Talk:Water fluoridation/Archive 9

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Choi review

How about this Harvard study?

• http://www.hsph.harvard.edu/news/features/fluoride-childrens-health-grandjean-choi/

— Preceding unsigned comment added by 50.13.53.93 (talk) 17:13, 21 July 2013 (UTC)

Actually this is a good source we could use. It's a review with a secondary use at Harvard. We can cite both if we wish

• Choi, et al. Developmental Fluoride Neurotoxicity: A Systematic Review and Meta-Analysis. Environmental Health Perspectives, 2012 October; 120(10): 1362–1368. Published online 2012 July 20. doi: 10.1289/ehp.1104912, PMC 3491930

• Impact of fluoride on neurological development in children. HSPH News, July 25, 2012

This is about very high exposure, not normal exposure. Let's figure out good wording and then find a spot to use it. It's usually best to use something from the conclusion. -- Brangifer (talk) 19:12, 21 July 2013 (UTC)

Since this article is about the artificial addition of fluoride to water supplies, and not about water already endemically high in fluoride as in the Choi study (as well as the fact that the study looked at levels of fluoride much higher than what is typically used in artificial water fluoridation), this is not an appropriate article here. Similar studies are already cited in the fluoride toxicity article, where it is appropriate. Yobol (talk) 15:21, 22 July 2013 (UTC)

I agree with Yobol. Unless there is comparison with the exposure levels studied with the levels in normally fluoridated water, I don't know how or why we'd include Choi. --Ronz (talk) 15:51, 22 July 2013 (UTC)

Oh it's only a neurotoxin after a certain dosage. Well that's fine then. — Preceding unsigned comment added by 50.13.53.93 (talk) 15:44, 23 July 2013 (UTC)

I heard dihydrogen monoxide in high enough doses can cause confusion, seizures, and even death. Better label it a neurotoxin and ban its use! Yobol (talk) 15:48, 23 July 2013 (UTC)

"The dose makes the poison." Paracelsus -- Brangifer (talk) 15:41, 24 July 2013 (UTC)

I have to agree with Yobol and Ronz. Many of the studies included in Choi's meta-analysis (Table 1) reported fluoride levels of 0.5-1.0 ppm (mg/L) in their "reference" populations—the same level of fluoride recommended by WHO guidelines for artificially fluoridated water. The "high fluoride" populations typically reported drinking water fluoride concentrations significantly higher, most coming in far in excess of WHO recommended levels. At best, Choi's meta lends moderate support to the hypothesis that extremely high fluoride levels may have neurotoxic effects. It says nothing about the effects of artificial water fluoridation to recommended levels; as such, it is potentially a worthwhile source for our article on fluoride toxicity, but isn't really relevant to this article. TenOfAllTrades(talk) 00:37, 24 July 2013 (UTC)

That makes sense. Use it in the other article. -- Brangifer (talk) 15:41, 24 July 2013 (UTC)

"other sources of fluoride"

I see the phrase "other sources of fluoride" mentioned in this article but it doesn't explain what those "other sources" might be. We know fluoride can be found in toothpaste, tea, tobacco, air pollution, in pesticide residues left on our foods, in soft drinks, juice, raisins, flour, etc. Perhaps it would be easier to just explain what people can ingest that DOESN'T contain fluoride?

We already know that fluoride bio-accumulates in the body from ALL sources, regardless of the amount maintained in tap water.

And what agency/organization is responsible for monitoring the bio-accumulative effects of fluoride? Would that be Colgate? Or your family dentist? Or your local water district? Is there a special lab test one can request to determine their body load of fluoride? As in determining whether they're exposed to too much, or too little? Or is this just determined by guess-timation (or psueudo-science)?

A little clairification in this area would be great and would thus reduce a great deal of controversy regarding dose... scientifically speaking... of course. — Preceding unsigned comment added by 99.61.176.89 (talk) 21:10, 4 August 2013 (UTC)

Edit request on 22 August 2013

Could you please include a link to "Fluoride - a chronological history" (http://www.infiniteunknown.net/2010/10/31/fluoride-a-chronological-history/) to provide an alternative perspective.

203.2.35.176 (talk) 22:53, 22 August 2013 (UTC)

I can't see how that is a reliable source in any way. --Ronz (talk) 23:23, 22 August 2013 (UTC)

 Not done per Ronz. TippyGoomba (talk) 23:24, 22 August 2013 (UTC)

Sources Buffet

Please enjoy with plentiful servings added to main article: http://www.slweb.org/bibliography.html Campoftheamericas (talk) 02:29, 9 September 2013 (UTC)
See also http://www.actionpa.org/fluoride/reasons.pdf
At these sites, you will find links to unbiased, relevant, peer-reviewed scientific research. Campoftheamericas (talk) 05:29, 9 September 2013 (UTC)

Firstly, these are activist sites and not relevant for our purposes. Secondly, even if they weren't activist sites no one is going to waste time reading through dozens of articles to find...what exactly? If you'd like to include something on the page then suggest specific wording and include a source or two to cite your wording. Also, I'm not sure why you reverted the archive bot - those conversations are dead so there's no reason to keep them on the page. N^oformation ^Talk 04:45, 9 September 2013 (UTC)

Also, please read WP:MEDRS and WP:NOTFORUM. Once you read these, if you think there's anything useful among those links, please suggest an edit. TippyGoomba (talk) 04:50, 9 September 2013 (UTC)

Caption

The caption on the first picture says that the fluoride in the water "doesn't change the appearance, taste or smell of drinking water." and then cites a source where those claims are inaccessible to the public because it needs to be purchased after going through login registration. In the information available to the public the claim isn't there. To view the reference it costs $35.

I live in Japan, where fluoridation is rare and went back home the the US and tasted the fluoride in concentrated orange juice. Perhaps the reason most people don't taste the fluoride in the water is that they have been drinking fluoridated water all or most of their lives. Regardless, that caption should be changed and use of the inaccessible references should be minimized.

Being that one of the first things that anyone viewing the page sees is probably those claims, doesn't that claim also poison the well? Instead of reading the article someone could go to the page and see those claims, that without $35 no one can confirm, and jump to conclusions.

Please change the caption. It isn't a good caption.

126.13.41.49 (talk) 23:23, 13 September 2013 (UTC)

No one actually pays the $35, many of us access these articles via a university proxy, which has a license to a large amount of scholarship. If you were ever enrolled at a university, you should check if you still have access to their proxy, sometimes they don't bother to turn it off. Or you could ask a friend with access... TippyGoomba (talk) 01:24, 14 September 2013 (UTC)

Even if that was not the case WP:PAYWALL, which specifically states that sources should not be rejected due to cost of access, applies here. In that case unless someone is suggesting replacing the current source with a free alternative of equal value there is nothing to discuss.--70.49.73.6 (talk) 05:29, 14 September 2013 (UTC)

IQ citations

Also, please stop adding irrelevant citations to the "IQ" line. I've said it twice but please understand: that sentence is about antifluoridationist literature on the web. not about specific studies that confirm/deny anything. That line is cited already (cite #22) and is not making the statement you think it is/should be. It would be wise for you to discuss changes before making them. N^oformation ^Talk 04:58, 9 September 2013 (UTC)

Would you suggest a different sentence to place it at? Or perhaps creating a new sentence? Campoftheamericas (talk) 05:12, 9 September 2013 (UTC)

I would suggest you revert yourself and hope an admin at WP:3RRN takes that into consideration instead of blocking you, but until then a conversation is pointless since you'll probably be taking a break for 24-48 hours otherwise. After the administrative issue is resolved the content issue can be discussed. N^oformation ^Talk 05:15, 9 September 2013 (UTC)

You don't want to talk about the article? Campoftheamericas (talk) 05:19, 9 September 2013 (UTC)

"until then a conversation is pointless since you'll probably be taking a break for 24-48 hours otherwise. After the administrative issue is resolved the content issue can be discussed" N^oformation ^Talk 05:20, 9 September 2013 (UTC)

Ok, how about now? Do you think this citation can be put somewhere in the article? I would like to say that flouride at 1.31mg/L (approx 1.31ppm) causes decreased IQ. Any objections? Campoftheamericas (talk) 01:41, 11 September 2013 (UTC)

That statement requires a source. Please provide a source which meets the criteria of WP:MEDRS. You should read it carefully, expect me to quote from it to explain why whatever source you'll come up with is invalid. 03:22, 11 September 2013 (UTC)

http://www.ncbi.nlm.nih.gov/pubmed/21237562/Campoftheamericas (talk) 03:49, 11 September 2013 (UTC)

From WP:MEDRS: In general, editors should rely upon high-quality evidence, such as systematic reviews, rather than lower-quality evidence, such as case reports, or non-evidence, such as anecdotes or conventional wisdom.

This paper which you claim to be "lower quality evidence", was published in the Journal of Hazardous Materials. The publisher is Elsevier, one of the biggest if not the biggest publisher of scientific journals. Do you think articles published by Elsevier are of low quality? Campoftheamericas (talk) 03:09, 25 September 2013 (UTC)h

That's not the point WP:MEDRS is making. What WP:MEDRS is indicating is that a secondary source is needed; the study by Ding that you mentioned is a primary source. A secondary source will gather, evaluate and analyze a number of primary sources like that one. Zad68 03:32, 25 September 2013 (UTC)

Got any systematic reviews we can look at? TippyGoomba (talk) 03:57, 11 September 2013 (UTC)

systematic review, aka "secondary" source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3491930/ Campoftheamericas (talk) 04:15, 11 September 2013 (UTC)

How about removing the line "Other adverse effects lack sufficient evidence to reach a confident conclusion.[11]", or at least making the article clear that it is referring only to low levels of fluoride? Campoftheamericas (talk) 06:46, 11 September 2013 (UTC)

The statement is sourced, why would we remove it? It's clear that it only applies to water fluoridation, the topic of the article, and not contaminated or natural water supplies. If there is a more-recent systematic review of water fluoridation that contradicted the statement, only then would we replace the statement with the new revelation. TippyGoomba (talk) 07:07, 11 September 2013 (UTC)

The statement should be clarified, because there is a newer systematic review showing that water fluoridation can cause other ill effects. So for example, instead of "There is no clear evidence of other adverse effects.[11]", it should say "At the dosage level recommended for water fluoridation, there is no clear evidence of other adverse effects.[11]" Campoftheamericas (talk) 07:52, 11 September 2013 (UTC)

Source? (When you make a claim and don't provide a source, I will ask for the source, please provide it in advance.) TippyGoomba (talk) 04:46, 12 September 2013 (UTC)

Did you forget the systematic review above? I thought you would remember since you asked for it before. It is in bold. Campoftheamericas (talk) 21:08, 13 September 2013 (UTC)

It doesn't pertain to your suggested edit anyway. I increased the verbosity to make it clear we're talking about water fluoridation [1]. I don't think it adds anything, personally. TippyGoomba (talk) 03:18, 25 September 2013 (UTC)

RFC? I see Campoftheamericas restored the RFC notification box but it's hard to figure out what the RFC question might be, especially for a newcomer to this conversation. An RFC works best when the question is clearly defined and focused on one particular proposed change along with the source. Zad68 03:41, 25 September 2013 (UTC)

IQ Citations, Ding Et Al

http://www.ncbi.nlm.nih.gov/pubmed/21237562/Campoftheamericas (talk) 03:49, 11 September 2013 (UTC)

Fyi, the article you gave is also not about water fluoridation: Mean value of fluoride in drinking water was 1.31±1.05 mg/L (range 0.24-2.84). We require a higher quality source anyway, so it doesn't really matter but I thought you might be interested. TippyGoomba (talk)

I don't follow. How can research that involved fluoridated water, not involve the topic of water fluoridation? Campoftheamericas (talk) 04:09, 11 September 2013 (UTC)

We have to follow WP:SYNTH and WP:OR, there is an article on Fluoride toxicity. You gave a source but you didn't suggest an edit. TippyGoomba (talk) 05:36, 11 September 2013 (UTC)

I disagree with this edit that adds a primary source that does not study or review antifluoridationist literature to a sentence covering that topic. Zad68 12:40, 11 September 2013 (UTC)

(1) This is not a primary source (2) The sentence has bias, and should be changed to say: "Research presented links fluoride exposure to a wide variety of effects, including AIDS, allergy, Alzheimer's, arthritis, cancer, and low IQ, along with diseases of the gastrointestinal tract, kidney, pineal gland, and thyroid." Campoftheamericas (talk) 18:58, 11 September 2013 (UTC)

Please provide a source (like a recent systematic review) for your suggested edit. TippyGoomba (talk) 04:48, 12 September 2013 (UTC)

I wish to change the sentence to read as (2) above, without use of a source, because to say "antifluoridationist literature" is an argument from ignorance. Campoftheamericas (talk) 21:04, 13 September 2013 (UTC)

Perhaps you mean ad hominem? I don't think it's either, but I think I now understand what you're suggesting. If you're saying you'd like to replace "antifluoridationist literature" with different description, I have the same desire. However, unfortunately, that's what the source uses. TippyGoomba (talk) 01:42, 14 September 2013 (UTC)

While the source may use it, let's not purposely try to bring out the worst content in the citation. Campoftheamericas (talk) 04:47, 28 September 2013 (UTC)

Since it's in the water it's in everything

Should be made more clear that since it is in the water it ends up in most prepared food, beers, sodas, juices, and wines.

this was previously on the USDA website. http://www.fortcollinscwa.org/pages/fluoride.htm

Would be interesting to see a side by side comparison with countries that don't add fluoride to the water. — Preceding unsigned comment added by 184.78.20.231 (talk) 05:14, 4 August 2013 (UTC)

ok i found it on the USDA website. http://www.ars.usda.gov/SP2UserFiles/Place/12354500/Data/Fluoride/F02.pdf

Can still be found here: http://web.archive.org/web/*/http://www.ars.usda.gov/SP2UserFiles/Place/12354500/Data/Fluoride/F02.pdf Campoftheamericas (talk) 23:33, 1 October 2013 (UTC)

A few specific foods to highlight the issue in the safety section or perhaps the ethics and politics section. Beer, wine, juice, and some fruits and vegetables should be mentioned specifically. — Preceding unsigned comment added by 184.78.20.231 (talk) 12:47, 6 August 2013 (UTC)

Don't leave out the amount of fluoride found in "Tea, instant, powder, unsweetened" of 897.72 parts per million (ppm). — Preceding unsigned comment added by 99.61.176.89 (talk) 16:44, 6 August 2013 (UTC)

I understand that you can't add a comparison of food from fluoridated countries to others, but it does seem worth mentioning that "other sources of fluoride" include beer, wine, fruits, vegetables, etc.

So It has been a month... Can someone add something to the article regarding other sources of fluoride? Also from the World Health Organization this seems quite relevant: While daily intake of 1–3 mg of fluoride prevents dental caries, long-term exposure to higher amounts may have deleterious effects on tooth enamel and bone. http://www.euro.who.int/__data/assets/pdf_file/0018/123075/AQG2ndEd_6_5Fluorides.PDF — Preceding unsigned comment added by 184.78.20.231 (talk) 10:53, 10 September 2013 (UTC)

I believe that if you sign up for an account, you can add the information yourself. Campoftheamericas (talk) 20:11, 23 September 2013 (UTC)

Aesthetic Concern

The following statement in the article: "most of this is mild and usually not considered to be of aesthetic or public-health concern.[10] "
contradicts with [11], where the research states: "At a fluoride level of 1 ppm an estimated 12.5% (95% confidence interval 7.0% to 21.5%) of exposed people would have fluorosis that they would find aesthetically concerning".
I propose changing the wording to: "Those exposed to fluoride level of 1ppm or above, have a 12.5% chance of having dental fluorosis they would find aesthetically concerning [11]"
FYI, [11] is right next to [10] on the following page: https://en.wikipedia.org/wiki/Water_fluoridation#References Campoftheamericas (talk) 08:14, 11 September 2013 (UTC)

Please provide links, rather than the reference numbers (which can change). 10 is older than 11. We always prefer newer systematic reviews, all else equal. TippyGoomba (talk) 05:01, 12 September 2013 (UTC)

How do you propose to deal with the discrepancy? Can the article be improved? Campoftheamericas (talk) 22:12, 13 September 2013 (UTC)

Generally, we go with the most recent but that's not always the case. See WP:MEDDATE. TippyGoomba (talk) 01:27, 14 September 2013 (UTC)

Any suggestions on changing the wording, since there is conflicting evidence? Definitely can't be said as if it is fact. Campoftheamericas (talk) 05:24, 1 October 2013 (UTC)

RFC

please see Talk:Water_fluoridation#IQ_citations for the topics of discussion. Also Water_fluoridation#Aesthetic_Concern and Water_fluoridation#IQ_Citations.2C_Ding_Et_Al Campoftheamericas (talk) 09:13, 26 September 2013 (UTC)

I have had a look through the above discussion but I am still not quite sure exactly what the disagreement is about. Is it principally about the standard of source required to make certain adverse comments about fluoridation? Martin Hogbin (talk) 08:28, 27 September 2013 (UTC)

What is the question being asked of the community? This does not appear to be a RfC. Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:37, 27 September 2013 (UTC)

I agree with the other commenters that this RFC should be clarified so that it asks a direct question. Zad68 13:01, 27 September 2013 (UTC)

If I provide a quality source on a particular topic, then I can use it to support a sentence in the article on the same topic, correct? I believe that is how to create a well documented Wikipedia article. Campoftheamericas (talk) 15:41, 27 September 2013 (UTC)

Is this an RFC comment, or something more general? Yes we start with good-quality sources, but then we also apply things like WP:WEIGHT to make sure the information ends up in the right article and with the right emphasis. It'd be better if you would propose a specific article content change based on a named source, rather than asking a general theoretical question. Zad68 16:05, 27 September 2013 (UTC)

What text do you want to support with what ref? No ref supports all text. Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:18, 27 September 2013 (UTC)

Jmh649, aka Doc James, I restored an edit by Podiaebba, which is the text that I wanted to support with the reference. I would also like to use the reference elsewhere in the article, where IQ effects are mentioned. I appreciate your work with "formatting" the reference https://en.wikipedia.org/w/index.php?title=Water_fluoridation&diff=573617661&oldid=573605652, but I would like to preserve the text by Podiaebba, and the links to the articles. Campoftheamericas (talk) 20:40, 27 September 2013 (UTC)

We generally paraphrase rather than quote. And if every sentence started with the type of study supporting it our articles would look like a joke. Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:08, 30 September 2013 (UTC)

I think we still need a bit more work on the use of Choi, specifically what Choi et al. mean by "high fluoride". This is being used in our article's Safety section, and it needs to be specified whether this effect is something that would be expected to be found in water that has its fluoride levels managed for the purpose of dental health. I would not want a reader of our article to come away with the idea that these effects would be found at those levels, if Choi isn't saying that. Specifically, Choi says "The exposed groups had access to drinking water with fluoride concentrations up to 11.5 mg/L (Wang SX et al. 2007); thus, in many cases concentrations were above the levels recommended (0.7–1.2 mg/L; DHHS) or allowed in public drinking water (4.0 mg/L; U.S. EPA) in the United States (U.S. EPA 2011)." I think this should be worked in if we're going to use Choi, I'd like to pore over it a bit more on this. Zad68 04:08, 30 September 2013 (UTC)

For reference, Choi et al. has come up before on this talk page, most recently in July: Talk:Water fluoridation/Archive 9#Choi review. The problem with using Choi's metaanalysis in this article is that the study populations were drawn from areas where the water had naturally abundant fluoride. In practice, the comparisons were between moderate fluoride levels (often comparable to – or even appreciably exceeding – the WHO-recommended level of 0.5-1.0 ppm fluoride in artificially-fluoridated water) in the "reference" groups, and extremely high levels (anywhere from two to more than a hundred times the WHO guideline) in their "high fluoride" groups.

Bluntly, I didn't notice that it had snuck into the body text of this article, and I'm removing it now, since the consensus in the last discussion was clear. The data are more relevant to fluoride toxicity, and may warrant mention in that article. Choi's data, unfortunately, did not include information relevant to this article, as it did not include sufficient data (or offer analysis, or draw conclusions) about the effects – if any – of the relatively low fluoride levels in artificially-fluoridated water (0.5-1.0 ppm) versus unfluoridated, naturally-low-fluoride water (<0.5 ppm). TenOfAllTrades(talk) 14:13, 1 October 2013 (UTC)

OK, I added it to fluoride toxicity. Please expand there, if you can, on the fluoride levels covered by the study. Podiaebba (talk) 14:52, 1 October 2013 (UTC)

non-article content

Is this a RfC or not? If you want to discuss a particular edit, make a section for it. You're turning the talk page into a mess. TippyGoomba (talk) 02:52, 28 September 2013 (UTC) Maybe you didn't see that the above, where I say: "Jmh649, aka Doc James, I restored an edit by Podiaebba, which is the text that I wanted to support with the reference. I would also like to use the reference elsewhere in the article, where IQ effects are mentioned. I appreciate your work with "formatting" the reference https://en.wikipedia.org/w/index.php?title=Water_fluoridation&diff=573617661&oldid=573605652, but I would like to preserve the text by Podiaebba, and the links to the articles. Campoftheamericas (talk) 20:40, 27 September 2013 (UTC)". This is a discussion about article content. Feel free to reply in a logical way. Campoftheamericas (talk) 05:34, 28 September 2013 (UTC) This does not help matters. Do not refactor the comments of others. Refactoring your own comments is very confusing, please don't do that either. TippyGoomba (talk) 04:07, 28 September 2013 (UTC) Again, this does not help matters, see WP:REDACT. Please stop this. TippyGoomba (talk) 05:15, 28 September 2013 (UTC) Let's keep the bickering out of the content, shall we? If you have issues, address them on my talk page. Campoftheamericas (talk) 05:34, 28 September 2013 (UTC)

Sounds reasonable. And I removed it again. Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:57, 2 October 2013 (UTC)

Please all bear in mind

We are writing an encyclopedia not acting out the pro/anti fluoridation debate. Both sides of this debate should, of course, be represented here in an encyclopedic manner but this article is not the place to push views for or against fluoridation. Martin Hogbin (talk) 09:04, 28 September 2013 (UTC)

Fluoride Research Letter

http://www.fluorideresearch.org/463/files/FJ2013_v46_n3_p104-117_pq.pdf — Preceding unsigned comment added by 99.52.192.202 (talk) 20:01, 29 September 2013 (UTC)

A systematic, second source study showing that the only safe level of Fluoride is zero. Will look further into it, and if the study is well done, it could add to the safety section. Campoftheamericas (talk) 00:00, 30 September 2013 (UTC)

An editorial is not a systematic review. The source fails WP:MEDRS pretty hard, so I'd guess it's useless for the article. But if anyone wants to suggest an edit, I'm prepared to be surprised. TippyGoomba (talk) 00:56, 30 September 2013 (UTC)

Yes, an editorial from an advocacy website. Campoftheamericas (talk) 01:50, 30 September 2013 (UTC)

By saying "Yes" here, are you agreeing that as this is an editorial from an advocacy website, it would not be a sufficient source per Wikipedia's WP:MEDRS standards to support biomedical claims? Zad68 03:50, 30 September 2013 (UTC)

I asked the editor, and he said that his editorial was published in the journal Fluoride. Fluoride is published by the International Society for Fluoride Research, and is in it's 46th year of publication. The Society does not take a position on fluoridation. To answer your question, I don't think this article qualifies as a peer-reviewed systematic study. However, his editorial cited 110 different sources. Perhaps some of those sources could be used to make the Wikipedia article more neutral, rather than only PRO-fluoridation. Campoftheamericas (talk) 05:04, 30 September 2013 (UTC)

This paper does not appear to be pubmed indexed which raises concerns. Doc James (talk · contribs · email) (if I write on your page reply on mine) 05:07, 30 September 2013 (UTC)

The journal Fluoride is not carried by the National Library of Medicine at all, its NLM catalog entry is here but this shows none of its articles are PubMed or MEDLINE indexed. I think we're all in agreement that per WP:MEDRS its articles can't be used here to source biomedical info. Campoftheamericas, although you state that the "Society does not take a position on fluoridation", Quackwatch says The International Society for Fluoride Research may sound respectable, but it is actually an antifluoridation group. We really need to be very careful about using anything published by them, even as a resource to gather sources, because clearly we'd only get one side. I do not see any value in using the lists of references their publications use when we can just use PubMed to search for well-qualified sources. Regarding "Perhaps some of those sources could be used to make the Wikipedia article more neutral, rather than only PRO-fluoridation"-- if the authoritative reliable sources do indeed express a consensus that fluoride is largely safe and beneficial, the Wikipedia article will reflect that, and it would not make it "more neutral" to change the article away from what the best-quality sources say. Zad68 15:37, 30 September 2013 (UTC)

I would consider Quackwatch to be an advocacy site, since it doesn't try to be impartial. Quackwatch does not present supporting arguements for both sides. Speaking of... how about this change: https://en.wikipedia.org/w/index.php?title=Water_fluoridation&diff=575031116&oldid=574835058 Campoftheamericas (talk) 02:21, 1 October 2013 (UTC)

non-article content
What does that diff have to do with the fluoridation editorial? If you want to change topics, create a new section. TippyGoomba (talk) 03:19, 1 October 2013 (UTC) If you have an issue, please post on my talk page. Campoftheamericas (talk) 03:21, 1 October 2013 (UTC)

Quackwatch has been discussed at length on Wikipedia before and consensus is that it's a useful resource to comment on those pushing fringe views in science and medicine. Either way, as mentioned, Fluoride isn't PubMed indexed and would not be useful to look for sourcing for this article. Per WP:MEDRS The International Society for Fluoride Research isn't the kind of organization we seek out for sourcing, either. From WP:MEDRS, we're looking for: literature reviews or systematic reviews published in reputable medical journals, academic and professional books written by experts in the relevant field and from a respected publisher, and medical guidelines or position statements from nationally or internationally recognized expert bodies. Zad68 03:33, 1 October 2013 (UTC)

Regarding the single person that writes Quackwatch with no peer-review, and whose editorials are not published in any journal: "Under cross-examination Barrett conceded that he was not a Medical Board Certified psychiatrist because he had failed the certification exam. The most damning testimony before the jury, under the intense cross-examination by Negrete, was that Barrett had filed similar defamation lawsuits against almost 40 people across the country within the past few years and had not won one single one at trial. During the course of his examination, Barrett also had to concede his ties to the AMA, Federal Trade Commission (FTC) and Food & Drug Administration (FDA)." Campoftheamericas (talk) 05:22, 1 October 2013 (UTC)

No one is using quackwatch to justify anything. See WP:NOTFORUM. Let's get back on topic. Are you suggesting an edit? TippyGoomba (talk) 05:25, 1 October 2013 (UTC)

Article Edit

I would consider Quackwatch to be an advocacy site, since it doesn't try to be impartial. Quackwatch does not present supporting arguements for both sides. Speaking of... how about this change: https://en.wikipedia.org/w/index.php?title=Water_fluoridation&diff=575031116&oldid=574835058 Campoftheamericas (talk) 02:21, 1 October 2013 (UTC)

Is this supposed to be a new section? TippyGoomba (talk) 06:07, 1 October 2013 (UTC)

This edit proposes the follow change to the opening sentence: "Water fluoridation is the controlled addition of fluoride to a public water supply to reduce for the purpose of reducing tooth decay." This edit appears to add more words without really changing the meaning conveyed. I prefer the existing wording. Zad68 12:52, 1 October 2013 (UTC)

I see what you mean. How about "Water fluoridation is the controlled addition of fluoride to a public water supply. This is done with the belief that this reduces tooth decay, even though there are conflicting studies on effectiveness and safety. Campoftheamericas (talk) 18:04, 1 October 2013 (UTC)

Unfortunately that would put the opening sentences of the lead at odds with the content in the article body, and specifically the information in the section Evidence basis: Effectiveness. That section states pretty clearly that fluoride is indeed effective and good-quality secondary sources are cited in support. The lead needs to summarize the article body, it really can't contradict it. Zad68 18:26, 1 October 2013 (UTC)

NPOV concerns

I was randomly selected for the RFC and I don't have any experience arguing about water fluoridation. However, it seems that the overwhelming amount of evidence supports the idea that fluoridation is completely safe. Adding caveats like Campoftheamericas proposes would be at odds with scientific consensus. Andrew³²⁷ 19:13, 1 October 2013 (UTC)

After reading this article, you may believe this. http://www.columbian.com/news/2013/may/19/fluoride-question-portland-water-supply-vote/#.Uksgm9j0f6o and https://en.wikipedia.org/wiki/Fluoridation_by_country Campoftheamericas (talk) 19:31, 1 October 2013 (UTC)

I don't have any deeply held feelings on the matter, but I just can't find any major peer reviewed study that has found any harm in fluoridation. Feel free to find something in any of these journals if you want to change my mind. Andrew³²⁷ 19:41, 1 October 2013 (UTC)

Try other search engines. For example: http://scholar.google.com/scholar?q=drinking+water+fluoride+toxicity. Or use the work of someone else who has done the search for you: http://www.adelaide.edu.au/library/guide/med/wd.html Campoftheamericas (talk) 19:57, 1 October 2013 (UTC)

Google Scholar, ProQuest, and Ebsco Host are all giving me basically the same results. Too much fluoride is bad and there are documented cases from India and elsewhere where natural fluoridation levels are unhealthy. The literature appears to agree that the amount put in drinking water is good. I'm just not finding replicable studies in peer reviewed journals that connect municipal fluoridation with negative effects. Andrew³²⁷ 20:10, 1 October 2013 (UTC)

The null hypothesis is, and will continue to be, that fluoride is toxic to humans at any level. It is not a nutrient. You could do the same study with trace amounts of cyanide in the water supply, and have a hard time proving that the trace amounts have a detrimental effect on human health. Sure, at higher amounts cyanide will kill you, but at trace amounts we do not have sufficient evidence that it is harmful. This is poor use of logic. Most developed nations do not fluoridate their drinking water. For reading about the toxicity of fluoride, see here: http://www.slweb.org/bibliography.html Campoftheamericas (talk) 20:38, 1 October 2013 (UTC)

The Environmental Protection Agency actually has standards for how much cyanide is safe to drink. On the flipside, water toxicity has been well established, meaning that water is toxic if consumed in high enough doses. What you need to prove is that the level of fluoride in municipal water systems is unhealthy, and you need to do it using respected peer reviewed medical journals. Andrew³²⁷ 20:49, 1 October 2013 (UTC)

The null hypothesis is, and will continue to be, that fluoride is toxic to humans at any level. I could also discredit previous studies for conflict of interest, correct? Campoftheamericas (talk) 21:03, 1 October 2013 (UTC)

That's not the null hypothesis. The studies I've found use variations of this as the null hypothesis: "Drinkers of fluoridated and non-fluoridated water have no differences in terms of long-term health outcomes." Besides, Wikipedia doesn't have a null hypothesis. It uses reliable sources, and you have yet to cite a single peer-reviewed medical journal article that clearly states that municipal water fluoridation causes any negative effects whatsoever. I am still open to reading any such article. The consensus of reliable medical sources appears to be that fluoridation is a good thing. Andrew³²⁷ 21:25, 1 October 2013 (UTC)

Evidence that water fluoridation is not a good thing: from http://www.ncbi.nlm.nih.gov/pubmed/10916327 " Importantly, this means that fluoride incorporated during tooth mineral development at normal levels of 20 to 100 ppm (even in areas that have fluoridated drinking water or with the use of fluoride supplements) does not measurably alter the acid solubility of the mineral. Even when the outer enamel has higher fluoride levels, such as 1,000 ppm, it does not measurably withstand acidinduced dissolution any better than enamel with lower levels of fluoride. Only when fluoride is concentrated into a new crystal surface during remineralization is it sufficient to beneficially alter enamel solubility. The fluoride incorporated developmentally, that is, systemically into the normal tooth mineral is insufficient to have a measurable effect on acid solubility. 21,3" What this is saying, is that fluoride ingested and incorporated into tooth enamel as children develop, has no measurable effect on preventing cavities for the life of the tooth In other words, there is no benefit to ingesting fluoridated water. Campoftheamericas (talk) 22:10, 1 October 2013 (UTC)

What edit are you suggesting using this source, Featherstone 2000? It's 13 years old and using it would be a problem per WP:MEDDATE. Regardless, its abstract says the same thing more up-to-date sources say: Fluoride in drinking water and in fluoride-containing products reduces caries through topical action. I'm not sure how you're getting Evidence that water fluoridation is not a good thing out of it. Zad68 01:05, 2 October 2013 (UTC)

I see you modified your statement after I replied to it, I really wish you wouldn't do that, please. Yes, I agree with you that the medical literature indicates that the anticavity action of fluoride is topical (as I said) and not systemic. The article already states that pretty clearly. I think historically people used to believe the effect was systemic but that's not the consensus today. Still not sure what the issue is you're looking to address. Zad68 02:08, 2 October 2013 (UTC)

Overall uncertainty, for both stances: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2001050/ "Given the certainty with which water fluoridation has been promoted and opposed, and the large number (around 3200) of research papers identified,9 the reviewers were surprised by the poor quality of the evidence and the uncertainty surrounding the beneficial and adverse effects of fluoridation." Also note: "Fluoride is not in any natural human metabolic pathway." In other words, fluoride is not nutrient. Water is a nutrient. Campoftheamericas (talk) 22:17, 1 October 2013 (UTC)

This source Cheng 2007 is a nice overview of the controversies and has been used in our Wikipedia article since at least the time it was promoted to WP:FA. It's still being used now. Cheng 2007 doesn't mention "nutrient" anywhere in it, it's unclear what article edit you're proposing using this source, or why you're bringing up this "nutrient" idea. Zad68 01:09, 2 October 2013 (UTC)

Yes, the quotes above are from Cheng 2007. Also this quote: "there have been no randomized trials of water fluoridation", which means that there is not PROOF that water fluoridation reduces cavities. This Wikipedia article reads like a pro-fluoridation activist article. It does not express the current scientific establishment. Campoftheamericas (talk) 02:45, 2 October 2013 (UTC)

This Wikipedia article ... does not express the current scientific establishment <== Demonstrating that this is true through the proper use of authoritative reliable sourcing that meets WP:MEDRS is the one and only path to seeing changes to the article stick. I think most of the editors here don't agree with your statement, and feel the article already does express the views of the current scientific establishment. The sources you've brought, or your use of them, haven't yet made a convincing argument that there's a NPOV problem. Zad68 02:58, 2 October 2013 (UTC)

Edit Protection

Please keep the NPOV tag, to show that the neutrality is being discussed on the talk page. — Preceding unsigned comment added by Campoftheamericas (talk • contribs) 03:55, 2 October 2013 (UTC)

I see you applied a {{Edit protected}} template at the top of the page. That template is not for requesting page protection (it's for requesting edits to be made to a protected page), so I removed it. If you want to request protection, see WP:RFPP and follow the instructions there, although we should probably wait and see what the outcome of the WP:ANEW report is first, as page protection is a possible result from that. Zad68 04:01, 2 October 2013 (UTC)

NPOVN discussion notice

Note to editors: A WP:NPOVN noticeboard discussion has been opened about this article here. Zad68 19:10, 1 October 2013 (UTC)

And now an AN/EW. TippyGoomba (talk) 03:33, 2 October 2013 (UTC)

Sigh, edit-warred over a POV tag and got a 72 hour ban. TippyGoomba (talk) 04:36, 2 October 2013 (UTC)

Consensus over POV tag

To be clear, is there a consensus to add a POV maintenance tag to this article? I do not believe it is necessary, but I want to give a chance for broader input. I won't bother with an RFC unless there is more disagreement than I'm expecting. Andrew³²⁷ 15:50, 8 October 2013 (UTC)

I'm not sure what you're querying the necessity of—the discussion, or the tag? (Neither seems necessary.)

If there is an NPOV dispute on this article, it would be helpful to have someone actually summarize the open issues that still require discussion. The {{npov}} template isn't required to indicate that there is a tiny fringe minority that is unhappy about WP:MEDRS, else it would have to permanently decorate every article that doesn't embrace or endorse every pet conspiracy theories. TenOfAllTrades(talk) 18:27, 8 October 2013 (UTC)

Do not agree tag is needed, prerequisites of {{NPOV}} article-wide tag not met. Zad68 19:14, 8 October 2013 (UTC)

Noting also that TippyGoomba recently reverted the addition of the tag here, Jmh649 did here, and BullRangifer did here. It's up to them to provide any further clarification on their positions, but based on their recent reverts, it looks like they don't agree either. Zad68 19:18, 8 October 2013 (UTC)

Thanks, all. There are enough anti-fluoridation people out there that it's worth confirming that consensus still supports the article text as written. I completely agree that the article is written in a neutral manner. Andrew³²⁷ 19:59, 8 October 2013 (UTC)

I'm neither decidedly pro- or anti-fluoridation (I use fluoride toothpaste and drink the water), but I do not think that the article as written is neutral. It appears strictly pro-fluoridation and one-sided in my read. It feels like it is written to by anti-anti-fluoridation campaigners, and overstates the certainty of absolute safety. It does not fairly convey recent (post 2005) concern expressed by scientists about the potential impacts of fluoride levels below 4.0 mg/L or even below 1.0 mg/L. This concern is coming from the likes of the National Research Council. In 2006 the National Research Council published a review of the EPA's drinking water standard for fluoride. The report noted evidence for potential negative effects due to fluoridation, including cognitive impairment, impaired thyroid functioning, and increases in bone fractures, in addition to the fluoridosis of children's teeth. The NRC called for a reduction of the EPA's limit of 4.0 mg/L of fluoride in drinking water. It should be noted that this was a higher standard than the recommended levels for water fluoridation (targeting levels from 0.7 to 1.2 mg/L). However, members of the committee were quoted in an article published in a Scientific American expressing some concern about the fluoride exposure even at those levels.

John Doull, the chair of the NRC committee, expressed “worry” about the thyroid issue, and said that overall there was a surprising deficit of scientific information.

“What the committee found is that we’ve gone with the status quo regarding fluoride for many years—for too long, really—and now we need to take a fresh look. In the scientific community, people tend to think this is settled. I mean, when the U.S. surgeon general comes out and says this is one of the 10 greatest achievements of the 20th century, that’s a hard hurdle to get over. But when we looked at the studies that have been done, we found that many of these questions are unsettled and we have much less information than we should, considering how long this [fluoridation] has been going on. I think that’s why fluoridation is still being challenged so many years after it began."

In the Scientific American article:

"the NRC report...found that infants and toddlers in fluoridated communities ingest about twice as much fluoride as they should. Furthermore, the committee noted that adults who drink above-average amounts of water, including athletes and laborers, are also exceeding the optimal level for fluoride intake."

This is a specific place where the wiki article "slants" the interpretation of the NRC report. Members of the NRC committee, both within the report, and commenting in the media, said that their review of the scientific literature lead them to have some concerns about levels and impacts of water fluoridation, but the wiki article just says that the NRC report pertains only to high levels of natural fluoride.

Clearly, water fluoridation has been the subject of less-informed critics (conspiracy theorists, if you will). But that doesn't mean that every critic of the current water fluoridation regime is a crack pot. Pigkeeper (talk) 18:50, 24 November 2013 (UTC)

Generalization based on 11 year old study criteria

Zad68, wants to discuss the removal of the claim = "Studies on adverse effects have been mostly of low quality." and "With regard to potential adverse effects, almost all research has been of low quality." https://en.wikipedia.org/w/index.php?title=Water_fluoridation&diff=prev&oldid=576431509 This generailzation on the science is based on review criteria from 2002 http://www.nature.com/bdj/journal/v192/n9/full/4801410a.html Because the statement is based on a 11 years old review criteria, it gives a false impression on current studies on potential adverse effects. Prokaryotes (talk) 13:13, 9 October 2013 (UTC)

I'd be OK with changing the text to "A comprehensive 2002 study on fluoride safety found that studies of adverse effects were generally of low quality." Andrew³²⁷ 13:25, 9 October 2013 (UTC)

The source suggest otherwise "The small quantity of studies, differences between these studies and their low quality rating suggests caution in interpreting these results." Prokaryotes (talk) 14:13, 9 October 2013 (UTC)

(e/c) Are there more up-to-date reviews we can cite to support the same statements? Can we resolve the concerns by instead stating in the article the year the source was published? Zad68 13:27, 9 October 2013 (UTC)

This meta analysis shows adverse effects on the brain http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3491930/ Prokaryotes (talk) 13:29, 9 October 2013 (UTC)

Ah, yes, Choi 2012. The quality of that study is hotly debated, and even if it weren't, what they looked at isn't actually relevant to this article. Their conclusion was based on exposure to fluoride at levels many times higher than found in water fluoridated for dental health. So I don't think it's useful for these statements. Zad68 13:33, 9 October 2013 (UTC)

Choi et al 2012 isn't hotly debated, as far as i know there was 1 dispute which was based on a misunderstanding. Prokaryotes (talk) 14:22, 9 October 2013 (UTC)

(edit conflict) It appears that the study you cite refers to naturally occurring levels of fluoride as opposed to intentional water fluoridation. There's no doubt that too much fluoride is a bad thing, just like too much water. But I have not been able to find a study that says that the level of fluoride used in municipal water systems causes any harm. Even the studies conclusions only "support the possibility of adverse effects". Andrew³²⁷ 13:43, 9 October 2013 (UTC)

There's another way that this could have been written, and it points to an overall bias of the page. McDonagh et al are cited in order to dismiss concerns about adverse impacts, on the grounds that studies about adverse effects are of lower quality (mainly because they don't account for potential confounding effects). There is a failure in logic here. The same lack of quality research means that claims of safety (an absence of adverse effects) are also under-supported. As McDonagh et al. say (page xiv), "The research evidence is of insufficient quality to allow confident statements about other potential harms." I read this as saying that there is insufficient evidence to say whether fluoridation safe or unsafe. If you're going to be citing McDonagh et al, why not express what they say about the state of research overall? They also criticize the quality of research for the efficacy of water fluoridation on preventing caries. It is better than the research on safety, but it is still lacking, they say. Why not include the following quote by McDonagh? "Given the level of interest surrounding the issue of public water fluoridation, it is surprising to find that little high quality research has been undertaken." This aligns with the quote from the NRC Commission chair, above. Two groups of scientists conducted in depth reviews and both found that the scientific research basis for water fluoridation (efficacy, and especially safety) was less than you would expect for such an old and widespread program.Pigkeeper (talk) 19:56, 24 November 2013 (UTC)

WP:SYNTH

Goal section: Once a cavity occurs, the tooth's fate is that of repeated restorations, with estimates for the median life of an amalgam tooth filling ranging from 9 to 14 years.[23] Oral disease is the fourth most expensive disease to treat.[24]

Suggesting that tooth decay (dental caries) is the fourth most expensive disease to treat. As the source states, oral disease is not only dental caries, it includes periodontal disease, tooth loss, oral mucosal lesions, oropharyngeal cancers, oral manifestations of HIV/AIDS, necrotising ulcerative stomatitis (noma), orodental trauma. Periodontal disease and tooth loss are linked to chronic diseases such as diabetes mellitus.

It's as if in the article cerebrovascular disease, one would write "30% of all global death is attributed to cardiovascular disease". Ssscienccce (talk) 15:57, 6 December 2013 (UTC)

Mechanism section: Fluoride's effects depend on the total daily intake of fluoride from all sources.[12] ... Drinking water is typically the largest source of fluoride. In many industrialized countries swallowed toothpaste is the main source of fluoride exposure in unfluoridated communities. ...

Suggesting that fluoride intake is what determines the protective effect on tooth enamel, despite previously stating that the effect is mainly due to topical, not systemic fluoride. The source document itself is not about the beneficial effects or the mechanism, it deals mainly with adverse effects due to excess systemic fluoride. Of the 125 pages, 43 are about methods to remove fluoride from drinking water, 15 about testing fluoride content, and 28 pages of country specific data on skeletal and dental fluorosis associated with fluoride in drinking water. Ssscienccce (talk) 16:43, 6 December 2013 (UTC)

minor typo

"No clear evidence of other adverse effects exists though almost research thereof has been poor" - somebody accidentally a word, I think. Should be "almost *all* research". Would fix but page is locked and I have no account. — Preceding unsigned comment added by 91.237.176.7 (talk) 16:01, 27 January 2014 (UTC)

Y Done. Thanks! 0x0077BE [^talk/_contrib] 01:58, 16 February 2014 (UTC)

Natural Fluoride levels correlated to cognitive impairment, and implications for water fluoridation; impacts were found at levels which were not "much higher" than fluoridation targets

Choi et al 2012 is a major Meta-Analysis by a Harvard and Chinese team which found an association between higher fluoride levels and lower IQ. It can be found at http://www.hsph.harvard.edu/news/features/fluoride-childrens-health-grandjean-choi/

This was discussed previously ( https://en.wikipedia.org/wiki/Talk:Water_fluoridation/Archive_9 ). Someone referenced the article and suggested it for inclusion (without making a case). Some thought it would be good to include it. Others argued against its inclusion for two reasons. First, it was argued that this page is about human-caused water fluoridation, not naturally occurring higher levels of fluoride. Second, it was argued cognitive impacts were found at water fluoride levels which were were "far in excess of WHO recommended levels" of 1.5 mg/L. People made cheeky comments that even water is toxic at very high doses.

This was too hasty a decision. There should be a reconsideration, and Choi et al should be included on this page. At a bare minimum, IQ reduction should be added to the adverse effects of elevated levels of natural fluoride in water. [Safety section] However, from Choi et al, there is justification for making a stronger statement.

First, as the article currently stands, there are references to adverse effects associated with high levels of naturally occurring fluoride in water. But this does not included reduction in IQ. Why not?

Second, most of the studies which Choi et al reference show reduced IQ scores at fluoride concentration levels which are NOT "much higher" than WHO levels (as one wikipedian said), but rather are within the same order of magnitude. From table one, I count 19 studies which look at drinking water levels within an order of magnitude of the WHO levels--and most of them were much closer than an order of magnitude. Seventeen of those found that children from areas with higher-fluoride water had significantly lower IQ.

Not good enough for you? I counted 12 studies where the "high dose" of fluoride was less than 3x the WHO recommendation, and in 10 of those, there was a detectable decrease in IQ. That's really a big deal. Consider the therapeutic ratio for drugs. Drugs which have toxic effects at 3x the therapeutic range are considered dangerous. Of course, when you're dosing whole populations with the water, dosing levels are anything but exact. Some people drink more water. And in the United States, people get a good deal of fluoride from other sources besides drinking water, too. (Fagin 2008 citing Levy's work)

Furthermore, there is a 2011 article ( http://www.ncbi.nlm.nih.gov/pubmed/21237562 ) which addresses the question of "whether low fluoride exposure levels less than 3.0 mg/L in drinking water adversely associated with children's intelligence". Children from several sites in Inner Mongolia, China were compared, where there was natural fluoridation at lower levels in the drinking water (0.24–2.84 mg/L). The sample size was 331 children, and a comparison was made between the children's urine fluoride levels and IQ. From the abstract: "Urine fluoride was inversely associated with IQ in the multiple linear regression model when children’s age as a covariate variable was taken into account (P< 0.0001). Each increase in 1 mg/L of urine fluoride associated with 0.59-point decrease in IQ (P= 0.0226). Meanwhile, there was a dose–response relationship between urine fluoride and dental fluorosis (P< 0.0001). In conclusion, our study suggested that low levels of fluoride exposure in drinking water had negative effects on children’s intelligence and dental health and confirmed the dose–response relationships between urine fluoride and IQ scores as well as dental fluorosis."

Something about this deserves to make it on the page, in the safety section. This isn't manufactured hysterical controversy, this is the real deal.Pigkeeper (talk) 23:37, 24 November 2013 (UTC)

To include such information in this article you need to find a high quality WP:MEDRS compliant source that mentions artificial water fluoridation safety in this context. Splicing together different studies as you propose above is clear WP:SYNTH. Yobol (talk) 00:34, 25 November 2013 (UTC)

That's a reasonable statement. However, neglecting any mention of the very real and repeated risks of fluoridation in multiple contexts to public health from multiple extremely credible sources in study after study may reduce the value of Wikipedia as reference material.

Both the Choi et al. meta-analysis and the small Ding et al. (2011, [2]) study were discussed across multiple sections on that archive page; I don't think you're being fair or accurate to suggest that the previous discussions were as brief or dismissive as you make them out to be. There was broad agreement that the proper place to consider the Choi study was in our article on fluoride toxicity.

Ding et al. is actually a good example of why we don't – and why we shouldn't – rush to include primary papers as sources for medical claims (not to mention why the abstract of an article should never be trusted by itself). While it appeared in a reasonably reputable journal, it also fell well outside the usual types of studies published in J. Hazardous Mater.. That journal does a lot of physical chemistry, and detection of environmental chemicals and toxins, and remediation strategies, and a wee bit of wet biology, and so forth, but precious little in the way of direct studies of human health and epidemiology (speaking anecdotally, I couldn't find any other such studies in any of the journal's recent articles or last couple of issues). It raises a red flag when a paper doing clinical chemistry and public health studies doesn't make it into a medical or public health journal. The paper itself has a number of gaps in its analysis and problems with the robustness of its raw data (which I won't go into for WP:NOTFORUM reasons), and the variety of conclusions drawn from the data (or selectively not drawn, when looking at the full paper) is quite a bit broader than one might infer from looking only at the article's (presumably length-constraimed) abstract. TenOfAllTrades(talk) 16:14, 16 February 2014 (UTC)

Addition

Have brought this here for discussion "A 2012 meta-analysis found that fluoride exposure may be associated with adverse neurodevelopmental outcomes in children, as manifested in lower IQ scores,though the authors cautioned that its results are not really applicable to the United States as their research focused on much higher levels of fluoride exposure."

The ref [3] does not appear to be about water fluoridation but high levels of naturally occuring fluoride. Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:04, 23 February 2014 (UTC)

Agreed, it's important to understand the difference between problems with large amounts of the substance and problems with the level present in drinking water. Studies have shown serious issues arising from excessive levels of fluoride, but not from the small amounts that we drink. Andrew³²⁷ 18:33, 23 February 2014 (UTC)

This is just Choi et al. (2012) again, which has been discussed to death on this talk page. Heck, the most recent conversation about it is right at the top of this page. TenOfAllTrades(talk) 18:50, 23 February 2014 (UTC)

Perhaps it's worth considering what Philippe Grandjean (professor), the lead author of Choi et al., has to say about this paper, namely that its results "do not allow us to make any judgment regarding possible levels of risk at levels of exposure typical for water fluoridation in the U.S. On the other hand, neither can it be concluded that no risk is present." [4] Jinkinson talk to me 20:29, 23 February 2014 (UTC)

Also, here's an even stronger statement by Grandjean: "Fluoridation's

potential to produce "chemical brain drain," Grandjean writes, is an issue that "definitely deserves concern." And: ""only 4 of 27 studies" in the Harvard review used the high levels that the Wichita paper described, and "clear differences" in IQ "were found at much lower exposures." [5] Note: the "Wichita paper" refers to this article. Jinkinson talk to me 02:53, 24 February 2014 (UTC)

"Fluoride Action Network" is not a reliable source. Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:59, 24 February 2014 (UTC)

Alright, I guess that's true, but I still find it far-fetched that FAN would completely make up those quotes and then attribute them to Grandjean if he didn't actually say them. Jinkinson talk to me 03:17, 24 February 2014 (UTC)

Are they published in a recent review article? Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:23, 24 February 2014 (UTC)

Oh, Grandjean said it – it's at the bottom of this press release – but FAN doesn't seem to notice that he (and the first author of the paper, Choi) issued a second "revised" release a week later that walked back the overreach in Grandjean's original statement. Grandjean and Choi return to and restate the conclusions from their paper: that extremely high levels of fluoride appear to be harmful, that no conclusion can be drawn regarding fluoride at levels in artificially-fluoridated water, and that further study is warranted (please fund us). This is, incidentally, why we don't base Wikipedia article content on "science by press release". TenOfAllTrades(talk) 03:34, 24 February 2014 (UTC)

Lancet Neurology Study

This new study, conducted by a professor at Harvard's School of Public Health, was published in a high impact journal is compelling and should be integrated in this article. I heard about this study on NPR, and it has rightly gotten much press. I say "rightly" because this review of research was published in a high impact journal and was conducted by a professor at Harvard (even Harvard's press release about this study is noteworthy). http://www.thelancet.com/journals/laneur/article/PIIS1474-4422(13)70278-3/abstract DanaUllman^Talk 16:04, 24 February 2014 (UTC)

Yes it is a 2014 review articles in Lancet Neurol. The problem is that it does not appear to mention "water fluoridation" So what should we use it to say? Yes we all agree that large amount of fluoride are bad. So are large amounts of iron as they fairly rapidly result in death. Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:27, 24 February 2014 (UTC)

Based on this important new review of research, it seems prudent to reduce exposures to certain elements, such as fluoride, and its various means to exposure, especially for children whose brains are in more active development. Because Doc James is a special in preventive medicine, I assume that he has some appreciation for the precautionary principle. I'm no expert on water fluoridation and do not plan to participate in the writing of the article, but I hope that those of you who are active in this article will figure out a place for this body of evidence. DanaUllman^Talk 01:31, 25 February 2014 (UTC)

Yes well aware of the precautionary principle. The difficulty in question is that the article you list does not mention water fluoridation. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:57, 25 February 2014 (UTC)

The article in question provides a strong case for limiting exposure to certain toxic substances, and because fluoride in water provides additional exposure, it seems obvious that fluoridated water creates additional risk to populations, not just because of people drinking the water but also due to people using water to wash fruits and vegetables and to water their edible gardens. Whether fluoride in water is naturally occurring or fluoride in water is an added ingredient, it seems prudent to warn people about the dangers of both, especially because the evidence here commands it. DanaUllman^Talk 15:39, 25 February 2014 (UTC)

Everything after "it seems obvious..." in your statement above is unsupported by the linked paper (or the 2012 Choi meta that its fluoride claims are based on). As Wikipedia article talk pages are not discussion forums for general chat, I hope that you can understand why I would ask you to propose specific changes to this article (and indicate specifically which passages of the source support your proposed statements) if you would like to continue posting on this talk page. TenOfAllTrades(talk) 16:00, 25 February 2014 (UTC)

In the article's section on "Evidence," there is the statement: "No clear evidence of other adverse effects exists, though almost all research thereof has been of poor quality." At the very least, there is clear evidence now from a couple meta-analyses published in high impact journals that provide evidence from high quality studies verifying dangers to exposure to fluoride. For starters, this statement now needs to be removed. DanaUllman^Talk 03:53, 26 February 2014 (UTC)

I can't believe I actually have to point this out, but that statement is in a paragraph that specifically says it's talking about "water fluoridation". I know it's been mentioned many times exactly what that means, that this whole article is limited to that scope, and that the ref is not within that scope. DMacks (talk) 04:36, 26 February 2014 (UTC)

Z I'm in agreement with the others here that the Lancet article doesn't appear to be related to the topic of water fluoridation so that it can be used here. DanaUllman, what exactly is your proposed change to the Wikipedia article using this source? Without a specific change proposal this discussion doesn't appear to be a good use of time. Zad68 05:03, 26 February 2014 (UTC)

[User:Zad68] has asked me what "specific" change I was recommending. I thought I was clear about this. I will reiterate: "At the very least, there is clear evidence now from a couple meta-analyses published in high impact journals that provide evidence from high quality studies verifying dangers to exposure to fluoride. For starters, this statement now needs to be removed." And for the record, the research that I referenced provided evidence that fluoride can lead to disruption in cognitive function, and because water fluoridation increases exposure to fluoride, there IS a case for why reference to this study in a high impact journal is worthy of reference in this article. If I am the only one who considers this reference worthy, I will relent, but in any case, the above mentioned sentence still deserves to be deleted. DanaUllman^Talk 02:13, 27 February 2014 (UTC)

Can you please quote the exact passage from the paper that specifically contradicts the statement in this Wikipedia article? Like Zad68 and DMacks, I cannot find any mention of water fluoridation – the controlled addition of small, regulated amounts of fluoride to drinking water – in Grandjean's review. (As I noted a few days ago at Talk:Water fluoridation controversy, you appear to be conflating and confusing fluoridation and fluoride.)

As far as I can see, of the 115 footnotes in Grandjean, just one deals with fluoride toxicity: the already much-discussed Choi et al. 2012 meta on which Grandjean was senior author. That paper deals with studies of naturally-occurring, uncontrolled, high fluoride levels in rural Chinese water supplies; it further explicitly notes that no conclusions can be drawn from the data regarding the (potential) toxicity of fluoride exposure at the levels used for water fluoridation. TenOfAllTrades(talk) 02:58, 27 February 2014 (UTC)

My apologies for confusing people here when asked what I was specifically recommending as a change in the article. Although my original comment above was clear, my repetition of this comment was not clear and was erroneous. I meant to say that this sentence needs to be deleted from the section on "Evidence": "No clear evidence of other adverse effects exists, though almost all research thereof has been of poor quality." DanaUllman^Talk 02:14, 1 March 2014 (UTC)

Once again, you have failed to identify the passage within Grandjean that contradicts the sentence you're asking be deleted. There remains no clear evidence of other adverse effects of water fluoridation—the topic of the sentence in question and of this entire article. The only adverse effects that Grandjean has published on deal with uncontrolled exposure to high concentrations of (naturally-occurring) fluoride – generally significantly greater than those in fluoridated water – and even those possible effects are based on studies which Grandjean himself acknowledged suffer from incomplete data and methodological flaws. You're insisting on reading into Grandjean something that just isn't in his papers, and you're pushing deep into WP:IDHT territory to do it. TenOfAllTrades(talk) 02:58, 1 March 2014 (UTC)

Agree with Ten, I don't see support for this change with the source provided. Unwilling to continue down the path of repetitious arguments any further, so if that's all that's happening here it's probably best to just stop responding. Zad68 05:26, 5 March 2014 (UTC)

what about this info from NZ government site

Some of the earliest opponents of fluoridation were biochemists and at least 14 Nobel Prize winners are among numerous scientists who have expressed their reservations about the practice of fluoridation [6] 212.200.213.54 (talk) 20:46, 26 March 2014 (UTC)

Discouraging new contributions on this topic

Wikipedia is a challenging site to edit.. and takes some time to do so. As only an occasional editor, it is discouraging to have had my edits completely undone. It was fair to list the key and effective lawsuit in Israel and the resulting change in public policy. When the editors on this site reverted all work based on my citing the Choi study, the didn't remove part of it.. they removed the whole thing.

A process that is destructive to the contributions of less familiar contributors who have interest in the subjects progress!

The second effort was to properly categorize the two facts as controversy since they were not the majority opinion. That should have been let stand. I referenced the very detailed debate on why the Harvard Choi study was not listed because upon examination saw that great detail went into it. If it offended I would not have repeated it. Also again, shouldn't the editors of this page have simply removed that and not all contributions.

There seems to be a very aggressive group protecting this page. When I tried to reference one site, the computer showed me it was a blacklisted site. I found that odd as it seemed to be a simply activist site on the topic.

For all of the guarding of this page and topic, against possible zealots, the result is you are frustrating reasonable contributors.. at least me for certain, and the article has so much run on repetition it looks like a bad sales page quite frankly.

The cartoon under the Ethics topic is just prejudicial and insulting grouping dissenting opinion together with other groups.

This page has a long way to go. Please realize this is a moving subject and many quotes and sources are OLD dated and not reflective of key changes. Israel banned the use of Fluoridation after a public lawsuit. That's a whole nation, why remove that?

Please put back the content on controversy and remove the comment that offended. Thank you for any assistance!!

WikiShares (talk) 22:30, 26 March 2014 (UTC)

You are trying to edit a featured article and one of the most controversial at that. Please have a read of WP:MEDRS. Plus part of what you are attempting has been discussed above.Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:06, 26 March 2014 (UTC)

Compounds used

Reverted this [7] as the compounds were already mentioned Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:01, 27 March 2014 (UTC)

Fluoride vs Fluorides

The summary paragraphs are too long it obscures the Index it its fervor to sum up the process. Let readers click to topics of interest. And left out of the full screen of summary is reference to the key component being varied.

More importantly the use of fluoride is oversimplifying.. Early on varying Fluoride Compounds should be referenced, letting the reader find the variations below and not mistakenly assume as was once commonly thought a naturally occurring substance. The most predominantly used Fluoride compound is an acid compound, and was derived from fertilizer. I understand that is not a warming comment but it is real. So at the very least.. one or more of varying Fluoride compounds are added might lessen the over simplification of the summary. We do want to suggest early on that the reader look further into the types.. and might learn.. of calcium fluoride vs Fluorosilicic acid - https://en.wikipedia.org/w/index.php?title=Water_fluoridation&diff=601624283&oldid=601442814 That is what is added for the most part. WikiShares (talk) 14:13, 28 March 2014 (UTC)

Lead is fine and follows policy. Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:27, 28 March 2014 (UTC)

From the standpoint of what comes out of the tap, fluoridation with sodium fluoride versus sodium fluorosilicate or fluorosilicic acid is essentially indistinguishable. At high dilution (low concentration) and near-neutral pH – that is, under the conditions at which the compounds are used in water fluoridation – fluorosilicates are rapidly and completely hydrolyzed into fluoride and trace amounts of inert silicon dioxide. (Silicon dioxide, incidentally, is the major chemical ingredient in the glass you're drinking the water from.)

As for the "acid compound" and "derived from fertilizer" stuff—I'll file that under 'factual but irrelevant and misleading'. The former is an appeal to the sort of 'acids are scary!' cartoon view of chemistry, preying on the relative lack of knowledge of readers to attempt to scare them. The latter is implicitly some combination of genetic fallacy and appeal to nature, again with the intent to scare without informing. It would be technically correct – and equally misleading – to say "Oranges contain acid compounds derived from fertilizer". We treat our readers with more respect than that. TenOfAllTrades(talk) 14:49, 28 March 2014 (UTC)

The verifiability policy

The new Choi/ Harvard study must be admitted based on Wikis Verifiability policy which is as follows:

"The threshold for inclusion in Wikipedia is verifiability, not truth — that is, whether readers are able to check that material added to Wikipedia has already been published by a reliable source, not whether we think it is true".

The Choi Harvard Study has been quoted by Harvard it its own press release supporting the research, Huffington Post, and Fox News to name a few. It is verifiable! It must be admitted as a reference on this topic of varying opinion... even if it is considered the minority, it can be shown as such. But realize it is decades newer so minimizing fewer new studies in favor of many old studies is not exactly cutting edge research, as people want to see. Its simply old science we are showing. Obviously studies based on longer time periods available have more data to utilize so it is highly imprudent to have delayed this so long.

WikiShares (talk) 06:23, 28 March 2014 (UTC)

On the same policy page you are referring to, it states (and I quote): "While information must be verifiable in order to be included in an article, this does not mean that all verifiable information must be included in an article. Consensus may determine that certain information does not improve an article, and that it should be omitted or presented instead in a different article." So there's really no "must" on what you are trying to include; except that you "must" stop trying to include it against consensus. Doc talk 08:20, 28 March 2014 (UTC)

It is helpful, when discussing sources, to include both a full citation and/or a link to the study so that we know which study we're talking about, and to avoid confusion. When you say 'new Choi/Harvard' study, do you mean Choi et al. (in Grandjean's group) from 2012, or is there a newer 'new' Choi paper? If the former, then you should know that the 2012 paper – and where it might be useful to Wikipedia – has been pretty thoroughly discussed on this talk page in the past; searching archives (using the search box near the top of this page) will find those for you.

As Doc9871 notes, reliability (per WP:RS and WP:MEDRS) is just one criterion for inclusion of material in a Wikipedia article; specific relevance and appropriate context (per WP:NPOV, especially WP:UNDUE) are others.

As a bit of general Wikipedia editing advice, when opening a talk page discussion about a specific edit or proposing the addition of particular text, it's very helpful to include a diff showing the edit, or a copy of the proposed new text, or at least a specific-as-possible description of the proposed change. Discussions about the use of sources always need to address two elements: the source itself, and how the source is intended to be used to support a specific portion of a Wikipedia article. TenOfAllTrades(talk) 13:06, 28 March 2014 (UTC)

Ten, thanks for the politeness and tips, I am finding this a cumbersome process. LOL. Lets begin with simple things that go to the datedness of this featured article. Firstly and most obviously a dated article.. is the politically incorrect pejorative reference to economically disadvantaged persons as "the poor". This was corrected quite decently of me and reverted. I found that reckless and frustrating, as if the editors were so single minded of purpose the goal being simple to guard the hope diamond, a hopelessly dated pitchy article on a very key, in trending topic, and embarrassment to Wiki. Hopefully this is a diff.. ha https://en.wikipedia.org/w/index.php?title=Water_fluoridation&diff=601624283&oldid=601453146 — Preceding unsigned comment added by WikiShares (talk • contribs) 13:52, 28 March 2014‎

As near as I can tell, no one has reverted your change of "the poor" to "economically disadvantaged". It appears that you made that change with this edit. That edit appears to have inadvertently introduced a grammatical error by deleting the first part of another paragraph (by removing the Although water...); that error was corrected by Piguy101 in this edit, but the rest of your change was left unmodified. (As a general style note/opinion – and an argument that I'm not interested in starting or carrying on here – I'm not sure that you're going to get universal agreement that "the poor" is pejorative when used in an appropriate context, and you may get some pushback if you get too aggressive in trying to replace it widely with what some will see as a rather cumbersome euphemism.) TenOfAllTrades(talk) 14:20, 28 March 2014 (UTC)

We should be writing with simple English, thus "the poor" is better than "economically disadvantaged" Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:28, 28 March 2014 (UTC)

I reverted the word back to "poor". Many people reading these articles are not native English speakers and do not understand the Western practice of using long unusual words as a show of respect to disadvantages persons. This community has literally thousands of pages of debate in the Manual of Style for best practices for all kinds of purposes and there is consensus for not using new jargon terms when older simple words are better understood. You could petition for change as we do wish to be as respectful as possible, but this might best be done by building off the existing precedent and years of past discussions advocating for simplicity in presentation rather than debating a single instance in a single article. Thoughts? Blue Rasberry (talk) 14:54, 28 March 2014 (UTC)