The York review did not endorse fluoridation!

What the 'York Review' on the fluoridation of drinking water really found

28 October 2003

For immediate release

A statement from the Centre for Reviews and Dissemination (CRD)

In 1999, the Department of Health commissioned CRD to conduct a systematic review into the efficacy and safety of the fluoridation of drinking water. The review specifically looked at the effects on dental caries/decay, social inequalities and any harmful effects. The review was published on the web and in the BMJ in October 2000.

We are concerned about the continuing misinterpretations of the evidence and think it is important that decision makers are aware of what the review really found. As such, we urge interested parties to read the review conclusions in full at http://www.york.ac.uk/inst/crd/summary.pdf.

We were unable to discover any reliable good-quality evidence in the fluoridation literature world-wide.

What evidence we found suggested that water fluoridation was likely to have a beneficial effect, but that the range could be anywhere from a substantial benefit to a slight disbenefit to children's teeth.

This beneficial effect comes at the expense of an increase in the prevalence of fluorosis (mottled teeth). The quality of this evidence was poor.

An association with water fluoride and other adverse effects such as cancer, bone fracture and Down's syndrome was not found. However, we felt that not enough was known because the quality of the evidence was poor.

The evidence about reducing inequalities in dental health was of poor quality, contradictory and unreliable.

Since the report was published in October 2000 there has been no other scientifically defensible review that would alter the findings of the York review. As emphasised in the report, only high-quality studies can fill in the gaps in knowledge about these and other aspects of fluoridation. Recourse to other evidence of a similar or lower level than that included in the York review, no matter how copious, cannot do this.

The full report is available via the CRD Fluoridation Review web site (http://www.york.ac.uk/inst/crd/fluorid.htm). For more
information, please contact Paul Wilson (01904 434571).

Here are the references to my previous post - a critique of the case for fluoridation by Rix and Donahue.

References:

Alarcon-Herrera MT et al. (2001). Well water fluoride, dental fluorosis, bone fractures in the Guadiana Valley of Mexico. Fluoride;34:139-149.

Armfield JM, Spencer AJ. (2004). Consumption of nonpublic water: implications for children’s caries experience. Community Dent Oral Epidemiol ;32:283-296.

Bachinskii PP et al. (1985). Action of fluoride on the thyroid function of healthy persons and thyroidopathy patients. Probl Endokrinol 1985;31(6):25-9 (in Russian).

Brunelle JA, Carlos JP. (1990). Recent trends in dental caries in U.S. children and the effect of water fluoridation. J. Dent. Res 69, (Special edition), 723-727. http://www.fluoridealert.org/brunelle-carlos.htm

Centers for Disease Control and Prevention (CDC, 1999) Achievements in Public Health, 1900-1999: Fluoridation of Drinking Water to Prevent Dental Caries. Mortality and Morbidity Weekly Review. (MMWR). 48(41): 933-940 October 22, 1999. http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/mm4841a1.htm

Centers for Disease Control and Prevention (CDC, 2002). Prevalence of self-reported arthritis and chronic joint symptoms among adults. MMWR;51:948-950.

DHHS (1991). Review of Fluoride: Benefits and Risks, Report of the Ad Hoc Committee on Fluoride of the Committee to Coordinate Environmental Health and Related Programs. Department of Health and Human Services, USA, Table 23, page 46.

Diesendorf M. (1986). The mystery of declining tooth decay. Nature;322:125-129.

Feltman R. (1956). Prenatal and postnatal ingestion of fluoride salts: A progress report. Dent Dig;62:353-357.

Feltman R, Kosel G. (1961). Prenatal and postnatal ingestion of fluorides - Fourteen years of investigation - Final report. J Dent Med;16:190-99.

Freni SC. (1994). Exposure to high fluoride concentrations in drinking water is associated with decreased birth rates. J Tox Environ Health;42:109-12.

Grimbergen GW. (1974). A Double Blind Test for Determination of Intolerance to Fluoridated Water (Preliminary Report). Fluoride;7:146-152.

Jacobsen SJ et al. (1990). Regional variation in the incidence of hip fracture: US white women aged 65 years and older. J Am Med Assoc 1990;264:500-2.

Jacobsen SJ et al. (1990). The association between water fluoridation and hip fracture among white women and men aged 65 years and older; a national ecologic study. Ann Epidemiol 1992;2:617-626.

Jolly SS. (1968). An epidemiological, clinical and biochemical study of endemic, dental and skeletal fluorosis in Punjab. Fluoride;1:65-75.

