Email Correspondence with O’Brien Institute
Subject linke: peer reviewed papers on fluoride exposure during pregnancy?
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Sun, Jun 2, 12:04 PM |
Dear Dr. Ghali and Professor Guichon,
None of the Ontario institutions I’ve contacted have been able to provide any studies in response to the following Freedom of Information request.
Can you cite for me any published primary, peer reviewed studies showing that fluorideexposureduring pregnancy is safe with respect to IQ, or ADHD symptoms, in human offspring?
Background
Two important studies examining total exposure to fluoride during pregnancy and neurodevelopmental effects in offspring, by Bashash et al., were published in late 2017 and late 2018. Both were funded by the U.S. National Institutes of Health and conducted by an international team that included researchers from the Harvard School of Public Health, the Dalla Lana School of Public Health at the University of Toronto and various other universities and institutions.
Both studies used data collected from mother-child pairs followed in Mexico City, with measurements of total fluoride exposure at various time points obtained from urine samples starting in pregnancy. Both studies found that higher total fluoride exposure in pregnancy is related to worse outcomes in children. Specifically, the researchers found lower IQs and increased ADHD symptoms in the children whose mothers had the higher total fluoride exposures.
A third study by Till et al. published in late 2018, also funded by the U.S. government, found that the total fluoride exposures of Canadian pregnant women in fluoridated cities are very similar to those of the mothers in the Bashash et al. studies. It also found that pregnant women in Canadian fluoridated cities have double the fluoride exposure as compared those in unfluoridated cities and that drinking water is the major source of fluoride exposure for pregnant women in Canada.
Public Health Ontario’s review of the 2017 Bashash el al IQ study entitled Article Review on “Prenatal Fluoride Exposure and Cognitive Outcomes in Children at 4 and 6–12 Years of Age in Mexico” (https://www.publichealthontario.ca/-/media/documents/fluroide-iq-mexico.pdf?la=en) stated that:
- ” Previous research in the area of fluoride exposure and neurological outcomes during childhood has often been limited by small sample sizes and/or ecological study designs. The study by Bashash et al. is a considerable improvement over previous research given the large population size and the availability of individual level data to assess both exposure and outcome.”
- “…a 0.5mg/L increase in maternal urinary fluoride was associated with a decrease in GCI of 3.15 points (95% CI: -5.42,-0.87), and a decrease in IQ of 2.50 points (95%CI: -4.12, -0.59).”
- “The authors used linear regression, adjusting for a number of potential confounders…”
- “Another strength of the study design is that exposure was measured during what is perhaps the most vulnerable window of neurological development in children, the prenatal period….”
References
1. Prenatal Fluoride Exposure and Cognitive Outcomes in Children at 4 and 6–12 Years of Age in Mexico
https://ehp.niehs.nih.gov/doi/10.1289/ehp655
September 19, 2017 Press Release from University of Toronto:
Fluoride exposure in utero linked to lower IQ in kids, study says
https://media.utoronto.ca/u-of-t-in-the-news/fluoride-exposure-in-utero-linked-to-lower-iq-in-kids-study-says/
2. Prenatal fluoride exposure and attention deficit hyperactivity disorder (ADHD) symptoms in children at 6–12 years of age in Mexico City
https://www.sciencedirect.com/science/article/pii/S0160412018311814
October 10, 2018 Press Release from Dalla Lana School of Public Health, University of Toronto:
Higher levels of urinary fluoride associated with ADHD in children:
’“Our findings are consistent with a growing body of evidence suggesting that the growing fetal nervous system may be negatively affected by higher levels of fluoride exposure,” said Dr. Morteza Bashash, the study’s lead author and researcher at the Dalla Lana School of Public Health…
… The research team — including experts from the University of Toronto, York University, the National Institute of Public Health of Mexico, University of Michigan, Indiana University, the University of Washington and Harvard School of Public Health…
… This work builds off of previous research the team published on this population demonstrating that higher levels of urine fluoride during pregnancy are associated with lower scores on tests of IQ and cognition in the school-age children.’
http://www.dlsph.utoronto.ca/2018/10/higher-levels-of-urinary-fluoride-associated-with-attention-deficit-hyperactivity-disorder-adhd-in-children/
3. Study: Community Water Fluoridation and Urinary Fluoride Concentrations in a National Sample of Pregnant Women in Canada
https://ehp.niehs.nih.gov/doi/pdf/10.1289/EHP3546
October 10, 2018 Press Release from York University:
Study: Fluoride levels in pregnant women in Canada show drinking water is primary source of exposure to fluoride
“The research was conducted as part of a larger study funded by the National Institute of Environmental Health Sciences, part of the National Institutes of Health (NIH) investigating whether early life exposure to fluoride affects the developing brain.
