Thursday, December 02, 2010

Confronting the Myths of Water Fluoridation Promoters

The following are excerpts adapted from the recently-released book, The Case Against Fluoride by Paul Connett, PhD; James Beck, PhD; and H. S. Micklem, DPhil (Chelsea Green Publishing, 2010) from an excerpt published in its entirety on the truth-out website

Proponents of fluoridation have made a number of claims that have been effective with an ill-informed public. Let’s take a look at them.

Claim 1: Fluoride is “natural.” We are just topping up what is there anyway.

There is nothing “natural” about the fluoridating chemicals. 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. What is more, under international law they cannot be dumped into the sea.

Claim 2: Fluoridation is no different than adding iron, folic acid, or vitamin D to bread and other foodstuffs.

There is a world of difference:
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 tap water.

Claim 3: The amount of fluoride added to the public water system, 1 ppm, is so small it couldn’t possibly hurt you.

Promoters use analogies such as 1 ppm is equivalent to one cent in $10,000 or one inch in sixteen miles to make it appear that we are dealing with insignificant quantities of fluoride. Such analogies are nonsensical without reference to the toxicity of the chemical in question. For example, 1 ppm is about a million times higher than the safe concentration to swallow of dioxin, and 100 times higher than the safe drinking water standard for arsenic; it is also up to 250 times higher than the level of fluoride in mother’s milk.

Claim 4: You would have to drink a whole bathtub of water to get a toxic dose of fluoride.

Here again, proponents are confusing a toxic dose with a lethal dose—that is, a dose causing illness or harmful effect as opposed to a dose causing death. Opponents of fluoridation are not suggesting that people are going to be killed outright from drinking fluoridated water, but we are suggesting that it may cause immediate health problems in those who are very sensitive and, with long-term exposure, persistent health problems in others.

Claim 5: Fluoridated water is only delivered to the tap. No one is forced to drink it.

Unfortunately, that is not a simple option, especially for families of low income who cannot afford bottled water or expensive fluoride filtration systems. Even those who can afford alternatives cannot easily protect themselves from the water they get outside the home. Fluoridated tap water is used in many processed foods and beverages (soda, beer, coffee, etc.). 

Claim 6: Fluoridation is needed to protect children in low-income families.

This is a powerful and emotional argument. However, it ignores the fact that poor nutrition is most prevalent in families of low income, and the people most vulnerable to fluoride’s toxic effects are those with a poor diet. Thus, while children from low-income families are a special target for this program, they are precisely the ones most likely to be harmed. Moreover, some of the many distressing newspaper accounts of children suffering from tooth decay in low-income areas located in cities that have been fluoridated for over thirty years. In fact numerous state oral health reports indicate the continued disparity in tooth decay between low-income and high-income families, even in states with a high percentage of the population drinking fluoridated water.

Claim 7: Fluoridation has been going on for over sixty years; if it caused any harm, we would know about it by now.

Such statements would start to be meaningful only if fluoridated countries had conducted comprehensive health studies of their fluoridated populations. Most have not. Only a few health studies have been performed in the United States, most many years ago; very few health studies have been performed in Australia, Canada, New Zealand, or the UK; and none has been performed in Colombia, Ireland, Israel, or Singapore (all coun tries with more than 50 percent of the population drinking fluoridated water).

Claim 11: Every major dental and medical authority supports fluoridation.

Here we return to the dubious nature of endorsements not backed up by inde pendent and current reviews of the literature. Many of the major associations on the list frequently cited by the American Dental Association endorsed fluoridation before a single trial had been completed and before the first health study had been published, in 1954.

Claim 12: When fluoridation is stopped, tooth decay rates go up.

There now have been at least four modern studies showing that when fluo ridation was halted in communities in East Germany, Finland, Cuba, and British Columbia (Canada), tooth decay rates did not go up.

Claim 13: Hundreds (or thousands) of studies demonstrate that fluoridation is effective.

On the contrary, the UK’s York Review was able to identify very few studies of even moderate quality, and the results were mixed.

Claim 14: Fluoridation reduces tooth decay by 20–60 percent.

The evidence for fluoridation’s bene fits and found is 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.

Claim 15: Hundreds (or thousands) of studies demonstrate that fluoridation is safe.

When proponents are asked to produce just one study (a primary study, not a governmental review) that has convinced them that fluoridation is safe, they are seldom able to do so. Apparently, they have taken such assurances from others at face value, without reading the literature for themselves. The fact is, it is almost impossible to prove conclusively that a substance has no ill effects. A careful and properly controlled study may show that, under the conditions and limitations of the investigation, no harm is apparent. A hundred such studies may permit a considerable degree of confidence—but in the case of fluoridation, very few studies have even been attempted. As fluoride accumu lates progressively in the skeleton and probably the pineal gland, studies need to extend over a lifetime. Meanwhile, fluoride at moderate to high doses can cause serious health problems, leav ing little or no margin of safety for people drinking fluoridated water. 

Claim 16: 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. Currently, over 3,000 individuals from medicine, dentistry, science, and other relevant professions are calling for an end to fluoridation worldwide. Furthermore, many opponents without professional qualifications have educated themselves on the science relevant to fluoridation and are qualified to evaluate many aspects of it.

Claim 17: 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.

Claim 18: There is no evidence that fluoride at the levels used in fluoridation schemes causes any health problems.

There are three weaknesses to this argument. First, it does not make clear that fluoridating countries have done few basic health studies of populations drinking fluoridated water. Absence of studies does not mean absence of harm. Second, just because a study is conducted at a higher water fluoride level than 1 ppm does not mean that it is not relevant to water fluoridation. Toxicologists are nearly always extrapolating from high-dose animal experi ments to estimate safe doses for humans. In the case of fluoride, we have the luxury of a large number of human studies conducted in countries with moderate to high levels of exposure to naturally occurring fluoride. What is required here is a “margin-of-safety” analysis to see if there is a sufficient safety margin between the doses that cause harm and the doses likely to be experienced in fluoridated communities. In our view, there is not. And third, it is not true that there is no evidence of ill effects from fluoride at present levels of fluoridation.

Claim 21: Skeletal fluorosis is very rare in fluoridated countries.

It is difficult for promoters of fluoridation to deny that high natural levels of fluoride have caused severe bone damage in millions of people in India, China, and several other countries. However, proponents insist that skeletal fluorosis is a rare occurrence in countries with artificial fluoridation like the United States. What they really mean by this is that the crippling phase (stage III) of this condition is rare in the United States; they fail to recognize that the earlier phases (stage I and stage II) are associated with pains in the joints and bones, symptoms identical to the early symptoms of arthritis, a condition that affects many millions of adults in the United States.The 2006 NRC review recommends that stage II skeletal fluorosis be considered an adverse effect: “The committee judges that stage II is also an adverse health effect, as it is associated with chronic joint pain, arthritic symptoms, slight calcification of ligaments, and osteosclerosis of cancellous bones.” No fluoridating country has undertaken a study to see if there is a relationship between fluoridation and arthritis.

The complete chapter can be found here: