by Paul Connett
To be more specific, no studies have been carried out in the United States or most other fluoridating countries to investigate possible relationships between fluoridation and the following:
• Lowered IQ in children, even though twenty-three studies published in four different countries have now found an association between moderate and high fluoride exposure and lowered IQ in children (see chapter 15)
• Alzheimer’s disease in adults, even though one study showed that rats given water containing 1 ppm of fluoride for one year had a greater uptake of aluminum into their brains and the formation of beta-amyloid deposits, which are associated with Alzheimer’s disease5
• Lowered thyroid function, even though doctors used to give fluoride to patients to lower thyroid activity, and millions of Americans today suffer from hypothyroidism or subclinical hypothyroidism, in which there occurs an abnormally low level of thyroid hormone without clinical symptoms or signs (see chapter 16)
• Increased arthritis rates in adults, even though an estimated 46 million Americans have arthritis, and the first symptoms of poisoning of the bones by fluoride are identical to the first symptoms of arthritis (see chapter 17)
• Bone fractures in children, even though the first health study of children exposed to fluoridation6 showed an increase in cortical bone defects and a study from Mexico7 showed a positive linear correlation between the severity of dental fluorosis (a biomarker of fluoride exposure before the permanent teeth have erupted) and the frequency of bone fractures in children (see chapter 17; although the Mexican study had methodological weaknesses, its approach of using dental fluorosis as a simple and noninvasive biomarker was sound [see the following section], and authorities in fluoridating countries should have attempted to repeat at least that aspect of the study)
• Lowered melatonin levels and earlier onset of puberty, even though it has been shown that fluoride accumulates in the human pineal gland, 8 and lowered melatonin levels commensurate with earlier onset of puberty have been observed in animals exposed to fluoride from birth, 9 and the earlier onset of menstruation was observed in the fluoridated population in the Newburgh-Kingston trial (see chapters 10 and 16)
• Irritable bowel syndrome, and the many other common complaints that, in some individuals, apparently are triggered by fluoride exposure (see chapter 13)
Dental fluorosis is not used as a biomarker in epidemiological studies to investigate the effect of fluoride on children.
It is well known that the severity of dental fluorosis indicates the level of overexposure to fluoride in children prior to the eruption of their secondary teeth. This presents an ideal—and obvious—biometric measure of exposure for epidemiological studies on children, as illustrated by the Mexican study on bone fractures discussed in chapter 17. 10 We are not aware of any studies in fluoridated countries, with the single exception of Morgan et al. , 11 that have used that biometric measure.
Animal and biochemical studies are largely discounted.
Many reviews of the fluoridation issue exclude any consideration of animal or biochemical studies. Yet these are routinely used by toxicologists to tease out the potential harmful effects of a suspected toxic substance. The only recent review by an agency in a fluoridated country that has considered animal and biochemical studies was done by the U. S. National Research Council12 (see chapter 14).
What animal and biochemical studies do is help establish the biological plausibility of epidemiological findings. Thus, they provide a valuable contribution to a weight-of-evidence analysis. Clearly, such an analysis is more likely to be meaningful to authorities who have some sympathy for the precautionary principle (chapter 21), as opposed to those who insist on absolute proof of harm before acting.
More effort has gone into studying fluoride’s impact on the teeth than on any other tissue.
A vast proportion of the budgets assigned to studying the effects of fluoride in fluoridated countries has gone into studying its effects on the teeth. For example, in the UK in 2002, a committee appointed by the Medical Research Council (MRC) to follow up on the York Review13 recommended a higher priority for further research on dental fluorosis than for research on the possible effects of fluoride on the brain, the endocrine system, or the kidneys. 14 It made no recommendation to attempt to replicate the IQ studies carried out in China, even though several of those studies had already appeared in English15–18 and other studies referenced in them had been published in Chinese journals. Nor did it recommend studies on the pineal gland, even though it was well aware of Luke’s work in that field. 19, 20
Less effort has gone into replicating studies that found harm than into discrediting them.
Fluoridated countries have spent more time and money in attempts to discredit the methodologies of studies that have found harm than on any effort to replicate the findings. A classic example of this occurred in February 2009, when the Strategic Health Authority (SHA), pushing for fluoridation in Southampton in the UK, hired a firm of consultants with extensive experience in government work, Bazian Ltd. , to handle eighteen studies that demonstrate a lowering of IQ associated with moderate to high exposure to fluoride, provided to the SHA by Paul Connett, and to dismiss the relevance of the 2006 NRC review21, 22, 23 (see chapters 14 and 15).
No effort has been made to follow up claims by many individuals that they are sensitive to fluoride.
Proponents of fluoridation have tended to treat the issue of fluoride sensitivity as only a possible allergic reaction and not as a response to a toxic substance. Health agencies in fluoridating countries have made no effort to pursue this matter scientifically even when urged to do so by independent observers and bodies like the Australian National Health and Medical Research Council in 199124 (see chapter 13). Most doctors are apparently unaware that a problem of sensitivity to fluoride exists.
Key health studies have been entrusted to researchers in dental schools, who have a bias in the matter.
When fluoridating countries finance studies on health concerns—for example, the possible relationship between fluoridation and hip fractures or bone cancer in young men—such studies are frequently given to dental schools, which clearly have a conflict of interest in this matter. To their credit, some dental researchers (e. g. , Luke, Li, and Bassin) have risen above their “loyalty” to the fluoridation program and have objectively reported adverse effects. 25–28 But that has not always been the case, and when a huge amount of government funding is at stake, more care should be taken to make sure that those who are funded do not have an obvious vested interest in the outcome. The dangers are clearly illustrated in chapter 18, where it is pointed out that the U. S. National Institute of Environmental Heath Sciences (NIEHS) funded a known fluoridation advocate, Professor Chester Douglass, to investigate the very sensitive issue of a possible relationship between osteosarcoma and exposure to fluoridated water.
When studies find harm, promoters try to discredit either the author or the methodology used.
When studies finding evidence of harm do emerge in fluoridated countries, often efforts have been made to prevent their publication or, if that does not work, to attack the methodology (often privately) or undermine the credibility of the primary author. Such was the experience of George Waldbott, Alfred Taylor, Ionel Rapoport, and others in the United States. 29 The response sometimes goes as far as termination of employment, as in the case of Dr. Phyllis Mullenix (see chapter 15). Such tactics, incidentally, are by no means limited to fluoridation; they are quite characteristic of areas where science impinges on powerful political and financial interests. 30
The American Dental Association dismisses all evidence of harm.
In the fluoridation promotion piece of the American Dental Association (ADA) titled Fluoride Facts, nearly every piece of evidence indicating harm is described as not meeting “generally accepted scientific knowledge. ”31 However, the ADA has violated normal scientific procedures again and again. One violation is the manner in which the ADA di
smissed the work of Dr. Stan Freni.
After reviewing the many animal studies indicating that fluoride affected the reproductive system, a subject he reviewed for the important Department of Health and Human Services report of 1991, 32 Freni decided to compare fertility rates in counties in the United States as a function of fluoride levels in the drinking water. He found that fertility rates were lower in counties with 3 ppm or more fluoride in their water. His conclusion was that this might be relevant to water fluoridation of 1 ppm when that is factored into the total dose of fluoride a person might ingest from all sources. 33
This is how the ADA handled Freni’s finding: “One human study compared county birth data with county fluoride levels greater than 3 ppm and attempted to show an association between high fluoride levels in drinking water and lower birth rates. (271) However, because of serious limitations in design and analysis, the investigation failed to demonstrate a positive correlation. (272)”34 Reference 272 is a “personal communication” from Thomas Sinks dated two years before Freni’s paper was published. Sink’s critique was never sent to Freni for his response. 35
Another example of the ADA’s unscientific behavior was its eagerness to dismiss the relevance to water fluoridation of the 2006 507-page National Research Council review36 on the very day it was published37 (see chapter 14). The CDC followed suit six days later. 38 Neither body had had the time to review the scientific analysis within the report thoroughly.
On safety, fluoridation promoters work backward.
Time and again fluoridation promoters like the ADA and the CDC give the impression that they are working backward from the firm belief that fluoride at 1 ppm cannot possibly (and must not) do any harm to health.
The normal application of the scientific method requires the scientist to collect data, propose an explanation for any apparent relationship (this is called developing a hypothesis), and then test the hypothesis by making predictions, which are tested by further data collection (experiments). If the further data continue to be consistent with the hypothesis, then it is elevated to the status of theory. Even at that point, to paraphrase Thomas Huxley, an ugly fact can destroy a beautiful theory.
In the case of water fluoridation, the hypothesis that drinking water at 1 ppm was both safe and effective was quickly elevated to an accepted theory and, within the pro-fluoridation establishment, became virtually inscribed in stone as an irrefutable “law” when the U. S. Public Health Service endorsed the practice in 1950 (see chapters 9 and 10). Since then proponents have appeared to work in the opposite direction from true scientists. They start with the conclusion that fluoridation is safe and effective and simply leave out the hypotheses and the experiments. In other words, fluoridation is not a public health policy based on science so much as a practice propagated as a “belief system. ”
Absence of study is used to imply absence of harm.
