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The Health Service Executive Says You Must Drink Fluoridated Tapwater

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    #152
    jh79
    Registered Users Posts: 8,216 ✭✭✭jh79


    To put it in plain english

    Definite evidence of effectiveness in children + a possibility of effectiveness in adults is better than no evidence that it is ineffective (if you have some provide a link).

    Wouldn't you agree.

    P.S. insufficient evidence means there is some evidence, making it possible that it is effective in adults. Also the rejected studies while not meeting the high rating still give a good indication of likely effectiveness so I would be pretty confident that if a new study meeting the high grade came out it would show fluoridation's effectiveness.


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    #153
    weisses
    Registered Users Posts: 9,447 ✭✭✭weisses


    jh79 wrote: »
    To put it in plain english

    Definite evidence of effectiveness in children + a possibility of effectiveness in adults is better than no evidence that it is ineffective (if you have some provide a link).

    Wouldn't you agree.

    Uhh No ... Where do they state it is a possibility ? You cannot base a descision to fluoridate based on a possibility ... that's not really scientific now is it

    Plus the results for children also came with a remark from Cochrane stating
    These results are based predominantly on old studies and may not be applicable today.
    jh79 wrote: »
    P.S. insufficient evidence means there is some evidence, making it possible that it is effective in adults.

    They said
    No studies that aimed to determine the effectiveness of water fluoridation for preventing caries in adults met the review's inclusion criteria.

    Don't try to spin it.
    jh79 wrote: »
    Also the rejected studies while not meeting the high rating still give a good indication of likely effectiveness so I would be pretty confident that if a new study meeting the high grade came out it would show fluoridation's effectiveness.

    You can have an opinion on that

    Meanwhile the Cochrane report supports studies that show a decline in caries despite these countries don't fluoridate, they just stopped the use or banned it ... It kinda makes sense now


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    #154
    jh79
    Registered Users Posts: 8,216 ✭✭✭jh79


    Water fluoridation has been effective at reducing caries in children in the past
    Therefore when introduced it was effective and justified

    There is uncertainty around the size of effect of water fluoridation in populations today

    It is likely that new studies, in areas with greater use of fluoride toothpastes and other caries preventive measures, lower caries levels and different dietary patterns, will show a reduced effect of water fluoridation

    To be expected but can't assume it is ineffective

    There is insufficient evidence to determine the effect of water fluoridation on disparities in caries levels across socio-economic status
    So more research needed

    There is insufficient evidence to determine the effect of water fluoridation on caries levels in adults
    So more research needed

    There is insufficient evidence to determine the effect of removing water fluoridation programmes from areas where they already exist
    Again more research needed

    There is an association between fluoridated water and dental fluorosisProves that fluoridation has a topical mode of action

    The review does not provide a comprehensive review of harms
    None of them are of sufficient quality anyways so there are no known adverse effects bar fluorosis



    The above is from the plain english summary. You said you only read the plain english summary so which of the above proves it is not effective??

    And also from Cochrane and why effectiveness in adults is a possibility;

    In the past 20 years, the majority of research evaluating the effectiveness of water fluoridation for the prevention of dental caries has been undertaken using cross-sectional studies with concurrent control, with improved statistical handling of confounding factors (Rugg-Gunn 2012). We acknowledge that there may be concerns regarding the exclusion of these studies from the current review. A previous review of these cross-sectional studies has shown a smaller measured effect in studies post-1990 than was seen in earlier studies, although the effect remains significant. It is suggested that this reduction in size of effect may be due to the diffusion effect (Rugg-Gunn 2012); this is likely to only occur in areas where a high proportion of the population already receive fluoridated water.”


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    #155
    weisses
    Registered Users Posts: 9,447 ✭✭✭weisses


    jh79 wrote: »
    The above is from the plain english summary. You said you only read the plain english summary so which of the above proves it is not effective??

    Which proves it is effective and thus can be implemented in a policy ?


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    #156
    jh79
    Registered Users Posts: 8,216 ✭✭✭jh79


    weisses wrote: »
    Which proves it is effective and thus can be implemented in a policy ?

    It's already here so the question is whether there is enough evidence to justify ending it.

    It might not be as effective as originally thought but that is not the same as saying it is an ineffective public health intervention.

    Is there any evidence, that meet the high criteria on the GRADE framework, which shows it is no longer effective ?

    I take it we can agree the answer is no. So what is the justification for ending it?


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    #157
    Johnboy1951
    Registered Users Posts: 13,999 ✭✭✭✭Johnboy1951


    jh79 wrote: »
    It's already here so the question is whether there is enough evidence to justify ending it.

    I don't see it like that.
    Rather than disputing the effect of the present scheme, and whether or not it should be ended without a replacement, we would be much better off properly defining the aim and then researching how best to reach that.
    It might well be that dosing potable water would be best or (IMO more likely) another distribution scheme would be best for everyone.

    Nothing should be done without this research.
    It might not be as effective as originally thought but that is not the same as saying it is an ineffective public health intervention.

    Is there any evidence, that meet the high criteria on the GRADE framework, which shows it is no longer effective ?

    I take it we can agree the answer is no. So what is the justification for ending it?


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    #158
    jh79
    Registered Users Posts: 8,216 ✭✭✭jh79


    Johnboy1951 wrote: »
    I don't see it like that.
    Rather than disputing the effect of the present scheme, and whether or not it should be ended without a replacement, we would be much better off properly defining the aim and then researching how best to reach that.
    It might well be that dosing potable water would be best or (IMO more likely) another distribution scheme would be best for everyone.

    Nothing should be done without this research.

    Read this piece and tell me if you think the research is sufficient given the limitations stated in the article.

    http://www.nature.com/bdj/journal/v220/n7/full/sj.bdj.2016.257.html


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    #159
    weisses
    Registered Users Posts: 9,447 ✭✭✭weisses


    jh79 wrote: »
    It's already here so the question is whether there is enough evidence to justify ending it.

    No ..

    If you argue the use of fluoridation to a government and you have to answer them with the lines you put in red in your posts earlier you will be kicked out of the door and rightly so

    Saying "hey while we have it use it because its use hasn't been proved ineffective" is one of the most ridiculous remarks i have seen here lately


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    #160
    Johnboy1951
    Registered Users Posts: 13,999 ✭✭✭✭Johnboy1951


    Johnboy1951 wrote: »
    I don't see it like that.
    Rather than disputing the effect of the present scheme, and whether or not it should be ended without a replacement, we would be much better off properly defining the aim and then researching how best to reach that.
    It might well be that dosing potable water would be best or (IMO more likely) another distribution scheme would be best for everyone.

    Nothing should be done without this research.
    jh79 wrote: »
    Read this piece and tell me if you think the research is sufficient given the limitations stated in the article.

    http://www.nature.com/bdj/journal/v220/n7/full/sj.bdj.2016.257.html

    As that only looks at one distribution method, it is, on its own, useless to help decide which method might be best, which was what I posted.
    (i) to evaluate the effects of water fluoridation (artificial or natural) on the prevention of dental caries, and
    (ii) to evaluate the effects of water fluoridation (artificial or natural) on dental fluorosis.


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    #161
    jh79
    Registered Users Posts: 8,216 ✭✭✭jh79


    weisses wrote: »
    No ..

    If you argue the use of fluoridation to a government and you have to answer them with the lines you put in red in your posts earlier you will be kicked out of the door and rightly so

    Saying "hey while we have it use it because its use hasn't been proved ineffective" is one of the most ridiculous remarks i have seen here lately

    What you would say is that it has been proven to be effective in children in the past and the best available research shows that this is still the case in children and the that the best available research shows effectiveness in adults too and there are no known side effects. Oh and it is cheap.

    You could also add that there is no evidence available showing that it is ineffective too.


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    #162
    jh79
    Registered Users Posts: 8,216 ✭✭✭jh79


    Johnboy1951 wrote: »
    As that only looks at one distribution method, it is, on its own, useless to help decide which method might be best, which was what I posted.

    What other methods are you referring to?


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    #163
    jh79
    Registered Users Posts: 8,216 ✭✭✭jh79


    weisses wrote: »
    No ..

    If you argue the use of fluoridation to a government and you have to answer them with the lines you put in red in your posts earlier you will be kicked out of the door and rightly so

    Saying "hey while we have it use it because its use hasn't been proved ineffective" is one of the most ridiculous remarks i have seen here lately

    Cochrane answered your concerns already;

    “However, there has been much debate around the appropriateness of GRADE when applied to public health interventions, particularly for research questions where evidence from randomised controlled trials is never going to be available due to the unfeasibility of conducting such trials. Community water fluoridation is one such area.”


    "In the past 20 years, the majority of research evaluating the effectiveness of water fluoridation for the prevention of dental caries has been undertaken using cross-sectional studies with concurrent control, with improved statistical handling of confounding factors (Rugg-Gunn 2012). We acknowledge that there may be concerns regarding the exclusion of these studies from the current review. A previous review of these cross-sectional studies has shown a smaller measured effect in studies post-1990 than was seen in earlier studies, although the effect remains significant. It is suggested that this reduction in size of effect may be due to the diffusion effect (Rugg-Gunn 2012); this is likely to only occur in areas where a high proportion of the population already receive fluoridated water.”


    That is what a government official will see and why we still have fluoridation


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    #164
    Johnboy1951
    Registered Users Posts: 13,999 ✭✭✭✭Johnboy1951


    jh79 wrote: »
    What other methods are you referring to?

    Please read what I wrote ....... that is where the research is needed ... to find the best and most efficacious method of distributing the fluoride in proper quantities to the target population.


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    #165
    jh79
    Registered Users Posts: 8,216 ✭✭✭jh79


    Johnboy1951 wrote: »
    Please read what I wrote ....... that is where the research is needed ... to find the best and most efficacious method of distributing the fluoride in proper quantities to the target population.

    And what do you think should happen to water fluoridation in the mean time?


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    #166
    Johnboy1951
    Registered Users Posts: 13,999 ✭✭✭✭Johnboy1951


    jh79 wrote: »
    And what do you think should happen to water fluoridation in the mean time?

    Nothing


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