Twenty frequently unanswered questions
FREQUENTLY UNANSWERED QUESTIONS
Here are a few of the qustions that promoters of fluoridation are least likely to answer accurately, together with some of the facts you may need to correct them.
1 Do you accept the 2006 US National Research Council’s review “Fluoride in Drinking Water” as relevant to water fluoridation?
Evidence of harm is provided by the NRC 2006 report and is quite conclusive The review is THE textbook on the toxicology of fluoride. A panel of 12 experts of the U.S. National Research Council spent three and a half years reviewing the literature and on March 22, 2006 produced a 507-page report with over 1000 references. They found fluoride damaged bones, thyroid, pineal gland and other areas at the then maximum contaminant load of 4 p.p.m.
Rejecting its findings cannot be justified on the basis that it was only concerned with higher concentrations. The report decided that the maxim mum contaminant level of 4 p.p.m. was not conducive to public health. A new level was later proposed of 2 p.p.m. The safety margin between this and the 1 p.p.m of most fluoridation schemes is clearly inadequate – see later question on dosage.
2 What primary studies in the scientific literature show that the only damage caused by ingestion of fluoride is dental fluorosis?
The idea of drinking fluoridated water assumes that fluoride acts systemically, i.e. it affects the internal mechanism. If so it is completely reasonable to believe that as damage on the developing tooth cells, seen as dental fluorosis, occurs, other adverse effects on the body can be expected.
Another clue on the discrepancies in the claimed benefits comes from a 2008 contested submission to the British Medical Journal. The writer suggests that the adverse effects of fluoride on human health are IDENTICAL to those ascribed to iodine deficiency, explaining the delayed eruption effect as well as thyroid and other problems. Fluoride induced iodine deficiency is an extremely serious problem to which the writer ascribes a large number of deaths in China and elsewhere.
3 Are there any other chemicals in drinking water that are intended to treat the consumer rather than to treat the water, and make it safe to drink?
There are none, other than one early test with iodine. Chlorine and aluminium are added to purify or improve the water quality - although according to some sources, these also cause some problem.
Fluorosilicic acid is never present ‘naturally’ in drinking water.
Fluoride in any form was formally considered a contaminant and fluorosilicic acid can be the result of a number of industrial processes, including the production of aluminium and phosphate fertilisers.
4 Has Hydrofluorosilicic acid ever been approved as a food or a medicine with or without any other dangerous contaminants?
The Water Inspectorate has admitted to the NPWA that it has not tested fluoridated water for safety
Hydrofluorosilicic acid proposed for fluoridation does not have any certification of ‘purity’, has never been approved as a food or a medicine and contains other dangerous contaminants.
During the Scrutiny Panels for South Hants. and Southampton City that accompanied the Southampton fluoridation proposal, the Southern Water representative listed on his presentation permitted contaminants including arsenic, cadmium, chromium, lead, antimony and 0.75% phosphate. It is claimed that, unlike most US schemes, the UK does not source fluoridation chemicals from the phosphate fertiliser industry, although such sources were certainly available in the past.
5. Is the BSEN number an assurance of purity?
The BSEN number 12175 given for the substance proposed for fluoridation is simply a definition of the substance, nothing more than an agreed statement of composition. It is NOT an indication of purity. Details are purchasable from British Standards. There are ‘standards’ for a vast rage of products, including sewage sludge, that do not make them pure or edible.
6 Are you aware of the research proving the link between fluoridation and osteosarcoma?
Elise Bassin’s 2001 study published by Harvard University in 2006, showed that boys who drink publicly fluoridated water are five times more likely to have osteosarcoma, a crippling and often fatal bone cancer, than boys who drink unfluoridated water. The ‘wider review’ that her supervisor, Dr. Chester Douglas, published after a further five years, failed to discredit her findings.
The team found a five-fold increased risk of developing osteosarcoma in teenage boys who drank fluoridated water at ages 6, 7, and 8.
Bassin’s approach of investigating the risk of osteosarcoma as a function of the year in which the child is exposed is a breakthrough in understanding how fluoride causes bone cancer. She points out that if studies which only look at lifetime fluoride exposure or accumulated bone fluoride levels are re-examined with this method, they too may reveal the same relationship
However, the Washington DC based Environmental Working Group claimed that her thesis adviser, Dr. Chester Douglass, withheld her thesis findings from the public and the scientific community in 2005 and has further attempted to downplay Bassin's findings in a letter in the same issue of Cancer Causes and Control. Douglas, who has edited the dentists' newsletter of Colgate, the toothpaste giant for more than a decade, was also charged with misrepresenting Bassin's findings to her government funder.
7 Why has there been no monitoring of levels of fluoride ingestion in currently fluoridated areas or in any areas proposed for fluoridation?
We simply do not know the long term health effects of fluoridation because we do not look for them.
Fluoride ingestion, expressed as grams / kilo body weigh, is easy to determine by urine sample but not routinely done in the UK or the US, either in the healthy population or in patients – so impossible to match, e.g. arthritis with fluoride ingestion. Not only are here are NO government laboratories in the UK testing fluoride levels in blood and urine, there is no incentive to fund appropriate research projects.
The advice of the World Health Organization that public health administrators should be aware of the total fluoride exposure in the population before introducing any additional fluoride for caries prevention, seems to be generally ignored.
8 In calculating possible risks, do you distinguish between concentration and dose? If not, how can you avoid fluoride’s toxic effects on vulnerable groups or on people of different ages and physical requirements?
Dosage takes account of the quantity consumed – 2 litres of water at 1 p.p.m will give the same dose as 1 litre at 2 p.p.m, and should also include intake from other sources including food and drinks from fluoridated supplies and dental products.
The NRC (2006) review identified those particularly sensitive to fluoride’s harm as including the very young, the very old, those with poor nutrition and those with impaired kidney function.
Estimates of proportion of general population who are sensitive has been from 2 to 4 %. In Holland, Moolenburgh proved effects were caused by fluoride in double blind tests. Symptoms experienced by sufferers include stomach pains, nausea, constipation, irritable bowel syndrome, excessive tiredness, headaches, rashes etc,
You cannot control the amount of water people consume. Athletes, large water or soft drink (or beer, tea or wine) drinkers, kidney sufferers, children, all consume more.
Proportionate effects are also much higher on young children. It is officially recommended that baby milk is not made up with fluoridated water. The swallowing reflex in children under 3 is such that 50% is likely to be swallowed and only a ‘pea sized’ amount of fluoride toothpaste is recommended for children.
9 How can fluoride be poisonous at 2-4 p.p.m and harmless at 1 p.p.m?
Medically, low doses of poisonous substances are likely to produce small results, but this does not make them safe.
The maximum permitted figure as harmful has been reduced following the CDC recommendations, from 4 to 2 p.p.m .
An acceptable ratio between concentrations where harm of a substance is established and a possible therapeutic value is 10 to 1. To allow for all the variables in individuals when exposing a whole population to a therapeutically active substance, this margin of safety (therapeutic index) should be increased to 100.
10 Why do the savings in tooth decay claimed for fluoridation vary so widely? Is there a large scale statistically impeccable evaluation that shows a measurable benefit and to whom does it apply?
The York systematic review of evidence set criteria that included the requirement for the trial to be randomised or account and adjust for at least three confounding factors, for the status of participants to be unknown to the assessors and for ‘before and after’ periods to be defined as within one year of starting or ending a scheme, with a follow up after 2 years for positive and 5 years for negative effects. These reasonable demands were not met by a single published report.
The largest scale survey ever completed (Brunnelle and Carlos) that reviewed records of almost 40,000 children, suggested benefits of less than 1%. ( 0.6 of a single tooth surface), a figure described as ‘not statistically significant’ and other studies have shown none, or a negative benefit from fluoridation.
Apparent benefits can be achieved by
‘Cherry –picking’ areas – e.g. picking one area with better teeth than another out of a list of 300 health areas.
Comparing 5-year olds and extrapolating to all age groups. The figures at 5 years old are affected both by the delayed caries effect and the delayed eruption of teeth in the presence of fluoride.
Examinations conducted by dentists who know they are assessing fluoride.
Variations in ground water supplies, particularly the presence of calcium
11 Are the benefits of fluoride to teeth topical, rather than systemic?
The fact that any possible benefit from fluoride comes from its action on the surface of the tooth, rather than, as previously suggested, by strengthening the growing teeth, was established by the US Centre Disease Control Fluoride Recommendations Work Group in Aug. 2001:
‘The prevalence of dental caries in a population is not inversely related to the concentration of fluoride in enamel. Laboratory and epidemiologic research …indicates that fluoride's predominant effect is post eruptive and topical …Fluoride works primarily after teeth have erupted’.
On this basis, drinking fluoridated water makes as much sense as eating sun tan lotion
12 What did the York review actually conclude about fluoridation’s effectiveness and safety?
Public statement following the York review FROM: Professor Jos Kleijnen, Director, NHS Centre for Reviews and Dissemination.; Professor Trevor Sheldon, Head of Department, Department of Health Sciences, University of York; Sir Iain Chalmers, UK Cochrane Centre; Professor George Davey-Smith, Department of Social Medicine, University of Bristol.;
TO The Minister
COPIES TO: Rt. Hon Alan Milburn, MP; Sir Liam Donaldson, Chief Medical Officer; The Lord Hunt of Kings Heath; Sir Anthony Cleaver, Chairman, MRC.
We are scientists involved in the systematic review of evidence on the effects of water fluoridation, carried out by the NHS Centre for Reviews and Dissemination at the University of York. As far as we are aware, no other review of this topic is of comparable scientific standard, and we are concerned about some continuing misinterpretations of the evidence which could have implications for public policy. It is not for us to say whether the standard of evidence should be judged sufficient for a public health measure affecting whole populations, but we think it is important that decision makers are aware of what the review really found.
1. Effectiveness of fluoridation in reducing caries. We could discover no reliable good-quality evidence in the fluoridation literature world-wide. What we found suggested that fluoridation was likely to have a beneficial effect, but in fact the range could be anywhere from a substantial benefit to a slight disbenefit to children's teeth.
2. Effectiveness of fluoridation in reducing inequalities in dental health across social groups. This evidence is weak, contradictory and unreliable.
3. Safety of fluoridation. Apart from an increase in dental fluorosis (mottled teeth) we found no clear pattern among the possible negative effects we examined, and we felt that not enough was known because the quality of the evidence is poor.
We append relevant extracts from the report of the review from which the conclusions under 1 and 2 can be substantiated. 3 covers too broad an area to summarise easily.
Since the report was published in September 2000 there has been no other scientifically defensible review that would alter the findings of the York review. As emphasised in the report, only high-quality studies can fill in the gaps in knowledge about these and other aspects of fluoridation. Recourse to other evidence of a similar or lower level than that included in the York review, no matter how copious, cannot do this.
We think these matters are important enough to bring directly to your attention, as well as to the notice of others who have a stake in public health policy.
13 What is the best evidence that fluoridation does, or does not, contribute to reducing inequalities in health?
The following was the result of the 2003 U.S. National Survey of Children’s Teeth looking specifically for evidence that fluoridation removes inequalities.
The graph of the 2003 national US survey shows the % of low income residents with good teeth, and that of higher income with good teeth, are both exactly the same in areas with 100% fluoridation and those with none.
The graph shows clearly that fluoridation does nothing for removing inequalities
14 Does the addition of fluorosilicic acid to customers' water supplies intended as a means of preventing tooth decay, by definition, makes the fluoridating chemical a medicine?
Fluoridation is medication without consent and therefore contravenes Article 3 of the Human Rights Convention which covers the right to accept or refuse medication.
The definition of a medicine is agreed by the EU and is not open for debate. As has been fully explained by Doug Cross of UKCAF, anything intended to, or believed to, have a medical effect, is a medicine. The right to refuse medication is internationally agreed as a human right. Unlike. ‘civil rights’ it cannot be ‘balanced’ by other responsibilities.
15 Can we justify ignoring the ethical objection to what is essentially mass- medication?
Adding a substance to the public water supply for medical purposes, however beneficial, denies a basic human right of an individual to decide what he or she should eat or drink.
There are two reasonable positions.
One answer would be ‘ it is NEVER justified’. The practice of water fluoridation is no different in principle from a doctor prescribing a drug in unspecified doses, without reference to individual needs, and without the patient’s consent.
A second answer might be that there may be a justification on the basis of ‘the greater good’ if:
1. The disease to be treated was a national threat such as a contagious epidemic.
2. The proposal is absolutely safe for everyone.
3. There is no alternative.
Asked this question at a public debate, Barry Cockcroft, Chief Dental Officer for England, claimed that 30% of the population with tooth decay constitutes an epidemic. He did not explain how it could be life threatening or even infectious.
Safety has been widely covered in questions 1 – 10.
Although it is not the job of those opposing fluoride to find treatments for tooth decay, clearly alternative approaches exist. Often addressing the lack of available dental care is an obvious solution. Prof. Connett proposes xylatol as an alternative to both fluoridation and fluoride dental products. There are also detailed reports of dental health campaigns in Sweden and elsewhere that have shown considerable success.
16 What right have dentists to decide what goes into our bodies?
For a proposal to ingest a chemical with whole body health consequences, there is no justification for allowing the fluoridation debate to be controlled by dentists, who have little or no training in medicine or toxicology.
17 Does WHO data show any international benefits of fluoride?
The coloured graph, is based on 12 year olds ( not 5s), and covers over 20 countries. The four labelled countries that are largely fluoridated,- Australia, New Zealand, Ireland and the U.S. show no discernible difference in direction; they are all downwards. The chart shows that fluoridation has absolutely no recognisable effect on decay trends.
Fluoridation has been made illegal or abandoned in most places of Europe. Israel was the most recent to abandon mandatory fluoridation, in 2013. (Following a change in government an attempt to reintroduce fluoridation is currently the subject of a legal and politcal battle)
Support national and international
18. Are there any respected professionals opposed to fluoridation?
Over 2000 distinguished scientists, doctors and dentists (including Nobel Prize Winners and over 500 Professional persons in the UK) are opposed to Fluoridation on the grounds that its safety has not been established and have signed the register of the U.S. Fluoride Action Network
Other bodies registering formal opposition to fluoridation include US Environmental workers (the EPA) and a group of over 100 Irish dentists;
19. What is the basis for the claim that fluoridation is ‘one of the ten greatest public health achievements of the century’?
In 1999, the U.S. CDC claimed that fluoridation was one of the great public health achievements of the 20th century, and this statement is cited nearly every day somewhere in the world. Below is the evidence they produced.
20 Has fluoridation been rejected or discontinued anywhere recently?
19 In the U.S., the first and still the most fluoridated country in the world, communities continue to stop or reject fluoridation plans. The largest city so far is Portland, Oregon who voted 61% to 39% to reject fluoridation despite its promoters spending $1m on their campaign. In Canada, Calgary has recently joined the list of newly fluoride free cities. Battles continue in New Zealand, where government supporters are planning to take the decision away from local authorities, effectively making it the subject of a national mandatory scheme. In Ireland, the only European country with a current national scheme, there is a vociferous national campaign to change the policy. Most of the campaigns from 2013 to 2016 can be found in the SWIS monthly pages
FINALLY, ONE BONUS QUESTION:
How did it all start?
Here are some facts about fluoridation and its origin.
Artificial water fluoridation was exported from the U.S. in the late 1950s
Fluoride is important to many industrial processes including the manufacture of aluminium and the military. However, it is highly dangerous both as a liquid and as a gas.
After the war multi-million dollar lawsuits were being prepared against these industries for damage to employees’ health, and to the environment through poisoning of cattle and crops (e.g. peach farmers).
To offset these, a number of major companies including AlCoA, US Steel, DuPont and Monsanto employed a team, the Fluorine Lawyers Committee, who employed Burnays, the PR guru who sold cigarettes to liberated women. The job was to change the perception of fluoride .
By showing fluoride is in toothpaste, it appeared ‘safe’; by putting in water supplies, even more so.
The same industrial and military interests were behind the Mellon Institute and the Kettering Laboratories, where research is paid for by the recipients. Hodge and others used these to support fluoridation. A well respected researcher who showed it to be neurotoxin was fired from and not allowed to work again.
Sodium fluoride , the rat poison produced by Alcoa has now given way to fluorosilicic acid. There is an extra benefit to the phosphate fertiliser industry that can sell a contaminated waste product that it highly corrosive, to be dumped in to the water supplies.
In 1963 the US PHS ( controlled by a fluoridation proponent) spent $2.7m in the UK alone in influencing bodies to support and promote fluoridation. The process always includes
Influence dental or medical bodies, usually by loading a small committeeGet as m any endorsements as possible, even from bodies that could not possibly do their own research.Suppress any oppositionDenigrate anyone who opposes.
The same process continues– with public money spent to ensure that one side is overwhelmingly heard and, in the UK any ‘consultation process’ is designed to promote or retain fluoridation.