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.

Another argument against fluoridation is the risk in transporting a dangerous substance.

http://www.azcentral.com/news/articles/0205downtownhaz05.html

Acid spill downtown sends 16 to hospitals

Judi Villa and Jacqueline Shoyeb
The Arizona Republic
Feb. 5, 2005 12:00 AM

A truck traveling through Phoenix leaked more than 110 gallons of hydrofluorosilic acid on Friday, closing a significant part of downtown and keeping residents inside.

Sixteen people - the truck's driver, 11 police officers and four civilians - were taken to hospitals for evaluation because they may have stepped into the liquid. Three firefighters also were evaluated for possible exposure.

Dr. Paul Connett responds to MF.

MF: At last, a voice of reason in the fluoridation debate. Thank you Colin Rix and Diana Donohue.

MF: Can those opposed to fluoridation please explain why more than 100 of the world's leading health and scientific authorities endorse water fluoridation?

PC RESPONSE: Can MF explain why it is with such illustrious support, the vast majority of countries worldwide have not succumbed to this practice? Only a handful of countries – largely English speaking –have more than 50% of their population drinking artificially fluoridated water (i.e. Australia, Columbia, Hong Kong, Ireland, Israel, Malaysia, New Zealand and the United States).

MF: These authorities are the most respected agencies in the world, both government and non-government.

PC RESPONSE: As a scientist I was trained to examine the evidence and not simply rely blindly on "authority" no matter how impressive that authority might appear to be. Respect has to be earned and earned every day by the quality of one’s work and the integrity with which it is applied. Whatever the track record of these agencies has been in other areas, I am sad to say that neither the quality of their work on fluoridation nor the integrity with which they have pursued the issue is very impressive.

PC: Very few of these bodies have done their own independent work or scientific review of this issue. Unfortunately, once the US Public Health Service endorsed fluoridation in 1950 (before one single trial on fluoridation was more than half complete, and before any long term health effects had been studied) most of these agencies –at least the American ones – fell into line. Simply put, they are either part of the US Public Health Service, or they receive a bulk of their research funds from one or more of their agencies. The old adage applies: you don’t bite the hand that feeds you.

PC: Professional organizations like the American Dental Association (ADA) have ways of keeping their members in line on this issue. Here for example is a quote from an 1979 ADA white paper:

"Individual dentists must be convinced that they need not be familiar with scientific reports of laboratory and filed investigations on fluoridation to be effective participants in the promotion program and that nonparticipation is overt neglect of professional responsibility."

PC: Here is another from Dr. Michael Easley, a sometime spokesperson for the American Dental Association and the American Council on Science and Health:

"Like parasites, opponents steal underserved credibility just by sharing the stage with respected scientists who are there to defend fluopridation. Unfortunately, a most flagrant abuse of the public trust occasionally occurs when a physican or a dentist, for whatever persoanl reasons, uses their professional standing in the community to argue against fluoriadtion, a clear violation of professional ethics, the principles of science and community standards of practice." (Easley, 1999)

PC: If they were pursuing a sound policy the dental establishment would not need to intimidate their own rank and file; ridicule opponents and refuse open public debate.

MF: Is it a vast, world-wide conspiracy to poison people, or is it just possible that fluoridation is both safe and effective?

PC RESPONSE: Hardly worldwide, since so few countries actually fluoridate their water. But conspiracy is a loaded word. Let’s simply say that huge economic interests have benefited greatly from the distraction that fluoridation provides:

a) It draws attention away from the harmful effects fluoride has had on workers’ health and the local environment of many industries which either use fluoride in their manufacturing processes (like the aluminum, steel and other metal industries and the nuclear industry) or produce it as a byproduct (like the phosphate, ceramic and brick industries). Their involvement in the propagation of this practice is fully and meticulously documented in The Fluoride Deception by Chris Bryson which was published last year.

b) It drew attention away from one of the causes of tooth decay: over-consumption of sugary foods. The US sugar lobby - the year before the US PHS endorsement of fluoridation - was on record as saying that they wanted to find a way to reduce tooth decay without reducing sugar consumption, and subsequently they have put a considerable amount of money into fluoride research.

c) It draws attention away from the failure of the US to provide decent dental care for poor children. Over 80% of American dentists refuse to treat children on Medicaid.

