exist today? Have they been brain washed into thinking that they are the solution to world hunger? That is a myth put out by the GMO industry, it is not true. See for example the reports put put by the International Assessment of Agricultural Knowledge, Science and Technology for Development, agriculture's equivalent to the IPCC.

Anonymous said...

I'll play but only if you start calling them dentistry deniers.


dhogaza said...

One can be a fluoridation opponent while not denying the science. One can acknowledge that fluoridation does decrease the rate of cavities in kids while believing that it's not the best use of limited financial resources to do so. Arguments along these lines were part of the debate on fluoridation in Portland and aren't anti-science per se.

One can't deny climate science without, well, denying climate science.

It's not an apples-to-apples comparison at all.


If genus lumpus is on the card, you'd better spike the cage atmosphere with AsF5.

a_ray_in_dilbert_space said...

Lumpus, the stock market is dominated by noise as well. Does that mean that you won't invest in stocks?

You are so ignorant that you don't even know what you are denying.

Anonymous said...

It's true that "the consensus on water fluoridation being safe isn't at the same level of strength as that of the climate consensus", but the statement betrays a lack of understanding of science. Real science is all about the evidence, not consensus.
How about this little comparison between the cult of fluoridology and climate science?
1. There is no credible alternative explanation to anthropogenic global warming for the changes in climate which have been observed in recent decades. In contrast, credible alternative explanations for the dramatic declines which have been seen in rates of dental cavities throughout the developed world in recent decades, with or without fluoridation, are better nutrition, better dental hygiene, the use of fluoridated toothpaste (which has fluoride concentrations three orders of magnitude greater than fluoridated water, and a completely different mode of delivery, and shouldn't be conflated with water fluoridation), and increased consumption of certain antibacterial chemicals in foods.
2. The basic mechanism by which greenhouse gases affect the climate, namely differing response to electromagnetic radiation of different frequencies, is well understood. The means by which fluoridated water is supposed to prevent cavities is still unknown. The latest theory I've heard is that it's supposed to make teeth less sticky.
3. The detailed mathematical modelling of global climate is a credible exercise, whereas the human body is nowhere near well enough understood for detailed mathematical modelling of its biochemistry to be meaningful.
4. The global climate is being continuously monitored in detail, whereas individual fluoride exposure and its relationship to health outcomes has been almost completely ignored.
5. The best available science has been applied to the theory of anthropogenic global warming, but the same cannot be said for fluoridation. Ecologic studies are used to justify fluoridation, instead of randomised controlled trials. There is a lack of blinding, individual fluoride exposure is not measured despite extreme variability, and confounding factors are not properly accounted for. Findings of efficacy have amounted to the false claim that correlation equals causation. Short-term double-blind studies have shown that many people are fluoride sensitive, and suffer symptoms from water fluoridation, but that research is ignored.
6. The number of dental cavities a person has is a subjective measurement, whereas climate science does not rely on subjective measurement.
7. The predictions of climate scientists have been broadly consistent with subsequent observations, and climate scientists haven't dramatically changed their story. Fluoridationists initially said that fluoride worked systemically, not topically, but now say that the benefit is mainly from direct contact with the teeth. Communities which have discontinued fluoridation have seen a decrease, not increase, in rates of cavities. Rates of dental fluorosis are far higher than the 10% initially predicted. Fluoridation hasn't come close to curing dental decay, or putting dentists out of business. It was claimed that fluoride is an essential nutrient, but that has since been disproved.
8. The idea of anthropogenic global warming is driven by qualified scientists and opposed by industry, whereas the opposite is true of water fluoridation.
9. Most geologists are not qualified to speak on climate science, and most dentists are not qualified to speak on the harm caused by fluoridation. It doesn't make any sense to pretend that dentists are experts on toxicology or environmental impacts.
10. You can't rely on common sense to tell you that continuing to increase atmospheric concentrations of carbon dioxide and other greenhouse gases is a bad idea, whereas anyone with a little common sense can understand that the indiscriminate, uncontrolled, wasteful medicating of populations via public water supplies is ridiculous.
11. It makes sense to apply the precautionary principle in both cases.

Dan Germouse

Martin Vermeer said...

