Why I voted NO to fluoride in drinking water

Fluoride in drinking water is on the county ballot next week. There is much passion expressed on both sides, and plenty of pamphlets being circulated, signs posted, and even meetings with "expert" speakers. I set out on an Internet quest for first-hand information versus all the propaganda and opinion. Quackwatch (http://www.quackwatch.org/) had good information, but didn’t tell me much about the science. I eventually found the best information at the CDC website (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htm) where there is new 2004 recommendations.

Beyond the conspiracy and hype, it’s evident that the scientific issue boils down to prevention of dental carries while minimizing health impacts of fluorosis. Fluorosis in a mild presentation constitutes visible opacity or chalky bands or ribbons seen in the dentition of teeth. Historically, this kind of mild fluorosis is considered a cosmetic rather than a health concern. Fluorosis is a health problem only when the function of the tooth enamel is compromised and teeth underneath are subject to wear and disease.

I spent some time on CDC and other professional and government websites, and abstracts of the last 12 months of MEDLINE, and won't share all my notes. I understand that my discovery is far from a thorough or scientific coverage of the issue. Nevertheless, I stopped here with the following conclusions:

Properly supplementing the world’s drinking water supply can significantly reduce morbidity associated with dental carries. Fluoride can be in water naturally and as a byproduct/contaminant of industry. Fluorosis does become a health risk in some communities world-wide due to natural fluoride or contaminated drinking water/foods. In our society, supplemental fluoride is available in foods/beverages, toothpaste, inexpensive supplements, and professional dental treatments. Mild Fluorosis is present in the population to a degree with or without supplements of fluoride. Mild fluorosis is not known to be a true health risk. The degree to which fluoride prevents carries/causes fluorosis depends heavily on oral intake of fluoride and contact of teeth to fluoride, and the age of the individual. The CDC recommendations are based on a estimate of how much tap water each individual in the entire population ingests along with the fluoride toothpaste and other sources of ingested fluoride. Optimal levels of fluoride added to drinking water for the prevention of dental carries will likely result in a notable increase in the percentage of the population with mild fluorosis. Costs associated with cosmetic procedures for opacity or conditions associated with mild fluorosis are a reality.

Water fluoridation is dissimilar to the other government compelled health issue of vaccination in that associated mortality is not nearly as epic, there are proven alternatives, and there is no dependence on a "herd effect" for efficacy. Thus, I feel comfortable with the political arguments about less government coercion and/or bureaucracy.

Bottom line: A fluoride program for municipal drinking water in my community will directly cost the municipality tax money. There are adequate, alternate sources for fluoride supplements/treatments available in my community, that can also be perhaps tax subsidized for those who will most benefit from supplementation. There is a potential for no benefit to a significant portion of the population in my community, and there is an associated increased risk for mild fluorosis in my community associated with water supplementation.

Well, I’m off to the market to buy iodized salt, enriched flour and vitamin D milk before heading to the poll booth to vote NO.

Cortislim radio plugs

Esteemed radio show producers and host:

Cort(i)Slim plugs occur once or twice during each daily Rome show. Phil Henry does one and even addresses the "clones" in it. Huge props to the host and posse of the Jim Rome Show for not sacrificing integrity for a buck to do slimy advertising for a bogus product!!!!


"Cort(i)Slim/Cort(i)Stress marketers charged with false advertising.The Federal Trade Commission has charged the marketers of Cort(i)Slim and Cort(i)Stress with making false and unsubstantiated claims that their products can cause weight loss and prevent or reduce the risk of several serious health conditions..." http://www.ftc.gov/opa/2004/10/windowrock.htm

Nothing about Chronic Pelvic Pain

Frustrating for sufferers of chronic pelvic pain is that readily identifiable causes are often ruled-out and the pain persists. I've seen everything from EMG, to salivary hormone testing, to patient assisted laparoscopy with conscious pain mapping promoted or suggested to determine etiology. With a subjective set of symptoms, it seems sometimes a coin toss as to what the chronic pelvic pain is labeled. Polycystic ovary syndrome, interstitial cystitis, and pelvic congestion syndrome are among conditions that are available. Besides the therapies listed below, if you haven't tried progesterone, estrogen, testosterone, Depo-Lupron, metformin, thyroid, biofeedback, pelvic floor therapy (physical therapy), percutaneous electrical stimulation (PENS), percutaneous sacral nerve root neuromodulation (PNT), vein embolization, biomagnetic therapy, and various laparoscopic procedures you haven't done all that has been tried.

All these tests and treatments, and others, have different levels of acceptance and scientific validity within a clinical pathway. Several could be argued either way for many clinical presentations. This demonstrates that medicine is an art; the lucky/wise sufferers see a clinician that is both systematic and scientific as well as intuitive and compassionate.