Kunzel W, et al. (2000). Decline in caries prevalence after the cessation of water fluoridation in former East Germany. Community Dent. Oral Epidemiol. 28(5): 382-389.

Kunzel W, Fischer T. (2000). Caries prevalence after cessation of water fluoridation in La Salud, Cuba. Caries Res 34(1): 20-5.

Institute of Medicine. (1997). Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride; Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition Board; National Academy Press: Washington, DC, page 310.

Li Y. et al. (2001). Effect of long-term exposure to fluoride in drinking water on risks of bone fractures.J Bone Miner Res 2001;16:932-9.

Locker D. (1999). Benefits and Risks of Water Fluoridation. An Update of the 1996 Federal-Provincial Sub-committee Report. Prepared for Ontario Ministry of Health and Long Term Care, Ottawa, 2001. http://www.health.gov.on.ca/english/public/pub/ministry_reports/fluoridation/fluoridation.html (January 3, 2005).

Luke J. (1997). The Effect of Fluoride on the Physiology of the Pineal Gland. Ph.D. Thesis, University of Surrey, Guildford, UK.

Luke J. (2001). Fluoride deposition in the aged human pineal gland. Caries Res.;35:125-128.

Maupome G, et al. (2001). Patterns of dental caries following the cessation of water fluoridation. Community Dent Oral Epidemiol. 29(1): 37-47.

McDonagh M. et al. (2000). A systematic review of public water fluoridation; Report 18, NHS [National Health Service] Centre for Reviews and Dissemination. York, University of York, 2000.

National Research Council. (1993) Health Effects of Ingested Fluoride; National Academy Press: Washington, DC.

Phipps KR, et al. (2000) Effects of fluoridated drinking water on bone mass and fractures: the study of osteoporotic fractures. Brit Med J. 2000;321:860-4.

Seppa L, et al. (2000). Caries trends 1992-98 in two low-fluoride Finnish towns formerly with and without fluoride. Caries Res. 34(6): 462-8.

Shea JJ et al. (1967). Allergy to fluoride. Ann Allergy;25:388-91.

Singh A, et al. (1963). Endemic fluorosis. Epidemiological, clinical and biochemical study of chronic fluoride intoxication in Punjab. Medicine;42:229-246.

Spencer AJ, et al. (1996). Water fluoridation in Australia. Community Dent Health;13(2 Supp):27-37.

Sutton PRN. (1996). The Greatest Fraud: Fluoridation. Kurunda Pty. Ltd, Lorne, Australia.

Varner JA, et al. (1998). Chronic administration of aluminum-fluoride and sodium-fluoride to rats in drinking water: alterations in neuronal and cerebrovascular integrity. Brain Res 1998;784:284-298.

Waldbott GL. (1956). Incipient fluorine intoxication from drinking water. Acta Med Scand;156:157-168.

Waldbott GL et al. (1978). Fluoridation the Great Dilemma; Coronada Press; Lawrence , KS, Chs.9 &14.

World Health Organization. WHO Oral Health Country/Area Profile Programme. Department of Noncommunicable Diseases Surveillance/Oral Health. WHO Collaborating Centre, Malmo University, Sweden. Available Online at http://www.whoco.od.mah.se/expl/regions.html (January 3, 2005) and displayed graphically at http://www.fluorideaction.org/who-dmft.htm (January 3 2005).

Xiang Qet al. (2003). Effect of fluoride in drinking water on children's intelligence. Fluoride;36:84-94.

Xiang Qet al. (2003). Blood lead of children in Wamiao-Xinhuai intelligence study. Fluoride;36:138-216.
___________________________________

Dr. Paul Connett,
Professor of Chemistry,
St. Lawrence university,
Canton, NY 13617.
315-379-9200
email: paul@fluoridealert.org

Deconstructing the response of Colin Rix and Diana Donahue to Mark Diesendorf's scientific arguments against fluoridation (January-February issue of Chemistry in Australia).

