Errors and
Omissions in Experimental Trials - 2c
CHAPTER 20
Further
criticisms and comments.
In
the second edition of the monograph Fluoridation. Errors and Omissions in
Experimental Trials it was stated that copies of the first edition were
sent by the Federal President of the Australian Dental Association to all
the men in charge of the trials which had been considered.
As
has been mentioned, criticisms by the authors of the Evanston and the
Brantford (Canadian Department of National Health and Welfare) studies,
were published as "book reviews" in the February, 1960, issue
of the Australian Dental Journal.
After
the second edition was "in press", the June 1960 issue of
Nutrition Reviews was received, containing (Vol. 18, pp. 161-165) a paper
by Dr J.M. Dunning entitled "Biased criticism of fluoridation. This
paper quoted some passages from "... letters to Dr Kenneth Adamson,
President of the Australian Dental Association" from the senior
author of the Grand Rapids trial, Dr F.A. Arnold Jr., and from the senior
author of the Newburgh trial, Dr D.B. Ast, and some criticisms by Dr J.R.
Blayney of the Evanston trial, which had not been published in the
above-mentioned "book reviews" in the Australian Dental
Journal.
The
following pages contain all the passages from those letters which were
published by Dr Dunning. In view of the title he gave to his paper, it is
considered likely that he cited from those letters the quotations which
he considered to be the most important criticisms advanced by the authors
of those fluoridation trials.
These
comments were prepared in 1960 and had a very limited circulation in
roneoed form. They have not been otherwise published until now because of
the refusal of many editors to accept comments which question
fluoridation.
Dr F.A. ARNOLD JR
Dr
Dunning said that: "Dr F.A. Arnold, Jr., Director of the National
Institute of Dental Research and principal investigator at Grand Rapids,
writes in part as follows (Arnold to Adamson. October 16. 1959)".
The
quotation from Dr Arnold's letter which will be considered first is the
following accusation (as reported by Dr Dunning):
(84)
"Although he [the author of the monograph] did not publish his
material until 1959, he (apparently intentionally) overlooked the report
of the tenth year of the study which appeared in 1956. As was originally
planned, it was this year that we obtained "complete" age
groups of adequate size."
Comment.
It is difficult to believe that Dr Arnold could have made this
extraordinary accusation for, if the monograph is consulted, it can be
seen that "...the report of the tenth year of the study which
appeared in 1956" the paper by Arnold et al. (1956) - was (a) listed under Dr Arnold's own name in
the references, (b) shown, again under his name, in the Index, which
indicates that this paper was mentioned on four pages, and (c) was given
as the source of the data from which Figures 1 and 2 were compiled (pages
147 and 148). These two figures depict the caries rates reported for each
age group in each year in the city of Muskegon up to the time when, as a
result of its water supply having been fluoridated, it ceased to be the
"fluoride-free" control city for Grand Rapids. (See explanatory
notes to Figures 1 and 2, pp. 147 and 148).
If
Dr Arnold is correctly quoted by Dr Dunning, it would appear that, before
criticizing it, he read the monograph only superficially, even that part
of it which relates to his own study. Furthermore, it is clear that,
before making the accusation that "apparently intentionally"
this 1956 report from the Grand Rapids study had been "overlooked",
he failed to check both the list of references and the Index.
If
this is not the case, one is forced to conclude that Dr Arnold made this
accusation deliberately, knowing that it was untrue, with the intention
of misleading the President of the Australian Dental Association.
That
author was also reported to have written (85-91):
(85)
"He [Sutton] overlooks the fact that one examiner has been with the
study throughout."
Comment.
This fact was not "overlooked". This can be seen by referring
to the monograph, the top of page 144 where Arnold et al. were quoted as saying that: "There have been
changes in the dental examiners with the exception of one officer who has
participated in each series of examinations. Each new examiner has been
calibrated against this one officer to standardize diagnostic
criteria" (Arnold et al.,
1953).
(86)
"If we used his findings, we would come up with the same general
result."
Comment.
As it is unlikely that the findings of this examiner were not used in
this study, it is concluded that Dr Arnold is referring to the situation
which would have arisen if the data from this study had been confined to
those obtained by that one examiner. However, no comment can be made in
this matter as in the published data the findings of the examiners were
combined.
