The case against fluoride

i-f9a82a1b0a206a91e01b3866d8c02997-flouride.jpgAlthough I just play the role of a scientist on the internet, my father actually is one. As well as being a medical doctor, he is a retired professor of biophysics. I am telling you this because he has recently co-authored a book on a subject that might interest readers of ScienceBlogs: fluoridation of human water supplies. The book is entitled "The Case Against Fluoride: How Hazardous Waste Ended Up in Our Drinking Water and the Bad Science and Powerful Politics That Keep It There" and you can read a detailed review of that book here [PDF].

At my request, he has written up a guest post outlining the arguments he and his co-authors make in much greater detail in "The Case against Fluoride" and says he will be checking the comments in case there are questions. So, without further ado, take it away Dad!


Guest post by James S. Beck

Participants in this blog will be familiar with at least one struggle between science and science-deniers in the context of a man-made disaster, where material interests and greed and reluctance to face responsibility and fear of legal liability all lie in the background. That’s the drama of climate change. Well, here’s another one for us: fluoridation of public water supplies. The science is perhaps simpler and the solution certainly is easier but the parallels are nevertheless striking.


This drama got its start in North America in the 1940’s after a big effort on the part of industries that were faced with costly law suits over illness and death, things apparently caused by their industrial use of fluorine-containing chemicals. The government of the United States was also involved in fluorine use in its enrichment of uranium for fission bombs. The public became involved unknowingly in 1945 with the beginnings of trials of fluoride as a preventive of dental caries (cavities). These trials were imposed on large cities in Canada, the US and New Zealand without consent of their inhabitants. The goal of some of the actors was prevention of cavities. The goal of the pushers seems to have been to make fluoride look harmless and beneficial, thus making legal challenges hopeless of success. But these trials were imposed without prior tests for safety or effectiveness and fluoridation of public water supplies was approved and promoted by the US Public Health Service in 1950 – half-way through these ill-conceived and incompetently executed trials. After that other government agencies and some professional associations quickly got on the bandwagon. Currently about two-thirds of the population of the United States is using fluoridated water. In Canada usage varies with province but overall less than 40% of the population has it. In Europe the practice has been refused and stopped to the extent that over 90% of the people do not have it.

A brief review of three critical questions about fluoridation follows.

Is fluoridation effective in reducing the incidence of dental caries (cavities)?

Fluoridation of public water supplies has been in effect somewhere in the world for seven decades now. Over that time the prevalence of dental caries has fallen in industrialized countries. This has been taken by many to indicate efficacy. But research has consistently shown that the decrease has occurred in countries without fluoridation to the same or greater degree as in those with fluoridation. Furthermore it is observed that in jurisdictions where fluoridation has been discontinued the incidence of caries has not risen. And studies comparing caries experience of cities fluoridated with cities not fluoridated have shown no difference, except where the nonfluoridated cities do better.

The answer to this first question is clearly no.

Is fluoridation safe?

The most obvious toxic effect has been dental fluorosis. In mild cases it appears as mottling discoloration of tooth surfaces. In moderate and severe cases it involves discoloration, pitting and weakening of the enamel and has serious consequences. The treatment of this condition costs tens of thousands of dollars per patient. Even if this effect were only cosmetic, it would have serious negative effects on a child’s or teenager’s life. Aside from dental fluorosis, evidence uncovered over the last two decades has shown an association of fluoride in drinking water with lower IQ in children. There are over twenty published studies showing this association. In laboratory studies of animals and of aborted human fetuses an association with abnormalities of cells of the brain has been found. Also it has been shown that fluoridation is associated with high levels of lead, a known neurotoxin, in the blood of children.

And there’s more, including, but not limited to, the following:

  • Fluoride intake is a cause of impaired thyroid function. Indeed fluoride was once used medically to suppress thyroid function.
  • Deleterious effects on reproductive systems in humans have been found to be associated with fluoridation: in girls, early onset of menstruation; in men, low sperm counts.
  • We now have strong evidence of the association of osteosarcoma in boys and young adult males with fluoridation. Osteosarcoma is a bone cancer which is often fatal.
  • The possible incidence of bone fracture with fluoridation has been studied with mixed results. One of the strongest studies is presented in a paper by Li et al. published in 2001 which shows a rising prevalence of hip fracture correlated with a rising intake of fluoride starting with concentrations comparable with those used in fluoridation in North America. And this is just one example that suggests that hip fracture is caused by fluoridated water.
  • Fluoride adversely affects kidneys.
  • Two recent studies have shown adverse effects on the heart and the aorta.

Ironically, this multiplicity of demonstrated and possible toxicities has actually been cited by some proponents of fluoridation as discrediting the arguments of opponents. That tactic appears as an assertion that opponents are scaremongers, that nothing would cause so much trouble for so many body systems. But these effects of fluoride are not so surprising to anyone who recognizes that the element fluorine is the most reactive chemical element and that it reacts with many components of the human body. For example, fluoride has been used in thousands of laboratory investigations as an inhibitor of enzymes, the proteins that catalyze (facilitate) biochemical reactions. It is also well known that fluoride, in combination with other elements such as aluminum and with components of cell membranes, disrupts the normal signalling across the membanes of hormones and other messengers that activate or moderate cellular functions. Really, the multiple toxicities are to be expected rather than dismissed because there are so many.

All of this is backed up by scientific reports in peer-reviewed journals. I recognize that there are well educated proponents of fluoridation including scientists, physicians and dentists, but in my experience they have never offered evidence of safety or efficacy that stands up to careful scrutiny.

So the answer to the second question, "Is it safe?", is clearly no.

Is fluoridation ethical?

Given the evidence that fluoridation is ineffective and that it is unsafe, the question of ethicality is easily answered in the negative. But even if it were effective, it would not be acceptable for the following reasons.

It is unethical to administer a substance or procedure to a person without the consent of that person, consent informed by a qualified professional who must answer questions from that person and who must inform the recipient of the reasons for the administration and of possible side effects. Such consent has never been sought from, much less given by, those whose tap water is fluoridated.

It is unethical to administer a substance or procedure that has not been approved by a qualified body. Dosage and/or intensity must be monitored and controlled and the effects on individuals must be monitored by a qualified professional (control of concentration in water does not control amount per unit body weight consumed by an individual). The recipient must be able to stop the administration at will. These are simple precepts of medical ethics, precepts clearly not adhered to in the case of fluoridation.

In short the substances used to fluoridate drinking water (mostly hexafluorosilicic acid) have not been tested or approved for use in humans; the dosage is not controlled; individual consent has not been obtained; the effects on individuals are not monitored; individuals can not stop the administration.

Fluoridation of public water supplies fails on all these ethical requirements.

For more information on this issue, such as which city water supplies are fluoridated and how you can get involved can be found at the Fluoride Action Network.

[Update: references for this book can be found here: http://fluoridealert.org/caseagainstfluoride.refs.html, sorry this was not offered initially]

292 thoughts on “The case against fluoride

  1. Lynxreign:

    @183
    “Seriously? The full quote adds nothing to the part mandas quoted. There are absolutely questions as to whether flouride damages health and to state otherwise is unreasonable. You have an entire comment thread here of people posting rebuttals to the idea that flouride damages heath, Orac wrote an entire post about it, they’ve included links to papers and other sites all of which question the idea that flouride damages health.”

    I don’t think this is correct. The major criticisms I have seen wrt the toxicity of fluoride are not that it does not exist (maybe you can support your statement here with some quotes?) but that it does not occur at dosages typical at water concentrations of 1ppm. My impression is that the toxicity of fluoride at dosages typical at several times higher concentration levels, or at least many times higher, is not controversial.

    @201
    If this is true (and really, you need to start linking to the sources) then a reasonable conclusion would be that ingesting flouride from “all sources combined” over the period of a day does not affect people the way concentrated tablets do as there’d be an epidemic of people with thyroid conditions. That or flouride only brings the thyroid to a certain point and then ceases to have any affect. There are others as well, but if those numbers are correct, despite the huge ranges for each, then flouride doesn’t seem to be a problem in this area.

    I agree, Dad should provide more direct citations, I have asked him to try to do this. But I don’t think you have arrived at a reasonable conclusion from your charitable assumption the numbers provided are correct, at least not without some additional knowledge specific to thyroid functions you may not be sharing. Your conclusion depends on the range of normal BMR levels, the range of abnormal BMR levels and the degree to which fluoride affects them.

    Your comment about how if it were true then there would be an epidemic relies on a general and very common misunderstanding of these kinds of medical statistics. I could tell you if you do X, your chance of Y are 20 times greater. You look around at everyone doing X, apparently without suffering from Y and say I must be wrong. Not necessarily, it really depends on the background rates involved. If the background rate is one chance in 1 million of getting Y, 20 times greater is one chance in 50,000. You will still look around and very likely see no one with Y, but in a city of 5 million people, all doing X, there will be on average 95 individuals who now have Y and who otherwise would not have. [update: which I would like to add is both not an epidemic and a number worth considering.]

    In the case of X = fluoridation, the legitimate questions are what are the “Y” effects and fluoride’s affect on background levels, and are they favorably balanced by any benefits to dental health. But to address that rationally, the above point must be understood.

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  2. @James Beck
    “By the way, they have embedded a conclusion of their own into their Results. The results showed what the reviews claim to have shown. They themselves didn’t study efficacy or harm in their review. ”
    James, I’m posting this specifically because it shows one of your misunderstandings. And those misunderstandings illustrate why you are are, in my honest opininion, completely unfit to makea judgement on this data.

    First off all, the results section is correct. Reviews have shown a beneficial effect of fluoridation. You may not like this, but that is what every single scientifically valid review has found so far, and thus that is what should be presented in the results section.
    Reviews aren’t meant to parrot other articles. They are meant to summarize the currently available literature show their conclusions based on that. And those conclusions are sound. Based on the available literature, there is very little to no indication that exposure beneath 1 mg/l fluoride has any side effects, aside from an increased incidence of mild fluoridosis. You have offered nothing, and I mean exactly nothing, against that.

    But it shows something more abhorrent (that is the right word, skip? 🙂 ). You have elevated studies showing negative effects of fluoride to “good studies”, while lowering studies showing efficacy of fluoride to “bad studies”. This leads you to opposite conclusions as the literature actually warrant. If you would be consistent, you conclusion would be exactly the opposite from the opening post.

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  3. @Coby
    “I don’t think this is correct. The major criticisms I have seen wrt the toxicity of fluoride are not that it does not exist (maybe you can support your statement here with some quotes?) but that it does not occur at dosages typical at water concentrations of 1ppm. My impression is that the toxicity of fluoride at dosages typical at several times higher concentration levels, or at least many times higher, is not controversial.”
    But that wouldn’t be my impression if I read only post #170. Through the set-up of the post, if I would read only that, my impression would be that levels of fluoridation used in the US are close to those for negative health effects. I mean, if not, why write a book about it?

    And that is one of the problems I have with Beck’s and Connet’s argumentation right there. They hardly ever mention dosage, when this is important. They overstate negative effects, while understating positive effects.

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  4. Coby @203

    See, that’s exactly what I’m getting at. There was no specificity in the post that would allow readers to judge the data, the claims or the issue. My comment is more about how they haven’t provided enough information for anyone to make sense of their comments or the sparse numbers they have provided.

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  5. Holy cow — over 200 comments? Welcome to the internet Dr Beck. I grew up in Edmonton where we had fluoridated water. I was ticked when my dentist insisted for health reasons that I should not drink anything for a half hour after my fluoride treatment — where was the warning on toothpaste I used to eat? Anyway, I look forward to hearing more about this. But I’ve got to save the world first, so I won’t get to reading these comments any time soon. Best wishes.

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  6. I believe some have asked about the lower IQ claims presented in the OP. Over at Orac’s thread about this post a commenter offered this:

    Biol Trace Elem Res. 2008 Winter;126(1-3):115-20. Epub 2008 Aug 10.
    Fluoride and children’s intelligence: a meta-analysis.

    Tang QQ, Du J, Ma HH, Jiang SJ, Zhou XJ.

    Department of Pathology, Nanjing University School of Medicine, Nanjing Jinling Hospital, Nanjing, Jiangsu 210002, People’s Republic of China.
    Abstract

    This paper presents a systematic review of the literature concerning fluoride that was carried out to investigate whether fluoride exposure increases the risk of low intelligence quotient (IQ) in China over the past 20 years. MEDLINE, SCI, and CNKI search were organized for all documents published, in English and Chinese, between 1988 and 2008 using the following keywords: fluorosis, fluoride, intelligence, and IQ. Further search was undertaken in the website http://www.fluorideresearch.org because this is a professional website concerning research on fluoride. Sixteen case-control studies that assessed the development of low IQ in children who had been exposed to fluoride earlier in their life were included in this review. A qualitative review of the studies found a consistent and strong association between the exposure to fluoride and low IQ. The meta-analyses of the case-control studies estimated that the odds ratio of IQ in endemic fluoride areas compared with nonfluoride areas or slight fluoride areas. The summarized weighted mean difference is -4.97 (95%confidence interval [CI] = -5.58 to -4.36; p

    PMID: 18695947 [PubMed – indexed for MEDLINE]

    I have not verified this to be accurate, nor can I offer an expert analysis of it. Two main questions come to mind: what dosage and concentrations of fluoride are we talking about here, and two, are these dosages possible/probable to recieve from 1ppm fluoride in drinking water?

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  7. The meta-analysusis paper mentioned by coby in #208 does not ever define dosages. The terms in the paper are all qualitative, not quantitative; speaking of “severe” and “slight” fluoridation. What this means is never defined.

    However, in chasing references, it seems that the problem arises with higher levels of fluoride than used in fluoridated drinking water. Coby, my guess is that you have been sucked in badly on this one. Asking questions is good, but you’ve learned this very late in the game.

    If I find more, I’ll let you know. Gotta run for now, sorry.

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  8. The meta-analysusis paper mentioned by coby in #208 does not ever define dosages. The terms in the paper are all qualitative, not quantitative; speaking of “severe” and “slight” fluoridation

    Huh?. The paper doesn’t refer to fluoridation but fluorosis, presumably dental (staining, pitting of teeth) which normally occurs during childhood in areas where there are high levels of fluoride in the drinking water. The Deans Index describes levels of fluorosis – severe/moderate/mild etc according to the staining/pitting evident from visual inspection.

    And what do you mean by dosages?. Do parents typically record the water intake of their children for their first 8 years of life?.

    The paper, although short on detail , merely establishes a link between high levels of fluoride in drinking water (as evidenced by fluorosis) and low IQ. Nothing more. It does not follow from this paper, that levels in fluoridated water have the same effect, although I’m beginning to wonder.

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  9. Coby should begin to think in damage limitation terms and put an end to this thread. Whatever I may think about the AGW hypothesis I have always found his blog to be a lively and interesting place. I regret the way its credibility and reputation have been shot to pieces by this foray into crankery.

    No doubt Coby will believe I am being disingenuous. But I am not. We are witnessing an example of how a reputation that has been built up over several years can be destroyed almost overnight.

    Coby, it was a serious error of judgment to have promoted this anti-fluoridation book. I think that much is obvious by now. Even your most ardent supporters have lapsed into embarrassed silence. The sooner you can put this episode behind you the better.

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  10. by this foray into crankery

    You disappoint yet again Snowman. Given your climate crankery I thought you’d be better equipped to assess the situation. Tell me, how many studies on fluoridation have you read, and which ones really convinced you?.

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  11. Just goes to show… we all have a little bit of the tin foil milliner in us.
    Next…Coby’s nephew from Alabama will post on Intelligent Design.
    Oh dear oh dear.

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  12. Snowman – Dapplewater, your capacity to miss the point never fails to astound me.

    So you haven’t read any studies on fluoridation?. Figures.

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  13. @Coby:
    “I have not verified this to be accurate, nor can I offer an expert analysis of it. Two main questions come to mind: what dosage and concentrations of fluoride are we talking about here, and two, are these dosages possible/probable to recieve from 1ppm fluoride in drinking water?”
    I’ll repeat my comment I left at Orac’s blog here. I could not get the article, only look at the abstract. But from the abstract it becomes clear they looked at places with exposure to naturally occurring fluoride. What I’ve of such studies, the reference group generally has an exposure of 1 mg/l, while the moderate to how exposure ranges would be 4 to 8 mg/l, way above the levels used anywhere for fluoridation and probably not applicable to the levels people are exposed to here.

    @Dappledwater:
    “Huh?. The paper doesn’t refer to fluoridation but fluorosis, presumably dental (staining, pitting of teeth) which normally occurs during childhood in areas where there are high levels of fluoride in the drinking water. The Deans Index describes levels of fluorosis – severe/moderate/mild etc according to the staining/pitting evident from visual inspection.”
    I don’t think they looked at fluorosis, although it is hard to tell. Reading the abstract, it seems they used fluorosis when they meant fluoride a couple of times, given the way they use the terms. If they would have used fluorosis as a measure by some kind of index, that would have been mentioned more clearly (also, the categorization they use does not match any fluorosis indexes I’m aware of). Unless you actually had access to the paper?

    “And what do you mean by dosages?. Do parents typically record the water intake of their children for their first 8 years of life?.”
    That is one of the reasons why concentrations are often used. Otherwise you’ll have to guesstimate backwards.

    “The paper, although short on detail , merely establishes a link between high levels of fluoride in drinking water (as evidenced by fluorosis) and low IQ. Nothing more. It does not follow from this paper, that levels in fluoridated water have the same effect, although I’m beginning to wonder.”
    Why?

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  14. Replying to @210 by Dappledwater:
    Huh?. The paper doesn’t refer to fluoridation but fluorosis, presumably dental (staining, pitting of teeth) which normally occurs during childhood in areas where there are high levels of fluoride in the drinking water. The Deans Index describes levels of fluorosis – severe/moderate/mild etc according to the staining/pitting evident from visual inspection.

    I am referring to the paper mentioned in the thread: Fluoride and Children’s Intelligence: A Meta-analysis, by Tang et al, in Biol Trace Elem Res (2008), 126(1-3):115-20. The abstract is in @208, and a pdf preprint can be found at this link. (It’s in a collection of documents used in some commission or other; normally it is behind a paywall.)

    This paper is looking to “assess the strength of the association between the level of fluoride in water and IQ” (quoting from introduction).

    Your suggestion makes good sense… it appears to identify areas as “severe fluorosis” or “slight fluorosis” rather than by quantifying levels of fluoride in water directly. By this measure, areas with fluoridated water would be in the slight fluorosis area; not in the areas of severe fluorosis where a small drop in IQ levels is indicated.

    Hence this appears to be yet another case in which the Connett, Beck and Micklem are misusing references.

    Dappledwater continues: The paper, although short on detail , merely establishes a link between high levels of fluoride in drinking water (as evidenced by fluorosis) and low IQ. Nothing more. It does not follow from this paper, that levels in fluoridated water have the same effect, although I’m beginning to wonder.

    IMO the paper would suggest that levels of fluoride in fluoridated water would not have the low IQ effect which is discussed; they would be in the slight or non fluorosis areas.

    Questions are fine; but here as in other topics like AGW or vaccination or evolutionary biology, real scientific skepticism is being turned on its head and cherry picked or distorted information is used to manufacture doubt in a way that is far from reasonable.

    It’s been very interesting to look at this topic and I’ll be checking out further; as I have a longstanding interest in subjects like this where there are popular movements to object to conventional scientific conclusions.

    It sure looks at this point that the book being touted in this post is a poor guide, and belongs in the same category as books “raising questions” about AGW or vaccination or other topics which seem to attract this kind of pseudo-skepticism.

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  15. Thank you Beaker for attempting to address the 10 questions I posed and doing it with the minimum of aggression. There are several mistakes and misunderstandings in your responses and I will be addressing these shortly. Meanwhile, have you yet prepared answers to questions 6 and 10, which you said you would get back to?

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  16. I noticed the environmentalist dog-whistle “Hazardous Waste” in the subtitle of the book. It is not a good sign when the intellectually dishonest arguments start right on the cover.

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  17. I’ve just had a look at the Tang et al. paper (Fluoride and Children’s Intelligence: A Meta-analysis, Biol Trace Elem Res (2008), 126(1-3):115-20).

    It’s supposed to be a meta-analysis of 18 case-control studies, but it’s not immediately clear to me after looking at Table 1 that any of the papers are case-control studies.

    A study that employed a case-control design would be evaluating the association between exposure (flouride) and disease (low IQ).

    So a case would be defined on the basis of IQ, but the way that the results are summarised in Table 1, suggests that in some of these studies the samples were drawn based on exposure.

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  18. Beaker here I will comment on your responses to the 10 questions I posed to supporters of fluoridation on this list. Again I thank you for taking the time to do this.

    Beaker: I’ll go through your arguments. I’ll see how far I get today, but have little time, so others will follow tomorrow and in the weekend:

    Question 1) Why is it if it is a sensible practice to use the public water supply to deliver medicine, it has never been used again for this purpose for any other drug or nutrient (there is no evidence that fluoride is a nutrient)?

    Beaker 1) Fluoride is added to the water and other substances are not because fluoride is a simple and cost effective measure that benefits the health of the whole population and that can actually be practically executed. It benefits everyone who has teeth, other than for example folic acid, which only benefits expectant mothers. It can be administered through water, other than vaccinations, for example. Governments have considered adding other substances to water or food, but this can be done with very few.

    Paul: In actual fact it has not been done with any other medicine since fluoridation began, has it? In other words this delivery system – regardless of the purported benefits of the medicine – has not been used for any substance. Why is that? I think the answers are fairly obvious. 1) Once you add a drug to the water supply you cannot control the dose people get because people drink vastly different amounts of water. 2) You can’t control who gets it. Everyone who drinks water will get it, including the very young, the very old, the very sick those with a poor diet and who are nutritionally deficient. In the case of fluoride it was also include people with poor kidney function. These people will have a greater uptake of fluoride into their bodies than the average person. 3) There is no individual supervision by a doctor, which means that there is no one tracking any side effects. 4) It also violates the individual’s important right to informed consent to medication. The AMA defines this right pretty carefully on their web site.