It has been clear from the very beginning of fluoridation of public water systems that not sound science but a dearth of science has been used to demonstrate safety. For example, in 1952, Dr. John Knutson stated that the best evidence that fluoridation was safe was the fact that millions of people had been drinking naturally occurring fluoride in their water without visible signs of harm39 (see chapter 10). The same notion was repeated by Harold Hodge in 1963. 40 Such assertions, however, are based on anecdotal, not scientific, evidence. Even today, promoters trivialize the issue by implying that the absence of study is the same as absence of harm. For example, in April 2007, Dr. Peter Cooney, the chief dental officer for Canada, told an audience in Dryden, Ontario, that, although Dryden had been fluoridated for forty years, he had walked down the town’s main street that afternoon and did not see anyone “growing horns. ”41
Summary
We have summarized a long list of examples of the poor science involved in promoting and protecting the fluoridation program. These include the use of endorsements in place of scientific evidence; the failure to involve a proper regulator such as the FDA; the poor monitoring of the accumulation of fluoride in the bones of individuals exposed to fluoride; the paucity of basic health studies in fluoridated communities; the failure to use dental fluorosis as a biomarker in epidemiological studies, especially on health effects in children; the frequent discounting of animal and biochemical studies; the excessive attention to studies on teeth while other tissues are largely ignored; the efforts to discredit any study that finds harm; the lack of concern for those who appear to be particularly sensitive to fluoride; the granting of highly sensitive studies such as those of osteosarcoma and hip fractures to dental schools rather than independent researchers; and the assumption that an absence of study means absence of harm.
The many activities of the ADA and other promoters appear to flow backward from the notion that fluoridation has been ordained safe and effective and that any evidence to the contrary must be flawed in some way. These examples of poor science are best explained by the need to protect the program at all costs. We discuss some of the possible motivations behind this unscientific stance in chapter 26. In the next chapter, we review the tactics used by fluoridation promoters, tactics that merely underline their inability to prove their case scientifically. If the science were in their favor, many of their tactics would be unnecessary.
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Promoters’ Strategies and Tactics
We have seen in the course of this book how poor the science is that promoters claim supports the notion that fluoridation is an acceptable medical practice and is both safe and effective. At this point, we expect that many of our readers are left wondering how on earth the promoters of this program have been able to get away with that claim for over sixty years. There are two simple one-word answers to that question: power and prestige. The promoters have the political power of the U. S. government (and the governments of other countries where fluoridation is practiced), and they have the prestige that goes with professional bodies and professional status. They exercise this power and prestige through two chains of command, as we outline below. The overarching strategy that proponents use to protect the fluoridation program is to exploit these two chains of command to keep the media, decision makers, and dental, medical, and other professionals away from the primary scientific literature.
The Chains of Command
The two chains of command that relentlessly promote fluoridation are the government’s public health service network and the national dental association’s professional network. One reaches down to every state health department and eventually every local governmental health official. The other reaches down to every state and local dental association and thence to nearly every dentist.
Once these chains of command were captured at the top (which occurred in the United States in 1950; see chapters 9 and 10), fluoridation-promotion policy could move down from their headquarters to every town in every fluoridating country. Moreover, each chain of command is self-perpetuating. Since 1950, the belief system that supports water fluoridation (it has never been based on science; see chapters 9, 10 and 22) has been passed on to each new generation of dentists and public health bureaucrats. Most courses at dental schools and public health programs do not challenge the dogma of the “safety and effectiveness” of fluoridation. Fluoridation is promoted as a crusade. Within the links of the governmental and dental chains of command, it seems to be the norm to accept recommendations from above, almost without question. In fact, to question policy, especially that of fluoridation, is not a healthy move for career advancement.
We see here the potential of a handful of people to influence the actions and opinions of a vast number of public health, dental, and medical professionals in their own countries and around the world. What makes this disturbing is that the vast majority of rank-and-file professionals have little time to examine the issue for themselves, at least not in detail. Moreover, those who do and speak out against fluoridation are treated so badly it discourages others from following suit. By and
large, the dentists and doctors at the bottom end of these chains of command believe, or behave as though they believe, what they are told either by their parent government health body or by their professional organization. There is very little independent or rational discussion or intervention. Self-serving reviews by government agencies also go a long way to convince even intelligent, but busy, professionals that fluoridation is safe and effective and keep them in line (see chapter 24). Sadly, despite lacking firsthand knowledge of the issue, many seem to have little problem repeating the “safe and effective” mantra in public.
Together or separately, the two chains of command can generate letters to the editor, fund a PR campaign, provide a small group to lobby newspaper editors behind closed doors, or turn out a posse of dentists and health officials in any community where fluoridation is newly proposed or threatened.
Two Personal Stories
Two stories from Paul Connett’s experience illustrate prestige and power in action at each end of the chain of command.
Prestige at the Bottom of the Chain of Command
The first story emerged on the very first day of Paul Connett’s involvement with this issue nearly fourteen years ago. In July 1996, at a meeting of the Canton, New York, village board, Dr. Connett heard local citizens say that although they weren’t scientists, they “trusted” their doctor on the safety of fluoridation. After the meeting, Dr. Connett offered copies of three scientific articles to one such doctor who happened to be present. He refused to take the copies, saying that he did not have time to read the literature. What was troubling to Dr. Connett was not just that the doctor was unwilling to read the articles, but that he was quite content to have the public trust his judgment on a matter for which he was not prepared to do the research.
