Johnson & Johnson to pay $72m in case linking baby powder to ovarian cancer.

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Johnson & Johnson to pay $72m in case linking baby powder to ovarian cancer.

A Missouri jury has awarded $72m to the family of a woman who died from ovarian cancer, which she said was caused by using Johnson & Johnson’s baby powder and other products containing talcum.

The civil suit by Jackie Fox of Birmingham, Alabama, was part of a broader claim in the city of St. Louis circuit court involving nearly 60 people. Her son took over as plaintiff following his mother’s October 2015 death at 62, more than two years after her diagnosis.

Marvin Salter of Jacksonville, Florida, said his late mother, who was a foster parent, used the brand of talcum powder as a bathroom staple for decades. “It just became second nature, like brushing your teeth,” he said. “It’s a household name.”

The attorney representing the family of a woman whose death from ovarian cancer was linked to her use of Johnson & Johnson products says the company knew the risks

An attorney for Fox said the jury verdict Monday night, which came after nearly five hours of deliberations at the conclusion of a three-week trial, was the first such case among more than 1,000 nationally to result in a jury’s monetary award.

The jury said that Fox was entitled to $10m in actual damages and $62m in punitive damages. Attorney James Onder said he “absolutely” expects Johnson & Johnson – the world’s biggest maker of healthcare products – to appeal the verdict.

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The New Jersey-based company previously has been targeted by health and consumer groups over possibly harmful ingredients in items including in its Johnson’s No More Tears baby shampoo.

In May 2009, a coalition of groups called the Campaign for Safe Cosmetics began pushing Johnson & Johnson to eliminate questionable ingredients from its baby and adult personal care products. After three years of petitions, negative publicity and a boycott threat, the company agreed in 2012 to eliminate the ingredients 1,4-dioxane and formaldehyde, both considered probable human carcinogens, from all products by 2015.

Spokeswoman Carol Goodrich said that the company was considering its next legal move. In a written statement, she said the verdict “goes against decades of sound science proving the safety of talc as a cosmetic ingredient in multiple products,” citing supportive research by the US Food and Drug Administration and National Cancer Institute.

In the trial, Fox’s attorneys introduced into evidence a September 1997 internal memo from a Johnson & Johnson medical consultant suggesting that “anybody who denies [the] risks” between “hygenic” talc use and ovarian cancer would be publicly perceived in the same light as those who denied a link between smoking cigarettes and cancer: “Denying the obvious in the face of all evidence to the contrary.”

Talc is a naturally occurring mineral, mined from the soil and composed of magnesium, silicon, oxygen, and hydrogen. It is widely used in cosmetics and personal care products, such as talcum powder, to absorb moisture, prevent caking and improve the product’s feel.

Nora Freeman Engstrom, a Stanford University law professor not involved in the Missouri case, said it was unlikely the $72m award would survive, noting that the US Supreme Court, in a recent series of rulings, has maintained that appeal courts clamp down on punitive damages.

“Big jury verdicts do tend to be reined in during the course of the appellate process, and I expect that to be the case here,” she told Associated Press.

Monday’s verdict “doesn’t bode well for Johnson & Johnson” as it faces at least 1,200 still-pending lawsuits and possibly thousands more, she said.

“This case clearly was a bellwether, and clearly the jury has seen the evidence and found it compelling,” she said, concluding “the jury was distressed by the company’s conduct”.



MRSA superbug’s resistance to antibiotics is broken.

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MRSA superbug’s resistance to antibiotics is broken.

From superbug to… bug. Newly discovered chemical compounds can make MRSA bacteria vulnerable to the antibiotics they normally resist, restoring the old drug’s former powers.

Methicillin-resistant Staphylococcus aureaus, commonly known as MRSA, is a major cause of hospital-acquired infections, and the second biggest cause of death by drug-resistant bacteria in the US. These bacteria are resistant to the most widely used class of antibiotics, called beta-lactams, which include penicillin, methicillin and carbapenems.

These drugs work by targeting essential components of a bacterium’s cell wall called peptidoglycans. But MRSA protects itself by using a type of molecule that can soak up the drug and stop it from working.

Now Christopher Tan and colleagues at Merck Research Laboratories in New Jersey have found a way to break this resistance. They have identified two compounds that make beta-lactam antibiotics powerful against MRSA again.


