by Paul Connett
“Tap Into a Healthier Smile” is the theme for the LDA’s new public affairs campaign to broaden public, media and governmental awareness of the benefits of community water fluoridation and lay the groundwork for passing legislation in 2008 that could bring fluoridated water to virtually everyone in Louisiana.
The campaign is a partnership with the ADA and part of the State-Based Public Affairs Program initiated by the ADA earlier this year. With ADA funding, the LDA has hired a leading Louisiana communications firm, Creative Communications, Inc. (CCI) from Baton Rouge, to direct the public relations aspects of the project. We’ve also engaged our lobbying firm, Roedel Parsons, et al. , in a new, separate contract to handle the campaign’s governmental relations aspect. 30
While citizen groups have held off these attempts in the past, one wonders how long they can keep such efforts at bay. The two chains of command relentlessly renew themselves; dental schools keep producing wave after wave of new dentists who have heard only one side of the story; and in the United States each state health department has a dental director who spends a considerable amount of his or her time and budget promoting and defending fluoridation.
Currently, citizens in New Jersey, Oregon, and Pennsylvania are facing renewed attempts to introduce mandatory fluoridation in their states. Promoters are also preparing to push for mandatory fluoridation in several New England states, including Massachusetts.
The approach of going after a large jurisdiction rather than winning one community at a time also occurred recently in the state of Queensland, Australia. Since the 1960s, the majority of communities in the state (including the capital, Brisbane) have resisted fluoridation. Then, almost out of the blue, the newly appointed (not elected) premier of Queensland, Anna Bligh, announced that she was going to introduce mandatory fluoridation to the state. Her party has a large majority in parliament, so once the bill was introduced, it sailed through, even though the same party had voted against a similar bill introduced by the opposing party a few years before. 31
Opponents of fluoridation in Queensland have been stunned at how fast they lost the whole state, when in the relatively recent past they were able to keep proposals out of their individual communities. Many believe that in this process they lost their democratic rights. Some are preparing to do battle on constitutional grounds.
Meanwhile, in other Australian states, particularly New South Wales and Victoria, equally authoritarian efforts are being made to force fluoridation on communities, even when those communities have made it clear that they do not want the measure. Wendy Varney has written an excellent book on fluoridation in Australia32 and has recently updated her thoughts in an essay posted on the Web site of the Fluoride Action Network. 33
In the UK the percentage of the population drinking fluoridated water held steady at about 10 percent for many years. Little expansion occurred because (1) most communities made it clear that they did not want the measure and (2) private water companies were fearful of liability.
Then in 2003, the Labor government passed a new Water Act that indemnified the private water companies against any lawsuits. According to a report in The Guardian, the government changed the law “to enable health chiefs to order, rather than request, water companies to add fluoride. ”34 Moreover, the bill took the decision out of the hands of local councils and gave the sole authority to initiate fluoridation to unelected “strategic health authorities” (SHA). The only requirement was that these authorities organize public consultations before going ahead with a measure.
In the fall of 2008, the South Central SHA demonstrated what a mockery such so-called public consultations could be, when, having heard from the people that 72 percent did not want to be fluoridated, they nevertheless voted unanimously to go ahead to fluoridate much of Southampton and several surrounding communities. 35 They dealt with the many scientific questions posed to them during their so-called consultation by hiring a firm of consultants, 36, 37 which dismissed the “direct” relevance of both the 2006 NRC report (see chapter 14) and eighteen IQ studies (see chapter 15) to fluoridating Southampton. Although citizens in Southampton are doing everything they can to overturn this decision, we may have seen the blueprint of what could happen elsewhere in Britain. The latest news from the UK is that the Southampton council, which had previously supported fluoridation, has voted to ask the SHA “to hold a referendum before fluoride is introduced to the water supply, and for the authority to honour the result of that vote. ”38, 39
Promoters intimidate decision makers when communities try to stop fluoridation.
Whenever there is a suggestion that a community is considering halting fluoridation, a series of orchestrated actions ensue. Letters are sent to the editors of local newspapers warning of the enormous catastrophe that will befall the community if that happens. At the first public meeting held on the issue, a posse of dentists, doctors, and representatives of state or county health departments descend upon the chambers of the city council or other local government body. Most local decision makers cave in under such pressures.
A blogger, Rae Nadler-Olenick, gives a fascinating blow-by-blow account of what happened in Del Rio, Texas, after the town councilors there tried to halt the fluoridation program. 40 What she describes is fairly typical of what has been observed in other communities when decision makers, at the urging of citizens, try to reverse years of fluoridation.
Summary
The two chains of command of the pro-fluoridation lobby, headed by the CDC and the ADA, respectively, and similar bodies in other fluoridating countries, have used a number of different tactics to achieve their overall strategy of keeping the public, the media, and dental and medical professionals away from the primary scientific literature that indicates that fluoridation is neither effective nor safe. Instead of encouraging impartial review of the literature and open debate, fluoridation proponents have tried to win the argument with a combination of extolling their own authority (particularly via endorsements) and dismissing the credibility of their opponents.
While there is no doubt that the various tactics discussed in this chapter have been very effective at protecting the fluoridation program, that protection may have come at a heavy price. These tactics constitute a series of betrayals. The refusal to publish articles that present negative information on fluoridation, the refusal to debate the issue in public, and the refusal to present both sides of the argument to dental and medical students all represent a betrayal of what we have the right to expect of science: a free flow of information.
The expectation that dentists should promote fluoridation whether they have studied the issue or not and the disparagement and harassment of those who speak out against the practice constitute a serious betrayal of the standards we have the right to expect from any profession.
Using the authority of governmental office or the prestige of one’s profession to confidently assure the public that fluoridation is safe and effective, when such assurance is not based on one’s own review of the literature, is the worst betrayal of all: it is the betrayal of the public’s trust.
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Self-Serving Governmental Reviews
Every so often, particularly when their fluoridation programs are under threat because of renewed public concern, fluoridation-promoting governments organize panels to review the issue. More often than not those panels are selected to deliver the necessary re-endorsements.
In their recent book Fluoride Wars (2009), which is otherwise slanted toward fluoridation, Alan Freeze and Jay Lehr concede this point when they write:
There is one anti-fluoridationist charge that does have some truth to it. Anti-fluoride forces have always claimed that the many government-sponsored review panels set up over the years to assess the costs and benefits of fluoridation were stacked in favor of fluoridation. A review of the membership of the various panels confirms this charge. The expert committees that put together reports by the American Association for the Advancement of
Science in 1941, 1944 and 1954; the National Academy of Sciences in 1951, 1971, 1977 and 1993; the World Health Organization in 1958 and 1970; and the U. S. Public Health Service in 1991 are rife with the names of well-known medical and dental researchers who actively campaigned on behalf of fluoridation or whose research was held in high regard in the pro-fluoridation movement. Membership was interlocking and incestuous. 1
We have already questioned the objectivity of the report by the Department of Health and Human Services2 in chapter 18. Here we will examine three more recent government-sponsored reviews for which we believe the panels were selected to reach a pre-ordained pro-fluoridation position: the review by the Fluoridation Forum in Ireland (2002), 3 the review by the National Health and Medical Research Council in Australia (NHMRC, 2007), 4 and the review by Health Canada (2008, 2009). 5, 6
Fluoridation Forum
A fairly recent example of a panel stacked with pro-fluoridation experts and government employees is the Fluoridation Forum in Ireland, which published its “review” in 2002. 7 Paul Connett was able to watch that process closely.
The Republic of Ireland is the only country in Europe that has mandatory fluoridation. By 2000, over 70 percent of the Irish population was drinking fluoridated water. In Northern Ireland (part of the UK and separate from the Republic of Ireland), by contrast, no fewer than twenty-six of twenty-seven councils had rejected a renewed bid to fluoridate in the late 1990s. So intense was the opposition that the whole political spectrum from Sinn Féin to Ian Paisley had gone on record in opposition to fluoridation. Meanwhile, news of the furor spread to the Republic of Ireland, and several anti-fluoridation groups sprang up there, including the 150-member Irish Dentists Opposed to Fluoridation. Also involved was the environmental group VOICE for the Irish Environment.
As a result of the political waves generated by this movement against fluoridation, the Irish Department of Health and Children organized a forum to review the matter. This was called the Fluoridation Forum. In October 2000, Hardy Limeback, PhD, DDS, and Paul Connett, PhD, were invited to present their concerns about water fluoridation to the Irish panel. They accepted.
Fluoridation opponents in Ireland were upset to hear that Connett and Limeback had agreed to testify. They believed that most of the forum members had been hand-picked to “whitewash” fluoridation, and that, by testifying, Limeback and Connett would give an illusion of legitimacy to any report the forum produced.
Connett and Limeback were in a dilemma. Although they also suspected that the forum was merely a rubber stamp for government policy, they both had a strong desire to bring the best science available before its members. Had they chosen not to appear, proponents could have argued that there was no valid scientific case to be made against fluoridation, and the issue would have been lost by default.
In the face of fierce opposition, they proceeded to testify. In giving his testimony, Connett explained to the panel members that many citizens felt the forum was fixed. Then he offered the panelists a challenge whereby they might demonstrate that they really did intend to perform an objective review of the issue. He presented a document titled “50 Reasons to Oppose Fluoridation”8 and asked the panel to prepare a written, scientifically documented response to the document and make it publicly available.
Initially, the panel agreed to respond to the document and set up a subcommittee for the purpose. Forum minutes over the next year indicate several exchanges about the progress being made. However, shortly before the forum’s report was completed, it was announced that the panel had not had time to provide a written response to Connett’s “50 Reasons” but would address the issues in the body of the report. However, that did not happen.
The final report was one of the worst reviews ever conducted concerning the potential health effects of fluoridation. This was all the more shocking as not a single health study has been conducted in Ireland since mandatory fluoridation was introduced in 1963.
In its 296-page review, the panel devoted only seventeen pages to health issues, with most of their comments coming from other reviews. Fewer than two pages were devoted to primary health studies, and there the panel focused on just one issue: bone fractures. The three primary studies on bone fractures mentioned briefly by the forum panel did not even include the study by Li et al. 9 on which Connett placed special emphasis in his presentation. The Li study was published after Connett testified (he had received a pre-publication copy in his role as an invited peer reviewer of the York Review) but before the Fluoridation Forum published its report in 2002. Besides that important study, the panel ignored all of the other primary health studies referenced by Limeback and Connett. Incredibly, the forum spent less space examining the primary literature on health than on illustrating what a pea-sized amount of toothpaste looks like on a toothbrush.
Subsequently, a group of eleven scientists, including Limeback and Connett, issued a detailed critique of the forum’s report. 10 After a delay of over three years, in 2005, an anonymous critique of “50 Reasons to Oppose Fluoridation” appeared on Ireland’s Department of Health’s Web site, 11 to which Connett responded. 12
Australian National Health and Medical Research Council
Another entity that delivers reports on fluoridation to fit in with government policy is the Australian National Health and Medical Research Council (NHMRC). This agency is part of the Australian federal government and has endorsed fluoridation since 1958.
In 2007 the NHMRC produced a systematic review that purported to demonstrate the safety and effectiveness of fluoridation. 13 This report has been used extensively in Australia in efforts to get more communities fluoridated there, especially in Queensland. However, the NHMRC report is little more than a duplication of large chunks of the York Review, 14 but without the caveats the York Review provided. 15
To circumvent the science, the NHMRC had to find a way around the extensive evidence of harm given in the report from the U. S. National Research Council of the National Academies (NRC) published the previous year. 16 The only reference the NHMRC made to the NRC report was the following brief comment that appeared in the introduction to the report:
The reader is also referred to recent comprehensive reports regarding water fluoridation by the World Health Organization (WHO, 2006) and the National Research Council of the National Academies (NAS, 2006). The NAS report refers to the adverse health effects from fluoride at 2–4 mg/L, the reader is alerted to the fact that fluoridation of Australia’s drinking water occurs in the range of 0. 6 to 1. 1 mg/L. 17
This was political sleight of hand. Although the authors did not actually state that the NRC report was irrelevant to Australia, they encouraged the reader to draw that conclusion. As we explain in chapter 14, the NRC report is very relevant to fluoridation. However, with one sentence, the NHMRC served up a convenient excuse for dodging any need to review the NRC report, acknowledge its findings, or bother about any of its 1, 100 references. While this certainly made the NHMRC’s task easier, the result was hardly the kind of analysis the Australian public had a right to expect from this government-financed agency.
Moreover, while claiming that there was no evidence to support any health effects from fluoridation at 1 ppm, nowhere did the NHMRC acknowledge that practically no health studies had been conducted on this matter in Australia or, indeed, in any other fluoridating country. By ignoring the NRC report, 18 the council members largely ignored the voluminous material on the health effects observed in areas endemic for fluorosis published in non-fluoridated countries. They reviewed no animal or biochemical studies and no clinical trials. They examined only studies in English (thus ignoring the important Chinese literature). They devoted more pages to the study of teeth than to the study of other tissues and organs combined. In fact, they devoted ten times more space to studies on teeth than to those on bone or brain (see table 24. 1). Overall, they included over three times more citations from dental journals than nondental journals. They give the levels of fluoride in water,
soil, air, food, tea, and baby formula but somehow overlook the all-important level in mother’s milk. See chapter 18 for the way they downplayed Elise Bassin’s findings on osteosarcoma. 19, 20
Despite its huge limitations and bias, this 2007 NHMRC review has been very influential in efforts to fluoridate more towns in Australia. Here is an excerpt from a letter by the premier of Queensland, Anna Bligh, explaining why her government has imposed mandatory fluoridation on the state:
I would like to reassure you that my Government did not take this decision lightly. At all times the health and safety of Queenslanders has been our paramount concern, and we have based our decision on the overwhelming amount of credible, peer-reviewed medical and scientific evidence, from long-term use around the world, that shows that fluoridation is a safe, proven and effective preventive health measure to combat tooth decay and improve oral health.
The most recent review by Australia’s National Health and Medical Research Council found that fluoridation does not cause bone fractures, allergies or cancer or other adverse health effects. 21
Health Canada: Expert Panel, 2008; Health Canada Report, 2009
Our third example of a self-serving review comes from a two-part review by Health Canada in 2008 and 2009 that was undertaken at a time of growing opposition to fluoridation in Canada. 22, 23 Quebec City, as well as three towns in the Niagara region of Ontario, had recently stopped fluoridation after many years. Several other major cities in Canada were also actively engaged in reviewing their programs, including Hamilton, London, Oakville, Sarnia, and Waterloo in Ontario and Calgary in Alberta.
The panelists for this Health Canada review were perhaps the most biased that could have been selected. Four of the six (Steven Levy, Christopher Clark, Michel Levy, and Jayanth Kumar) are dentists and well-known promoters of fluoridation, and the remaining two (Robert Tardif and Albert Nantel), along with dentist Michel Levy, were engaged in writing a pro-fluoridation report for the Institut National de Santé Publique du Québec at the time of their selection. 24 It must have been clear to those at Health Canada who selected this panel where their sympathies lay.
