Talk:Water fluoridation/Archive 7

STOP
Can I request that everyone stop editing this article right now. It is clear that recent changes reflect a misunderstanding of the sources used and that the original text was absolutely fine. In light of this we need to discuss changes before editing the article any further. Colin°Talk 17:36, 22 February 2013 (UTC)
 * Page is fully protected for one week. I will add consensus changes if developed here. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 17:55, 22 February 2013 (UTC)


 * It's not remotely clear that the original text was fine - in fact its blindingly obvious that the original text is a gross misrepresentation. I get that you're passionately invested in this issue, but taking the conclusions of a serious study, and replacing them with those of a pamphlet put out by the British Fluoridation Society that better fits your point of view is ridiculous.
 * The authors of the York Review say ""What evidence we found suggested that water fluoridation was likely to have a beneficial effect, but that the range could be anywhere from a substantial benefit to a slight disbenefit to children's teeth." http://www.york.ac.uk/inst/crd/fluoridnew.htm
 * I am honestly baffled that you think it is ok to represent in the same sentence as reporting their numbers that it is "is roughly equivalent to preventing 40% of cavities." It's directly contradicting their reported findings. Tilapidated (talk) 17:57, 22 February 2013 (UTC)

recommended changes to lede
I made what I thought were a few minor wording changes in the lede that were reverted, so I am bringing it here for consensus. The changes I recommend in the final paragraph are shown in bold below, with justification to follow.

The final paragraph states "The goal of water fluoridation is to prevent a chronic disease whose burdens particularly fall on children and on the poor.[19] Its use presents a potentialconflict between the common good and individual rights.[20] It is controversial,[21] and opposition to it has been based on the grounds of perceived ethical, legal, safety, and efficacy issues. (deleted "grounds").[22] Health and dental organizations worldwide have endorsed its safety and effectiveness.[3] Its use began in 1945, following studies of children in a region where higher levels of fluoride occur naturally in the water.[23] Researchers discovered that moderate fluoridation prevents tooth decay,[24] and as of 2004 about 400 million people worldwide received fluoridated water.[18]"

The intent was to recognize that there are a multitude of sources and opinions on the topic, as represented within the body of the article. Stating that there is a conflicr between common good and individual rights is a subjective opinion espoused by some factions. Some factions believe there is not conflict there. Whether or not there is a conflict between two social constructs is not a measurable thing or a universal; it is an opinion. One I happen to agree with, but one which remains an opinion. I think it best to simply add "potential" to indicate that there is debate about this, as represented by the sources and discussion in the article. Similarly, the sentence about opposition gives what I assume is an unintended implication that opposition has been based on the grounds of actual ethical, legal, safety and efficacy problems. Again, since different factions have different takes on this, I think it best to indicate that opposition is based on what the opponents view as those factors instead of stating that those issues universally and objectively exist. Another alternative for the latter sentence would simply be to say "...opposition to it has been based on arguments concerning...etc etc etc". IN that way it's clear we're indicating the position of the opposition, and not implying that the grounds are universally held to be true things.I don't want to argue about whether fluoridation is good or is not...that's not the purpose of this page, though I know it's a touch issue. I'm just trying to make a minor change to improve neutrality.Jbower47 (talk) 21:17, 22 February 2013 (UTC)


 * I don't think that either change is an improvement. Watering down statements with unnecessary qualifiers is not a move towards neutrality. Public health always involves a balance between the community good and the individual, not just potentially. Courts do not rule on "grounds of perceived... issues".Novangelis (talk) 21:35, 22 February 2013 (UTC)
 * I don't agree that that;s a universal. As reflected in the varying viewpoints in the article, the community good/individual rights issue is not recognized universally as an issue for this topic. It's inherently a subjective opinion. When we say that there is "conflict" we are lending creedence to one viewpoint over another. If there are better ways to word either, I'm certainly up for hearing them. I just would like to see us veer away, as we have done in other areas, from anything that implies, intentionally or not, that there is validity or invalidity of subjective opinions held by either faction in the discussion. It's not intended as watering down; it's intended to recognize the complexity of the issue and avoid endorsing any given view of it. Saying the opposition sees a conflict between public good and individual rights is decidedly different than saying there IS a conflict. One is recognizing an opinion exists; the other is endorsing that opinion as universal fact.Jbower47 (talk) 21:55, 22 February 2013 (UTC)


 * I agree with that the addition of mitigating or viewpoint language, (which can less charitably be viewed as weasel words) does not add significantly to the article, and in fact detracts from it. -- [ UseTheCommandLine ~/talk ] #_ 22:04, 22 February 2013 (UTC)


 * In that case, can you recommend a way that would be mutually agreeable to deal with the "conflict" sentence at least? The latter change is somewhat negligible, so I'm not too concerned about it. But stating there IS a conflict between public good and individual rights is a viewpoint not held universally. I think something as simple as saying that "opponents believe that..." would make it a much more verifiable statement. Again, it's the difference between saying there is a conflict, and saying that opponents feel there is. The former is advocating that belief, that latter simply recognizes that it is there. I think that might be a simple way to make the statement more neutral.Jbower47 (talk) 22:18, 22 February 2013 (UTC)
 * Is it a big enough issue to be mentioned in the lead section more than it already is (why do these conversations always seem to be about changes to the lead section? in my experience anyway) without being WP:UNDUE? mention of ethical/political conflict/controversy has been in the lead section for some time. Would additional language actually achieve anything? -- [ UseTheCommandLine ~/talk ] #_ 22:43, 22 February 2013 (UTC)


 * Thank-you for proposing this change here for discussion. I see the earlier edit was reverted by Zad68 here with the comment "sources cited do not limit these ethical concepts to opponents only, advocates and critics draw different conclusions but they both deal with the ethical issues". I agree with his comment. I'm not convinced that one side thinks there are ethical problems and the other side thinks there are none. Even if fluoridation was completely without potential side-effects, there would be ethical considerations about adding it to the water supply. But all sides accept there is a potential for side-effects. There will be some children who have excellent oral health, use fluoride toothpaste, eat a healthy diet and develop mild fluorosis because of fluoridation yet wouldn't have suffered cavities without fluoridation. Is there anyone who doesn't think that is the case at all? There will be other children who develop no or fewer cavities because of fluoridation. And there will be others whose minds are taken over by the government in an evil scheme in collaboration with the nuclear and fertilizer industry. Ok perhaps not that bit. Therefore the "common good and individual rights" issue raises its head and must be dealt with. Lots of things involve a balance of risk and only work at the collective-statistics level. An individual might drive faster with the reassurance of wearing a seatbelt, and then lose control at a sharp corner and crash into a bus shelter -- killing the occupants of the bus shelter but his seatbelt prevents him flying through the window so he survives with minor chest bruising. So essentially I'm happy with saying there is conflict and there are ethical issues. The difference between the sides is the conclusion one comes to when dealing with these. -- Colin°Talk 22:51, 22 February 2013 (UTC)

Pinellas County, Florida recently did away with fluoridation
Per community pressure and vote of County Commission. See: Pinellas county commission votes to stop putting fluoride in water supply Star767 (talk) 02:17, 24 February 2013 (UTC)
 * That was a year ago. -- Orange Mike &#x007C;  Talk  02:15, 5 March 2013 (UTC)

But they return it amongst some bitter feelings. See Pinellas county commission voes 6-1 to return fluoride to drinking water Star767 (talk) 02:29, 24 February 2013 (UTC)

CLAIMED: article does not reference relevant facts
Attempts to correct false statements in this article have been strongly resisted by parties that are unknown. The article promotes the infusion into public water supplies of diluted industrial hazardous waste fluorosilicic acid simply because it contains some fluoride. Adding waste or any proposed medicament into public water supplies and then recommending that people consume it is a violation of the intent of the Safe Drinking Water Act, the Water Pollution Control Act and the Food Drug and Cosmetic Act. Indeed no controlled clinical trials in human volunteers even exist for this material or for sodium fluoride. The article is promoting quackery since the science is compelling and complete indicating that industrial fluoride (rather than the nontoxic calcium fluoride) is a cumulative substance that causes harm, is present in saliva to bathe teeth at only 0.02 ppm which is 75,000 times less concentrated than in toothpaste,and is unable to influence teeth caries. If you don't do your own hand-on research, you have no right to force your opinions in an article such as this. It destroys the credibility of Wikipedia and makes a mockery out of a source that some perceive as a credible reference.The article cannot be repaired and should be completely re-written, this time with facts such as summarized in lay terms by the NRC 2006 Report, the 2013 monographs by Declan Waugh for fluoridated Southern Ireland, and the text by Connett, The Case Against Fluoride, 2010. — Preceding unsigned comment added by 72.199.234.172 (talk) 16:50, 3 March 2013 (UTC)
 * Actually, the "parties" that write these "false statements" are rather well known, we are registered editors at Wikipedia, generally with elaborate user pages. It is those that disagree that rant from behind anonymous IP addresses and never join the rest of us in writing this encyclopedia.  --Smokefoot (talk) 18:32, 3 March 2013 (UTC)
 * That's perhaps overbroad, Smokes: I'm sure that some of the anti-fluoridation folks who bombard this article have contributed useful edits on other topics. They just don't do it here, since they have The Truth™® and thus are impervious to mere scientific consensus. -- Orange Mike &#x007C;  Talk  02:11, 5 March 2013 (UTC)

This entire article ....
The entire article on water fluoridation is very unbalanced. Criticism of it seems to be limited to negatively calling it 'conspiracy theories'. Funny thing is, in this case, the conspiracy happens to be a true one. Read the book, 'The Fluoride Deception' By Christopher Bryson. No, it's not some quack paranoia book full of sensationalism with no references or research. It's a book by a BBC journalist, and if you want references and proof, there is PAGES of them at the back of the book.