It's refreshing to see a real, honest-to-goodness drinking-water fluoridation denialist show up. With all the attributes!

Just one point: calling drinking-water fluoridation "medication" gives Dan away as the political hack he is. Of course he knows, but will deny knowing, that the beneficial effect of fluoride was found in areas where it is a natural part of the water. No Virginia, drinking water != pure H2O. Demineralized water is actually bad for you.

He also misrepresents the existing research, which has come a long way since the initial "ecological" studies that started it all. Start here

a_ray_in_dilbert_space said...

Dan Germouse,
Scientific consensus is also all about evidence. If you haven't understood that, you haven't understood science.

Anonymous said...

Martin, providing the link to that paper was redundant, because I had already read it. Thanks for proving my point, anyway. The study is actually partially ecologic, because fluoride exposure is assigned at the group level, not the individual level. It also wasn't blinded, and even then they only found piddling 11% and 10% differences in DMFT. There is no mention of minerals in water which may affect rates of cavities, such as calcium, phosphorus, magnesium, and molybdenum, or of diet in general, and there are missing data. The study was based on data from the 2004-2006 Australian National Survey of Adult Oral Health, which is clearly biased because it ignores dental fluorosis. It also lists Colgate Oral Care as one of its funding sources.

Fluoride is added to water for the stated purpose of preventing dental cavities, so by definition it's medication. What part of that don't you understand? When you write "the beneficial effect of fluoride was found in areas where it is a natural part of the water" you are referring to more poor quality research. I think you'll find that it's the overall dietary intake of essential nutrients which matters, not their presence in water. Moderate levels of calcium, magnesium, and so on in water may benefit the health of a population, but it doesn't follow that demineralised water is bad for every individual. Anyhow, fluoride is not an essential nutrient, and usually contributes little to the total dissolved solids in drinking water. If it does make a substantial contribution to TDS, it's generally a major problem.

a_ray_in_dilbert_space, you don't seem to grasp the difference between an ideal world and reality. No doubt there are many instances in which scientific consensus and the evidence are in accord, but arguing that something is true because of a scientific consensus is nonetheless an appeal to authority, which makes it more of a political than scientific stance.

Dan Germouse

Martin Vermeer said...

Dan, the link was to several papers, all about the effect of water fluoridation in adults -- and there's more where these came from. Actually this studies a second-order effect; originally it was believed that fluoride only affected growing youngsters.

What you're missing is that studies consistently find positive effects for water fluoridation. Good luck finding a confounder explaining that.

While it is difficult to provide fluoridation / non-fluoridation as part of a controlled experiment through the communal water supplies, such controlled studies have been done (again, more than a few) using fluoride tooth paste and pasta applications, and the effect is clear. Anybody (but not you, apparently) can connect the dots.

...and of course it's not medication. Neither are vitamins in food, but scurvy and rachitis are definitely medical conditions.

Otherwise I'll just ignore your Gish Gallop. Surely you're not claiming that all fluoride research is poor, and all researchers in the field incompetent if not corrupt? Where did I hear that before?

Anonymous said...

From medication - a drug or other form of medicine that is used to treat or prevent disease
medicine - a drug or other preparation for the treatment or prevention of disease
drug - a medicine or other substance which has a physiological effect when ingested or otherwise introduced into the body
"Among other cosmetic/drug combinations are toothpastes that contain fluoride"
"Due to the toxicity associated with fluoride active ingredients, the following package size limitations are required for anticaries drug products"

Fluoride administered for the stated purpose of preventing dental cavities may not be a medication in your own private, make-believe language, Martin, but in the English language it clearly is a medication. I had a look at the second, third, and fourth papers on your list, and surprise, surprise, they aren't of high quality either. There are two more partially ecologic studies which aren't blinded and don't account properly for confounding factors. The 2007 meta-analysis titled "The Effectiveness of Fluoride in Preventing Caries in Adults" conflates water fluoridation with self- and professionally applied fluoride. The first sentence of the abstract is "To date, no systematic reviews have found fluoride to be effective in preventing dental caries in adults." So much for the consistency of positive findings you claim. Saying "Good luck finding a confounder explaining that" shows yet again that you just don't get it. There is no need to find a single confounding variable to explain the results, because different combinations of multiple confounders are very likely to be involved. For studies on children, the delay in tooth eruption caused by fluoride ingestion, which means that the teeth have had more time to develop caries at a given age, could be a significant factor. There is also the lack of blinding, with the potential to affect both dental examinations and dental health awareness in fluoridated communities.