Unconventional care is often mainstream care in unconventional circumstances. Nothing wrong with that when it's based on scientific observation or sound theory. The material enters the realm of fraud when medical intervention involves deceit, often about the likelihood for definitive (or predictable) outcomes or answers. The more obvious, or perhaps intentional the deceit is, the more it is fraud. Often the deceit surrounding care not based on scientific logic is not obvious, or is altogether absent among ignorance or an error in understanding or judgement. In these circumstances, maybe it's not fraud, it could be just poor practice of the art.

When alternative medicine cures cancer

Dear SLTrib Editor:

Like probably many in our community, chimes went off in my head when I read your headline of 14 June 2004 because of a similarity and proximity to another Utah story that recently hit national headlines.

The reason for this note is that I believe there is additional background information on this story that becomes important because of its likely association with the other child/cancer/court/alternative medicine case.

There are WEBSITES (http://www.jessekoochin.com/) advocating alternative medicine that have followed this child's health. The sites present the child as a glowing success of alternative medical treatment.

Please find this information out for yourself:
http://www.google.com/search?hl=en&q=%22Jesse+Koochin%22,

To me, the present outcome does not appear to be glowing example of the success of so-called alternative cancer treatment. I wonder if the child could perhaps be more alive today had the State intervened on his behalf a little sooner. Do you think any of these Websites will ever tell the rest of this story? Someone should.

Insurance coverage study: Chiro vs MD for some care

Comparative Analysis of Individuals With and Without Chiropractic Coverage: Patient Characteristics, Utilization, and Costs Antonio P. Legorreta; R. Douglas Metz; Craig F. Nelson; Saurabh Ray; Helen Oster Chernicoff; Nicholas A. DiNubile Arch Intern Med 2004;164 1985-1992 http://archinte.ama-assn.org/cgi/content/abstract/164/18/1985?etoc
.................

I think there are some important observations about this study that serve to qualify any conclusions that availability of insurance benefits for chiropractic care results in lower medical care costs.

This study looked at claims data on 1.7 million members of a managed care organization over 4 years. It compared total claims data and neuromuscular diagnosis claims data of members with and without a 40 visit/yr chiropractic benefit. It also analyzed claims data for neuromuscular diagnosis for chiropractors and MD’s minus those associated with surgery. Based on analyses of the data, the authors conclude that the existence of chiropractic coverage may reduce overall health care expenditures.

The sheer amount of data within the cohort populations and the "natural" setting of the trial increase the risks for confounding results. There may just be too much data and/or variables to be able to account for all things that might introduce a statistically significant bias within the study.

The study noted a disparity in demographics of the two groups; thus the study analysis had to have this disparity calculated out. It would have been nice had the populations not had such an obvious disparity to begin with. For example, although members with chiropractic coverage had a 12% lower annual medical care cost, this became 1.6% (still statistically significant) when adjusted for demographic differences. That’s quite an amount to be calculated out where a direct measurement of more similar demographics could have eliminated the bias in the first place.

The study concluded that six percent of people with neck and back pain went to a chiropractor versus MD when given the choice. The study does not provide data to compare how close the six percent compared to the total number of members with neck or back pain who saw a chiropractor. That is, if 6% of those with neck or back pain that chose to see a chiropractor instead of an MD is 100 patients, it would be nice to know how many members are seeing a chiropractor for neck or back pain. If that number is 500, where did the other 400 members seeing the chiropractor for neck and back pain come from? One step further, this could make episode of care cost comparison analyses less meaningful if those extra 400 members are included. That is because this represents 400 (more or less) episodes of care that would not have existed had there been no chiropractic benefit. A true episode of care cost analysis would be one made on only those members who are seeing a Chiropractor instead of a MD.

The specific data analyzed may have omitted other potentially statistically significant factors influencing the study conclusions. For example, the study does not analyze or consider in comparisons those members using (versus having) chiropractic benefits. Very definitive comparisons could be made on analysis of overall health expenditures and demographics for managed care members before and after chiropractic benefits become available. Cohorts could be those who choose, and those that do not choose to use the benefit. This way we could better understand an overall increase (or decrease) in cost when the benefit is offered, and what (if any) population would most or least benefit by having coverage for chiropractic care.

In conclusion, I suggest that the limited analysis points, size and demographics used by this study may ignore potential significant factors that contribute to a comparison of costs associated with offering versus not offering a chiropractic benefit.
This argument of a better, cheaper, alternative to expensive knife-dominant allopathic care is the primary Naturopathic Medicine argument (ala NIH studies.) Nice chiropractic spin here.

