**UPDATE: Full rebuttal published in the Curacao Chronicle**
Dr. Marilyn Moses MP (PAIS) Supports Fluoride In Drinking Water
Jul 24th, 2013 – Curaçao, Caribbean
1) “The member of Parliament for PAIS, Dr. Marilyn Moses indicated that she is in favor of fluoride in water. Because she’s a General Practitioner, her opinion weighs heavily in the discussion on fluoride in drinking water.”
As a General Practitioner, Dr. Moses should be familiar with the principle of individual informed consent to treatment. Water fluoridation, by its very nature, denies individuals the right to informed consent. As opposed to agents like chlorine, which are used to treat the water and make it safe to drink, fluoride is added to water with the express intent of treating people via the water. Dr. Moses is advocating a treatment that will go to all patients/consumers, regardless of age or health status, and she will not be able to control their daily dose or monitor them for potential side-effects. Moreover, she has not informed them of the potential side-effects of ingesting fluoride, which is a key aspect of the informed consent process. As pointed out by Cheng et al. (2007), in the European (although universally applicable) context:
“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… 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… 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.”
Fluoride is a highly biochemically active substance that can interfere with many biological processes:
“Until the 1990s, the toxicity of fluoride was largely ignored due to its “good reputation” for preventing caries via topical application and in dental toothpastes. However, in the last decade, interest in its undesirable effects has resurfaced due to the awareness that this element interacts with cellular systems even at low doses. In recent years, several investigations demonstrated that fluoride can induce oxidative stress and modulate intracellular redox homeostasis, lipid peroxidation and protein carbonyl content, as well as alter gene expression and cause apoptosis. Genes modulated by fluoride include those related to the stress response, metabolic enzymes, the cell cycle, cell–cell communications and signal transduction… it is important to highlight that fluoride must be actively considered as a potent toxic compound in the field of toxicology, both in epidemiologic/ecological research and in fundamental or applied research… in drinking water, fluoride is frequently used with other elements (metals and/or metalloids)… in some particular cases, antagonistic effects have been reported. Therefore, in the absence of clear proof to counter the known toxic effects of fluoride in combination with metalloids and metals, extensive studies are needed to conclusively determine the effects of such combinations on relevant cell types” (Barbier et al. 2010).
In addition to the ‘known’ or reasonably assumed toxicity of fluoride, even more concerning are the wide range of ‘unknowns’ associated with long-term ingestion. With such a highly toxic substance, considering the numerous serious unresolved health issues, can Dr. Moses really claim that no one in her community will be harmed by fluoridation? If not, how can she ethically justify advocating such a measure – especially one based on acknowledged poor quality evidence?
2. “Dr. Moses shares the thought that any decision to decrease or to completely stop adding fluoride in water must be based on thorough research.”
This statement is beyond ridiculous, when one considers that fluoridation was launched on poor quality, and inadequate evidence; and that fluoridation, after decades, is still ‘supported’ by poor quality, and inadequate evidence:
“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. 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″ (Connett et al. 2012).
“When we [the NRC committee] looked at the studies that have been done, we found that many of these questions are unsettled and we have much less information than we should, considering how long this [fluoridation] has been going on” (Doull 2008).
“The [York] review did not show water fluoridation to be safe. The quality of the research was too poor to establish with confidence whether or not there are potentially important adverse effects in addition to the high levels of fluorosis… The review team was surprised that in spite of the large number of studies carried out over several decades there is a dearth of reliable evidence with which to inform policy” (Sheldon 2001).
In other words, Dr. Moses is quite happy for people to continue being exposed to this known toxic compound, without informed consent or dosage control, and without rigorously monitoring them for fluoride accumulation or side effects. Instead, she maintains the nonsensical, contradictory view that to reduce levels of the toxic substance that may be harming them, would require “thorough research.” In the context of the information above, this statement is absurd. Moreover, what “thorough research” does Dr. Moses propose? Perhaps she could start by organising studies to address the myriad of health research gaps identified by the US National Research Council in 2006 [Ch. 2 (pp. 87–88) | Ch. 3 (pp. 101–102) | Ch. 4 (p. 130) | Ch. 5 (p. 180) | Ch. 6 (p. 204) | Ch. 7 (pp. 222–223) | Ch. 8 (pp. 266–267) | Ch. 9 (pp. 302–303) | Ch. 10 (pp. 338–339) | Ch. 11 (pp. 352–353)].
The real question Dr. Moses should be asking is this: ‘Is there an adequate margin of safety to protect the entire population – including potentially sensitive and high intake sub-populations – from the known or reasonably assumed adverse effects of fluoride?’ Perhaps Dr. Moses should be taking notes from risk assessment experts, rather than public relations experts. For example, Dr. Kathleen Thiessen:
“Dental fluorosis, skeletal fluorosis, and increased risk of bone fracture are all reasonably well known and acknowledged adverse health effects from fluoride exposure. However, EPA is also required to consider the “anticipated” adverse effects (which may occur at lower levels of fluoride exposure than the “known” effects) and allow for an adequate margin of safety… water fluoridation at 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. In addition to the “known” adverse health effects of dental fluorosis, skeletal fluorosis, and increased risk of bone fracture, “anticipated” adverse health effects from fluoride exposure or community water fluoridation include (but are not limited to) carcinogenicity, genotoxicity, endocrine effects, increased blood lead levels, and hypersensitivity (reduced tolerance) to fluoride” (Thiessen 2011, p. 5).
3. “One of the biggest achievements in the public health.”
Since Dr. Moses (and her sidekick, Dr. Whiteman) are obviously so ignorant and confused on the basics of the issue, we will make the assumption that they are actually getting this idea from the US CDC’s infamous statement of 1999 that fluoridation is, “one of the top ten public health achievements of the 20th Century.” If so, we wish to make these two GP’s aware of the following:
“Not a day goes by without someone in the world citing the CDC’s statement that fluoridation is “One of the top ten public health achievements of the 20th Century”… Those that cite this probably have no idea how incredibly poor the analysis was that supported this statement. The report was not externally peer reviewed, was six years out of date on health studies and the graphical evidence it offered to support the effectiveness of fluoridation was laughable and easily refuted by examining the WHO data base” (Connett 2009).
4. “It is a safe, economic way without making any distinction in classes to prevent decaying teeth.”
The evidence behind this claim is poor, as the authors of the York Review clarified: “The evidence about reducing inequalities in dental health was of poor quality, contradictory and unreliable” (CRD 2003). Recently, Dr. Kathleen Thiessen elaborated on this matter.
5. “The allowed fluoride dosage in drinking waters should be, according to WHO, 0.5 – 1.5 ppm. If this dosage is maintained then the issue of decaying teeth is considerably reduced. In Curacao our dosage is 1.5 ppm.”
We are now beginning to doubt if Dr. Moses is actually a real doctor. Is she really so ignorant that she does not know the difference between CONCENTRATION and DOSE? We caught out our own former Chief Health Officer doing this on many occasions, hence the following challenge question:
“Why does Dr Carnie continue to perpetuate the elementary confusion between concentration and dose of fluoride? While engineers can control the concentration of the fluoride added to the water supply no one can control the dose people get each day. This will depend on how much water they drink and how much fluoride they get from other sources” (Burgstahler et al. 2009).
If Dr. Moses is a real General Practitioner, we would like to know what other treatment she would prescribe in her clinic, under the following conditions (for the patient): “Take as much of this as you like; over your entire lifetime; no matter how old or young you are; no matter your individual health status; no matter how much of the active ingredient you may inadvertently receive from other sources; and by the way, there is no need to come back to me for a follow-up medical assessment at any point, because you’ll be fine.” If Dr. Moses said this to her patients in her medical clinic, she would lose her medical license. But if she advocates this for the entire population, that’s just fine and dandy, it seems.
6. “If we also consider that these last years a relation between decaying teeth and cardiovascular problems has been discovered, like for example heart attack and stroke, it can be concluded that there is even more reason to add fluoride to our drinking water.”
Going by her preceding logic, why doesn’t she just add some blood pressure medication to the public water supply, as a preventive measure; or how about some lithium, just in case anyone gets sad about it. 🙂
7. “When it is about public health it must be based on evidence.”
She should take up her own challenge and examine the evidence for ‘benefit’ more closely (Fluoride & Tooth Decay: An Overview; Fluoride & Tooth Decay: The Facts; The Evidence of Benefit is Very Weak; The Iowa Fluoride Study; The Mystery of Declining Tooth Decay) in conjunction with properly examining the drawbacks and potential adverse impacts; and last but not least, she should re-visit the concept of ‘informed consent‘ to treatment (especially where the use of silicofluorides is concerned).
Suggested further reading for Dr. Moses (and her sidekick):
Additional information for our readers: