The 'Smoking Gun':
why 'disadvantaged' children have more bad teeth.
Last week the Magazine 'New Scientist' featured articles in a Special Issue, 'Get Smarter' (New Scientist 228, Vol 3051, 12 December 2015:30-39) They described just how badly we are at evaluating evidence, especially numerical and probabalisitic information, and our incompetence at strategic thinking.
This scientific illiteracy amongst policy-makers is a permanent threat to rational judgment and protecting pubic health from charlatans, and you'd think - hope, even - that those who exercise control over such matters would be very careful to avoid the pitfalls that lie in wait for those who attempt to use numbers to justify dubious or controversial health policy.
If that's what you believe, then leave now, because things aren't nearly as rosy as you suppose. I've spent a lot of time delving into the official dental health statistics on which fluoridation policy in England is founded, and what emerges is not a pretty sight at all.
This is not just me, a renegade scientist (an 'Activist' dammit!), banging my drum again. I take a lot of care in researching what I'm looking at before publishing. I've made no secret of my contempt for our new health super-Quango, Public Health England (PHE), and its attempts to pretend to be scientific. Having worked
'on the inside' for ten years, I do have some experience of how things work.
You've seen how PHE pushes fluoridation, as if it were 'The Answer to Life, The Universe, Everything!'. You've noticed its tearful concern for under-privileged kids - and who could possibly argue with that?
What this little article is about is PHE's obsession with fluoridation as the magic bullet to eliminate bad teeth amongst poor kids. You've read the nonsense, maybe even followed up the carefully cherry-picked references that are used to 'prove' the wonders of this treatment for the dentally challenged 'underprivileged' toddlers amongst us. and you've probably just gone away confused.
There seems to be such strong evidence from British surveys that you can't help entertaining just a little bit of doubt - maybe there is something in it after all? If so, that's what you're supposed to believe - doubt is what PHE relies on to get its wicked ways!
So just humour me here, and consider these three recent statements by PHE, in its infamous 'Water Fluoridation: Health Monitoring Report, 2014:
1. Sizeable inequalities still exist between affluent and deprived communities and dental caries is one of the most common causes of hospital admission in children. (p7)
2. The reduction in tooth decay in children of both ages in fluoridated areas appears greatest among those living in the most deprived local authorities (p5)
3. There is also consistency in the relationship found between dental decay and deprivation, the most deprived local authorities having the highest decay levels. This relationship is supported by other studies.13 (p20)
(Source - Executive summary, Water fluoridation. Health monitoring report for England 2014.PHE publications gateway number: 2013547 Published March 2014)
The first contains two separate statements, both of which are true in themselves. Kids from poor neighbourhoods do indeed have more dental decay, and dental treatment is a major reason for childen being admitted to hospital. But they're not cause and effect, just two parallel facts.
The second statement strongly suggests that there is evidence that fluoride reduces tooth decay. This is unsupported by any credible scientific evidence, as the York and Cochrane reviews have shown. It then states that the effects of fluoridation 'appears to be greatest' within deprived communities. Weasel words!
If fluoridation doesn't really work at all, just how is it able to cast its magic wand over the rotting teeth of the kids of the poor? (A bit of a give-away, really, that 'appears' wording. That means PHE really knows that there's just that little bit of doubt about its own claims.)
But put these two little sentences together, as folk do, and the entirely unproven implication is unavoidable. You're expected to believe that if you're a kid living under deprived conditions, and the Council allows the water supply to be fluoridated, then you're less likely to have to be hauled off to hospital, kiching and screaming, to have your teeth pulled. Now who could argue against that?
Well me, for one. The overall effect of these two sentences is to attempt to persuade Councils that the burden of hospital treatment for dental decay in children from such communities can be eased by fluoridation. (Even if it did work as claimed, it would relieve the average English Council of one extra case a month. Not a lot of people know that, but it's all in there, hidden away in their Grand Report!)
Now look at sentence 3 in the Box. Impressive, eh? So what are these 'other studies' that PHE tells us support its belief in fluoride's value to the underprivileged? It dismisses possible argument by providing just a single reference, No. 13, to a publication by Mellor, of the University of Manchester - yes, THAT Manchester again.
It was published in the British Dental Journal, the outlet for the dentists' Union, in 2000 - fourteen years ago. And it's not a scientific paper at all. It hasn't been peer-reviewed and it's never been cited as a reference source. Does that seem strange to you? It should - it's nothing but an Editorial comment, a mere opinion!
Only PHE falls back on such dross, just to dress up its own perforated propaganda!: (13. Mellor, A.C. (2000). Tooth decay and deprivation in young children. British Dental Journal 189: 372).
