by Paul Connett
Is it economically wise to put medicine in the water supply, most of which will be used to wash streets, flush toilets, and make beer?
And finally, is it right to subject everybody to a dosage of any kind without his consent?
For there is no reason to stop at fluorides. The drinking water can carry tranquilizers, laxatives and aphrodisiacs, for the sake of giving chosen groups of the Children of Techne a happier life. One hopes behind the fluoride scheme there are politics and selfish business interests; the presence of solid ulterior motives would restore one’s faith in common intelligence. 36
Review and Conclusion
This book deals with fluoridation of the public water supply through the addition of a chemical compound yielding fluoride ions in the water to achieve a concentration of approximately 1 ppm, purportedly to fight tooth decay.
In part 1 (chapters 1–5) we examined the ethical and commonsense arguments against fluoridation and explained that most countries have rejected this practice. In part 2 (chapters 6–8) we examined the purported benefits and found the evidence for them very weak. In part 4 (chapters 11–19) we examined the risks. A reading of parts 2 and 4 should convince the independent observer that the risks far outweigh the benefits. Part 5 (chapters 20 and 21) puts the matter of risk into the context of a public policy decision. When exposing a whole population to a toxic substance—especially when the dose cannot be controlled—both decision makers and risk calculators have to be cautious, not cavalier. The decision to fluoridate does not provide an adequate margin of safety to protect everyone in the population, especially the most vulnerable. That is what the science tells us. This raises two questions: Why did this practice ever start? Why do a handful of countries, led by the United States, continue to promote this practice so relentlessly? We considered the early history in part 3 (chapters 9 and 10) and the politics of promotion in part 6 (chapters 22–26).
The following paragraphs contain some of the salient facts we have discussed that may increase the demand for an end to water fluoridation:
• Fluoridation is a very bad medical practice. Once fluoride has been added to the public water supply, there can be no control over the dose people receive or who receives it. There is no oversight of individual responses, and it is assumed that an individual may continue drinking the water over a lifetime.
• Fluoridation defies medical ethics. When communities fluoridate their water, they are doing to the whole community what an individual doctor is not allowed to do to anyone: prescribe medication without the individual’s informed consent. There may be some situations where governments could reasonably claim the right to overrule that ethical principle, but this is clearly not one of them, since tooth decay is neither life threatening nor contagious at the community level.
• Fluoridation defies common sense. With leading proponents of fluoridation admitting that the predominant benefit of fluoride is topical and not systemic, the practice of forcing people to ingest fluoride has become even more absurd.
• None of the agencies of the U. S. Department of Health and Human Services, or any other U. S. federal agency, accepts responsibility for the safety of fluoridation. Although many organizations promote and endorse fluoridation, including agencies of the U. S. Department of Health and Human Services, and over 180 million Americans drink fluoridated water every day, no U. S. federal agency (e. g. , EPA, CDC, or FDA) accepts responsibility (liability) for the safety of the program or the chemicals used in it.
• The FDA has never approved fluoride for ingestion. The U. S. Food and Drug Agency has never approved fluoride for ingestion. It rates fluoride as an “unapproved drug. ” However, the FDA does require an acute-toxicity warning to be placed on fluoridated toothpaste. The designation “unapproved drug” puts into question the ethics and legality of school nurses and teachers administering fluoride pills and/or rinses to students in schools located in non-fluoridated areas.
• Fluoride has never been subjected to rigorous, randomized clinical trials. Fluoride has never undergone rigorous clinical trials for effectiveness by the FDA or any health authority in the world. Nor has any serious attempt been made to establish the long-term safety of fluoridation.
• Fluoridation’s benefits have been wildly exaggerated. Even though the great majority of countries do not fluoridate their water, the tooth decay rates of children in those countries are no worse than the tooth decay rates of children in the countries that do. Very high rates of tooth decay in the United States occur in cities that have been fluoridated for years.
• Bottle-fed babies are at risk. The amount of fluoride added to the public water system, 1 ppm, is 25 to 250 times higher than the level of fluoride in mother’s milk, so a bottle-fed baby (when the formula is made up with fluoridated tap water) will get far more fluoride than a breast-fed one.
• U. S. children are being overexposed to fluoride. Thirty-two percent of American children in fluoridated areas now have dental fluorosis—visible damage to the tooth enamel indicating that a child has swallowed too much fluoride before the permanent teeth have erupted.
• There is no margin of safety. There is no margin of safety from fluoride’s harmful effects. In 2006, the National Research Council’s review, Fluoride in Drinking Water: A Review of EPA’s Standards, reported that fluoride was associated with damage to the teeth, bone, brain, and endocrine system and possibly caused bone cancer. The review panel declared that the U. S. safe drinking water standard for fluoride (4 ppm) was not protective of health. Since the report was published, further evidence has emerged of lowered IQ associated with exposure to fluoride and of an increased incidence of osteosarcoma in boys who drink fluoridated water in the sixth to eighth years of life.
• Fluoridation continues because its promoters have power and prestige. Promoters get away with false or doubtful pronouncements on safety and efficacy not because they provide convincing scientific evidence to support their claims but rather because they use the “authority” of their office or position they hold.
• Fluoridation started at a time when scientists and government officials held a very optimistic view about the safety of chemicals used in many products. In 1950, when fluoridation began in the United States, DDT, PCBs, tetraethyl lead (a gasoline additive), asbestos, and fluoride were considered safe by scientists and government officials. Except for fluoride, all have since been banned.
• There is some evidence that fluoridation was started for reasons of political and corporate financial expediency. There was little solid scientific evidence to support fluoridation’s effectiveness or its long-term safety when it was endorsed by the U. S. PHS in 1950.
• Fluoridation was a huge gamble from the very beginning. The only harm that promoters recognized in 1950 was that ingested fluoride caused dental fluorosis, and they were willing to take the gamble that while fluoride was interfering with the growing tooth cells, it was not interfering with any other cells in the body.
• Absence of study does not mean absence of harm. The only way fluoridating countries have been able to deny the adverse health effects of fluoridation is by not conducting relevant studies. Not only is the practice of fluoridation a giant experiment, but those who are conducting the experiment are not even collecting the data.
• Any slight benefit from fluoridation must be judged against the risk of harm. How much doubt regarding just one of the health concerns identified in this book is needed to override a benefit that, when quantified in the largest survey ever conducted in the United States, amounts to protecting less than one permanent tooth surface (out of 108) in a child’s mouth?1 This benefit has to be matched against the results of twenty-three studies that indicate a possible lowering of IQ at fluoride levels as low as 1. 9 ppm—a level far too close to the 1 ppm used in artificial fluoridation to guarantee protection for every child drinking uncontrolled amounts of fluoridated water.
• Bones are not protected from lifelong exposure. About 50 percent of the fluoride
we ingest each day concentrates in our bones and accumulates there. Governments promoting fluoridation have not done enough to demonstrate that such accumulation does not contribute to arthritic symptoms and bone fractures.
• The precautionary principle should be applied. A simple application of the precautionary principle, or indeed common sense, would show the practice of fluoridation to be indefensible. When exposing a whole population to a known toxic substance, decision makers should not wait until there is absolute proof of harm before acting. There is enough evidence of harm right now to stop this practice. This is perhaps the most fundamental point of difference between promoters and opponents of fluoridation.
• Endorsements don’t constitute scientific enquiry. Instead of scientific enquiry, promoters of fluoridation use a long list of endorsements from associations and agencies that parrot one another and rarely present supporting data from the primary scientific literature.
• Fluoridation is experimentation on humans without their informed consent. With so many unanswered questions about fluoridation’s safety, there is no question that the practice is experimental. Try as they may, fluoridation promoters cannot get around the fact that human experimentation without the individual’s consent violates human rights treaties and conventions that most of the fluoridating countries have signed.
• Governments are trying to protect their credibility. Unfortunately, because U. S. government officials and officials in other fluoridating countries have put so much of their credibility on the line in defense of fluoridation, it is difficult for them to speak honestly and openly about the issue even if they wished to.
• The 2006 NRC review is a beginning. The restoration of scientific integrity to the issue of fluoride’s toxicity begins with the 2006 review of fluoride in drinking water by the National Research Council. The chairman of the review panel, Dr. John Doull, is quoted in a 2008 article in Scientific American as follows:
What the committee found is that we’ve gone with the status quo regarding fluoride for many years—for too long, really—and now we need to take a fresh look. . . when we looked at the studies that have been done, we found that many of these [health] questions are unsettled and we have much less information than we should, considering how long this [fluoridation] has been going on. 2
• There are better ways to fight tooth decay. As demonstrated in Europe, there are other ways of protecting teeth that do not force people to drink fluoridated water.
Conclusion
We have endeavored to show that water fluoridation has been propped up with poor science and poor ethical judgment for over fifty years. If we succeed in identifying and pulling those two cards away, then perhaps this house of cards may finally fall. As we have worked on this book, we have become more and more convinced about the short- and long-term health risks that fluoridation poses and increasingly disturbed about the willingness of so many qualified people to go along with the practice because of the authority of agencies and organizations that support it, rather than an objective assessment of the information available. This blind acceptance of authority is beneficial neither for science nor for the public’s trust in government health policies.
So What Now?
Fluoridation is not going to disappear overnight. Change will require the pressure of public opinion. Here are a few things that we hope will happen:
1. We hope that this book will encourage many more scientists, doctors, dentists, health workers, environmentalists, and others to consider the issues raised and reach an informed opinion. The current attempts to extend fluoridation in the United States and elsewhere offer people an important opportunity to influence the course of events by talking to politicians and local and national media. We hope, too, that they will sign the Professionals’ Statement to End Fluoridation. The number of signatories is already nearing three thousand from all parts of the world at the time of this writing and includes many distinguished physicians, dentists, scientists, politicians, and environmentalists. Their names can be viewed and signatures added online. 3
2. Although we have not discussed alternative ways of reducing the incidence of tooth decay, it will be obvious to the reader that more needs to be done, particularly for poor and minority families who have the highest incidence. Education, not fluoridation, is the answer. We need education about better diets and better dental habits. In low-income areas there is clearly a need for free and accessible pediatric dental clinics. These might be combined with advice and counseling centers for pregnant mothers and their children and might also deal with the large and growing problem of obesity, as suggested by the work of Tavares and Chomitz. 4 The potential savings from reducing the incidence not only of tooth decay, but also of the various obesity-related illnesses such as diabetes, would more than justify the cost of such clinics.
3. Readers can also play an important part in informing the media, which have tended to be over-impressed by the apparent authority of the official line. We need everyone with an open mind to examine this issue more carefully. We need to enlist the involvement of teachers and students at universities, colleges, and high schools. We also need those environmental organizations that have so far stood on the sidelines of the debate to get involved. This is one environmental issue that is as easy to solve as turning off a tap, once we have the political will.
4. Everyone who is persuaded by the facts we have presented can contribute to informed political pressure at all levels. Those who have read this far will be well equipped to do that and to play a significant part in ending fluoridation.
Stopping fluoridation of the public water system may well be an uphill battle, but let’s remember that great moments in history do not begin with everyone shouting yes, but with a few having the courage to say no.
APPENDIX 1
Fluoride and the Brain
Links to the references in the appendices and endnotes can be accessed at http://fluoridealert.org/caseagainstfluoride.refs.html.
Twenty-three human studies that report an association of lowered IQ with fluoride exposure.
Y. Chen, F. Han, Z. Zhou, et al. , “Research on the Intellectual Development of Children in High Fluoride Areas, ” Fluoride 41, no. 2 (2008): 120–24, (originally published in 1991 in Chinese Journal of Control of Endemic Diseases), http://www.fluorideresearch.org/412/files/FJ2008_v41_n2_p120-124.pdf.
X. Guo, R. Wang, C. Cheng, et al. , “A Preliminary Investigation of the IQs of 7–13 Year Old Children from an Area with Coal Burning-Related Fluoride Poisoning, ” Fluoride 41, no. 2 (2008): 125–28 (originally published in 1991 in Chinese Journal of Endemiology), http://www.fluorideresearch.org/412/files/FJ2008_v41_n2_p125-128.pdf.
F. Hong, Y. Cao, D. Yang, and H. Wang, “Research on the Effects of Fluoride on Child Intellectual Development Under Different Environmental Conditions, ” Fluoride 41, no. 2 (2008): 156–60 (originally published in 2001 in Chinese Primary Health Care), http://www.fluorideresearch.org/412/files/FJ2008_v41_n2_p156-160.pdf.
X. S. Li, J. L. Zhi, and R. O. Gao, “Effect of Fluoride Exposure on Intelligence in Children, ” Fluoride 28, no. 4 (1995): 189–92, http://fluoridealert.org/scher/li-1995.pdf.
Y. Li, X. Jing, D. Chen, L. Lin, and Z. Wang, “Effects of Endemic Fluoride Poisoning on the Intellectual Development of Children in Baotou, ” Fluoride 41, no. 2 (2008): 161–64 (originally published in 2003 in Chinese Journal of Public Health Management), http://www.fluorideresearch.org/412/files/FJ2008_v41_n2_p161-164.pdf.
F. F. Lin, Aihaiti, H. X. Zhao, et al. , “The Relationship of a Low-Iodine and High-Fluoride Environment to Subclinical Cretinism in Xinjiang, ” Xinjiang Institute for Endemic Disease Control and Research; Office of Leading Group for Endemic Disease Control of Hetian Prefectural Committee of the Communist Party of China; and County Health and Epidemic Prevention Station, Yutian, Xinjiang, Iodine Deficiency Disorder Newsletter 7, (1991): 3, http://fluoridealert.org/scher/lin-1991.pdf; also see http://www.fluoridealert.org/IDD.htm.
S. Liu, Y.
Lu, Z. Sun, et al. , “Report on the Intellectual Ability of Children Living in High-Fluoride Water Areas, ” Fluoride 41, no. 2 (2008): 144–47 (originally published in 2000 in Chinese Journal of Control of Endemic Diseases), http://www.fluorideresearch.org/412/files/FJ2008_v41_n2_p144-147.pdf.
Y. Lu, Z. R. Sun, L. N. Wu, et al. , “Effect of High-Fluoride Water on Intelligence in Children, ” Fluoride 33, no. 2 (2000): 74–78, http://www.fluorideresearch.org/332/files/FJ2000_v33_n2_p74-78.pdf.
L. Qin, S. Huo, R. Chen, et al. , “Using the Raven’s Standard Progressive Matrices to Determine the Effects of the Level of Fluoride in Drinking Water on the Intellectual Ability of School-Age Children, ” Fluoride 41, no. 2 (2008): 115–19 (originally published in 1990 in Chinese Journal of the Control of Endemic Disease), http://www.fluorideresearch.org/412/files/FJ2008_v41_n2_p115-119.pdf.
D. Ren, K. Li, and D. Liu, “A Study of the Intellectual Ability of 8–14 Year-Old Children in High Fluoride, Low Iodine Areas, ” Fluoride 41, no. 4 (2008): 319–20 (originally published in 1989 in Chinese Journal of Control of Endemic Diseases), http://www.fluorideresearch.org/414/files/FJ2008_v41_n4_p319-320.pdf.
D. Rocha-Amador, M. E. Navarro, L. Carrizales, et al. , “Decreased Intelligence in Children and Exposure to Fluoride and Arsenic in Drinking Water, ” Cadernos de Saúde Pública 23, suppl. 4 (2007): S579–87.