Called tarocin A and tarocin B, these compounds target a different part of a bacterium’s cell wall, called teichoic acid. Neither of these drugs kill bacteria on their own, but when either one is combined with an antibiotic, the combination can kill MRSA in both clinical samples and in infected mice. The compounds haven’t yet been tested in humans.

“It’s like a two-prong attack,” says David Brown, of the charity Antibiotic Research UK. “They’re weakening the wall by a second mechanism, which makes it easier for the beta-lactams to have their effect as well.”

New weapons

But there is a snag: if the combination alone was used to treat patients, bacteria could become resistant to it. To get round this, Tan suggests adding a third drug that targets another part of teichoic acid production. “We think by having a deep understanding of the biology of this particular pathway, it enables us to identify where the weak spots are in the bacterium to address resistance,” he says.

This method of using existing antibiotics in combination with compounds that restore their potency could be a powerful weapon in the global antibiotic resistance crisis. A similar strategy is already used to treat Escherichia coli and pneumonia that have become resistant to beta-lactamase. These bacteria have an enzyme that breaks these antibiotics down, but adding compounds that inhibit this enzyme makes beta-lactams more effective.

Brown believes we need to apply this strategy more broadly. His charity is funding a screening programme to see if any existing compounds also work as antibiotic resistance breakers.

“It will take 20 years minimum to come up with a reasonable number of new antibiotics,” says Brown. “So we’ve got to salvage our current antibiotics over the next 20 years or so with resistance breakers, which are really the only chance we’ve got.”


Stephen Fry sneers at child sex abuse victims and says free speech is being stifled.

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Stephen Fry sneers at child sex abuse victims and says free speech is being stifled.

Free speech is under attack and here comes Stephen Fry to defend it. Bemoaning the “infantilising” culture of safe spaces and trigger warnings that has developed at universities in recent years, Fry launches into an extraordinary attack on victims of sexual abuse, saying: “It’s a great shame and we’re all very sorry that your uncle touched you in that nasty place – you get some of my sympathy – but your self-pity gets none of my sympathy.” It was a sustained attack. “Self-pity is the ugliest emotion in humanity,” he said. “Get rid of it, because no one’s going to like you if you feel sorry for yourself. The irony is, we’ll feel sorry for you if you stop feeling sorry for yourself. Grow up.”

That such contempt for victims of child abuse should emerge from the lips of Fry, a man lauded for his great work highlighting mental health issues, is remarkable. That he should use his right to free speech and his platform to express himself in this way is reprehensible. It is also risible, for this is the same Fry who regularly flounces off Twitter because he doesn’t want to hear people criticising him over things he has said and done. Now he expects us to join him in condemning people who have been affected by events they could not possibly control.

And there are many of them. A recent study found that up to 80% of abused people had at least one psychiatric disorder by their 21st birthday: depression, anxiety, thoughts of suicide. Schoolyard bullying can be just as destructive, with one study arguing that bullying carried out by other children is five times more likely than neglect or abuse at home to cause anxiety.

Just as the body’s immune system is still forming in childhood, so too is the brain’s stress response. The effects of childhood trauma cannot be overstated: abuse, sexual abuse in particular, is devastating. Children need love, and they need to feel safe.

While the effects of abuse can never be erased completely, therapy for survivors is crucial. Despite this a recent study in the US revealed that, of the 294,000 reported child abuse cases, only 81,000 of the survivors had received any form of counselling. We don’t live in a culture that “indulges” abuse victims; we live in one that is woefully failing them. Fry is talking rubbish.

He is allowed to, of course, because of free speech: for in 2016, an absolutist interpretation of free speech has become popular among the chattering classes. If only the overwhelmingly white, middle-class, Oxbridge-educated, male-dominated commentariat would take “freedom from prejudice” as seriously as it takes “freedom of expression”.

Free speech means something only if you have a platform with which to use it. These free speech fetishists don’t seem to realise that “free speech” is a privilege usually afforded only to people like themselves. To blithely assert that everyone enjoys the same right to free speech is like claiming that I have a right to buy a large house in north London because there is a “free market”. Theoretically it is possible, but life in our real world isn’t like that.

Utilising his right to free speech, Fry says it would be awful if people didn’t read Titus Andronicus. Sorry, Stephen: I haven’t. I went to a rundown comprehensive and read Romeo and Juliet for my GCSEs. I knew one person in my hometown who went to university. I’m from Nottingham, which as the BBC reported in 2013 is the poorest city in Britain, measured by disposable household income. The Beeb sent a reporter to speak to some of its poor residents and met Michael, a man in his twenties who lives on nothing but beans on toast because, as he says “It’s not healthy but it’s cheap”. He spends most of his time hanging around an estate. I wonder how much his notional right to free speech is worth? Very little, I’m afraid, without an invite to Oxford Union.

I have a platform now. Why? Because I had sex for money and put myself through university. Luckily for me, I fell in love with a nice, middle-class boy in my final year and gave up prostitution. After a few months, I moved to London to live with him. He was a banker.

Free speech isn’t under attack; platform privilege is. Stephen Fry, Germaine Greer and the rest of the commentariat are the free speech 1%, enjoying regular and ready access to platforms the rest of the population can only dream about. When you use such platform privilege to pour scorn on minorities and sneer at victims of child abuse, you’re not a champion of free speech – you’re a bully.


Muslims in Burma (Myanmar) now facing finals stages of genocide.

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Muslims in Burma (Myanmar) now facing finals stages of genocide.

Despite the U.S.-led rolling back of economic sanctions and internationally backed national elections taking place early next month, more than a million people in Burma are facing state-sponsored genocide, according to a new report.

The Rohingya Muslim community of the military-dominated Southeast Asian nation, which is now officially known as Myanmar, has been systematically persecuted and expunged from the national narrative — often at the behest of powerful extremist groups from the country’s majority Buddhist population and even government authorities — to the point where complete extermination is a possibility, according to a damning new study by the International State Crime Initiative (ISCI) at the Queen Mary University of London.

“The Rohingya face the final stages of genocide,” concludes the report.

ISCI uses noted genocide expert Daniel Feierstein’s framework of the six stages of genocide, outlined in his 2014 book Genocide as Social Practice, as a lens through which to view Burma. Through interviews with stakeholders on both sides of what it describes as ethnic cleansing, as well as media reports and leaked government documents, the report enumerates how the Rohingya have undergone the first four stages — stigmatization and dehumanization; harassment, violence and terror; isolation and segregation; systematic weakening — and are on the verge of “mass annihilation.” The sixth stage, which involves the “removal of the victim group from collective history,” is already under way in many respects, the report says.

Stricken from Burma’s 135 officially recognized ethnicities in 1982, the Rohingya have undergone decades of discrimination and disenfranchisement, albeit never to the degree they currently face. The Burmese government’s official position is that the Rohingya are interlopers from neighboring Bangladesh, despite many having lived in the country for generations, and it refuses to even acknowledge their collective name, preferring the loaded term “Bengali.” The report documents a systematic deterioration of the Rohingya’s situation since communal violence broke out in June 2012 in Burma’s Rakhine (formerly Arakan) state.

Although the Burmese government has painted the strife — which saw hundreds of people, mainly Muslims, slaughtered during two main waves of violence that June and October — as a spontaneous outbreak of long-mounting religious tensions following the reported rape of a Buddhist woman, the ISCI report presents compelling evidence that the attacks were premeditated and possibly even organized by local authorities.

Interviews with some of the perpetrators — none of whom have been prosecuted because of a supposed lack of concrete evidence — reveal that they were bused into Rakhine state’s capital city Sittwe from nearby villages, provided two free meals a day and told it was their “duty as Rakhine to participate in an attack on the Muslim population.”

There are also strong indications that the government not only allowed the violence to take place unabated for almost a week, but that police, military and other state security forces participated in the attacks themselves, the report says.

Since then, close to 140,000 Rohingya have been sequestered in squalid camps outside the state’s capital, heavily guarded and prevented from leaving by security forces. The 4,500 that remain in Sittwe reside in a run-down ghetto with similar restrictions on movement. A majority of the Rohingya, numbering about 800,000, are spread out across two townships in northern Rakhine state — another region completely blocked off from the outside world by the military.

A lot of the food rations sent by international aid organizations never make it to the Rohingya camps, and denial of access to adequate health care have turned them into hotbeds for malnutrition and disease. As a result of the apartheid-like conditions, the inhabitants of these camps are also largely prevented from receiving an education and earning any sort of livelihood.