PHE knows that if it tarts up its reports with impressive-seeming references Councillors won't understand the wretched nonsense. If its all there in complicated language that only the 'Expert' can comprehend, they'll have to ask PHE's busy little minions, cunningly now embedded in our Local Authorities for explantions - and you can guess what they're going to tell them! If this is what the Executive Summary says, then it must be true, right? No - wrong! It's a scam, and they - and you - have fallen for it, just as was intended.
These dodgy claims appear right at the front of the PHE document, in the Executive Summary. That's because PHE knows that the vast majority of Councillors - and indeed, dentists and the Dental Though Police keeping them in line - can't be bothered to read the complicated stuff that comes later.
Why do I believe that this a case of scientific fraud? Because the entire statistical basis of estimating dental decay in English children, the National Surveys of Oral Health, is overwhelmingly worthless. So PHE's attempts to analyse these useless data, are themselves inevitably meaningless.
Or perhaps, not really merely 'inevitable' at all - 'intentionally' might be a more accurate description of what is going on here. The initial data collection is so inadequate that the figures for the prevalence and severity of dental decay in young kids have huge margins of error.
They are no better than poor guesses. But instead of taking these errors into account when they carry on regardless with their sums and calculations, they fall back on those absurdly silly 'mean values, calculated to astonishing but idiotic precision, to compare dental decay in kids from highly variable Local Authority areas.
Remember one crucial point here - the more variable the things you're looking at, the more accurate your data have to be if you want to make some sort of sense out of it. Fudge the first counts and everything that follows is junk.
The result of all PHE's fiendish torturing of its dubious data and its statistical jiggery-pokery is pure scientific pandemonium. These vague guesses on 'selected' groups of kids are manipulated, corrected, weighted and contrived in even more complex and impressively impenetrable analyses.
They produce amazingly detailed but statistically meaningless results that are then described in pure raving gobbledegook. (See Box below)
“An a priori interaction between deprivation quintiles and fluoridation status was tested, followed by an exploratory analysis with deprivation coded as binary, most deprived quintile compared to the combined four least deprived quintiles. A formal test for interaction was then carried out using a likelihood ratio test between models with and without inclusion of an interaction term between fluoridation status and the binary deprivation variable – the null hypothesis being no evidence of interaction.” (p1)
I trust you followed that? But if the number of children whose teeth were examined for decay in many Local Authority areas were too small to draw reliable conclusions, its even less believable that quintiles - one fifth - of the generally relatively small proportions of 'deprived children' living in those same areas can possible tell us anything at all about even their basic dental health, let alone the effect of a so-called 'treatment' - fluoridation - that is in fact completely ineffective anyway!
All that impenetrable language describing the statistics in the Box? Pure hogwash, designed to confuse Councillors. If that's 'plain English' then it's not the stuff that I learned at school.
But even worse, this pseudo-analysis garbage is then republished in scientific Journals. This lends a spurious air of authority to the propaganda. Don't be fooled - PHE employs professional statisticians, it knows exactly what it's doing. Publishing such junk 'science' can't be excused by arguing that the results are what their favourite computerised statistical package came up with - remember the old programmer's warning, 'Garbage in - garbage out!'.
PHE is perfectly well aware that virtually all scientists on both sides of the fluoridation fence don't bother to take such intimidating stuff apart to see if the increasingly wild numbers produced by these button-pushers really do stand up to scrutiny. I have, and it's frightening to see just how corrupt this wretched organisation really is.
It's pretty simple really. If the basic data on which public health policy relies is inadequate, then it's professional misconduct to try to pretend that it is actually sound, and then to carry out weird and wonderful pseudo-analysis to try to prove your policy is 'evidence-based'.
To put it bluntly, its scientific fraud, and anyone who uses this tactic to try to force
a discredited and actually harmful belief on the public is too damned dangerous to be allowed to remain in office.
The 'smoking gun' behind deprived kids' rotting teeth.
If you're still persuaded that PHE must know what its busy little propagandists are talking about, here's a couple of interesting items that you may have missed. Let's take a closer look at this 'deprivation' issue.
First, smoking is much more common amongst people living in these so-called 'deprived' communities. It's partly down to personality and psychological attitude - “Everyone else does, so I may as well!” - and partly down to a rather weird ''neighbourhood effect' associated with poorer housing and other physical influences of these run-down districts.
But then, on top of that, if there is a smoker in the house and babies are exposed to passive smoke from between birth and three months of age, they're likely to have twice as much dental decay later as kids brought up in a smoke-free home.
That's right - just breathing the fumes as a baby doubles your risk of bad teeth - and the poor smoke more than the rich.
Put these two snippets together and this is quite enough to provide a credible alternative explanation - a confounding factor - for the very real increase in dental decay in kids from deprived communities.
But that decay isn't down to their being 'deprived' - it's a far more complex sociological problem, that has nothing to do with whether or not there's any fluoride in their drinking water. Only an idiot or an obsessive would claim that dribbling this toxic substance into the public water supply could possibly stop poor parents smoking at home!