PC: As far as the quality of fluoridation research is concerned, it is extraordinary to me that the most fundamental of studies has not been performed. For example, even though we have known for years that about 50% of fluoride ingested each day accumulates in our bones and steadily increases over a lifetime, no government promoting fluoridation has yet to undertake a comprehensive analysis of bone levels in their population, (or for that matter plasma levels or urine levels). We are flying blind, even while we are seeing a massive rise in arthritis, osteoporosis, and hip fractures in the elderly. Another example is that even though it has been known for over 60 years that there is a very strong correlation between the severity of dental fluorosis and level of exposure to fluoride before a child’s second teeth have erupted, this obvious biomarker has seldom been used in epidemiological studies to investigate possible connections between fluoride exposure and health concerns in children. Despite the millions of dollars spent by the Australian government on promoting fluoridation they have not sponsored one primary study on health effects on any organ but the teeth.

PC: When the York Review panel examined 3200 papers on the safety and effectiveness of fluoridation not one study was given a high quality rating (i.e. minimal risk of bias). Only 252 met their inclusion criteria (B and C quality –i.e. moderate and high risk of bias). Considering the enormous promotion that fluoridation has received from governments in the US, Australia, Britain, Ireland and New Zealand for over 40 years, it is astonishing to find how low a quality the studies have been which they have largely funded.

PC: As far as the integrity of their work is concerned, let us look at one of the most prestigious agencies on MF’s list of 100: the US Centers for Disease Control and Prevention (CDC). This agency has been quoted worldwide as saying that fluoridation is "one of the top 10 public health achievements of the Twentieth Century" (CDC, 1999). However, as I explained in my earlier comments above, the report on which this statement was based was six years out of date on the health studies it cited to support its claim that the practice was "safe". As far as their demonstration that fluoridation was "effective", the evidence produced was laughable. In the only figure produced in the paper they showed a graph covering the period from the 1960s to 1990s and on this graph they had two lines. One line represented the tooth decay in 12 year olds as measured by decayed missing and filled permanent teeth (DMFT). This line was coming down. A second line showed the percentage of the US population drinking fluoridated water. This line was going up. Voila. Cause and effect. Tooth decay in the US was coming down because the percentage of the US population drinking fluoridate water was going up! One would have thought that such a "prestigious and highly respected agency" before printing this simplistic nonsense would have first checked out to see what was happening to dental decay in 12 year olds in other countries – both fluoridated and non-fluoridated. It turns out that this data is available online from the WHO. It shows just as dramatic declines in tooth decay over the same time period in 16 non-fluoridated countries as in 4 fluoridated ones. Readers can compare the CDC graph with the WHO data (displayed graphically) at http://www.fluorideaction.org/who-dmft.htm. I will leave it to readers to decide whether this CDC figure was an example of gross incompetence or a deliberate attempt to deceive.

MF: Why is it that most of the "scientific studies" quoted by Dr Connett and fellow anti-fluoridationists are irrelevant to optimal water fluoridation,

PC RESPONSE: I consider myself an independent scientist who has patiently and independently examined the literature on this issue for over 8 years (i.e. twice the length of time that I spent on my PhD). It is undignified of MF to attempt to trivialize my efforts by putting scientific studies in quotation marks, and to label me as a "fellow anti-fluoridationist" as if I had joined some cult. None of the scientific studies I cite are irrelevant to optimal fluoridation.

MF: …misquote legitimate health and scientific authorities,

PC RESPONSE: MF gives no example of where I have misquoted any one. Will he please retract this statement or give an example?

MF: …or are taken from junk journals such as Fluoride?

PC RESPONSE: I do not believe that Fluoride is a junk journal. Far from it. It has been one of the few journals to bring the important research on fluoride toxicity being carried out in India and China to the attention of the English speaking world.

MF: 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.

MF: 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...

PC RESPONSE: Here MF completely misses the crucial point. The correlation was not between bone fractures in children and the level of fluoride in the water (i.e. it was not an ecological study) but between bone fractures in children and the severity of their dental fluorosis (a biomarker for fluoride exposure). This correlation was almost linear, with the highest incidence of bone fracture associated with the most severe level of dental fluorosis. This part of the study was blind to the level of fluoride in the water and how much the children may have drunk.

PC: While there may be limitations to this study it is very important since it suggests that dental fluorosis is more than just a "cosmetic effect" as claimed by those promoting fluoridation, and could well signal damage to the bones as well as the dental enamel. Rather than dismissing this study out of hand as MF and most pro-fluoridation governments have, it needs careful repeating. This is especially so since this is not the only evidence that fluoride damages bones in children. In one of the early trials of fluoridation in the US (Schlesinger et al. 1956 see also NAS, 1977). Children in fluoridated Newburgh, NY had significantly more (13.5 versus 6.5%) cortical bone defects than children in non-fluoridated Kingston, NY (the control city). The importance of this is that it is the cortical bone (the outside layer of the bone) which provides the key resistance to bone fracture (particularly in the arms and legs). Any defects in the cortical bone could thus lead to increased fracture rates as observed by Alarcon-Herrera et al (2001).

MF: Why, of the 37 studies quoted by Dr Connett, do only about a third actually relate to optimal water fluoridation?

PC RESPONSE: MF’s arithmatic is rather suspect here. I count 25 studies which directly examine the impacts of "optimal" water fluoridation. It is true that a few of the papers examine effects at higher concentrations (Bachinskii, Li and Xiang) but that is important because while the concentration of fluoride added to water can be controlled, the dose to recipients cannot. It is critically important to find out what effects can occur at higher concentrations as a way of estimating what might happen to those recipients who drink large quantities of water and receive doses from other sources. No regulatory toxicologist would refuse high dose data to tease out effects which might occur in vulnerable individuals within an heterogeneous population. In the studies I cited the authors report serious impacts at only slightly higher concentrations of fluoride in the water (1.5 –4.3 ppm) than the so-called optimal concentration of 1 ppm.

MF: 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?

PC RESPONSE: I only make it 6 authors ( Brunelle, Carlos, Spencer, Slade, Davies and Armfield) but do please read the articles MF, because the findings from these pro-fluoridation researchers, strengthens the opponents’ case not weakens it, as you imply. When one reads their papers one finds a huge discrepancy between what they actually found and how they use their findings to support water fluoridation.

PC: For example, in table 6 in the Brunelle and Carlos paper (1990) they indicate an average DMFS for children (5-17) who have all their lives in a non-fluoridated communities of 3.36 and for the fluoridated ones of 2.76. If we subtract 2.76 from 3.36, we get a saving of 0.6 tooth surfaces. This represents a saving of less than 0.5% of the 128 tooth surfaces in a child’s mouth. However, that is not how they report it, they report it as an 18% saving in tooth decay (exploiting the vagaries of comparing two small numbers). Even so this is much smaller than the 40-60% frequently claimed by fluoridation promoters.

PC: More to the point, here is how they describe this miniscule saving of 0.6 of one tooth surface (which was not even shown to be statistically significant) in their abstract, which sadly is often all that busy decision makers get a chance to read:

"Children who had always been exposed to community water fluoridation had mean DMFS scores about 18% lower than those who had never lived in fluoridated communities. When some of the "background" effect of topical fluoride was controlled, this difference increased to 25%. The results suggest that water fluoridation has played a dominant role in the decline in caries and must continue to be a major prevention methodology."