After going through the references, the links to the manhattan project, aluminium manufacture and fluoride as a waste product with no use, dumping it into water supplies to get rid of it, is all proven in the book. This is one of the biggest medical and governmental coverups in 50 odd years.

The whole article needs to be re written, using references and evidence from the book (many from science journals) to show both sides of the story.

50 years from now, we will be shaking our heads at how we were dumb enough to put it in toothpaste and dump it into water, in the same way we laugh at how dumb it was to add radium to skin creams at one time. — Preceding unsigned comment added by 70.75.21.118 (talk) 00:16, 3 November 2012 (UTC)
 * We need good references in scientific journals. If any of the references you mentioned satisfy that criteria, please let us know. TippyGoomba (talk) 23:53, 4 November 2012 (UTC)


 * The dentists who support this also suggest the mercury in amalgams is totally safe. How can non-scientists/non-physicians be so incredibly knowledgeable completely outside of their own fields? — Preceding unsigned comment added by 64.134.237.16 (talk) 05:35, 29 January 2013 (UTC)


 * Absolutely. This article is so one-sided that there's hardly any baby with the bathwater. We should merge it with the well-sourced and neutrally-written article Water fluoridation controversy. Most of the content honestly isn't worth keeping, but I made a new talk section at bottom for discussion.Boleroinferno (talk) 20:17, 18 March 2013 (UTC)


 * Instead of talking about updating this article with this research, why not just do it? I'm not trolling, I'm being serious.  Lets get the ball rolling here. Neillithan (talk) 06:21, 21 March 2013 (UTC)


 * Disagree, that's not a good idea. The Bryson book is not an acceptable source to support scientific or medical content in this article, see WP:MEDRS for Wikipedia's sourcing guidelines for biomedical information.  The Bryson book is appropriate for use in the article Water fluoridation controversy, and I see it is already used there.    12:16, 21 March 2013 (UTC)

When reporting the results a scientific review, is it appropriate to substitute other researcher's interpretations, or should we report on the original author's conclusions?
Currently the article section in question reads: "A 2000 systematic review found that water fluoridation was statistically associated with a decreased proportion of children with cavities (the median of mean decreases was 14.6%, the range −5 to 64%), and with a decrease in decayed, missing, and filled primary teeth (the median of mean decreases was 2.25 teeth, the range 0.5–4.4 teeth), which is roughly equivalent to preventing 40% of cavities."

The authors of the review cited state "The best available evidence suggests that fluoridation of drinking water supplies does reduce caries prevalence, both as measured by the proportion of children who are caries free and by the mean change in dmft/DMFT score. The studies were of moderate quality (level B), but of limited quantity. The degree to which caries is reduced, however, is not clear from the data available. The range of the mean difference in the proportion (%) of caries-free children is -5.0 to 64%, with a median of 14.6% (interquartile range 5.05, 22.1%). " and that "What evidence we found suggested that water fluoridation was likely to have a beneficial effect, but that the range could be anywhere from a substantial benefit to a slight disbenefit to children's teeth." http://www.york.ac.uk/inst/crd/fluoridnew.htm, http://www.york.ac.uk/inst/crd/fluorid.htm

The York authors' conclusion is that, while the evidence suggests that fluoridation reduces caries, it is not possible to make definitive statements about levels of reduction of caries based on their data. This has been replaced with the interpretation of Worthington H, Clarkson J. (The Evidence Base for Topical Fluorides. Community Dental Health, 2003, 20: 74-76.) cited in a pamphlet by the British Fluoridation society offering the interpretation their interpretation of the York data as "roughly equivalent to preventing 40% of cavities."

Tilapidated (talk) 18:39, 22 February 2013 (UTC)


 * I propose presenting the views of both the authors and commentators (from quality peer reviewed sources) and clearly attributing them, but the current phrasing (omitting the original conclusion and inserting another) suggests that the 40% figure comes from the review, and obscures the different conclusions of the original study authors. Tilapidated (talk) 18:39, 22 February 2013 (UTC)

I propose the following wording for the paragraph (citations are not shown in this version): "A 2000 systematic review of 214 studies (The York Review) stated that 'the best available evidence suggests that fluoridation of drinking water supplies does reduce caries prevalence', but 'that the degree to which caries is reduced, however, was not clear from the data available', and that 'the range could be anywhere from a substantial benefit to a slight disbenefit to children's teeth'. Commentators (including Worthington et al) propose that the York data may be interpreted as "roughly equivalent to preventing 40% of cavities."

The review found that the evidence was of moderate quality: many studies did not attempt to reduce observer bias, control for confounding factors, report variance measures, or use appropriate analysis. Although no major differences between natural and artificial fluoridation were apparent, the evidence was inadequate to reach a conclusion about any differences."

The conclusions quoted are from the study or the subsequent author's statement. Tilapidated (talk) 18:59, 22 February 2013 (UTC)


 * Comment This RFC seems to be comparing apples and oranges, the two items mentioned aren't dependent on each other.  Worthington and Clarkson's analysis is from, it may have been cited in a pamphlet but it's also cited by, for example, Ireland's comprehensive Oral Health Services Research Centre report, and was made in direct comment and review of the York report.  Worthington and Clarkson are the editors for the Cochrane Oral Health Group, which makes them as prestigious and reliable a source as needed for the kind of basic math analysis they're making.  If that's the apple, the orange is whether the York study's findings are accurately represented in the article.  As has been mentioned elsewhere on this Talk page, the view is that the specific ranges provided in the York report are represented in the article.  Expanding the citing of this 13-year-old report (especially as we have newer sources reviewing the same data) to essentially repeat the fact that the range of the specific values provided was broad seems unnecessary.    18:55, 22 February 2013 (UTC)
 * I'm not suggesting that Worthington et al are not suitable commentary, simply that we should not substitute their conclusions for those of the original authors. I propose mentioning Worthington's comment, but clearly attributing it. Unfortunately the math is far from basic. Simply taking the median of the means of the studies, and then attempting to figure out from that the reduction in caries is something the York team declines to do on the basis of their understanding of the quality of the data. There are all kinds of methodological reasons why this is not a simple or appropriate thing to do, as they point out in several different places (another example "The best available evidence on stopping water fluoridation indicates that when fluoridation is discontinued caries prevalence appears to increase in the area that had been fluoridated compared with the control area. Interpreting from this data the degree to which water fluoridation works to reduce caries is more difficult" page 67 of the report). I'm not opposed to showing that others do it, but I think it's important to point out that the authors specifically claim that the data doesn't support it.
 * Since we do mention the 13 year old article, we should represent what it says accurately. Tilapidated (talk) 19:03, 22 February 2013 (UTC)


 * The statement above "cited in a pamphlet by the British Fluoridation society" isn't a helpful characterisation of the source. Where it ends up getting cited is of little matter. More important to consider whether the authors and journal form a reliable source. They do. I now have access to the editorial and is indeed those esteemed authors' interpretation of the York figures. Since as Wikipedian's we are unable to perform such interpretations, we rely on the best authors in the best publications to do that for us. The article text currently makes it quite clear, both in that paragraph and surrounding text, that studies vary hugely in their numbers and that the York findings were of a wide range so I don't think we are misguiding the readers at all. In fact, wrt the 14.6% figure, Worthington and Clarkson state "It is important to emphasise that a change of 15% in caries free is a huge reduction in caries". Colin°Talk 20:07, 22 February 2013 (UTC)
 * I agree - I was simply citing where I was shown it (by you). It's standard practice to report where you saw citations if you have not seen the original. I also agree that Worthington is an appropriate source to cite.
 * Where I disagree is that we should, in describing the York Review's findings, replace their conclusions with those of Worthington. We should represent Worthington, but separate from our reporting of the York review's findings. The two sources disagree on the meaning of the data - we should reflect that. The 15% figure is the median of the means of the studies reviewed, and the York authors assert that in their opinion it is not possible given the quality of the data to draw conclusions about the degree of reduction from it. That Worthington disagrees is fine, but it's not our role to replace one set of findings with another. Tilapidated (talk) 20:20, 22 February 2013 (UTC)


 * We have policies for this. The York Review looked at primary sources and is so better that the original sources and is a reliable source. It also looks to be unbiased when compared to the cheery-picking of many of the tertiary sources that comment on the York Review to support their own field or specialty. However see PSTS and make your own mind up.--Aspro (talk) 20:37, 22 February 2013 (UTC)
 * There is nothing in PSTS to say that tertiary sources are more biased or likely to cherry-pick. Indeed the whole ethos of Wikipedia is that editors must not themselves cherry pick. Therefore, I'm far more comfortable with Worthington and Clarkson of the Cochrane Oral Health Group interpreting the York review than User:Tilapidated, User:Colin, User:Aspro or User:AnyoneElse. Because experience is that Wikipedian's are awful cherry pickers. It is easy to assume "X says something I disagree with => X must be biased". Far harder to accept that X may have a point even if I disagree with them. But ultimately I'm puzzled by the fuss created because the section on efficacy is quite clear about the range of study results and the lack of truly high-quality research in this area. The worry over who's wording this is isn't really that important to the reader: like worrying which of the York study's authors wrote that bit or who of Worthington or Clarkson came up with the 40% figure. We cite where it came from, and the reader can follow the links if they care to. Colin°Talk 22:24, 22 February 2013 (UTC)
 * That's a bizarre characterization Colin - it is not me interpreting the York Review. My view on this is that we should present the conclusions of the York Review, and the conclusions of relevant commentators, not remove the conclusions of the review authors and replace them with the commentators, especially where there is a direct conflict between them. The issue is not simply the range, but the fact that the York authors specifically state that the data does not support conclusions in the size of the effect. Tilapidated (talk) 23:21, 22 February 2013 (UTC)
 * WP also expects editors to use their common sense. Say a tire/tyre  manufacture reviews a review, on general aircraft safety. Would you expect it to only comment on those aspects that affects it position... Yes.  Would it included self criticism on over-speed-tire busts (pilot error) etc.? Or included its on analysis of air craft safety that concerns flight engineering and systems that is out of its field of expertise? No. So it would cheery pick from the whole mass of data.  Therefore, they would not  give balanced view of the whole original study .  Thus, is the problem with many and most tertiary reviews and why we should not use them as summary’s.  I would have been shot if I included such a reference  in a technical report.--Aspro (talk) 23:07, 22 February 2013 (UTC)
 * Wikipedia is quite different source-wise and editing-wise from any other publication on the planet. Academic writing would cite primary sources and landmark reviews only -- citing a plain old literature review would be very bad form. As for common-sense, I have no reason to think that Worthington and Clarkson's comments on the York data are faulty and every reason to think they know an awful lot more about the subject than any of us. Colin°Talk 23:20, 22 February 2013 (UTC)
 * Colin - I'm not sure you understand what is being proposed - you seem to be arguing a point that no one is making. Worthington disagrees with the conclusions of the York review. Replacing the York review's conclusions with those of Worthington is confusing and does not make plain the range of opinions. The proposal is to state the conclusions of both, but state and attribute them clearly. I'm baffled as to why you would want to oppose that. Tilapidated (talk) 23:24, 22 February 2013 (UTC)
 * "Worthington disagrees with the conclusions of the York review" Really? You know them personally? You've read the paper and they say this? -- Colin°Talk 23:28, 22 February 2013 (UTC)


 * Actually Colin. The WP article say: “A 2000 systematic review found that water fluoridation was statistically associated with a decreased proportion of children with cavities (the median of mean decreases was 14.6%, the range −5 to 64%), and with a decrease in decayed, missing, and filled primary teeth (the median of mean decreases was 2.25 teeth, the range 0.5–4.4 teeth),[11] which is roughly equivalent to preventing 40% of cavities.[52]” (emphases mine). Yet, Worthington is accentual talking about 'topical' fluorides -which the York Review does give some credence to . So this sentence in the article is misleading to link it to water fluoridation. This goes back to my comment above, that I would have been shot for mixing things  up like this.--Aspro (talk) 00:10, 23 February 2013 (UTC)
 * I'm aware of what the article is about and fully aware of what Worthington and Clarkson wrote because I've read it. If you had, you wouldn't make this remark. Colin°Talk 16:01, 23 February 2013 (UTC)


 * Honestly, Colin, I have a hard time following you. I think you are misunderstanding me for comic effect? Worthington, in his paper (the one we're talking about above) offers an estimate of the percentage reduction in caries based on the median of the means of the 214 studies in the York Report. In the York report (and in subsequent writing) the York authors explicitly state that this is not possible based on the data quality. They come to different and incompatible conclusions about the ability to make a determination about the size of the effect. I hope that is clear? It is these different conclusions that make it inappropriate to remove York's conclusions and substitute Worthington. We should cite both, but be clear which is the original author and which is commentary. Tilapidated (talk) 23:42, 22 February 2013 (UTC)

On Wikipedia, we are writing an encyclopaedia, not an academic journal. For that to work, and be accessible to a wide range of readers, some interpretation of complex statistics and figures is helpful. But we cannot do such interpretations ourselves beyond the most basic maths per WP:OR. The Worthington and Clarkson figure is an interpretation of the York results. Several times in the section we talk of "reduction in cavities" but the York figures are a "reduction in children with any cavities" or a "decrease in decayed teeth". For the reader to compare the various reviews, it is helpful to not be comparing apples with oranges. The Worthington and Clarkson figure lets the reader see that the median result in the York review roughly corresponds to a 40% reduction in cavities. But we make quite clear that the York results cover a wide spread. Indeed reading the whole section, the reader is left in no doubt that reviews vary widely in their results and there is no one true figure.

Pulling out Worthington and Clarkson's 40% figure into its own paragraph ("Other researchers claim that fluoridation results in a reduction of 40% in cavities.") made it appear this value was the result of different review or even a different study performed by those authors. It isn't and so doing that is misleading.

I think the statement "range could be anywhere from a substantial benefit to a slight disbenefit to children's teeth" is a quite misleading summary of their figures. Although factually correct, it gives equal emphasis to the "slight disbenefit" side which is clearly an outlier in their data (it comes from one study out of 30, whereas 20 showed a significant benefit). It should be noted that this text is from a press-release on their website and not from the report itself or from a peer-reviewed journal. It is the sort of phrasing someone might make in a heated argument to make a point but hardly a balanced summary of the data.

On an encyclopaedia, the facts are more important than academic trivia like "The York Review" or "Worthington and Clarkson say..." This is just noise. The reader says "Why am I being told these names?" I do see some of Tilapidated's points though I feel the reader is not being nearly as misled as he thinks. How about


 * A 2000 systematic review of 30 studies found that water fluoridation was statistically associated with a decreased proportion of children with cavities (the median of mean decreases was 14.6%, the range −5 to 64%), and with a decrease in decayed, missing, and filled primary teeth (the median of mean decreases was 2.25 teeth, the range 0.5–4.4 teeth), [York] The range of study results varied considerably but for comparison with other reviews, the median figures have been interpreted as roughly equivalent to preventing 40% of cavities. [Worthington] 

Colin°Talk 16:01, 23 February 2013 (UTC)
 * Colin - there's plenty of interpretation in the article - this section is specifically on the scientific basis, and calls out several key literature reviews (I think there should be more, and more recent, but that's another issue). This isn't an introductory paragraph, it's a section devoted to the key science. I realize that what the York Review concluded isn't what you would have liked, but we need to stick to the science. It's fine to note that commentators have interpreted their figures differently, but the York authors are specific in pointing out that the quality of the data does not, in their view, allow conclusions about the size of the effect.
 * You say you are worried that "Pulling out Worthington and Clarkson's 40% figure into its own paragraph ... made it appear this value was the result of different review" - that's the point - Worthington is not an author of this review - his conclusions are a different piece of work, commenting on the York Review. They're not the same review.
 * Perhaps if you don't have a background in statistics this could seem obtuse, and it definitely sounds as if you feel that this is minor. Your statement that the -5% study is 'clearly an outlier' makes me think that you might not understand what the review is doing. This isn't a normal distribution that they are dealing with - it's the median of the means of all the 26 studies. Without knowing the population sizes, and the ranges and distribution characteristics of those studies, drawing conclusions about the size of the effect is impossible, and whether or not any particular study is an outlier is impossible (that data is not available for all the studies). When they say it's impossible to know the size of the effect from their data, they are making a statement about the quality of the data, not about fluoridation.
 * I'm not sure if I'm more amused or horrified that you characterize this as 'academic trivia'. To go ahead and do the calculation for them is to misrepresent their findings. Now, I'm happy to note that some commentators have gone ahead and done this, presumably they have their reasons, and that's fine, but to not represent the findings of the study is not a commitment to the facts, its a misrepresentation of the facts. Again, you may think it is misleading, but "range could be anywhere from a substantial benefit to a slight disbenefit to children's teeth" is THEIR summary of their study. For the purposes of this article, whether you agree with them or not isn't the point. Tilapidated (talk) 17:36, 23 February 2013 (UTC)
 * As long as you keep saying things like "I realize that what the York Review concluded isn't what you would have liked, but we need to stick to the science" there really is no point in you or I conversing. I've made my position clear: I have none. Worthington is a not separate review but is a separate "commentator" as you put it earlier. And Worthington is a she. Again, I see little point in arguing over what that Worthington states with someone who misinterprets from a position of ignorance. I'm aware the studies don't form a normal distribution. But neither are they utterly random. Otherwise the author's wouldn't have stated their median or interquartile range but merely held up their hands in despair. But they did give the median figures and the 40% is an interpretation of that median so no more incorrect to give than the 14.6% decrease or the 2.25 teeth. Just another way of looking at those figures. I appreciate the nature of the studies and their analysis means this median is less useful a figure and that perhaps some authors are over-emphasising it.


 * The single negative result is unique, unrepresentative of the 30 studies and drowned out by the 20 studies that show a significant positive result. To give it equal weight when characterising the range is simply misleading. But this is beside the point -- we don't source an FA from a press-release on a website. Let's stick to what the serious academic literature says.


 * Re-read what I said was "academic trivia". Again, it is quite tiresome to argue with someone who misinterprets what the other person said. Must I spend most of my response correcting your mistakes while ignoring your insults?


