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Sutton 9



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 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 Dunning 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.

"...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 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.


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.


1. Gross numerical errors in statements of the number of children examined.

The Evanston Trial

These comments on the Evanston trial were published in 1980 in the present author's book Fluoridation Scientific Criticisms and Fluoride Dangers. It was stated:

"Additional Errors in the Evanston Trial Data."

In January, 1967, which was the twentieth anniversary of the commencement of the Evanston Trial, an entire special issue of the Journal of the American Dental Association was devoted to a report on that study (Blayney and Hill, 1967). In this, the original tables, complete with their gross numerical errors, were reproduced, despite the fact that these [errors] had been pointed out eight years earlier (Sutton, 1959) and some of them had been acknowledged by the authors (Sutton, 1960). In addition, several faulty tables were published for the first time.

The tables [in this issue of the J. Amer. Dent. Ass.] then showed three different statements regarding the number of children aged 6-8 years who were examined in Evanston during the 1946 examination:

(i) 1991 children - see Tables 10, 11,30,40 and 47.

(ii) 1985 children - see Tables 7,8,16,18,21 and 32.

(iii) 1754 children - see Tables 24 and 25.

There were also no fewer than six different statements in that article of the number of children aged 12-14 years examined in Evanston in 1946:

(i) 1703 children - see Tables 15 and 32.

(ii) 1702 children - see Table 47.

(iii) 1701 children - see Tables 11,30,41,44 and 45.

(iv) 1697 children - see Tables 7,9,12,13,17,19,22 and 31.

(v) 1556 children - see Table 26.

(vi) 1146 children - see Table 46.

Between the sum of the two highest statements of the number of children examined in Evanston in 1946, and the sum of the two lowest statements of children examined in the same year in the same study in the same city, there is a difference of 794 children (1991 + 1703 - 1754 - 1146 = 794).

The number of children stated to have been examined in Evanston is even more divergent in the original papers than in this special article. Blayney and Tucker (1948) and Hill et al. (1950) both gave a figure of 4375 children, compared with the number of 3310 in Hill et al. (1957b), a difference of 1065 children.

It was these differences which the medical journalist Anne-Lise Gotzsche, in a letter to the Lancet in 1975, said that she had showed to workers in other fields, and that they had "simply laughed" at the statistics (see Fig. 5, p. 167).

In that book (Sutton, 1980) - prepared as a submission to the Committee of Inquiry into the Fluoridation of Victorian Water Supplies (1980) - it was stated (p. 203):

"These errors were mentioned [by the present author] 12 years ago to the Tasmanian Royal Commission on Fluoridation. Since that time I have not heard of any mention of them or of a criticism having been made of the numerical data published in that report."

It appears that, in the manner common in fluoridation trials, those erroneous tables have been accepted at their face value, without investigation.

More than thirty years ago it was pointed out (Sutton and Amies, 1958b) that:

"This uncritical attitude to these studies is rife." "Also it has been assumed that associations and individuals that ... accepted the responsibility of publicly advocating fluoridation, have undertaken independent examinations of the data, and not merely repeated the opinions of others."

This situation was referred to by Professor John Polya (1964) in his book Are We Safe? He wrote:

"It is immaterial that other evidence in favour of fluoridation is not always false; the point is that persons, bodies and arguments that knowingly or in simplicity acquiesce in one blatant falsehood are unreliable witnesses before a jury either of scientists or of lay common sense."

He continued:

"The scandal created by the exposure of this absurdity resulted in the admission that the first figure (4,375) was correct. In defence of the other claims it was explained that "out of range" children were eventually excluded from the survey, but then further critical check revealed more numerical inaccuracies, not to speak of the magnitude of a correction exceeding 1,000. In better examples of scientific work the author sticks to his experimental group; discarding on the scale quoted strongly suggests that the experiment had to be altered to fit pre-conceived results. This is one of the common consequences of working without control of observer bias."

