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Ch. 7 The Greatest Fraud
Fluoridation: Errors and Omissions in Experimental Trials - 2c CHAPTER 20 Further criticisms and comments.by Dr.
Philip R.N. Sutton from fluoridationfacts.com
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.
Cover
| Introduction
| 1a | 1b | 1c | 1d | 2a | 2b | 2c | 2d | 3
|
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