by Paul Connett
Claim 21: 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. 9 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 22: Opponents of fluoridation are a vocal minority.
In a democratic society, opponents should not have to apologize for being vocal. As far as being a minority is concerned, it is frequently true that for any controversial issue only a minority of people get actively involved. However, it is our experience that the more educated people are on this issue, the more likely they are to oppose fluoridation. Usually, it is only when the matter is resolved by an appeal to “authority, ” with little resort to scientific information, that proponents prevail.
Claim 23: Opponents of fluoridation use “junk science. ”
The epithet “junk” is rarely defined and almost entirely subjective. It tends to mean scientific data that the speaker considers (1) inconclusive or (2) inconsistent with his or her personal prejudices. “Junk” is not a term that is used in respectable scientific discourse, but it crops up frequently when science impinges on politics, big business, or the law, where conflicts of interest lead to mudslinging.
Claim 24: 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 25: 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 experiments 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 (see chapter 20) 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 (see chapter 10–19).
Claim 26: There is no evidence that fluoridation harms the thyroid.
Even though many animal experiments show that fluoride can affect thyroid function, and even though some doctors between the 1930s and the 1950s used fluoride to lower thyroid function in hyperactive patients, governments that promote fluoridation have not taken this issue seriously. Very little research has been supported in fluoridating countries, but two studies raise concerns. 10, 11 See chapter 16 for a full discussion of this issue.
Claim 27: There is no evidence that fluoridation is associated with an increase in hip fractures.
Not true: The evidence is mixed. Some studies show an increase in hip fractures among the elderly in fluoridated areas, and others do not. One of the better studies (Li et al. 12 ) showed an increase in hip fractures in the elderly (in a series of villages) as the fluoride levels in the water rose from 1 ppm to 4. 3 ppm (see chapter 17).
Claim 28: There is no evidence that fluoride causes cancer.
Again, the evidence is mixed. Some studies show an increase in osteosarcoma (a rare but frequently fatal bone cancer) among young men in fluoridated communities, and others do not. Even though the study results are mixed, a study by Elise Bassin from Harvard, with the most robust methodology to date, has shown a positive relationship between exposure to fluoride in the sixth, seventh, and eighth years of age and a fivefold to sevenfold increased risk of contracting osteosarcoma in young men by the age of twenty. 13 Although a large study has been promised that allegedly rebuts this finding, 14 after four years it has not appeared, nor does it appear in principle to be capable of refuting Bassin’s conclusion (see chapter 18).
Claim 29: There is no evidence that fluoride lowers IQ.
There have now been twenty-three published studies showing that moderate to high levels of natural fluoride in source waters are associated with a lowered IQ in children. While proponents point to weaknesses in some of the IQ study designs, what is truly impressive is the fact that, apart from one small study in New Zealand, 15 fluoridated countries have chosen not to replicate them. Moreover, these IQ studies are buttressed by over eighty animal studies that show that fluoride damages the brain, as well as three Chinese studies that show fetal brain damage in areas endemic for fluorosis (see chapter 15).
Claim 30: There is no evidence that any individuals are particularly sensitive to fluoride’s toxic effects.
It would be far more accurate to state that governments practicing fluoridation have shown no interest in testing scientifically the many anecdotal reports from citizens (along with case studies published by a number of authors) that they are sensitive to fluoride. Patients complain of a number of symptoms that disappear when the source of fluoride is removed and return when the source is reintroduced (see chapter 13).
Claim 31: Dental fluorosis is only a “cosmetic” problem.
Dental fluorosis is the one condition caused by fluoride that proponents do not deny. However, they commonly claim that the condition is not a health effect but merely a cosmetic effect. Fluoridation opponents, on the other hand, maintain that dental fluorosis—the result of fluoride’s interference with the growing tooth cells—is the first visible evidence that fluoride has had an adverse systemic effect on the body, and they wonder what other developing tissues may have been affected while the tooth cells were being damaged. Of particular concern are the skeletal system, the brain, and the endocrine system, where damage could be happening without visible telltale signs. Proponents offer no evidence that other tissues have not been affected while dental fluorosis is occurring.
