by Paul Connett
Mandatory Fluoridation
The imposition of fluoridation on individuals without their informed consent becomes even more egregious when legislation is introduced to mandate the practice for whole states, provinces, or countries. While we do not consider that a local referendum is ethically satisfactory, since the medicine we take should not be determined by our neighbors, such a process may allow discussion, deliberation, and the opportunity for people to express their concerns—at least at the local level. When the practice of adding fluoride to the public water system becomes mandatory at the state, provincial, or even national level, the vast majority of the population has little idea of what is going on, either during the passage of the legislation or subsequently, when the measure is enforced. Informed citizens are usually dispersed in large jurisdictions and have few resources to match the lobbying power of either the national dental associations or governmental health bodies hell-bent on introducing this measure. Those who hold the ethical requirement of informed consent to be the final argument on this matter will continue to battle at the national and international levels to insist on this principle being recognized. But in practice, in today’s world, local democracy—when it is allowed to operate—probably offers citizens a greater chance of protecting themselves against forced fluoridation.
A number of legislatures have introduced mandatory fluoridation legislation in various states within countries and sometimes for the whole country. These include the states of Victoria and Queensland in Australia; the states of California, Connecticut, Georgia, Illinois, Indiana, Louisiana, Michigan, Minnesota, Nebraska, Nevada, Ohio, and Tennessee (as well as Washington, D. C. ) in the United States; and the countries of Singapore and the Republic of Ireland. As we write, efforts to introduce mandatory fluoridation are under way in the U. S. states of New Jersey, Oregon, and Pennsylvania Mandatory fluoridation measures violate the principle of the crucial role of community participation in health measures outlined in the Ottawa Charter for Health Promotion. 22
Mandatory fluoridation also violates the Council of Europe’s Convention on Human Rights and Biomedicine, whose article 5 states, “An intervention in the health field may only be carried out after the person concerned has given free and informed consent to it. This person shall beforehand be given appropriate information as to the purpose and nature of the intervention as well as on its consequences and risks. The person concerned may freely withdraw at any time. ”23
No local, state, or federal government—no matter how well intentioned— has the right to force anyone to take a medicine for a disease that is neither contagious (in a communal sense) nor life threatening.
Summary
Fluoridation—the deliberate addition of fluoride to the public water supply— is a poor medical practice because it violates the principle of informed consent to medication. It is indiscriminate and offers no control over the dose received by an individual. It makes inadequate allowance for differing sensitivity to toxic effects, or for the size and body mass of recipients; this last point is particularly important for young children who may receive proportionately much higher dosages than adults at a time when their bodies are far more vulnerable to toxic agents. Fluoride used in the fluoridation of drinking water is considered to be a drug, not a nutrient. It is chronically toxic at moderate doses. As a drug, it has not been rigorously tested and has not been approved by the U. S. FDA. Fluoridation increases the chances that a child will develop fluorosis of the permanent teeth, which can be disfiguring and require expensive cosmetic treatment in a minority of cases. The notion that fluoridation is equitable is misplaced for two reasons: Children from low-income families are more likely to have poor nutrition, making them more vulnerable to fluoride’s toxic effects; and low-income families are least able to afford avoidance measures.
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An Inappropriate and Inefficient Practice
Inappropriate Practice
When water fluoridation first began, in the 1940s, dental researchers believed that fluoride’s main benefit came from ingesting it during the early years of life. They thought that fluoride worked systemically—specifically, that it built up in the enamel inside the growing tooth cells before the teeth erupted. They believed that early absorption of fluoride made the enamel more resistant to acids (the acids generated by bacteria breaking down sugars) when the teeth emerge into the oral cavity. However, starting in the early 1980s, as a result of new epidemiological and laboratory studies, many leading dental researchers and fluoridation promoters changed their position on fluoride’s mechanism of action.
In 1999, the U. S. Centers for Disease Control and Prevention finally conceded what many dental researchers had been reporting over the previous two decades: Fluoride’s predominant mechanism of action was topical, not systemic. 1 In other words, if fluoride works at all, it does so via direct exposure to the outside of the tooth and not from inside the body. 2–12 Here is the quote from the CDC report:
Fluoride’s caries-preventive properties initially were attributed to changes in enamel during tooth development because of the association between fluoride and cosmetic changes in enamel and a belief that fluoride incorporated into enamel during tooth development would result in a more acid-resistant mineral. However, laboratory and epidemiologic research suggests that fluoride prevents dental caries predominantly after eruption of the tooth into the mouth, and its actions primarily are topical for both adults and children. 13
The acceptance by the CDC that fluoride works mainly in a topical fashion undermines the argument for swallowing fluoride and greatly strengthens the argument against mandatory fluoridation, especially if there is a hint of any health problems involved in the latter (and there are many hints in chapters 11–19). Since fluoride works largely on the outside of the teeth, and fluoridated toothpaste is universally available, there is simply not a strong enough reason to force people (often against their will) to drink fluoride because it is in their water supply. This position was clearly stated by Dr. Douglas Carnall, associate editor of the British Medical Journal, shortly after the publication of the York Review in October 2000. 14 He wrote, “Professionals who propose compulsory preventive measures for a whole population have a different weight of responsibility on their shoulders than those who respond to the requests of individuals for help. Previously neutral on the issue, I am now persuaded by the arguments that those who wish to take fluoride (like me) had better get it from toothpaste rather than the water supply. ”15
The point was recently echoed by Nobel laureate Dr. Arvid Carlsson. In a videotaped interview with Michael Connett in 2005, Carlsson stated, “In pharmacology, if the effect is local [topical], it’s awkward to use it in any other way than as a local treatment. I mean this is obvious. You have the teeth there, they’re available for you, why drink the stuff?”16
Using fluoridated toothpaste, instead of swallowing fluoridated water, does not eliminate systemic exposure completely, especially in young children who have not mastered their swallowing reflex. Even in adults some fluoride may be absorbed through the gums. However, this would be better than exposing every tissue in the body to fluoride with every glass of water that is drunk.
Inefficient Practice
Even if it could be demonstrated that ingesting fluoride produced more benefits than risks, using the public water supply to deliver the medicine is an extremely inefficient and clumsy method of distribution. Most of the medicine (over 99. 5 percent) is thus used for washing the dishes, flushing the toilet, and watering the garden. Very, very little goes anywhere near the target, the teeth; the rest merely adds to environmental pollution. This process is very wasteful except for the phosphate fertilizer industry, which is probably happy to get rid of waste chemicals in this way. Without a purchaser manufacturers would have to arrange for costly disposal of this hazardous waste (see chapter 3).
In his PhD thesis, the late Dr. John Colquhoun outlined the argument that education had been more important
than fluoridation in fighting tooth decay in children in New Zealand. 17 The same message was reiterated by a dentist in a recent editorial published in a California newspaper. He wrote, “Poverty and ignorance are the culprits responsible for rampant dental decay, not the lack of fluoride in the water. That’s where our efforts should be directed, not toward mass medicating the entire population in order to serve a few. Education, education, and more education on oral hygiene, diet, and habits, along with easier access to preventive care, are the ultimate solutions. ”18
The writer is talking about educating not just children and parents but also dentists when he argues, “Dentists have been denied the education necessary to make a truly informed opinion regarding fluoride and community water fluoridation. They simply do not know the truth. Altruistic in aim, misguided in direction, led by many of our nation’s finest servants, the dental profession has been ambling down the wrong path. It is time to correct our direction from mass medication to mass education. ”19
The miscalculation of opting for fluoridation over education has produced another horrible dividend. Many parents have taken their eyes off the important goal of limiting the sugar content of their children’s meals, as well as the junk-food snacks and endless gallons of sweetened soft drinks consumed between meals. As a result, we are seeing a huge increase in obesity in children. Besides the health effects of obesity, it threatens to overwhelm the health care system with the massive costs of treating diabetes and other complications. According to a 2009 CNN report, the cost for treating diabetes is currently about $113 billion a year in the United States. In 2034, it is projected to be $336 billion. 20
The money that is currently misspent on fluoridating chemicals, fluoridating equipment, and the whole apparatus of fluoridation promotion would be better devoted to a joint educational effort to fight obesity and tooth decay.
Summary
For many years, fluoride was believed to act systemically to prevent caries— tooth decay—by being incorporated into the enamel of the developing teeth. However, it is now known to act topically—that is, at the surface of the tooth. Thus, the main reason for ingesting fluoride has disappeared, but the increased risk of dental fluorosis and other possible health risks associated with the accumulation of fluoride remain. Even if fluoride worked via ingestion, using the water supply to deliver the drug would be highly inefficient since over 99. 5 percent of the public water supply is not ingested, and most of the fluoride ends up in the environment. Education, not fluoridation, is what is needed to fight not only tooth decay but also the related and much larger problem of childhood obesity.
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The Chemicals Used
It comes as a surprise to many people that the chemicals used to fluoridate drinking water in the United States are not pharmaceutical grade, meaning that they are not of the same purity used in dental products. Instead, the bulk of the chemicals used come from the wet-scrubbing systems of the phosphate fertilizer industry.
The Phosphate Fertilizer Industry
Wet scrubbers were introduced into the phosphate manufacturing process to remove two highly toxic gases: hydrogen fluoride (HF) and silicon tetrafluoride (SiF4). For many years these gases had damaged vegetation in the vicinity of phosphate plants, as well as crippling cattle on local farms. Fortunately, a spray of water is able to capture the gases and convert them to a solution of hexafluorosilicic acid (H2SiF6). When this resulting solution has reached a concentration of about 23 percent, it is shipped untreated in large tanker trucks to chemical companies that then send it around the country to be used as a fluoridating agent in over 90 percent of the water supplies fluoridated in the United States. Sodium fluoride is used as a fluoridating agent in less than 10 percent of the water fluoridated.
This is how a research report from the Florida Institute of Phosphate described the history of the situation:
In the late 1960s the state of Florida passed laws restricting air emissions in part because fluorine [actually silicon tetrafluoride and hydrogen fluoride] from the phosphate industry had begun to harm citrus trees and there were cases of fluorosis in cattle. Since that time phosphate companies have improved the techniques they use to remove contaminants before they are released into the air— such as scrubbing the stacks that processing plants use to release steam. Today fluoride emissions are not considered to be a problem. It is scrubbed from the stack and is either recovered to make fluorosilicic acid, which can be sold for uses such as water fluoridation, or is sent to the cooling ponds where losses to the air are within regulatory limits. 1 [emphasis added]
In 1975, there came perhaps one of the biggest regulatory changes for the phosphate industry: The U. S. Environmental Protection Agency required mandatory reclamation of the industry’s waste products. For example, Florida’s typical phosphate rock, which is mined to produce the phosphate used in the fertilizer industry, contains naturally occurring uranium-238 and radium-226, the latter of which gives birth to radon—an odorless, colorless gas that is known to cause lung cancer. Indeed, the same rock that is mined for phosphate is also mined for uranium.
Just how much of this radioactive material ends up in the bulk liquids used in fluoridation is not known. Nor is it known, outside the industry, whether any measures are taken to remove it prior to shipment. It would appear that the promoters of this practice rely on the dilution of approximately 180, 000 to 1 at the waterworks to bring all the contaminants in the wet-scrubbing liquor (including arsenic and lead, for example) below regulatory levels (see “Other Contaminants in the Hexafluorosilic Acid Solution” below).
“An Ideal Solution”
For some regulatory officials, the use of the scrubbing liquor from phosphate plants for water fluoridation is considered a positive development. In 1983, Rebecca Hanmer, the deputy assistant administrator for water at the EPA, described the practice as “an ideal solution to a long standing problem. By recovering by-product fluosilicic acid from fertilizer manufacturing, water and air pollution are minimized, and water authorities have a low-cost source of fluoride available to them. ”2
However, William Hirzy, PhD, an EPA scientist, argues that the public water supply should not be used as a means of getting rid of hazardous waste, and in testimony before the U. S. Senate in 2000 he described Hanmer’s views as “linguistic de-toxification. ”3
Clearly, being able to convert a hazardous waste material into a saleable product is very attractive for the phosphate industry. It would be extremely expensive to send this material to hazardous waste treatment facilities, but once this contaminated hexafluorosilicic acid waste product is purchased by someone, it becomes a “product” and no longer has to meet the stringent EPA legal requirements for handling hazardous waste. In this case, the purchasers are the public water utilities. Ironically, these hazardous waste products cannot be dumped into the sea by international law, nor can they be dumped locally, because they are too concentrated.
As Rebecca Hanmer pointed out, this practice does allow local communities access to a “low-cost” source of fluoride. Indeed, the alternative of using pharmaceutical-grade fluoride compounds in community fluoridation programs would be cost prohibitive. One of the reasons that is the case is because, as pointed out in chapter 2, over 99. 5 percent of the fluoridating chemical goes nowhere near the teeth but gets used for washing, cleaning the car, and flushing the toilet.
Spinning the Fluoridating Chemicals
Because proponents of fluoridation are worried about the public’s perception of adding a hazardous industrial waste to the public water supply, some of them have gone to tortuous lengths in an attempt to persuade citizens that the fluoridating chemicals are not captured hazardous waste products. Here is an example of some extraordinary spin from a Q&A pamphlet distributed by the Department of Human Services in Victoria, Australia, in 2009:
Does fluoride come from the fertiliser industry?
Scrubbers can also be used to reduce atmospheric pollution by gases,
leading some people to conclude that because a scrubber is used to extract fluoride from rocks, fluoride must be a pollutant, but this is not the case.
Fluoride is not a waste product of the fertiliser manufacturing process, but rather, a co-product. If fluoride is not actively collected during the refining process for water fluoridation purposes, it remains in the phosphate fertiliser. However, due to the widespread practice of water fluoridation in Australia, fluoride is commonly extracted during the refining process. 4 [numbered references removed from excerpt]
Maybe this “health” agency is happier using the word “co-product” rather than “hazardous by-product, ” but the simple truth, as indicated previously, is that the captured gases (hydrogen fluoride and silicon fluoride) did enormous damage to crops and cattle surrounding phosphate fertilizer plants for about a hundred years before the industry was forced to put on wet scrubbers to capture those “co-products. ” Substances that cause damage to plants, animals, or humans are called pollutants. It is also not true, as this fluoridation-promoting health agency claims, that the captured gases would magically return to the phosphate fertilizer if they were not scrubbed from the air emissions. These claims are nonsense.
Other Contaminants in the Hexafluorosilicic Acid Solution
There is no question that the fluoridating agents are contaminated with other toxic pollutants. However, proponents claim that by the time a 23 percent solution of hexafluorosilicic acid is diluted by about 180, 000 to 1 (to reach a fluoride concentration of 1 ppm), the contaminant levels will be below regulatory concern. However, this may not be true of arsenic.