“We found that fluoride in drinking water was the major source of exposure for pregnant women living in Canada. Women living in fluoridated communities have two times the amount of fluoride in their urine as women living in non-fluoridated communities,” said Christine Till, an associate professor of Psychology in York’s Faculty of Health and lead author on the study…
… The levels of fluoride among pregnant women living in fluoridated communities in Canada were similar with levels reported in a prior study of pregnant women living in Mexico City where fluoride is added to table salt.
“This finding is concerning because prenatal exposure to fluoride in the Mexican sample has been associated with lower IQ in children. New evidence published today in Environment International also reported an association between higher levels of fluoride in pregnancy and inattentive behaviours among children in the same Mexican sample,” said Till.”
http://news.yorku.ca/2018/10/10/study-fluoride-levels-in-pregnant-women-in-canada-show-drinking-water-is-primary-source-of-exposure-to-fluoride/
Description of Requested Items:
Any primary, peer-reviewed scientific research papers on fluorideexposure during pregnancy published in scientific journals during the last 73 years, showing that fluorideexposureduring pregnancy is safe with respect to IQ or ADHD symptoms in human offspring, relied upon by Public Health Staff, the Health Commissioner and/or the municipality when advising Council and the public that water fluoridation is safe for everyone.
Best,Christine Massey, M.Sc.
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Sun, Jun 2, 2:03 PM | ||
Hello Ms. Massey,
Thank you very much for your message.
The Fluoride Action Network can rely on studies that are not relevant to the North American context because they were performed in India, China and Mexico where waters can containments at levels we do not see here, or that are methodologically unsound. I am not qualified to reply to your specific request. Dr. Slott DDS has done so below.
With best wishes,
Juliet Guichon
1. There is no valid, peer-reviewed scientific evidence to support the claim that fluoridation during pregnancy is safe with respect to IQ, or ADHD symptoms, in human offspring” In the absence of credible evidence that fluoridation is unsafe during pregnancy, it is the responsibility of no one to prove that fluoridation is unsafe.
2. Following the review of the Bashash study to which Ms. Massey refers, the American Congress of Obstetricians and Gynecologist reaffirmed its recommendation that pregnant women drink fluoridated water – a recommendation shared by the American Dental Association and numerous other health organizations and agencies as detailed in the 2011 Oral Health Care During Pregnancy: A National Consensus Statement available athttps://www.mchoralhealth.org/materials/consensus_statement.php., updated in 2018. From this statement: “Drink water throughout the day, especially between meals and snacks. Drink fluoridated water (via a community fluoridated water source) or, if you prefer bottled water, drink water that contains fluoride.” https://www.mchoralhealth.org/PDFs/Oralhealthpregnancyconsensusmeetingsummary.pdf
3. As for the studies Ms. Massey cites: a) Due to the limitations stated in the study, itself, the Bashash et al. IQ study has no applicability to optimally fluoridated water in the US and Canada. A recent critique of this study by an ADA panel of noted researchers provides a good explanation of these limitations: https://www.ada.org/~/media/ADA/Public%20Programs/Files/2017_NFAC_Comments_on_Bashash_Study_11-27-2017.pdf?la=en b) While Ms. Massey listed the few strengths of the Bashash ADHD study cited by Public Health Ontario, she omitted the extensive list of limitations cited in that same critique: The study population was comprised of two cohorts (referred to as “Cohort 2A” and “Cohort 3”) that were both recruited from hospitals in Mexico City that serve low-to-moderate income populations. It is not necessarily representative of the general population.
• The two cohorts were recruited at different time periods, under different study designs. There were differences in the distribution of covariates between the two study cohorts. For example, as per the authors’ previous study, participants in cohort 2A had higher mean bone lead levels (p-value 0.001) than participants in cohort 3. This study also shows differences between children’s ages between cohorts at outcome assessment (p<0.01). Further, the CPT-II results for all three dimensions were significantly different between the two cohorts: omission errors (p=0.024); commission erors (p=0.007); and reaction time (0.016).
• This study did not assess source of fluoride exposure (e.g., consumption of foods high in fluoride or swallowing of toothpaste) contributing to total fluoride exposure. Therefore although the study showed an association with a biomarker of fluoride exposure it is not possible to attribute the fluoride exposure to any particular source.
• The authors used gamma regression for their analysis. While this choice is defensible, it would give greater confidence in the results if results for other regression models were used and gave similar results. This is particularly important given the marginal statistical significance of some of the associations found. A more detailed discussion of the analysis and the residuals would have be helpful. • The curvilinear relationships found between fluoride and outcomes such as ‘cognitive problems and inattention’ are unusual. They depart from more common ‘dose-response’ relationships found in studies of environmental risk factors and are difficult to explain with respect to underlying mechanism. Although some adjustment for cohort was done during the analysis, the relationship reported in the study may reflect different relationships in the two cohorts.
• There was an attempt to adjust for maternal lead in this study, by measuring and adjusting for maternal bone lead levels of mothers where data were available. Bone lead is an excellent measure of long-term exposure to lead, but for a study such as this it would be preferable to have measured umbilical cord blood lead or maternal blood lead during pregnancy given that the interest is in circulating lead that would have the potential to cross the placenta and negatively affect neurological development in utero. Given the environmental levels of lead that would be present during the study period, and the well-established link between lead and neurological outcomes in children, there is potential for unmeasured confounding. The study also lacks data on other environmental exposures that could potentially confound the association between fluoride and cognitive performance; for example, persistent organic pollutants, iodine and arsenic. The potential for confounding from other environmental exposures is a serious limitation with respect to interpreting the associations found with maternal urinary fluoride.
• Only 6.5% of women had urinary fluoride level data from each trimester of pregnancy. Themajority, 57%, had only one urine sample. This has potential for exposure misclassification. TheMUF levels vary over pregnancy, increasing from trimester 1 to trimester 3.3 Combining MUFvalues from different trimesters has a potential to affect the validity of the exposure variable. A study by Malin et al., published on the same date as this study (October 10, 2018) and conducted in Canada, used three urine samples, from each trimester, for all study participants, which is a better way of assessing the exposure. ·
Spot samples may reflect acute, rather than ongoing fluoride exposure. It is not clear if any sample with severely high values (outliers) were excluded from analysis or not. ·
There is no mention if assessors or participants in the study were blinded to the outcome. If not, then there is a potential for confirmation bias. ·
Covariates: ·
The study did not take into consideration any paternal covariates, such as father’s mental health,5 education and smoking status.·
The HOME score, an important predictor of home environment, was administered only to a subset of participants and therefore was not included in the adjusted model but was only a part of the sensitivity analyses.·
Participants’ marital status or mental health status was assessed only during the first trimester of pregnancy. This information was not updated at the time of ADHD testing, as it can change over time, and existing literature suggests that mothers with depression or parent can report higher ADHD scores for their children.Secular·
Secular trends also need to be taken into consideration. In the last decade or so reporting and treatment of ADHD is on the rise
Reliability
• The authors are from established universities in Canada, the US, and Mexico.
• The 2016 impact factor for the journal Environmental International was 7.08.• No declarations were made in regard to any conflicts of interest.
• This study was supported by U.S. NIH R01ES021446, NIH R01-ES007821, NIEHS/EPA P01ES022844, NIEHS P42-ES05947, NIEHS Center Grant P30ES017885 and the National Institute of Public Health/Ministry of Health of Mexico.
• Reporting issues:
• Not reported whether those administering the psychological tests were blinded for theoutcome assessment.
• Authors present plots showing a curvilinear relationship while Table 2 implies linear relationship between MUFcr and outcomes. This is confusing and appears inconsistent with the authors’ comments on a ceiling effect.
Review of: Prenatal fluoride exposure and attention deficit hyperactivity disorder (ADHD) symptoms in children at 6–12 years of age in Mexico City https://www.publichealthontario.ca/-/media/documents/fluroide-iq-mexico.pdf?la=en
c) The Till study assumes validity of the Bashash IQ study. Because Bashash has no applicability to optimally fluoridated water, Till’s reported findings are moot.
Steven D. Slott,
DDSBurlington, NC. 27216
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Sun, Jun 2, 4:27 PM | ||
Dear Dr. Ghali and Professor Guichon,
Professor Guichon, thank you for making it 100% clear that you rely solely on assurances, not science, from fluoridation promoters who go to great lengths to critique studies that do not support their position while relying on lesser studies, and in this case, no studies, when insisting that water fluoridation is safe.
I can only guess why you chose to imply:
- that Mexico is not a part of North America,
- that it’s irrelevant when studies show that Canadian pregnant women in fluoridated cities have total fluoride exposure very similar to women in Mexico where children were found to have lowered IQs and increased ADHD symptoms, and that total fluoride exposure is twice as high for pregnant women in fluoridated vs. unfluoridated Canadian cities,
- that special qualifications are needed to admit that you have no studies to provide me,
- that it’s ethical to assure anyone who will listen that water fluoridation is safe, in the absence of scientific proof,
- that it’s ethical to gamble with the neurodevelopment of other people’s babies,
- that it’s unethical to inform the public of the existing science.
Will this admission not keep you awake tonight, Professor?
“There is no valid, peer-reviewed scientific evidence to support the claim that fluoridation during pregnancy is safe with respect to IQ, or ADHD symptoms, in human offspring”
— Steven D. Slott, DDS, American Fluoridation Society, June 2, 2019
I look forward to Dr. Ghali’s response.
Best,Christine
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Sun, Jun 2, 6:02 PM | ||
Hello Ms. Massey,
Thank you very much for your message.
I do not speak for Dr. Ghali.
Dear Dr. Ghali and Professor Guichon,
Professor Guichon, it’s astonishing to communicate with a lawyer / ethics professor who seems determined not to exercise any brain cells in this debate. All that education and you prefer to make authority your truth, rather than truth your authority?
The amusing thing is that if you lived in France, Germany, Belgium, the Netherlands, Denmark, Norway or Sweden you’d be singing a different song because the authorities in those countries banned water fluoridation. You’d be insisting “Water fluoridation is unethical!” and rejecting it along with most of the world.
I await Dr. Ghali’s response.
Best,
Christine
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Mon, Jun 3, 12:43 PM | ||
Dear Ms Massey and Dr. Guichon,
Dr Ghali forwarded me your weekend correspondence, and asked me to respond officially on behalf of the O’Brien Institute for Public Health.
By way of this message, we confirm that your correspondence has been received. Our team’s work remains active and ongoing, and the information that you have both provided will be reviewed in detail.
Given the nature of the work we are conducting, and the contentious nature of this matter, the Institute will not weigh in to the debate that the two of you are having on email, nor make any public declarations, until completion and submission of our report.
We appreciate your shared concern for the health and safety of all Calgarians.
Warmly,Aleem
Aleem Bharwani, MD, MPP, FRCPCDirector Public Policy and Strategic Partnerships Specialist in Internal MedicineClinical Associate Professor
From: Christine Massey <cmssyc@gmail.com>
Sent: Sunday, June 2, 2019 8:11 PM
To: Juliet R. Guichon; William Ghali
Cc:mzurowski@calgaryherald.com; ward.sutherland@calgary.ca; joe.magliocca@calgary.ca; jyoti.gondek@calgary.ca; Chu, Sean; george.chahal@calgary.ca; jeff.davison@calgary.ca; Druh.Farrell@calgary.ca; Evan.woolley@calgary.ca; Gian-carlo.carra@calgary.ca; ray.jones@calgary.ca; Shane.keating@calgary.ca; Peter.demong@calgary.ca; cityclerk@calgary.ca; themayor@calgary.ca
Dear Dr. Ghali and Mr. Bharwani,
I did not ask Dr. Ghali or the O’Brien Institute to participate in a debate, rather I asked Dr. Ghali a simple yes/no question:
Can you cite any published primary, peer reviewed studies showing that fluoride exposure during pregnancy is safe with respect to IQ, or ADHD symptoms, in human offspring?
The serious nature of this public issue makes it all the more distressing to find the Institute choosing evasiveness and stalling over transparency and accountability. However this is not surprising to me given the Institute’s stated intention to rely on secretive, unaccountable CADTH as their main input on the water fluoridation issue.
Secretive: CADTH refuses to disclose the authors of their water fluoridation reports, at least to the public.
From requests@cadth.ca, Feb 25, 2019, 11:47 AM:
Good day Christine Massey,
Thank you for your inquiry and interest in CADTH.
In response to concerns expressed for the privacy and well-being of our staff and other contributors to this assessment, CADTH had decided not to list the names of the authors, contributors, and reviewers in the final report. All questions or comments about the report can be sent to requests@cadth.ca.”
Sincerely,
Stephanie Gabrielle
Central Intake
613 226 2553 ext. 1221
Personal Email: stephaniega@cadth.ca
Which leads to another question: were Juliet Guichon, Lindsay McLaren or any other O’Brien Institute members involved in the making of any CADTH water fluoridation reports?
Unaccountable: CADTH was described as follows in ClinicoEconomics and Outcomes Research, 2017:
“The adherence of CADTH’s processes to the principles of accountability, transparency, participatory, equity, responsiveness and consensus is poor… CADTH’s overriding responsibility is toward the governments that “own,” fund and manage it, while the agency’s status as a not-for-profit corporation under federal law protects it from standard forms of accountability…
CADTH’s governance documentation is not publicly available and CADTH is protected from freedom of information requests, whistle-blowing, Auditor General of reviews and ombudsman or integrity commissioner inquiries and investigations.
Canadians need a national organization for evaluating drugs for reimbursement in the public interest that fully embraces the principles of good governance – one that is publicly accountable, transparent and fair and includes all stakeholders throughout its processes….”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5702169/
CADTH Disclaimer:“…no representations or warranties are made…info in this document should not be used as a substitute for professional medical advice or as a substitute for the application of clinical judgment in respect of the care of a particular patient..”
Best,
Christine
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