PC: In the abstract of the Spencer et al. (1996) paper the authors write:

"In the press and scientific literature there has been questioning of fluoridation, although the most recent Australian review reasserted its safety and effectiveness. Results from Australian oral epidemiological studies consistently support the accumulated evidence on the effectiveness of water fluoridation. This includes recent evidence that lifetime exposure to fluoridation is associated with average reductions of 2.0 dmfs and between 0.12 and 0.3 DMFS per child compared with non-exposed children."

PC: When we translate the technical terms we find that Spencer et al. are offering a saving of between 0.12 and 0.3 permanent tooth surfaces (out of 128 tooth surfaces in a child’s mouth) as "evidence of the effectiveness of water fluoridation". This is even smaller than the miniscule saving reported by Brunelle and Carlos!

PC: In the abstract of the Armfield and Spencer (2004) paper the authors write:

"The consumption of nonpublic water (i.e. tank and bottle water, PC) on permanent caries experience was not significant."

PC: But that didn’t stop Dr. Spencer in an interview in the Sydney Morning Herald (November, 2004), recommending that bottled water be fluoridated!

PC: I think it is fairly clear that dental researchers worldwide know that in order to keep the money flowing into their research coffers they need to keep supporting the party line, even while revealing to those who take the trouble to actually read their papers, that they are not finding the evidence that water fluoridation is very effective, especially in protecting the permanent teeth.

PC: But possible motivation aside, it is important to stress that it is the promoters’ own literature which wins our argument: today there is no need to fluoridate the community’s water since those communities that don’t fluoridate their water have just as good (permanent) teeth as those that do. There may be several reasons for this, one of them being that there is far greater correspondence between tooth decay and poverty and poor diet than with lack of fluoride. Thus tooth decay in industrialized countries has come down in both fluoridated and non-fluoridated communities (and countries) as standard of living has gone up.

MF: 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.

PC RESPONSE: You wish!

MF (12/02/2005) has described Fluoride: quarterly journal of the International Society for Fluoride Research as an example of "junk journals". I would be grateful if the reasons for this view could be given. I commenced an association with this journal as an
Associate Editor in 1994 and have been Managing Editor since 1999. The journal indicates in its guidelines to authors that, as far as possible, the "Uniform requirements for manuscripts submitted to biomedical journals" prepared by the International Committee of Medical Journal Editors should be followed (updated last October 2004, and available at www.ICMJE.org). The editorial staff endeavour to follow these requirements. Readers may judge the degree to which they have succeeded at the journal's web page at http://homepages.ihug.co.nz/~spittle/fluoride journal.htm

Response to Rix and Donohoe by Dr Mark Diesendorf follows:

The commentary by Rix and Donohue on my article, “Sustainable development and toxic chemicals: the case of fluoride”, is disappointing, since it is full of the usual pro-fluoridation generalities, sweeping statements, spin substituting for science (e.g. “fluoride occurs naturally”), and appeals to pro-fluoridation authorities. It evades or misrepresents most of my specific points of concern, for example:

1. Many studies have reported skeletal fluorosis in several different countries (including the USA) where fluoride concentrations in drinking water are less than or approximately equal to 2.5 ppm and in one village as low as 0.7 ppm (1), which is even acknowledged in the profluoridation NH&MRC (1991) report. So why do Rix and Donohue persist, in the face of all the evidence, in fostering the false impression that that skeletal fluorosis is only seen above 8 ppm?

2. Toxicology generally requires that average exposure levels to chemicals be a factor of 100 below levels known to cause chronic health damage. This point evaded, as was my specific concern for babies who are fed on milk formula reconstituted with fluoridated water and ingest adult doses of fluoride daily (2) that are 100-200 times the doses received by breast-fed babies.

3. The majority of epidemiological studies published in refereed journals find an increased rate of bone fractures (especially hip fractures) in fluoridated communities. This point was misrepresented with claims that studies that found a positive association had inadequate samples etc. Actually, the reverse is true: most studies that failed to find an association had inadequate samples.