Dr. Paul Connett,
Professor of Chemistry,
St. Lawrence university,
Canton, NY 13617.
315-379-9200
email: paul@fluoridealert.org

Permit me if I may to jump into the fluoridation debate. For the past three years I have traveled three times to Australia and on each occasion I have challenged promoters of fluoridation to debate the issue with me on a public platform. Unfortunately, no government official or ADA spokesperson has agreed to do so. Now that we have a cogent article promoting fluoridation in your journal, I would like to join with Mark Diesendorf and engage in this debate and specifically respond to the arguments made by Rix and Donahue. Their response to Diensendorf's tightly argued and documented case against fluoridation, is the typical response from promoters of this practice. Sweeping claims are made but few references are given to the primary literature. Instead, they heavily rely on the "authority" of others to make their points. This "authority" usually takes the form of outdated reviews commissioned by pro-fluoridation governments. Examination of the up-to-date primary scientific literature undermines their case. Below I have reproduced Rix and Donahue's piece and indented my comments in red.

http://www.onlineopinion.com.au/view.asp?article=3016

The case for fluoride

By Colin Rix and Diana Donahue - posted Thursday, February 10, 2005 (http://www.onlineopinion.com.au/view.asp?article=3016)


Mark Diesendorf proposes that chemicals in food and drink, in this instance fluoride, are a threat to both the natural environment and social equity. The article fails to acknowledge the considerable number of studies in recent years, several of them pivotal in terms of study design and adjustment for confounding factors, that have rigorously examined the effects of fluoride on human health. There is now overwhelming evidence that adding trace amounts of fluoride to water supplies has led to a dramatic decrease in the incidence of dental caries, particularly in children.

Response: No studies are cited to support these claims. In actual fact, the latest studies from Australia indicate little to no benefit accruing from water fluoridation to the permanent teeth, larger benefits were found for the primary teeth. These studies are in line with the largest study ever conducted in the US (Brunelle and Carlos, 1990). In the 1996 study by Spencer et al. the teeth of children in Queensland and South Australia were examined and a miniscule saving of 0.12 and 0.3 permanent tooth surfaces (out of 128 tooth surfaces in a child's mouth) was recorded. In the 2004 study by Armfield and Spencer no difference was found between the permanent teeth of children who had spent all their lives drinking fluoridated water and these drinking either tank or bottled water.

The strength and vitality of a society are vested in the opportunity for balanced and informed debate on issues of public concern, especially if it challenges an established practice or long-held belief.

Response: This is true. So it is a great shame that Australian authorities and professinal bodies have steadfastly refused to debate with me on this issue in three separate visits to Australia, or even respond in writing to carefully documented objections to this practice (see http://www.fluoridealert.org/50reasons.htm)

Society‚s attitudes change, and new research can clarify issues of concern or point to other unforeseen consequences, as exemplified in our attitude to smoking and asbestos products, and the recent withdrawal of the antiarthritic drug Vioxx® from the Australian market.

Response: True again. Thus the authors should be concerned about the recent findings that fluoride lowers IQ (Xiang et al. 2003); accumulates in the pineal gland (Luke, 1997, 2001) and other impacts discussed below.

Governments are charged with caring for the society they represent in a benign and cost-effective manner, and they have an obligation to consider carefully any recommendations from their expert committees prior to implementation. Public health programs are a balance between the benefit to society and the infringement of an individual‚s rights, as illustrated by the examples of vaccines and chest X-rays. Similarly, water fluoridation provides dental health benefits to society in a cost-effective and socially equitable manner. It can be compared to the addition of vitamin D to margarine to maintain healthy bones, or folic acid to cereals to reduce the risk of pregnant women bearing children with spina bifida.

Response: Neither of these comparisons are valid. 1) Both vitamin D and folic acid are essential nutrients, fluoride is not. 2) The margin of safety for them both is very large where with fluoride it is very small. 3) In both cases the health outcomes being treated are far more serious.

Fluoride occurs naturally in soil, water, plants and animals in trace quantities. It is the thirteenth most abundant element in the earth‚s crust. Fluoride compounds in air rank third in air pollutants. Fluoride occurs naturally in all water supplies, mostly at levels too low to protect teeth from dental decay. It is present to some extent in most foods and drink. It is impossible to devise a fluoride-free diet.

Response: The natural occurrence and relative abundance of fluoride hurts - not helps -the pro-fluoride case. The natural level of most interest is the level in human milk. If fluoride was necessary for healthy teeth (or anything else for that matter) this is where you would expect to find it. The level is actually remarkably low, ranging from 0.005 to 0.012 ppm (Institute of Medicine, 1997). Why did evolutionary forces - with plenty of fluoride to draw from (it occurs on average at 1.4 ppm in sea water) fail, or choose not, to provide it in any significant quantity in baby's first meal? By adding fluoride to water this means that a bottle fed baby will get between 100-200 times more fluoride than nature intended. Are we to believe the preposterous notion that dentists know more about the baby's nutrition than mother nature?

Fluoride is not classified as a medication by medical authorities. In those communities with naturally fluoridated water it was observed that fluoride protected against tooth decay and that in some areas dental fluorosis occurred.

Response: These early observations and trials have been heavily criticized for methodological inadequacies (Sutton, 1996).

Subsequent observation and experiment found that 1 ppm fluoride gave a balance between reduced decay and a minimal risk of mild dental fluorosis.

Response: This was the theory. Today the rates of dental fluorosis are 3-5 times higher than the original goal. For example the dental fluorosis impacts 56% of children in South Australia (Spencer et al. 1996) and not all of it occurs in the very mild or mild categories. The original goal was to reduce tooth decay and hold the percentage impacted with dental fluorosis to 10% of children in its very mild condition (NRC, 1993).

Fluoride is absorbed mostly from the stomach and small intestine and about half is then excreted in the urine. Most of the retained fluoride is taken up by bones and teeth. Very small amounts circulate in the blood and saliva and there is virtually none in other body tissues.

Response: In 1997 Luke showed that fluoride accumulates in the human pineal gland (Luke, 1997, 2001).

The fluoride content of teeth reflects the biologically available fluoride at the time of tooth formation. After this time fluoride levels remain constant, except for the outermost layer of the enamel. This is important for two reasons. First, it means that at the time of tooth development only what was available after absorption can form part of the tooth structure. Once the tooth is formed no more fluoride is incorporated into it, but this does not apply to the enamel surface. Second, for enamel protection the tooth surface needs continuous bathing with fluoride.

Decay was previously thought to be prevented by incorporation of fluoride into the tooth enamel during formation. It is now known that decay prevention occurs on the surface of the tooth. Fluoride can be leached from the tooth surface as liquids pass over it, so it is important to protect erupted teeth by maintaining fluoride levels at the enamel surface. The presence of fluoride in plaque and saliva aids remineralisation of the enamel lesions before cavities become permanent. In this way it benefits both children and adults.

In erupted teeth, there is no doubt that the action of fluoride is essentially topical "surface ion exchange", whereby the fluoride ion exchanges with the isostructural hydroxide ion present in the hydroxyapatite biomineral in teeth (and bone) to strengthen enamel and promote the remineralisation of microcavities, which form on teeth every day.

Certainly, ingestion leads to systemically absorbed fluoride, which can bathe the teeth as it is recycled in saliva - this not only ensures protection of the enamel, but also acts on cementum at the base of the tooth as gum shrinkage occurs. In older people, fluoride helps reduce the incidence of root surface decay as the surface becomes exposed to oral bacteria when the gums shrink. It also reduces the incidence of decay of the crown of the tooth. This is significant for the health of adults and, especially, aged people, because the single most important factor in maintaining health of the aged is good dental health for adequate nutrition.

Response: In the above 4 paragraphs the authors are confirming what Diesendorf reported: most dental researchers now conclude that fluoride's benefits are predominantly topical not systemic (CDC, 1999). However, Rix and Donahue avoid the logical conclusion from this important finding. A more sensible approach to deliver fluoride topically is to use fluoridated toothpaste, which largely avoids systemic exposure and systemic risks, as well as avoiding the unsavory business of forcing fluoride on people who don't want it, of which there are many.

The health concerns raised in Diesendorf‚s article regarding fluorosis, bone effects, mental acuity and so on, have been reviewed extensively and exhaustively in our recent document commissioned by the National Health and Medical Research Council (NHMRC) in 1999. In that instance, an independent expert group of toxicologists, chemists, pharmacologists and epidemiologists concluded, on the basis of current information, that there were no unforseen consequences that might arise from fluoride exposure at the nominal 1 ppm level in drinking water. The evidence indicated that the current levels of fluoride added to drinking water supplies throughout Australia did not need altering (from the current 1.1 ppm in temperate Hobart to 0.6 ppm in subtropical Darwin, allowing for different water intake depending on climate).

