摘要：We were interested to read the article by Choi et al. (2012), who investigated the effects of increased fluoride exposure and delayed neuro behavioral develop ment by reviewing published studies and perform-ing a meta-analysis. Of the 39 studies identi-fied, the authors considered 27 to be eligible. Choi et al. reported a mean difference in IQ (intelli gence quotient) score between exposed and reference populations of –0.4 (95% con-fidence interval: –0.5, –0.3) using a random-effects model. Thus, children in high-fluoride areas had significantly lower IQ scores than those who lived in low-fluoride areas.Even if we ignore the weaknesses of the study (Choi et al. 2012), including a lack of individual-level information and the high probability of confounding because the authors did not adjust for covariates, a dif-ference of 0.4 in mean IQ is clinically neg-ligible (Jeckel et al. 2007; Rothman et al. 2008; Szklo and Nieto 2007) even though it was statistically significant. In general, clini-cal importance takes priority over statistical significance. The p-value can easily change from significant to nonsignificant because of sample size or the mean difference and stan-dard deviation of the variable in the study population (Jeckel et al. 2007; Rothman et al. 2008; Szklo and Nieto 2007). As Choi et al. (2012) pointed out in their conclusion, there is a "possibility of an adverse effect of high fluoride exposure on children's neu-rodevelopment." Such a conclusion can be considered an ecological fallacy, which can easily lead to mis interpretation of the results. It is important to know that statistics can -not provide a simple substitute for clinical judgment (Jeckel et al. 2007; Rothman et al. 2008; Szklo and Nieto 2007).
