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(05/01/16) A summary of 'Cochrane Collaboration systematic review of water fluoridation 2015' has been posted in Reports.
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(16/04/14) A critique of 'One in a Million: The Facts' has been posted in Reports.
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(16/04/14) 'Fluoridation: Popularity' has been posted in the Archive.
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(18/04/10) New fluoridation scheme for Southampton

(18/04/10) The Reports and Archive sections have been updated with further documents and links

(11/07/09) A critique of Prof. Newton's report to South Central SHA has been posted in Reports.
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(28/09/08) A critique of the South Central Strategic Health Authority Consultation Paper on Water Fluoridation in Southampton, has been posted in Reports.
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(07/09/08) A response to the Chief Dental Officer's 'Dear Colleague' letter of guidance for new schemes, endorsed by scientists from the York review, has been posted in Reports.
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(23/06/08) Isle of Man has announced on 12th June that it will not be fluoridating its water supply
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Edward Baldwin's letter to Dr. Beal

11th January 2003

Dear Dr. Beal,

As a member of the All-Party Group Against Fluoridation I have been shown your letter of 5th December to Bill Etherington MP. Wearing the hat of an advisory group member to the York systematic scientific review, I am shaken by the many errors of scientific fact in it and am impelled to write to you directly. I will take them in the order in which they appear, giving references so that you may read what York actually reported.

1. It was not just a matter of more refined modern methodological standards. The York reviewers were surprised by the poor quality of recent studies as well (York, Executive Summary, Objective 1; 4.9), when good methodology was "commonplace".

2. York did not "find" the benefit you state in your 2nd paragraph. This implies a certainty that was noticeably absent. Scientists and others who should know better have been using terms like "found", "demonstrated" and "confirmed", but this is their gloss on the actual words of the York report which told of "moderate quality", "limited quantity" (12.1), and said "To have clear confidence in the ability to answer the question [on caries reduction], the quality of the evidence would need to be higher" (4.9). York found fluoridation to be probably effective on the evidence so far, but because this evidence was of indifferent quality this could prove wrong, as it has recently proved wrong with HRT and ß-carotene in similar circumstances. The point is fundamental.

3. This does indeed make it "of interest" that the MRC has joined other bodies in convincing itself that York "confirmed" fluoridation's effectiveness, as I have set out in recent letters to the Chairman and Chief Executive of the Council and to the Chief Medical Officer. With the support and approval of the two leading figures on the York review I have circulated a critique of the MRC working group's report which analyses many other features of interest. One would not have expected the MRC exercise to match that of York, as it was neither systematic not transparent, nor did it have a balanced membership in its orientation to the subject-matter, nor work with the same thoroughness. But the lack of simple rigour in some areas was a surprise, and the misrepresentation of York's findings on effectiveness was very hard to explain.

It is significant that the four senior independent scientists from the York review issued the enclosed letter soon afterwards. May I ask you to read it with care, together with the earlier open letter from Professor Sheldon, because if anyone knows what the report that they were responsible for actually said, they do. Prof. Kleijnen was the senior researcher; Prof. Sheldon chaired the whole exercise.

If you also read carefully my critique of the MRC (enclosed), which was endorsed by Professors Kleijnen and Sheldon, you will find some helpful background to what follows.

4. Reducing inequalities in dental health: York scientists call the evidence for reduction "weak, contradictory and unreliable"; you write of its "Confirmation" !

5. On dental fluorosis you say the MRC "points out" that York included studies from hotter climates which will have distorted the picture. York points out, in the shape of the enclosed letter from Prof. Kleijnen, that this was controlled for in their analysis (as explained in York 7; 7.1.2). He could have added that he also dealt with this specific point in a letter to the BMJ on 16 June 2001 (BMJ 2001; 322:1487). Does no one do their homework over fluoridation, or read the original sources?

6. What is this "most recent evidence" that suggests that fluorosis is much less prevalent than York suggested? With one possible exception, a secondary source, I can see nothing in the MRC report that was not known to York. Please see my critique, and elsewhere in Prof. Kleijnen's 23rd October letter, for consideration of why York's assessments are likely to be more reliable than the MRC's.

7. The argument from long use, which you adduce in your 5th paragraph, is not reputable in scientific circles, as you surely know. Smoking was practised for far more than 50 years, but it took high-quality research among populations (with wide varieties of ailments) before its particular causal effects were pinpointed. These things do not just jump out at you. Nor is naturally fluoridated water relevant here, given that it may have a less harmful effect and the MRC has recommended research into this.

Because of the paucity of the available data, and York's warning that "Some possible adverse effects..may take many years to develop and so..the relationship may go undetected" (1.) it is not legitimate to infer, as you do, that there are no significant risks to fluoridation. Point 3. from each of the enclosed letters describes accurately what York found, and why it recommended that "High quality research [into adverse effects] needed" (12.9.2). The MRC has not picked this up in a serious way.

York might have found a pattern, a trend of no effect; even this, in view of the low quality of the evidence, would hardly have given the reassurance needed for safety in a public health measure. But it did not: it found "no clear pattern", because the studies (such as they were) suggested a mixture of harm and no harm. It needs a singular devotion to the cause of fluoridation to read safety into this. The work is still to be done.

8. The MRC's recommendations are indeed helpful in many areas. But from what I have written here and the York scientists have written more publicly, you will understand that something more is needed if the research priorities are to reflect the actual as distinct from the supposed state of the evidence over the three most important health questions that York addressed. I enclose a shortened critique which looks at some of the research issues (C.1-3). Since both the Chief Medical Officer and the Minister for Health in the Lords have given me assurances that the MRC report will not be used to detract from the York findings, I trust that good science and good sense will soon prevail.

I offer two general thoughts that it should not fall to a non-scientist to provide. Many commentators are misleading themselves and, worse, the public, by their inability to distinguish good evidence from bad, with its consequences for certainty and uncertainty about fluoridation. York (alone) was meticulous about this, and it is all there to be read. I have gained a strong impression that few who pronounce on these questions have truly taken in what the York reviewers said. And following on from this, if you believe in good science in this case it is not now legitimate to cite "other expert panels" as you do, since they have been superseded by the higher-quality work on primary sources done by York - unless, that is, you can make a convincing case why, say, Knox or Acheson should be preferred on a particular issue. Prof. Kleijnen's 2nd paragraph makes this point from his more expert perspective.

I may circulate this letter to some of my colleagues from York and others.

Yours sincerely,


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