“The abuses that the Rohingya are experiencing are at a level and scale that we have not seen elsewhere in Southeast Asia,” Matthew Smith, the founder and executive director of Bangkok-based nonprofit Fortify Rights, tells TIME. The human-rights organization has been documenting abuses in Burma, and Smith echoes the assertion that there is a strong reason to believe state-enabled ethnic cleansing is taking place in the country.

“The Rohingya don’t have to be annihilated for someone to be held responsible for the crime of genocide,” he says. “They [Burmese authorities] are creating conditions of life for over a million people that are designed to be destructive.”

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There are more than just physical aspects to the Rohingya’s plight — they have been stripped of their citizenship, with their children no longer being issued birth certificates and laws restricting their marriage and birth rate. The government also excluded the community from the 2014 census unless they registered as “Bengali.”

They have also been denied the right to participate in the upcoming Nov. 8 general elections, a complete reversal from the last election in 2010 when Rohingya voted in large numbers and some were elected to the legislature, as the military-backed government yoked their animosity to the Rakhine to see of the challenge of ethnic parties aligned with the latter.

No political party has countered the Islamophobic national narrative, with even the liberal National League for Democracy (NLD) of Nobel laureate Aung San Suu Kyi going to the polls without a single Muslim candidate, and the Rohingya’s deplorable situation will likely endure no matter the election’s result.

“There will be no change for the Rohingya,” says Shwe Maung, a Rohingya lawmaker from northern Rakhine state who has been barred from re-election. “The government is totally denying our community, totally denying our ethnicity,” he tells TIME. “Whatever is happening is with the ultimate objective of genocide or cleansing, which is to finish these people … and to drive them out.”

In the absence of a light at the end of the tunnel, there is a growing likelihood that Rohingya will take to the seas en masse in order to flee their country — like thousands did earlier this year — in the coming months, falling pray to people-smugglers with often deadly consequences.

“Many Rohingya tell us that their options are to stay in Rakhine state and face death or flee the country,” Smith says. “Many of them know that attempting to flee the country is in itself life-threatening, and they’re willing to take those risks because the situation in Rakhine state is as bad as it is.”

The previous exodus, which reached its height this June, was not only enabled and encouraged but also enforced by government authorities, interviews conducted by al-Jazeera for its new documentary Genocide Agenda reveal.

“They said, ‘You are Muslim and you are not allowed to live in Rakhine state. Get on the boat and flee wherever you want,’” an elderly Rohingya man says, recounting the presence of members of Burma’s security forces, army and police who forced them into the vessels. When his elder brother tried to resist, Rakhine Buddhists hacked him to death with a sword on the spot, he tells al-Jazeera before breaking down in tears.

The documentary, released on Monday, is the culmination of a yearlong investigation by al-Jazeera and contains stark evidence of government intent to, at the very least, promote an anti-Muslim sentiment among the Burmese population. Classified government documents obtained by the news channel’s investigative unit warn of “countrywide communal violence between Muslims and Burmans” being planned at a mosque in Burma’s capital, Rangoon, (violence that ultimately did not take place), and a presentation given to new army recruits contains sections on the “Fear of Extinction of Race” detailing how “Bengali Muslims … infiltrate the people to propagate the religion” and aim to increase their population and wipe out the Burmese Buddhists.

The film’s findings, as well as Fortify Rights’ research, were also the subject of an eight-month analysis by the Lowenstein Clinic at Yale Law School. The clinic examined the Rohingya’s circumstances according to the 1948 International Convention on the Prevention and Punishment of the Crime of Genocide and precedents set by international law, and concluded that “strong evidence” exists to substantiate the claim that genocide is being carried out in Burma with intent to destroy the Rohingya.

The clinic’s report, released on Thursday, calls for a commission of inquiry by the U.N. Human Rights Council to conduct an “urgent, comprehensive and independent investigation” into alleged genocidal acts perpetrated against the Rohingya.

“The international community needs to understand in a deeper way, in a clearer way, that the abuses being perpetrated against the Rohingya are widespread, systematic and a matter of state policy,” Smith tells TIME. “The international community needs to take action. These abuses have been going on for decades.”

Neither TIME nor al-Jazeera was able to obtain a response to the allegations from the Burmese government despite repeated attempts, though Deputy Information Minister Ye Htut told us last year: “We never pay attention to organizations such as Fortify Rights, which are openly lobby groups for the Bengalis.”

Such attitudes do not bode well for the Rohingya, whose plight is grimly summed up by a woman living in one of the camps interviewed by ISCI.

“If the international community can’t help us, please drop a bomb on us and kill all of us,” she says.


Psychologist: Young men’s health affected by online pornography.

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Psychologist: Young men’s health affected by online pornography.

Angela Gregory says more and more men in their late teens and early 20s are suffering from erectile dysfunction.

She puts the blame on people becoming addicted to watching online porn.

There are no official figures but she says a lot of the time it is via smartphones and laptops.

“What I’ve seen over the last 16 years, particularly the last five years, is an increase in the amount of younger men being referred,” she said.

“Our experience is that historically men that were referred to our clinic with problems with erectile dysfunction were older men whose issues were related to diabetes, MS, cardio vascular disease.

“These younger men do not have organic disease, they’ve already been tested by their GP and everything is fine.

“So one of the first assessment questions I’d always ask now is about pornography and masturbatory habit because that can be the cause of their issues about maintaining an erection with a partner.”

Angela Gregory

Psychosexual therapist Angela Gregory says too much porn can damage men’s health.

Nick, not his real name, started watching porn when he got his first laptop aged 15.

“It quickly escalated and it was every day. What I was watching, it definitely got more extreme over a short period of time in my case.

“There was nothing that would give me a kick. Normal stuff didn’t do anything any more, so I had to get more and more extreme material.

“[It was] disturbing stuff that disturbed me that, in normal life, I wouldn’t dream of doing.”

It wasn’t long before Nick’s own sexual health began to suffer.

‘Wired to porn’

“I found that when I was lying next to a girl a lot that I just wouldn’t be horny at all, despite being really attracted to the girl and wanting to have sex with her, [because] my sexuality was completely wired towards porn.

“At my peak I was probably watching up to two hours of porn every day.”

neon sign saying 'sex'

Newsbeat has been finding out how having easy access to online porn is affecting body image, sex and relationships for documentary Brought up on Porn, available now on iPlayer.

Getting help

Once Nick realised he had a problem he tried to get help.

“At first I went to a doctor and she said, ‘I don’t think there’s enough evidence to suggest it’s a thing, however I do have a lot of young men coming to me with this problem.'”

In the end Nick went 100 days without watching porn and was relieved when things got back to normal.

“My libido came back with a vengeance and I met this girl and it was great.

“For the first time in ages I was able to flirt and within quite a short time I was able to have normal sex.

“I was feeling so balanced and happy.”

He also has advice for anyone suffering with a similar problem.

“Once I recovered I spent a lot of time on online forums trying to help others do the same.

“There’s a lot more information online than when I had problems.

“You should tell your friends, tell people who are close to you or just a couple of people you trust. And don’t worry, there are many of us in the same boat.”

If you think you’re having a problem related to porn, Angela Gregory advises talking to your GP.


This is unprecedented: 174 heroin overdoses in 6 days in Cincinnati.

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This is unprecedented: 174 heroin overdoses in 6 days in Cincinnati.

The original numbers were startling enough — 30 heroin overdoses across Cincinnati in a single weekend.

Then they just kept climbing.

Another 78 overdoses and at least three deaths were reported during a 48-hour period Aug. 23 and 24.

And at the end of last week, after a six-day stretch of emergency room visits that exhausted first responders and their medical supplies, the overdose tally soared to a number health officials are calling “unprecedented”: 174.

But pure heroin is what’s responsible for that average. And that’s not what’s on the streets now, they say. The culprit responsible for the staggering number of 174 was likely heroin cut with the latest opioid boost meant to deliver consumers a stronger, extended high — carfentanil. That’s a tranquilizer for, among other large animals, elephants. And it’s 100,000 times stronger than morphine.

For now, law enforcement officials have been unable to track down the source of the toxic cocktail but believe the spate of record-high overdoses could be caused by a single heroin batch laced with carfentanil.

State, local and federal authorities have mobilized across Hamilton County — home to Cincinnati — to investigate the source or sources, Newtown police Chief Tom Synan told the Enquirer.