Response: It is interesting that the authors are happy to cite the "authority" of the NHMRC but fail to point out that this same agency in 1991 urged the Australian health authorities to collect fluoride bone levels to check on a possible relationship between fluoride and bone damage and investigate in a scientific fashion the numerous reports from individuals of hypersensitivity to fluoride. Such anecdotal reports are backed up with published case studies and double blind trials (Waldbott, 1956; Feltman, 1956; Feltman and Kossel,1961; Shea et al., 1967 Grimbergen et al., 1976; Waldbott et al. 1978) who report hypersensitivity to fluoride even at 1 ppm in water and at 1 milligram per day when administered in tablet form. No Australian health authority has commissioned follow up scientific studies on this serious issue and for that matter none has commissioned any study on fluoride's possible impact on any body tissue or organ other than the teeth. Nor did Rix and Donahue point out that these NHMRC reports on fluoridation have been discontinued, despite (and possibly because of) the growing scientific evidence that long term exposure to fluoride in water and other sources is leading to detectable health problems.

Since then, several other groups have reported extensive studies and made similar conclusions based on new evidence. The author‚s interpretation of the negative health effects of fluoride listed in the Table in his article is at odds with the numerous peer-reviewed journal articles in the literature

Response: Rix and Donahue cite no supporting references for this sweeping dismissal.

References to websites are of little value unless their validity can be established by independent peer review.

Response: Diesendorf offered these websites as a convenient way of listing all the peer reviewed and published articles that support his concerns.

It should also be noted that the NHMRC review The Effectiveness of Water Fluoridation explicitly examined the author‚s claims about fluoride.

It is public knowledge that fluoride, like any other chemical, including vitamins and iron tablets, is a poison at high doses. The fatal dose for a 70 kg adult is equivalent to drinking about 2500 litres of optimally fluoridated water. Toxic effects may occur at moderate levels of exposure.

Response: Here the authors missed a splendid opportunity to quantify this argument by offering what they consider to be an adequate margin of safety for chronic effects. As Diesendorf explained, normally a toxicologist or pharmacologist would like to see a margin for safety between the dose causing the lowest observable adverse effect and therapeutic dose of 100. If Rix and Donahue had compared this ideal with recent findings in the literature they would be appalled at just how little, or no, margin of safety there is. Water is fluoridated at 1 ppm fluoride. At this level dental fluorosis rates range from 30-50% of children exposed; moreover, Mexican researchers have found that the occurrence of bone fractures in children increase in a linear fashion with the severity of dental fluorosis (Alarcon-Herrera et al., 2001). At 1.5 ppm, hip fractures rates in the elderly in China double (Li et al., 2001); at 1.8 ppm, IQ in children is lowered in China (Xiang et al., 2003); at 2.3 ppm, thyroid function is lowered in Russia (Bachinskii, 1985); at 3 ppm, fertility is lowered in the US (Freni, 1994) and at 4.3 ppm, hip fractures are tripled in China (Li et al., 2001). Thus we have serious end points occurring with a margin of safety far less than 100, and even less than 5. When we consider that once fluoride is put into the water we cannot control the dose, because we cannot control how much water people drink, nor can we control the dose from other sources, one is forced to conclude that this policy is being recklessly pursued in the face of ample warnings provided in peer reviewed and published literature.

Skeletal fluorosis occurs in countries where the natural concentration of fluoride in water is more than 8 ppm and exposure is for 20 years or more. This is not a public health issue in Australia. Fluoride is indeed deposited in the bones, and gradually accumulates with time, but epidemiological studies do not indicate any causal association between fluoride and bone disorders.

Response: It is puzzling how Rix and Donahue can claim this when no studies on fluoride's impact on bone in Australia have ever been conducted. Australia hasn't even undertaken the most elementary of tasks, i.e. collecting fluoride bone levels. Thus, their conclusion is highly optimistic considering that the first symptoms of fluoride poisoning of the bones is identical to arthritis (Singh et al., 1963; Jolly, 1968 and DHHS, 1991) and we have millions of people (1 in 3 American adults, CDC, 2002) suffering from some form of arthritis.

Studies of the effect of exposure to fluoridation on fracture incidence have shown fracture incidence to decrease, increase or remain unaffected. These results are inconsistent because the studies were poorly designed, using small numbers of people different methods and differing fluoride levels.

Response: Actually some of the studies were very large (Jacobsen et al., 1990 a) and b))

They did not always consider confounding factors such as age, diet, weight, physical activity, hormone therapy, alcohol use and smoking, all of which are well recognised influences on the risk of fractures.

Response: Rix and Donahue should carefully review the study by Li et al. (2001) which examined elderly citizens in 6 Chinese villages (with approximately 1000 citizens in each village). This study was published in the Journal of Bone and Mineral Research, the leading journal in this field. The authors found that hip fractures doubled (compared with the village at 1 ppm fluoride) in the two villages with levels between 1.5 and 3 ppm, and tripled in the village with levels between 4.3 and 8 ppm. The authors will be hard put to explain away this dose response increase with the factors cited above.

The better designed studies suggest water fluoridated at optimal levels has a protective effect against hip fracture.

Response: If the authors are referring to the Phipps study (Phipps et al. 2000), they fail to acknowledge that this received a rather low quality rating from the York Review (McDonagh et al. 2000) and also that the same study found an increase in wrist fractures!

Several well-designed studies after 1998 have similarly found either no increase in the risk of hip fracture or a reduced risk with optimally fluoridated drinking water.

Response: Unfortunately, this comment is not supported with any citations. But note the study by Li et al., 2001 discussed above.

Dental fluorosis is a defect in the development of tooth enamel. The link between natural levels of fluoride in drinking water and dental fluorosis has been known for over 100 years. Fluorosis occurs at exposures to fluoride above the optimal level. Mildly fluorosed enamel is fully functional and resists acid attack better than enamel from low or optimally fluoridated areas. Dental fluorosis occurs in both fluoridated and non-fluoridated areas. Some overseas studies show the biggest increases in its incidence are in areas of non-fluoridated water supply.

Response: Again this latter point hurts not helps the argument for the fluoridation of more communities in Australia, since the fluorosis rates in non-fluoridated communities in Western Australia and South Australia are approximately 30%, i.e. three times the level associated with an "optimal" dose of fluoride (Spencer et al., 1996). Thus children in Australia are already being exposed to fluoride without water fluoridation. Unfortunately, Australian authorities are ignoring the advice of the World Health Organization (1984) who recommend that officials take into account the current total exposure to fluoride from other sources before embarking on water fluoridation programs. This has seldom, if ever, been done in Australia or in other countries promoting and practicing fluoridation.

Dental fluorosis is a result of total fluoride absorption from all sources - natural sources, fluoridated water, or inappropriate use of fluoride toothpaste and or supplements at a young age. It is acknowledged that children should not receive excessive amounts of fluoride, so much so that manufacturers formulate specific toothpaste for children and recommend its use in small amounts, to reduce the risk of mottled enamel. The crucial age for fluoride intake as a risk for dental fluorosis is from 22 to 26 months, the time of development of the permanent front teeth. Adults do not develop dental fluorosis. Dental fluorosis is undesirable but not a threat to health. It is not as disfiguring or disabling as severe tooth decay or missing teeth.

Response: But see the Alarcon-Herrera et al. (2001) study from Mexico which indicates that increased bone fractures in children are linearly related to the severity of dental fluorosis. The fracture rates double when comparing children with very mild dental fluorisis with those with no dental fluorosis.

Claims that fluoride is allergenic are not supported.

Response: Again, no references are given and the assertion is particulalry outrageous since the Australian authorities have failed to follow up on the 1991 NHMRC request that they investigate this issue.

Evidence shows that fluoride is unlikely to produce effects on the immune system. There is strong evidence against suggestions linking Down syndrome to fluoridation. Claims that optimally fluoridated water causes repetitive strain injury (RSI), sudden infant death syndrome (SIDS), diminished intelligence or Alzheimer‚s disease are unsubstantiated. The Alzheimer‚s Association itself supports fluoridation to help maintain the dental health of those with dementia.

Response: In this latter point we again see Rix and Donahue resorting to "authority" rather than reference to the scientific literature. Dismissal of such evidence out of hand is cavalier to say the least. For example, a study by Varner et al. (1998) indicates that rats fed fluoride at 1 ppm in their water led to an increase of aluminium in their brains as well as the formation of beta amyloid deposits which are characteristic of Alzheimer's disease.

The assertion that fluoride has "been largely ignored in Australia as a toxic chemical" is incorrect. Fluoride has been subject to considerable and continuing investigations regarding all aspects of human health.

Response: The only studies in Australia have been on teeth, despite requests from the NHMRC (1991) to look at other tissues. The rest of the investigations have taken the form of reviews of the literature, and often - as in this case - selective, self-serving and out of date reviews at that.

It is trite to suggest that fluoride is "the protected pollutant", since it has undergone intensive scientific scrutiny over many years, and is still considered a benign and efficacious means of preventing tooth decay.

Response: This view is not held by most independent reviewers of this practice.

In many countries, particularly in Europe, where for technical or other reasons it is not feasible to fluoridate the water supply, table salt or milk are fluoridated.

Response: For a more accurate summary of why the majority of European nations have rejected water fluoridation see http://www.fluoridealert.org/govt-statements.htm .

Indeed, the health effects of fluoride have been reviewed by "socially responsible chemists and biochemists", and their deliberations and conclusions conveyed to both the Commonwealth Government, through the NHMRC, and the Victorian Government, in an independent enquiry, and through the Department of Human Services.

Response: These reviews are all outdated by research reported since 1999.

In Australia in the 1950s, dental decay in children and adults was uniformly and uncontrollably high across social and demographic boundaries. In 1953, the Tasmanian town of Beaconsfield was the first in Australia to add fluoride to a public water supply. During the 1960s and 1970s, water fluoridation was introduced in most Australian capital cities. Dental decay has since declined in most Australian children to about 10 per cent of what it was in the 1950s.

Response: Rix and Donahue somehow manage to ignore the fact that tooth decay has come down as dramatically in non-fluoridated communities in Australia as in fluoridated ones. A result which is also observed in non-fluoridated countries compared to fluoridated ones (see WHO figures available online). In fact Mark Diesendorf was one of the first scientists to point this out in a seminal paper published in Nature in 1986.

About three quarters of Australians receive the health benefit of living in fluoridated water areas. Dental health in fluoridated areas is significantly better than in nonfluoridated areas.

Response: Again, the studies from pro-fluoridation Australian researchers fail to support this claim see Spencer et al. 1996 and Armfield and Spencer, 2004, and discussed above.

The best available evidence from studies after cessation of water fluoridation demonstrates a subsequent increase in the incidence of dental decay.

Response: Four recent studies conducted in former East Germany (Kunzel, 2000), Finland (Seppa et al., 2000), British Columbia (Maupome et al., 2001) and Cuba (Kunzel and Fisher, 2000), fail to support this claim.

Australia has established, centralised and regulated supplies of reticulated water. The fluoridation process and levels in domestic water are monitored regularly to ensure a reliable source in compliance with the Australian Drinking Water Guidelines. The government‚s peak medical advisory body, the National Health and Medical Research Council, reaffirmed in 1993, and again in 1999, that fluoride concentrations in public water supplies ranging from 0.6 to 1.1 ppm, depending on the climate, are a safe and effective dose of fluoride for dental health.

Response: Again, note the resort by Rix and Donahue to authority rather than the primary literature.

Water fluoridation has been endorsed by more than 150 public health and scientific organisations

Response: but rejected by the vast majority of countries worldwide;

including the Fédération Dentaire Internationale;

Response: endorsement by the dental establishment is a self-fulfilling prophesy;

Irish Forum on Fluoridation

Response: This report was a travesty and represents a triumph of politics over genuine science. Out of 285 pages only 17 pages were devoted to health and of those only 2 pages dealt (and selectively) with primary studies on one end point, even ignoring the study I presented to them in person!

International Association for Dental Research;

Ontario Ministry of Health, Canada

Response: In a report commissioned by this authority, Dr. David Locker reported that "The magnitude of the effect (benefit of water fluoridation, PC) is not large in absolute terms, is often not statistically significant and may not be of clinical significance";

UK National Health Service Centre for Reviews and Dissemination, University of York;

Response: To characterize the York review as offering unreserved support for fluoridation is perverse. Four people associated with the York Review - Professor Jos Kleijnen and Professor Trevor Sheldon of York University, Professor George Davey-Smith of Bristol University and Sir Iain Chalmers of the Cochrane Centre - informed Hazel Blears, the UK public health minister that they "could discover no reliable, good quality evidence in the fluoridation literature worldwide" and added, "What we found suggested that fluoridation was likely to have a beneficial effect, but in fact the range could be anywhere from a substantial benefit to a slight disbenefit to children's teeth." http://www.fluoridealert.org/news/1569.html);

and WHO

Response: WHO's key recommendation - as explained above -is being ignored by Australian authorities.

The British Medical Association, the British Dental Association and the British Fluoridation Society remain convinced that there is no definitive evidence of any adverse risk to human health from water fluoridation, and that introduction of fluoridation in areas of high need would significantly reduce tooth decay and bring the additional benefit of a reduction in the number of general anaesthetics administered to children.

Response: It is not difficult to convince these 'authorities' since they have been promoting the practice for years!