(87)
"Also, we could call attention to the fact that two more of the four
examiners used throughout the first ten years of the study started
examining during the third year of the study and have participated each
year since. "
Comment.
Dr Arnold refers to "the four examiners used throughout the first
ten years of the study". However, in a note published on the first
page of his report of the tenth year of the study (Arnold et al., 1956), he stated that:
"The following dental officers of the Public Health Service conduct
the annual dental examinations", and named five examiners: Doctors
Likins, Russell, Scott, Singleton and Stephan. In addition, he mentioned
the names of four other dentists who "also participated as
examiners" in the study: Drs Loe, McCauley, Ruzicka and Short. In
his 1953 report also (Arnold et al.,
1953) he had acknowledged the participation of the same nine examiners
not four as Dr Arnold stated in his misleading letter to the President of
the Australian Dental Association.
(88)
"He criticizes our selecting samples by school grade. If he would
realize it, and probably he does, this strengthens the study."
Comment.
It is evident that Dr Arnold has changed his views on this matter. When,
in 1953, he described the method used (Arnold et al., 1953), he acknowledged that "choosing examinees
by grade in this manner will, in some instances, not give
well-distributed specific age groupings." But now he says that
"... selecting samples by school grade ... strengthens the study."
(89)
"In the first place this gives us a random sample."
Comment.
In order to be satisfied that the children examined constitute a random
sample of those in the city, it is necessary to know if the children were
a random sample of those in their school and, also, that the schools in
which the examinations were made were a random sample of those in each
city. The method of sampling, as described by Arnold et al. (1953), was stated on page 153. The meagre description
that "on the basis of available information" (which was not
disclosed) " 25 representative schools were selected" - no
description of the method of selection being given - does not permit the
reader even to attempt to determine whether or not the schools selected
constituted a random sample of those in the city. In the next report
(Arnold et al., 1956) it was
not stated how many schools were selected, merely that "The annual
samples of the school population of Grand Rapids and Muskegon are taken
from schools selected as representative of each city as a whole."
(See comment 91 below for an independent report on the sampling methods
used in this study.)
(90)
"Also, it permitted us to examine all the children of a grade
without the examiners knowing whether the child belonged to the
"continuous resident" group or not."
Comment.
This fact was mentioned by Arnold et
al. in 1953. However, it is of little consequence, for no comparisons
were published between the caries rates in the "continuous
resident" group and the other children in Grand Rapids. This
statement by Arnold indicates that he realized the need for
"blind" examinations. However, he made no attempt to
incorporate this vital point in experimental design when he arranged for
the examination of the Grand Rapids children and their comparison with
those of the control city of Muskegon. The desirable aim of eliminating
unintentional bias on the part of the examiners would have been achieved
if the children in the test and the control cities had been examined on
the same occasions "without the examiners knowing whether the child
belonged to the "continuous resident" group in Grand Rapids or
the "continuous resident" group in the control city of
Muskegon. Unfortunately this was not done.
(91)
"The planning of the study and the analysis of the data were done by
a group of people all of whom are more knowledgeable in this field of
research than is Dr Sutton."
Comment.
No comment will be made on this remark (except to say that Dr Arnold has
never met me) but it is pertinent to quote another opinion. T.M.
DeStefano (Bull. Hudson County Dent. Soc, 23: 20-31, Feb. 1954) quotes
from the critique of the report of the "seventh Year of Grand
Rapids-Muskegon Study" (Arnold et
al., 1953) that "... had been sought and paid for by a group of
general practitioners from a reliable statistical firm" (the
Standard Audit and Measurement Services, Inc., 89 Broad St., New York 4,
N.Y ). DeStefano quotes this critique as stating:
"The
authors appear to have demonstrated an unfortunate disdain for some of
the pre-requisites of valid research." Also that "In the first
place, the sampling design of the experiment is embarrassingly
conspicuous by its absence.
Such
a brief description as: "On the basis of available information the
31 school districts in Grand Rapids were classified on a socio-economic
basis. From the 79 schools in those districts, 25 representative schools
were selected and the examiners assigned ... etc." leads one to
suspect that the drawing of the sample was dangerously amateurish. This
suspicion makes one feel that either the results of fluoridation are so
dramatic as to force themselves through the veil of poorly selected
samples or "at the other extreme" that the reported results are
merely the fiction of a biased sample. From work other than that reported
by the authors, one tends to discard the latter possibility but the lack
of sophistication shown in selecting the sample leads to complete
bewilderment as to the precise effects or the extent of the effect of
fluoridation."
This
critique by the Standard Audit and Measurement Services continues:
"With
a pre-listed population (such as a school enrolment) there would appear
to be no excuse for not using modern sampling tools and procedures.
Employment of these devices would enable not only a more certain
statement of the effects of fluoridation but (perhaps more importantly) a
precise estimate of the error inherent in such statements."
DR D.B. AST
Dr
Dunning then said that "Dr David B. Ast, Director, Bureau of Dental
Health of the New York State Department of Health, makes the following
comments (Ast to Adamson, March 3, 1960)".
Dr
Ast is reported to have written (92-7):
(92)
"Sutton criticizes the comparability of data among the four studies
because in Newburgh and Kingston we used the rate based on DMF per 100
erupted permanent teeth instead of DMF per child."
Comment.
Contrary to this statement by Dr Ast, "the comparability of data
among the four studies" was not criticized. However, it was pointed
out that it is very difficult to compare the results shown in the five
reports from Dr Ast's Newburgh trial because of the different methods of
presentation of data that were adopted by Dr Ast and his co-workers. Nor
was criticism levelled at the use of "the rate based on DMF per 100 erupted
permanent teeth"
(93)
"We explained why we used the permanent tooth population as the
universe considered."
Comment.
The paper giving this explanation (Ast et al., 1956) was referred to on twelve pages of the
monograph.
(94)
"However, in order to make our data comparable to other study data,
in the reports for 1953-54 and 1954-55, the Newburgh-Kingston data were
given both ways - DMF per 100 teeth, and DMF per child."
Comment.
If the aim of Dr Ast and his co-workers was to make the data from their study
"comparable to other study data", it is unfortunate that they
did not examine the methods used in publishing the data obtained in other
studies and publish some tables in which the Newburgh-Kingston data were
presented in the form used in these other studies. Owing to this
omission, they prevented comparisons being made with the results
published in the other studies considered in the monograph by: (a) not
disclosing any caries rates for deciduous teeth except in their 1951
report, (b) confining the rate "DMF teeth per 100 children" in
1953-54 to those aged six, seven, eight, nine and ten years (Ast et
a1.,1956); (c) combining the 1954-55 caries data into four groups
children aged six to nine years, ten to twelve years, thirteen to
fourteen years, and sixteen years of age (Ast a a1.,1956). In the other
main studies, although the DMF rates were shown per child or per 100
children, either clinical examinations only were used, or the data were
reported for individual yearly ages or for age ranges which were
different from those used by Ast et
al. Thus, comparison of these rates with those published from the
Newburgh study cannot be made.
(95)
"What is significant and had escaped Sutton is the fact that the
percentage differences in Newburgh and Kingston were almost the same for
both methods used."
Comment.
Dr Ast, no doubt, did not mean to suggest that the results were almost
the same in the test and the control cities, but intended to refer to the
percentage differences (in caries rates) between Newburgh and Kingston.
It
is surprising that Dr Dunning should have published this remark of Dr
Ast, for a paper which he wrote almost ten years earlier (Dunning, 1950)
showed that he realized the inadequacy of results stated merely as
percentage reductions. In the summary of that paper he pointed out that
"Interpretative and other examining errors in DMF studies may be
large, easily exceeding 100 per cent differences between samples."
He said also that:
"Illustrations
of actual data indicate that the standard deviations of observations
about the means (averages) in DMF studies are large even where examining
errors are reduced to a minimum." Dr Dunning then said that:
"These two sources of variability imply that human DMF studies
should be subjected to close scrutiny as to the validity of the data and
statistical significance tests applied and reported wherever possible.
Mere statements that "caries was reduced by x per cent" are not
sufficient."
It
can be seen that it is precisely this method of presenting data, that Dr
Dunning criticized in 1950, which was used by Ast et al. to report the results from the Newburgh trial:
"Mere statements that "caries was reduced by x per cent"
(differences between the test and the control cities) without
"statistical significance tests applied and reported."
(96)
"Another criticism made is that baseline data were collected in
Kingston a year after the Newburgh survey. I can't believe Sutton really
believes this to be valid criticism. He must be, or should be aware of
the fact that caries is not an acute disease of short duration, but a
slowly developing one ..."[end of published quotation].
Comment.
Dr Ast is wrong in his assumption - it certainly is considered to be
valid criticism to point out that the initial examination was not made in
the control city until after the fluoridation of the test one. By writing
about the obvious fact "that caries is not an acute disease of short
duration, but a slowly developing one" Dr Ast avoids the significant
point: that he and his co-workers assumed that the caries rates in the
children in the control city would be similar to those in the test one,
and that they omitted, prior to starting the experiment, to test this
vital matter.
(97)
"The baseline data in Newburgh and Kingston based on the examination
of all the school children age six to 12 in both cities were almost
identical. All of the examinations were made by the one examiner. Could
Sutton really believe that the DMF rate of 20.8 for Kingston, and the
21.0 for Newburgh could have been significantly different if both
examinations were made exactly at the same time?..." [end of
published quotation]. "... this type of criticism questions not the
research but the professional acumen of the critic."
Comment.
Dr Ast and his co-workers were fortunate that they were able to present
figures for caries rates which were comparable, although the fact should
not be forgotten that they improved the comparability between the initial
caries rates in the test and the control cities by combining the data
from children of different ages.
The
workers who conducted the Evanston study made the same assumption and
failed to examine the children in the control city until after the
fluoridation of the test one (Blayney and Tucker, 1948; p. 153). They
were not as fortunate as were Ast et
al., for they found "...a lower caries rate for school children
of the control area" (Hill et
al., 1951). In the younger children, there were gross differences
between the initial caries attack rates in Evanston and its control city.
The same omission was made in the trial in Hastings, New Zealand. As a
result, the control was abandoned, for its caries rates were lower than
in Hastings (Ludwig, 1958).
DR J. R. BLAYNEY
Dr
Dunning then said that "J.R. Blayney, Director of the Evanston
Dental Caries Study, comments thus (Blayney to Adamson, November
23,1959)". Dr Blayney is reported to have written (98-100):
(98)
"Dr Sutton ....states, "the arbitrary selection of the data
which is then termed "representative", instead of making the
ultimate findings to be considered valid and reliable, would render a
report based on this selective data unfit for serious
consideration."
Comment.
This "quotation" is inaccurate. Dr Blayney has omitted the
words "a section of and refers to "selective data" instead
of to "selected data" . The original paragraph was:
"However, the process which they described - the arbitrary selection
of a section of the data, which is then termed "representative"
- instead of making "the ultimate findings to be considered valid
and reliable", would render a report based on this selected data
unfit for serious consideration."
(99)
"We feel that this type of criticism is unworthy of the scientific
nature and dignity of the University of Melbourne and would tend to imply
that the rather reasonable separation of white and Negro, public and
parochial children, for the purpose of comparing like with like, is an
"arbitrary selection" making the "data unfit for serious
consideration" and that the entire report hinges only on this
pre-selected data. "
Comment.
This comment by Dr Blayney to the President of the Australian Dental
Association is misleading. The statement by Hill et al. (1950), which was quoted on pages 151 and 152 and to
which the comment made by the author of the monograph refers, made no
mention of the "separation of white and Negro, public and parochial
school children", but instead, stated the intention of including
"... only those groups of children which are representative of the
population, with respect to dental caries experience",
Hill
and Blayney originally did not intend to separate the children into
racial and school groups. It was not until their 1951 report that mention
was made that they contemplated such an action, that is, not until a year
after they published the statement mentioned above. They decided to
separate the
Evanston data into racial and school groups when they found that the
initial examinations "... indicated a lower caries rate for school
children of the control area" (Hill et al., 1951). They have not explained why it was necessary
to exclude from the main body of white children those who happened to
attend the parochial school, rather than the public one.
As
they consider that Negroes have less dental caries than white children it
is, of course, reasonable to consider the data of white children
separately from those of Negro children. However, Hill et al., first included the data of
Negro and parochial school children (with those of the white children
attending public schools), then excluded these (Negro and parochial
school) data for several years, and then, despite their statement that
such a process was necessary, reversed their policy and included these
data with those of the white children attending public schools. By this
reversal of policy they were able to present initial caries rates for the
test city which were more comparable to those in the control city than
would have been the case if they had not disregarded their
previously-stated policy of comparing
"like with like". This cannot be considered to be a reasonable
course of action.
(100)
"We have gathered no secret or concealed data" ...[end of
published quotation].
Comment. This
assertion by Dr Blayney should be considered in the light of the numerous
instances, in his study, in which relevant data were not published, in
some cases even for as long as twelve years after they were obtained.
The
failure of Dr Blayney and his co-workers to publish these relevant data
has, without question, concealed them from readers of their reports.
Dr
Dunning quoted two further paragraphs from Dr Blayney's letter. These
were printed in the "Book Review" published in the Australian
Dental Journal in the February, 1960, issue.
DR J.M.
DUNNING
The
criticisms made by Dr Dunning himself will not be considered, for his
attitude to the monograph and the lack of care in the preparation of his
critique are evident from even one example:
He
stated that "In discussing requirements for a control, Sutton adopts
the position that the control city should be "comparable in all respects"
to that where fluoride is being added." That phrase was not used by
the author of the monograph, but was quoted by him from two sources (pp.
141, 178, 179,190). His, considerably different, views on this matter
were stated on pages 190 and 193.
Therefore,
by attributing to the author an opinion which he did not express, and
that he actually criticized (p. 190), and by omitting the different
opinion that the author did express, Dr Dunning misleads his readers.
Furthermore,
the fact that Dr Dunning has elected to publish these extracts from
letters written by authors of fluoridation trials, indicates either that
he has chosen to ignore or has failed to detect errors in them which
should be obvious to a careful investigator.
In
1984, twenty-four years later, Dr Dunning was still criticizing papers
which questioned fluoridation. He continued his former technique of
misleading his readers by inventing false statements, attributing them to
the author of the article he was criticizing, then disputing his own
false statements. He stated that Colquhoun (1984):
"...
mentions an increase in periodontal disease as if it might have been
caused by fluoridation."
In
fact, Colquhoun (1984) stated that: "... water fluoridation does not
affect" periodontal disease.
Dr
Dunning also wrote that:
"Colquhoun
continues to quote Sutton on the subject of defects in early studies of
fluoridation, stating that he (Colquhoun) has seen no convincing
refutation of this. I offer him my article, "Biased Criticism of
Fluoridation" in which I quote the views of several of the leading
fluoride researchers of the day. The studies Sutton criticizes most
harshly have survived as pioneer efforts and been confirmed not only for
their conclusions but for their methodology."
This
was the paper in Nutrition Reviews, mentioned above, which has remained
unchallenged in print until now, years after it was written, because of
the difficulty in having accepted for publication any material which
questions fluoridation.
It
is interesting that Dr Dunning (1984), after so many years, can call the
authors of the original studies:
"...
the leading fluoride researchers of the day".
and
say that their methodology had been accepted, when he himself (Dunning,
1950) condemned the method they used of expressing caries changes as
percentages without the use of statistical tests.
That
Dr Dunning now accepts their methods, such as that used in the Evanston
study which led to the authors admitting that they had made gross errors
in stating the number of children seen during one examination, one of
which was a discrepancy of more than 1000 children shows that he should
be included with those described by Professor John Polya (1964) as:
"...
unreliable witnesses before a jury either of scientists or of lay common
sense."
It
is clear that Dr Dunning's criticisms can be disregarded. He is one of
those critics whose intense pro-fluoridation opinions have made them
muddled thinkers, and he is one who intentionally manufactures incorrect
statements about those he criticizes to try to attack work which he
cannot find grounds to fault by legitimate means.
ADDITIONAL
OBSERVATIONS ON THE EVANSTON, GRAND RAPIDS AND NEWBURGH TRIALS
1. Gross
numerical errors in statements of the number of children examined.
The Evanston
Trial
These
comments on the Evanston trial were published in 1980 in the present
author's book Fluoridation Scientific Criticisms and Fluoride Dangers. It
was stated:
"Additional
Errors in the Evanston Trial Data.
In
January, 1967, which was the twentieth anniversary of the commencement of
the Evanston Trial, an entire special issue of the Journal of the
American Dental Association was devoted to a report on that study
(Blayney and Hill, 1967). In this, the original tables, complete with
their gross numerical errors, were reproduced, despite the fact that
these [errors] had been pointed out eight years earlier (Sutton, 1959)
and some of them had been acknowledged by the authors (Sutton, 1960). In
addition, several faulty tables were published for the first time.
The
tables [in this issue of the J. Amer. Dent. Ass.] then showed three
different statements regarding the number of children aged 6-8 years who
were examined in Evanston during the 1946 examination:
(i)
1991 children - see Tables 10, 11,30,40 and 47.
(ii) 1985 children - see Tables 7,8,16,18,21 and 32.
(iii) 1754 children - see Tables 24 and 25.
There
were also no fewer than six different statements in that article of the
number of children aged 12-14 years examined in Evanston in 1946:
(i) 1703 children - see Tables 15
and 32.
(ii) 1702 children - see Table 47.
(iii) 1701 children - see Tables 11,30,41,44 and 45.
(iv) 1697 children - see Tables 7,9,12,13,17,19,22 and 31.
(v) 1556 children - see Table 26.
(vi) 1146 children - see Table 46.
Between
the sum of the two highest statements of the number of children examined
in Evanston in 1946, and the sum of the two lowest statements of children
examined in the same year in the same study in the same city, there is a
difference of 794 children (1991 + 1703 - 1754 - 1146 = 794).
The
number of children stated to have been examined in Evanston is even more
divergent in the original papers than in this special article. Blayney
and Tucker (1948) and Hill et al.
(1950) both gave a figure of 4375 children, compared with the number of
3310 in Hill et al. (1957b), a
difference of 1065 children.
It
was these differences which the medical journalist Anne-Lise Gotzsche, in
a letter to the Lancet in 1975, said that she had showed to workers in
other fields, and that they had "simply laughed" at the
statistics (see Fig. 5, p. 167).
In
that book (Sutton, 1980) - prepared as a submission to the Committee of
Inquiry into the Fluoridation of Victorian Water Supplies (1980) - it was
stated (p. 203):
"These
errors were mentioned [by the present author] 12 years ago to the
Tasmanian Royal Commission on Fluoridation. Since that time I have not
heard of any mention of them or of a criticism having been made of the
numerical data published in that report."
It
appears that, in the manner common in fluoridation trials, those
erroneous tables have been accepted at their face value, without
investigation.
More
than thirty years ago it was pointed out (Sutton and Amies, 1958b) that:
'This
uncritical attitude to these studies is rife." "Also it has
been assumed that associations and individuals that ... accepted the
responsibility of publicly advocating fluoridation, have undertaken
independent examinations of the data, and not merely repeated the
opinions of others."
This
situation was referred to by Professor John Polya (1964) in his book Are
We Safe? He wrote:
"It
is immaterial that other evidence in favour of fluoridation is not always
false; the point is that persons, bodies and arguments that knowingly or
in simplicity acquiesce in one blatant falsehood are unreliable witnesses
before a jury either of scientists or of lay common sense."
He
continued:
"The
scandal created by the exposure of this absurdity resulted in the
admission that the first figure (4,375) was correct. In defence of the
other claims it was explained that "out of range" children were
eventually excluded from the survey, but then further critical check
revealed more numerical inaccuracies, not to speak of the magnitude of a
correction exceeding 1,000. In better examples of scientific work the
author sticks to his experimental group; discarding on the scale quoted
strongly suggests that the experiment had to be altered to fit pre-conceived
results. This is one of the common consequences of working without
control of observer bias."
