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latest information

(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
Read more.

South Central SHA consultation on water fluoridation

30th May 2009

Dear Mr. Easton,

I am writing in response to your letter of 26th April to Anna McNair Scott to which you kindly copied me in. My concern is about your sentence "I strongly disagree with your comments on the bias of the consultation document." I have been studying responses to the scientific evidence since the 'York' review in 2000; a number of critiques I have authored have been specifically endorsed by senior scientists from the review such as Sir Iain Chalmers and Prof. Trevor Sheldon, in particular that concerning the Chief Dental Officer's guidance letter to SHAs and PCTs of February 2008; I can therefore represent a well-informed view of the arguments deployed.

Please find enclosed a copy of my critique of the SHA's consultation paper, which has been in the public domain for six months (www.appgaf.org.uk). (I apologise for the poor quality of the photocopy which I have only just noticed.) I should be most grateful if you would have another look at it. For ease of reference I have highlighted the most obvious weaknesses in the SHA's document, which I summarise in 4.1 as involving "inappropriate citations, exaggerations, omissions, selective quotation, carelessness with references, [and] other inaccuracies". These are serious in themselves; what makes them worse is that without exception they err in one direction, in favour of fluoridation. The conclusion of bias is inescapable. From the enclosed copy letter by Prof. Sheldon you will note that this began many years ago in respect of the august bodies you cite in your final paragraph. Eminence-based medicine is not always a sound guide, especially where, to use Professor Newton's term, a "professional orthodoxy" is involved, and a campaign (see my 2.3.26).

The most obvious errors are these, with references to my paragraphing.

2.3.9 & 19 York was careful "not to convey a message of no evidence of harm" (Prof. Kleijnen, BMJ, 16 June 2001). SHA however says York "found no evidence . . [of] harmful effects". Department of Health confirmed in a parliamentary answer on 20th May 2009 that "no evidence of harm" (for cancer) was incorrect.

2.3.10 York was "critical of the quality and quantity of the research available", and stressed the uncertainties. Yet in the same paragraph SHA says York "confirmed" specific figures for caries reduction.

2.3.12 York found only one acceptable study on adult teeth in the world literature. Nothing significant has appeared since then. SHA claims without qualification that "Adults . . will also benefit".

2.3.14 York estimated 12.5% of children with unsightly fluorosis. SHA omits York's estimate, citing only lesser reviews giving lower figures more favourable to fluoridation. Yet SHA in 4.4 emphasises the importance of "good quality reviews".

2.3.16 York found no clear association with bone fractures and cancer, the weakish studies pointing both ways. SHA selects two low-quality studies to give reassurance on safety. Yet SHA in 4.4 says "Selective quotation of individual results can be very misleading."

2.3.18 SHA selects two examples to give reassurance on osteosarcoma and bladder cancer. One of the cited studies has not been published; the other citation produced a correction from the first author, who commented "I believe that the information [the SHA] provide to the public should be correct."

2.3.20 SHA makes no mention of the recent major US review of possible harms from fluoride in water, and the caution about bottle-feeding with fluoridated water from the American Dental Association that followed it. SHA claims to set out "all the facts about fluoridation".

2.3.25 SHA cites the support for fluoridation round the world. It does not mention first-world countries that have stopped fluoridating or have never fluoridated: a clear majority. SHA claims to set out "all the facts".

2.3.28 SHA omits environmental issues, having said it would address them.

2.4.2 SHA exaggerates the numbers of teeth saved, with consequences for costings, misquoting an "independent study".

Other particular and a few general criticisms are detailed in my paper, and I would earnestly ask that you re-read it in full. One basic criticism is that the consultation exercise is predicated on the recent caries figures for 5-year-olds. 12-year-olds provide the usual bench-mark for dental health because of their permanent dentition, but their statistics were not provided. Because of their low levels of caries, they would not have helped the argument for fluoridation.

Not only the selection of evidence, but also the language is not neutral. 1 part per million as the "optimal" concentration, and "adjusting" the level of fluoride in water, are two common examples of fluoridespeak that are rarely found outside pro-fluoridation literature. 1 ppm has not been validated, and the recent Iowa study has cast further doubt on it; and "adjusting" gives a false picture when in Southampton's case the fluoride level is raised 12-fold.

It is always hard for a professional orthodoxy to recognise its own biases. Most professions have them. It cannot be easy to take a balanced view when there is clear pressure from Government to fluoridate, for example in CDO's letter mentioned above. Please believe me when I say that I have not been intentionally selective in my critique of the SHA's consultation paper: to be exact, I have not knowingly omitted any instance where the SHA understated the case for fluoridation. If you can point to such a case I will correct what I have written. Nor do I claim that anti-fluoridators are without bias.

I shall attempt to copy this letter to all the recipients of your own letter, and/or will post it on the website quoted above.

Chief Executive, South Central SHA
Rivergate House, Newbury Business Park
Newbury, Berks. RG14 2PZ.

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