Point 1 is that it was not the fact that Chiropractic can heal more cheaply than a MD spine-specialist. Self limiting conditions, and that fact that doing something for back pain almost always has better outcomes than doing nothing detracts from this Chiropractic-is-better argument. I propose there may be cheaper, just as effective alternatives to the chiropractic benefits option.

Point 2 this study appears much too broad and variable to draw specific conclusions about the cost versus health benefit of chiropractic primary care. Sweeping extrapolation of data (of the kind that makes a press report) is likely very speculative.

Point 3 is that health insurance actuaries already know exactly how much a chiropractic benefit costs (or reduces costs) in the whole scheme of overall healthcare of the subscriber. Detailed reports are probably proprietary, but we can make observations. Carriers typically limit the chiropractic benefit, either by dollar, or number of visits - hhhm. Health insurers hire health educators to work with employee groups to get subscribers to be more responsible with their own health. They also offer programs not associated with benefits or claims that entail discounts for spas, gyms, and some alternative healthcare. The point being that there may be evidence for better options than Chiropractic primary care benefits.

This type of study needs to be repeated at different managed care co.

The few and rigid parameters of this study in looking only at certain ICD-9 on Chiro vs. MD claims is hugely suspect of leaving important factors about the cost of chiropractic benefit unattended. Given the huge number of claims and disparate factors of the cohorts, I'm thinking that being able to calculate everything to be equal except the chiropractic benefit factor as being close to insurmountable.

This study makes a clinical versus actuarial approach to the data, yet makes a monetary conclusion. The cost of a chiropractic benefit will likely depend on analysis and prediction of what percent of a membership will use the benefit, how many claims the use will generate on average, and the average fee on each claim. This study fails to recognize that an additional benefit means an additional number of claims; or, does not adequately address the difference between added claims, and instead-of-MD claims. When the study compares episodes of care, how do we know that many of the chiropractic episodes were not self-generated due to the existence of the benefit?

In focusing on the existence of a chiropractic benefit, rather than the use of a chiropractic benefit I think this study is too broad and leaves too much open to speculation.

"Evidence of Harm"

Camille wrote a persona note to Dr. Haley, who has some ideas he'd like to promote about autism. She was offended by the reply she received. Here is my note to Camille, with her original note and Dr. Haley's reply following.-dras


Camille asked Dr. Haley for 2 things: quit using the term "Mad child disease" to describe Autism and to stop placing emphasis on mercury in vaccines as a danger to children.

I take Dr. Haley's (or an e-mail reply designate) responses to mean: the issue of mercury endangerment is so serious we should use any term to garner recognition of it; and, mercury is serious just as explained in "...an investigative book just being released called 'Evidence of Harm" by David Kirby.'"

FDA and CDC combined conspiracy, fraudulent studies published, secret e-mails, hidden documents revealed using the Freedom of Information Act, and "why else" arguments. This kind of sensationalism strongly hints of a sales pitch for something like a book...like the one being recommended.

Camille's issue is about children and autism, not mercury-vaccine fanaticism. I am sorry that Camille had this directed at her. If I am right, she doesn't need to read any such book. She's read the studies first-hand, and she understands how the research was done and who and how it was published. She has searched out the history of vaccines as well as the history of the CDC and FDA on that regard. More importantly, she knows about autism; all that has been presented from epidemiological, to in-utero, to autoimmune associations. Beyond knowledge, she has intimate understanding of the autistic child. Based on this knowledge and understanding, and the fact she is educated, she has the right to demand that an apparent vaccine controversy not be carried to exploit children and children with autism to strike an emotional cord, especially for marketing purposes.



dras
wrote:

It was no attempt at wit nor any attempt to hitch a ride on the mad cow hysteria and the attached document explains the situation. Take the time to hear the tape of my talk and you will realize that I was dead serious about this issue. It is parents like yourself who are being deluded by bureaucrats at the FDA and CDC that have made a major mistake and are doing everything to cover it up. You really need to educate yourself on the "statistics" issue and autism and the biological work that strongly supports that thimerosal exposure causes the symptoms of autism. The Freedom of Information Act has supplied Safe Minds with information that early epidemiological studies done by the CDC clearly show that thimerosal was associated with a significant risk of autism and other childhood illnesses. Only by manipulation over several attempts (blatantly discussed in obtained emails between the officials) did a publication result that showed no correlation. Also, do you really think the USA, Britain, Denmark, Sweden, etc. would all decide to make manufacturers remove thimerosal from their vaccines if there wasn't knowledge of a risk? I and others are just not that powerful unless our research is correct and provable. What I have published has been repeated by several other university groups and all concur that autistics represent a subset of the population that do not effectively excrete mercury. What I am fighting is those who are convinced, not because they have read the science, but because they believe in bureaucratic releases (you have the same opinion as the IOM who only considered the well known manipulated CDC study and those from Europe where the reports were done by employees of vaccine manufacturering entities that sell thimerosal containing vaccines to the rest of the world, including the USA). I am taking the time to respond because, as the mother of an afflicted child and someone who is in education, you may have the interest in the truth about this issue. Also, there is an investigative book just being released called "Evidence of Harm" by David Kirby. You should read it. Sincerely, Boyd HaleyAt 12:23 PM 10/5/04 -0700, you wrote:>Greetings,>>I am writing to say that the use of the term "Mad Child Disease" as used by>Dr. Boyd Haley is an apparent attempt at wit and a transparent attempt at>hitching a ride on "mad cow" disease hysteria. I object strenuously to its>use and that I hold those who use the term in very low repute.>>I am requesting that all people, especially those of education and>standing, who have access to mass media and those in public office cease>from using the term "Mad Child Disease" to refer to autism, and further,>out of concern for humanity, that they desist in applying it to any other>children.>>I request, also, that the heavy emphasis on mercury as a major threat to>the minds of children be ended. The statistics used to support this idea>are twisted and abused very frequently, (see:> for atrue analysis of the>statistics). One need only follow the money to see if those leading the>panicked cry of "dangerous vaccinations!" are profitting from the sale of>"chelation" treatments or in other ways. The autism plague rhetoric plague>must end before more are damaged by it.>>Autistic children are aware of what is being said about them, so are>autistic adults. We are not plague rats, we are not cows with damaged>brains and we are not meat-on-the-hoof ready to be culled by heartless>doctors and scientists.>>Autistics of all kinds contribute to the betterment of the communities they>live in. There are many ways we all can contribute. Autistics shouldn't>function as your whipping posts or pariahs. Shame on those who try to use>us as such.>>>Camille Clark>autistic ->mother of an autism spectrum adult ->undergraduate student ->Psychology major>>http://www.isn.net/~jypsy/AuSpin/ournames.htm>>http://www.neurodiversity.com/mothers_for_dignity.html>>>>To see the use of "mad child disease", see this page:>>http://www.lewrockwell.com/miller/miller14.html>>My own web site:>www.oddizm.com

Ban the Sale of Soda and Junk Food in School

I watched a local TV news segment that advocated not letting children watch reality television programs because it advocates/demonstrates bullying and submitting to peer-pressure to do unpleasant and dangerous things - and rewards the participants who are best at it.

I'd rather see legislation banning reality TV over banning Pepsi.

dras- (Willing to blame any acedemic shortcomings on his steady college years diet of Dr. Pepper and BigRed gum.)

A Bradford Hill's 1965 paper about determining causation by association in epidemiological studies

Good reading on Hill's criteria of causation.http://www.epi-perspectives.com/content/1/1/3/abstract
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I read this editorial on A Bradford Hill's 1965 paper about determining causation by association in epidemiological studies.

I can only approach the article's points of advice based on my own background knowledge and experiences, which is not epidemiology. Thus, I excuse my replies if I turn out to be "on a different hill" from the authors. It would have been nice had the authors provided specific epidemiologic or health policy examples to help drive the points; but then, people outside epidemiology are not their target audience.

For example, I would not encourage researchers to incorporate a great deal of health policy recommendations along with an outcome analysis of their own study. The way I see it, giving clinical researchers elevated political clout to present health policy advice will allow a strong influence for research bias. People should turn to the research more for facts rather than direction. Ideally, health policy is based on a degree of scientific consensus (peer review,) not on the conclusions of one group of researchers observations and outcomes.

Another point of this article is that statistical precision should not be mistaken for outcome validity. In my experience in the periphery of health policy development, this seldom occurs anyway. Peer review is often quick to slam the numbers based on other study design factors. Once in awhile it seems that a researcher has been self-fooled by attributing too much rigidity in the numbers. The study numbers often but serve as fodder for marketers to sell products to investors and consumers. Good numbers are an important key in determining a valid study, but not the only one. I believe most understand this. I must admit that based on experience, I am a little more skeptical of studies that appear to overly emphasize p values and statistical significance numbers.

Lastly, the article advocates that neither action nor inaction should occur despite lack of supporting or detracting scientific evidence. Again, I don't see this as a problem. There is much more than scientific understanding that dictate good and bad health policy. Health policy is often probably shamefully utilitarianistic (if that's a word.) There is only so much resources for paying for all of health care. Health policy cannot afford to support an intervention just because it appears to be benign, and can possibly benefit.