It
is pertinent to point out that, in the Foreword to that article in the
special edition of the Journal of the American Dental Association, in
January 1967, Dr F.A. Arnold, Jr., the Assistant Surgeon General, Chief
Dental Officer, U.S. Public Health Service (and formerly the chief
experimenter in the study in Grand Rapids) stated:
"Here,
in a single report, are data on the effect of water fluoridation on dental
caries so completely documented that the article is virtually a text book
for use in further research. It is an important scientific contribution
towards the betterment of the dental health of our nation. It is a
classic in this field."
It
is indeed a classic - a first-class example of the errors, omissions and
misstatements which abound in the reports of these fluoridation trials.
2. False information in the Abstracts of papers
The
abstracts of reports on fluoridation trials are unusually important, for
it is likely that lay people, and politicians in particular, will confine
their reading of the report to the Abstract, assuming that it accurately
reflects the findings, and will base their opinions and actions on its
statements.
The Grand
Rapids Trial. The final report of the
Grand Rapids study was published in 1962. Reading the Abstract which
preceded the body of the article it would seem that, at last, the authors
(Arnold et al., 1962) had come
to realize the necessity for comparing the results from the test city
with those from the control one for they stated that the results had been
"...compared with the caries attack rates in the control group of
children in Muskegon, Mich." This claim was not made in the body of
the article, which included the statement that: "... fluorides were
introduced to this [Muskegon] water supply in July, 1951" Therefore
at that time Muskegon ceased to be a control city, some eleven years
before this final report (Arnold et
al., 1962) from Grand Rapids.
How
then, in 1962, could the final result from the test city be compared with
data from a non-existent control one?
The
claim of Arnold et al. (1962)
that they compared the Grand Rapids caries rates with those in the
"control group of children in Muskegon, Mich." is shown to be
false by their statement that: "...in subsequent [after 1954]
analyses of Grand Rapids data, comparison has been made with the original
Grand Rapids findings and with those for Aurora."
This
is confirmed by the statement in the Abstract that:
"Caries
attack rates were lowered by 57 per cent in children 12 to 14 years old
in 1959." This figure of 57 per cent is obtained by averaging the
figures of 57.0, 63.2 and 50.8 per cent for the ages of 12, 13 and 14
years shown in their Table 2 to be the "per cent reduction in DMF
teeth (19441959)" in Grand Rapids (not between Grand Rapids and its
control city of Muskegon).
The Newburgh
Study. Similar mis-information
regarding comparisons being made between test and control cities was published
in the same year (1962) by Dr David Ast, the senior author of the
Newburgh study. In the Abstract of that paper (Ast and Fitzgerald, 1962)
he wrote:
"Among
children 12 to 14 years old in the four study areas, reductions in the
DMF rates as compared to the rates in control cities ranged from 48 to 71
per cent."
Table
2 is the only one in that paper showing DMF rates for children aged 12-14
years (in one case 13-14 years). In the first two studies listed, Grand
Rapids and Evanston, no reference is made to a control, the
"reduction" in Evanston, shown as 48.4 per cent, is obviously
the 48 per cent mentioned in the Abstract. This "difference" is
between the rates in Evanston in 1946 and 1959, not between Evanston and
a control, as stated in the Abstract. The Grand Rapids rates are also
shown between that city in 1944-45 and 1959, no control data being used.
Indeed Ast and Fitzgerald stated in the main text:
"In
the Grand Rapids and Evanston studies the control cities were lost before
the study was completed, so that the current data have been compared with
the base line data."
Not
with control cities, as they stated in their Abstract.
There
should not have been any confusion regarding the use of the term
"control", for the co-author of that paper, Bernadette
Fitzgerald, was described as the "senior biostatistician, division
of special health services, New York State Department of Health."
Therefore the authors' incorrect statement that they compared the caries
rates "in the four study areas" with rates in control cities is
unlikely to have been made inadvertently.
3. Continuing
publication of false statements.
It
has just been shown that Dr Ast (the senior author of the Newburgh study)
and Dr Arnold (the senior author of the Grand Rapids study) continued to
disseminate false statements regarding their studies many years after
those ten-year studies were concluded, Also, the arrogance of Drs Blayney
and Hill (the authors of the Evanston study) in publishing an article in
1967, which repeated, in a special issue of the Journal of the American
Dental Association, figures which they had acknowledged seven years
earlier were faulty (Sutton, 1960), indicates the reckless disdain of all
those authors for the truth, and for the members of the scientific
community (which normally trusts statements made in established journals
by senior scientists, for it is not used to being misled by such
readily-verified deceptions).