    QUESTION 2) Why is it if the arguments are so overwhelmingly in favor of fluoridation, such that there is no room for debate on the issue, that so few countries actually use water fluoridation? Only eight countries in the world have more than 50% of their population drinking fluoridated water (Australia, Colombia, Ireland, Israel, Malaysia, New Zealand, Singapore and the US).

    Beaker 2) Bad argument (Coby, please teach your father and Paul Connett a little bit about argumentation). Different countries will take different decisions, not necessarily because the science is different but because the circumstances in the countries are different. The Netherlands does not add fluoride to the water, but chooses other ways to deliver fluoride, either through tablets, tooth paste and other means. When I was a kid I ate two fluoride tablets every day, on top of brushing my teeth with fluoride tooth paste. Fluoride treatment at the dentist was also very common.

    PAUL: Beaker I think you miss the point here. If this practice was as good as those who promote it in the US say it is why did so few countries follow America’s lead? Waldbott et al. (1978) document some of the efforts undertaken by fluoridation promoters in the US to get other countries to do so, but the vast majority resisted these efforts. On our web page we have listed a number of statements by countries that were convinced NOT to go ahead with this practice. (see http://www.fluoridealert.org/govt-statements.htm )The usual reasons offered, were that a) they didn’t feel all the health questions had been resolved and b) they were not willing to force this practice on citizens who didn’t want it. Yes you are correct that other countries have been able to fight tooth decay without putting this toxic substance in their drinking water, the Netherlands being one (although they did start). The vast majority of European countries neither fluoridate their salt nor their water and yet their teeth appear to be no worse than ours.

    Question 3) The level of fluoride in mothers’ milk ranges from 0.04 to 0.004 ppm. This means a bottle fed baby in a fluoridated community can get up to 250 times the amount of fluoride that a breast fed baby gets; is that wise?

    BEAKER: 3) You answered your own question in 6).

    PAUL: Not quite Beaker. In question 3) I raise the question as a general matter. When you have found out that the levels of fluoride in mothers’ milk are so extremely low doesn’t that raise a question about whether or not a) the baby actually needs fluoride (in other words if it does need it then clearly nature screwed up on baby’s first meal. Meanwhile, we know that no one has been able to show that there is a nutritional requirement for fluoride) and b) that there may be some exclusion mechanism operating here. Whether the latter is the case or not it would appear to be very lucky that fluoride levels are low in mothers milk because that clearly minimizes the baby’s risk of dental fluorosis and if you go to my question 7) even more lucky if it is serving to keep fluoride away from the baby’s developing brain.

    QUESTION 4) Why does the CDC Oral Health Division continue to push water fluoridation even though it admits the predominant benefits of fluoride are TOPICAL not SYSTEMIC (CDC, 1999)? In other words fluoride works largely on the outside of the teeth not from inside the body. Why expose every tissue in the body to a known toxic substance when you can brush it on the teeth and then spit it out?

    BEAKER: 4) The CDC recommends adding fluoride to the water, because brushing teeth with fluoride tooth paste and drinking fluorided (sic) water has an added preventive effect above using fluoridated water alone (http://www.cdc.gov/mmwr/PDF/rr/rr5014.pdf).

    PAUL: I would argue about how great that actual benefit is from ingesting fluoride (see chapters 6-8 in our book) however, be that as it may, doesn’t the CDC’s admitting this fact greatly undermine the case for forcing fluoride on people in their drinking water when if people want to be exposed to it they can do so by using the universally available fluoridated toothpaste to get the PREDOMINANT benefit? I think it would be useful to see exactly what the CDC said on this matter in their 1999 paper:

    “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.” (CDC, 1999).

    QUESTION: 5) The CDC has reported (CDC, 2005) that overall 32% of all American children now have a condition caused by swallowing fluoride called dental fluorosis (a permanent mottling and/or discoloration of the tooth enamel) and that for 12-15 year olds the percentage is 41% (CDC, 2010). What is the most convincing evidence that while fluoride is causing this condition by some biochemical mechanism a similar mechanism is not impacting other developing tissues in the child’s body which do have such visible signs of damage? These tissues include the brain, the bone and the endocrine system.

    BEAKER: 5) While the evidence that more children have dental fluorosis in areas with fluoridated water is strong (note that in areas with low fluoride concentrations in drinking water the percentage is still between 10 – 20%, against around 40% in areas with fluoridated drinking water), no such evidence exists for other conditions.

    PAUL: To state that NO such evidence exists is incorrect. An important study on osteosarcoma was carried out by Elise Bassin at Harvard as part of her doctoral thesis (Bassin, 2001). This was later published in 2006 (Bassin et al., 2006). She found in matched case-control study that young boys exposed who were exposed to fluoridated water in their 6th-8th years had a 5-7 fold increased risk of succumbing to osteosarcoma by the age of 20. Osteosarcoma is a fairly rare bone cancer but it often proves fatal in young men. This issue has a long history stretching back to observations of the bones of children in the Newburgh-Kingston fluoridation trial (1945-55); animals studies conducted by the National Toxicology Program (NTP, 1990) and a number of epidemiological studies with mixed results (see chapter 18 in our book for a listing and discussion.) While only a few hundred young men maybe affected by this condition how many amputations or even deaths would one accept in order to save a very small if any (see Question 10 below) amount of tooth decay? To date no one has published a refutation of Bassin’s work, although her thesis adviser Chester Douglass promised that he would do so in the Summer of 2006 and we are still waiting! Meanwhile, promoters of fluoridation are using this “promise” of an un-peer-reviewed and unpublished study as if it had actually occurred! (again see chapter 18 for an account of these shenanigans).

    As far as other health effects are concerned Beaker your argument here would be forceful if good faith efforts had been made in fluoridated countries to investigate a possible relationship between both short-term and long-term health effects that are PLAUSIBLY related to exposure to fluoride. Sadly many important health studies have not been attempted. For example:

    • 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 in our book and question 7 below)
    • 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 disease (Varner et al., 1998)
    • Lowered thyroid function, even though doctors used to give fluoride to patients to lower thyroid activity (Galleti and Joyet, 1958), 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 in our book)
    • 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 in our book for a list of references)
    • Bone fractures in children, even though the first health study of children exposed to fluoridation (Schelsinger et al., 1956) showed an increase in cortical bone defects and a study from Mexico (Alarcon-Herrera et al., 2001) 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 in our book; although the Mexican study had methodological weaknesses, its approach of using dental fluorosis as a simple and noninvasive biomarker was sound (see the comment below), 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, (Luke, 1997, 2001) and lowered melatonin levels commensurate with earlier onset of puberty have been observed in animals exposed to fluoride from birth (Luke, 1997) (see chapter 16 in our book)
    • Irritable bowel syndrome, and the many other common complaints that, in some individuals, apparently are triggered by fluoride exposure (see chapter 13 in our book). Here governments that practice fluoridaiton have been unwilling to test these many anecdotal reports with carefully designed double-blind studies. Why not?

    BEAKER: “Where evidence of adverse health effects exists due to chronic fluoride exposure, concentrations are much higher than allowed in the US.”

    PAUL: Hardly Beaker. Xiang estimates that IQ is lowered at 1.9 ppm. To state the obvious a child drinking two liters of water at 1 ppm would get more fluoride than a child drinking one liter of water at 1.9 ppm. You like many other commentators on this constantly confuse concentration and dose (and dosage). Bachinskii et al. (1985) estimate that thyroid function is affected at 2.3 ppm. Li’s data (already cited many times) indicates that hip fractures MAY increase above 3 mg/day. Freni (1994) reported an association between lowered fertility among people in US counties with fluoride at 3 ppm or more. In the context of a situation where you cannot control how much water people drink or the fluoride they get from other sources, none of these levels could be described as “much higher” than allowed in the US. These levels are too close for comfort.

    BEAKER: Could it have adverse health effects in the concentrations in the US? Possibly. Have such effects been shown? No.

    PAUL: Again see my comment above. There is not much effort in fluoridated countries to investigate health effects. The absence of study does not mean the absence of harm.

    We review the poor science that has underpinned this practice since it first began in 1945, and endorsed in 1950 by the US PHS, in chapter 22. In addition to not attempting to investigate the many possible and plausible conditions that may be related to fluoridation two other crucial aspects of the bad science need to be highlighted.
    1) Researchers and government agencies in fluoridated communities are not tracking the fluoride levels in our bones, blood or urine. Why not? Isn’t exposure the first thing you want data on?
    2) Nor are they using the most OBVIOUS (and non-invasive) biomarker of exposure to investigate conditions in children: the severity of dental fluorosis. The severity of this condition is well-established to be linearly related to the amount of fluoride a child is exposed to prior to the eruption of their permanent teeth. We literally have millions of children in at least four categories of dental fluorosis (very mild, mild, and moderate) and thousands in the severe category. That’s lots of kids to look at for many, many conditions that may be related to fluoridation. Apart from one small study by Morgan et al., 1998, this has not been done. Why not?

    Critics have every right to hack away at the epi studies which are waving red flags about some of these conditions, however, in my view the greater problem is that these same critics are not insisting that fluoridating governments go about doing studies of their own, with the best methodologies that the critics can devise. Moreover, when these critiques come from government agencies themselves, they do so without feeling obliged to do studies of their own It looks very much like that they are more interested in protecting this practice than protecting the health of their citizens.

    QUESTION 6) Both the ADA and the CDC actually recommend that parents not use fluoridated tap water to make up baby formula for children under one year of age. Why are they not taking aggressive steps to inform parents about this? What steps could be taken to help low-income families get an alternative source of water for this purpose?

    BEAKER: 6) I cannot make a judgement on what the CDC could do if they are concerned on the intake of fluoride by babies, given that I don’t know how the US helps new mothers. One thing the CDC has done is convincing industries producing formula to lower fluoride concentrations in their products.

    PAUL: Beaker this is weak. This is THEIR practice that they promote from one end of the country to the other and are prepared to force on people whether they want it or not. If they now know that drinking fluoridated water is causing harm to babies (even if they feel that it is acceptable harm) at the very least they should feel obliged to make sure these warnings get to parents. Neither the ADA nor the CDC is taking aggressive steps to do this. That is simply not acceptable. There are simple things they could do. They could request that water departments put warnings in water bills. They could get this advice to WIC clinics. They could take steps to stop bottled water companies selling “nursery water” with added fluoride.

    QUESTION: 7) The ADA and the CDC are concerned about dental fluorosis but opponents of fluoridation have other concerns. The baby’s blood brain barrier is not fully developed at birth (that doesn’t occur to about 6 months of age). Is it wise to expose a bottle-fed baby’s brain to fluoride at levels 250 times higher than would occur for a baby receiving mothers’ milk?

    There have now been over 100 animal brain studies, 3 fetal brain studies and 23 human IQ studies that fluoride can interfere with brain development (see all the references on the brain at http://fluoridealert.org/caseagainstfluoride.appendices.html )

    The lowest level of fluoride in water estimated to lower IQ is 1.9 ppm (Xiang et al., 2003 a,b). Bearing in mind that this result was obtained in a relatively small study group of several hundred children is there an adequate margin of safety to protect ALL children from this potential damage when drinking uncontrolled amounts of water at 1 ppm? Bear in mind one normally uses a safety margin of 10 to take into account the full range of sensitivity in a human population and sometimes an extra margin when protecting children.

    BEAKER: 7) This’ll have to wait.

    PAUL: I will handle your response when I receive it Beaker.

    QUESTION: 8) The National Research Council, at the request of the US EPA Water Division, appointed a 12-membered panel to review the toxicology of fluoride in water and thereby ascertain the safety of its current safe drinking water standard for fluoride. Both the Maximum Contaminant Level [MCL]– the federally enforceable standard – and the Maximum Contaminant Level Goal [MCLG] the level deemed safe to protect the whole population from “known and reasonably anticipated adverse effects” were set at 4 ppm in 1986. In March 2006, after a three-year review, the panel produced a 507-page report, which concluded that the 4 ppm was not protective of health and recommended that EPA determine a new MCLG.
    a) Why after four and half years has the US EPA not done this?
    b) Why did the ADA dismiss the relevance of this review to water fluoridation on the day it was published?
    c) Why did the CDC follow suit 6 days later?
    d) Did either the ADA or the CDC determine what a new MCLG should be in 1 day and 6 days respectively and if they did where is their analysis?
    e) Why has every fluoridating country either ignored or downplayed this landmark review?

    BEAKER: 8) A review recommended lowering the safety limit to levels lower than the current 4ppm.

    QUESTION 8 CONTINUED: a) Why after four and half years has the US EPA not done this?

    BEAKER: a) I don’t know why the EPA hasn’t followed up on this. They may just be slow.

    PAUL: The calculations necessary to correct the old 1986 determination of the MCLG can be done very quickly. After all The NRC did all the work for them as far as end points are concerned. In a few hours to a few days the EPA would have at least found out that a new MCLG would have to be set less than 1 ppm, which would end fluoridation overnight. Dr. Robert Carton, a former risk assessment specialist at the US EPA published his own risk assessment of this and concluded a new MCLG should be zero (Carton, 2006). A more likely explanation for this extraordinary delay is perhaps the EPA not wishing to cross swords with the Department of Health and Human Services on their long-standing support for fluoridation.

    For those new to this subject it might be helpful for you to know how the EPA determined the 4 ppm MCLG in 1986. It consisted of five simple steps:

    1) They assumed only one health effect to be of concern: crippling skeletal fluorosis.

    2) The estimated dose at which the condition is estimated to occur (the Lowest Observable Adverse Effect level, or LOAEL) was 20 mg/day.

    3) They then applied a safety factor of 2.5 (to account for the full range of sensitivity in a human population) and produced a so-called “safe” daily dose of 8 mg/day.

    4) They then assumed that water represented the only source of fluoride people were exposed to

    5) People drank (on average) two liters of water per day. Thus they concluded that each liter could contain 4 mg, to give a daily dose of 8 mg/day (two liters/day x 4 mg/liter = 8 mg/day).

    Each of these five steps (or assumptions) is inadequate and when simple adjustments are made based on NRC recommendations and common sense (see chapter 20 in our book) a new MCLG would have to be set at less than 1 ppm. If people want me to go through these changes I will.

    BEAKER: Perhaps the new maximum levels do not occur in the population, removing the urgency.

    PAUL: Beaker how do you know that if they (or you) haven’t ascertained what the MCLG should be?

    BEAKER: Note that what is under concern here will be the removal of natural occurring fluoride,

    PAUL: That is incorrect Beaker. That concern only comes into play when you are moving from an MCLG to an MCL. The MCLG calculations should not be “tainted” by economic, social or political considerations. Note that the MCLG for arsenic is 0 , but the MCL for arsenic is 10 ppb.

    BEAKER: since if fluoride is added the recommended level is 1 ppm, which from the studies I have seen would be above the newly recommended safety levels.

    PAUL: Right you have hit the nail on head Beaker! 1 ppm would be above “a scientifically based MCLG” if appropriate margins of safety are used to protect everyone drinking tap water. Thus fluoridation should be halted PERIOD.

    QUESTION 8 b) Why did the ADA dismiss the relevance of this review to water fluoridation on the day it was published?

    BEAKER: b) I don’t know why the ADA dismissed the relevance to water fluoridation, but if I have to guess, what I wrote under a) would be the reason. Ie, the recommendations are relevant for the levels in areas where natural occurring fluoride in the water is high, not for the parts where water is fluoridated, since those levels are far below the limits.

    PAUL: A judgment about the relevance of the NRC recommendations and report must hinge on what the new MCLG is found to be. The relevance to water fluoridation cannot be determined until that MCLG is calculated – see the discussion above. The ADA was simply being political here – i.e. protecting the program they so aggressively promote.

    QUESTION: 8c) Why did the CDC follow suit 6 days later?

    BEAKER: c) Ditto for the CDC.

    PAUL: And ditto from me too. I repeat: a judgment about the relevance of the NRC recommendations and report must hinge on what the new MCLG is found to be. The relevance to water fluoridation cannot be determined until that MCLG is calculated – see the discussion above. The CDC was simply being political here – i.e. protecting the program they so aggressively promote.

    QUESTION 8d) Did either the ADA or the CDC determine what a new MCLG should be in 1 day and 6 days respectively and if they did where is their analysis?

    BEAKER: d) From what I know of the CDC and ADA, they don’t determine Maximum Contaminant Level Goals,

    PAUL: But they would have had to have done this determination for their statement to have been scientifically as opposed to politically based…

    BEAKER: that is the job for the EPA.

    PAUL: Yes and after four and half years they have not done that job (and a simple job at that)! So who meanwhile is protecting the American people?

    BEAKER: All the reviews I have seen so far indicates that levels of 1ppm are low enough so no chronic toxicity will occur (except for dental fluorosis), which is also the position of the CDC (for example http://www.york.ac.uk/inst/crd/fluores.htm).

    PAUL: Beaker again you are confusing dose and concentration. The York Review was important (I was actually an invited peer reviewer) but limited in scope. The 507-page National Research Council report of 2006 was a far more comprehensive review of the scientific literature. Moreover, their exposure analysis in chapter 2 indicates that subsets of the population are already exceeding safe reference doses (the IRIS level) consuming water fluoridated at 1 ppm.

    QUESTION 8 e) Why has every fluoridating country either ignored or downplayed this landmark review?

    BEAKER: e) Fluoridating countries have not acted upon the review of the NRC (not the EPA) recommending lowering of the MCLG, because the levels talked about in the NRC study are twice as high as those common with fluoridation (2.0 mg/l). Hence, these limits are only relevant for areas where the natural occurrence of fluoride is high, not for areas where drinking water is fluoridated.

    PAUL: Beaker again you are confusing dose and concentration and ignoring the politics operating here.

    BEAKER: Note by the way that the 10-fold uncertainty factor you talk about applies to animal studies. If human data is available, the factor is often 1. How can you not know that if you have studied the issue for many years? And if you knew it, why didn’t you mention it in your questions?

    PAUL: This refers to a statement in 7. Not yet otherwise addressed by Beaker: (The lowest level of fluoride in water estimated to lower IQ is 1.9 ppm (Xiang et al., 2003 a,b). Bearing in mind that this result was obtained in a relatively small study group of several hundred children is there an adequate margin of safety to protect ALL children from this potential damage when drinking uncontrolled amounts of water at 1 ppm? Bear in mind one normally uses a safety margin of 10 to take into account the full range of sensitivity in a human population and sometimes an extra margin when protecting children.)

    PAUL: No Beaker you are wrong- check your toxicology books again. The default safety factor going from animals to humans – as you rightly state – is 10. This is invoked to allow for “interspecies” variation. ALSO, the default safety factor used going from human studies to protect the whole population is also 10. This is invoked to allow for “intraspecies” variation. Now it is true that when there is a lot of human data that the safety factor may be reduced, from 10, but this would not occur if you were extrapolating from a study of a relatively small population. A safety factor of 1 implies total certainty, meaning that you have so much data that you believe that you have accounted for the the total variation in the whole population. We don’t usually have that amount of data in human studies and certainly not in this case.

    QUESTION: 9) Why has the FDA never been asked by the Department of Health and Human Services to regulate the ingestion of fluoride? Here is a clue: the FDA does regulate fluoride when used in toothpaste and requires this label on the back of the tube: “WARNING: Keep out of reach of children under 6 years of age. If you accidentally swallow more than used for brushing, seek professional help or contact a poison control center immediately.”

    The recommended amount is a pea size. A pea size of toothpaste at 1000 ppm fluoride contains approximately one quarter of milligram of fluoride which is the same amount of fluoride in a quarter of a liter at 1ppm, i.e. one glass of water. If that reflects the FDA’s concern about the toxicity of fluoride what do you think it would say about 180 million American drinking unregulated amounts of this substance on a daily basis? No wonder they are not asked!

    BEAKER: 9) The FDA has not been asked to regulate the ingestion of fluoride, because that is not the job of the FDA.

    PAUL: The FDA regulates drugs. Since fluoride is being used to prevent a disease, by definition it is a drug. Their current classification of fluoride is that it is an “unapproved drug.”

    BEAKER: Monitoring ingestion of tap water and setting limits there would be the task of the EPA. What do you expect the FDA to do? Put a warning label on water taps “WARNING, DO NOT SWALLOW 5 LITERS OF WATER. KEEP OUT OF REACH OF CHILDREN. IF YOU ACCIDENTALLY SWALLOW 5 LITERS OF TAP WATER, SEEK PROFESSIONAL HELP OR CONTACT A PHYSICIAN IMMEDIATELY.

    PAUL: First of all if FDA was consistent with its warning label on toothpaste – it wouldn’t be 5 liters that shouldn’t be drunk, but one glass! And yes that would be preposterous wouldn’t it? But so is knowingly adding this toxic substance to the drinking water, when a) you can’t control the dose; b)you can’t control who gets it and c) you are forcing it on people without giving them the right to informed consent to medication.

    BEAKER: Furthermore, FDA is mainly concerned with acute toxicity.

    PAUL: I am not sure if that is correct.

    BEAKER: Safety limits in that are often much lower than they have to be.

    PAUL: I do not understand the point you are making here?

    QUESTION 10) Sometimes promoters of fluoridation cite the largest study of tooth decay in the US as evidence that fluoridation is effective. This study was conducted by the National Institute of Dental Research (NIDR) in 1986-87 and involved examining the teeth of about 39,000 children in 84 communities. When comparing children that had lived all their lives in a fluoridated community with those who lived all their lives in a non-fluoridated community, they found an average saving in tooth decay for 5-17-years old of 18% in decayed tooth surfaces. However, this 18% saving was not shown to be statistically significant and amounted to a difference of 0.6 of one tooth surface (see Table VI, Brunelle and Carlos, 1990). By the time all the child’s teeth have erupted there are 128 tooth surfaces – so we are talking about a saving that amounts to less than 1% of the tooth surfaces in a child’s mouth. Question: could this saving – if real- justify taking the risks with the baby’s developing brain and other tissues? In actual fact, Brunelle and Carlos did not take into account the delayed eruption of teeth that may be caused by fluoride, which has been reported by several researchers (see Komarek et al, 2005). A delayed eruption of the teeth by one year would account for this difference of 0.6 of one tooth surface. ( All references cited above can be found at http://fluoridealert.org/caseagainstfluoride.refs.html )

    PAUL: I will handle your response to this Beaker when I get it. Meanwhile, thanks for all your input to the above.