 * Well I've offered a suggested change. It increases the emphasis on the wide range of results and makes it clear what the 40% figure is an interpretation of. Let's see what other people think, and I suggest you wait a few days till folk get back from the weekend. Colin°Talk 20:23, 23 February 2013 (UTC)
 * Colin, let's get a few of the facts straight - the York authors don't throw up their hands in despair, no one is claiming they do. They quote the median and the ranges, and conclude that the evidence shows a benefit to fluoridation. They then explicitly go on (in the paper - you can ignore the press release, it's simply a re-stating of the paper, and I thought it might help you to understand the issues in the paper) to state that their data does not allow conclusions as to the magnitude of the benefit.
 * You may think that the York review is misleading, but frankly that's not relevant. Your or my opinion of the scientists' interpretation is not important - stating what their interpretation was is what is important. You statement that the 40% interpretation is no more incorrect than the other is fascinating, but not grounds for inclusion in an encyclopedia article. Your position disagrees with the author's of the studies. You have someone who commented on the study who agrees with you, that's fine, but it is important to include the conclusions of the original authors, even when they don't agree with our own positions.
 * Worthington's 40% is an interpretation, but it's an interpretation that is incompatible with the author of the study's interpretation, which is that you cannot conclude the degree of effect on the basis of their data. Worthington is not part of the review - she is writing a separate commentary on it.
 * You seem to be misunderstanding the claim that is being made still. The authors do claim a beneficial result, and don't give equal weight to the negative result, but the essential problem with the data quality (according to the authors) is that there is no way to tell reliably how much of a beneficial effect there is or how much weight to give to each study. That is why they conclude that there is an effect, but that it's impossible to know how big it is.
 * As I've said time and again, commentary of the study by third parties has a place, but it's not in the sentence where we report what the study found, especially where it conflicts with the study.
 * I have not insulted you. Tilapidated (talk) 22:09, 23 February 2013 (UTC)
 * Since nearly every statement above is a misinterpretation of what I said, I see no further benefit in continuing the conversation between us two. If someone else joins the conversation (be patient) then perhaps they can help or mediate. Colin°Talk 22:39, 23 February 2013 (UTC)
 * From the above:Since nearly every statement above is a misinterpretation of what I said, I see no further benefit in continuing the conversation between us two. If someone else joins the conversation (be patient) then perhaps they can help or mediate.... It boils down to your view Colin,   It  doesn't it  make sense on the basis of the evidence of resent scientific reviews of the literature. Water fluoridation has moved from a  scientific hypothesis to a religious cult. Today, we need good evidence. What goes on WP should have some basis on scientific fact. Not, Oh well. we believed this for the last forty years so it must be true. Colin, Stop bashing your head against the brick wall of blind believe. To day we have Google and Google  Scholar and medical practitioners (in Europe) have free access to data bases such as Ovid. Most of Europe ( and China et.al.) has now abandoned water fluoridation as a waste of money and scientific gobble gook. The English version of WP covers the English speaking world – please stop trying to impose you unscientific beliefs upon us for the reason it gives you a nice warm feeling inside. It is dental heath which matter -and don't forget you  that!--Aspro (talk) 01:12, 24 February 2013 (UTC)
 * Aspro, per WP:NOTAFORUM any further posts like that will just be deleted. Per WP:NPA further posts like that will get you blocked. I will not warn you again. Stick to discussing the article text wrt the highest quality sources. If you can't do that, don't comment. Colin°Talk 09:44, 24 February 2013 (UTC)
 * I'm sorry Colin - I am having a hard time understanding what it is you're trying to communicate. I do hope you try again, Tilapidated (talk) 23:20, 23 February 2013 (UTC)

I am not a big fan of the proposed new wording for a number of reasons "A 2000 systematic review of 214 studies (The York Review) stated that 'the best available evidence suggests that fluoridation of drinking water supplies does reduce caries prevalence', but 'that the degree to which caries is reduced, however, was not clear from the data available', and that 'the range could be anywhere from a substantial benefit to a slight disbenefit to children's teeth'. Commentators (including Worthington et al) propose that the York data may be interpreted as "roughly equivalent to preventing 40% of cavities.""


 * 1) If people which to know how many studies it is based on they can look at it.


 * 2) We do not name any of the other reviews in the article so why this one?


 * 3) It is IMO preferable to paraphrase as is done than to quote the exact wording. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 03:16, 24 February 2013 (UTC)
 * Plus the evidence for "does reduce caries" was drawn from far fewer than 214 studies. It is the paucity of even moderate-quality studies that is part of the issue, so claiming that 214 studies produce this result is widely over-stating the evidence-base. Colin°Talk 09:44, 24 February 2013 (UTC)
 * Colin - you're quite right on the 214 - it should read 26 - 214 is the total number of studies considered, 26 is the number relevant to this issue.
 * Jmh - thanks for commenting - there are several studies called out in the science paragraph - I was proposing to name them for clarity, rather than referring to each as 'a study in 2000', or a study in 2007'. It's not important to me to name them, it just seems clearer. Stating the number of studies gives an indication of the scale of the review - several large scale reviews are cited, and there are others that have been proposed as relevant. These large scale literature reviews are one of the best ways of understanding the state of the science. Paraphrasing is fine, the issue is that the original conclusion has been removed and replaced with a conflicting one from another author entirely. Tilapidated (talk) 16:13, 24 February 2013 (UTC)


 * Support Colin's proposal above as it's a perfectly reasonable and accurate representation of both the York study findings, including a plain-language interpretation of the authors' observation of the wide result ranges, but also cites Worthington appropriately as an expert for a plain-language interpretation of the primary finding of a median 15% (rounded up from York's 14.6%) decrease in caries-free children which is exactly the thing Worthington comments on. The York study cannot at all be used in support of article content suggesting that no benefit was found, or that the benefit suggested by the data was statistically insignificant.  York states very clearly and plainly at the introduction of the paragraph discussing the findings, "The best available evidence suggests that fluoridation of drinking water supplies does reduce caries prevalence, both as measured by the proportion of children who are caries free and by the mean change in dmft/DMFT score."    21:33, 25 February 2013 (UTC)


 * Holy-molly Zad. The York review doesn’t suggest that. Have any of you, done any more than skim though and cherry pick? They went on to say What the 'York Review' on the fluoridation of drinking water really found. “What evidence we found suggested that water fluoridation was likely to have a beneficial effect, but that the range could be anywhere from a substantial benefit to a slight disbenefit to children's teeth.” From an encyclopedic point of view this analysis   should be accurately   reflected in its 'proper' context. The word 'suggests ' is as they say  based on poor studies. Thus, it is not WP's job to pass judgement on this evidence and unilaterally suggest “that fluoridation of drinking water supplies does reduce caries prevalence.” Surly you see this. We have to report the evidence as accurately as possible. I may have the advantage that havimg working in an R&D environment I am more use to annualising  this type of literature but whilst Colin may accuse me of an ad hominem attack, when all I am attempting, is to get him to read the ruddy report as it is written. Why does subject of fluoridation warrant such convoluted debates. Just look at the length of this  talk page. The  Circular arguments just go round and round – lets just  stop it... and just accurately  report the unadulterated knowledge of what is and isn't known.--Aspro (talk) 19:06, 26 February 2013 (UTC)


 * It'd be very nice if you'd assume good faith, stop making snarky comments about your fellow editors at this article, and comment only on the content. What exactly are you saying is the thing the York review authors do not suggest? The review itself, and the 2003 clarifying comment, state two important things regarding fluoridation and dental health:  1) there is moderate but not good quality evidence that fluoridated water is likely to reduce caries, and 2) the range of benefit of the evidence reviewed was wide.  Now, please take a close look at Colin's suggestion above, both items are represented.  Perhaps we can change "found" to "suggested".  Also note that in the article right now, the very next sentence after this starts "The review found that the evidence was of moderate quality". You state The word 'suggests ' is as they say based on poor studies - be careful here, the quality of evidence for a consequent increase in fluorosis was described as "poor".  The quality of evidence for the reduction in caries was "moderate". I'm still not seeing a significant problem with how Colin's suggestion, or the existing article content for that matter, seriously misrepresents the sources.    19:50, 26 February 2013 (UTC)


 * Request to Aspro - I haven't seen your suggestion for article content. Maybe you could clarify your position on how the sources can best be represented if you'd suggest a specific article content change?  Thanks...   19:53, 26 February 2013 (UTC)
 * Hey, step back fellas and look at this unemotionally. I'd be happy to clarify my position (and I was trying to do before but obviously not well enough).  Remove the opportunity of pro/anti fluoridation  faux arguments and rename the article water  fluoridates (there are two main common chemical compounds). Then have artifactual water fluoridation as a sub heading. Not a panacea but better than the situation we have at present.  Why?  The lead in the article:  Water fluoridation is the controlled addition of fluoride to a public water supply to reduce tooth decay. Fluoridated water has fluoride at a level that is effective for preventing cavities; this can occur naturally or by adding fluoride.[2] is misleading. The York Review found that the much quoted  studies did not  control for any confounding factors. So, to a scientist they are not of a good  quality. Argue that as you will but but it doesn’t change anything.  So the phrase “ that is effective” needs qualifying with the word 'thought'.  Water that contains certain levels of fluoride is 'thought' by some studies to prevent dental caries. Also if drinking water has high 'natural' or 'artificial'    fluoridates which go onto cause     server dental fluorosis,  that make the teeth more susceptible to decay (there is no argument about this, last figures is saw suggested that over the life of a dental patient with server fluorisosis,  costs for veneers etc., are  currently somewhere in excess of US$10,000).   It may be easy to concatenate 'artificial' and 'natural' into the same paragraph...  that just-anybody-can-edit but it reads very amateurish.  A 'Total dietary fluoride load' sub section can then be added in the appropriate place to give proper context to artificial water fluoridation’s  Raison d'être (i.e.,  too little dietary fluoride) . Thus giving the WP reader ( which is why we contribute is it not ) a broad NPOV of the subject and the current state of knowledge.--Aspro (talk) 18:29, 27 February 2013 (UTC)
 * Quit with the "look at this unemotionally" crap please. The only thing I care about here is a high quality article on WP and have zero zip nada emotions wrt fluoridation. The article topic is artificial fluoridation. Deal with it. You are wrong about confounding factors. Read pages 5 and 6 of the report and note the studies were classed "B". That doesn't demote them to junk science as you are trying to make out. They have value but clearly everyone would want better designed studies. Very little in health and medicine is based on A-class research and indeed most government-led initiatives are based on no research whatsoever. Artificial fluoridation does not produce "high" levels of fluoride and does not cause "severe dental fluorosis". Concatenating natural and artificial text, when the sources don't (and they do so rarely) is called synthesis and not allowed per policy. We know why folk want to mix natural and artificial fluoride -- because then the lead image can be horrible brown stained teeth and the lead paragraph can mention brain-damaged children living in some toxic Chinese valley. But our best reliable sources do nothing of the sort, and neither should we. -- Colin°Talk 19:14, 27 February 2013 (UTC)


