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1b |
1c |
1d |
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2b |
2c |
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3
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 |