    Paul Connett, co-author “The Case Against Fluoride.”

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  19. I’m way behind here, but trying. Here are responses to two posts, thoughtful and helpful ones.

    #192 from Ash. Thanks for the careful and nonviolent comment. I am taking seriously your criticisms. Your conclusions are reasonable, though I might disagree on the confidence to be put on, for example, the Li et al. 2001 paper on fractures. And #200 from Kieran. I thank you also. Your (Kieran’s) first several paragraphs on the state of research, particular clinical research are off-topic (I’m picking up the blogosphere jargon) but, I believe, quite correct. My first immersion into the practice of science was in the 1950s. So during my four decades of research in fields that sometimes got close to clinical research and clearly did include biological systems were times of increasing application of inferential statistics in biomedicine. I came to believe, as Kieran does, that those applications were often faulty and were used by people who didn’t understand what they were doing. Beyond that, I felt that statistics—the more elaborate, the better—was often used as window dressing, often required by journal editors appropriate or not, or even something to obscure the low quality of the experimentation. We need Kieran’s expertness but we need to be rational in its application. As he was, by the way. Enough off-topic.

    With respect to both #192 and #200, I suggest that there is merit in Li et al. simply for the reason that, whether or not it is strong evidence of an association, it has used what has been called a “natural experiment”. Nature and human societal development has presented us with villages comparable in life style, occupational history, probable genetic similarity, in groups which have stayed put through many generations. And nature has given very different concentrations of fluoride in the water supplies of those villages. So, though I may have erred in saying that this paper is one of the better ones on fracture, I still think it is one of the more useful ones. And “useful” brings up another point that has not been raised in this blog-drama. There seems to be on the part of proponents of fluoridation of public water supplies and many of the comments here that only absolutely certain demonstration of association—perhaps even causal connections—of fluoridation with harms should cause us to stop fluoridation. I have seen governmental reports that conclude that since that study or those studies are not perfect and don’t prove absolutely that X causes Y then we should continue fluoridating until such proof arises. Now turn that around. Say we don’t have fluoridation and we are considering starting it, but we have some evidence that it may be harmful. Would we start it anyway? Would we propose research and wait for valid assurance that the harm is not related to fluoride? The unions of EPA scientists petitioned Congress in the US to declare a moratorium on fluoridation while its suggested association with cancer was properly investigated. Seems reasonable, given the at best limited benefit of fluoridation. And responsible.

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  20. Beaker @ 218. I’ve read the study (Tang 2008), not the abstract. Compared to the many hundreds of climate science papers I’ve read, it’s like a post-it note. I agree with you there’s a lot there that isn’t clear.

    also, the categorization they use does not match any fluorosis indexes I’m aware of

    Dean’s Fluorosis Index

    That is one of the reasons why concentrations are often used. Otherwise you’ll have to guesstimate backwards.

    I thought I summarized clearly enough, but apparently not. You don’t appear to understand that quantifying such concentrations is not possible. The extent of fluorosis simply establishes exposure to high levels of fluoride in the drinking water for the first 8 years of childhood (when flourosis develops)

    although I’m beginning to wonder

    Just humour mate. Aimed at some of the more vitriolic commenters.

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  21. Chris Ho-Stuart @ 219 – IMO the paper would suggest that levels of fluoride in fluoridated water would not have the low IQ effect which is discussed

    See above. Just a smart-alec comment on my part.

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  22. Re: #146, Question 1

    1) Why is it if it is a sensible practice to use the public water supply to deliver medicine, it has never been used again for this purpose for any other drug or nutrient (there is no evidence that fluoride is a nutrient)?

    While no other medicines/nutrients are in the U.S. water supply, there are two close analogs in food: Iodized salt (to prevent thyroid disease), and Vitamin-D fortified milk (to prevent rickets).

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  23. Thank you R. Simmon.

    I was all set to point out that they had actually tried adding iodine to water supplies in the 1930s but had to stop when they found that a number of people developed hyperthyroidism. When I searched on google to get the details (search under iodination of water) I found that there have been a number of smaller trials of iodination of water in specific areas endemic for iodine deficiency in more recent times (in the 1990s) and they have had some success. Unlike fluoridation these limited programs have been tightly monitored for potential side effects.

    It would be interesting to find out if there had been any discussion of adding vitamin D to water supplies before adding it to milk (perhaps there is a water solubility issue here). The use of milk is a more sensible choice because unlike water there is a smaller range of consumption across the population, allowing a tighter control over dose, as well as individual choice in the matter

    Needless, to say in the case of both iodine and vitamin D – unlike fluoride – we are looking at genuine nutrients with known serious health problems when they are absent or low in the diet.

    Paul Connett

    Paul Connett

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  24. PS to R.Simmon

    ..nor (unlike fluoride) do we have an industry anxious to get rid of thousands of tons of industrial grade vitamin D, which would otherwise have to be treated as hazardous waste. Pharmaceutical grade vitamin D (or fluoride for that matter) would be far too valuable to have most of it flushed down the toilet or used to wash the dishes!

    Paul Connett

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  25. When considering the possible causal role a particular exposure or treatment may have on a disease outcome, summarising the available evidence is a daunting task.
    There will invariably be many studies published which examine the association between the exposure and the disease, they will use different types of study design, and they will vary markedly in quality.
    The best quality evidence will come from randomised controlled trials and the least reliable evidence from ecological studies. In between you’ll find cohort studies, case-control studies, and cross-sectional studies.
    Once the studies are classified by design, you’ll find variation in quality within each of these classifications. Some randomized trials describe how randomization was performed, some don’t. Some will be double-blinded, some single blinded, and some will make no mention of this. To be truly rigorous, you’ll need to contact the authors of some studies to get further information about their study.
    The same sort of thing needs to be done for cohort studies. How were the cohorts defined? How was the exposure assessed? How were the cohorts followed over time? How were disease cases ascertained? And then for case-control studies, etc, etc.
    Once that has been done, the studies can be classified not only by study design, but also graded by quality.
    If you summarize the results of these studies, what you invariably find is that the most robust study designs find smaller effects than the less robust study designs and, within each study classification, the best quality studies will find much smaller effects than the least quality studies.
    Now it is a sad fact that in clinical and epidemiological research the proportion of studies that can be classified as high quality is very small. If this were not the case, we would not need CONSORT guidelines for the reporting of randomized controlled trials or STROBE guidelines for the reporting of epidemiological studies.
    So there will be lots of “evidence” of an effect of fluoride on a whole variety of disease outcomes, but not much good evidence.

    With regard to the meta-analysis performed by Tang et al. I really can’t be too confident in the ability of the authors to conduct a meta-analysis when they can’t even identify the study design of the studies they are reviewing.
    What other things could affect a child’s IQ? Iodine deficiency perhaps? What about lead? Lead-based paint is banned where I live, but what about in China? Kids like to chew lead-based paint: it tastes sweet. What about lead in cooking utensils? Is that a problem in rural China? What about lead in petrol? If you want to tease out the effects of fluoride on IQ, you need to account for other exposures that have known effects. Did the studies reviewed by Tang et al. do this?

    Now as far as the Li paper is concerned, the assertion that the communities chosen were comparable with regard to life style, occupational history, etc, is not something that can be made from the information supplied in that paper. Falls can produce forces that may or may not be sufficient to cause a fracture and, if fluoride is to have any causative role in the occurrence of a fracture, then it is here, at the margin of the forces required to produce a fracture, that you would see the effect of fluoride.
    Therefore, if the comparison between communities is to be valid, the risk of falling must be similar between these communities, but we don’t even know where these communities are, how can we be confident that the risk of falling is similar? China is a big place. What are the weather conditions like in these communities? What about ice on the ground in winter?

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  26. I have been waiting patiently for Beaker to respond to questions 7) and 10) in my entry #148 above. Readers can see my responses(see entry #224)to Beaker’s responses (see entry #164) to the other eight questions.

    Perhaps someone else on this list could have a go at responding (hopefully abuse free) to either question 7) or question 10) or both.

    Paul Connett

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  27. Unbelievable. After lurking successfully for so long, enjoying the hard work indicated by your critical thinking skills on AGW and other items, I am flabbergasted at your stepping into a steamin’ pot ‘o woo, and no even noticing that your feet have John Birch all over them. No, no, no!!
    But that is it, isn’t it? Stepping in it, and not even noticing. Doesn’t this _sound_ familiar? Aren’t the woo/conspiracy analogy gears clicking Coby?

    I haven’t read all comments, but I do see many folks have spoken up in support of critical thinking on this subject; that is to say rejecting the conspiracy meisters.

    Now I’ll let others slice and dice most of it, but I just have to make a comment or two. First of all, as a chemical water-quality professional, I observe and review the regulatory side a good bit. I don’t know the exact source of the “let’s just see how we can use these excess hazardous materials we have laying around, …wait! I know, let’s use them in thousands of communities across the country to 1) fund haz waste companies; 2) control minds; 3)sap and impurify all our bodily fluids…they’ll never realize what’s happening” conspiracy, but I gotta tell you it is one of the most mindless, idiotic, suck the brain dry pieces of flabby cranksterism I have ever had the misfortune to encounter.

    I don’t care about any other arguments you want to toss out…it doesn’t matter…if your critical thinking skills have ebbed low enough to argue forcefully for this load of proto-landfill, then may I suggest you have problems that will not be addressed by the removal of 1 ppm fluoride in your water.

    For those interested in reality: The flouride used in the water treatment industry comes from a natural source, the mineral apatite. This mineral is used to produce phosphorous-bearing fertilizers, because it is high in P. Apatite, and an associated mineral, fluoroapatite, contain some low percentage of F (3-6% I think?) And so, a by-product of this P production yields various F compounds. And for those with their conspiracy generators tuned to auto-play, a by-product is not per se bad – really, go ahead, look it up, we’ll wait.

    If you want to be into worrying about by-products, go after one that makes sense: the by-products of the mining industry nice enough to bring you all of the heavy metals and rare earth elements which make your computing fun even possible…look for mining disasters in Africa, South America, and yes, even in America if you are looking for a fight.

    I actually feel a bit bad for the level of snark I am using, but this has seriously pegged my woo meter. And the fact that your meter hasn’t even registered, Coby, is…..interesting? There are so many good materials out there on this…

    I was going to say more, but I need to go read some Carl Sagan or something to wash away the flibber.

