“Not Great Science”

There’s an article haunting the JAMA Network, one they can easily exorcise by simply retracting it.

Yes, it’s the “fluoride-IQ” study I’ve covered again and again (four good links here, here, here, and here).

It was resurrected via an interview at the AAAS Annual Meeting last month (video below, released earlier this week), where JAMA EIC Kirsten Bibbins-Domingo was joined by NEJM EIC Eric Rubin and Science EIC Holden Thorp.

The article’s core issues are back on the table.

I’ve transcribed the relevant portion of Bibbins-Domingo discussing this paper, adding a few highlights, one of which I’ll explain:

Bibbins-Domingo: I’m going to give the example, which might get me stoned out of this room. So, I’m the Editor-in-Chief of JAMA, which is a network of journals, 13 journals, and, um, one of our journals, [JAMA] Pediatrics, received a review article, a systematic review, a meta-analysis of fluoride and its relationship to IQ. Right? So, this came to us, it was an NIH-funded study, rigorously conducted, a systematic review, meta-analysis of not-great science. I mean, the field, that field is full of not-great studies, right? The editors had to decide were they going to review this, were they going to accept this, and made the decision that after peer review, they knew that even this well-done study was flawed, and by its nature it’s based on a lot of studies with problems, and it was going to be high-profile.

So, the editors together made the decision to publish it with not one but two editorials, and the editorials were to help understand “this is the science as we have it in the systematic review and meta-analysis, and then here are the ways in which — not arguing with the study, but here are the ways in which you might perceive these studies differently if you’re trying to apply them to a policy, if you’re trying to think about the next type of experiment that needs to be done, if you’re thinking about the gaps in the literature. And one of the things we were really pleased by when this was finally published was that, and I’ll just point to the New York Times, was that the New York Times’ article referenced the study and the two editorials that are in it.

And I think that’s the type of publication we want to be able to do — we want to recognize a study that’s going to get attention, recognize that it’s complex, and then trust that we can give you more information about the complexity that will help in other people being able to understand it as well.

Now, you never expect you’re going to accept this study before the new Administration comes in, then the new Administration comes in who have a very different point of view and a very specific point of view about this very issue.

Bibbins-Domingo then acts surprised that RFK, Jr., walked into his confirmation hearing carrying the study to bolster his pre-existing anti-fluoride arguments. He wasn’t concerned with “complexity” but with a valid-seeming, cherry-picked study he could use to support one of his established narratives.

• It is naive at any time to assume pure motives with health information claims, especially so these days.

Let’s take a step back and talk about this study in a more objective manner, because I think it reveals that the JAMA Network editors might be out of touch:

• This study was published OA, with JAMA Pediatrics charging the authors thousands of dollars via an APC. We don’t know who paid this APC, because the journal is not required to disclose it and the publisher hasn’t opted to embrace the practice. In fact, large OA publishers have worked hard to block the requirement for disclosure in years past.
  • Only last year did COPE “recommend” the practice, and I’ve only seen it done once, on an Elsevier paper.
• The last author (James Bucher) is notorious for a preprint about cell phone radiation and brain cancer, which was debunked with great effort but has since itself been revived by MAHA. If the editors didn’t look him up, shame on them.
• The claim about it being NIH-funded is a bit of a stretch, as the authors were “supported by the Intramural Research Program (ES103316, ES103317) at the National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health and was performed for NIEHS under contract GS00Q14OADU417 (order HHSN273201600015U)” but then this is included:

NIEHS had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation of the manuscript. NIEHS did have a role in the review approval of the manuscript and the decision to submit the manuscript for publication.

• It was not a specific study receiving specific funding, but a bunch of authors in a funded lab generating a systematic review — the most problem-plagued kind of article these days — and paying an APC from some bucket of funds somewhere. It’s a bit of a stretch to call it “NIH-funded.”
• The topic itself — fluoride and IQ — is a eugenics-laced no-go zone for solid science because the topics individually aren’t worthy of scientific inquiry. Fluoride is well-studied and uniformly found to be far more beneficial than risky. IQ is pseudoscience. Put them together and you make a well-known and well-rehearsed conspiracy theory used to drive racist policies. Being ignorant of this means never having watched Dr. Strangelove, being unaware of shameful Supreme Court cases and the history of racism and eugenics in the US and so much more.
  • Postulating that this paper was OK before RFK, Jr., made it clearly not-OK is a bit rich.
• Signing an agreement with OpenEvidence knowing you’re depositing “not great science” that you describe as “flawed” and with “problems” is the cherry on top.
  • Bibbins-Domingo announcing the OE deal: “Clinicians seek reliable information to guide their care of patients and want the best scientific evidence readily accessible.”
    • Ingesting this study led to OE becoming a MAHA mouthpiece . . .
      • Reminder: This paper inspired RFK, Jr., to tell President Trump about fluoride, “The more you get, the stupider you are.” It led to the FDA restricting fluoride supplements for kids, to Florida and Utah banning fluoride in drinking water, and more.

But here’s the rub — if any editor I’ve known had said the science in an area is “not great,” a “flawed” review of such not-great science has been submitted, and it is going to be high-profile, alarm bells would have been sounding left, right, and center in a good editorial operation. And when the authors themselves in the paper express qualms about the quality of their references? And when the topic itself represents a disgraceful racist conspiracy theory built on pseudoscience? And then you take money to publish it via Gold OA, making it available for anyone to read while placing two editorials throwing shade on it behind the paywall, and you call this contextualization and believe it’s adequate in the age of Substack and YouTube and Twitter/X? Then you celebrate when the New York Times mentions the editorials, as if this is the meaningful media source patients are accessing these days, even as your article clicks tracker shows for more than a year that the paper is driving traffic to a disproportionate degree?

It beggars belief.

Here are two questions I wish the journalists at the event had know to ask:

1. Who paid the APC?
2. What are the five main sources driving the consistent traffic to the article?

My advice?

JAMA Pediatrics, just retract the paper, and be done with it.

Then we can find out if OE can actually retract a paper . . .