Synan also heads the law enforcement task force for the Hamilton County Heroin Coalition, which was created so public health and law enforcement officials from Ohio, Indiana and Kentucky could collaboratively combat the heroin epidemic plaguing the tri-state area.

Additional heroin overdoses reported in that area, plus New Jersey, tipped the total to 225-plus, according to reporting on Fox 13 News Now.

In the same time period of the Cincinnati overdoses, 13 were reported in Jennings County, Ind., on Aug. 23, 12 were reported on Aug. 24 in Montgomery County, Kentucky, and 29 overdoses linked to free samples of heroin, marked with a Batman symbol, were reported between Aug. 23 and Aug. 25 in Camden, New Jersey.

That comes after 27 people overdosed during a five hour period on Aug. 15 in one town in West Virginia.

But the epidemic surrounding Cincinnati has captured the most national attention — and area leaders are not sugarcoating the situation.

“It’s unlike anything we’ve seen before,” Hamilton County Commissioner Dennis Deters told the Enquirer.

He called the startling uptick a public health emergency.

“This is unprecedented to see as many alerts as we’ve seen in the last six days,” the county’s health commissioner, Tim Ingram, told the Enquirer on Aug. 26.

Officials have even begged people to turn away from the drug while the source of this potent batch is still a mystery.

“We’re urging you, please don’t do heroin right now,” Synan said, according to WCPO Cincinnati. “If for no other reason, because we don’t know what’s in the stuff on the street.”

Carfentanil, a cousin of the less potent but still dangerous opioid fentanyl, is the strongest commercially used opioid. As they continue to do with fentanyl, drug dealers have begun cutting their heroin supplies with carfentanil to make it stretch for longer periods of time and deliver stronger — and more addictive — highs.

“These people are intentionally putting in drugs they know can kill someone,” Synan told WCPO. “The benefit for them is if the user survives it is such a powerful high for them, they tend to come back. … If one or two people die, they could care less. They know the supply is so big right now that if you lose some customers in their eyes there’s always more in line.”

Further complicating matters is that Narcan, the nasal-spray version of the drug Naxalone, which reverses the side effects of an overdose, isn’t working anymore, at least not as reliably. Usually one, maybe two doses of Narcan will stabilize a patient. But the recent overdoses required two or three times that dosage.

Tests to determine if the heroin contained fentanyl or carfentanil aren’t yet available at most hospitals in the city, the Enquirer reported.

“We can’t confirm in the short term if someone’s had fentanyl, carfentanil or heroin — the tests flag only as positive or negative for opiates,” Nanette Bentley, spokeswoman for Mercy Health, told the newspaper.

Ultimately, this past week’s outbreak has been most taxing on the first responders.

“It’s been exhausting,” Cincinnati police Lt. Col. Mike John told the Enquirer. “They’re running from one run to another. It’s been very taxing on the officers and the fire department.”


Flossing might not actually have any proven medical benefits.

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Flossing might not actually have any proven medical benefits.

It’s one of the most universal recommendations in all of public health: Floss daily to prevent gum disease and cavities. Except there’s little proof that flossing works.

Still, the federal government, dental organizations and manufacturers of floss have pushed the practice for decades. Dentists provide samples to their patients; the American Dental Association insists on its website that, “Flossing is an essential part of taking care of your teeth and gums.”

The federal government has recommended flossing since 1979, first in a surgeon general’s report and later in the Dietary Guidelines for Americans issued every five years. The guidelines must be based on scientific evidence, under the law.

Last year, the Associated Press asked the departments of Health and Human Services and Agriculture for their evidence, and followed up with written requests under the Freedom of Information Act. When the federal government issued its latest dietary guidelines this year, the flossing recommendation had been removed, without notice. In a letter to the AP, the government acknowledged the effectiveness of flossing had never been researched, as required.

The AP looked at the most rigorous research conducted over the past decade, focusing on 25 studies that generally compared the use of a toothbrush with the combination of toothbrushes and floss. The findings? The evidence for flossing is “weak, very unreliable,” of “very low” quality, and carries “a moderate to large potential for bias.”

“The majority of available studies fail to demonstrate that flossing is generally effective in plaque removal,” said one review conducted last year. Another 2015 review cites “inconsistent/weak evidence” for flossing and a “lack of efficacy.”

One study review in 2011 did credit floss with a slight reduction in gum inflammation — which can sometimes develop over time into full-fledged gum disease. However, the reviewers ranked the evidence as “very unreliable.” A commentary in a dental magazine stated that any benefit would be so minute it might not be noticed by users.

The two leading professional groups — the American Dental Association and the American Academy of Periodontology, for specialists in gum disease and implants — cited other studies as proof of their claims that flossing prevents buildup of gunk known as plaque, early gum inflammation called gingivitis, and tooth decay. However, most of these studies used outdated methods or tested few people. Some lasted only two weeks, far too brief for a cavity or dental disease to develop. One tested 25 people after only a single use of floss. Such research, like the reviewed studies, focused on warning signs like bleeding and inflammation, barely dealing with gum disease or cavities.

Wayne Aldredge, president of the periodontists’ group, acknowledged the weak scientific evidence and the brief duration of many studies. In an interview at his private practice in New Jersey, he said that the impact of floss might be clearer if researchers focused on patients at the highest risk of gum disease, such as diabetics and smokers.

Still, he urges his patients to floss to help avoid gum disease. “It’s like building a house and not painting two sides of it,” he said. “Ultimately those two sides are going to rot away quicker.”

Aldredge also said many people use floss incorrectly, moving it in a sawing motion instead of up and down the sides of the teeth. Pressed about the origins of his organization’s endorsement of flossing, he said it may simply have “taken the ADA’s lead.”

When the ADA was asked for proof of its claim that flossing helps prevent early gum disease and cavities, the group cited the 2011 review and a 2008 two-week study that measured bacteria and did not even consider gum disease.

In a later statement to the AP, the ADA said flossing “removes plaque” and “is proven to help remove” debris from between teeth. A video on its website proclaims that flossing “helps prevent gum disease.” When pressed, Matthew J. Messina, a practicing dentist and spokesman for the dental association, acknowledged weak evidence, but he blamed research participants who didn’t floss correctly.

Even companies with a big market share of the flossing business — by next year, the global market is predicted to reach almost $2 billion, with half in the United States, according to publisher — struggled to provide convincing evidence of their claims that floss reduces plaque or gingivitis. Yet the industry has paid for most studies and sometimes designed and conducted the research.

Procter & Gamble, which claims that its floss fights plaque and gingivitis, pointed to a two-week study, which was discounted as irrelevant in the 2011 research review.

Johnson & Johnson spokesman Marc Boston said floss helps remove plaque. When the AP sent him a list of contradicting studies, he declined comment.

The floss-making companies partner with the ADA through its Seal of Acceptance program. The ADA promotes the seal to companies as something that “directly affects the purchase decisions of consumers;” each manufacturer is charged $14,500 for the evaluation. If it approves the product, the ADA then charges an additional annual fee of $3,500.

The ADA says it rigorously evaluates products and makes no profit from the program. However, floss companies themselves are allowed to design the studies.

“The funding can come from companies — no problem at all,” said dentist Marcelo W.B. Araujo, vice president of the ADA’s Science Institute, who joined the organization after serving as an executive for Johnson & Johnson. “The design can start from the company.”

When flossing first gained acceptance, no proof was required of remedies. Dentist Levi Spear Parmly is credited with inventing floss in the early 19th century. By the time the first floss patent was issued, in 1874, the applicant noted that dentists were widely recommending its use.

The ADA has been promoting floss universally since 1908. “They just looked into what they did every day in their clinical practice and what they would recommend for patients,” said Araujo.

Count dentist Damien Walmsley, scientific adviser to the British Dental Association, among the skeptics. “It’s important to tell people to do the basics. Flossing is not part of the basics.”

Floss can occasionally cause harm. Careless flossing can damage gums, teeth and dental work. Though frequency is unclear, floss can dislodge bad bacteria that invade the bloodstream and cause dangerous infections, especially in people with weak immunity, according to the medical literature.

National Institutes of Health dentist Tim Iafolla acknowledged that if the highest standards of science were applied in keeping with the flossing reviews of the past decade, “then it would be appropriate to drop the floss guidelines.”

Regardless, he added, Americans should still floss.

“It’s low risk, low cost,” he said. “We know there’s a possibility that it works, so we feel comfortable telling people to go ahead and do it.”


Links to research study abstracts: