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Fluoride Action Network Australia August 3, 2017 A damning critique and analysis of the NHMRC's 2017 "Sham" review of water fluoridation and appeal for Royal Commission Inquiry: 23 Reasons why Australia needs a Royal Commission into the NHMRC’s fraudulent fluoride review By Merilyn Haines on behalf of Fluoride Action Network Australia Inc. Email: [email protected] Mob: 0418 777 112 EXECUTIVE SUMMARY August 3, 2017, was the deadline for very limited public comment on a draft Public Statement on Water Fluoridation by the Australian government’s National Health and Medical Research Council (NHMRC). This Public Statement was drawn largely from these documents: 2017: National Health and Medical Research Council (NHMRC). Information Paper - Water Fluoridation: dental and other human health outcomes. July. 2016: Health Effects of Water Fluoridation: Technical Report. Report to the National Health and Medical Research Council (NHMRC), Canberra. By Jack B, Ayson M, Lewis S, Irving A, Agresta B, Ko H, Stoklosa A. August 24, 2016, (released in September). 322 pages. 2016: Health Effects of Water Fluoridation: Evidence Evaluation Report. Report to the National Health and Medical Research Council (NHMRC), Canberra. By Jack B, Ayson M, Lewis S, Irving A, Agresta B, Ko H, Stoklosa A. August 24, 2016, (released in September). 284 pages. On behalf of the Fluoride Action Network Australia, Merilyn Haines is calling for a Royal Commission to investigate the manner in which the Australian government’s NHMRC conducted its review of the safety, effectiveness and ethics of Water Fluoridation. Haines charges that a) the 2017 NHMRC review of water fluoridation was unprofessional, unscientific, biased, highly selective, deeply flawed and prevented meaningful scientific and public input and b) other NHMRC activities - outside this review (see items 12 and 21 below) - clearly demonstrate a bias of the NHMRC (a federal government agency) in favor of both promoting and defending the practice of water fluoridation - a long-standing government policy. In examining the manner in which the panelists were selected, the way studies were selected and excluded, the very limited opportunities for public participation and independent scientific input, Haines argues that it is hard to come to any other conclusion than that this review was designed simply to defend a long-standing government policy and not to genuinely examine the science (or lack of science) on which it is based. This is not the first time this has happened. The NHMRC produced a very poor review in 2007 which received extensive criticism from independent scientists. To produce an even more biased and restrictive review in 2016 is even more egregious in lieu of the new science published (or updated) since 2007. For example, on effectiveness, the 2015 Cochrane review (a gold standard when it comes to meta-analysis of health issues) found little in the way of high quality studies to demonstrate the effectiveness of fluoridation. On safety, there have now been over 300 published animal and human studies indicating that fluoride is neurotoxic. This large body of evidence has been largely ignored in the 2017 NHMRC review, even though it is being currently scrutinized by the National Institute of Health Sciences (NIEHS) and the National Toxicology Program (NTP) in the USA. In this analysis, 23 specific examples of NHMRC manipulations have been documented. Many of these by themselves should disqualify the NHMRC 2017 review from serious consideration, but in combination should question the very existence of the

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Page 1: A damning critique and analysis of the NHMRC's 2017 Sham

FluorideActionNetworkAustraliaAugust3,2017

AdamningcritiqueandanalysisoftheNHMRC's2017"Sham"reviewofwaterfluoridationandappealforRoyalCommissionInquiry:

23ReasonswhyAustralianeedsaRoyalCommission

intotheNHMRC’sfraudulentfluoridereview

ByMerilynHainesonbehalfofFluorideActionNetworkAustraliaInc.

Email:[email protected]:0418777112

EXECUTIVESUMMARY

August3,2017,wasthedeadlineforverylimitedpubliccommentonadraftPublicStatementonWaterFluoridationbytheAustraliangovernment’sNationalHealthandMedicalResearchCouncil(NHMRC).ThisPublicStatementwasdrawnlargelyfromthesedocuments:

2017:NationalHealthandMedicalResearchCouncil(NHMRC).InformationPaper-WaterFluoridation:dentalandotherhumanhealthoutcomes.July.

2016:HealthEffectsofWaterFluoridation:TechnicalReport.ReporttotheNationalHealthandMedicalResearchCouncil(NHMRC),Canberra.ByJackB,AysonM,LewisS,IrvingA,AgrestaB,KoH,StoklosaA.August24,2016,(releasedinSeptember).322pages.

2016:HealthEffectsofWaterFluoridation:EvidenceEvaluationReport.ReporttotheNationalHealthandMedicalResearchCouncil(NHMRC),Canberra.ByJackB,AysonM,LewisS,IrvingA,AgrestaB,KoH,StoklosaA.August24,2016,(releasedinSeptember).284pages.

OnbehalfoftheFluorideActionNetworkAustralia,MerilynHainesiscallingforaRoyalCommissiontoinvestigatethemannerinwhichtheAustraliangovernment’sNHMRCconducteditsreviewofthesafety,effectivenessandethicsofWaterFluoridation.

Haineschargesthata)the2017NHMRCreviewofwaterfluoridationwasunprofessional,unscientific,biased,highlyselective,deeplyflawedandpreventedmeaningfulscientificandpublicinputandb)otherNHMRCactivities-outsidethisreview(seeitems12and21below)-clearlydemonstrateabiasoftheNHMRC(afederalgovernmentagency)infavorofbothpromotinganddefendingthepracticeofwaterfluoridation-along-standinggovernmentpolicy.

Inexaminingthemannerinwhichthepanelistswereselected,thewaystudieswereselectedandexcluded,theverylimitedopportunitiesforpublicparticipationandindependentscientificinput,Hainesarguesthatitishardtocometoanyotherconclusionthanthatthisreviewwasdesignedsimplytodefendalong-standinggovernmentpolicyandnottogenuinelyexaminethescience(orlackofscience)onwhichitisbased.Thisisnotthefirsttimethishashappened.

TheNHMRCproducedaverypoorreviewin2007whichreceivedextensivecriticismfromindependentscientists.Toproduceanevenmorebiasedandrestrictivereviewin2016isevenmoreegregiousinlieuofthenewsciencepublished(orupdated)since2007.

Forexample,oneffectiveness,the2015Cochranereview(agoldstandardwhenitcomestometa-analysisofhealthissues)foundlittleinthewayofhighqualitystudiestodemonstratetheeffectivenessoffluoridation.Onsafety,therehavenowbeenover300publishedanimalandhumanstudiesindicatingthatfluorideisneurotoxic.Thislargebodyofevidencehasbeenlargelyignoredinthe2017NHMRCreview,eventhoughitisbeingcurrentlyscrutinizedbytheNationalInstituteofHealthSciences(NIEHS)andtheNationalToxicologyProgram(NTP)intheUSA.

Inthisanalysis,23specificexamplesofNHMRCmanipulationshavebeendocumented.ManyofthesebythemselvesshoulddisqualifytheNHMRC2017reviewfromseriousconsideration,butincombinationshouldquestiontheveryexistenceofthe

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NHMRCasabodythatcanberelieduponbythepublicanddecision-makerstoprovideobjectiveanalysisofgovernmentpolicy.Herearethe23examples:TheNHMRC,

1.Stackedthefluoridereviewcommitteewithfluoridationlobbyistsandadvocates.

2.Brokeapromisethatitwouldincludeexpertsopposedtofluoridation.

3.Secretlycommissionedanewstudyondentaleffects(previouslylistedas“outofscope”),whenthe2015CochraneCollaborationreviewdidn’tdeliveraconvincingpro-fluoridationposition.

4.First,misledaboutitsknowledgeofanewthyroidstudy(Peckhametal.,2015)andthendismisseditsfindings,reachingabiasedandfalsepositionthatthereisnoevidencethatfluorideinterfereswiththyroidfunction.

5.Falselyclaimedalow-qualityIQstudy(Broadbentetal,2014)wasahigh-qualitystudy.

6.Downplayed,dismissedorexcludedmostotherIQstudiesandevidenceoffluoride’sneurotoxicity.

7.OnflimsygroundsexcludedasignificantstudylinkingfluoridationtoADHD(MalinandTill,2015)–thenfailedtoevenacknowledgeitsexistence.

8.In2007,theNHMRCusedapromisedstudyinaLetter-to-the-EditortonegateanunrefutedOsteosarcomastudy(Bassin,2006)toclaimtherewasnolinktocancer.Theninits2017reviewtheNHMRCfailedtoacknowledgethatthepromisedstudyfailedtorefutetheBassinstudybutstillcontinuedtomaintainnoevidenceofalinkbetweenfluoridationandcancer.

9.Selectedapublicationcut–offdateforstudies(thatwouldbeconsidered)thatwouldexcludeaverysignificantreviewbytheUSNRC(2006)andtheBassin(2006)studythatwerenotgivendueconsiderationinits2007review.

10.TheNHMRC2017reviewbaseditsclaimsofsafetylargelyonits2007review,however,its2007reviewwaslargelyacopyofthe2000YorkUniversityreview,whichaccordingtotheYorkReview’sProfessorSheldondidNOTshowfluoridationtobesafe!

11.Obfuscatedonchronickidneydiseaseeventhoughitisawarethatpoorkidneyfunctionincreasesuptakeoffluorideintothebonesandposesrisksoveralifetime.Suchcumulativerisks–andthespecialplightofthosewithpoorkidneyfunction–haveneverbeeninvestigatedbyNHMRC.

12.Onanotherbutrelatedmatter,theNHMRCendorseddoublingchildren’suppersafetylimitsforfluorideingestion(usingdatafromthe1930s)almostcertainlyanticipatingthatthepre-existinglimitswouldbeexceededbybottle-fedinfantsinwhichformulaismadeupwithfluoridatedtap-water.

13.Abandonedthenormalevaluationmethodforstudiesoffluoride’seffectivenessalmostcertainlyinanefforttodisguisethefactthatmostofthestudiesreviewedwereoflow,orverylowquality.

14.NHMRC2017ratestoothdecayanddentalfluorosisasmoreimportantend-pointsthanotherhealthincomes,includingcancerandloweredIQ.

15.Commencedreviewwithstrictrestrictionsforacceptableevidence,thenincludeda)unpublishedwork;b)afavourablenarrativeandc)anabstract.

16.Attemptedtodiminishknowndentalfluorosisharmbymanipulatingfluorosisratingsandraisingthresholdofconcern.

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17.Misleadsthepublicanddecision-makersbyclaimingfluoridationreducestoothdecayby26-44%-butwithoutindicatingjusthowsmallsuchreductionsareinabsoluteterms–oftenlessthanonetoothsurfaceoutofover100toothsurfacesinachild’smouth!

18.Dishonestlyclaimsfluoridationissafebyexcludingimportantstudiesonspuriousgrounds,ignoringmanyothers,andevencherry-pickingweakstudiesthatservetheirpurpose(e.g.BroadbentonIQ).

19.Doesn’texhibitanunderstandingof,orappreciate,thebasicprinciplesoftoxicology–concentrationisnotthesameasdose!

20.Pervertedtheprinciplesofmedicalethicsbypresentingabogusethicalclaimconstructedbylobbyistsratherthanethicists.

21.GaveanincompleteprojectofdubiousqualityaprestigiousNHMRCaward

22.NHMRCfluoridationpublicconsultationshavebeenshams.

23.TheNHMRC’sextraordinaryefforttomaintainthedubiousclaimsthatfluoridationissafe,effectiveandethical,arebecomingmoreandmoredesperatebytheyear.NHMRC2007wasverybad,NHMRC2017vergesonfraud.

Conclusions

TheNHMRChasignoreditsDutyofCareandbetrayedtheAustralianpublicwithitspoorandpervertedfluoridereview.TheNHMRC’sfluoridereviewshouldbeshredded.

WerequestthatcitizensandscientistsfrominsideAustraliaandaroundtheworldwillcallforaRoyalCommissioninquirytoinvestigatetheNHMRC’sbehaviorinthismatter.HopefullytheywillcallforanewreviewtobecommissionedbytheFederalgovernmentbutcarriedoutbyanindependentorganization,withthepanelcomprisedofunbiasedscientistsandprofessionals.

Intermsofreviewinggovernmentpoliciesingeneral,itisrequestedthattheRoyalCommissioninvestigatethewisdomofusingagovernmentdepartmentsuchasNHMRCtoreviewthescienceofcontroversialprograms,whenthoseprogramshavebeenpartoflong-standinggovernmentpolicy.UndersuchcircumstancesitisurgedthattheRoyalCommissionrecommendsuchreviewsbeorganizedbyanon-governmentalagency.Thisagencywouldberequiredtoselectpanelscompletelyindependentofgovernmentalinfluence.Ideallysuchpanelswouldconsistofexpertsdrawnfrombothsidesoftheissueinquestion,andthosewhohavenottakenapositionontheissue:agoodmodelwouldbethepanelselectedbytheU.S.NationalResearchCouncilforitsreviewoffluoride’stoxicityin2006.

Thefollowingisadetailedanalysisofthe23items:

23REASONSWHYAUSTRALIANEEDSAROYALCOMMISSIONINTOTHENHMRC’sFRAUDULENTFLUORIDEREVIEW

1.NHMRCstackedthefluoridereviewcommitteewithfluoridationlobbyistsandadvocates.

TheNHMRCappointedatleast10knownfluoridationadvocatesandlobbyiststoitsFluorideReferenceGroup(FRG)thatconductedtherecentNHMRCreviewonthehealtheffectsofwaterfluoridation.Fourofthecommitteemembers(dentistsProfsJohnSpencerandKayeRoberts-ThomsonfromAdelaideUniversity,ColgateProfessordentistMikeMorganfromMelbourneUniversityandformerNSWChiefDentalOfficerCliveWright)arewellknownfluoridationlobbyistswhohaveallalsoreceivedsignificantgrantfundingfromtheNHMRCandallhaveusedtheirownpublicationstopromotefluoridation.TwoofNHMRC’sFRGmembersProfsJohnSpencerandCliveWright,haveevenparticipatedincourtcasestohelpfluoridationbeforcedonNSWresidents.AnadditionalsixmembersoftheFRGcommitteearealsoknowntohavepubliclyadvocatedforwaterfluoridation–makingfluoridationlobbyistsandadvocatestobeatwo–thirdsmajorityofthe15memberNHMRCcommittee.TheNHMRCdeliberatelystackedtheFRGcommitteewithmembersextremelybiasedtowardsfluoridation.Additionally,whenthenamesoftheFRGmemberswerefirstpubliclylisted(wellaftertheFRGhadalreadystartedmeeting)thelistingoftheFRG’scommitteemember’sconflictsofinterestsweredelayedandseverelydownplayed.ThenameofoneFRGappointee(ProfCorbett)a

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fluoridationadvocatefromasearlyas1993,wasnotevenlistedontheNHMRCwebsiteuntilafterthe2014publiccallforevidencehadalreadyclosed.2.NHMRCbrokeapromisethatitwouldincludeexpertsopposedtofluoridation.Rightfromtheverybeginning,theNHMRCwasmisleadingaboutitsproposedreviewcommittee.BeforetheNHMRCappointedtheFRGmembers,theNHMRChadprivatelycommunicatedtomembersofthepublicthatanewfluoridereviewcommittee,whensetup,wouldincluderepresentationofpeopleopposedtofluoridation.Asanexample,anextractofanemailfromtheNHMRCon15Jan2014–

“Weaimtoincluderepresentationfromtherelevantareasofscience,publichealth,policyarea,consumer/communityviewsandaswehavediscussed,fromthoseopposedtopopulationlevelfluoridation”

However,theNHMRCwasmisleadingbecausetheyneverallowedthatpromisedrepresentation.The2006NationalResearchCouncilthatreviewedhealtheffectsoffluoridefortheUSGovt’sNationalAcademyofSciencehadabalancedpanelcomprisedofexpertswhowereinfavouroffluoridationandalsoexpertswhowereopposedtofluoridation–incontrast,theNHMRCwouldnotallowanyonewhowasopposedtofluoridationtobeonitsFRGcommittee.3.NHMRCsecretlycommissionedanewstudyondentaleffects(previouslylistedas“outofscope”),whenthe2015CochraneCollaborationfoundthattherewerefew,ifany,high-qualitystudiesthatweresupportiveoffluoridation)BecausetheCochraneCollaborationwasalreadyexaminingfluoride’sdentaleffects,thenewNHMRCreviewwasONLYtoexaminehealtheffectsotherthandental.InAugust2014whenthepublicwasinvitedtosubmitevidencefortheNHMRCtoreview,dentaleffectswerelistedasstrictly“outofscope”withtheNHMRCreviewonlytoexamineotherhealtheffectsoffluoridation.TheNHMRCwasonlyto“criticallyappraise“theCochranereviewontoothdecayandfluorosis–theNHMRCwerenottodotheirownreviewondentaleffects.WhentheCochraneCollaborationreview(1)waspublishedinJune2015itwasnotflatteringtofluoridationwiththereviewfindinglittleevidencetosupportfluoridationbeingeffective.Newsweekgaveanoverview-http://www.newsweek.com/fluoridation-may-not-prevent-cavities-huge-study-shows-348251Fortoothdecay,theCochranereviewusedahighstandardprotocol,itonlyusedstudieslookingattoothdecayinbothfluoridatedcommunitiesandnon-fluoridatedcommunitiesmeasuredatleasttwodifferentpointsintime.Thatprotocolwouldprovidecontrolstotakeinaccounttemporaldecreasesintoothdecaythatcouldnotbeattributedtofluoridation.Thisisimportantaslargedecreasesintoothdecayinnon-fluoridatedcommunitieshasbeenseenworld-wide–seehttp://fluoridealert.org/studies/caries01/ThepublishedCochranereviewfindings,didnotfitNHMRC’sapparentagendaofprotectingfluoridation.Inresponsetothis,theNHMRCsecretlycommissionedtheirownreviewoftoothdecaywheretheycouldincludedentalpublicationsthatwereunsuitablefortheCochranereview.ManypublicationsthattheNHMRCthenallowedtobeincludedintheirsecretlycommissionedreviewhadbeenwrittenbyAustralianfluoridationlobbyistswhoweremembersoftheNHMRCFRGcommittee.TheNHMRC’s2017InformationPapercites24dentalpublicationsco-authoredbyFRGmemberJohnSpencer,8publicationsco-authoredbyFRGmemberKayRoberts-Thomson,2publicationsco-authoredbyFRGmemberMikeMorganand2publicationsco-authoredbyFRGmemberClive(akaFrederick)Wright.4.NHMRCfirstmisledaboutitsknowledgeofanewthyroidstudy(Peckhametal.,2015)andthendismisseditsfindings,reachingabiasedandfalsepositionthatthereisnoevidencethatfluorideinterfereswiththyroidfunction.On24thFeb2015(withthenewNHMRCfluoridereviewbarelyunderway)aFairfaxjournalistwasinteractingwiththeNHMRCandsenttheNHMRCinformationaboutanewstudyfromtheUKbyPeckhametal(2)whichwasstillmediaembargoed.Thisstudylinkedwaterfluoridationtohypothyroidism.VeryearlythefollowingdaytheNHMRCpublishedastatementfromtheCEOre-affirmingthe2007NHMRC’srecommendationandclaimedthatbasedontheworkconductedinthereviewsofar,theNHMRCwasexpectedtomaintainitssupportforfluoridationaseffectiveandsafe.InlatercorrespondenceNHMRCstaffclaimedthattheNHMRChadnotknownaboutthisnewthyroidstudyuntilthe25thFeb2015andinothercorrespondencealsoclaimedthatthenewthyroidstudywasnotthereasonforthereleaseoftheCEO’sStatement.TheNHMRCclaimed:

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“NHMRCfirstbecameawareofthePeckhametal2015studyon25Feb2015,onedayafteritwasfirstpublishedonline.AMemberoftheFluorideReferenceGroup(FRG)informedtheFluorideProjectTeam(FTP)thattherehadbeensomemediaactivitysurroundingitsrelease”.

EmailsinreleasedFreedomofInformationdocumentsprovesthattheNHMRCknewaboutthePeckhamthyroidstudyearlierthanwhattheyclaimed.ApartfrombeingmisleadingaboutwhentheNHMRCknewaboutthisthyroidstudy,theNHMRCwasalsomisleadingaboutthesourcethatinformedthemofthestudy.EventhoughtheNHMRCdeniedit,itisobviousitwasthenewthyroidstudythathadtriggeredthereleaseoftheCEO’sStatementanditwasobviouslywrittenandreleasedbytheNHMRCtoprotectfluoridation.Knowingofthisnewstudyanditsimplications,theNHMRCstillputoutastatementassertingthatfluoridationwassafe.ThisNHMRCstatementwasputoutsome18monthsbeforetheNHMRCpublishedevenitsdraftInformationPaper.WhentheNHMRCeventuallypublishedits2017informationpaper,insteadofacknowledgingconcernsaboutpossibleadversethyroidhealtheffectsitseverelydownplayedthePeckhamthyroidstudy.ThedownplayingbytheNHMRC’sFRGwaslargelybasedontwofact-poorcommentaries(notscientificstudies)particularlyonewrittenbyaQueenslandHealthdentistwhoisaveryactivelobbyistforforcedfluoridation.Insteadofinvestigatingfurther,orevenacknowledgingpotentialriskofharmtothyroidfunctiontheNHMRCclaimedfluoridationwassafebymisleadinglyclaimingthisnewstudywas“unreliableevidence“.Additionally,theNHMRCiswellawarethatthe2006USNationalResearchCouncilreport“FluorideinDrinkingWater”NRC2006(3)acknowledgedriskforthyroidharm,specificallystating:

“Inhumans,effectsonthyroidfunctionwereassociatedwithfluorideexposuresof0.05-0.13mg/kg/daywheniodinewasadequateand0.01-0.03mg/kg/daywheniodineintakewasinadequate.”

Despiteknowingthis,theNHMRChasdeniedfluoridationposesarisktothyroidfunction.5.NHMRCfalselyclaimedalow-qualityIQstudywasahigh-qualitystudy.

TheNHMRCfalselyclaimedthatastudy(4)conductedbyNewZealanddentist/fluoridationlobbyistJonathonBroadbentwasahighqualitystudy.BroadbentclaimedthatthestudyshowednolinkwithfluoridationandIQdeficit.TheNHMRConlyhadtoreadtheopeningparagraphsofBroadbentstudytoseethathewasclearlyaprotagonistinthefluoridationdebate,withakeeninterestinhowthepracticewasbeingpursuedinNZ.

Communitywaterfluoridation(CWF)isacost-effective,1,2safe,3andenvironmentallyfriendly4meansofreducingdentalcariesrates3andsocialinequalities.5However,CWFhasrecentlybeencriticizedasacauseofIQdeficitsamongchildren,6despitealackofevidencetosupportthatclaim.ThisclaimwasconsideredpivotalintherecentrejectionofCWFbyvotersinPortland,Oregon,7andbylocalgovernmentpoliticiansinHamilton,NewZealand.ItislikelythatsuchclaimsmaycontinuetobelobbiedagainstCWFworldwide…

Hamiltoncity(NewZealand’sfifth-largestmetropolitanarea)hashadCWFsince1966andhasrecentlybecomeatargetforCWFopponents.Despiteabinding2006referendumthatshowed70%supportforCWFamongvotingHamiltonians,10Hamilton’sCityCouncilchosetorelitigateCWFandheldatribunalonfluoridationinearly2013.ThecouncillorsvotedtoceaseCWF,leadingtoanoutcryfrommembersofthepublicandhealthofficials.Anewreferendumwasthenheld(accompanyingalocalgovernmentelection),whichagainshowed70%supportforCWFamongvotingHamiltonians.11TheHamiltonCityCouncilelectedtoawaittheoutcomeofaHighCourtrulingonachallengetothelegalityofCWFinanotherNewZealandcity(NewPlymouth)beforereinstatingCWF…(Broadbentetal.,2014)

Withsuchaclearpro-fluoridationagendaatstaketheNHMRCshouldhavebeenfarmorecautiousaboutlabellingthisasa“high-quality”studyandusingittodismissordownplayotherIQstudies.IftheNHMRChadreadtheBroadbentstudymorecarefullytheywouldhavefounditwasactuallyalow-qualitystudy.Forexample,inthestudytherewereapproximately1000childrenwhohadlivedinthefluoridatedcommunitybutonlyabout100inthenon-fluoridatedcommunity–andoftheseabouthalfwerelikelytohavetakenfluoridetablets.ThisseverelycompromisedBroadbent’sstudyastherewouldbelittledifferenceinfluorideintakebetweenthe2groups.ThisstudydidnothavethescientificpowertofindasignificantdifferenceinIQbetweenthefluoridatedandnon-fluoridatedarea.Thesecriticismswere

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publishedinthesamejournalwhereBroadbentpublishedhisarticle(Osmunsonetal,2016:LettersandResponses,AmericanJournalofPublicHealth,February2016,Vol106,No.2)andshouldhavebeencitedbyNHMRC.

NordidBroadbentetalconsideranumberofimportantconfounderssuchaslead,iodine,arsenicandMaternalIQ.ThisisironicconsideringthatBroadbenthadbeencriticalofauthorsofotherIQstudiesfornotconsideringtheseconfounders.TheNHMRCwasadvisedin2016oftheseandotherseverelimitationsforthisstudybutstillclaimedin2017thatBroadbent’sstudywasahighqualitystudy.Thiswasclearlyaglaringdoublestandard.6.NHMRCDownplayed,dismissedorexcludedmostotherIQstudiesandevidenceoffluoride’sneurotoxicity.TheNHMRCiswellawareofa2012HarvardUniversityMeta-analysisandSystematicreview(5)byChoietalof27humanIQ-fluoridestudiesthatindicatedIQwasloweredinchildrenexposedtofluoride.Overall,therewasadropofnearly7IQpointswithhigherexposurestofluoride.ManyofthewaterfluorideconcentrationsinstudiesintheHarvardreviewthatwereassociatedwithlowerIQwereonly2,3or4timesthatofAustralianfluoridatedwater.Despitethis,theNHMRCdesignedtheirlatestfluoridationreviewwithsuchseverelimitationssothatthisreviewandtheprimarystudiesincludedinthisreviewwouldnotbetakenintoconsideration.ThereisnotevenamentionofthisreviewintheNHMRC’sInformationPaper.InFebruary2014,theBritishMedicalJournalLancetNeurologypublishedapaper(6)ondevelopmentalneurotoxicantsandclassifiedfluorideasasubstancethatcanharmchildren’sdevelopingbrains.TheNHMRCalsoignoredthis.Therearenow50publishedhumanstudiesindicatingfluorideexposurecanreduceIQand45animalstudieshavefoundthatfluorideexposureimpairslearningand/ormemorycapacity–howevertheNHMRCdoesnotacknowledgethis.Allcitationsforthehumanandanimalstudiescanbeseenathttp://fluoridealert.org/studies/brain01/andathttp://fluoridealert.org/studies/brain02_/Becauseofincreasingscientificevidenceaboutfluorideneurotoxicity,theUSNationalToxicologyProgram(NTP)hascommencedanimalstudiestoinvestigatethisissue.TheNHMRChadadvanceanddetailedknowledgethatthisresearchwastocommencewhentheNHMRCwasconsultingwiththeUSGovt’sNationalToxicologyProgramandNationalInstituteofEnvironmentalHealthServicesonhowtodoasystematicreviewofanimalstudies.DespitetheNHMRC’sknowledgethatfluorideneurotoxicitywasofenoughconcernthattheNTPhadcommencedexpensiveandprotractedanimalstudiesandwasfindingsomeresultsofconcern,toprotectfluoridationtheNHMRChasdoneeverythingtheycantodenythatfluorideposesanyrisktoIQandcognitivefunction.7.NHMRC,onflimsygroundsexcludedasignificantstudylinkingfluoridationtoADHD–thenfailedtoevenacknowledgeitsexistence.TheNHMRCin2016becameawareofastudybyMalinandTill(7)publishedFeb2015,thatlinkedAmericanwaterfluoridationtohigherratesofmedicallydiagnosedAttentionDeficitHyperactivityDisorder(ADHD).ThisstudyfulfilledtheNHMRCcriteriatobeincludedintheNHMRCreviewhoweverbecausetheFRGdidnotliketheimplicationsofthispeerreviewedstudythathadbeenpublishedinEnvironmentalHealth,thepublicwillnotfindanymentionofthisstudyintheNHMRC2017InformationPaper.ThiscouldbeconsideredthatthislyingbyomissionbytheNHMRC.8.In2007,theNHMRCusedapromisedstudyinaLetter-to-the-EditortonegateanunrefutedOsteosarcomastudy(Bassin,2006)toclaimtherewasnolinktocancer.Theninits2017reviewtheNHMRCfailedtoacknowledgethatthepromisedstudyfailedtorefutetheBassinstudybutstillcontinuedtomaintainthattherewasnoevidenceofalinkbetweenfluoridationandcancer.WhentheNHMRCpublishedtheirpreviousfluoridereview(in2007),theNHMRCknewofasignificant2006studybyBassinetal(8)linkingage-relatedwaterfluoridationexposuretoOsteosarcomainboysandyoungmen.Insteadofgivingthisstudydueconsideration,theNHMRCwriggledarounditandunscientificallydeferredtoaLetter-to-the-EditorbyfluoridationlobbyistChesterDouglasinthesamejournalinwhichBassinhadpublished.DouglashadpromisedthathisstudywouldshowthatBassins’sthesisdidn'tholdwiththelargerdatabase.Bassin'shypothesis-basedonherdata-wasthatthecriticalissuewasthetimingofexposureofyoungboystofluoridatedwater.Namely,thatyoungboysexposedtofluorideintheir6th,7thand8thyearshada5-7foldincreasedriskofsuccumbingtoosteosarcoma(ararebutfrequentlyfatalcancerinyoungmen)bytheageof20.First,itwasaglaringdoublestandardonthepartofNHMRC,whichhadbeensofussyaboutwhichstudiestheywould

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acceptfortheirreview,toacceptasevidencethe"promise"oftheresultsofayetunpublishedstudy.Thisisnotatrivialissue-ifBassinwascorrectfluoridationmightactuallybekillingafewyoungmeneachyear.However,by2011,whenDouglass'spromisedstudyappeared(fiveyearsafterthepromiseddate)itdidn'tevenexamineBassin'shypothesis.Kimetal(2011)study(9)usedfluoridebonelevelsatdiagnosisorautopsyasthemetricofexposure.Thereisnowaythatsuchbonelevelscouldgaugeexposureoffluorideatcriticalyearsofexposure(6th,7thand8thyears)foundbyBassin.Thus,asof2017noscientistintheworld-includingKimetal.(2011)haverefutedBassin.TheNHMRC'sconclusion"thattherewasnoassociationbetweenfluoridationandosteosarcoma"ishighlymisleading.TomakemattersworseNHMRCofferednoanalysisofthequalityoftheKimetal.paper,whichhadotherseriousflaws,e.g.theyusedotherbonecancerpatientsascontrolswithoutrulingoutthatsomeoftheseotherbonecancerswerenotcausedbyfluorideexposure,whichmightwellbethecase.Kimetalalsoincludedolderpatientsover20.FormoreinformationontheweaknessesandflawsoftheKimetalOsteosarcomastudyandwhyitdoesnotandcouldneverrefutetheBassinstudysee-http://fluoridealert.org/articles/kim_fan/.Throughsubmissions,theNHMRCareawareofthisandawarethatthefindingsoftheBassinOsteosarcomastudyhaveneverbeenrefuted.In2017thiswasasplendidopportunityfortheNHMRCtoputtherecordstraightonthisissue,buttheNHMRCchosenotdoso.TheNHMRCstilldeceptivelyassertsthereisnolinkwithcancerandwaterfluoridation.9.NHMRCselectedapublicationcut–offdateforstudies(thatwouldbeconsidered)thatwouldexcludeaverysignificantreviewbytheUSNRC(2006)andtheBassin(2006)studythatwerenotgivendueconsiderationinits2007review.Thecut-offdatetheNHMRCselectedlooksverysuspiciousandself-servingforthosewishingtoexoneratefluoridationofanyharm.In2014theNHMRCselected1Oct2006astheearliestpublicationdateforstudiestobeincludedinthenewNHMRCreview.ThisdatewasalmostcertainlyselectedbytheNHMRCsothattheycouldexcludeboththe2006NRCreviewandtheBassinOsteosarcomastudywhichwerebothpublishedearlierin2006,but,whichwerenevergivenproperconsiderationinthe2007NHMRCreview.TohelpdismisstheNRC2006fromconsiderationinits2007reviewtheNHMRChadclaimedthattheNRC2006reportwasonlyaboutadversehealtheffectswith2-4mg/LfluorideconcentrationsandthatAustralianfluoridationwasintherange0.6–1.1mg/L.Therewereanumberofstudiesincludedinthe2006NRCwhichhadlowerconcentrationsthan2mg/L,oneexamplewasa1998ratstudybyVarneretal(1998BrainRes.784(1-2)284-298)thatshowedratsdrinkingwaterfluoridatedat1mg/Lforoneyearhadkidneydamage,braindamageandagreateruptakeofAluminiumintothebrainandBetaamyloiddepositsthoughtcharacteristicofAlzheimer’s.Althoughthe2007NHMRCreviewmentionedthe2006NRCreport,theNHMRCapparentlydismisseditfromanyconsiderationbecausenotallthestudieswereat0.6-1.1mg/L.Thisbetrayedlittleunderstandingoftoxicology.WhenconsideringharmitisnottheconcentrationthatisthecriticalcomparisonbutDOSE.Someofthestudiesthathavefoundharminfluoridestudieshavefoundharmatdoseswhichcanbeeasilyexceededespeciallyforhighwaterconsumersandthosegettingfluoridefromothersourcessuchasdentalproducts,tea-drinkingandpesticideresidues.10.TheNHMRC2017reviewbaseditsclaimsofsafetylargelyonits2007review,however,its2007reviewwaslargelyacopyofthe2000YorkUniversityreview,whichaccordingtotheYorkReview’sProfessorSheldondidNOTshowfluoridationtobesafe!In2000theYorkUniversitypublishedareviewofwaterfluoridation(10)byMcDonaghetalthathadbeencommissionedbytheUKgovt.ProfTrevorSheldon,asChairofthereview’sAdvisoryCommitteelaterwrotetotheHouseofLordsadvisingthatthereviewdidnotfindwaterfluoridationtobesafe.SeeProfSheldon’sletterat-http://fluoridealert.org/content/sheldon-york-review/.SomeofProfSheldon’sadviceontheYorkUniversityreview’sfindingswasthattherewaslittleevidencetoshowthatwaterfluoridationhasreducedsocialinequalitiesindentalhealthandthatthereviewdidnotfindwaterfluoridationtobesafe,withthequalityoftheresearchbeingtoopoortoestablishwithconfidencewhetherornottherearepotentiallyimportantadverseeffectsinrelationtothehighlevelsoffluorosis.In2007theNHMRCpublishedtheirpreviousfluoridereview.TheNHMRC2007review’ssectiononwaterfluoridationwaslargelyacopycatofthe2000YorkUniversityreview.TheYorkUniversityreviewwastitled“ASystematicReviewofWaterFluoridation”.DespitethesectiononwaterfluoridationinNHMRC’s2007reviewbasicallybeingacopycatofthe2000Yorkreview,theNHMRCcleverly,andgrandly,titledtheirreviewas“ASystematicReviewoftheEfficacyandSafetyofFluoridation.”The2007NHMRCreviewwasthenusedtoclaimfluoridationwassafe.IntheNHMRC’srecentreviewtheNHMRChasstillnotproducedgood

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qualityresearchorevidence,butdespitethis,claimsthatfluoridationissafe.Itisbadenoughthattheydidthisin2007–butitisevenworsethattheyrepeatedtheirmisleadingclaimsin2017afterthepublichaspointedoutSheldon’scommentary.11.NHMRCobfuscatedonchronickidneydiseaseeventhoughitisawarethatpoorkidneyfunctionincreasesuptakeoffluorideintothebonesposesrisksoveralifetime.Suchcumulativerisks–andthespecialplightofthosewithpoorkidneyfunction–haveneverbeeninvestigatedbyNHMRC.In2007theNHMRCputoutapublicstatement(NHMRCRecommendation)aspartofabrochure.FreedomofInformationondraftversionsofthebrochureshowthatawarningforpeoplewithkidneyimpairmentwasincluded-untiltwodentists(FRGmemberJohnSpencerwasoneofthe2dentists)andtwoSouthAustralianwaterqualityadvisorsreviewedthebrochure–afterthistheNHMRCremovedthekidneywarningandanyreferencetofluoridatedwaterandkidneyimpairment.

AlthoughthecurrentandpastNHMRCAustralianDrinkingWaterGuidelines-Part5FactSheetsFluoride,acknowledgesriskfromfluoridatedwaterforthosewithkidneyimpairment,“Peoplewithkidneyimpairmenthavealowermarginofsafetyforfluorideintake.Limiteddataindicatethattheirfluorideretentionmaybeuptothreetimesnormal”,theNHMRC’s2017fluoridationInformationPapermakesnomentionofkidneyimpairment.

Thenew2017NHMRCPublicStatementclaimsfluoridationisSAFE,buttheNHMRChastotallyignoredanypotentialharmtothosewithkidneyimpairment.TheNHMRChasneverinvestigatedcumulativeeffectsoffluorideonpeoplewithkidneyimpairmenteventhoughaNHMRCFileNoteinNHMRCdocumentsobtainedthroughFOIconfirmstodothiswasarequirementoftheNHMRC’s2007fluoridereview.(FOIdocumentsprovidedbyNHMRCearly2008)

RecentAustraliandataindicatesthat10%ofAustralianadultsaged18yearsandolderhavebiomedicalsignsofhavingChronicKidneyDisease(CKD);thoseinthe65-74yearsoldagegrouphaveaCKDprevalenceof21%andthose75yearsandabove42%prevalenceofCKD(AIHWhttp://www.aihw.gov.au/chronic-kidney-disease/prevalence/)

TheNHMRCdeliberatelymuddiesthewatersclaimingintheNHMRC’sEvidenceStatement(astatementwrittenbytheFRGwhichwastwo–thirdscomprisedoffluoridationlobbyistsandactivists)“ThereisnoreliableevidenceofanassociationbetweenwaterfluoridationatcurrentAustralianlevelsandchronickidneydisease.”

TheNHMRC’sFRGapparentlyareclaimingthatfluoridationdoesn’tcausekidneydisease-howevertheNHMRChavetotallyignoredtherealissueofconcernthatifyouhaveimpairedkidneyfunctionandcan’texcreteasmuchfluoridefromyourbody,youwillaccumulatemorefluorideinyourbody–andtheNHMRChaveneverinvestigatedthecumulativeeffects.Thisissue,inrecentyearshasbeenthesubjectofcorrespondencewiththeNHMRCsotheNHMRCiswellawareofit,butstilldoesnotacknowledgeanyrisk.

AboriginalsareagrouphavemuchhigherratesofCKDthanotherAustraliansandDiabeticsalsohaveahigherriskforCKD–buttheNHMRChasnotconsideredhealtheffectsofconsumingfluoridatedwateronpeoplewithkidneydisease,Aboriginals,Diabeticsorothervulnerablepopulationsub-groups.TheNHMRChasalsonotconsideredeffectsonpeoplewithDiabetesinsipiduseventhoughitisknownthattheyarehigherriskofdevelopingdentalfluorosis.

BytotallyignoringtheissuethatpeoplewithkidneyimpairmenthavepotentialriskfromfluoridatedwatertheNHMRCcanignoreadvicelikethisfromakidneyspecialistattheUniversityofMunich:

“Afairlysubstantialbodyofresearchindicatesthatpatientswithchronicrenalinsufficiencyareatanincreasedriskofchronicfluoridetoxicity.Thesepatientsmaydevelopskeletalfluorosisevenat1ppmfluorideinthedrinkingwater.”-Dr.HelmutSchiffl,MD(2008)

BynotallowinganimalstudiestobeincludedinthereviewtheNHMRCcouldignoreevidencelikethis:

“….theWHO’srecommendedconcentrationsindrinkingwaterbecomenephrotoxictoCKDrats,therebyaggravatingrenaldiseaseandmakingmediavascularcalcificationsignificant.”-A.Martín-Pardillosetal.inEffectofwaterfluoridationonthedevelopmentofmedialvascularcalcificationinuremicrats.Toxicology.2014Apr6;318:40-50

Byignoringrisksforkidneyimpairedandthendishonestlyclaimingwaterfluoridationissafe,theNHMRChastotallyignoreditsdutyofcaretopeoplewithkidneyimpairment.

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12.Onanotherbutrelatedmatter,theNHMRCendorseddoublingchildren’suppersafetylimitsforfluorideingestion(usingdatafromthe1930s)almostcertainlyanticipatingthatthepre-existinglimitswouldbeexceededbybottle-fedinfantsinwhichformulaismadeupwithfluoridatedtap-water.ThisitemgoesbeyondtheNHMRC2017reviewbutitgoestothebiasofNHMRCinitscontinuedpromotionanddefenceofwaterfluoridation.Despitethesteadilyincreasingnumberofhumanstudiesindicatingfluorideisadevelopmentalneurotoxin,theNHMRChasrecentlyapprovedthedoublingoftheuppersafetylimitsoffluorideingestionforchildrenupto8yearsofage.Thenewchildren’sfluorideintakesafetylimitsrecentlyendorsedbytheNHMRCarenowtwiceashighastheEuropeanandUSAUpperTolerableIntakeLimits.ApparentlytheNHMRCthinksthatAustralianchildrenarebiologicallydifferenttootherchildrenandcansafelyingestandtoleratetwiceasmuchfluorideastheirinternationalcounterparts.Thesenewdoubleduppersafetylimitswereconstructedbyacommitteeof8members,includingaQueenslandHealthdentistwhoisalobbyistforforcedfluoridation,aswellas5AdelaideUniversityDentalSchoolstaff.Atleast6outthecommitteeof8whohavedoubledthepreviousAustralianfluorideintakesafetylimitsareextremelybiasedtowardsfluoridation.TheQueenslandHealthdentistwhowasonthiscommitteehasbeenrepeatedlyreportedbyAustralianmediaassayingthatpeoplewhoareopposedtofluoridationarenutters,conspiracytheoristsandflat-earthers.Whywassomeonelikethisevenonthecommittee?Andsincewhendiddentistsbecomeexpertsinnutritionandtoxicology?Thisgroupbasedtheirrecommendationstodoublechildren’sfluorideingestionsafetylimitsontheirchosenextremeendpointofseveredentalfluorosisandthen,fortheircalculations,heavilyusedfluorosisdatacollectedinthelate1930sfrom273Americanchildreninanareawheredrinkingwaternaturallycontained1.9mgoffluorideperlitre.Seventy–fivepercentofthechildreninthatgrouphadsomelevelofdentalfluorosisbutthecommitteewhodoubledAustraliansafetylimitstotalledignoredthat.TheNHMRCcannotpossiblycareaboutthesafetyofchildrenwhentheNHMRCendorsessuchshoddyandextremelyunprofessionalwork.ThecommitteewhodoubledtheuppersafetylimitsforchildrenusedthefluoridecontentofprocessedfoodsasmeasuredbyFoodStandardsAustraliaNewZealandinBrisbane–justpriortoBrisbanebeingfluoridated-thusminimisingthemeasuredfoodfluoridecontent.ThiscommitteealsoignoredanycurrentcontributiontofluorideburdencontributedbyfoodsfumigatedwiththepesticideSulfurylFluoride(AKAProfume).SulfurylFluoridewasapprovedforuseinAustraliainearly2008andbynowcouldhavewidespreaduseinAustralia,asintheUSA.Regardlessofthis,theNHMRCstillendorsedthedoublingofuppersafetylimitsforfluorideingestionbychildrenupto8yearsofage.Through2publishedstudies,oneinAustraliapublished2009(11)andanotheroneinNewZealandpublished2010(12)theNHMRCisawarethatthefluorideintakeofbottle-fedinfants,ifinfantformulaisreconstitutedwithwaterfluoridatedat1.0mg/LitrebreachestheNHMRC’spreviousuppersafetylimits-thisisalmostcertainlywhytheNHMRCwaskeentoendorsedoublingfluorideuppersafetylimitsforchildren.TheNHMRCisawarethatitisthefluoridecontentofthewateraddedtoinfantformulathatistheissueofconcern–buttheNHMRCobfuscatessayingthatthefluoridecontentofinfantformulapowderissafe.Again,theNHMRCseemstowanttoprotectfluoridationmorethanitwantstoprotectchildren.13.NHMRCabandonedthenormalGRADEevaluationmethodforstudiesoffluoride’seffectivenessalmostcertainlyinanefforttodisguisethefactthatmostofthestudiesreviewedwereoflow,orverylowquality.Here'saquotethatsaysitall(NHMRC2016TechnicalReportp54)

"TheGRADE(GradingofRecommendationsAssessmentDevelopmentandEvaluation)systemforassessingevidencewasnotoriginallydesignedtoconsiderevidenceforpublichealthinterventions.Consequently,forpublichealthinterventionslikewaterfluoridation,whereevidenceofefficacycomesfromobservationalstudies,muchoftheevidencewillultimatelyberatedas‘low’or‘verylow’quality.Duetoconcernsthatthepotentialpejorativeconnotationsofthesedescriptorsmayresultintheevidencebeingdisregardedand/ormisinterpreted,theFluorideReferenceGroupdecidedtoomitthedescriptorsanddescribetheevidenceintermsoftheconfidenceinthereportedresults."

EssentiallytheFluorideReferenceGrouprejectedthestandardtermsforevidencequalityintheassessmentsystemtheywereusingbecausetheywouldmaketheevidencelooktoopoor.Thosetermsare"low"and"verylow"quality,andtheypredictedthatthemajorityoftheeffectivenessstudieswouldgettheseratings.Astudythatwouldhavebeenratedas“alowqualitystudy”couldthenbecomegradedbytheNHMRCas“Ourconfidenceinthereportedassociationsislimited”.ThishelpeddisguisethefactthatmostofthestudiesusedbytheNHMRCwerelowquality,orverylowquality.TheNHMRCthenadoptedsomeveryflexiblecriteriaforacceptingorrejectingastudyintotheirreview.Basically,thepersonreviewingaparticularstudyhasnoclearandsharpguidelines,theycanusetheirflexibilityandprettymuchjustsay"Idon'tthink

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thisstudyisgoodenough"andrejectit.ThisisshownintheCEO’sAdministrativeReportwherein2016-17theFRGusingextremelyflimsyreasonstorefusetheinclusionofmanyapplicablestudiesthatindicatedharm.Forexample,the2015studybyMalinandTill(7)linkingUSwaterfluoridationtoADHDwasexcludedbytheFRGbecause(a)theydidn’tlikethehypothesisinthepublishedpaperand(b)becausetheFRGhadn’tincludeditinthe2016draftinformationpaper–sotheywouldn’tinclude(orevenmentionit)inthe2017informationpaper.AtotalfarcebytheNHMRC!14.NHMRC2017ratestoothdecayanddentalfluorosisasmoreimportantendpointthanotherhealthincomes,includingcancerandIQ.AsshownintheNHMRCreview’sTechnicalReport(page53)beforetheNHMRCreviewstarted,theFluorideReferenceGroupclassifiedtheimportanceofhealthoutcomesforitsdecisionmaking.TheFluorideReferenceGroupclasseddentalcariesanddentalfluorosisas“Criticalfordecisionmaking.”TheFluorideReferenceGroupthenclassedallotherhealthoutcomes,includingneuro-cognitiveeffects,renaleffects,cancer,thyroiddysfunctionetc,as“Important,butnotcritical.”TheNHMRCandtheFRGhavegotaseriousproblemwiththeirprioritieswhentheyconsidertoothdecayisamoreimportanthealthissuethancancer,orharmtoIQ.15.NHMRCcommencedreviewwithstrictrestrictionsforacceptableevidence,thenincludeda)unpublishedwork;b)afavourablenarrativeandc)anabstract.SomeofthewaystheNHMRCexcludedrelevantstudies

a. StudymustbepublishedinEnglish.TheNHMRCthuseliminatedmanypublishedChineseandothernon-EnglishstudiesonfluorideandIQ.

b. Noanimalstudieswouldbeaccepted,eventhoughsuchstudiesarerequiredbygovernmentregulatoryagenciessuch

astheUS’sEPAandFDA.Animalstudiesareanessentialcomponentofa"weightofevidence"evaluationofthetoxicityofachemicalsubstanceormedicalintervention.Standardtoxicologyassessmentsofadrugorachemicalalwaysstartwithanimalexperiments.Thesecanprovidemorereliableinformationthanhumanexperimentsbecausetheycantightlycontrolallthevariablesexceptexposuretothechemicalinquestion.Youcancontroleverything.Theonlydownsideisextrapolatingtheresultsfromanimalstohumans,butthatisconsideredanacceptablelimitationforimportantregulatorydecisions.

c. Exposurecouldonlybefromfluorideindrinkingwater.TheNHMRCevenrejectedstudieswhichuseddrinkingwaterFexposurewhenthestudyadditionallyconsideredexposurefromothersourcessuchasswallowedtoothpaste.Thisisridiculous,sinceitisclearlytotalexposurethatisofinterestforbotheffectivenessandsafetystudies.

d. Forsafetystudies,theNHMRCadoptedcriteriathatifthewaterFconcentrationismorethan1.5mg/L,thestudywill

bedowngradedorevenrejectedbecauseitisclaimedtobeinapplicabletoAustralia.Thisignorestheobviouspointthatwhenstudyingadversehealtheffects,itisoftennecessarytostudyhigherexposuresthancommonlyoccurtoteaseouteffectsinrelativelysmallsamples.Furthermore,thisignoresthefactwhenotherexposuresareincludedthetotalFexposureinAustraliamaybewithintherangeoftotalFexposureinthese(ignored)studieseventhroughthewaterFlevelisabove1.5mg/L.

Tofullyprotectahumanpopulationfromharmfromaknowntoxicsubstancea"weightofevidenceanalysis"isessential.ThiswasoneofthekeydifferencesbetweentheUSNRCreviewof2006andtheNHMRCreviewsof2007.ThisseverelimitationoftheNHMRC2007reviewwaspointedoutbyscientistsin2007,anditisthereforesurprisingthattheyhavereproducedtheirun-protectiveanalysisin2017.SofartheNHMRChasofferednoreasontoexcludeanimalstudies.ThisisstrangesinceweknowthattheNHMRCwasincorrespondencewiththeUSNIEHS/NTPagenciesonhowasystematicreviewofanimalstudiesonfluorideshouldbeconducted!Wesuspectthatitwasbecauseintheirreviewtheseagenciesreportedthattheyfoundlowtomediumqualityanimalstudiesthatindicatedthatfluorideisneurotoxic.WhentheNHMRCreviewcommenced,theallowablescopeofwhattheNHMRCwouldacceptasevidencewasseverelylimitedbytheNHMRC.Evidenceofharmviamedicalnotes,casehistories,animalstudies,non-Englishtextstudies,narrativeswerenottobeacceptedbytheNHMRCforthereview.WhattheNHMRCwouldacceptforevidencehadtobefullpublishedstudies(notabstracts)andwasextremelyrestrictedbytimeframeandscope.ItwastheheavilybiasedFRGcommitteethatwasthefinalgatekeeperandarbiterofwhatevidencewouldandwouldnotbeacceptedforthereview.

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HalfwaythroughtheNHMRC’sreview,probablyattherequestoftheFRG–therulesonwhatevidencewasacceptableforthereviewwerechanged;theNHMRC’sbarwasseriouslyloweredtoallowpublicationsotherthanscientificstudiestobeincluded.AscanbeshownintheAdministrativereportfortheNHMRCCEO,inlate2016theFRGincludedintheNHMRC’sreviewa(favourabletofluoridation)narrativeasevidence-(StateoftheSciencecommunitywaterfluoridation.ColoradoWaterResearch2015CromwellDA,McTigueNE,HayesS).Additionally,theFRGevenincludedanunpublishedconsultingreportbyJaguarConsulting(ImpactAnalysis:ExpandingWaterFluoridationinVictoria:Unpublished).JaguarConsultingareeconomistswithnoscientificqualifications.TheNHMRCFRGevenincludedanabstractintotheNHMRCreview-under“AdditionalConsiderations”.ThisdentalAbstractwasco-authoredbyFRGmembersMikeMorgan,KayRobertsThomsonand(F)CliveWright.TheNHMRCCEO’sAdministrativereportshowshoweverthattheFRG,asthe2017InformationPaper’sfinalgatekeeperexcludedallsubmittedIQstudiesandalldentalfluorosisstudiesthatweresubmittedviatheSept–Aug2016publicconsultation.IncludingthesewouldprobablyhavebeenpotentiallydamagingtotheNHMRC’sclaimthatfluoridationwassafe.TheNHMRC’sAdministrativereportalsoshowsthatastudylinkingUSAwaterfluoridationtoincreasedageadjustedincidenceofdiabetesin22states(13)wasexcludedbytheFRG.Thereisnotevenamentionofthisdiabetesstudyinthe2017NHMRC’sInformationpaper,eventhoughthisstudyhadbeensubmittedtotheNHMRCthroughtheSept-August2016publicconsultation.AlthoughthisisapublishedstudythathadresultedfromanapprovedThesis,theFRGclaimedtheyhadtroubleunderstandingit.ThemainreasonthattheFRGgaveforthemexcludingitfromthefinalNHMRCInformationpaper(published4July2017)wasbecauseithadn’tbeenincludedinthe2016draftNHMRCinformationpaper(published14September2016),sotheywouldn’tincludeinthefinalInformationpaper.In2016,diabeteshadnotevenbeenincludedasanoutcomeinthe2016draftpaper.Awordsearchfor“diabetes”intheNHMRC’s2017Informationpaperreturnszerofinds.WiththeFRGjustbeingabletoexcludeandcensorstudiesattheirwhimitmadeamockeryofboththeNHMRC’spublicconsultationprocessandtheNHMRC’sresearchandevaluationprocess.16.NHMRCattemptedtodiminishknowndentalfluorosisharmbymanipulatingfluorosisratingsandraisingthresholdofconcern.DatafromtheNSW2007ChildDentalHealthSurveyshowsthat25%of11-12yearoldchildreninNSWfluoridatedareashadsomelevelofdentalfluorosiswith3.3%ofthemhavingmoderatefluorosis(TF3)andafurther0.5%havingmoderate-severefluorosis(TF4andabove).TheNHMRCisnowclaimingthatwithexpansionoffluoridationdentalfluorosishasdecreased-downfrom25%in2007downto16.8%in2012–2014,nowwithonly0.8%ofchildrenhavingafluorosisscoreofTF3(withNHMRCalsonowclaimingTF3isonlymildfluorosisnotmoderatefluorosis).ThewayNHMRChasclaimedfluorosisratesarenowlowerisbymanipulationbytheNHMRC.TheNHMRChasdiluteddowntherateoffluorosisbynowcombiningfluoridatedwithnon-fluoridatedareas.ToclaimthatfluorosisisdecreasingtheNHMRChasswitchedgoalposts–thepreviousrateoffluorosisinNSWfluoridatedareasisnowbeingcomparedtoanoverallwholeofAustraliaratewhichcouldincludeareasfluoridatedaslowas0.6mg/landalsototallynon-fluoridatedareas.TheNHMRCisnowcomparingapplestooranges.TheNHMRChasalsoallowedthedownplayinganddiminishingdentalfluorosisbyallowingchangingthewayfluorosisisgraded.PreviouslyinAustraliaverymildfluorosiswasgradedasTF1(ThylstrupFejerskovindexof1),mildfluorosisasTF2,andmoderatefluorosisasTF3,moderate-severefluorosisasTF4andabove.ForthisNHMRCreviewafluorosisgradingofTF3(previouslyacknowledgedasmoderatefluorosis–eg,asinthe2007NSWchilddentalsurvey)isnowdowngradedbytheNHMRCandclaimedbytheNHMRCtobeonlymildfluorosis.TheNHMRCalsosimultaneouslyupgradedthethresholdlevelforfluorosisofaestheticconcernfromTF3uptoalevelofTF4.DentalFluorosisratesposeariskforfluoridationprogrammes,sobydownplayingfluorosisandthenclaimingfluorosisisnotaconcern,theNHMRChelpsprotectfluoridation.Inthe1998AustralianInstitutesofHealthandWelfare(AIHW)“ReviewofWaterFluoridation:NewEvidenceinThe1990s:FinalReportApril1998“FRGmemberProfJohnSpencer(asExecutiveofthatAIHWreview)hadreportedonpage106:

“HoskinandSpencer(1993)foundthatchildrenaffectedbyfluorosisandtheirparentsareabletoperceivethepresenceoffluorosisataverymildlevel.Theyconcludedthatchildrenwithmildfluorosisshowedasignificantadversepsychologicalresponsetotheirdentalappearance”(thiswasfromfindingsonthepersonalperceptionsofdentalfluorosisofSouthAustralianchildrenasreportedtoaDec1993ConsensusConferenceinPerthWestAustralia).

TheNHMRCFRGisnowassertingthatchildrenwithmildandevenmoderatedentalfluorosisperceivenoproblemswiththeappearanceoftheirteethwithfluorosis,despitethisbeingcompletelycontradictorytowhatFRGmemberJohnSpencerhadpreviouslyfoundandreported.

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TheNHMRCclaimsthatfluorosisrateshavedecreased–claimingthatAustralianchildfluorosisisnow16.8%.This16.8%figureisfromthe2012–14NationalChildOralHealthSurveythatwasco-editedbyFRGmemberJohnSpencer.TheNHMRCprovidedalargepartofthefundingforthesurvey.Toothdecayanddentalfluorosiswascollectedoneverychildinthesurvey,yetwhiletoothdecaywascomparedbyeverystateandterritoryinthesurveyreport,theeditorsdidnotreportfluorosisdatathisway.ThereisadearthofAustralianfluorosisdataandthiswasaperfectopportunitytocomparechildfluorosisratesinthestatesandterritories,butinstead,theauthorschosetowithhold.Thisisconsideredascensorship.ThecurrentNHMRCCEOProfAnneKelsoshouldneverhavesignedoffonthisNHMRCfundedsurveywhentheeditorsdidnotevenreportchildfluorosisdatabyeachstateandterritory.Dentalfluorosisdatawasalsocollectedonadultsineverystateandterritoryforthe2004-2006NationalAdultOralHealthSurvey(NAOHS2004-6)whichwasalsofundedbyanNHMRCgrant.FRGmemberJohnSpencerwasaleadauthoroftheadultsurveyreport.TothebestofourknowledgetheadultdentalfluorosisdatathatFRGmemberProfJohnSpencerhadcollectedinthatsurveyhasbeenwithheldforover10yearsandhasneverbeenpublicallyreported.Dentalfluorosisisasignoffluoridetoxicity,abiomarkerofoverexposuretofluorideamongyoungchildren.TheNHMRCwouldbeawarethateventheverymildestlevelofdentalfluorosisisproofthatchildrenhavebeenover-exposedtofluoridewhentheirteethareformingintheirgums.Itiscommonlyacceptedthatchildren’spermanentteethareformingintheirgumsuntiltheyarearound8yearsofage–thustheyareriskofdevelopingdentalfluorosisuntiltheyare8yearsold,yettheNHMRCclaimsthatthisisonlyuntiltheyare6yearsofage!GoodexamplesofNHMRC’sdoublestandardscanbefoundinAppendixBoftheNHMRCCEO’sAdministrativereportwhichcanbefoundathttps://www.nhmrc.gov.au/_files_nhmrc/file/your_health/fluoridation/17378_nhmrc_-_administrative_report_for_ceo-web_revised.pdf)

ThisAdministrativereportlistsanadditional5DentalFluorosisstudiesthatmettheadvertisedscopefortheSept–August2016publicconsultationonthedraftInformationPaperandtheFluorideReferencesGroup’sassessment.AllofthesewereexcludedbytheFRG.

EventhoughtheNHMRChadincludedthreeBraziliantoothdecaystudiesforitsreviewandInformationpaper,theFluorideReferenceGroupexcludedthreeBraziliandentalfluorosisstudiesclaimingforeach“BasedinBrazilsolacksrelevance/notapplicabletodentalfluorosisinAustralia”.DataontoothdecayinBrazilwasincludedinthe2017NHMRCreviewontheclaimthatitwasrelevanttoAustralia,butdataondentalfluorosisinBrazilwasexcludedfromtheNHMRCreviewontheclaimthatitwasnotrelevanttoAustralia.

TheFRGalsoexcludedaColombiandentalfluorosisstudy,partlybecauseitdidnottakeintoconfounderssuchasthestraightnessofteeth.TheFRGthenalsoexcludedanAmericandentalfluorosisstudyclaiming“Lacksrelevance/notapplicabletoperceptionsofdentalfluorosisinAustralia.Notjustaboutfluorosisbuttheshapeoftheteeth”.TheFRGthusexcludedonefluorosisstudypartybecauseitalsotookintoaccounttheshapeofchildren’steeth,whilesimultaneouslyexcludinganotherfluorosisstudybecauseitdidn’talsotakeintoaccounttheshapeofchildren’steeth.

17.NHMRCmisleadsthepublicanddecision-makersbyclaimingfluoridationreducestoothdecayby26-44%-butwithoutindicatingjusthowsmallsuchreductionsareinabsoluteterms–oftenlessthanonetoothsurfaceoutofover100toothsurfacesinachild’smouth!Asreferredtoinitem3,aftertheCochraneCollaborationreviewondentaleffectswaspublishedtheNHMRCsecretlycommissionedtheirownreviewofdentaleffectsandtheNHMRC’sFRGaddedinseveralpublicationsthatsomeFRGcommitteemembershadthemselvesauthored.BasedonNHMRC’ssecretlycommissionedreviewandbyincludingmanypublicationsauthoredbyFRGmemberstheNHMRCisnowclaiming“waterfluoridationreducestoothdecay26%-44%inchildren,teenagersandadults“ApparentlytheNHMRChasnotheardthatcorrelationisNOTcausation,yettheyaremakingtheiroverreachingclaimasifitwasproven.TherearemanyfactorsinvolvedinhowmuchtoothdecayanindividualhasandnoRandomControlledTrialshavebeendone.AlmosteverystudytheNHMRCusedwasalowquality,observationalecologicalstudy.Howmuchis26%oreven44%relativepercentagetermsinrealterms(theactualabsolutedifference)intoothdecay?Alargeclaimedpercentagedifferencecanactuallybeaverysmallabsolutedifference.InthepreludetoforcedfluoridationbeingintroducedinQueensland,fluoridationlobbyists,theAustralianDentalAssn(Qld)andQueenslandHealthinnewspaperadvertisementswereclaimingthatchildreninfluoridatedTownsvillehad65%lesstoothdecaythanchildrenfromnon-fluoridatedBrisbane.Thiswasbasedonalargestudy(14)publishedin1996thathadbeenco–authoredbyFRGmemberJohnSpencer.Thisstudyhadmeasuredtoothdecayintoothsurfaces.Theoriginalstudypublicationshowsthatthe65%lesstooth

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decaythatwasclaimedbyfluoridationadvocateswasbasedonasingledatapoint:anabsolutedifferenceofonly0.17toothsurfacesoutofover100toothsurfacespresentinachild’smouthatage7years.Thisstudyreportedchildrenaged6to12yearsold,whowerelifetimeresidentsoffluoridatedTownsvillehadanaveragedifferenceonly0.23toothsurfaceslessdecayintheirpermanentteeth,comparedtochildrenofthesameagewhowerelifetimeresidentsofnon-fluoridatedBrisbane.Tokeepthisinperspective-withalifetimeofexposuretofluoridatedwatertheaveragedifferenceintoothdecayforchildren’spermanentteethaged6to12yrswasonly0.23toothsurfaces–andthereareover100toothsurfacesinachild’smouth.Relativepercentagescanobviouslygiveamisleadingpicture.TheNHMRC’sInformationPaperhasonlypublishedclaimeddifferencesintoothdecayasrelativepercentages,butnotasabsolutedifferences.Whenfluoridationlobbyistshaveinthepastclaimed65%lesstoothdecayforanaverageabsolutedifferenceoflessthanonequarterofatoothsurfacewedonotknowhowsmalltheabsolutedifferencesintoothdecaymaybetobeabletogainatrueperspectiveandtheNHMRCcertainlydonotshowtheircalculationshowtheycameupwiththosefiguresof26%to44%.StateandTerritorydatafromthe2004–2006AustralianNationalAdultOralHealthSurvey(NAOHS2004-2006)showsthatadultsfromthenvirtuallynon-fluoridatedQueensland,whencomparedtoalltheotherstatesandterritorieswhichareheavilyfluoridated,didnothavethemosttoothdecayinanyofthe4adultagegroupsexamined.InMarch2013someoftheauthorsofthe2004-2006NAOHS(whoarealsomembersoftheNHMRCFRG)usingthedatafromtheadultsurveypublishedapaper(15)comparingtoothdecayinadultswhohadlivedinfluoridatedareasandnon-fluoridatedareas,forvaryinglengthsoftheirlives.Lookingatthegenerationbornbetween1960and1990(thosebornafterwaterfluoridation)comparingadultswithmorethan75%oflifetimeexposuretofluoridatedwatertothosewithlessthan25%exposuretofluoridatedwater,itwasfoundthatthosewhohadprolongedexposuretofluoridatedwaterhadnearly8teethwithdecay,whilethosewhohadverylittleexposuretofluoridatedwaterhadnearlynineteethwithdecay.Fornearlifetimeexposuretofluoridatedwaterthedifferencewasonly1.14teeth(approx11%differenceintoothdecay)Forbothapre1960sborncohortandpostcohorttherewasanapproximately11%relativedifferencecomparingprolongedvsnegligiblelifetimefluoridationexposure.Animportantconfounder–accesstodentalcare(e.g.,abilitytoaccessdentistsinmoreruralareascomparedtocityareas)wasnotevenconsidered,sotherealdifferncemayhavebeenevenless.The11%differenceinadulttoothdecayhadbeenmeasuredusingthemostcommonstandardofmeasuringtoothdecayDMFT–thenumberofDecayed,MissingandFilledTeeth.However,byusingalesscommonwayofmeasuringdecayedtoothsurfaces-DecayedMissingFilled(tooth)SurfacesDMFS(with4or5toothsurfacespertoothdependingonthetypeoftooth)AND,then,bytotallyignoringorexcludingthenumberofMissingteethfromtheequation(changingDMFStoonlyDFS)theauthorsthenclaimedthedifferenceintoothdecayfromfluoridationinthepre-1960cohortwas30%andinthepost1960cohortwas21%lessdecay.Thisishow11%differenceintoothdecayinadultscanbedoubledoreventripledpurelybythemanipulationofremovingsomedataandcanexplainhowtheNHMRCcanmisleadinglyclaimatleast26%lesstoothdecayforadultsfromfluoridation.TheNHMRCmakesmuchofpercentageswhenclaiminglargereductionsintoothdecay–butmakeslittlementionofwhatcanbeverysmallabsolutedifferences–largerelativepercentages,inabsolutedifferencesareoftenlessthanafractionofonetoothonaverage.18.NHMRCdishonestlyclaimsfluoridationissafebyexcludingimportantstudiesonspuriousgrounds,ignoringmanyothers,andevencherry-pickingweakstudiesthatservetheirpurpose(e.g.BroadbentonIQ).TheNHMRCstructuredtheirreviewsomanystudiesandevidencecouldnotbeincluded.Evenwiththestudiesthatwereleft,overall,forbothdentalbenefitsandforadversehealtheffects,thequalityofevidencewasloworverylow.

Foradverseeffects,theselowratingsappliedequallytostudiesclaimingnoadverseeffectsastostudiesclaimingtofindanadverseeffect.Thus,thisNHMRCreviewcouldnotruleoutadverseeffectswithanydegreeofconfidence.HereisaquotefromtheExecutiveSummaryConclusions:

“ThereislimitedevidencethatthereisnoassociationbetweenwaterfluoridationatAustralianlevelsandtheIQofchildrenandadults.ThereisalsolimitedevidencethatthereisnoassociationbetweenwaterfluoridationatAustralianlevelsandtheoutcomesofdelayedtootheruption,toothwear,osteosarcoma,Ewingsarcoma,totalcancerincidence,hipfractureandDownsyndrome.ThereviewalsoidentifiedevidencesuggestingthatwaterfluoridationatAustralianlevelsareassociatedwithasmallreductioninall-causemortality;however,ourconfidenceinthisassociationislimited,andthissmallreductionmaybeduetochance.Forallotheroutcomescanvassedinthisreview,theevidencewasofinsufficientqualitytodrawanyconclusions.”

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Formostadverseoutcomestherewas“limitedevidencethatthereisnoassociation”withfluoride,andforothersthequalityofevidencewassolowthatnoconclusionscouldbedrawn.FarfromthisNHMRCreviewbeingaresoundingrebuttaloftheevidencethatfluoridationcausesharm,itactuallyconcludesthereisinsufficientqualityevidencetoruleoutharm.Notasingleadverseoutcomehassufficientqualityevidencetoruleitout.Becausetheonusisonthosepromotingfluoridationofpublicwatertoprovewithsufficientconfidencethatitissafe,thisreportisaresoundingindictmentagainstfluoridationpromoters,becauseitconcludestheydonothavesufficientqualityevidencetoconfidentlyconcludeitiseithersafeoreffective.ItisshamefulthattheNHMRCshouldcontinuetowastetaxpayers’moneyonreviewslikethisandinsteadshouldputmoneyintowell-designedstudiesinAustraliaorbetterstillinreviewingthesuccessfulmethodsbeingusedtofighttoothdecayinchildren(includingchildrenfromlow-incomefamilies)innon-fluoridatedcountries.19.NHMRCdoesn’tunderstandprinciplesoftoxicology–concentrationisnotthesameasdose!TheDOSEoffluoridereceivedfromwatereachdayisnottheconcentrationoffluorideinwater-istheconcentrationoffluorideinthewater(measuredasmg/Litre)multipliedbyhowmuchwater(howmanylitres)youdrinkeachday.Someonedrinking2litresofwaterfluoridatedat1.0mg/Lingestsasmuchfluorideassomeonedrinking1litreofwaterfluoridatedat2mg/L.

TheTOTALDOSEreceivedeachdayisacombinationofhowfluorideyougetfromwater,fromtea,fromfood,fromdentalproducts,fromairpollutionandpesticideresidues.

WhentheNHMRCcommenceditsreviewitrestrictedthehealthstudiesitwouldaccepttoonlystudiesthatwereatAustralianfluorideconcentrations–NHMRC’sAustralianDrinkingWaterGuidelinesallowsupto1.5mg/Lfluorideindrinkingwater.TheNHMRC,byrejectingstudiesdoneonfluorideexposuresathigherlevelsthanthoseusedforfluoridationignoredtheeffectofdoseinpeoplewhodrinkmorewater(eg,athletes,outdoorworkers,peopleoncertainmedications,peoplewithDiabetesinsipidusorDiabetesmellitus),peoplewhoretainmorefluoride(eg,peoplewithkidneydisease)andinfantsfedformulamadewithfluoridatedwaterandfluoridefromothersources(seeabove).Adiscussionoffluorideaccumulationfromchronicingestionislacking.Dr.KathleenThiessen,RiskAssessmentScientistonthe2006NationalResearchCouncilpanel(NRC2006)hasstated–

“Therangeofindividualfluorideexposuresat1mg/Lwilloverlaptherangeofindividualexposuresat2mg/Loreven4mg/L.Thus,evenwithoutconsiderationofdifferencesinindividualsusceptibilitytovariouseffects,themarginofsafetybetween1and4mg/Lisverylow”

TheNHMRCeitherignores,ordoesnotseemtounderstandboththeissueofdose,andalsotheissueofindividualsusceptibility.20.NHMRCpervertedtheprinciplesofmedicalethicsbypresentingabogusethicalclaimconstructedbylobbyistsratherthanethicists.Waterfluoridationistheadditionoffluoridechemicalstopublicdrinkingwatertotryandtreatpeople.Waterfluoridationbyitsverynatureismassmedicationandmanycountriesdon’tundertakethispracticebecauseofconsiderationthatitisunethical,see-http://fluoridealert.org/content/europe-statements/.Additionally,theQueenslandgovernmentinitsofficial2003PositionStatement(copiedatend)hadacknowledgedthatwithouttheexpressconsentofthecommunityfluoridationisunethicalmassmedication.Fluoridationisbothmassmedicationandmedicaltreatmentthroughpublicwatersupplieswithoutindividual’sconsent.Inearly2013CairnsCouncilendedfluoridationacknowledgingthe2012positionoftheLocalGovtAssnofQldthatwithouttheexpressconsentofthecommunityfluoridationisunethicalmassmedication.TheNHMRCwouldbeawaresince2012,therehavebeen29QueenslandCouncilsthathaveformallyrejectedfluoridation.SomeoftheQueenslandCouncilsthathaveendedfluoridationhavedonesoaftercommissioningsurveysfindingapproximately50%upto70%ofthosesurveyeddidnotsupportfluoridation.AReferenduminMountIsafound89%ofvotersdidnotwantfluoridation.Knowingthatthereisindividualandcommunityoppositiontofluoridation,theNHMRCstillclaimsfluoridationisethical.ApparentlytheNHMRCbelievesitisethicaltoforceamedicationoratreatmentonnon-consentingindividuals.Nutrientsaresubstanceswhichfeed,nourishandsustaingrowth.Fluorideisnotanutrient.In2005–2006theNHMRCendorsedandpublishedNutrientReferenceValuesforAustraliaandNewZealand.In2006theNHMRChadmaintainedfluoridewasclassedasessentialtohumanhealthandincludeditinthenewnutrientsvalues.

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TheNHMRCFRGin2017nowintimatesthatfluoridationisjustthesameasaddingthenutrientIodinetosalt,orthenutrientFolicacidtobread.ThisisdeliberateobfuscationasIodineandFolicacidareprovennutrientsandsufficientintakeisessentialforlife,whereasfluorideisnotanutrient(despitetheNHMRCcallingitthis).TheNHMRCwouldnotbeabletoprovideinformationonasinglebiologicalpathwaywithinthehumanbodythatrequiresfluoride,becausetherearenone,yetstillclaimsfluorideisanutrient.DespitetheNHMRCendorsingfluoridationsince1953,theNHMRChadneverexaminedtheethicsoffluoridation.TheNHMRCnowclaimsthatfluoridationisethical.TheNHMRCclaimsthatfluoridationisethicalbasedontheNHMRC’sclaimthatfluoridationissafe.ThewaytheNHMRCclaimsfluoridationissafeisbydenyinganyfluoriderisktothyroidfunction,denyingasignificantassociationwithOsteosarcomabonecancer,excluding,ignoringordownplayinglinkstoADHDandIQdeficit,andtotallyignoringriskofcumulativeeffectsforpeoplewithkidneyimpairment.AspartoftheirreasonsforclaimingthatfluoridationisethicaltheFRGintheethicssectionoftheinformationpaperclaimedthatis“Itisnotpossibletobuyfluoridesupplements.”ApparentlytheNHMRC’sFRGhasneverheardabouteBaywhereitiseasytobuyfluoridetablets(supplements)FreedomofInformationdocuments(NHMRCFOI2016-17/019)indicatefluoridationlobbyistsintheNHMRC’sFRGcommitteeplayedalargepartinwritingtheEthicssectionofthe2017NHMRC’sfluoridationInformationPaper.Itappearsthatapartfromrequestingsomesmallcosmeticchanges,TheNHMRC’sAustralianEthicsCommitteemostlyjustsignedoffonwhattheFRGhadconstructed.21.NHMRCgaveanincompleteprojectofdubiousqualityaprestigiousNHMRCawardAsoneexampleofpreviousNHMRCbias-inAugust2008theNHMRCawardedProfsCliveWrightandMikeMorganaprestigiousNHMRCaward–“OneoftheTenBestResearchProjects2008”fortheirresearchprojectonwaterfluoridationandcosteffectiveness.By2011theNHMRChadthestatusofProfsWright/Morganprojectmarkedascomplete–yetapparentlyonlyonepublishedarticle(16)haseverbeenresultedfromthisprojectandthatwaspublished2yearsafterProfsWright/MorganweregiventheNHMRCaward.TheirarticlewaspublishedonlyintheAustralianDentalJournalin2010,notinaninternationaldentaljournalofhigherranking.ProfsCliveWrightandMikeMorgan’sprojectleadresearcherhaddiedinMay2008anditwasunlikelythatanyotherpublicationswouldevereventuate.In2014theNHMRCappointedbothCliveWrightandMikeMorgantotheNHMRCFluorideReferenceGrouptodotheNHMRC’supcomingreviewonfluoridation.TheWright/MorganprojectwasbysupportedbyaNHMRCgrant.ExaminingtheprojectsProgressReportstotheNHMRC(obtainedthroughFreedomofInformation-NHMRCFOI2011-00643)didnotinspireanyconfidenceinthequalityoftheprojectdatathathadbeencollected–yettheNHMRCstillgaveitsprestigiousawardtoProfsWrightandMorganonanunfinishedprojectofdubiousquality.Alsonote–anyfluoridationcost-effectivenessanalysesarealwaysone–sided,theyneverincludethecostoftreatmentofdentalfluorosisoreverconsideranyotherpotentialadversehealtheffects.22.NHMRCfluoridationpublicconsultationshavebeenshams.

TheNHMRChadadvisedin2016publicconsultationwouldbeavailablewhentheInformationpaperwasreleased.However,theNHMRC’spublicconsultationsonfluoridationaretotalshamsandfarces.TheONLYpublicconsultationsubmissionsthattheNHMRCwillnowacceptisonthetwosentenceNHMRCPublicStatementandthentheNHMRCwillonlyacceptanswerstotheNHMRC’sfiveveryself-servingquestions.SubmissionsandcriticismoftheactualInformationpaper,published4July2017willNOTbeaccepted.Withthepublicconsultationthepublicarenotallowedtosubmitabstractsornarrativereviews–despitetheFRGincludinganabstractandnarrativetheyhadselected.IntheNHMRC’s2014publiccallforevidence,theNHMRChadlimitedallpublicsubmissionsto500words.ThisludicrousactionbytheNHMRCcreatedsomeoutrage.In2016theNHMRCwouldalsonotacceptanysubmissionsorcriticismofthe2016TechnicalReport,orthe2016EvidenceEvaluationreport.Inotherwords,theNHMRChasgiventhepublictheopportunityto“ventoffsteam“butthroughouttheprocesshasdeniedindependentscientistsagenuineopportunitytoaddressthemanyflawsandweaknessesinthisreviewinasubstantialway.Thewholethinghasbeenascam.NHMRC’sfarcicalpublicconsultationsareaninsulttothemanyAustraliancitizensandscientistswhohavemanyyearsstudyingthissubjectindepth.ThisdisdainfulapproachtoseekinggenuineandmeaningfulinputishighlysuggestivethattheNHMRCknowsthatitisdefendingaverypoorreviewonaverypoorpractice.

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Onthe13thSeptember2016,theNHMRChadaWebinarforjournalistsaboutNHMRC’sdraftInformationPaperthatwastobereleasedthefollowingday.ThespeakerswereNHMRCCEOAnneKelsoandFRGmemberProfCliveWright.TheNHMRChadpreparedaPowerPointpresentationforthemediawithkeymessagesthatAustralianfluoridationwassafeandwasnotlinkedtoanyharm.Publicconsultation,restrictedtoonlytheNHMRC’sdraftInformationpaper,openedonthe14thSept2016,yettheNHMRChadalreadybroadcastviaAustralianmediathatfluoridationwassafe.The2016publicconsultationthenwasatotalsham–therereallywasnopointinlettingthepublicsubmitcontraryevidencewhenitwasgoingtomakenodifferencetotheNHMRC’spublishedclaimthatfluoridationwassafe.IntheendwhentheInformationPaperwasreleasedonthe4thJuly2017,theNHMRCwouldnotevenallowthepublictosubmitsubmissionsonit.23.TheNHMRC’sextraordinaryefforttomaintainthedubiousclaimsthatfluoridationissafe,effectiveandethical,arebecomingmoreandmoredesperatebytheyear.NHMRC2007wasverybad,NHMRC2017vergesonfraudTheNHMRCadministersnearlyaBILLIONdollarsintaxpayerfundseverynear,yetwithitsfluoridationreviewhaveemployedcorruptbiasedpracticesthatignorepublichealthrisks-andattemptedtoconcealsuchaunprofessionalreviewbygrosslylimitinggenuineinputfromthepublic-especiallythosewhohavestudiedtheissueclosely.

NHMRC’sactionsinitslatestfluoridationreview,iftheyhadbeendoneinacriminaltrial,wouldbedeclaredasamistrialbecause(1)TheJudgedeliberatelyappointedabiasedjury(2)TheJudgedeclaredtheverdictofinnocencebeforeandalsojustafterthetrialhadstarted(NHMRCreaffirmedits2007RecommendationstatementinJune2013andon25Feb2015(3)theJuryexcludedordeniedcriticaldamagingevidenceandthenchangedthetrialtoincludeevidencethathadbeendeclaredasoutofscope.TheNHMRCRecommendation(PublicStatement)in2007wasthis–

NHMRCRecommendation:Fluoridationofdrinkingwaterremainsthemosteffectiveandsociallyequitablemeansofachievingcommunitywideexposuretothecariespreventioneffectsoffluoride.Itisrecommendedthatwaterbefluoridatedinthetargetrangeof0.6to1.1mg/ldependingonclimatetobalancereductionofdentalcariesandoccurrenceofdentalfluorosis.(Emphasisadded)

NHMRC’snewPublicStatement(released4July2017)isnowthis–

NHMRCStatement:NHMRCstronglyrecommendscommunitywaterfluoridationasasafe,effectiveandethicalwaytohelpreducetoothdecayacrossthepopulation.NHMRCsupportsAustralianstatesandterritoriesfluoridatingtheirdrinkingwatersupplieswithintherangeof0.6to1.1milligramsperlitre(mg/L)(emphasisadded)

Inagiantleap,theNHMRCafteritsbiasedreview,isnowclaimingthatwaterfluoridationissafe,yettheyhaveignoredhealthissues(eg,kidneyimpairment)anddeniedothers(cancer,lossofIQetc).TheNHMRChasneverconsidereddifferentialsusceptibilityandvulnerabilitythatoccurswithinthepopulation.TheNHMRC,toshoreuptheirpublicstatementevencensoredanyreferencetoclimate,tobalanceandtofluoridationcausingdentalfluorosis.TheNHMRCevenclaimsfluoridationisethical,howeverthisclaimwasconstructedbyfluoridationlobbyistswithintheNHMRCandNHMRCFRG.HowcananyonetrusttheNHMRCaftersuchbiasedself-servingirresponsiblebehaviour-andinthenameofapublicagency?

CONCLUSIONS:TheNHMRChasignoreditsDutyofCareandbetrayedtheAustralianpublicwithitspoorandpervertedfluoridereview.TheNHMRC’sfluoridereviewshouldbeshredded.

WerequestthatcitizensandscientistsfrominsideAustraliaandaroundtheworldwillcallforaRoyalCommissioninquirytoinvestigatetheNHMRC’sbehaviorinthismatter.HopefullytheywillcallforanewreviewtobecommissionedbytheFederalgovernmentbutcarriedoutbyanindependentorganization,withthepanelcomprisedofunbiasedscientistsandprofessionals.

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Intermsofreviewinggovernmentpoliciesingeneral,itisrequestedthattheRoyalCommissioninvestigatethewisdomofusingagovernmentdepartmentsuchasNHMRCtoreviewthescienceofcontroversialprograms,whenthoseprogramshavebeenpartoflong-standinggovernmentpolicy.UndersuchcircumstancesitisurgedthattheRoyalCommissionrecommendsuchreviewsbeorganizedbyanon-governmentalagency.Thisagencywouldberequiredtoselectpanelscompletelyindependentofgovernmentalinfluence.Ideallysuchpanelswouldconsistofexpertsdrawnfrombothsidesoftheissueinquestion,andthosewhohavenottakenapositionontheissue:agoodmodelwouldbethepanelselectedbytheU.S.NationalResearchCouncilforitsreviewoffluoride’stoxicityin2006.

AuthorisedbyMHainesonbehalfofFluorideActionNetworkAustraliaInc.Econtact@fluoridealertaustralia.orgMob0418777112

Seetableatendforexamplesonsomeoftheknownconflictsofinterestson

10membersoftheNHMRCFluorideReferenceGroup(FRG)References

1. Iheozor-EjioforZ,WorthingtonHV,WalshT,O’MalleyL,ClarksonJE,MaceyRetal.Waterfluoridationforthepreventionofdentalcaries.TheCochraneDatabaseofSystematicReviews,2015;6:CD010856.

2. PeckhamS,LoweryD,SpencerS.ArefluoridelevelsindrinkingwaterassociatedwithhypothyroidismprevalenceinEngland?AlargeobservationalstudyofGPpracticedataandfluoridelevelsindrinkingwater.JEpidemiolCommunityHealth,2015;69(7):619-24

3. FluorideinDrinkingWater:AscientificReviewofEPAsStandards;NationalResearchCouncil(NRC)2006of

theNationalAcademyofSciences4. Broadbent,JM,Thomson,WMetal2014.CommunityWaterFluoridationandIntelligence.ProspectiveStudy

inNewZealand,AmericanJournalofPublicHealth,105(1)72-76

5. AnnaL.Choi,GuifanSun,YingZhang,andPhilippeGrandjeanDevelopmentalFluorideNeurotoxicity:A

SystematicReviewandMeta-Analysis;EnvironHealthPerspect;

6. Grandjean&Landrigan(2014);Neurobehavioraleffectsofdevelopmentaltoxicity;TheLancetNeurology,

13(3)330–338,March2014.7. MalinAJ,TillC.Exposuretofluoridatedwaterandattentiondeficithyperactivitydisorderprevalenceamong

childrenandadolescentsintheUnitedStates:anecologicalassociation.EnvironHealth,2015;14:17.8. Bassin,EB,Wypij,Detal2006.Age-specificfluorideexposureindrinkingwaterandosteosarcoma(United

States),CancerCauses&Control,17(4),421-4289. Kim,F.M.,C.Hayes,P.L.Williams,G.M.Whitford,K.J.Joshipura,R.N.Hoover,andC.W.Douglass.2011.“An

assessmentofbonefluorideandosteosarcoma.”JournalofDentalResearch,90(10):1171–1176.10. McDonaghM,WhitingP,etal;Asystematicreviewofpublicwaterfluoridation2000.UnitedKingdom:

UniversityofYork,NHSCentreforReviewsandDissemination,2000.(AKAYorkUniversity2000review)11. Clifford,H.,H.Olszowy,etal.(2009)."FluoridecontentofpowderedinfantformulameetsAustralianFood

SafetyStandards."AustNZJPublicHealth33(6):573-57612. CresseyP(2010).Dietaryfluorideintakeforfullyformula-fedinfantsinNewZealand:impactofformulaand

waterfluoride,JPublicHealthDent;70(4):285–291.13. FlueggeK.Communitywaterfluoridationpredictsincreaseinageadjustedincidenceandprevalenceof

diabetesin22statesfrom2005and2010.JWaterHealth,2016;14(5):864-7714. AJSpencer,GDSlade,DaviesM;CariesexperienceamongchildreninfluoridatedTownsvilleandnon-

fluoridatedBrisbane;AustNZJPublicHealth1996;20;623-915. GDSlade,AESanders,LDo,KRobertsThomson,andAJSpencer.EffectsofDrinkingFluoridatedDrinking

WateronDentalCariesinAustralianAdults;JDentalResMarch201316. CampainAC,MarinoRJ,WrightFACetal;TheImpactofchangingdentalneedsoncostsavingsfrom

fluoridation;AustralianDentalJournal2010;55:55:37-44Seefollowingpagesforexamplesonsomeoftheknownconflictsofinterestson10membersoftheNHMRCFluorideReferenceGroup(FRG)

AcopyoftheQueenslandGovernment’s2003PositionStatementthatacknowledgeswithouttheexpressofthecommunityfluoridationisunethicalmassmedicationisshownonthelastpage.

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NHMRCFluorideReferenceGroupCommitteeMember(FRG)

2014-2017

KNOWNCONFLICTSOFINTEREST

(knownlobbyistforfluoridation/fluoridationsupporter)

1

DrMeenakshiArora

Supporteroffluoridation–ascitedininterviewbyBundabergNewsMailDec2009“DrMeenakshiArora,UniversityofMelbourneresearchfellowforchemicalandbiomolecularengineeringandasupporteroffluoridation,toldapressconferenceonthesubject:“Itdefinitelyandsignificantlyreducestheriskofdentalcaries.Butweneedtobecarefulnottooverdosepeople,especiallykidsintheagerangeoftwotosevenyears.”http://fluoridealert.org/news/bundaberg-region-fluoride-in-two-years/

2

AssocProfStephenCorbett

Corbett’spaper“Fluoride:BenefitsFarOutweighRisks”publishedin1993NSWHealthPublicHealthBulletincanbedownloadedhere–http://www.health.nsw.gov.au/phb/Documents/1993-08.pdforjustthe2actualpageshere-http://www.publish.csiro.au/?act=view_file&file_id=NB93040.pdf

ClaimedthatdentalfluorosisinNSWin1993wasonly3%(hedidn’tspecifythatthatwouldonlybetherateofModeratefluorosis)NOTE–AssProfCorbettwasonlylistedasaFRGmemberAFTERtheNHMRC2014CallforEvidencehadclosed

3

AssProfSharonGoldfeld

AssociateProfessorSharonGoldfeld,ChairoftheP&CHDPaediatricOralHealthWorkingGroup.(RACPPaediatric&ChildHealthDivision(P&CHD)–“TheRACPandtheRACDS,throughtheirChildOralHealthStatement,havecalledfororalhealthawarenessinthetrainingofallhealthprofessionalswhoworkwithchildren.Collaborativepublichealthapproacheshavealsobeenidentified,includinghealthcareprofessionaltrainingandpublicwaterfluoridationforallcommunitieswithpopulationsgreaterthan1,000people.TheRACPandRACDSintendtopartneraroundmanyoftheseissuestoeffectmorepositiveoutcomesontheoralhealthofchildrenandyoungpeople.Source-BiteMagazine20thSept2012-

MemberofPublicHealthAssociationofAustralia(PHAA)joinedin2000.PHAAhasformanyyearsactivelylobbiedforfluoridation–particularlyforQld.

4

ProfAlisonJones

AspartofNSWHealthteampresentedtheYescaseforfluoridationatByronBaypublicinformationevening-16thOctober2013.WasalsopartofNSWHealthteamearlierin2013givingbriefingsessionspromotingfluoridationtoLismoreandBallinaCouncils

http://www.abc.net.au/news/2013-10-17/byron-fluoro-meeting/5028058“Butamedicalspecialisthasdescribedthemythologyandfearsaroundfluoridationofdrinkingwateras'nonsense'.WollongongUniversity'sDeanofMedicineandToxicology,ProfessorAlisonJonestoldthecrowdthattherewasnoevidencetosupportsuchclaims.”

5

DrFredericLeusch

“Toolittlefluoride,lessthan0.1mg/Lindrinkingwater,leadstopoordentalhealthandhighincidenceofdentaldecay”plusotherquotesinMay272014SunCoastNews

http://www.suncoasttimes.com.au/features/something-in-the-water/

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NHMRCFluorideReferenceGroupCommitteeMember(FRG)

2014-2017

KNOWNCONFLICTSOFINTEREST

(knownlobbyistforfluoridation/fluoridationsupporter)

6

ProfMikeMorgan

NHMRCPodcast19Feb2009-Andthedownsides?“Extremelyminimal,”ProfessorMikeMorgan,ColgateChairofPopulationOralHealthattheMelbourneDentalSchooltellsinterviewerStuartCameron.

http://www.nhmrc.gov.au/media/podcasts/2009/we-know-fluoride-saves-teeth-it-cost-effective

PartofCliveWright’steamwhichwonNHMRC10oftheBestResearchProjectsof2008NHMRCarticletitled“Linkingwaterfluoridationwithgooddentalhealth“

http://www.oralhealthcrc.org.au/content/professor-mike-morgan-0“ProfessorMorgan’sprincipalteachingresponsibilityisinpopulationoralhealth,focusingonoraldiseasecausationinrelationtocommonriskfactorsanddiseasepreventionatapopulationlevel-withanemphasisoncommunitywaterfluoridation”“HehasbeenaconsultanttotheVictorianGovernmentinareassuchastheAuditorGeneral’sreviewintopublicdentalservicesandtherecentVictorianGovernment’sexpansionofcommunitywaterfluoridationinVictoria.”

7

DrKatherineO‘Donoghue

President,IndigenousDentists'Association-anassociationwhichwantsallIndigenouscommunitiesofmorethan500peoplefluoridated

“IndigenousDentists’AssociationofAustralia-IndigenousOralHealthGoals”–extract

Goal1.CommunitywaterfluoridationTarget

Allindigenouscommunitieswithapopulationofmorethan1000willhaveafluoridatedwatersupplyby2015.

Allindigenouscommunitieswithapopulationofmorethan500willhaveafluoridatedwatersupplyby2020

QldHealthdentalemployee-ServiceLineDirectorofOralHealth,OralHealthServices,QueenslandHealth(QldHealthactivelypromotesfluoridation)

8

ProfKayeRoberts-Thomson

InterimDeanandHeadofSchoolofDentistryandDirector,DentalPracticeEducationResearchUnit,AustralianResearchCentreforPopulationOralHealth,TheUniversityofAdelaide–hascontinuouslypromotedfluoridationforyears.RecipientofgrantmoneyfromAIHWandNHMRC-hasusedemanatingpublicationstopromotefluoridation(childdentalhealthsurveys,nationaladultoralhealthsurvey)

9

EmeritusProfA.JohnSpencer

ParticipatedintwoNSWLandandEnvironmentcourtcases-(1)tohelpRousWater,LismoreandBallinaCouncilsbeabletofluoridatetheirjurisdictions(2011)(2)toassistcontinuedfluoridationbyEurobodallaCouncil(2013)

FormerdirectorofAustralianResearchCentreforPopulationOralHealth,TheUniversityofAdelaide–hascontinuouslypromotedfluoridationforyears.RecipientofgrantmoneyfromAIHWandNHMRC–hasusedemanatingpublicationstopromotefluoridation(childdentalhealthsurveys,nationaladultoralhealthsurvey).His1996studycomparingfluoridatedTownsvilletonon-fluoridatedBrisbanechildrenwasusedbyBlighgovtin2007tomandateQldfluoridation.Morerecentlyrecipientofapprox$900,000fromQldHealthtoanalysedatareportonbaselineoffluoridationinQld

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NHMRCFluorideReferenceGroupCommitteeMember(FRG)

2014-2017

KNOWNCONFLICTSOFINTEREST

(knownlobbyistforfluoridation/fluoridationsupporter)

10

Prof(Frederick)CliveWright

AsNSWChiefDentalOfficerhehadparticipatedin2011NSWLandandEnvironmentcourtcasestohelpRousWater,LismoreandBallinaCouncilsbeabletofluoridatetheirjurisdictions.

RecipientofNHMRCgrantswhichhehasusedtopromotefluoridation.ChiefInvestigatorofteam,whichwonNHMRC10oftheBestResearchProjectsof2008-NHMRCarticletitled“Linkingwaterfluoridationwithgooddentalhealth”–thiswindespitetheresearchnotbeingcompletedduetothedeathoftheleadresearcherandonlyonearticlethatwaspublishedintheAustralianDentalJournal

QueenslandGovernment

PositionStatementonWaterFluoridationWhilstrecognisingthatthebalanceofthescientificargumentfavourstheuseoffluorideinthepursuitoforalhealth,itisaprincipleofethicalpublichealththatmass,involuntarymedicationmustneverproceedwithouttheexpressconsentofthecommunity.Thebalanceofargumentrestsonevidencewhichsuggeststhattheprevalenceofdentalcariesinbothadultsandchildrenisreducedincommunitieswherethewatersupplycontainscertainlevelsoffluoride.InQueensland,referendumguaranteestheconsentofthecommunityundertheFluoridationofPublicWaterSuppliesAct(1963)(theAct).QueenslandGovernmentrecognisesthatthereisnotaunanimityofopiniononthehealthandenvironmentalimpactsoffluoridation,butinviewoftheprevailingbalanceofargument,encouragespublicdebateaimedatenhancingoralhealth.WaterfluoridationwasintroducedinallAustralianStatesinthe1960's,andabout80percentofthepopulationofmoststatesnowreceivefluoridatedwatersupplies.TheNicklinGovernmentintroducedtheActinQueenslandin1963.Itplacestheresponsibilityforproposingthispublichealthmeasuretocommunities,andcarryingouttheirdecisions,onindividuallocalgovernments.Atpresent,onlyabout5%oftheQueenslandpopulationhaveconsentedtothefluoridationoftheirwater.QueenslandGovernmentsupportstheintroductionofwaterfluoridationwhereveritreceivestheconsentofthecommunityaffected.Itacknowledgestheendorsementoffluoridationbymanyscienceandhealthorganisations,includingtheNationalHealthandMedicalResearchCouncil,FederationDentaireInternationale(FDI),theInternationalAssociationforDentalResearch(IADR),andtheWorldHealthOrganisation(WHO).TheachievementofimprovementsinoralhealthinthepopulationisoneoftheKeyPerformanceObjectivessetoutintheQueenslandHealthCorporatePlan1996-2001.Thefluoridationofwatersuppliesmaybeoneavenuefortheachievementoftheoralhealthobjectivessetoutinthisdocument,andthePublicHealthServicesPlanforAchievements1996-1999

QueenslandGovernmentQueenslandHealth2003


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