The American Dental Association estimates that "<sum> every dollar spent on putting fluoride in water saves about $80 in dental health costs <sum>"

Response: These calculations are crude. They ignore the costs of treating dental fluorosis, or any other health effect and they gloss over the key economic fact that if authorities were forced to use pharmaceutical grade fluoride, instead of an industrial waste product from the phosphate fertilizer industry, the costs would be prohibitive.

In April 1999, the Centers for Disease Control and Prevention stated, "Community water fluoridation ranks with eradication of smallpox and polio as one of the 10 great public health achievements of the 20th century".

Response: If Rix and Donahue were to actually read the report on which this statement was based (CDC, 1999), I feel they would be embarassed. Incredibly, health concerns were dismissed by the CDC authors in just one sentence based upon a review (NRC, 1993) which was already six years out of date in 1999 and now 12 years out of date. Moreover, it needs to be pointed out that this same agency - the (US) National Research Council is repeating their analysis of health concerns based upon the recent literature , some of which I have cited above.

In conclusion, on the basis of the current evidence, it would be remiss of government to deny the community the public health benefits from water fluoridated at the optimal levels.

Response: If, Australian authorities are going to rely on the CDC or NRC to convince them that there are no health problems, they would be remiss not wait for the publication of the NRC review this year, before imposing water fluoridation on more communities. They should also be prepared to jettison the whole sorry practice if the NRC confirms all or some of the findings outlined above.

Please make this small correction to my commentary on fluoridation. Please exchange the word overexposed for exposed in this sentence:

"Thus children in Australia are already being exposed to fluoride without water fluoridation."

it should read:

"Thus children in Australia are already being overexposed to fluoride without water fluoridation."

Pleae also note that while I was mastering the buttons to send these electronic comments, I sent the references before my commentary!

Dr. Paul Connett,
Professor of Chemistry,
St. Lawrence University,
Canton, NY 13617
315-379-9200
email: paul@fluoridealert.org

In their article Colin Rix and Diana Donahue say "Fluoride is not classified as a medication by medical authorities".

It is irrelevant that Australian Medical authorities do not classify fluorosilicic acid as medication. It is the intent to cause bodily change i.e. make teeth more resistant to decay (whether it works or not), that makes the fluoridating agent a medicine. Directive 2001/83/EC of the European Parliament and of the Council of 6 November 2001 on the Community code relating to medicinal products for human use defines a medicinal product as:

'Any substance or combination of substances presented for treating or preventing disease in human beings.'

'Any substance or combination of substances which may be administered to human beings with a view to making a medical diagnosis or to restoring, correcting or modifying physiological functions in human beings is likewise considered a medicinal product.'

I would expect a similar definition somewhere in Australia. The fact that fluorosilicic acid is being used to medicate Australians without a medicinal licence and without the individual consent of the recipients is something that should be taken-up in the Australian courts.

At last, a voice of reason in the fluoridation debate. Thank you Colin Rix and Diana Donohue.
Can those opposed to fluoridation please explain why more than 100 of the world's leading health and scientific authorities endorse water fluoridation? These authorities are the most respected agencies in the world, both government and non-government. Is it a vast, world-wide conspiracy to poison people, or is it just possible that fluoridation is both safe and effective?
Why is it that most of the "scientific studies" quoted by Dr Connett and fellow anti-fluoridationists are irrelevant to optimal water fluoridation, misquote legitimate health and scientific authorities, or are taken from junk journals such as Fluoride? As an example, consider the very first "study" quoted by Dr Connett in this forum; Alarcon-Herrera MT et al. (2001). Well water fluoride, dental fluorosis, bone fractures in the Guadiana Valley of Mexico. Fluoride;34:139-149.
Almost all the areas surveyed in the study had naturally occurring fluoride levels many times higher than those found in artificially fluoridated areas. The authors subjectively selected only bone fractures "that had ever occurred without apparent cause, where a bone fracture would not normally be expected to occur". They admit that validation was a difficult task "because we depended on the subjectivity of both the interviewer and the interviewed". The authors also found that "the incidence of fractures was found to decrease at higher fluoride concentrations", but could not explain why this could be the case. And "studies" of this calibre are used to argue against optimal water fluoridation. Puh-lease...
Why, of the 37 studies quoted by Dr Connett, do only about a third actually relate to optimal water fluoridation? At least a dozen of his quoted authors actually support the caries preventive effect of fluoride and water fluoridation. And yet Dr Connett quotes them to support his case! Does he expect no-one to actually read the articles?
The reason that the practice of water fluoridation continues to grow throughout the world is simple. It strengthens teeth against tooth decay and it's safe. End of story.