Dan Germouse

Anonymous said...

The studies I've seen on fluoride toothpaste and varnish haven't been particularly impressive, though more so than for fluoridated water, which isn't saying much. I have already said that fluoridated toothpaste has fluoride concentrations three orders of magnitude greater than fluoridated water, and a completely different mode of delivery, and shouldn't be conflated with water fluoridation. That you have resorted to doing so shows the weakness of your argument. With fluoride varnish you can add another order of magnitude. In some situations some extrapolation is justifiable, but in this case it's ridiculous. Any idiot can blindly extrapolate, but it's the person who sees the problem with doing so who is more intelligent. Do you drink your sunscreen too? What are "pasta applications"? Is that some kind of flouridation?

The best research on water fluoridation doesn't support the practice, it calls it into question. An example is the Iowa study. Instead of pretending that everyone of the same age living in a fluoridated area ingests the same amount of fluoride, as fluoridationist studies routinely do, the Iowa study has attempted to measure actual fluoride ingestion. The finding of extreme variability in individual fluoride intakes, and no given intake which is protective for both dental fluorosis and caries debunks the whole idea of an "optimal" fluoride concentration in water. It should be kept in mind that even though not all dental fluorosis is serious, it is a permanent and toxic effect. Once the permanent teeth have erupted, there is no further risk of dental fluorosis, but fluoride continues to accumulate in bone, and can cause skeletal fluorosis. As the fluoride concentration in bone increases, so does that in the blood and soft tissues.

Considerations on optimal fluoride intake using dental fluorosis and dental caries outcomes - a longitudinal study
Warren JJ et al 2009
"The 'optimal' intake of fluoride has been widely accepted for decades as between 0.05 and 0.07 mg fluoride per kilogram of body weight (mg F/kg bw) but is based on limited scientific evidence."
"Data on fluoride ingestion were obtained from parents of 602 Iowa Fluoride Study children through periodic questionnaires at the ages of 6 weeks; 3, 6, 9, 12, 20, 24, 28, 32, and 36 months; and then at 6-month intervals thereafter."
"CONCLUSIONS: Given the overlap among caries/fluorosis groups in mean fluoride intake and extreme variability in individual fluoride intakes, firmly recommending an 'optimal' fluoride intake is problematic."
"it is doubtful that parents or clinicians could adequately track children's fluoride intake and compare it with the recommended level, rendering the concept of an "optimal" or target intake relatively moot"
"These findings suggest that achieving a caries-free status may have relatively little to do with fluoride intake, while fluorosis is clearly more dependent on fluoride intake."

Every fluoridationist is either incompetent or dishonest, or both. Many researchers in the field are not fluoridationists, and there is much research which calls fluoridation into question. You imply otherwise because, being a fluoridationist, you are either incompetent or dishonest, or both. Climate scientists would be crucified by the media if they behaved the way the professional fluoridationists do.

Dan Germouse

Martin Vermeer said...

> Every fluoridationist is either incompetent or dishonest, or both. Many researchers in the field are not fluoridationists, and there is much research which calls fluoridation into question. You imply otherwise because, being a fluoridationist, you are either incompetent or dishonest, or both.

I rest my case.

Martin Vermeer said...

For non-conspirational bunnies wondering how to get an overview of the state of a field of research, no, it is not done by reading blogs, or even individual journal papers. Fundamentally it is about the hierarchy of evidence. It has served me well, and not only for climatology.

The evidence pyramid.

Note the top of the pyramid: "systematic reviews and meta-analyses". For climatology, that's the IPCC reports, or those of the US NAS.

Parnell Water Fluoridation
A Systematic Review of the Efficacy and Safety of Fluoridation Part A
A Systematic Review of the Efficacy and Safety of Fluoridation Part B.

Anonymous said...

Sorry, your little "evidence pyramid" is a joke. It's obviously designed for people who don't know how to think for themselves. For a start, it compares apples with oranges. Systematic reviews and meta-analyses can be very useful, but they are fundamentally different to original research, upon which they are completely dependent. Ranking "Ideas, Editorials, Opinions" against original research is also very silly. Even the ranking of different categories of original research doesn't make much sense, because there is so much variation in the quality of research within categories. It is also often important to consider different lines of evidence. One of the few things which can be said with certainty is that randomised controlled double-blind studies have the best potential for giving meaningful results.

The Parnell paper isn't actually a systematic review or meta-analysis, it's a brief review of three systematic reviews. One of those is the 2007 NHMRC review, which is laughable, another doesn't consider adverse health effects, and the third is the 2000 UK York review. Fluoridationists lied about the 2000 UK York review, as they do about everything relating to fluoridation, so a statement was made to set the record straight, which appears on the York University website.
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).
"The review specifically looked at the effects on dental caries/decay, social inequalities and any harmful effects."
"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."
"The evidence about reducing inequalities in dental health was of poor quality, contradictory and unreliable."
"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."

It's interesting that you mention the US NAS in relation to climatology, but not fluoridation, even though the 2006 National Academy of Sciences report on fluoride in drinking water is the most comprehensive review of fluoride toxicity yet conducted. The toxic waste pushers avoid it like the plague, and pretend that it doesn't have any relevance to fluoridation, even though anyone who bothers to read it can see that it is very relevant to fluoridation.

Dan Germouse

Rattus Norvegicus said...

Danny boy, the NAS was specifically looking at the EPA standards for contamination of 4mg/L and a secondary standard of 2mg/L and they point that out repeatedly in the review.

Even so, they found very few ill effects, although I suppose you could get worked up about it if you wanted to.

Martin Vermeer said...

Rattus, yes. The report also requires registration, which is useful in making 'anyone who bothers to read it' a small set ;-)

Rattus Norvegicus said...

Martin, all you have to do is give them your email and answer a question about what you want to use the report for.

The NAS is not google :-).

Martin Vermeer said...

Yes Rattus, I am one of their regulars. That's how I came to agree with you ;-)

Rattus Norvegicus said...

Yeah, I came to read it during a fluoridation controversy in my town. As you said: the NAS is the goto source for an introduction to any subject it has issued a report on, despite what Dan says.

Anonymous said...

A certain commenter does not appreciate that the EPA max (4 ppm) vs the recommended (1 ppm) level are different, or that many other "chemicals" have both therapeutic and toxic levels. Nor how to find and comprehend experts.

Rib Smokin' Bunny

Ed Darrell said...

"Yeah, but will global warming prevent the measles epidemic caused by fluoride misapplications?

"And, how do they get all that fluoride into the jet engines that make the chemtrails?

"Bigfoot used to be bald, before chemtrails, you know.

"Geeze, this is good stuff. Another hit?

"The Statue of Liberty is made from the original Liberty Bell, did you know that? Only the French could understand -- Belle Liberte, Liberty Belle . . . well you get the drift.

"Monckton knows because he was at that private dinner between Rachel Carson and John Kennedy. And Anthony Watts was their limo driver for the night."

Anonymous said...

Rattus, I am well aware of the brief which was given for the NAS report, but the fact is that it did consider fluoride concentrations in drinking water of 1 ppm and even lower. If you don't know that, you either haven't read it, have very poor reading comprehension, or have forgotten what you read. You are also overlooking the fact that, apart from gastrointestinal effects, it's the total dose of fluoride which matters, not concentration. As the exposure analysis in the report showed, individual fluoride exposure for people consuming water with the same fluoride concentration is highly variable. The report also identified subpopulations at higher than average risk of fluoride toxicity, and recommended research on those groups, which has still not been done to my knowledge. When you say "they found very few ill effects" you mean "they found very few proven ill effects". They found evidence of numerous ill effects, but the research had limitations. The evidence for ill effects was not trumped by better quality research indicating no ill effect. The responsibility for the lack of quality research regarding safety lies squarely with the governments of fluoridating countries. Considering that I am fluoride sensitive and have skeletal fluorosis, I think I'm entitled to have a strong opinion. If you have actually read the NAS report, as you claim, I can only assume you are a complacent dullard who doesn't understand the concept of risk, or of margin of safety.

Dan Germouse