A recent study by the Cochrane Collaboration claims, “There was insufficient information available to understand the effect of stopping water fluoridation programmes on tooth decay. No studies met the review’s inclusion criteria that investigated the effectiveness of water fluoridation for preventing tooth decay in adults, rather than children.” This leaves the study as virtually inconclusive on any information, which is sad, considering water fluoridation is now being used in nearly two thirds of all American households as reported by the CDC.
One thing is clear, there is fluoride in our water and no evidence to support that it is or isn’t safe for our health. The only consistent credible information produced from any of these studies is that it causes dental fluorosis in a low percentage of individuals exposed. This makes the enamel more porous and susceptible to cavity as reported by the AAPD (American Academy of Pediatric Dentistry). This means there is very little evidence proving water fluoridation causes cavities and virtually no evidence proving the classic claim the water fluoridation helps prevent cavities. Either way one thing can be sure, more study is needed.
Cochrane is widely regarded as providing the gold standard for study of effectiveness on public health policy. The collaboration formed an official relationship in January 2011 with the World Health Organization (WHO) as a partner non-governmental organization with a seat on the World Health Assembly to provide input into WHO resolutions. Clearly it would seem they are a credible source of information and their statistics can be trusted, but books shouldn’t be judged by their covers.
Cochrane has been scrutinized in the past by several organizations claiming its studies harbor a failure to include a sufficiently large number of unpublished studies, failure to pre-specify or failure to abide by pre-specified rules, an excessively high percentage of inconclusive reviews, and a high incidence of ghostwriting and honorary authorship.
In some cases, the Collaboration’s internal structure is known to make it just shy of impossible to publish studies that run against the preconceived opinions of internal subject matter experts. These claims aren’t just being made by random organizations, but rather what would typically be conceived as credible sources. These sources are comprised of Radcliffe Health, NCBI (National Center for Biotechnology Information), and even respected psychiatrists.
An ongoing systematic review being performed by Cochrane authors will examine the potential impact of selective inclusion of results in meta analyses, comparing Cochrane to non-Cochrane studies. Apparently it is only appropriate for a determination of a collaborations own credibility to be determined by that same collaboration, and we call this the gold standard. This gives a whole new perspective to the cliché you’re only as good as your word. In fact, the only thing we can be certain that Cochrane is right about is their word “There was insufficient information available to understand…” This must be why they are called Cohcrane, you would have to be high to believe it.
Featured image via Wikimidia Commons