Nor are cosmetic effects necessarily trivial. Moderate dental fluorosis, which involves discoloration of 100 percent of a tooth surface and affects over 1 percent of children living in fluoridated communities, 16 is likely to cause psychological damage to teenagers17 (see chapter 11) and is very expensive to treat.
Of some pertinence are the CDC’s stated objectives of the fluoridation program: “Adjusted fluoridation is the conscious maintenance of the optimal fluoride concentration in the water supply for reducing dental caries and minimizing the risk of dental fluorosis” [emphasis added]. 18 Regardless of whether the CDC’s first objective has been met, with 32 percent of American children now affected by dental fluorosis, 19 the second objective has clearly not been.
Claim 32: Most cases of dental fluorosis are so mild that only a trained professional can recognize the problem.
This may be true of some cases of the very mild condition of fluorosis, which impacts over 22 percent of children in fluoridated areas, but is certainly not true of the mild condition, which involves up to 50 percent of the tooth surface and affects 5. 8 percent of children in fluoridated areas, or the moderate condition, which involves
100 percent of the tooth surface and affects over 1 percent of children in fluoridated areas20 (see chapter 11).
Claim 33: Some cases of dental fluorosis actually improve the appearance of the teeth.
This claim dates back to a famously cynical comment made in 1951 by Dr. Frank Bull, the state dental director for Wisconsin. His remarks are quoted in full in chapter 11, under “Promoters’ Spin. ”
Claim 34: 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 (see chapter 17). 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. ”21 No fluoridating country has undertaken a study to see if there is a relationship between fluoridation and arthritis (see chapter 17).
Claim 35: Opponents use “scare tactics. ”
In reality, the potential that fluoride might be causing a number of harms (including osteosarcoma in young men; arthritis and hip fractures in the elderly; lowered IQ in children; and lowered thyroid function) in some of the 400 million people who are drinking fluoridated water daily is indeed worrying (see chapter 10–19). The risks for one individual may be small, but if millions of people drink fluoridated water, a small risk multiplies up to a lot of cases. If we suppose a risk of some harm to 1 in 1, 000, that would mean 400, 000 cases worldwide or 10, 000 in a large city.
Claim 36: Opponents are “poison mongers. ”
This bizarre claim originates from a piece of work authored by Dr. Stephen Barrett, a retired psychiatrist from Allentown, Pennsylvania, who started an organization called Quackbusters. 22 Another article (coauthored by Barrett) that makes the same silly charge is titled “Fluoridation: Don’t Let the Poisonmongers Scare You. ”23
The notion that people opposed to putting a known toxic substance into the drinking water supply are “poison mongers” is Alice in Wonderland nonsense. Fluoridation opponents are not selling a poison; in fact, they are not selling anything. It is the proponents, or their friends in the phosphate fertilizer industry, who are doing just that. This is a classic ploy of propagandists: Accuse your opponent of doing exactly what you are doing, or simply take your opponents’ arguments and turn them upside down.
Claim 37: Opponents are “conspiracy theorists. ”
This was true of one faction of the anti-fluoridation movement in the 1950s, whose members believed that fluoridation was a “communist plot, ” as parodied in Stanley Kubrick’s famous movie Dr. Strangelove. However, even in those early days many reputable scientists were opposed to fluoridation on scientific grounds and many more on the very rational grounds that it is unethical to deliver medicine through the public water supply, because it removes the individual’s right to informed consent to medical treatment. Today, there are still conspiracy theorists around, as there are in almost any field, but most opponents are increasingly well informed.
Claim 38: Opponents are members of a fringe element who propagate discredited myths.
It is true that a few people who oppose fluoridation do so based on claims that Nazi Germany and other totalitarian regimes used it as a method of mind control. There is little evidence that would satisfy a historian to support such claims. The vast majority of fluoridation opponents repudiate such views and base their opposition on science and ethics.
Claim 39: Over sixty countries practice water fluoridation.
A large majority of countries in the world do not fluoridate their water. They include China, India, Japan, nearly all the European countries, and almost all the industrialized nations. Only about thirty countries have some percentage of their population drinking fluoridated water, and of those only eight have more than 50 percent of their population doing so (see chapter 5).
Claim 40: The consensus of medical and dental professionals and scientists is that there is no valid debate on fluoridation.
Nothing in science is beyond debate. As far as consensus is concerned, we are reminded of what the late Michael Crichton said:
I regard consensus science as an extremely pernicious development that ought to be stopped cold in its tracks. Historically, the claim of consensus has been the first refuge of scoundrels; it is a way to avoid debate by claiming that the matter is already settled. . . The greatest scientists in history are great precisely because they broke with the consensus. . . There is no such thing as consensus science. If it’s consensus, it isn’t science. If it’s science, it isn’t consensus. Period. 24
Even if there are some areas of science where consensus seems legitimate, Crichton’s statement is certainly relevant to the fluoridation debate.
Summary
Proponents of fluoridation possess a wide repertoire of incorrect statements about the science and unfounded generalizations about those who disagree with them. We have reproduced and refuted some of the commoner ones in this chapter.
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The Promoters’ Motivations
We have put off any analysis of the possible motivations of those promoting fluoridation to the very end of this book. Because it is so difficult to get into other people’s minds, this chapter probably raises more questions than answers.
We venture into this problematic area because it is so puzzling to witness the efforts of promoters to fluoridate more and more water supplies, even as the evidence for the effectiveness and safety of fluoridation gets less and less convincing. The zeal with which this matter is still pursued calls for some serious questioning. Why, for example, do promoters do the following:
• Deny the possibility of any adverse health effects from fluoridation?
• Deny the relevance of the 2006 NRC review?
• Fail to do, or call for, the most basic human health studies on soft tissues?
• Fail to investigate a possible relationship between fluoridation and arthritis, hypothyroidism, or Alzheimer’s disease?
• Fail to monitor the fluoride in citizens’ bones, plasma, and urine?
• Fail to use dental fluorosis as a biomarker to examine health problems in children?
• Dismiss all studies done in other countries that pertain to health effects without attempting to replicate them?
• Refuse to debate the issue in public?
• Fail to conduct a genuine risk-benefit analysis?
• Insist that every man, woman, and child ingest fluoride, while conceding that its predominant mechanism of action is topical?
In short, what is driving the need by so many—from individual dentists to the highest levels of government in fluoridated countries—to keep this practice going at all costs?
Numerous people have tried to answer this question. Possible answers range from factors that influence individual beliefs and behavior to the economic interests of large corporations. Again, much of this is speculative. Two speculations we reject outright are that fluoridation is (1) some sinister plot to “dumb down” the population or (2) part of some worldwide plan to reduce the size of the global population.
Different Professional Perspectives
Edward Groth III, in a commentary contained within Brian Martin’s excellent book Scientific Knowledge in Controversy: The Social Dynamics of the Fluoridation Debate, 1 describes what he sees as a clash in the fl
uoridation debate between the dental public health perspective and the environmental health perspective. 2
One key difference between the public health and the environmental health perspectives is that the former is interested in providing the greatest good for the greatest number, while the latter is concerned about minimizing environmental and chemical risks. One focuses on what is safe for the average person, while the other is concerned about protecting everyone, including the most vulnerable.
One place where we can clearly see the dominance of the public health perspective is in the EPA’s derivation of the MCLG (maximum contaminant level goal; see chapter 20). Choosing 2 liters as the amount of water one person drinks each day was an assumption clearly designed to protect an average water consumer, since the EPA knows that some people consume much more water than that. Moreover, the EPA’s choice of a safety factor of 2. 5 (instead of the usual factor of 10) did not take into account the expected variation in sensitivity to a toxic substance in any population. The most vulnerable fall by the wayside. More generally, the refusal of proponents to get into any kind of margin-of-safety analysis is rooted in the notion that it is enough to protect the average person. This attitude is betrayed in simplistic statements such as “If fluoridation was causing any harm, we would know about it by now. ” The failure of any pro-fluoridation government to investigate in any scientific fashion the many anecdotal reports and case studies indicating that some individuals appear to be very sensitive to fluoride’s toxic effects again betrays an attitude of “We are doing some good for the many, why bother about the plight of the few?” The same applies to the dental community, which has always accepted the objective of reducing dental caries for the majority despite increasing dental fluorosis for the few. In all these situations, someone with an environmental health perspective would insist that we should not be imposing a practice on a whole population when we know full well that some individuals will be negatively affected, especially when there are alternative ways of tackling the problem.