 * Aspro, let me try to summarize your suggestions, and provide my responses:
 * You are suggesting that this article should be renamed from "Water fluoridation" to "Water fluoridates" - this would have the effect of expanding the scope of this article from covering the artificial control of the F- level in water for the intended purpose of improving dental health, to the more general topic of the existence of F- in water, no matter how it got there, and not limited to a discussion of considering it for the purposes of dental health.
 * My response: I do not support this proposal, as I think there should be a Wikipedia article about the specific topic of artificial control of the F- level in water for the intended purpose of improving dental health, and that is this article.  However, others might support your suggestion.  The way for you to go about this would be to start a requested move and explain your proposal, and there will be a discussion about how that will affect the article's scope.  As an alternative, instead of doing this, consider creating a new article Water fluoridates, but be sure it does not duplicate or become a WP:POVFORK of this article.
 * You appear to be suggesting that the existing article content (the opening sentences) "Water fluoridation is the controlled addition of fluoride to a public water supply to reduce tooth decay. Fluoridated water has fluoride at a level that is effective for preventing cavities; this can occur naturally or by adding fluoride." is misleading because of something in the York review, and that "that is effective" should be changed to "that is thought to be effective".
 * My response: The article content you're quoting doesn't cite York, it cites the CDC.  Are you saying the existing article content doesn't reflect the CDC's statement accurately?  The CDC is unequivocal in its assertion that water fluoridation is effective.  Or that the York review should be used in place of the CDC?  Is there an argument being made that the York report should be considered more authoritative than the CDC?  We need more clarity on what your suggestion is here.
 * You appear to be suggesting adding more content on fluorosis.
 * My response: Fluorosis is already covered well under Safety.  What is missing?  Sources for your suggested additional content?
 * You are suggesting to add a "Total dietary fluoride load" section with the idea that fluoride is added because it is thought people are getting "too little dietary fluoride".
 * My response: This suggestion doesn't seem to be based on what the sources say.  As the article states, fluoride is not an essential dietary element, and its effect is topical and not systemic.
 * Feel free to correct where I may have misunderstood.   19:33, 27 February 2013 (UTC)


 * Agree, the authors do not use the term "poor" to describe the fluoride-reduces-caries aspect of their review. Per WP:MEDRS we do not base featured articles on press releases. Instead we should do as they recommend themselves: "we urge interested parties to read the review conclusions in full". And I suggest folk also read the existing Wikipedia article in full. And read the other cited reviews and sources too, for the York authors are not gods. The text could be clarified a little as I proposed above, but on the grand scale of things this is a small change. We have wasted enough time on this silly game, frankly. Colin°Talk 20:09, 26 February 2013 (UTC)


 * OK, so I'm easily wearied. I admit it. I saw this controversy for the first time 1958 maybe, when I was student. The main thing that has changed since then is that nowadays the exchange of spittle more reliably starts with the second breath, sometimes with the first. The only reason I am here is the RFC. I suggest:
 * Colin's suggested amendment looks like a good basis.
 * List all the items or wording that it should not contain and does
 * List all the items or wording that it should contain and does not
 * Amend accordingly as necessary. If both lists are empty of substantial items, consider the process completed for now.
 * Schluss until someone has something new and constructive to say (like "Say guys, have you seen this NEW, HIGH-QUALITY study?") and redirect off-topic nattering such as comparisons between the merits of water fluoridation and additives in toothpastes etc, to appropriate articles like Water fluoridation controversy. JonRichfield (talk) 12:24, 14 March 2013 (UTC)

Merge this article with "Water fluoridation controversy"
The article Water fluoridation controversy deals with the exact same subject, bears a wealth of reliable sources, and deals with the subject in a much more neutral way. The fact is that the entirety of continental Europe and East Asia all decry the use of fluoride in drinking water. Why is the fact that fluoridated water is illegal in half the world not even hinted at in this article? It seems the only reason these two articles are separated is to allow the one-sided authors of this article to make unequivocal claims about the safety & efficacy of fluoridated water. They achieve this agenda by delegating all the 'alternative' critical points of view to a different article.

This article should be stripped for the few bits of neutral claims which can be added to the Water fluoridation controversy article, then be deleted. If there continue to be unprincipled edits intended to reduce the validity of sourced claims, especially those intended to minimize the very significant criticisms against water fluoridation, this article needs to be protected and repeat offenders banned from editing it. It would not be outside the scope of reason to find that someone has been editing this article on direct behalf of an organization involved in selling fluoridation to municipal water supplies. Boleroinferno (talk) 19:48, 18 March 2013 (UTC)
 * Dream on. Colin°Talk 20:41, 18 March 2013 (UTC)
 * Agreed. Water fluoridation and the controversy around it are two different topics, deserving their own articles as sources clearly show. I can't imagine how any attempt to conflate the two wouldn't be a FRINGE and NPOV violation. --Ronz (talk) 21:50, 18 March 2013 (UTC)


 * Oppose They are separate topics, and this is a fully developed WP:FA quality article.  23:08, 18 March 2013 (UTC)

A bit like merging Kepler's laws of planetary motion into Flat earth. The comment suggest that the "Water fluoridation controversy" article doesn't make it obvious enough where the science falls. But the article looks fine to me. Am I mistaken? TippyGoomba (talk) 03:16, 19 March 2013 (UTC)
 * Oppose on is a medical / scientific topic the other is a social movement. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 06:49, 19 March 2013 (UTC)
 * Oppose I found the Water fluoridation controversy non-neutral and doesn't cover the scientific side. This article covers the topic well and neutrally.Ian Furst (talk) 22:12, 19 March 2013 (UTC)
 * Comment. I do not think that editors need to respond to radical recommendations by timid drive-by conspiracy theorists.  Unhappy editors come to this page regularly to espouse fringe views with lackluster sources.  This activity has been ongoing for years. Almost none of these unhappy editors have an active talk page that would enable consensus-seeking conversations or collegial argumentation.  So my point is that proposals - such as the present one about merging two mature articles - from these timid conspiracy theorists should be ignored or even deleted.  There is no conversation with them to be had.  --Smokefoot (talk) 01:26, 20 March 2013 (UTC)
 * The benefits are that the proposed change will clearly be shown not to have consensus, and also a future editor making a similar change proposal can be pointed to a long history of such proposals and how they've consistently been rejected. Also, we shouldn't WP:BITE, these proposals are coming from real live people who are (probably) making a good-faith effort to correct what they see as a problem, and so they should be given some respect.  Besides, it only takes a few seconds to !vote appropriately for an obviously misguided proposal to an article you're familiar with.    04:10, 20 March 2013 (UTC)
 * The policy WP:BITE is intended to encourage greater tolerance by established editors to help WP recruit new editors. The anti-BITE policy in this case involves do-gooders (you, me) falling pray to evil doers: those with zero intention of editing, only seeking a soapbox.  Their goal, rather successful, is to convert Talk pages into forums for fringe views.  Their request for a change is invariably prefaced with some polemic - mission accomplished.  I understand that my perspective does not present any nice directions forward. --Smokefoot (talk) 13:00, 20 March 2013 (UTC)


 * Oppose The Water fluoridation controversy article is not neutral. I do not believe a single source makes for a reliable source that can be used here. We have an obligation to resist hyperbole in encyclopedia articles. &mdash; UncleBubba ( T @ C ) 06:32, 21 March 2013 (UTC)
 * Oppose The two topics are different topics. And whichever of the various points of view one can take, this is the most blatantly juvenile POV tactic I have seen in a long time. Those who disagree with the proposer and fail to oppose it are passing up their duty; those who do agree and put up with having their views parodied in such a childish fashion, are doing their cause a disservice. JonRichfield (talk) 11:49, 21 March 2013 (UTC)

CLAIMED: There is no difference in tooth decay rates in fluoridated versus non-fluoridated areas
See http://pubs.acs.org/doi/pdf/10.1021/cen-v067n019.p005

"An analysis of national survey data collected by the National Institute of Dental Research (NIDR) concludes that children who live in areas of the U.S. where the water supplies are fluoridated have tooth decay rates nearly identical with those who live in nonfluoridated areas."

