by Paul Connett
A shocking omission from the panel was that of Hardy Limeback. Both Limeback and Jayanth Kumar served on the 2006 NRC panel, 25 but Health Canada selected Kumar from New York over Limeback from Toronto. Limeback was eminently qualified for such a review. He holds both a DDS and a PhD in biochemistry; he is the former president of the Canadian Association for Dental Research and a professor and head of preventive dentistry at the University of Toronto and has his own dental practice. However, he does not support fluoridation. Kumar does and strongly. If both had been selected, it would have been a demonstration that Health Canada wanted a balanced review. However, Health Canada selected no dissenting voice. The result was entirely predictable.
The six members met in Ottawa in January 2007, and their five-page report was published on Health Canada’s Web site in April 2008, at the very time there was an intense debate going on about whether Hamilton, Ontario, would stop fluoridating its water. Here are some excerpts from the report:
Cancer: Weight of evidence does not support a link between exposure to fluoride and increased risks of cancer. It is important to avoid any generalization and overinterpretation of the results of the Bassin et al. paper and to await the publication of the full study before drawing conclusions and particularly before influencing any related policy. . .
Intelligence Quotient: Weight of evidence does not support a link between fluoride and intelligence quotient deficit. There are significant concerns regarding the available studies, including quality, credibility, and methodological weaknesses such as the lack of control for confounding factors, the small number of subjects, and the dose of exposure. . .
The current Maximum Acceptable Concentration (MAC) of 1. 5 mg/L of fluoride in drinking water is unlikely to cause adverse health effects, including cancer, bone fracture, immunotoxicity, reproductive/developmental toxicity, genotoxicity, and/or neurotoxicity. 26
We have already commented on the use of Chester Douglass’s letter promising a “full study” that would refute Elise Bassin’s findings on osteosarcoma (see chapter 18)—a promise still unfulfilled after four years. 27 It was nearly two years overdue when the expert panel met. However, the promise of a study was used by that panel to nullify any concerns about the possibility that drinking fluoridated water might be increasing the number of young men who contract that frequently fatal bone cancer.
In September 2009, Health Canada published a draft report that relied heavily on the findings of the 2008 expert panel. 28 The report concludes that the MAC level of 1. 5 ppm for fluoride should remain unchanged, thereby protecting Canada’s fluoridation program. The authors of this report called the findings on neurotoxicity “controversial, ” but their analysis suggested that they were unaware of most of the studies that have been published in this area. They cited only five out of the twenty-three studies on lowered IQ and cited no studies that did not find that association. In support of their conclusion that “the significance of these studies is uncertain, ” they referenced reviews29–31 that had appeared several years before the bulk of the IQ studies were published. Such a cavalier neglect of the primary literature is even more inexcusable since a joint conference was held by the International Society for Fluoride Research and the Fluoride Action Network on this very subject at the Mississauga campus of the University of Toronto over a year before the 2009 Health Canada report was released. Moreover, a press conference at which the significance of the eighteen of the twenty-three studies on fluoride and IQ that have been translated into English were discussed by scientists attending the conference received major national media coverage. 32, 33
Summary
An examination of several reviews of fluoridation conducted by panels selected by pro-fluoridation governments (e. g. , Fluoridation Forum in Ireland, 2002; NHMRC in Australia, 2007; and Health Canada, 2008 and 2009) indicate a clear bias toward supporting government policy. In any review of this type the outcome is largely dependent on the nature of the panel selected, and in many cases it is fairly obvious from the panel’s makeup what the outcome of its review will be. These reviews amount to little more than self-fulfilling prophecies, once again illustrating the hold that politics has over genuine science in this matter.
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25 •
A Response to Pro-Fluoridation Claims
Proponents of fluoridation have made a number of claims that have been effective with an ill-informed public. However, when those claims are examined carefully, they are found to have little merit. Although opponents have pointed out the weaknesses and fallacies in some of these “chestnuts” over the many years of this debate, they continue to crop up. Let’s take a look at them.
Claim 1: There is no difference in principle between chlorination and fluoridation.
This is wrong. Chlorination treats water; fluoridation treats people. Water is treated with chlorine to make the water safe to drink. It kills the bacteria and other vectors that carry disease. Chlorination is not without its critics, but millions of lives have been saved by this process.
Fluoridation, on the other hand, is not used to make the water safe. It simply uses the public water supply to deliver medicine. Such a practice is rare, indeed, for obvious reasons. Once medicine is added to tap water, key controls are lost. You cannot control the dose, and you cannot control who gets the medicine. Moreover, you are forcing medication on people without their informed consent and, especially in the case of low-income families, without their ability to avoid the medicine if they wish.
Claim 2: Fluoride is “natural. ” We are just topping up what is there anyway.
Natural does not necessarily mean good. Arsenic, like fluoride, leaches naturally from rocks into groundwater, but no one suggests topping that up. Besides, there is nothing “natural” about the fluoridating chemicals, as they are obtained largely from the wet scrubbers of the phosphate fertilizer industry (see chapter 3). 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, yet a dilution of about 180, 000 to 1 is supposed to protect against all harm when the same chemicals are added to the domestic water supply. In chapter 3, we discussed the language used in a recent Q&A pamphlet from the Victoria (Australia) Department of Human Services in an effort to persuade citizens that the chemicals used in fluoridation are not hazardous waste products of the fertilizer industry.
Claim 3: Fluoride is a nutrient.
As we explained in chapter 1, in order to establish that a substance is an essential nutrient, a researcher has to remove the substance from the diet and demonstrate that disease results. This has not been shown to occur with a lack of fluoride, nor is fluoride known to contribute to any normal metabolic process.
Claim 4: 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 5: 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 milk1 (see chapter 12).
Claim 6: Everything is toxic given a high enough d
ose, even water.
This is correct, but one has to be careful when using the word high. Fluoride is extremely toxic, especially for young children, as the following quote from Dr. Gary Whitford, a leading fluoride researcher at the Medical College of Georgia, illustrates:
It may be concluded that if a child ingests a fluoride dose in excess of 15 mg F/kg, then death is likely to occur. A dose as low as 5 mg F/kg may be fatal for some children. Therefore, the probable toxic dose (PTD), defined as the threshold dose that could cause serious or life-threatening systemic signs and symptoms and that should trigger immediate emergency treatment and hospitalization, is 5 mg F/kg. 2
Thus, according to Whitford, a 7 kg infant could be killed by a dose of just 35 milligrams of fluoride. To get such a dose would require swallowing 35 liters of water at 1 ppm (1 mg per liter). No infant could possibly drink 35 liters of water in one sitting, so we are not talking about killing babies with fluoridated water. But there is a world of difference between a chronic toxic dose and a lethal dose. What we are particularly concerned about is the impact of consuming water at 1 ppm over an extended period of time. In the case of infants, a huge concern is the possible impact on their mental development over the first few years of life, since studies have shown that levels as low as 1. 9 ppm fluoride in water are associated with a lowering of IQ in China. 3 In the case of adults, we are concerned about lifelong exposure to levels of 6 mg per day or even lower and what damage that might do to bones and ligaments. 4
Claim 7: 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 (chapter 13) and, with long-term exposure, persistent health problems in others (chapters 14–19).
Claim 8: 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 9: 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, in chapter 8 we referenced 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. Also in chapter 8 we reference the numerous state oral health reports indicating 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 10: 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 (see chapters 9 and 10); 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 countries with more than 50 percent of the population drinking fluoridated water). We discussed this and other examples of the very inadequate science involved in the promotion of fluoridation in chapter 22.
Claim 11: According to the Centers for Disease Control and Prevention, fluoridation is one of the top ten public health achievements of the twentieth century.
Most journalists, newspaper editors, and officials who quote this claim have little or no idea how poorly it is supported by the report that supposedly justifies the statement. 5, 6 We have discussed this matter in several places, including chapter 23.
Claim 12: For every dollar spent on fluoridation, $38 is saved in dental costs.
This statement is taken from another report written by members of the Oral Health Division of the CDC. 7 Two of its three authors, Susan Griffin and Scott Tomar, also wrote the report mentioned in Claim 11 above.
Griffin et al. inflated the benefits of fluoridation and ignored the costs of any side effects, including the one effect no one can deny, dental fluorosis. Cosmetic veneer treatment for fluorosis costs upward of $1, 000 per tooth. The CDC authors also allowed a loss of earnings of $18 an hour for time off work to get a dental filling. Not all people lose pay when they get dental treatment, and certainly children don’t.
Claim 13: The majority of the U. S. population drinks fluoridated water.
This statement is misused to put pressure on communities that do not fluoridate their water. They are led to believe that they are the odd ones out, behind the times, blocking progress. They are not. Only about 400 million people worldwide drink fluoridated water, and most of them live in North America. Globally, those who do are a distinct minority. Only eight countries have more than 50 percent of their population drinking fluoridated water; only 2 percent of the population of Europe drinks fluoridated water (see chapter 5).
Claim 14: The majority of U. S. cities are fluoridated.
There is a far longer list of cities in the rest of the world that do not fluoridate than of cities in the United States that do. Moreover, low-income areas in some major fluoridated cities in America and Australia still have major childhood dental problems (see chapter 8).
Claim 15: Every major dental and medical authority supports fluoridation.
Here we return to the dubious nature of endorsements not backed up by independent 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 (see chapters 9 and 10).
Claim 16: When fluoridation is stopped, tooth decay rates go up.
There now have been at least four modern studies showing that when fluoridation was halted in communities in East Germany, Finland, Cuba, and British Columbia (Canada), tooth decay rates did not go up. This issue was discussed in chapters 5 and 8.
Claim 17: Fluoridation is “safe and effective. ”
This empty phrase is parroted so many times by pro-fluoridation officials and dentists at meetings considering fluoridation that one begins to wonder if they receive some kind of commission every time it is uttered! Be that as it may, mechanically repeating a phrase, no matter how often, without backing it up with solid supporting evidence does not make it true.
Claim 18: 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 mixed8 (see chapter 6).
Claim 19: Fluoridation reduces tooth decay by 20–60 percent.
In chapters 6–8, we examined in detail the evidence for fluoridation’s benefits and found it to be 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—whic
h amounts to an absolute saving in tooth decay of a mere 0. 8 percent—does not look so impressive.
Claim 20: 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 accumulates progressively in the skeleton and probably the pineal gland, studies need to extend over a lifetime. In chapter 22, we listed the many health concerns that simply have not been investigated in fluoridated countries. Meanwhile, fluoride at moderate to high doses can cause serious health problems, leaving little or no margin of safety for people drinking fluoridated water (see chapter 20).