It is pertinent to point out that, in the Foreword to that article in the special edition of the Journal of the American Dental Association, in January 1967, Dr F.A. Arnold, Jr., the Assistant Surgeon General, Chief Dental Officer, U.S. Public Health Service (and formerly the chief experimenter in the study in Grand Rapids) stated:

"Here, in a single report, are data on the effect of water fluoridation on dental caries so completely documented that the article is virtually a text book for use in further research. It is an important scientific contribution towards the betterment of the dental health of our nation. It is a classic in this field."

It is indeed a classic - a first-class example of the errors, omissions and misstatements which abound in the reports of these fluoridation trials.

2. False information in the Abstracts of papers

The abstracts of reports on fluoridation trials are unusually important, for it is likely that lay people, and politicians in particular, will confine their reading of the report to the Abstract, assuming that it accurately reflects the findings, and will base their opinions and actions on its statements.

The Grand Rapids Trial. The final report of the Grand Rapids study was published in 1962. Reading the Abstract which preceded the body of the article it would seem that, at last, the authors (Arnold et al., 1962) had come to realize the necessity for comparing the results from the test city with those from the control one for they stated that the results had been "... compared with the caries attack rates in the control group of children in Muskegon, Mich." This claim was not made in the body of the article, which included the statement that: "... fluorides were introduced to this [Muskegon] water supply in July, 1951" Therefore at that time Muskegon ceased to be a control city, some eleven years before this final report (Arnold et al., 1962) from Grand Rapids.

How then, in 1962, could the final result from the test city be compared with data from a non-existent control one?

The claim of Arnold et al. (1962) that they compared the Grand Rapids caries rates with those in the "control group of children in Muskegon, Mich." is shown to be false by their statement that: "...in subsequent [after 1954] analyses of Grand Rapids data, comparison has been made with the original Grand Rapids findings and with those for Aurora."

This is confirmed by the statement in the Abstract that:

"Caries attack rates were lowered by 57 per cent in children 12 to 14 years old in 1959." This figure of 57 per cent is obtained by averaging the figures of 57.0, 63.2 and 50.8 per cent for the ages of 12, 13 and 14 years shown in their Table 2 to be the "per cent reduction in DMF teeth (19441959)" in Grand Rapids (not between Grand Rapids and its control city of Muskegon).

The Newburgh Study. Similar mis-information regarding comparisons being made between test and control cities was published in the same year (1962) by Dr David Ast, the senior author of the Newburgh study. In the Abstract of that paper (Ast and Fitzgerald, 1962) he wrote:

"Among children 12 to 14 years old in the four study areas, reductions in the DMF rates as compared to the rates in control cities ranged from 48 to 71 per cent."

Table 2 is the only one in that paper showing DMF rates for children aged 12-14 years (in one case 13-14 years). In the first two studies listed, Grand Rapids and Evanston, no reference is made to a control, the "reduction" in Evanston, shown as 48.4 per cent, is obviously the 48 per cent mentioned in the Abstract. This "difference" is between the rates in Evanston in 1946 and 1959, not between Evanston and a control, as stated in the Abstract. The Grand Rapids rates are also shown between that city in 1944-45 and 1959, no control data being used. Indeed Ast and Fitzgerald stated in the main text:

"In the Grand Rapids and Evanston studies the control cities were lost before the study was completed, so that the current data have been compared with the base line data."

Not with control cities, as they stated in their Abstract.

There should not have been any confusion regarding the use of the term "control", for the co-author of that paper, Bernadette Fitzgerald, was described as the "senior biostatistician, division of special health services, New York State Department of Health." Therefore the authors' incorrect statement that they compared the caries rates "in the four study areas" with rates in control cities is unlikely to have been made inadvertently.

3. Continuing publication of false statements.

It has just been shown that Dr Ast (the senior author of the Newburgh study) and Dr Arnold (the senior author of the Grand Rapids study) continued to disseminate false statements regarding their studies many years after those ten-year studies were concluded, Also, the arrogance of Drs Blayney and Hill (the authors of the Evanston study) in publishing an article in 1967, which repeated, in a special issue of the Journal of the American Dental Association, figures which they had acknowledged seven years earlier were faulty (Sutton, 1960), indicates the reckless disdain of all those authors for the truth, and for the members of the scientific community (which normally trusts statements made in established journals by senior scientists, for it is not used to being misled by such readily-verified deceptions).

Their false statements do not engender confidence in the reliability of the data published and the statements made by those senior scientists in their original reports of what are still regarded by fluoridation advocates as three of the four main fluoridation studies on which the case for fluoridation mainly relies - those in Newburgh, Grand Rapids and Evanston in U.S.A.

Commenting on the Grand Rapids study, Ziegelbecker (1983) pointed out that the experimenters had examined "all" children from 79 schools in Grand Rapids at the commencement of the trial, but that:

"After 5 years in 1949 they selected children at only 25 schools in Grand Rapids for their investigation and observed children at the same time at all schools in Muskegon (the control city)."

For instance, the number of children aged 12 to 16 years who were examined in Grand Rapids at the commencement of the trial was 7,661, but only 1,031 were examined in 1959 (Arnold et al., 1962).

In 1988, Colquhoun stated:

"In the control city of Muskegon all children were examined throughout the period. From the year-by-year figures for six-year-olds which were published three years later in 1953, it is revealed that an impossible 70.75% reduction was recorded in the first year of the trial (Arnold et aL,1953) and that there was then an increase and no overall reduction in the following years. Examination of similar data for other age groups shows that the sample of 25 schools could not have been representative of the population being studied."

He pointed out that:

"The reported DMF of several of the age groups in this sample, approximately one year after the initial examinations, was lower than that of the same children when they were a year younger."

He concluded:

"Fluoridated water cannot turn decayed, missing or filled teeth into sound ones. It follows that the caries experience of the children had not been reduced as claimed. The large recorded reductions, which were mostly in the first year only, were a result of selection of data."

4. Fictional results?

In 1954 De Stefano reported the findings of professional statisticians regarding the Grand Rapids study. They raised the question whether "... the reported results are merely the fiction of a biased sample."

Ziegelbecker (1983) also, studied this situation. He stated:

"We must conclude from this result that the sample in Grand Rapids was not representative for all children and with respect to the basic examination. In the following years from 1946 to 1949 (and later to 1954) the 25 schools in the sample were the same each year and we see that the caries experience in the sample was not reduced by fluoride in 1946-1949. If we accept that the sample was representative for the children, aged 6, in the 25 schools in those years then we must conclude that fluoride in the drinking water had not reduced the dental caries experience of children, aged 6, in Grand Rapids in the years before the US Public Health Service released the policy statement [endorsing fluoridation] to the American Dental Association."

He concluded:

"We must conclude from these results that a fluoride content of 1 ppm in the public water supply does not reduce dental caries experience."

Colquhoun stated in 1988:

"In their final study in Grand Rapids, published in 1962 after 15 years of fluoridation, American health officials [including the director of the U.S. National Institute of Dental Research, Dr F.A. Arnold, Jr.] wrote: "... no such dramatic and persistent inhibition of caries in large population groups had ever been demonstrated by any other means than fluoridation of a domestic water supply." ..."

Colquhoun commented:

"That statement, which could be described as the dogma of fluoridation, is now considered by an increasing number of critics to be unscientific and untrue."

In view of the disclosure of the types of error which have just been mentioned, such a grandiose claim, although it was widely accepted at the time, can no longer be considered to be true.

More than thirty years ago Sutton and Amies (1958a) commented on this sudden initial decrease in caries reported from Grand Rapids (and from other studies considered). It was stated that the results reported were not those which would be expected if the hypothesis was correct that fluoride "strengthens" developing teeth and makes them more resistant to attack by caries. Despite the fact that the results published from fluoridation studies do not support this hypothesis, it is still mentioned. For instance, the ten members of the task group which in 1984 wrote the latest WHO book on this subject: Environmental Health Criteria 36. Fluorine and Fluorides, referred to the importance of "lifelong consumption" of fluoridated water.

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