Their
false statements do not engender confidence in the reliability of the
data published and the statements made by those senior scientists in
their original reports of what are still regarded by fluoridation
advocates as three of the four main fluoridation studies on which the
case for fluoridation mainly relies - those in Newburgh, Grand Rapids and
Evanston in U.S.A.
Commenting
on the Grand Rapids study, Ziegelbecker (1983) pointed out that the
experimenters had examined "all" children from 79 schools in
Grand Rapids at the commencement of the trial, but that:
"After
5 years in 1949 they selected children at only 25 schools in Grand Rapids
for their investigation and observed children at the same time at all
schools in Muskegon (the control city)."
For
instance, the number of children aged 12 to 16 years who were examined in
Grand Rapids at the commencement of the trial was 7,661, but only 1,031
were examined in 1959 (Arnold et al.,
1962).
In
1988, Colquhoun stated:
"In
the control city of Muskegon all children were examined throughout the
period. From the year-by-year figures for six-year-olds which were
published three years later in 1953, it is revealed that an impossible
70.75% reduction was recorded in the first year of the trial (Arnold et aL,1953) and that there was
then an increase and no overall reduction in the following years.
Examination of similar data for other age groups shows that the sample of
25 schools could not have been representative of the population being
studied."
He
pointed out that:
"The
reported DMF of several of the age groups in this sample, approximately
one year after the initial examinations, was lower than that of the same
children when they were a year younger."
He
concluded:
"Fluoridated
water cannot turn decayed, missing or filled teeth into sound ones. It
follows that the caries experience of the children had not been reduced
as claimed. The large recorded reductions, which were mostly in the first
year only, were a result of selection of data."
4. Fictional
results?
In
1954 De Stefano reported the findings of professional statisticians
regarding the Grand Rapids study. They raised the question whether
"... the reported results are merely the fiction of a biased
sample."
Ziegelbecker
(1983) also, studied this situation. He stated:
"We
must conclude from this result that the sample in Grand Rapids was not
representative for all children and with respect to the basic
examination. In the following years from 1946 to 1949 (and later to 1954)
the 25 schools in the sample were the same each year and we see that the
caries experience in the sample was not reduced by fluoride in 1946-1949.
If
we accept that the sample was representative for the children, aged 6, in
the 25 schools in those years then we must conclude that fluoride in the
drinking water had not reduced the dental caries experience of children,
aged 6, in Grand Rapids in the years before the US Public Health Service
released the policy statement [endorsing fluoridation] to the American
Dental Association."
He
concluded:
"We
must conclude from these results that a fluoride content of 1 ppm in the
public water supply does not reduce dental caries experience."
Colquhoun
stated in 1988:
"In
their final study in Grand Rapids, published in 1962 after 15 years of
fluoridation, American health officials [including the director of the
U.S. National Institute of Dental Research, Dr F.A. Arnold, Jr.] wrote:
"... no such dramatic and persistent inhibition of caries in large
population groups had ever been demonstrated by any other means than
fluoridation of a domestic water supply."
Colquhoun
commented:
'That
statement, which could be described as the dogma of fluoridation, is now
considered by an increasing number of critics to be unscientific and
untrue."
In
view of the disclosure of the types of error which have just been
mentioned, such a grandiose claim, although it was widely accepted at the
time, can no longer be considered to be true.
More
than thirty years ago Sutton and Amies (1958a) commented on this sudden
initial decrease in caries reported from Grand Rapids (and from other
studies considered). It was stated that the results reported were not
those which would be expected if the hypothesis was correct that fluoride
"strengthens" developing teeth and makes them more resistant to
attack by caries. Despite the fact that the results published from
fluoridation studies do not support this hypothesis, it is still
mentioned. For instance, the ten members of the task group which in 1984
wrote the latest WHO book on this subject: Environmental Health Criteria
36. Fluorine and Fluorides, referred to the importance of "lifelong
consumption" of fluoridated water.
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