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  28. I haven’t read this entire thread (so apologies if I’ve missed something vital), and I’ve only started to read what papers I have access to — and I don’t know that I will necessarily have all the time I would need to go find and read everything in full detail. But, having said that, from skimming a number of papers on flouride effects and reading a few of the ones where I actually have full access, it doesn’t look like a clear evidence of risk. It seems on the face of it to be that the studies on bone brittleness or friability are often contradictory and focused on small effects, but do not show a distinctly elevated risk at the fluoride levels which are recommended for water; and the studies which show, for example, flouride toxicity effects in rats are dealing with flouride concentrations of considerably above the legal limit for drinking water (for example, Basha PM, Rai P, Begum S. “Evaluation of Fluoride-Induced Oxidative Stress in Rat Brain: A Multigeneration Study.” Biological Trace Element Research, DOI: 10.1007/s12011-010-8780-4).

    As for the effectiveness of fluoridation in dental caries, there are a number of papers which you seem to have missed considering, like Stephen KW, Macpherson LM, Gilmour WH, Stuart RA, Merrett MC., “A blind caries and fluorosis prevalence study of school-children in naturally fluoridated and nonfluoridated townships of Morayshire, Scotland.” BMJ. 2000 Oct 7;321(7265):855-9. ( http://www.ncbi.nlm.nih.gov/pubmed/11021861 ) and McDonagh MS, Whiting PF, Wilson PM, Sutton AJ, Chestnutt I, Cooper J, Misso K, Bradley M, Treasure E, Kleijnen J., “Systematic review of water fluoridation.”, BMJ. 2000 Oct 7;321(7265):855-9.( http://www.ncbi.nlm.nih.gov/pmc/articles/PMC27492/?tool=pubmed ).

    Speaking about the comparison of towns in Morayshire in the Stephen, et al. paper — I live in NE Scotland and have family in Morayshire, and am very familiar with Burghead, Findhorn and Buckie (moderately familiar with Kinloss, and not so familiar with Portessie) — for those towns I know, I can tell you that honestly, aside from where the boats pull up the towns themselves are much of a muchness, economically, educationally and culturally (although Burghead has the most amazing Pictish fort, Findhorn has a nearby ex-hippie community, and Kinloss has an RAF station, to distinguish them from each other) — and the only significant dietary difference is the relative quality of the local fish & chips shops. For the purposes of a study like this, however, you would be hard pressed to find better-matched communities overall. And these populations showed a 96% reduction in dental caries with the fluoridation of the water.

    It’s probably safe to say that fluoridation of the water has the largest dental-caries-prevention effects in lower-income populations with low rates of compliance with dental recommendations for toothbrushing and regular cleanings. However, this was a situation as well for much of rural America when fluoridation was first introduced, as I understand it.

    I can address one question, which I think was implicated in “why was the US one of only a few countries to introduce water fluoridation”, which is “why, when there is evidence of benefit, has the UK *not* introduced water fluoridation.” The answer to that is relatively simple: they tried, and the protests matched the burning of GM test crops in their ferocity. It wasn’t so much based on an understanding of the science or assessment of real risk; it was based on a populational primal reaction of ferocious protest against the government “drugging” the water (even though much of the mains water here is heavily chlorinated anyway, because the water has a lot of geosmin).

    I’d just like to point out one thing: it isn’t fair to accuse Paul Connett or any of the authors of “dishonesty”, like I think I saw upthread. One can be intelligent, and very sincerely convinced of a problem, but just wrong, especially if there is a lot of emotional involvement in a concern. I’m sorry, but I don’t see that this is an impossibility here.

    I’ll keep reading as and when I have time, but so far I’m not convinced about the “big, bad fluoride”, I have to admit. Following on from that, though, if anyone has it, would someone be willing to send me a copy of the full Xiang 2003 paper, “Effect of fluoride in drinking water on children’s intelligence.”? I can’t even locate the full paper online, even behind a paywall — all I can find is the abstract being quoted on various anti-fluoridation sites.

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  29. Unbelievable indeed Mike. If your diatribe is an example of critical thinking God help us. I just don’t understand why people who are so ignorant on the details of a subject are prepared to be so rude, so arrogant and so utterly disdainful with the efforts of people who have spent a very long time studying an issue in depth, and documenting every single argument they make.

    Outbursts like yours Mike do not help rational discourse.They are simply meant to intimidate people and keep them away from relevant facts and arguments. Your argument is about as clinical as a brain surgeon using a monkey wrench. Needless to say you won’t read our book so conveniently you will be able to take your prejudices to the grave. Good luck to you.

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  30. (Oh, I just looked at a map, and realised I *am* familiar with Portessie. I just hadn’t remembered it was so close to Findochty. Yes, those communities are all very well matched.)

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  31. Luna (comments 234, 236) Thank you for your contribution, which seems to have kept the invective to a minimum. It contains some really good points and I will get back this a little later. But here is a quick comment.

    It is well known that a rat needs to receive a dose 5-10 times as high so as to reach the same plasma levels as a human. There are a number of excellent studies from ZZ Guan and co-workers that have consistently found brain effects at levels of fluoride in water of 30 ppm. This would translate to humans getting 3-6 ppm fluoride in their water.

    One rat study used remarkably low levels of fluoride and found some serious effects. Varner et al (1998) treated rats with 1 ppm fluoride in their water for one year and found both kidney and brain damage visible under a microscope. They also found a great uptake of aluminium into the brain and beta-amyloid deposits. These authors were surprised by these results at these very low levels that they actually repeated their experiment three times.

    Paul Connett

    PS One of co-authors is from Edinburgh and I have asked him for comments on the study from Scotland. However, it was my understanding that Scotland was not fluoridated so was the study village artificially or naturally fluoridated?

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  32. Interesting, Paul, that you completely side-step the content, and feel the need to go on and on about the messenger. Just because I address this issue rather harshly gets your gander up, but all your defensive posturing will not be lost on people who realize you “forgot” to address the issue in your reply.

    And the core issue listed by me was the full-on, fear- mongering conspiracy touted by you and others stating that the water-quality fluoridation industry uses hazardous waste materials as their source for F compounds for “mind control” or [insert conspiracy here].

    You are simply incorrect, and all your posturing and whining that I am “rude” because I call BS only reaffirms to me that you have no real interest in discussing, but rather remaining entrenched in your shell.

    And if your listing in #148 is in any way indicative of your book, why would I read it?

    The problem I see, frankly Paul, is that the questions in #148 are all comfortably answered by “Conspiracy”!!

    Don’t believe me? Try it out for yourself.

    Why doesn’t the EPA(!)……
    Why don’t the CDC and the ADA(!)…
    Why hasn’t the NRC(!)…
    Why don’t other countries(!)…

    The fact is, there is no conspiracy. There is simply evidence, long held, and under constant review (you can look it up, here’s a hint though: you won’t find it on fluoridealert!)

    The conspiracies you allege against the NRC and the EPA are actually long, legislative slug fests, which are best served by good science, and not woo. And these protracted legislative and regulatory battles are made more and more difficult as anti-vaxers, anti-fluoridians, global warming deniers and other anti-science folks creep into public policy positions as is now happening in our Congress.

    For the damage that you are doing here, we are all going to need some luck going forward.

    Defensive much?

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  33. First — sorry, my link to the Morayshire paper was the wrong one, it’s here:
    http://onlinelibrary.wiley.com/doi/10.1034/j.1600-0528.2002.300110.x/abstract

    And, some water sources changed when new infrastructure was brought online in 1985, which introduced a naturally-fluoridated water supply to the named towns — fluoridation is almost exactly 1ppm, however. It is correct that water supplies are not artificially fluoridated (viz. the protests, as stated above), but there are naturally fluoridated sources in a number of places.

    Second, could I just ask, please — could you at least give paper titles as well as year of publiction when you refer to something as a source of information? I really like to check these things, and some are difficult to find when all I have is one author’s name. Speaking of which, for the Varner et al (1998) study you mention, is it “Chronic administration of aluminum-fluoride or sodium-fluoride to rats in drinking water: alterations in neuronal and cerebrovascular integrity.”? If so, I have access and will read it in detail.

    Again, I have to add a caveat here that I haven’t had a chance to read and analyse the detail of these papers, but I found quite a number of papers by ZZ Guan on fluorosis effects. From skimming them, however, it looks to me as if he is deliberately inducing clinical fluorosis with high doses of fluoridation (30-100ppm in drinking water over a period of 7 months, in one paper, maybe the one you are referring to, 7 months being just over 25% of a normal rat lifespan for lab animals), and it seemed like he was looking for signs of distinct skeletal fluorosis as diagnostic in his test animals. I will say without hesitation that when someone is exposed to enough fluoride to induce skeletal fluorosis that it is perfectly reasonable to look for and at other metabolic damage; but that wouldn’t really be the case for most of the human populations in question.

    In China, of course, there is in places an additional significant danger of fluorosis from the air pollution of coal burning, which I don’t think is reflected much in the current decades of the US and the UK, although it was potentially higher last century.

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  34. @Mike: I’m taking seriously Coby’s warning that Paul Connett is not a normal internet resident, and is unused to the usual level of interaction on forums. There is a normal expectation that people debating on the internet have a certain thickness of skin, but bear in mind that Paul may be genuinely rocked back on his heels by what he may be encountering for the first (or nearly the first) time.

    Of course that doesn’t invalidate the fact that he didn’t answer the content of your post, but cut him a little slack in getting used to these waters. If it were my dad on the internets, I could only imagine what his shock/horror reaction would be to the usual tone of forum posts, however legitimate the content.

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  35. Sorry Luna. Early on we gave a link to all the references we used in the book. These can be found here:

    http://fluoridealert.org/caseagainstfluoride.refs.html

    The Varner study can be found in Appendix 1, as well as the Xiang paper and follow up letter – for which there are links to the full text.

    It could be of course, that three old professors with PhDs in chemistry, physics (plus an MD) and biology – as well as a historian -have been carried away on this issue and are letting our emotions get the better of us, despite the many years that we have put into investigating the matter. However, not one of us got into this matter with an anti-fluoridation bias. In fact, speaking for myself I wanted to get rid of the issue as quickly as possible. Only the evidence kept me back. This may all be wishful thinking on our part, but the only way this can be fully judged would be for people to read the whole book and make their own judgment on the matter. Of course, every time I mention this sane approach I am accused of just wanting to sell books. What total nonsense. Quite frankly I couldn’t care a tiddly cuss if some of the people on this list read the book or not. They have received most of their education from Dr. Stranglelove and that is where they would like to keep their minds. As such I would rather they spouted their jaundiced tripe on the other side of the debate. They would be embarrassing to have on our side.

    Paul Connett

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  36. @Luna,
    I appreciate your sentiments on how Paul and others may receive these comments, but as you say that does not invalidate missing the point. I honestly don’t mean to be abrasive, but this really grinds me.

    @Paul #241
    Your bias on the subject is quite evident in the subtitle to your book…”The Hazardous waste industry”… This is fear-mongering 101, and you’ll have a hard time convincing anyone that wasn’t done to sell books or inflame using empty rhetoric.

    And no, I didn’t receive my education from Dr Strangelove (kudos for getting the reference, however), although the overt swipe at the Birchers was spot on, wouldn’t you say?

    Also, my education is every bit as good as yours regarding inorganic water quality and chemistry…hint: such a blatant appeal to authority is a candy-apple red flag.

    Perhaps my educations is even better since I tend to rely on actual peer-reviewed data, as opposed to materials found on quack sites such as fluoridealert, which appears to be the only reference you seem to think anyone needs. This fact alone truly does not inspire confidence that you have researched this material with any objectivity.

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  37. Mike I don’t really have to adopt a defensive posture. We have done everything anyone could possibly want from three scientists who are opposed to this practice. We have written a thoroughly documented text presenting our case – with the minimum of hyperobole. If we are completely wrong – as you suggest – then what we would expect within a year would be an equally transparent text and equally well-documented -” giving “The Case For Fluoride.” If you are correct that should not be difficult for promoters to do. We will wait but won’t hold our breath.

    Meanwhile, no amount of invective is a substitute for this approach.

    You are the one that brought up conspiracy – and some of your cronies – not me.In fact in our text we go out of way to disown some of the wilder conspiracy theories like “dumbing down the American people” and “limiting the world’s population.” Both of which I believe are insulting to those who promote fluoridation in good faith. Moreover, because motivation is such a tricky area we left this discussion to the very last chapter in our book. In my view the only fault I can find with most of the people who promote this practice is that rather than researching the issue for themselves they rely on the second-hand judgments of so-called authorities like the CDC and the ADA. However, since both these entities have been promoting this practice for so long it is difficult to see if their mission now is protecting their credibility or protecting the health of the people. The two questions I posed were meant to tease this out. How was it that the ADA was able to dismiss the 507-page groundbreaking review by the National Research Council on the day it was published – and ditto the CDC six days later – when at this point no one had actually determined the new safe drinking water standard and goal (MCL and MCLG) recommended by the NRC.

    You can’t have it both ways – if this was so easy to do that the ADA and CDC did it in one day and six days respectively – then how do you explain the fact that the EPA has been unable to come up with a new MCLG in four and half years?

    You might call this a “conspiracy theory” I call it plain old politics. The EPA has no desire to cross swords with the Department of Health and Human Services (DHHS) by pulling the rug from under DHHS’s pet practice. As far as the ADA is concerned they have huge liabilities to worry about since they have their seal of approval on so many dental products containing fluoride. Clearly, they have an invested interest in making sure that every paper that finds harm at levels close to the doses someone drinking fluoridated water would receive (by the way what would say is an adequate margin of safety between the doses that cause harm to protect EVERYONE drinking uncontrolled amounts of water?) is dismissed or ignored.

    For those of you who think that this whole business came about because the US government suddenly became obsessed with children’s teeth – I urge them to read the thoroughly documented book by Chris Bryson, “The Fluoride Deception.” I think he gives us some clues as to why it began. What we need now is an equally well-documented text explaining why it continues now despite the fact that promoters admit that fluoride works predominantly TOPICALLY rather than systemically (which they believed for 50 years)and harmful effects are being documented at levels far too close for comfort (see the NRC(2006) review) – to the levels that some people are getting in fluoridated communities. So if the benefits are topical, and the risks are systemic (whatever they are) why force this nonsense on people or yourself for that matter.

    As far as your diatribe on the hazardous nature of the fluoridating chemicals. Here is the history. For over 100 years the phosphate fertilizer industry put two very toxic gases into the environment. They were hydrogen fluoride and silicon tetrafluoride. These gases caused a great deal of damage to vegetation (including citrus groves in Florida) and crippled cattle that ate the grass contaminated by these emissions. This is all thoroughly documented in our book. These gases are generated when the phosphate rock is heated up with sulfuric acid. This acid converts fluoride to hydrogen fluoride which then reacts with silica to produce silicon tetrafluoride. After about 100 years of this pollution, the industry was finally required to put wet scrubbers on their facilities to capture these two gases (plus some other crud). A spray of water converts these two gases to a solution of hexafluosilicic acid (this is not a natural product Mike). This liquid is circulated until it reaches a concentration of 23% ( I assume some kind of eutectic mixture)and then it is removed. This liquor is officially classified as a hazardous waste by the US EPA. It cannot be dumped into the sea by international law, and it cannot be dumped into local waterways because it is too concentrated. This is where it gets fun. If someone buys this waste product from them it is no longer classified as a hazardous waste but as a “product” and can then be used without having to meet the normal regulations governing hazardous waste disposal. This “product” is then used to fluoridate our water. This product also contains other toxic substances including lead and arsenic. As you probably know the MCLG for both arsenic and lead are both set at zero. So whatever the dangers drinking fluoride are concerned, fluoridation inevitably results in knowingly exceeding the MCLG for both of these cancer causing elements.

    Now while this may save/make the phosphate fertilizer industry anywhere from 100 – 200 million dollars a year, I do not believe that it the tail that is wagging the dog of the fluoridation program. It is simply a very convenient way that this industry can save money on disposing of hazardous waste and make a little profit as well.

    Now there is a way our of this silly mess Mike. Let’s assume the best case from your point of view and that you can convince people it makes sense to swallow fluoride (and in the case of the baby at up to 250 times the level in mothers milk) then here is a solution, which would satisfy most rational people (i.e. the ones you have to convince, rather than ones who rabbit on all day long protecting us from conspiracy theorists with their rhetoric). Here is a solution: Make up fluoridated water in one liter bottles and make them freely available in pharmacies and supermarkets (and free for families of low -income). This way you could control the DOSE (people would be told to drink only one liter of this water a day); you could control the purity of the fluoridating agent – you could use pharmaceutical grade AND you wouldn’t have to force it on people who don’t want to drink it, thereby avoiding the violation of the patient’s right to informed consent to medication. It would provide an easy way for parents of low -income to make up baby formula without fluoride in the water (as both the ADA and CDC now rather reluctantly recommend)- they could simply use regular unfluoridated tap water.

    This would be a rational solution IF (an only IF) you could convince people that it was safe and sensible to drink fluoridated water at 1 ppm – and IF you were interested in rational argument, which I very much doubt is the case.

    Paul Connett

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  38. Delurking here, but, Paul, how are the ADA and the CDC “rather reluctantly” recommending? Do they include a statement like “We don’t really want to say this, but we have to” on their recommendations? Sorry for the snark, but Paul, regardless of the validity of your statements, to THIS relatively unbiased observer, your message comes across as not very substantial.

    I want to add that your “solution” for people who want fluoride in their water seems to raise more problems than it solves, especially on a blog that tends to focus on environmental solutions. Isn’t bottling water kind of a bad thing when you factor in the waste created through the production and shipping processes?

    I’ve followed this discussion (here and at Respectful Insolence), and while I can’t say definitively that fluoride is safe, I have to say that most of your arguments appear to have been rebutted or at least reinterpreted by many of the posters here. I’m NOT a scientist, and am not qualified to assess papers, but I’ve come to trust the scienceblogs community and a lot of the content here disagrees with your conclusions.

    It’ll take a little bit more convincing for me to buy the book or to change my (admittedly unpassionate) opinions about water fluoridation.

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  39. “They would be embarrassing to have on our side.”

    And yet having a quack ‘doctor’ anti-vaxxer who claimed to have cures for cancer and owns a million dollar mansion on your side somehow isn’t?

    http://www.quackwatch.org/11Ind/mercola.html

    Frankly I’m more inclined to listen to what a real doctor says and not someone peddling a book that’s clearly scaremongering (as can be seen on the front cover) who’s been accused of committing the dental equivalent of child abuse.

    http://quackfiles.blogspot.com/2005/06/experts-condemn-anti-fluoride-claims.html

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  40. Just caught up with all this. There’s some interesting stuff amongst all the playground games (reminds me of Prime Minister’s Question Time in London – lots of fun, but often short on illumination).

    To Quietmarc@245. I guess many people share your reasonable agnostic position, and I’d like to discuss a couple of your points.
    1. It’s what the ADA and CDC don’t do, not anything they do say. They have never attempted to get the message across widely. It’s been a matter of suggesting that dentists advise mums who are worried about fluorosis to use fluoride-free water to make up infant formula concentrate. Here’s the current CDC, fairly well buried in: http://www.cdc.gov/fluoridation/safety/infant_formula.htm
    “Parents and caregivers of infants fed primarily with formula from concentrate who are concerned about the effect that mixing their infant’s formula with fluoridated water may have in developing dental fluorosis can lessen this exposure by mixing formula with low fluoride water most or all of the time.” Not exactly a clarion call; you don’t get this advice unless you can afford to be seeing a dentist.

    2. Your point about disputed evidence. Dental fluorosis is the one harm that both sides of the argument agree can result from drinking fluoridated water. I think it is a significant harm in itself, but others dismiss it as merely cosmetic. All the other possible/probable harms are currently disputed. Any claim made on either side of the argument is likely to evoke some contrary claim (as you observe) and each side will seek to minimize the evidence of the other. We are dealing in probabilities here, not certainties. Taking into account evidence from animal and in-vitro studies and from humans consuming water with higher concentrations of fluoride, it appears that there are several serious risks that may face consumers of artificially fluoridated water, particularly if they drink a lot of water. This conclusion owes much to the findings of a large and well-documented official report by the US National Research Council of 2006 “Fluoride in Drinking Water: A Scientific Review of EPA’s standards”, available online at http://www.nap.edu/catalog.php?record_id=11571
    Others are perfectly entitled to make an opposite case if they can. My view is that while substantial risks may be acceptable to an individual taking a therapeutic drug or other intervention, such risks should contraindicate a program of mass medication for which only small benefits are demonstrable. Proponents of fluoridation seem to see it differently and to believe that if no harm (other than fluorosis) has been proved to be directly attributable to fluoridated drinking water then it is okay to continue and extend the fluoridation program. I think that’s a fair statement of their position. It strikes me as irresponsible and pointless. The McQuacker @246 may call it something else, or perhaps McQuacker’s problem is just mansion envy. Anyway, differing attitudes to risk lie near the core of the fluoridation dispute.

    H S Micklem, third author of the book; you know which one I mean.

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  41. Paul Connett:

    A few(!) quick(!) thoughts.

    1. Colleagues at a nearby mouse lab were unable to confirm your assertion that “It is well known that a rat needs to receive a dose 5-10 times as high so as to reach the same plasma levels as a human” wrt fluoride/NaF. The comment I received was more along the lines of “that doesn’t sound right; animal absorption is about on par with human absorption”, again specifically wrt fluoride/fluoride compounds. A quick search of literature found nothing to support your assertion either. Could you please give a reference for it?

    2. The Varner 1998 paper looks primarily at aluminum toxicity, and they do turn up good evidence that fluoride enables a more ready absorption of aluminum compounds…bearing in mind, too, that the exposure to aluminum in their lab was well above the standard MRL (1 mg aluminum/kg/day, as set by the US Dept. of HHS, a maximum of 0.2 mg/L being allowable in water, and the bulk of exposure being through food). Contrast this to the minimum 0.5mg/L in water being provided to the rats.

    The results are interesting, and certainly to a degree concerning; but as both the paper (the full paper, which I have in .pdf form) and the subsequent papers which cite the Varner paper make clear, Varner et al. are actually looking at levels of exposure far higher than what is allowable under current US/UK environmental law. There are obviously issues where natural occurrences of fluoride and/or aluminium are higher than normal, or where there are unregulated pollution sources (such as in China). Given the levels in the water in the bulk of the US, the case that the current levels of fluoride are dangerous stands as not proven. Worthy of monitoring, absolutely, beyond a doubt. A clear and present danger, maybe not so much. Proven, definitely not.

    As a matter of side interest, you say “These authors were surprised by these results at these very low levels that they actually repeated their experiment three times.” Are you referring to the statement in the paper, “All counts and ratings were conducted by three individuals, two of whom were always blind to the treatment of the rats from whom the tissues came”? I can’t see a reference anywhere in the paper itself to the experiment being repeated three times; it’s possible I’m missing it, but if that’s the case, could you point it out?

    It is undoubtedly worth reviewing dietary and air-pollution exposure levels to fluoride in at-risk populations, and periodically in wider populations, to review policies on fluoridation. That strikes me as being sensible risk assessment, given that we know that there *is* such a thing as fluoride toxicity at high levels. But to eliminate fluoridation entirely, especially where (actually) benefit in dental caries is reasonably well proven, and where there is a disparity of availability of dental care…hmm. I honestly can’t see that as justified, in the light of what is in the literature.

    Now, you had a number of comments on how fluoride is obtained, and how lead, arsenic, and other contaminants were supposedly introduced with it into water supplies.

    For one thing, I learned something that I didn’t know: that although there is no official nation-wide fluoridation policy in the UK, there are individual local councils which fluoridate water supplies, in England and Wales. And the British Fluoridation Society has this to say about supply:

    “The basis of the claims that the aluminium industry promotes fluoridation in order to dispose of its toxic waste seems to be based on a tenuous link more than 40 years ago in the USA. In the 1940s, The Aluminium Company of America (ALCOA) acquired a chemical manufacturing plant which produced fluoride compounds by the method described above (not as a waste product of aluminium production). ALCOA was then using sodium fluoride as a catalyst in the aluminium smelting process, but soon replaced sodium fluoride with less costly fluoride compounds. ALCOA sold the chemical plant in the early 1950s; their last sales of sodium fluoride were in 19522. Nowadays, the aluminium industry is the largest user of fluoride compounds. Thus, the aluminium industry has no interest in promoting water fluoridation whatsoever.”

    http://www.bfsweb.org/facts/tech_aspects/chemsmanufac.htm

    (On a side note, with further regard to your earlier question “it was my understanding that Scotland was not fluoridated so was the study village artificially or naturally fluoridated?” — makes no difference anyway. Reasonably straightforward studies, for example, A. Maguire, F.V. Zohouri, J.C. Mathers, I.N. Steen, P.N. Hindmarch, and P.J. Moynihan, “Bioavailability of Fluoride in Drinking Water: a Human Experimental Study” J Dent Res 84(11):989-993, 2005, have demonstrated that there is simply no effective difference in absorption or bioavailability of natural occurring or artificially added fluorides in water. Just for reference.)

    Finally, in your later response, you say “It could be of course, that three old professors with PhDs in chemistry, physics (plus an MD) and biology – as well as a historian -have been carried away on this issue and are letting our emotions get the better of us, despite the many years that we have put into investigating the matter.

    *ahem* Blatant appeal to authority much? Yes, you’ve got very impressive qualifications. No, that never protected anyone from being mistaken and becoming disconnected from evidence over time, occasionally to the point of being completely OTT. Look at Judith Curry, for example. Linus Pauling and vitamin C. Hoyle and panspermia. Look at Kary Mullis, even; he is certainly educated and qualified, and he has provided the world with a biology tool of absolutely incalculable worth (I love me my taq PCR I do I do), but let’s face it, the man is a complete frootloop. Your education and career can legitimately earn you a hearing; but they aren’t enough to guarantee your rightness, as they don’t ever protect you from getting emotionally involved in something which turns out to be improbable, or from becoming too dedicated to a proposition to evaluate evidence realistically (and I mean that as a generic “you”, not a specific “you”). And they should certainly not make your claims immune to scrutiny.

    There is one thing I really do find profoundly disturbing about this whole situation, however. From your discussion, I would think that you are concerned about the possibility of CNS damage and/or skeletal damage in children because of substances fed them to supposedly increase their health. Yes? No? But then, I saw allegations over at Respectful Insolence that you have voluntarily associated yourself with the likes of Blaylock and Autism One, as well as Mercola (and Mike Adams and other such), and this seems on the face of it to be the case. In other words, you have voluntarily associated yourself with people who advocate frequent chelation for children, when it is well-known that chelation is not risk free — and indeed, there is good evidence that chelation in the absence of confirmed presence of clinically toxic levels of heavy metals in tissues, results in cognitive damage itself, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1831518/ for the most famous example. You have in the past voluntarily associated yourself with people who simply lie about the results of clinical studies and about demonstrable results of conventional medical treatments. And what’s worse, some of these people have also actively advocated for the use of Lupron — Lupron! — at up to 5x the standard clinical dose in adolescents, to “cure” autism! Well, sure, it calms an adolescent boy right down, to have his body stripped of androgens, and I’m sure that improves behaviour. But let’s talk about damage to bones, shall we? With a helping of a 20-30% chance of cardiovascular disease on the side?

    So you are upset about what fluoride is potentially doing to people, on the one hand, and you hang out with people who advocate using treatments which are far more dangerous, on autistic children, on the other?

    I realise that just a day ago I was the one calling for restraint of language here. The irony of this is not lost on me. But I have to say it: Are you out of your fucking mind?!

    If you could provide an explanation for this, I really would appreciate it.

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  42. @Paul,
    I’m going to try a more settled rebuttal here.

    “We have written a thoroughly documented text presenting our case – with the minimum of hyperobole.”

    The last part of that introduction, my friend, is what is called a laughable statement. Have you even read the subtitle to your book? How is this not fear-mongering? This book screams cranksterism; sorry, I’m sure you don’t want to hear this, but try bringing it to 10 random DDSs in your community, and ask for their opinion. I have no doubt that several will reject in out of hand because of the way you present your message…which is chock-full of hyperbole, fearmongering, making people scared of something…but it sells! You know where the pathos and essence of this book would do well? Two places come immediately to mind. 1) The Glenn Beck show (’nuff said). 2) Gretchen and Doofus on FauxNewz, (’nuff said).

    The trajectory of you message is this: We are going to throw as much spaghetti at the wall as possible in the next XX pages, and if more than some minimum sticks, whoopee! Your post #148 clearly expounds how muddled your message is…you toss out everything hoping someone will believe something, somewhere along the line. Just. Wow.

    The Science:
    Well, this is the big one isn’t it? And I am going to hand wave it away in this fashion. You suggested somewhere that I (we) should write counter paper stating the pro-fluoride side. Well, no, we don’t need to…this is your fight, and you have shown how you are willing to fight it. I’ll leave the dozens of gov’t, health, and water agencies in this and other countries to do the pro- papers (which they have). What I will say, is that the decision for three retired PhDs (I think you said) to take your message to the popular press, rather than publishing a succinct paper in a peer-reviewed journal is a mistake. I know that Environmental Toxicology, or Environmental Health Perspectives, or even Medical Geology would all be willing to publish a well-reasoned paper.

    Science is done at that level, not on blogs, not in the press (popular or otherwise). And shame on you for pretending that you don’t know this, because we all know well that you do.

    Your mixed message:
    It only shows minimal efficacy…oh wait, no, it’s actually ineffective…no, what I mean to say is it’s deliterious, no, no I mean its TOXIC!!!!!

    No, no, no, and no. What a terrible, awful mess, for apparently well educated scientists that is. You cannot have it all four (ok, seven) ways. Gather, analyze, discuss, and report a single message. That is the only correct method for science communication. You and your co-authors do nothing but throw spaghetti here. Your message forces me to look away, seriously.

    And I’m not even going to get into the straw men you create out of the legislative process.

    That’s it. I could go on, but I’ve said my piece. My humble opinion, as a chemical water-quality professional, is that the content appears to be a mishmash of half-truths, poorly thought out stabs at any number of professional organizations, and a whole slew of misunderstanding and quote-mines. That is not to say that you might not have a kernal worth pursuing…you actually might. But I’ll never know, because I won’t read stuff like this.

    best wishes,

    Like

  43. After following this discussion for a week it’s become obvious the pro-fluoridationists are as immune to reason as they belive fluoridated teeth are from decay. Trying to convince them of the folly of fluoridation is analougs to Rachel Maddow trying to convince David Bahati that there might be something wrong with executing homosexuals.

    Like

  44. @ Luna

    So you are upset about what fluoride is potentially doing to people, on the one hand, and you hang out with people who advocate using treatments which are far more dangerous, on autistic children, on the other?

    I find it bizarre you believe a books credibility is determined by the harmful ideas espoused by a program used for the promotion of said book. If I’m promoting a book should I avoid avowed socilst Lawrence O’donnels msnbc show even those his socialism has done more damge that even chelation. Should I avoid the progressives on the View as well as uber-liberal Larry King?
    ———————

    It’s probably safe to say that fluoridation of the water has the largest dental-caries-prevention effects in lower-income populations with low rates of compliance with dental recommendations for toothbrushing and regular cleanings

    Yes lets all give our children dental fluorosis so we can help those feeding their kids lolly pops

    PS – Kids don’t get regular cleanings at the dentist

    ——————-

    Results: For 5/6-yr-olds, mean primary caries scores were 96.0% less in fluoridated than nonfluoridated subjects – In 8–12-yr-olds, DMFT values favoured water-fluoridated subjects; their caries-free trend was significant

    I don’t have access to the entire study – only the abstract, but the author makes no mention regarding delayed eruption in the primary dentition (where he/they cite 96% impact) He does mention it having no effect in the permanent dentition but fails to put an efficacy number on the 8-12 year old group. Maybe delayed eruption accounts for such splendid results. Interesting we go from 96% to just “significant”

    —————————

    Colleagues at a nearby mouse lab were unable to confirm your assertion that “It is well known that a rat needs to receive a dose 5-10 times as high so as to reach the same plasma levels as a human”

    The Textbook of Pharmaceutical Medicine By John P. Griffin P132 – goes into some detail on rats vs. humans

    Also google “rats typically require higher doses of drugs than humans to observe an effect” (the web address is quite long)
    ———————–

    I’m sure you don’t want to hear this, but try bringing it to 10 random DDSs in your community,

    Out of those 10 DDSs only 2 would even know how fluoride “worked”

    http://www.ncbi.nlm.nih.gov/pubmed/17899898The majority of dental professionals surveyed were unaware of the current understanding of fluoride’s predominant posteruptive mode of action through remineralization of incipient carious lesions.

    Like

  45. @Sid Offit

    After following this discussion for a week it’s become obvious the pro-fluoridationists are as immune to reason as they belive fluoridated teeth are from decay.

    I don’t even know what this means.

    Out of those 10 DDSs only 2 would even know how fluoride “worked”

    Ergo, it doesn’t work?? That’s really your argument?

    Trying to convince them of the folly of fluoridation is analougs to Rachel Maddow trying to convince David Bahati that there might be something wrong with executing homosexuals.

    You are correct…you have not convinced me. Hint: try less hyperbole and more science.

    Like

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