4. There is a substantial body of blind clinical studies, plus one double-blind epidemiological study, demonstrating that some people suffer hypersensitivity reactions to fluoride in drinking water or tablets or toothpaste. Rix and Donohue avoid the point by talking about allergies, which my paper does not mention. There is a difference -- allergies, as defined medically, involve the immune system, while hypersensitivity reactions may or may not involve the immune system.

5. Everyone agrees that large reductions in dental caries have occurred from the 1960s onwards, especially in developed countries. But Rix and Donohue evade my point, that has been published in my 1986 paper in Nature (3), that such reductions occurred in both unfluoridated and fluoridated communities, including prefluoridation Sydney and unfluoridated Brisbane.

6. They misrepresent the results of recent studies on cessation of fluoridation published in international journals, which all find that dental caries either remained the same or decreased following cessation (4).

7. They ignore the recent major study by pro-fluoridationists, Armfield and Spencer (5), which could find no statistically significant benefit of fluoride in permanent teeth of South Australian children. They also ignore the two major studies on 84 US cities using National Institute of Dental Research data, which could find no benefit when DMFT was used as an indicator and only a tiny benefit when DMFS was used (6).

8. Their ‘response’ to my point that fluoridation is mass medication, is to compare fluoridation with vitamin D and folic acid. This implies incorrectly that fluoride is an essential nutrient like a vitamin. But there are case studies of communities with excellent teeth who have very low fluoride intakes and communities with rotten teeth who have high fluoride intakes. Therefore, fluoride at the doses of several mg/day delivered by fluoridated water is neither necessary nor sufficient for sound teeth. It is no more a nutrient than a dental fissure sealant. Therefore, since fluoride is not a nutrient and is used to treat people, it is a medication. That it is used preventively does not change the situation, since there are many preventive medications. That it is a natural substance does not stop it from being a medication, since many medications are, or were originally, natural substances: e.g. penicillin, aspirin and digitalis. Therefore, the ethical arguments about the use of medication – the need to deliver a controlled dose, informed consent, and randomised controlled trials to determine safety and effectiveness – should be applied to fluoridation. The fact that they are avoided demonstrates that fluoride is indeed the protected pollutant.

9. Rix and Donohue attempt to address seriously, if inconclusively, only one of my points. Unlike the Australian Dental Association they concede that the mechanism of action of fluoride on teeth is predominantly topical (i.e. a surface effect), but they claim that there are still benefits from ingested fluoride, because it returns to the mouth in saliva. They omit to inform readers that the resulting fluoride concentration in saliva resulting from the ingestion of 1 ppm fluoride drops rapidly to a a few percent of 1 ppm. The claim that such low concentrations have significant dental benefit is still an unproven hypothesis. Counter-evidence is that animal experiments can find no dental benefit from even high concentrations of fluoride that are introduced directly into the bloodstream, initially bypassing the mouth (7).

In general Rix and Donohue rely on ‘reviews’ and endorsements by pro-fluoridation bodies such as the NH&MRC, Australian Dental Association and Australian Medical Association, which originally endorsed fluoridation in the 1950s and have been defending their position ever since.

In particular, to claim that the 1991 NH&MRC review addressed my concerns, is a sick joke. Although the review was indeed nominally set up in response to a letter from Dr John Colquhoun, Dr Philip RN Sutton and me, its bias was demonstrated by its gross misrepresentations of our case and its failure to cite any of the many refereed publications that we had published on fluoridation in the scholarly literature and submitted to the review (8). I see the NH&MRC review as a public relations document designed to give the superficial appearance of scientific scrutiny without its substance. The PR aspect was demonstrated by the way the executive summary misrepresented the little bits of evidence unfavourable to fluoridation that somehow slipped into the main body of the report – e.g. the fact that skeletal fluorosis is seen in India when fluoride concentration is as low as 0.7 ppm appeared in Section 6.4 but, through slick wording, the executive summary created the false impression that no adverse effects are seen at or below 1 ppm. It appears that Rix and Donohoe did not read beyond the executive summary.

Finally , Rix and Donohue’s choice of compulsory mass chest x-ray campaigns as a precedent and justification of fluoridation, is unfortunate for their case. The campaigns were discontinued because they were creating more cancers through irradiation than lives were saved through the early detection of tuberculosis. They were more dangerous to Australians than fallout from the French nuclear tests that were being carried out at that time. As it happened, it was my colleagues and I in the then Society for Social Responsibility in Science in Canberra who identified the problem and campaigned in the public interest for several years until compulsory chest x-rays were discontinued (9).

Dr Mark Diesendorf
Email: mark@sustainabilitycentre.com.au

References
1. e.g. Singh A, Jolly SS & Bansal BC, 1961, Skeletal fluorosis and its neurological complications, Lancet 1:197-2000; Jolly SS, Prasad S, Sharma R & Chander R, 1973, Endemic fluorosis in Punjab. I. skeletal aspect, Fluoride 6:4-18; Siddiqui AH, 1970, Neurological complications of skeletal fluorosis with special reference to lesions in the cervical region, Fluoride 3:91-96; Misra UK et al. 1988, Endemic fluorosis presenting as cervical cord compression, Arch Environ Health 43:18-21; Pinet A & Pinet F. Endemic fluorosis in the Sahara. Fluoride 1(2):86-93; Juncos LI & Donadio JV 1972, Renal failure and fluorosis, JAMA 222:783-5.

2. Diesendorf M & Diesendorf A 1997, Suppression by medical journals of a warning about overdosing formula-fed infants with fluoride, Accountability in Research 5:225-237.

3. Diesendorf M 1986, ‘The mystery of declining tooth decay’, Nature 322: 125-129.

4. Seppa L, Karkkainen S, Hausen H. 2000, Caries Trends 1992-1998 in Two Low-Fluoride Finnish Towns Formerly with and without Fluoridation. Caries Research 34: 462-468; Kunzel W, Fischer T, Lorenz R, Bruhmann S. 2000, Decline of caries prevalence after the cessation of water fluoridation in the former East Germany. Community Dentistry and Oral Epidemiology 28: 382-9; Kunzel W, Fischer T. 2000, Caries prevalence after cessation of water fluoridation in La Salud, Cuba. Caries Research 34: 20-5; Maupome G, Clark DC, Levy SM, Berkowitz J. 2001, Patterns of dental caries following the cessation of water fluoridation. Community Dentistry and Oral Epidemiology 29: 37-47.

5. Armfield J & Spencer J 2004, Consumption of non-public water: implications for children’s caries experience. Community Dent Oral Epidemiol 32:283-96.

6. Yiamouyiannis J 1990, Water fluoridation and tooth decay: results from the 1986-1987 national survey of U.S. schoolchildren, Fluoride 23:55-67; Brunelle, JA & Carlos JP, 1990, Recent trends in dental caries in U.S. children and the effect of water fluoridation, Journal of Dental Research 69 (special edition): 723-727.

7. e.g. Mirth DB et al. 1985, Comparison of the cariostatic effect of topically and systemically administered controlled-release fluoride in the rat, Caries Research 19: 466-74.

8. Colquhoun J 1991, letter, Aust J Pub Health 15:308-9; Diesendorf M 1991, letter, Aust J Pub Health 15:309-10.

9. Diesendorf M 1975, Low level ionising radiation and man, Search 6 (8): 328-334.

The Rix and Donahue posting on the supposed "safety" of "fluoridation" ignores the evidence on differences between sodium fluoride (tested for safety and well known from toothpaste) and hydrofluosilicic acid (H2SiF6) or sodium silicofluoride (Na2SiF6) -- silicofluorides which were NEVER tested before their use began in the 1940s and was approved by the U.S. Public Health Service in 1950. Working with Myron J. Coplan (a chemical engineer), I've published widely on harmful effects of water treated with silicofluorides that do not occur when sodium fluoride is used. These include increased blood lead levels in children exposed to comparable environmental exposures to lead (e.g., from lead paint in old housing) and higher rates of behaviors associated with lead and other toxins (such as learning disabilities, substance abuse, and violent crime). The issues discussed in the exchanges on "fluoridation" have ignored these effects on BEHAVIOR as established using conventional epidemiological methods and the enormous costs to taxpayers they entail. For instances, because in the U.S. it costs approx. $25,000 (or more) to incarcerate a violent criminal for one year. the added costs of criminal incarceration associated with the use of silicofluorides are in the millions of dollars.

