What is in the water? – June 12, 2013
The Office of the Prime Minister’s Science Advisory Committee
Claim: “The science of fluoride in water is effectively settled. It has been one of the most thoroughly worked questions in public health science over some decades.”
Response: On the contrary. When the University of York examined the evidence on fluoridation, the authors were surprised at its poor quality. According to the research team, “Given the level of interest surrounding the issue of public water fluoridation, it is surprising to find that little high quality research has been undertaken.” Three years later, the authors reiterated, “We were unable to discover any reliable good-quality evidence in the fluoridation literature world-wide… As emphasised in the report, only high-quality studies can fill in the gaps in knowledge about these and other aspects of fluoridation.”
Claim: “There is no doubt that the presence of low amounts of fluoride in water (either naturally occurring or adjusted to between 0.7 and 1 mg/litre) reduces the incidence of dental caries and this is even in advanced economies where dental hygiene has been much improved and where fluoride toothpastes are available. In some countries, fluoride need not be added to the water supply because their geology naturally provides water with fluoride in at least these concentrations.”
Response: The gaps in knowledge and poor quality of evidence exposed by the York team in the UK were blown wide open by the US National Research Council in 2006. The NRC’s report found a whole range of unresolved health issues relating to fluoride exposure, as evidenced by the panel’s recommendations. According to one of the expert panelists for this report, “0.7 mg/L is not adequate to protect against known or anticipated adverse effects and does not allow an adequate margin of safety to protect young children, people with high water consumption, people with kidney disease (resulting in reduced excretion of fluoride), and other potentially sensitive population subgroups.” As pointed out by Cheng et al. (2007), “In the case of fluoridation, people should be aware of the limitations of evidence about its potential harms and that it would be almost impossible to detect small but important risks (especially for chronic conditions) after introducing fluoridation.” Furthermore, European nations, for example, cite both medical and ethical considerations for not fluoridating water supplies (most countries do not fluoridate water). It is also worth noting how many famous cities of the world do not have their people drinking fluoridated water, yet still maintain good oral health. With this in mind, consider the words of Dr. Arvid Carlsson (Nobel Laureate, Medicine/Physiology, 2000): “Sweden rejected fluoridation in the 1970s… Our children have not suffered greater tooth decay, as World Health Organization figures attest, and in turn our citizens have not borne the other hazards fluoride may cause. In any case, since fluoride is readily available in toothpaste, you don’t have to force it on people.”
Claim: “Notably, both the very young and the old benefit from fluoride in the water supply. They develop fewer dental caries and thus have a significant reduction in the downstream effects such as the need for invasive dental surgery associated with problematic dental status.”
Claim: “It is absolutely clear that at doses used in New Zealand to adjust the natural level to a level consistent with beneficial health effects (0.7-1.0mg/litre), there is no health risk from fluoride in the water.”
Response: This type of statement exploits the elementary confusion between concentration and dose. As the NRC report specified, measures of exposure vary widely among the general population and there are high intake population subgroups that require special consideration. Individual dose depends on how much water one drinks, and how much fluoride exposure comes from other sources. As emphasised by Dr. Paul Connett, “officials should be concerned about the more subtle consequences of lifelong exposure to this substance once it gets into the drinking water. Moreover, concern about exposure to fluoride in the drinking water needs to be coupled with a concern about all the other sources of fluoride we are all exposed to today, including dental products, pesticide residues and other sources of fluoride in the diet.” Hence, the real issue is Margin of Safety, rather than concentration. This obvious lack of an adequate safety margin prompted former EPA risk assessment expert, Dr. Robert J. Carton, to conclude (after reviewing the NRC report) that, “The amount of fluoride necessary to cause these effects to susceptible members of the population is at or below the dose received from current levels of fluoride recommended for water fluoridation. The recommended Maximum Contaminant Level Goal (MCLG) for fluoride in drinking water should be zero.”
Claim: “However there is one side effect of fluoride that is found even at this low level of fluoride in the water supply; in a portion of the population, it causes minimal white mottling of the enamel of the permanent teeth.”
Response: Dental fluorosis is a biomarker of systemic toxic over-exposure to fluoride. The notion that fluoride can damage the tooth-forming cells (via a systemic mechanism), whilst not damaging any other part of the body in the process, could only be dreamed up by a tooth-obsessed dental lobby with a zealous agenda to protect fluoridation policy at all costs. Fluoride is a powerful substance that needs to be respected in terms of its biochemistry and toxicology.
Claim: “The exposures needed are chronic exposures at levels many times that in our water supply.”
Response: “What we are particularly concerned about is the impact of consuming water at 1 ppm over an extended period of time” (Connett, Beck & Micklem 2010, p. 248).
Claim: “Can food be used as a medium for delivering a public heath intervention?”
Response: As outlined by Cheng et al. (2007), “Under the principle of informed consent, anyone can refuse treatment with a drug or other intervention. The Council of Europe Convention on Human Rights and Biomedicine 1997 (which the UK has not signed) states that health interventions can only be carried out after free and informed consent. The General Medical Council’s guidance on consent also stresses patients’ autonomy, and their right to decide whether or not to undergo medical intervention even if refusal may result in harm. This is especially important for water fluoridation, as an uncontrollable dose of fluoride would be given for up to a lifetime, regardless of the risk of caries, and many people would not benefit.” It is little wonder, therefore, why public health expert, Professor Niyi Awofeso, said in 2012 that there is “insufﬁcient ethical justiﬁcation for artiﬁcial water ﬂuoridation.” Learn more about fluoridation and medical ethics here.
Claim: “The fluoride debate is based in no small part on numerous examples of inappropriate extrapolation from what happens at hugely higher doses of fluoridation, combined with what is frankly scaremongering.”
Response: Once again, this type of statement ignores the principle of Margin of Safety, whilst also glossing over the issue of dose. In 2012, environmental toxicology experts from Harvard University were unable to conclude that no risk is present from current fluoride exposure levels in fluoridating nations.
Claim: “Because the way one looks for side effects following population interventions requires particular epidemiological approaches, the language of evidence-based medicine can be confusing to the non-expert and easily exploited.”
Response: The scientific opponents of fluoridation are well-acquainted with the historical, political, ethical, toxicological, and epidemiological aspects of fluoridation.
Claim: “With regard to fluoride, there have been genuine concerns raised regarding risks of bone disease, thyroid disease, brain disease and cancer. While these issues have been settled, they continue to be emphasized by those who oppose fluoride.”
Response: These issues have not been settled. For instance, the York team said, on this matter, that “not enough was known because the quality of the evidence was poor.” The NRC panel, as mentioned above, also found that numerous health issues have not been resolved. For further research, we recommend this database.
Claim: “Some of this continued emphasis is based on inappropriate interpretations of studies in rats.”
Response: We recommend this book for a full discussion of all relevant animal studies.
Claim: “It is clear that there is no risk of such disorders at the doses of fluoride being used and extensive epidemiological surveys have repeatedly confirmed this to be the case.”
Response: Key health studies have not been done (50 Reasons #45).
Claim: “Bizarre form of conspiracy.”
Response: “Claim 37: Opponents are “conspiracy theorists.” This was true of one faction of the anti-ﬂuoridation movement in the 1950s, whose members believed that ﬂuoridation was a “communist plot,” as parodied in Stanley Kubrick’s famous movie Dr. Strangelove. However, even in those early days many reputable scientists were opposed to ﬂuoridation on scientiﬁc grounds and many more on the very rational grounds that it is unethical to deliver medicine through the public water supply, because it removes the individual’s right to informed consent to medical treatment. Today, there are still conspiracy theorists around, as there are in almost any ﬁeld, but most opponents are increasingly well informed” (Connett, Beck & Micklem 2010, p. 256).
Claim: “The Ministry of Health and its expert dental, public health and scientific advisors have been well positioned to opine on the science. Indeed their conclusions are in accord with other major scientific and public health authorities that have looked at the question repeatedly.”
Response: Endorsements do not represent scientific evidence (50 Reasons #46).