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The British Fluoridation Society (BFS)

Funding

House of Lords written answers, 11 Jan 2000: Columns WA107-8.

Lord Stoddart of Swindon asked Her Majesty's Government:

Whether it is a proper use of taxpayers' money to make grants of £154,000 during the past two years to the British Fluoridation Society, in view of the differing views on the moral, commercial and health aspects of water fluoridation; and[HL365]

What scrutiny measures are in place to ensure that the £154,000 of taxpayers' money given to the British Fluoridation Society is under proper financial control; and[HL366]

Whether the British Fluoridation Society (BFS) has supplied them with details of what use has been made and is being made of the £154,000 of taxpayers' money given to them; and what measures are taken to ensure that any information disseminated by the BFS using that money is accurate and impartial.[HL367]

Lord Hunt of Kings Heath:

The British Fluoridation Society (BFS) monitors relevant research, and maintains a database on safety, efficacy and legislative issues arising from the fluoridation of water. Since 1975 successive governments have funded the BFS to help promote and implement their policies on oral health and to provide objective, evidence based advice to all interested parties. Like other recipients of government funds, the BFS works to an annual business plan agreed with the Department of Health and submits audited accounts.

Accountability

In 1999, the NHS/CRD unit at York University was commissioned to carry out a 'scientific' review (review) of water fluoridation. This review has already come in for a great deal of criticism due to its narrow protocol, it's failure to review ALL scientific data, and also it's sometimes shoddy views. Despite these failings, the review did make some observations which the BFS have decided to reinterpret.

But was an reinterpretation required? The review came up with some distinct views on water fluoridation and used plain language to explain what those views were (that is black is black and white is white - no grey areas). However, the BFS, amongst other notorious pro-fluoridation lobby groups, has decided that not only is there grey areas, but in some cases black means white, and vice versa.

Now one would think that an organisation that the Government depends upon for "objective, evidence based advice", would ensure that they would adhere totally to the truth. Not so. It also appears that Health Minister, and ex-corporate BFS member, Lord Hunt is keen to overlook the BFS' lack of "objective, evidence based advice", judging by the BFS' interpretation of the final report of 'scientific' review into fluoridation.

If anyone is still in doubt about how the BFS are prepared to distort the truth to fit their own agenda, they should closely read the following statements.

Professor Sheldon

In a letter sent to the Government on 10 September, 2000, by Professor Sheldon (Chairman, Advisory Group for the systematic review on the effects of water fluoridation), he wrote:

"In my capacity as chair of the Advisory Group for the systematic review on the effects of water fluoridation recently conducted by the NHS Centre for Reviews and Dissemination at the University of York and as its founding director, I am concerned that the results of the review have been widely misrepresented. The review was exceptional in this field in that it was conducted by an independent group to the highest international scientific standards and a summary has been published in the British Medical Journal.

It is particularly worrying then that statements which mislead the public about the review's findings have been made in press releases and briefings by the British Dental Association, the National Alliance for Equity in Dental Health and the British Fluoridation Society. I should like to correct some of these errors."

The points raised in Professor Sheldon's letter, with the *BFS' interpretation, is documented below.

*Source: [1] the press release issued by the BFS on October 6th, 2001 and, [2] a BFS document entitled: York review: Questions and Answers.

[1] 'Effectiveness'.

Sheldon: "Whilst there is evidence that water fluoridation is effective at reducing caries, the quality of the studies was generally moderate and the size of the estimated benefit, only of the order of 15 per cent., is far from 'massive'."

BFS: "The report confirms that there is clear evidence that fluoridation reduces the average number of decayed missing and filled teeth per child, and increases the proportion of children completely free from tooth decay." And ... "The report confirms that water fluoridation continues to have an effect over and above alternative interventions and strategies. While fluoridated toothpastes have brought about huge improvements in dental health since their introduction in the 1970s, and their continued use remains important, the report does confirm that water fluoridation continues to be effective over and above the use of fluoride toothpastes."

Self: Sheldon makes the claim that there is some (based on moderate) evidence that fluoridation can reduce caries. However, the BFS have even ignored the fact that there is NO good evidence that fluoridation reduces caries and blatantly misrepresents the truth. It is also interesting to note that none of the studies used to determine the figures for reductions in caries, and quoted by the review, adequately controlled for confounding factors. How the BFS can therefore claim that fluoridation is 'confirmed' to work "over and above" the use of fluoride toothpaste is mystifying.

[2] 'Social Inequalities'.

Sheldon: "There was little evidence to show that water fluoridation has reduced social inequalities in dental health."

BFS: "Water fluoridation reduces health inequalities - The report confirms that fluoridation reduces dental health inequalities both between fluoridated and non-fluoridated districts, and, importantly, it significantly narrows the dental health gap between young children living in poverty and their more affluent peers.

Self: "Little evidence" becomes a "confirmation" in the eyes of the BFS.

[3] Natural and artificial fluorides.

