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In other words, what happens when a population suddenly stops taking fluoride in their drinking water, like Juneau's citizenry did?
Now, thanks to a recent study led by first author and public health researcher Jennifer Meyer from the University of Alaska Anchorage, we've got new insights into the subsequent effects.
In the study, Meyer assessed Medicaid dental claim billing records for two groups of children and adolescents aged 18 or under.
One of these groups represented what the researchers call "optimal" community water fluoridation (CWF) exposure: 853 non-adult patients on behalf of whom Medicaid dental claims were filed in 2003, years before the fluoride cessation began in 2007.
The other group was made up of 1,052 non-adult patients from families who similarly met Medicaid income requirements, and who made the same kind of dental claims almost a decade later, in 2012.
[...] "By taking the fluoride out of the water supply... the trade-off for that is children are going to experience one additional caries procedure per year, at a ballpark (cost) of US$300 more per child," Meyer explained to KTOO News.
Reference: Jennifer Meyer, Vasileios Margaritis & Aaron Mendelsohn, Consequences of community water fluoridation cessation for Medicaid-eligible children and adolescents in Juneau, Alaska, BMC Oral Health, https://doi.org/10.1186/s12903-018-0684-2
(Score: 5, Insightful) by FatPhil on Monday December 16 2019, @08:28AM (23 children)
Americans seem desperate to cling to anti-science at any cost, and this is just another example. I know this story would bring out what's effectively an anti-vax loon almost immediately, as I remember SN demonstrating a significant membership of that group last time there was a story along these lines.
You're so willfully anti-science, you even deliberately misrepresent their findings. They didn't "compare dental bills charged to medicare" at all. They measured procedures done: "kids who were exposed to fluoride in their tap water had on average 1.55 caries procedures annually – but this jumped to 2.52" (Handy hint, the fact this is what they measured is also in the summary, but your fact-resistence is clearly Pro level and can glide past that ignorantly without even needing to dive into the article itself and ignore all it says too.)
What are the implications of higher numbers of procedures? Higher costs. They're just spelling things out for the beancounters and the libertardians who demand nothing sould ever be spent on anything. Do you never wonder why no-one takes you lot seriously?
Great minds discuss ideas; average minds discuss events; small minds discuss people; the smallest discuss themselves
(Score: -1, Troll) by Anonymous Coward on Monday December 16 2019, @08:32AM (7 children)
If you think this is science just because they collected some data and compared some numbers YOU are the problem. This is cargo cult science. No rational thought went into this paper.
(Score: 4, Insightful) by FatPhil on Monday December 16 2019, @08:43AM (6 children)
If you see a problem with their science, identify it, and refute it, using equal or higher quality peer reviewed studies or metastudies.
I love the fact that them measuring things before and after an isolated change - exactly what do you think they've not controlled for? - makes you consider this not science. You're carrying the wouldn't-know-science-if-it-landed-on-his-desktop-in-a-respected-peer-reviewed-journal torch with quite some pride.
Great minds discuss ideas; average minds discuss events; small minds discuss people; the smallest discuss themselves
(Score: 0) by Anonymous Coward on Monday December 16 2019, @08:50AM (4 children)
An isolated change? There is no isolated change here. Lots of things changed in 11 years regarding dental practice, medicare policies, and prices. Also, it is obvious p-hacking of dates and age groups. Then even after the the underlying numbers they compare are simply incomparable.
Standards have fallen so far and the education system must be so dumbed down for this to get published and taken seriously. And like I said, if this is the best evidence they can come up with for fluoridation then there is the something seriously wrong with that practice.
(Score: 2) by FatPhil on Monday December 16 2019, @09:03AM (3 children)
Proof of the claim of p-hacking of dates requested. Yeah, they looked at a group before and a group after a change - obvious p-hacking to detect a difference across that change /sarc.
Great minds discuss ideas; average minds discuss events; small minds discuss people; the smallest discuss themselves
(Score: 0) by Anonymous Coward on Monday December 16 2019, @09:40AM (2 children)
So standard age groups are 0-6, 0- 7, 7-13, 13-18, and 0-18? No one comes up with age groups like that before looking at the data. Just like no one would only look at 2003 vs 2012 instead of all the data. If they didn't get the result they wanted there they would have paid for more years, etc.
Also, you do not seem to understand what p-hacking is to begin with.
(Score: 3, Informative) by FatPhil on Monday December 16 2019, @09:59AM (1 child)
> Just like no one would only look at 2003 vs 2012 instead of all the data. If they didn't get the result they wanted there they would have paid for more years, etc.
