Thread by @DBrozeLiveFree

Day 3 of phase 2 of the #FluorideLawsuit has begun.

FAN calls Dr. Grandjean back to the witness stand. He is their 3rd expert witness to be called.

FAN Connett: I'd like to return to the discussion on your pooled analysis. I want to start by looking at some of the urinary fluoride data looking at the Danish study itself.

Connett: Let's look at figure 2. I believe you testified yesterday that these urinary levels were adjusted for creatinine, correct?

Grandjean: yes.

Connett: what trimester were these taken?

Grandjean: I believe it was the 3rd trimester.

Connett: If the urine samples for the 1st and 2nd trimester were available would that have provided more info into the fluoride exposure?

Grandjean: It would have been better if we had samples from earlier in the pregnancy. Also, about half of the samples were spot.

Grandjean: half of the mothers provided, supposedly, 24 hour samples, bc we know its difficult for mothers to carry around this bottle for 24 hours.

Connett: so even a 24 hour sample is imperfect?

Grandjean: Correct.

Connett: if we are comparing urinary fluoride exposures between the Danish cohort & the MIREC cohort, do you think we should be looking at the 3rd trimester, does that matter?

Grandjean: it does matter.

Connett: that's more of an apples to apples comparison?

Grandjean: correct

Connett is showing Grandjean a table from the MIREC study which shows concentration of fluoride in maternal urine fluoride in the 1st, 2nd, and 3rd trimester.

Connett is asking Grandjean to explain what the table shows.

Grandjean notes that the levels of fluoride increase the further along the pregnancy, particularly by the 3rd trimester.

Connett shows Grandjean another table from his Danish study. Asks him to comment on it.

Now, back to the table from the MIREC study.

Connett: does this merger of the urinary fluoride levels that we observe in the fluoridated areas contrasted with your benchmark concentration lower bound (BMCL) do you see harms from water fluoridation?

Grandjean agrees.

Grandjean: is explaining the impact of someone drinking 1L of fluoridated water over a long period of time.

Grandjean: "As a physician, I know very well that we sometimes ask our patients to drink extra water bc we need to have that flow through the kidneys, if they have a kidney disease. Certainly there are people who will drink 3-4 L per day. "

Connett: is it a generally recognized position in toxicology that dose is more important when determining the impacts?

Grandjean: this goes back all the way to lead and gasoline. We did not relate neurotoxicity to the concentration of lead....

Grandjean: We measured lead in blood! And that's what EPA used to measure toxicity in lead. We're doing the same with fluoride.

Grandjean: I understand bc this was human data an uncertainty factor of 10 was applied to take into account those who are especially vulnerable.

Connett: in the course of working with the EPA, and reviewing publications which rely on your research, have you become aware of why the EPA would apply an uncertainty factor to your research?

Grandjean: My research considered everybody equal in my research, therefore EPA has to take into consideration that some people have other factors. I cant explain how we got a factor of 10, but thats what EPA has done for decades.

Connett: ok, let's move on. I am going to show you some recent studies on fluoride, which were not conducted by you. Connett puts on screen this study:

pubmed.ncbi.nlm.nih.gov/36214232/

Connett notes that the study is published in the Journal of Dental Research. Connett asks if Grandjean thinks its a credible journal.

Grandjean says he has looked at it for dental science, but not for environmental science.

Connett asks Grandjean about the author of the study.

Grandjean explains that this author is a dentist who hasn't done any environmental science or neurotoxicity research. Doesn't seem to think he is a reliable source.

EPA attorney interrupts Connett's line of questioning, saying it goes beyond the scope of Grandjean's deposition. Connett clarifies, tells EPA where the questions are in the court docs. EPA withdraws objections.

Connett is asking about L.G. Do (author of the study above) and one of his co-authors who used the Strength and Difficulties Questionnaire (SDQ), which Grandjean says was not an appropriate method of determining the impacts of fluoride.

Connett: in this study did they have any individualized data on water intake? did they have individualized data on the fluoride exposure? info on whether they consumed fluoridated toothpaste? any info on urinary fluoride levels?

Granjean answers no to all.

Connett: did this study do a single thing to assess the mother's exposure to fluoride during pregnancy?

Grandjean: no, the focus was on early childhood exposures.

Connett: so was their metric in this study was the child's residence?

Grandjean: yes.

Connett is now asking Grandjean about this study: Fluoride exposure during pregnancy from a community water supply is associated with executive function in preschool children: A prospective ecological cohort study pubmed.ncbi.nlm.nih.gov/37236475/

Grandjean is explaining how the above study was designed.

Connett again asks if the study had any data on if moms drank tap water, how long they lived in Calgary before pregnancy, etc.

Grandjean: I would think that type of data would be available, but surprisingly they did not

Grandjean: "I dont think this is an informative study."

Connett: will a woman who lives her life in a fluoridated area have more fluoride in her bones than a woman who does not?

Grandjean: yes, absolutely.

Connett: would you consider a pregnant mother who had live her whole life in fluoridated Calgary, would you consider her part of a non-fluoridated exposure group if she stopped drinking fluoridated water a couple months before pregnancy?

Grandjean: no, the problem is that our skeleton is continuously broken down and rebuilt. And during the break down of tissue that happens all the time, everyday, fluoride is released into the body, maybe fluoride that was consumed years ago.

Connett moves to ask Grandjean about a new study, this one:

Prenatal exposure to fluoride and neuropsychological development in early childhood: 1-to 4 years old children

pubmed.ncbi.nlm.nih.gov/34627799/

This study is part of the Infancia y Medio Ambiente (Childhood and Environment, INMA) project that looked at children in Basque area of Spain. This is the one that claimed fluoride increases IQ in boys.

Grandjean: the findings make absolutely no sense.

Remember, study author Jesús Ibarluzea has also been found to have lied under oath according to emails obtained by FAN.

Dr. Grandjean is making it clear that the Ibarluzea study is plain wrong and "was lucky to get published".

Grandjean: had I been the editor of this journal, I would have asked them to send the creatinine data back to the lab to check. Errors can happen.

"I don't have a fantasy to think that the data are somehow doctored. I think errors can happen during the focus of this study."

Grandjean: "this study, I would not consider valid. I would not use it in a review of the literature."

Connett: if the authors of this study, if they had detailed data on the amount of tap water that each mother consumed do you think they should have included that data as part of the fluoride consumption metric?

Grandjean: I happen to know that data was available.

Connett: do you think this is a weakness of this study that the authors had access to detailed data and chose not to include it?

EPA objects for leading, Judge Chen over rules, allows it to proceed.

Grandjean says he believes the data should have been included and the public should have been made aware of the data.

Judge asks a clarifying question. Grandjean explains that this study had issues with the creatinine levels, and the extra data could have helped provide clarity

Grandjean and Judge Chen are going back and forth to get clarity before moving forward.

Grandjean has basically eviscerated the Jesús Ibarluzea study that the EPA is attempting to rely on to show fluoride is actually beneficial to neurodevelopment.

Connett now wants Grandjean to comment on this study

Association between fluoride exposure in drinking water and cognitive deficits in children: A pilot study

pubmed.ncbi.nlm.nih.gov/37690675/

Connett asks Grandjean about the quality of the journal Neurotoxicology and Teratology, which published the study. Grandjean says its a credible journal, he knows the editor.

Connett: where was this study conducted?

Grandjean: that's interesting bc it was conducted in Ethiopia, where there is very little water fluoridation.

Connett: would you call this a low dose or high dose study?

Grandjean: high dose, some of those people were exposed to high levels of fluoride.

Connett: was this a small study or a big study?

Grandjean: small study.

Connett: does this being a small study make it more difficult to draw inferences from it?

Grandjean agrees but also says the study was useful for having "good exposure contrasts".

Grandjean explains that the study used various cognitive tests, including one where children were asked to draw some objects.

Connett: did the authors comment on whether some of the drawing tests were more complex than others?

Grandjean: you have to have easy tests and an increase in complexity.

Connett asks Grandjean to explain the complexity of the cognitive tests and how that might impact the determination of fluoride's effects.

Grandjean: it was clear there was a dose-dependency on the capacity of the child to make a reasonable drawing.

Connett: does it make sense that a child's exposure to fluoride would make it more difficult to do complex tasks than simple ones?

Grandjean is explaining how complex tasks, including drawing complex items, tests more than one modality of brain function.

Now Connett is showing pictures drawn by children in the above study. There are 4 of them. The first one on the top left looks most like a donkey, the bottom two are "very crude".

Grandjean explains that the best drawn pic had the lowest levels of fluoride exposure, & vice versa

Grandjean: "there's a clear association here - the higher the fluoride levels, the worse the drawing."

Connett brings back up Kaj Roholm, Danish scientist who researched fluoride's impact in the 1930's. Asks Grandjean to explain the influence of Roholm on science. Grandjean: what he did was to get chest xrays of workers (in the cryolite mines in Greenland).

Grandjean: the ribs were like marble bc they were made up of calcium and fluoride.

Grandjean says Roholm's work helped establish the science behind skeletal fluorosis.

Research on Roholm: en.wikipedia.org/wiki/Kaj_Roholm

Connett: based on the available research on fluoride exposure, do you think impact on neurodevelopment are more threatening than skeletal fluorosis?

Grandjean: yes, I do.

FAN Connett ends his questioning of Grandjean. EPA begins cross examination of Dr. Grandjean.

EPA brings up back up this study and asks Dr. Grandjean if he would call it a high quality study.

Association between fluoride exposure in drinking water and cognitive deficits in children: A pilot study

pubmed.ncbi.nlm.nih.gov/37690675/

Grandjean says yes, he would call it a high quality study.

EPA is asking Grandjean to compare the 3 different drawing tests (donkey, house, person), and asks if they only found difficulty in drawing a donkey.

Grandjean says he is not sure the question is relevant.

EPA: so Dr. Grandjean, just to be clear, the answer is yes that they didnt find any difficulty in drawing the house and the person?

Grandjean: yes, with the caveats I just added.

EPA is asking Grandjean to look at another cognitive test conducted by the study. Its known as a CANTAB cognitive test.

EPA: after they tested for the CANTAB, they found only 1 with statistically significant adverse effect, correct?

Grandjean: yes, they did find negative associations.

EPA tries to clarify, says 5 tests found no adverse effect and 1 did. EPA now showing Grandjean the text.

EPA is highlighting the text in this study that claims there was only 1 statistically significant adverse effect. Asks Grandjean to read the sentence and affirm what the study says.

Grandjean: "That's what it says."

EPA wants to talks to Grandjean about his testimony yesterday on the NTP monograph on fluoride.

EPA: yesterday you reviewed some of the studies in court, but you didn't review all 72 studies, right?

Grandjean: correct.

EPA: but just to clarify, you didn't read through all 72 studies here in court yesterday?

Grandjean: I've read them, but I dont remember them all at this moment.

EPA is now pulling up a chart from the NTP's meta analysis on fluoride showing high risk of bias studies vs low risk of bias studies.

EPA: you acknowledged in your testimony yesterday that the numbers on the right side are the levels of confidence interval, correct?

Grandjean: yes

EPA showing the chart, with highlights, to Grandjean. They are attempting to show that the studies used by the NTP were a majority of high-risk of bias studies. EPA asks Dr. Grandjean to count the number of low-risk of bias studies.

Dr. Grandjean says the table is new to him, he doesn't know much about it.

EPA is now highlighting a section of the studies, including some of the Chinese studies the FAN went over with Dr. Grandjean yesterday.

EPA is attempting to get Grandjean to comment on this table but he is saying he is not familiar with it.

EPA is asking about the 2017 Bashash study and the 2019 Green study.

EPA is highlighting the section of the table which appears to show that the results of these studies were not statistically significant.

Dr. Grandjean seems flustered with the line of questioning and surprised.

Judge Chen interrupts to say he is having trouble following and encourages the EPA to clarify through their questioning of Grandjean.

EPA asks Grandjean is he understands the Standardized Mean Difference table. Grandjean explains how he would typically create a SMD.

EPA: how can you explain that the Bashash and Green study became statistically insignificant and one became positive?

Grandjean: I dont know. You had a chance to question Dr. Lanphear yesterday and I think he explained it.

EPA switches gears to discuss a 2023 study by Grandjean. This one:

Dose dependence of prenatal fluoride exposure associations with cognitive performance at school age in three prospective studies

pubmed.ncbi.nlm.nih.gov/37798092/

EPA: It's possible that a study could change if you didn't adjust for urinary dilution, right?

Grandjean: we've always standardized it this way. I dont think we saw any significant difference when adjusting for creatinine.

EPA: this isn't the first time we met, is it Dr. Grandjean? I took your deposition in Boston last year. You swore to tell the truth, didnt you?

Grandjean: yes.

EPA calls to put previous statements made by Grandjean on screen.

EPA shows statement from Grandjean that it is standard to adjust urine dilution.

EPA: so you wouldnt conduct a study without adjusting for urinary dilution?

Grandjean confirms but adds caveats.

EPA once again pulls up his deposition.

EPA shows Grandjean's previous statement saying he wouldnt conduct a study without adjusting for urinary dilution.

Grandjean says he thinks there is a misunderstanding.

EPA repeats, failing to adjust for urinary dilution can change the results, correct?

Grandjean seems frustrated and said he is repeating himself. He says the answers he gave in his deposition are in agreement with what he is currently saying. Explains there are more than one way to adjust for urinary dilution.

EPA wants to read from his deposition again.

EPA reads Grandjean's previous statement, "if I ignore dilution, my data may not be valid."

Grandjean: we talked about 2 different things, you said you wanted to talk in general and now we are talking about the OCC study.

EPA: you ran multiple different models on the Danish OCC study, correct?

Grandjean: yes

EPA: across all those models you ran you never found a statistically significant effect, correct?

Grandjean: I wouldn't say never. Explains they ran multiple models and saw diverse results.

EPA: you ran at least 4 different models across the Danish samples and didnt find a statistically significant impact on IQ?

Grandjean doesnt answer directly. EPA calls for pulling up his deposition again.

EPA reads statements from deposition where Grandjean appears to say yes.

Grandjean explains that he stands by his statements in his deposition but says that EPA is taking things out of context.

EPA: Dr. Grandjean, you dont believe we should ignore the Danish OCC studies when examining whether fluoride at .7 mg/L is harmful?

Grandjean: it compliments other studies. The Danish cohort adds to the evidence that is available for these calculations.

EPA: you believe there is no reason to discount the Danish study? FAN Connett objects, judge over rules.

EPA calls again for showing Grandjeans deposition.

EPA: it wouldn't make sense to discount the Danish study as it relates to the question of fluoride's harm at .7 mg/L?

Grandjean: I've already answered this. This study adds to the overall data of fluoride's impacts.

EPA: you could say the Danish study is useful on its own, right?

Grandjean: you could, it adds to the material we can use for assessing the impacts.

EPA: you believe this danish study is a valid study?

Grandjean: I believe it is a valid study.

EPA: the Odense region is fluoridated at .03 mg/ L, correct?

Grandjean affirms. EPA asks about the levels of U.S. water fluoridation.

EPA asks if the difference between the water fluoridation levels in the U.S. and the Danish study are not too distant to be useful to draw conclusions.

Grandjean affirms with caveats that some people have fluoride levels beyond the amounts legally allowed.

EPA: your study only examined the 3rd trimester of pregnancy, would you say that was a small weakness of your study?

Grandjean: yes, a small weakness.

EPA asks Grandjean if he relied on the MIREC cohort for his Danish study. Grandjean says yes, and the ELEMENT cohort.

EPA pulls up his deposition where he said he only relied on MIREC.

Court breaks for first recess. Thanks for following!

Stay tuned for another thread in about 20 minutes.