Sheldon: "The review could come to no conclusion as to the cost-effectiveness of water fluoridation or whether there are different effects between natural or artificial fluoridation."

BFS: "The review shows no differences in the effects of natural versus artificial fluoridation."

Self: The BFS do not go in for a direct lie, they depend upon spin. The review made no conclusions about the difference between naturally and artificially fluoridated water. However, the BFS prefer to portray this statement as an absolute.

[4] Safety.

Sheldon: "The review did not show fluoridation to be safe. The quality of the research was too poor to establish with confidence whether or not there are potentially important adverse effects in addition to the high levels of fluorosis. The report recommended that more research was needed." And ... "Probably because of the rigour with which this review was conducted, these findings are more cautious and less conclusive than in most previous reviews."

BFS: "The review was set up to establish whether fluoridation is still effective, and whether it is still safe, and the report is unequivocal: water fluoridation is EFFECTIVE and SAFE."

Self: The BFS resort to an outright deception. The review did not find fluoridation to be "safe" and yet the BFS have made a deliberate attempt to mislead the reader, by making a claim which appears to be attributed to the opinions of the review body.

[5] Quality of studies.

Sheldon: "The review team was surprised that in spite of the large number of studies carried out over several decades there is a dearth of reliable evidence with which to inform policy. Until high quality studies are undertaken providing more definite evidence, there will continue to be legitimate scientific controversy over the likely effects and costs of water fluoridation."

BFS: "Research into water fluoridation dates back to the 1930s, so to some extent York were judging studies conducted many years ago, when research methodologies were not so sophisticated, by today’s `gold standard’. Nevertheless: [1] on effectiveness, the 24 prospective clinical trials identified by the review as being of being sufficiently high quality to meet their inclusion criteria all showed clear benefits of water fluoridation, [2] on general health, over 100 studies investigating possible negative effects were included."

Self: The BFS return to spin. They say that some of the studies were of "sufficiently high quality". This is a deliberate attempt to persuade the reader that such studies were of good quality. It has already been stated that the quality of work reviewed was not of a good standard. The studies refered to be the BFS were the best of a bad to moderate lot and nothing more - according to the review.

[6] Fluorosis.

Sheldon: "The review found water fluoridation to be significantly associated with high levels of dental fluorosis which was not characterised as 'just a cosmetic issue'."

BFS:"Dental fluorosis is recognised by the York review as a cosmetic issue, not a health problem. Based on these data, projections in the review estimate that fluoridation might be expected to increase the prevalence of dental fluorosis of “aesthetic concern” from a background level of around 6% to around 10%.

Self: According to the review's findings, the incidence of fluorosis that is likely to be seen in a fluoridated community is 48%. The incidence of fluorosis of "aesthetic concern" was given as 12.5%, not the 10% quoted by the BFS.

Benefits

The BFS are not only guilty of misrepresentation, they also like to put out their own one-sided propaganda. Sometimes it is suggestive rather than precise:

"Many thousands of children living in socially deprived, non-fluoridated parts of the UK continue to suffer unacceptably high levels of tooth decay. Only water fluoridation benefits everyone irrespective of personal behaviour or motivation."

They say that fluoridation "benefits everyone irrespective of personal behaviour or motivation." What exactly do they mean by this? And what about people who have false teeth?

Impartiality?

The BFS says this about the review:

"The review was completely impartial. The Department of Health had no control over the process or the protocol for the review. The review is probably unique in terms of openness and inclusivity."

At the outset a web site was established (http://www.york.ac.uk/inst/crd/fluorid.htm) and the public was encouraged to monitor and contribute to the review.

The University of York NHS Centre for Reviews and Dissemination is a highly respected independent centre which aims to bring together the results of health research in order to provide the NHS with clearer evidence on the effectiveness of its treatments.

The review was an independent, rigorous, systematic examination of all the relevant evidence – including that relating to bone health, cancer, Down Syndrome, IQ and infant deaths.

All material identified by the review team, and that submitted or suggested by groups and individuals, was assessed for inclusion using the same criteria to test for relevance and quality.

The criteria for inclusion were agreed at the outset by the Advisory Panel, which included prominent opponents of fluoridation. All studies that met the inclusion criteria were included.

Those that didn’t were excluded. This methodology minimises bias and is an important strength of systematic reviews.

The review was not totally impartial. The review panel did have a representation, albeit a weak one, form the anti-fluoridation lobby. However, the number of people sitting on the panel with pro-fluoridation views outnumbered the antis. The review body also was open to bias with one of the Cardiff-based researchers also having pro-fluoridation sympathies.

The question of "inclusivity" is also misleading. The review did not consider large quantities of evidence such as animal studies. As a consequence, the findings of the review were weakened considerably. Some contributions that were made and which were relevant to the review were also ignored - including the Peer reviews which were very critical of the review process and it's findings.

It must also be noted that the review was conducted by the NHS/CRD unit at the Universities of York and Cardiff. The NHS is not independent of the Government.

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