You cannot say that with any certainty. They only looked at one before/after pair, and the data from those years was clear. They did not p-hack, as they did not look at any other years.
It is you who does not understand p-hacking. You have to throw away data that's inconvenient in order to p-hack, they did no such thing. And even if they'd bought 3 years of data from each side of the change, which they didn't, and thrown away the least convenient 2 of each, which they didn't, their p-values would still have been significant (e.g. p<0.004, and p<0.001).
You're making a claim of scientific fraud - that's a serious claim - you need serious evidence to back that up, and you have none (as there is none).
Great minds discuss ideas; average minds discuss events; small minds discuss people; the smallest discuss themselves
(Score: 0) by Anonymous Coward on Monday December 16 2019, @10:08AM
That is wrong, look it up.
(Score: 3, Interesting) by sonamchauhan on Monday December 16 2019, @12:07PM
I see a problem in cost calculation and interpretation.
The authors calculated the increase in dental treatment cost using national CPI numbers. But CPI for Dental Services [in2013dollars.com] increased at a faster clip (43% versus 25% for the period in question).
Second, they ignored the increasing abundance of dentists. In Alaska, the dentist-to-population ratio grew around 17% (give or take a couple percent) for the period in question:
- 2002: 1 dentist for 1233 persons (source data: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1449253/) [nih.gov]
- 2012: 1 dentist to 1045 persons (source data: https://datausa.io/profile/geo/juneau-ak#category_trade. [datausa.io] Data collection year for '2014' report year)
As cost of dental services, and supply of dentists, both increase faster than expected, it's natural there will be a tendency to over-treat. Quoting Upton Sinclair, "It is difficult to get a man to understand something when his salary depends upon his not understanding it." I recall my old dentist telling me he wasn't going to drill certain 'spots' on my teeth -- he said they would "re-mineralise". Another, younger, dentist treating a family member didn't seem to appreciate "re-mineralisation" much, being of the 'drill 'n fill' persuasion. Perhaps, in time the younger man will come around to the older dentist's views.
To draw firmer conclusion, we'd need comparative data on changes in incidence of caries, and changes in the tendency to _treat_ caries, in the general population over the same timespan.
But other than that, on the science I have no problems. This study's results are broadly as expected -- flourine toughens tooth enamel and I'd find it strange if there was no effect. But the study cannot answer a more serious question: what's the effect of that extra flourine (above background) circulating in your bloodstream over decades.
(Score: 0) by Anonymous Coward on Monday December 16 2019, @08:36AM (1 child)
"The mean caries-related treatment cost for the 0- to 18-year-old age cohort was significantly higher in the suboptimal CWF group than that in the optimal CWF group ($593.70 vs. $344.34, p 0.0001) without adjusting for inflation."
This is comparing apples and oranges.. You have to be so ignorant about what you are measuring to even report this result.
(Score: 0) by Anonymous Coward on Monday December 16 2019, @08:40AM
It's Alaska, you moran! Different math up there, doncha know. (Seriously, what a maroon!)
(Score: 4, Interesting) by deimtee on Monday December 16 2019, @09:15AM (5 children)
The evidence is that water fluoridation slightly reduces tooth decay. The benefit is almost zero in those who use a fluoride toothpaste and brush regularly, but significant in those who don't brush or don't use a fluoride toothpaste.
Long term water fluoridation is also correlated with hip breakage in the elderly. 50% of ingested fluoride settles in the bones, where it increases bone density without increasing bone strength.
The question is whether the elderly broken hips cost more or less than the fillings for kids who don't brush their teeth.
If you cough while drinking cheap red wine it really cleans out your sinuses.
(Score: 0) by Anonymous Coward on Monday December 16 2019, @09:20AM
That is not the question this paper attempts to answer at all...
(Score: 3, Informative) by FatPhil on Monday December 16 2019, @09:39AM (3 children)
Youths will use their teeth more than oldies their hips, and that osteoporosis was only correlated with *suboptimal* flouride level (>2ppm, yes, too much is bad, everyone knows that, and has done since the 50s). If you're looking at the economics of healthcare, you've got to multiply everything by the number of years it's in use (and more, it gets complex, but only in ways that make grannies less important, I'm sorry to inform you).
Great minds discuss ideas; average minds discuss events; small minds discuss people; the smallest discuss themselves
(Score: -1, Troll) by Anonymous Coward on Monday December 16 2019, @10:56AM (1 child)
Power is not the efficicacy... Every one of your posts here is BS pseudoscience, just like this study..
(Score: 2) by FatPhil on Monday December 16 2019, @02:24PM
If the natural fluoride level is near optimal levels, (a) the treatment is unnecessary, and will display no efficacy to the public; (b) the test will not detect any benefit.
If the natural fluoride level is very low, (a) the treatment is useful, and will display high efficacy to the public; (b) the test will with high probability detect a benefit.
Maybe we have different views on what the public view efficacity is. The above two 'if's tell me that it is directly related to the likelyhood a test detects the benefit, independent of the precise test used. You'd expect that just by looking at the effect size - both the public making their opinions, and the scientist making their measurements will be more likely to see a larger effect size.
I was trying to map things between the public/scientist domains that are in some way equivalent - the public view on whether the effect is real vs. the scientific view on whether the effect is real (i.e. true/false values) - perhaps I should have just stuck with the effect size instead.
Great minds discuss ideas; average minds discuss events; small minds discuss people; the smallest discuss themselves
(Score: 0) by Anonymous Coward on Tuesday December 17 2019, @08:05AM
Fluoride in bones is cumulative. >2ppm gives you breakages in short enough time frame to show up in the studies.
Longer term exposure to lower levels is only just starting to come into play.
(Score: 2) by JoeMerchant on Monday December 16 2019, @03:05PM (4 children)
Science is fine. I still prefer my non-chlorinated, non-fluoridated well water to the municipal piped stuff.
If you want fluoride on the kids' teeth, get that at the dentist - pumping a steady drip into the whole population seems... insensitive to the poorly studied negative aspects of polluting our precious bodily fluids... O-P-E Code prefix locked. Switch all receiver circuits to CRM discriminators.
🌻🌻 [google.com]
(Score: 2) by FatPhil on Tuesday December 17 2019, @10:15AM (2 children)
Great minds discuss ideas; average minds discuss events; small minds discuss people; the smallest discuss themselves
(Score: 2) by JoeMerchant on Tuesday December 17 2019, @03:39PM (1 child)
Natural variation ranges from zero fluoridation through higher levels than you might want, as does "natural" variation of other elements in water like salt, arsenic, lead, etc.
Just because residents of the Colorado Rockies and airline pilots/crew receive a dose of radiation equivalent to a chest X ray every year isn't a good basis of argument to irradiate everyone with a chest X ray every year for little benefit.
🌻🌻 [google.com]
(Score: 2) by FatPhil on Tuesday December 17 2019, @04:25PM
Put that match away, your petrol-soaked straw man will burn.
Great minds discuss ideas; average minds discuss events; small minds discuss people; the smallest discuss themselves
(Score: 0) by Anonymous Coward on Friday December 20 2019, @01:46PM
Also we should stop the disingenuous practice of calling all different things "fluoride". Sodium Fluoride is what occurs naturally and at the dentist's office. The chemical being added to civic water supplies is HydroFluoroSilicic Acid, a waste product from the phosphate mining industry.
(Score: 0, Troll) by Bot on Monday December 16 2019, @06:09PM
>Americans seem desperate to cling to anti-science at any cost
This remark should be left to sociological contexts, which are not quite science themselves.
Account abandoned.
(Score: 0) by Anonymous Coward on Tuesday December 17 2019, @09:11AM
Oddly enough, I find people who use words like 'anti-science' tend to have a limited understanding of science to begin with. The word itself is somewhat of an oxymoron since it tends to refer to skepticism of an established view, when that is itself a fundamental component of science.
Beyond that you demonstrate a specific misunderstanding here. A number (in this case procedures) jumping from 1.55 to 2.52 doesn't mean anything in a vacuum. You need to measure variance. In other words, how much would you expect your results to vary based on little more than noise? Turns out dental procedures have extremely high variance. The figures from the paper are 1.55 +/- 3.89 in 2003, and 2.52 +/- 4.35. So in other words, the change after fluoride was removed was well within the range as expected by statistical noise alone.
The paper shows that there is minimal value to fluoridation of water. Also noteworthy is that the study was exclusively based around kids from very poor families. This sample is going to substantially over-represent the value of fluoride since it's biasing itself towards a sample that is going to have disproportionately poor eating habits, oral hygiene, and numerous other factors that increase the value of fluoridation. Ultimately it shows that there is negligible value to water fluoridation. Given potential side affects, it's probably not a smart idea.