Water fluoridation benefits all, but especially the poor – June 22, 2013
Dr. Jonathan Broadbent
1. a) Claim: “Fluoride is a natural mineral, the 13th most common element on earth. It occurs in earth and water naturally, but levels in water can be adjusted to maximise the benefit on our collective health.”
1. b) Response: “Natural does not necessarily mean good. Arsenic, like ﬂuoride, leaches naturally from rocks into groundwater, but no one suggests topping that up. Besides, there is nothing “natural” about the ﬂuoridating chemicals, as they are obtained largely from the wet scrubbers of the phosphate fertilizer industry. The chemicals used in most ﬂuoridation programs are either hexaﬂuorosilicic acid or its sodium salt, and those silicon ﬂuorides do not occur in nature” (Connett, Beck & Micklem 2010, p. 246).
2. a) Claim: “Water fluoridation… [reduces] inequalities between poor and rich people.”
2. b) Response: According to the York Review, “The evidence about reducing inequalities in dental health was of poor quality, contradictory and unreliable.”
3. a) Claim: “Here is how water fluoridation came about. During the early 1900s, dentists observed that people living in areas with a lot of natural fluoride in the water had very little tooth decay. A dentist named Trendley Dean soon discovered that water fluoride levels could be adjusted in areas without much natural fluoride. In the 1940s, researchers tracked the dental health of 30,000 school children following artificial water fluoridation in Grand Rapids, USA. Tooth decay rates dropped by more than 60 percent!”
3. b) Response: As pointed out in 50 Reasons (#18): “The studies that launched fluoridation were methodologically flawed. The early trials conducted between 1945 and 1955 in North America that helped to launch fluoridation, have been heavily criticized for their poor methodology and poor choice of control communities (De Stefano 1954; Sutton 1959, 1960, 1996; Ziegelbecker 1970). According to Dr. Hubert Arnold, a statistician from the University of California at Davis, the early fluoridation trials “are especially rich in fallacies, improper design, invalid use of statistical methods, omissions of contrary data, and just plain muddleheadedness and hebetude.” Serious questions have also been raised about Trendley Dean’s (the father of fluoridation) famous 21-city study from 1942 (Ziegelbecker 1981).” For further discussion, refer to Burgstahler 2012 and Burgstahler 2013.
4. a) Claim: “At that time, tooth decay in New Zealand was so bad that we had the world’s highest rate of edentulism (no teeth).”
4. b) Response: One of the favourite tactics of fluoridation proponents is to attribute reductions in tooth decay, over the past few decades, to water fluoridation. However, they conveniently leave out the fact that tooth decay was coming down before fluoridation started (50 Reasons #17), and that the science to support these claims is incredibly weak (FAN 2010; Connett 2011; Connett 2012). As reported by Diesendorf 1986, “Large temporal reductions in tooth decay, which cannot be attributed to fluoridation, have been observed in both unfluoridated and fluoridated areas of at least eight developed countries over the past thirty years. It is now time for a scientific re-examination of the alleged enormous benefits of fluoridation.” In Europe, for example, as pointed out by Cheng et al. 2007, “although the prevalence of caries varies between countries, levels everywhere have fallen greatly in the past three decades, and national rates of caries are now universally low. This trend has occurred regardless of the concentration of fluoride in water or the use of fluoridated salt.” In modern terms, according to Awofeso 2012, “It would appear that the effectiveness of artiﬁcial water ﬂuoridation in the 21st century is at best questionable.” All such facts considered, Howard 2010 concludes, “What is now clear is that, if proposed today, fluoridation of drinking water to prevent tooth decay would stand virtually no chance of being adopted, given the current status of scientific knowledge.”
5. a) Claim: “New Zealanders of my generation have much healthier teeth, in a big way thanks to water fluoridation.”
5. b) Response: This statement is scientifically flawed (see: 4. b), above). New Zealanders may indeed have better teeth these days as compared to a few decades ago, but the same could be said for people in Europe, with no salt or water fluoridation. Take Sweden, for example; as explained by Dr. Arvid Carlsson, “Sweden rejected fluoridation in the 1970s… our children have not suffered greater tooth decay.” Furthermore, when fluoridation ceases, decay rates do not rise as a direct consequence. To quote from Dr. Paul Connett’s response to a recent challenge by a pro-fluoridation lobby group in the US: “The Fluoride Action Network (FAN) stands by its claim that the role of fluoridation in the decline of tooth decay is in serious doubt. Unlike Wichitans for Healthy Teeth, FAN does not base this conclusion on two cherry-picked studies. FAN bases this conclusion instead on a wealth of data including (1) a seminal study published in the journal Nature which unequivocally reaches this same conclusion (Diesendorf 1986), (2) comprehensive data from the World Health Organization showing that countries with NO water fluoridation programs have just as low, and often lower, rates of tooth decay than countries with widespread fluoridation programs, (3) dozens of large-scale, modern studies (including the largest dental health study ever conducted in the U.S.) showing NO difference in decayed, missing, or filled teeth among children in fluoridated and non-fluoridated areas; (4) the results of a multi-million dollar NIH-funded study which shows that children with higher fluoride intake do not have significantly less tooth decay (Levy 2009); (5) the concession by the Centers for Disease Control that fluoride’s primary benefit to teeth is topical, not systemic (ergo, there is no need to swallow fluoride), and (6) the fact that four studies have recently reported that tooth decay continued to decrease in communities after fluoridation was terminated. It is irresponsible, let alone unscientific, for Wichitans for Healthy Teeth to continue to claim, in light of this evidence, that fluoridated water will have a large effect in preventing tooth decay” (Dr. Paul Connett responds to Wichitans for Healthy Teeth 2012 – hyperlinks included).
6. a) Claim: “Research continues to show that in the low quantities in which it is added (0.7-1.0 parts per million)… it is very safe for the body… There is no evidence of effects on the kidneys, liver, blood or breathing function, even among people exposed to fluoride at far greater levels than one could ever get from fluoridated water.”
6. b) Response: According to risk analysis expert, Dr. Kathleen Thiessen, “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” (Thiessen 2011, p. 5). Many health issues have not been resolved. For example, as we highlighted in our recent rebuttal of Dr. Gary Whitford’s claims, fluoride’s potential effects on the brain are coming under increasing scrutiny. But the brain is only one area of required investigation. The 2006 National Research Council report listed fluoride’s potential effects on endocrine function as a “major” area for investigation (NRC 2006, p. 8, p. 267). The NRC also directed attention to fluoride’s possible role in the onset of Alzheimer’s disease/Dementia (NRC 2006, pp. 222–223); Hypersensitivity reactions (NRC 2006, p. 303); and numerous other health conditions, whilst also acknowledging the potential biological effects of fluorosilicates (NRC 2006, p. 88). Given that dose cannot be controlled when water is fluoridated; that measures of exposure vary widely from all sources; and that it is “almost impossible to detect small but important risks (especially for chronic conditions) after introducing fluoridation” (Cheng et al. 2007), Carton 2006 stipulates, “The recommended Maximum Contaminant Level Goal (MCLG) for fluoride in drinking water should be zero.” For a full discussion of margin of safety and health effects, refer to: Connett, Beck & Micklem 2010 (Parts 4-5).
7. a) Claim: “Scientific studies have shown time and again that fluoridated water does not cause cancer, arthritis, thyroid problems or anything else that antifluoridationists declare.”
7. b) Response: The York Review examined the literature on potential health effects and concluded, “we felt that not enough was known because the quality of the evidence was poor.” Many key health studies have not been done, and, consequently, “The absence of studies is being used by [fluoridation] promoters as meaning the absence of harm (50 Reasons #45). The NRC Report identified inadequate biomonitoring of the population – this leaves crucial data gaps whereby subtle health effects may be occurring, but remain undetected. “No health agency in fluoridated countries is monitoring fluoride exposure or side effects. No regular measurements are being made of the levels of fluoride in urine, blood, bones, hair, or nails of either the general population or sensitive subparts of the population (e.g., individuals with kidney disease)” (50 Reasons #9). As noted 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.” One thing is for certain: in the absence of key health data, and without targeted primary health studies, an adequate margin of safety cannot be established to protect the entire population from the potential adverse effects of fluoride. See: Thiessen 2011, ibid.
8. a) Claim: “The science actually suggests a lower rate of hip fracture among older women who drink fluoridated water.”
8. b) Response: “Not true: The evidence is mixed. Some studies show an increase in hip fractures among the elderly in ﬂuoridated areas, and others do not” (Connett, Beck & Micklem 2010, p. 253). See also: Limeback 2012; and Health Effects Database: Bone Fracture.
9. a) Claim: “At worst, a small number of people get white flecks on the teeth (fluorosis), but that is cosmetic and it normally relates to sources of fluoride other than water (e.g. eating toothpaste). Fluorosis usually fades over time and is surely preferable to the great big holes that tooth decay causes in teeth.”
9. b) Response: “Dental Fluorosis caused by water fluoridation is irreversible, disfiguring, psychologically damaging and costly to repair. In essence, it is medical assault on children” (Limeback 2012); “The risk of dental ﬂuorosis increases as ﬂuoride concentration of water exceeds 0.3 parts per million” (Awofeso 2012). “Consider the finding that exposure to fluoride in water and in toothpaste leads to dental fluorosis. Left as a matter of a “human health effect” it is too easy for officials to miss the point and describe the effect as a “cosmetic” or “aesthetic”. Pursued at the biochemical level, however, it raises a different level of concern. From animal studies it has been demonstrated that dental fluorosis is caused by fluoride inhibiting enzymes in the growing tooth cell responsible for laying down the enamel (DenBesten, 1999). The last stage in this process involves enzymes called proteases, which chew up the protein remaining between the mineral prisms, which form the enamel. If this protein is not completely removed, it leads to small opaque patches on the enamel. It is well known from biochemical studies that fluoride inhibits enzymes in test tubes, which is the reason why a number of Nobel Prize winners (e.g Dr. James Sumner, the world’s leading enzyme chemist in his time) are among those who have expressed their reservations about fluoridating water. Dental fluorosis is thus an indication that fluoride even at 1 ppm in water can inhibit enzymes in the body. In a way, it is extremely lucky that fluoride inhibits these particular enzymes because the effect is visible. Thus we have a visible warning signal that something is happening. The key question then becomes (or should become): What other enzymes is fluoride inhibiting in the body that we can’t see?… it is misleading to describe dental fluorosis as a “cosmetic” or “aesthetic” effect. These are not scientific terms but public relations terms. The simple scientific truth of the matter is that when dental fluorosis has occurred it means that fluoride has impacted the body systemically. The fluoride has moved from the water through the stomach membranes into the plasma, circulated the body and arrived inside the tooth. In the growing tooth cells it has reached a concentration such that it has inhibited the enzymes involved in laying down the enamel. Pam DenBeston’s (1999) work indicates that the enzymes involved are the ones which remove the last bit of protein from between the mineral prisms. Thus, instead of laying down a nice smooth enamel, the enamel has little patches in it… Now that it is recognized that dental fluorosis is occurring with increasing frequency and severity, we have to ask what other enzymes are being inhibited in the body. What enzymes are affected in the bones, in the other calcifying tissues and in the other soft tissues?” (Connett 2000, 2.8, 3.3.2-3.3.4). In a nutshell, “it is illogical to assume that tooth enamel is the only tissue affected by low daily doses of fluoride ingestion” (Limeback 2000). For an overview of dental fluorosis, watch this video and consult this database.
10. a) Claim: “It is also inexpensive and people can benefit from it without changing the way they live.”
10. b) Response: What, because buying a toothbrush is such a life-changing, earth-shattering experience? This comment is utterly absurd; true Alice in Wonderland stuff. Meanwhile, in the real world, those who cannot afford to avoid fluoridated water or who may be more vulnerable to fluoride’s toxic effects, are assaulted by the zealots who impose fluoridation upon them.
11. a) Claim: “It is similar to fortifying salt with iodide or breakfast cereal with iron, because fluoride is a mineral, not a medicine.”
11. b) Response: “1. Iron, folic acid, and vitamin D are known essential nutrients. Fluoride is not. 2. All of those substances have large margins of safety between their toxic levels and their beneﬁcial levels. Fluoride does not. 3. People who do not want those supplements can seek out foods without them. It is much more difﬁcult to avoid tapwater” (Connett, Beck & Micklem 2010, p. 247).
12. a) Claim: “Water fluoridation reduces dental decay by 20-40 percent more.”
12. b) Response: “In chapters 6–8, we examined in detail the evidence for ﬂuoridation’s beneﬁts and found it to be very weak. Even a 20 percent reduction in tooth decay is a ﬁgure rarely found in more recent studies. Moreover, we have to remember that percentages can give a very misleading picture. For example, if an average of two decayed tooth surfaces are found in a non-ﬂuoridated group and one decayed surface in a ﬂuoridated group, that would amount to an impressive 50 percent reduction. But when we consider the total of 128 surfaces on a complete set of teeth, the picture—which amounts to an absolute saving in tooth decay of a mere 0.8 percent—does not look so impressive” (Connett, Beck & Micklem 2010, p. 251).
13. a) Claim: “Everyone benefits, but especially the disadvantaged and the poor. Most health interventions benefit the rich the most, but this one helps the poor more!”
13. b) Response: The evidence behind “reducing inequalities in dental health” is “of poor quality, contradictory and unreliable” (CRD 2003). Fluoridation goes “to all households, and the poor cannot afford to avoid it, if they want to, because they will not be able to purchase bottled water or expensive removal equipment. The poor are more likely to suffer poor nutrition which is known to make children more vulnerable to fluoride’s toxic effects.”
14. a) Claim: “Fluorophobic conspiracy theorists want to undermine this public health measure, making outrageous, emotionally-charged claims, relying on poorly-produced pseudoscience, and presenting misleading interpretations.”
14. b) Response: This type of smearing represents typical pro-fluoridation tactics – when they can’t defeat anti-fluoridation arguments, they default to the gutter. These responses deal with this kind of trash: “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); “Opponents of ﬂuoridation use “junk science.” The epithet “junk” is rarely deﬁned and almost entirely subjective. It tends to mean scientiﬁc data that the speaker considers (1) inconclusive or (2) inconsistent with his or her personal prejudices. “Junk” is not a term that is used in respectable scientiﬁc discourse, but it crops up frequently when science impinges on politics, big business, or the law, where conﬂicts of interest lead to mudslinging (Connett, Beck & Micklem 2010, p. 252); “Opponents of ﬂuoridation do not have professional qualiﬁcations. Some opponents of ﬂuoridation do not have professional qualiﬁcations (of course); many do. Many highly qualiﬁed doctors, dentists, and scientists have opposed ﬂuoridation in the past and do so today” (Connett, Beck & Micklem 2010, p. 252). In the words of Dr. Edward Groth (Senior Scientist, Consumers Union, 1991), “The political pro-fluoridation stance has evolved into a dogmatic, authoritarian, essentially anti-scientific posture, one that discourages open debate of scientific issues.” As noted by Krauss, true science is inherently anti-authoritarian, thus Groth’s words are spot on.
15. a) Claim: “They copy/paste from the internet with little critical thought.”
15. b) Response: “Opponents of ﬂuoridation get their information from the Internet. No one denies that plenty of rubbish appears on the Internet. But just because a published study can be found using the Internet does not invalidate it. In fact, scientists now do much of their reading of the scientiﬁc literature online. The Fluoride Action Network maintains a Health Effects Database on its Web site, which provides citations, excerpts, abstracts, and in some cases complete pdf ﬁles of many published studies. Proponents would do well to read some of these papers, rather than trying to dismiss them because they are available online” (Connett, Beck & Micklem 2010, p. 252).
16. a) Claim: “I urge you to listen to reputable organisations such as the New Zealand Ministry of Health, World Health Organisation, US Centers for Disease Control and Prevention, Royal Society of New Zealand, and NZ Dental Association.”
16. b) Response: Instead of encouraging his readers to critically analyse both sides of the debate for themselves, Dr. Broadbent makes a desperate and pathetic appeal to authority. “Endorsements do not represent scientific evidence. Many of those promoting fluoridation rely heavily on a list of endorsements. However, the U.S. PHS first endorsed fluoridation in 1950, before one single trial had been completed and before any significant health studies had been published (see chapters 9 and 10 in The Case Against Fluoride for the significance of this PHS endorsement for the future promotion of fluoridation). Many other endorsements swiftly followed with little evidence of any scientific rationale for doing so. The continued use of these endorsements has more to do with political science than medical science” (50 Reasons #46). Further reading: Citizens are Being Misled 2009; Dr. Carnie Needs to Answer Questions 2009.