Chem. Eng. News, 1989, 67 (19), pp 5–6 DOI: 10.1021/cen-v067n019.p005 Publication Date: May 08, 1989 Copyright © 1989 AMERICAN CHEMICAL SOCIETY — Preceding unsigned comment added by 99.61.178.14 (talk) 17:17, 8 April 2013 (UTC)


 * Really, a 1989 article by the American Chemical Society? After you posted your last batches of sources, I assumed good faith and carefully reviewed each one, explained how they did not meet Wikipedia medical sourcing guidelines, and pointed you to WP:MEDRS so that you could learn how to identify useful sources.  You followed that up with a declaration indicating your involvement here is in opposition to WP:NOTADVOCACY, and now you're bringing more inappropriate sources, without any clear suggestion for the article. I recommend that nobody bother with these bad-faith source dumps.   17:25, 8 April 2013 (UTC)

It is regarding the largest study ever undertaken regarding tooth decay in fluoridated versus non-fluoridated areas but you find it insignificant? Your motives are quite telling. — Preceding unsigned comment added by 99.61.178.14 (talk) 17:36, 8 April 2013 (UTC)
 * Oh riiight! Bigger means better? Grow up! Any idiot who is willing to ask the wrong questions can get any answer he pleases to any study, big or small. Did you see who ran the study? Do me a favour! JonRichfield (talk) 18:30, 8 April 2013 (UTC)

@JonRichfield - Yiamouyiannis obtained the survey data from NIDR under the Freedom of Information Act.

It's clear you don't understand. Read PROCEEDINGS Fourth Annual Conference of State Dental Directors with The Public Health Service and The Children's Bureau, June 6-8, 1951; Federal Security Building, Washington, D.C..

This is the United States Government documentation of the minutes of a meeting sponsored by the U. S. Public Health Service in regards to the “Promotion and Application of Water Fluoridation.” Thesetminutes are officially recorded in Volume #5 of Hearings, 89th Congress, Dept. of Labor and Health Education and Welfare Appropiations for 1967. They are also recorded, Case #8425, Exihibit 108, of Public Utilities Commission of Calif. 1966. Its the infamous U.S. Dental Conference, 1951 with the "missing" minutes. I'm sure you'll find it interesting. — Preceding unsigned comment added by 99.61.178.14 (talk) 21:12, 8 April 2013 (UTC)
 * Clearly you're not getting support for this. Got any better references? TippyGoomba (talk) 02:44, 9 April 2013 (UTC)
 * As an outsider to this conversation, I am curious as to learning more about why this article is unreliable per WP:MEDRS. It seems to me that the ACS would have a conflict of interest in favor of water fluoridation, if anything, but I am not particularly familiar with them.  I also have not seen the IP's declaration "indicating that his/her involvement here is in opposition to WP:NOTADVOCACY", but I would take care to note that being personally opposed to water fluoridation cannot instantly qualify as a violation of WP:NOTADVOCACY unless personally supporting water fluoridation is a violation of WP:NOTADVOCACY.  Perhaps the IP believes that the article does not adhere to WP:NPOV but is not expressing this.  Lastly, does the source presented not immediately disprove that this is scientific consensus: "Water fluoridation is effective at reducing cavities in both children and adults"?  Thanks,  Gold   Standard  03:10, 9 April 2013 (UTC)
 * it's out of date, see WP:MEDDATE. Also, it meets none of the criteria of This page in a nutshell: Ideal sources for biomedical material include general or systematic reviews in reliable, third-party, published sources, such as reputable medical journals, widely recognised standard textbooks written by experts in a field, or medical guidelines and position statements from nationally or internationally recognised expert bodies. TippyGoomba (talk) 03:52, 9 April 2013 (UTC)
 * Got it, that clears things up. One last thing, assuming the source was recent, why wouldn't the ACS be considered a "reliable, third-party, published source"?  Gold   Standard  04:06, 9 April 2013 (UTC)
 * The same reason you don't see any theological scholarship in the evolution article, it's not a medical journal. It may be that the journal is a reliable source, just not for medical claims. TippyGoomba (talk) 04:10, 9 April 2013 (UTC)
 * I see, I hadn't considered that. Is it specifically a medical claim, though?  It seems to me that the ACS would not have published a study if it was not related to their area of study.  Could this claim not be considered both a medical claim and a claim relating to chemicals?  For example, would a study from the ACS identifying a certain chemical as damaging to the eyes not be considered reliable when writing about that chemical?  Gold   Standard  04:19, 9 April 2013 (UTC)
 * I could imagine not needing a WP:MEDS citation for the fact that putting lye in my eyes is harmful. But it's hard to think of an example where we'd wish to discuss such effects, not be able to find a meds source, and require a source in the first place (see WP:BLUE). I'm fairly certain the example I gave fits none of these criteria. TippyGoomba (talk) 06:51, 9 April 2013 (UTC)
 * So a meds citation is only necessary for controversial claims (e.g. that sodium fluoride doesn't actually slow tooth decay)? Gold   Standard  07:17, 9 April 2013 (UTC)
 * Yes, except I would replace "controversial" with WP:EXCEPTIONAL. Also, I would apply it more broadly, to all of science and history at the very least. There's nothing special about meds in this case, it's simply that meds has some unusual requirements like 5 year systematic reviews. TippyGoomba (talk) 08:07, 9 April 2013 (UTC)
 * Cool, thanks for your help! It's always good to learn and understand more of Wikipedia's policy as it applies to real scenarios.  Hopefully our conversation helps the IP too if he/she reads this.  Gold   Standard  08:31, 9 April 2013 (UTC)

Evidence-basis
"Fluoride's caries-preventive properties initially were attributed to changes in enamel during tooth development because of the association between fluoride and cosmetic changes in enamel and a belief that fluoride incorporated into enamel during tooth development would result in a more acid-resistant mineral. However, laboratory and epidemiologic research suggests that fluoride prevents dental caries predominately after eruption of the tooth into the mouth, and its actions primarily are TOPICAL for both adults and children "

"Achievements in Public Health, 1900-1999..".

This deserves at least a mention somewhere in this article. — Preceding unsigned comment added by 99.61.178.14 (talk) 19:48, 9 April 2013 (UTC)


 * And amazingly enough it already is in the article.   19:55, 9 April 2013 (UTC)

Notice to IP editor 99.61.178.14
IP editor 99.61.178.14, I have left you a request to adhere to WP:TPG and WP:MEDRS at your talk page here. I am leaving you this note here in case your IP changes. 03:50, 10 April 2013 (UTC)

section on studies and reviews

 * I think it would be great to start a section on the general quality of the research, the different types of research, studies and reviews in the article. Tilapidated (talk) 19:23, 20 February 2013 (UTC)
 * I took the liberty of beginning this - I am a little troubled at the overall poor quality of the data - I hope someone will be able to add more impressive reviews and meta-studies. Tilapidated (talk) 21:10, 20 February 2013 (UTC)

It appears that many papers/studies on PubMed are leaning away from water fluoridation. See "Caries frequency in permanent teeth before and after discontinuation of water fluoridation in Kuopio, Finland." "In spite of discontinued water fluoridation, no indication of an increasing trend of caries could be found in Kuopio. The mean numbers of﻿ fluoride varnish and sealant applications decreased sharply in both towns between 1992 and 1995. In spite of that caries declined."

"Caries prevalence after cessation of water fluoridation in La Salud, Cuba" "In the past, caries has usually increased after cessation of water fluoridation. More recently an opposite trend could be observed: following the cessation of drinking water fluoridation, in contrast to an expected rise in caries prevalence, DMFT and DMFS values remained at a low level for 6-9-year-olds and to decrease for﻿ 10/11-year-olds. In the 12/13-year-olds, there was a significant decrease."

"Decline of caries prevalence after the cessation of water fluoridation in the former East Germany" "In contrast to the anticipated increase in﻿ dental caries following the cessation of water fluoridation in the cities Chemnitz and Plauen, a significant fall in caries prevalence was observed. This corresponded to the national caries decline and appears to be a new population-wide phenomenon. There is still no explanation for the pattern."

"Prevalence and severity of dental caries in adolescents aged 12 and 15 living in communities with various fluoride concentrations" "In an analysis of caries severity (DMFT > or = 4), both adolescents with very mild/mild and moderate/severe dental fluorosis have higher caries severity. Fluoride exposure (measured through fluorosis presence) does not appear to be reducing the caries prevalence (DMFT > 0) or caries severity (DMFT > or = 4) in these high-altitude communities."

"An epidemiological profile of dental caries in 12-year-old children residing in cities with and without fluoridated water supply in the central western area of the State of São Paulo, Brazil" "There was no statistically significant difference between DMFT in municipalities of the same size, regardless of the presence or absence of fluoride in the water supply... Prevalence of caries in the region was 'high', with a DMFT of 4.82, thus failing to reach the goals set for the year 2000."

"Patterns of dental caries following the cessation of water fluoridation" Canada "The prevalence of caries (assessed in 5,927 children, grades 2, 3, 8, 9) decreased over time in﻿ the fluoridation-ended community while remaining unchanged in the fluoridated community."

"The fluoride content of drinking water and caries experience in 15-19 year old school children in Ibadan, Nigeria" "Nine hundred and fifty five students aged 15-19 years randomly selected from eleven secondary schools in Ibadan metropolis were examined for dental caries over a period of 4-5 months. Only teeth with obvious cavitations were recorded as being carious using the WHO standard method. The fluoride level of﻿ the different water sources was between 0.02 and 0.03 ppm. [only] Forty-four (4.6%) of the children had dental caries. In conclusion, both the fluoride level and caries prevalence were low."

"The effects of a break in water fluoridation on the development of dental caries and fluorosis" North Carolina "It was concluded that while the break had little effect on caries, dental fluorosis is sensitive to even small changes in fluoride exposure from drinking water, and this sensitivity is greater at 1 to 3 years﻿ of age than at 4 or 5 years."

"New evidence on fluoridation" "A review of recent scientific literature reveals a consistent pattern of evidence--hip fractures, skeletal fluorosis, the effect of fluoride on bone structure, fluoride levels in bones and osteosarcomas--pointing to the existence of causal mechanisms by which fluoride damages bones. In addition, there is evidence, accepted by some eminent dental researchers and at least one leading United States proponent of fluoridation, that there is negligible benefit from ingesting fluoride, and that any (small) benefit from fluoridation comes from the action of fluoride at the surface of the teeth before fluoridated water is swallowed."

"Is there a need of extra fluoride in children?" "The issues related to fluoridation of water or fortification of tooth paste with compounds of fluorides are controversial. Fluoride is stored mainly in the bones, where it increases the density and changes the internal architecture, makes it osteoporotic and more prone to fractures. Fluoride consumption by human beings increases the general cancer death rate, disrupts the synthesis of collagen and leads to the breakdown of collagen in bone, tendon, muscle, skin, cartilage, lungs, kidney and trachea, causing disruptive effect on various tissues in the body. It inhibits antibody formation, disturbs immune system and makes the child prone to malignancy. Fluoride has been categorized as a protoplasmic poison and any additional ingestion of fluoride by children is undesirable."

"Developmental fluoride neurotoxicity: a systematic review and meta-analysis" "The results support the possibility of an adverse effect of high fluoride exposure on children's neurodevelopment." "Impact of fluoride on Neurological Development in Children" "Some studies suggested that even slightly increased fluoride exposure could be﻿ toxic to the brain."...

"Fluoride seems to fit in with LEAD, MERCURY, and other poisons that cause chemical brain drain," Grandjean says. "The effect of each toxicant may seem small, but the combined damage on a population scale can be serious, especially because the brain power of the next﻿ generation is crucial to all of us."

"Effects of the fluoride on the central nervous system" "The prolonged ingestion of F may cause significant damage to health and particularly to the nervous system. Therefore, it is important to be aware of this serious problem and avoid the use of toothpaste and items that contain F, particularly in children as they are more susceptible to the toxic effects of F."

"Fluorine as a factor in premature aging" "In conclusions, the use of fluoride, particularly by dentists and pediatricians, must be controlled and adapted to individual needs."

"Oral manifestations of thyroid disorders and its management" "Fluoride was used as a drug to treat hyperthyroidism because it reduces thyroid activity quite effectively. This is due to the ability of fluoride to mimic the action of thyrotropin (TSH). Excess fluoride correlates with the other thyroid-related issues such as iodine deficiency. Fluorine and iodine, both being members of the halogen group of atoms, have an antagonistic relationship. When there is excess of fluoride in the body it can interfere with the function of the thyroid gland. Thus, fluoride has been linked to thyroid problems."

The prior therapeutic use of F to reduce thyroid hormone levels in cases of thyrotoxicosis is well documented (Goldemberg, (1926, 1930, 1932); May (1935, 1937); Orlowski (1932) and Galletti and G. Joyet, (1958)).

"Fluoridation: a fifty-year-old accepted but unconfirmed hypothesis" "The fifty-year-old fluoridation hypothesis has not been confirmed. Despite this, millions of people are still medicated with fluoride by government decree, on the assumption that this process has been proved to be entirely safe, and very efficacious in reducing dental caries. In fact, the scientific basis of fluoridation is very unsatisfactory. It is promoted, in the main, by emotion-based 'endorsements' rather than by scientifically-acceptable evidence."

"Fluoridation: a violation of medical ethics and human rights" "Silicofluorides, widely used in water fluoridation, are unlicensed medicinal substances, administered to large populations without informed consent or supervision by a qualified medical practitioner. Fluoridation fails the test of reliability and specificity, and, lacking toxicity testing of silicofluorides, constitutes unlawful medical research. It is banned in most of Europe; European Union human rights legislation makes it illegal. Silicofluorides have never been submitted to the U.S. FDA for approval as medicines. The ethical validity of fluoridation policy does not stand up to scrutiny relative to the Nuremberg Code and other codes of medical ethics, including the Council of Europe's Biomedical Convention of 1999. The police power of the State has been used in the United States to override health concerns, with the support of the courts, which have given deference to health authorities." — Preceding unsigned comment added by 99.61.178.14 (talk) 19:44, 6 April 2013 (UTC)


 * I reviewed the sources provided:
 * is a primary study from 1998
 * is a primary study from 2000
 * is a primary study from 2000
 * is a primary study from 2007
 * is a primary study from 2002
 * is a primary study from 2001
 * is a primary study from 2008
 * is a primary study from 2000
 * is a review from 1997
 * is an editorial from 2009
 * is a 2012 review article but with extremely qualified findings ("The results suggest that fluoride may be a developmental neurotoxicant...", "The results support the possibility ...") with no conclusion of a cause-and-effect relationship.
 * The HSPH article is a commentary on
 * focuses on "populations exposed to the intake of this mineral at concentrations outside official guidelines", and so outside the scope of this article
 * is a review from 2004, also doesn't appear to be talking about flouride levels like those discussed in this article
 * talks about treatment of patients with thyroid disfuction, does not appear to discuss flouride levels like those discussed in this article
 * is a Medical Hypotheses article from 1988
 * is an editorial from 2003
 * In short, not a single one of these articles looks appropriate for use here. Please refer to WP:MEDRS for Wikipedia's standards for sourcing biomedical information, and please take care not to misrepresent the applicability of sources.    03:31, 7 April 2013 (UTC)

WP:MEDRS states that PubMed is an excellent source of information. Are you stating that it is not? — Preceding unsigned comment added by 99.61.178.14 (talk) 04:48, 7 April 2013 (UTC)
 * See WP:MEDDATE. TippyGoomba (talk) 04:58, 7 April 2013 (UTC)

@TippyGoomba - WP:MEDDATE is a rule of thumb but isn't mandatory. "Here are some rules of thumb for keeping an article up-to-date, while maintaining the more-important goal of reliability. These instructions are appropriate for actively researched areas with many primary sources and several reviews and may need to be relaxed in areas where little progress is being made or few reviews are being published."

I am still searching for safety studies done on consuming & bathing in water with added hexafluorosilicic acid instead of calcium fluoride. There is quite a difference in the LD50 toxicity levels. The LD50 for calcium fluoride is 4250 mg/kg. The LD50 for hexafluorosilicic acid is 70 mg/kg. Hexfluorosilicic acid (also known as hydrofluorosilicic acid) was banned by the EU in 2006 due to lack of toxicological data to show it was safe for humans and the environment yet this banned biocide/pesticide is used to fluoridate the water. Confounding many of these epidemiological studies is the fact that artificially added inorganic fluoride is much more damaging to living tissue (not to mention corrosive to pipes) than organic, naturally occurring calcium fluoride. And when measuring only the absolute levels of the fluoride anion, studies end up comparing apples to oranges. — Preceding unsigned comment added by 99.61.178.14 (talk) 05:52, 7 April 2013 (UTC)
 * Are you trying to be funny, or just bog-ignorant? CaF2 is organic??? If you don't know anything about chemistry, much less organic chemistry, not even to mention metabolic or biochemistry, and too dumb or bone-idle to do some homework, then stop wasting the time of people who have something more useful to do. JonRichfield (talk) 06:41, 7 April 2013 (UTC)

@JonRichfield - When I used the word "organic", I was using it in an "informal way". See Wikipedia, "Organic Matter". "Organic matter is present throughout the ecosystem. After degrading and reacting, it can then move into soil and mainstream water via waterflow. A majority of organic matter not already in the soil comes from groundwater." Didn't mean to enrage anyone. I stand corrected. — Preceding unsigned comment added by 99.61.178.14 (talk) 08:13, 7 April 2013 (UTC)


 * An informal way? You mean total, radical incomprehension of highschool basics? You want organic flourine? Try a few ppm of fluocitrate or the like; that is organic. You didn't enrage me, you horrified me, much as if I found a fellow-passenger wrestling with the pilot of the plane I was a passenger in, because he thought the pilot didn't understand about placating the gremlins holding up the wings. Am I making it a bit clearer now? JonRichfield (talk) 20:09, 10 April 2013 (UTC)


 * You appear to be confused. WP:MEDDATE is the same essay as WP:MEDRS, the one you quoted as saying "PubMed is an excellent source of information" in order to dispute Zad's observation that your citations are out of date. TippyGoomba (talk) 06:03, 7 April 2013 (UTC)

@TippyGoomba - What date should it be? Can you find something more recent? It doesn't appear that there are any peer-reviewed safety studies done on consuming hexafluorosilicic acid, aka hydrofluorosilicic acid, in tap water. Odd when you consider the difference in their LD50 toxicity levels to naturally occurring "calcium fluoride". Here's some information on hexafluorosilicic acid used for water fluoridation. See "Sodium Hexafluorosilicate and Fluorosilicic Acid, Review of Toxicological Literature". Its just a pesticide and rodenticide. Lets add it to tap water and feed it to American infants and children. — Preceding unsigned comment added by 99.61.178.14 (talk) 19:50, 7 April 2013 (UTC)


 * And with this last response you reveal that your intention is not article development in line with Wikipedia policy and guideline but rather an intention to use Wikipedia articles to advance a position. See WP:NOTADVOCACY.  As this discussion was proposed in bad faith, it is now closed.    22:32, 7 April 2013 (UTC)

STATEMENT OF Dr. J. WILLIAM HIRZY of the EPA
STATEMENT OF Dr. J. WILLIAM HIRZY.

Why is this completely omitted in this article?

Dr. J. William Hirzy of the EPA states, "Kingston and Newburg, New York Results- In 1998, the results of a fifty-year fluoridation experiment involving Kingston, New York (un-fluoridated) and Newburg, New York (fluoridated) were published (17). In summary, there is NO overall significant difference in rates of dental decay in children in the two cities, but children in the fluoridated city show significantly higher rates of dental fluorosis than children in the un-fluoridated city."

He further states, "a massive experiment that has been run on the American public, without informed consent, for over fifty years".

Does Wikipedia consider this insignificant? — Preceding unsigned comment added by 99.61.178.14 (talk) 20:15, 9 April 2013 (UTC)

Dr. William L. Marcus of the EPA is considered a "whistle-blower" concerning government policy regarding fluoridation. It was in the Washington Post on March 1, 1994. See Washington Post Article, "Whistle-Blower Clears the Air" dated March 1, 1994.

Why is this ignored in this article? — Preceding unsigned comment added by 99.61.178.14 (talk) 21:32, 9 April 2013 (UTC)
 * Perhaps a statement about Dr. Marcus' or Dr. Hirzy's position on the matter could be added to the Water_fluoridation section or to the Water fluoridation controversy article, but it could not be used to state that "there is NO overall significant difference in rates of dental decay in children in the two cities". To place this claim into the article, you need a reliable medical source that is less than 5 years old per WP:MEDDATE.  Thanks for understanding,  Gold   Standard  01:17, 10 April 2013 (UTC)
 * Also, the Washington Post is not a reliable source for this claim, see WP:MEDS. TippyGoomba (talk) 02:55, 10 April 2013 (UTC)
 * It would be acceptable for putting a statement about Dr. Marcus' position on the matter, although I'm not so sure that's what the IP wants.  Gold   Standard  03:03, 10 April 2013 (UTC)


 * The IP isn't even bothering to make a suggestion about article content here, but rather is only making pointed questions about the motives of Wikipedia editors: "Why is this completely omitted in this article?" "Does Wikipedia consider this insignificant?"  "Why is this ignored in this article?".  This is more evidence demonstrating WP:AGF would be misplaced.    03:08, 10 April 2013 (UTC)
 * I think the IP is genuinely concerned about the bias that he/she perceives in this article, but has not educated him or herself well enough on Wikipedia policies.  Gold   Standard  03:53, 10 April 2013 (UTC)
 * You're welcome to continue to WP:AGF but I've seen enough evidence to the contrary (as the AGF guideline allows).   03:56, 10 April 2013 (UTC)
 * I will continue to WP:AGF as I see little evidence to the contrary. The IP's questions, although accusatory of the motives of other editors, do not evidence bad faith.  In fact, since the IP is attempting to remedy a perceived bias on this page, the IP is seeking to improve Wikipedia (albeit without much of an understanding of Wikipedia policy).   Gold   Standard  04:50, 10 April 2013 (UTC)
 * Dr. Marcus isn't a reliable source either, which is why we have peer review. TippyGoomba (talk) 03:20, 10 April 2013 (UTC)

If you look at the footnotes on this article, MOST of the medical information it contains is older than five years old and may need to be removed if you are going to adamantly require WP:MEDDATE of less than 5 years on everything. Of course if you plan to cherry-pick, that would be a different matter. The whole article comes off as very biased in general. What makes Dr. Marcus unreliable? Is it simply his POV? — Preceding unsigned comment added by 99.61.178.14 (talk)
 * Sigh, i meant to cite WP:MEDRS and not WP:MEDS. Anyway, WP:MEDRS says we require peer-reviewed literature. TippyGoomba (talk) 04:46, 10 April 2013 (UTC)
 * Why was my signature copied? This was the IP:  Gold   Standard  04:50, 10 April 2013 (UTC)
 * Sorry about that. TippyGoomba (talk) 05:04, 10 April 2013 (UTC)
 * No worries. Gold   Standard  05:26, 10 April 2013 (UTC)

But we don't need peer-reviewed safety studies on consuming and bathing in water with added hexafluorosilicic acid? Its not the same as naturally occurring "calcium fluoride" yet it is added to tap water and simply called "fluoride". It doesn't even have the same LD50 toxicity level as "calcium fluoride". Unfortunately, I'm unable to find any peer-reviewed safety studies on it. But Wikipedia considers that okay? — Preceding unsigned comment added by 99.61.178.14 (talk)
 * I would be inclined to ask why you think that your LD50 figures are relevant, but you make it difficult to believe that you have any idea. You might have a point if this article had anything to do with possible accidents in which the population might be exposed to something like 100 (putting it charitably) times the required dosage, (always on the assumption that the 70mg/kg applied directly to humans, and under circumstances where essentially the whole F content of the water remained unchanged in form and quantity, from the point of introduction) but the debate is supposed to be about the benefits or otherwise of applying less than 1ppm of soluble fluoride in drinking water. Work out what that might suggest in mg/kg body weight. Now, if they were proposing xenon fluorides instead of hexafluorosilicate, you might have a point... JonRichfield (talk) 20:09, 10 April 2013 (UTC)

@JonRichfield - From what I understand, calcium mitigates the toxicity of fluoride compounds. This is why calcium of some form is used as an antidote in fluoride overdose or toxicity. And this is why calcium fluoride is considered the least toxic of fluoride compounds. Furthermore calcium fluoride is much less likely to dissociate in water as does hexafluorosilicic acid. There's quite a bit of difference in these compounds. I don't believe there is any calcium in hexafluorosilicic acid which is why I believe peer-reviewed safety should be required before any claims of safety can be made. Hexafluorosilicic acid can be used as a pesticide and rodenticide. Calcium fluoride does not make an effective pesticide due to its calcium content. I believe most medications are required to have peer-reviewed safety studies done on them. If there are any specific peer-reviewed safety studies on the use of hexafluorosilicic acid, I believe they should at least be mentioned and cited somewhere in this article. As stated before, hydrofluorosilicic acid (also known as hexafluorosilicic acid) was banned by the EU in 2006 due to lack of toxicological data to show it was safe for humans and the environment yet this banned chemical is used to fluoridate the water in the USA. Correct me if I'm wrong.


 * If you want to discuss it, create a new section and describe the issue more carefully. I don't quite follow what you're saying. TippyGoomba (talk) 05:04, 10 April 2013 (UTC)

Dr. Colquhoun a dentist of New Zealand says data was "doctored"
Shouldn't this be mentioned in an article regarding water fluoridation?

See AFFIDAVIT OF DR. JOHN COLQUHOUN IN SUPPORT OF MOTION FOR SUMMARY JUDGMENT.

"I was shocked to discover, when the statistics were sent to me, they revealed no such benefit. In fact, in most Health Districts the percentage of children who were "caries-free" was higher in the non-fluoridated areas than in the fluoridated areas. I disagreed sharply with my superiors' action in circulating a document, "overview of fluoridation statistics," which omitted the above information, disgracefully 'doctored' the remaining statistics, and claimed that a marginal benefit existed." — Preceding unsigned comment added by 99.61.178.14 (talk) 00:55, 10 April 2013 (UTC)
 * No, see WP:MEDS. An affidavit is not a journal article. TippyGoomba (talk) 03:21, 10 April 2013 (UTC)

His statements are also in a journal article. "Why I changed my mind about water fluoridation". Colquhoun, J. Perspectives in Biol. And Medicine 41 1-16 (1997). — Preceding unsigned comment added by 99.61.178.14 (talk) 04:13, 10 April 2013 (UTC)
 * Old, an opinion piece, and WP:FRINGE. TippyGoomba (talk) 04:23, 10 April 2013 (UTC)
 * On a separate note, would it not be acceptable to write a statement in the opposition paragraph specifically about this Doctor's views? or is he not notable enough? Gold   Standard  04:35, 10 April 2013 (UTC)

We'd need a good quality secondary source to establish this guy's opinion is notable. 04:43, 10 April 2013 (UTC)
 * Agreed. Gold   Standard  04:45, 10 April 2013 (UTC)

Dr. J. Colquhoun has several papers on PubMed regarding fluoridation but it doesn't look like abstracts are available to read. — Preceding unsigned comment added by 99.61.178.14 (talk) 04:48, 10 April 2013 (UTC) Dr. J. Colquhoun is also used as a reference in "Fluoride in Drinking Water: A Scientific Review of EPA Standards (2006), Board of Environmental Studies and Toxicology".

"Others claim that fluoride causes various adverse health effects and question whether the dental benefits outweigh the risks (Colquhoun 1997)." — Preceding unsigned comment added by 99.61.178.14 (talk) 05:17, 10 April 2013 (UTC)
 * Those are primary sources, what about secondary sources? TippyGoomba (talk) 05:21, 10 April 2013 (UTC)

@TippyGoomba - "Fluoride in Drinking Water: A Scientific Review of EPA Standards" (2006) is a "secondary" source. Its a book on fluoride. — Preceding unsigned comment added by 99.61.178.14 (talk) 18:43, 10 April 2013 (UTC)


 * Please provide the specific article content change you are proposing (provide the exact wording you are requesting and specify which section of the Wikipedia article you are proposing to change), and name the exact source you are proposing to use to support it, including page numbers.   19:02, 10 April 2013 (UTC)