R & D do not seem to be aware that while U.S. government agencies and dental associations have long ignored the difference between sodium fluoride and the silicofluoride, since our publications the National Toxicology Program has nominated the silicofluorides for study. Mr. Coplan and I have therefore proposed a moratorium on the use of silicofluorides until independent testing proves they are safe and explains our contrary findings. The text of such a proposal is below.

roger masters (NOTE: those wishing to know my credentials should consult the U.S. WHO'S WHO for 2005).

---

MOTION FOR A MORATORIUM ON ADDING SILICOFLUORIDES TO PUBLIC WATER UNTIL ADEQUATE BIOLOGICAL TESTING PROVES ABSENCE OF HARMFUL EFFECTS TO CHILDREN'S HEALTH AND BEHAVIOR

Draft Legislation:

“Effective _______, until the addition of either hydrofluosilicic acid (H2SiF6) or sodium silicofluoride (Na2SiF6) to a water supply shall have been found by health effects studies approved by the EPA to be without harmful effects to children’s health and behavior, no public water system within the state of New Hampshire shall use these chemical compounds for the purpose of “fluoridation” (i.e., adjusting the level of fluoride to a target level).


RATIONALE:

Recognizing that 91 percent of U.S. fluoridated water, in systems serving over 116 million people, collectively, has been treated with 200,000 tons per year of commercial grade silicofluorides (H2SiF6 and Na2SiF6), henceforth referred to as “SiFs”; and

Further recognizing that these SiFs have been used for water fluoridation since 1947; and

Noting the Environmental Protection Agency's acknowledgement to Congress, and to others, that it is unaware of any human health safety testing of these silicofluoride compounds; and

Also noting that in 1952, a Select Congressional Committee (82nd Cong., 2d Session) requested studies “to determine the long-range effects upon the aged and chronically ill of the ingestion of water containing inorganic fluorides” yet there is no evidence that any Federal Health agency ever developed a research program to address the issue of health safety of the silicofluorides; and

Noting, too, that health effects studies of fluoridated water performed in animals, including those conducted by the National Institute of Health's National Toxicology Program, have employed sodium fluoride (NaF), the agent first used in water fluoridation in 1945, and not SiFs, the principal agents currently added to water; , , , , , , , , and

Noting evidence that water treated with SiFs is dissimilar from water treated with NaF,
notwithstanding claims to the contrary. In particular, SiFs are unlikely to dissociate completely under water plant conditions, producing only free fluoride and silicic acid without side reactions, , given that the silicofluoride moiety [SiF6]2- can react with Al(OH)3 to produce a number of derivative compounds; and given that the dissociation of [SiF6] 2- is reversible depending on pH and concentration. The latter suggests that SiF residues ingested with fluoridated water will re-associate, both within the stomach (at intra-gastric pH levels of around 2.0) , and during various food preparation steps, producing SiF-related species including silicon tetrafluoride, (SiF4), a known toxin; , , , , , and

Finally, recognizing that commercial SiFs added to water supplies also are likely to be contaminated with fluosiloxanes, with arsenic and other heavy metals, as well as with alpha-emitting radionuclides, since these commercial SiFs are in fact by-products of phosphate rock processes antecedent to those by which uranium is extracted from the phosphoric acid so produced; , , , , and

Acknowledging with concern the fact that in 1950 the U.S. Public Health Service endorsed water fluoridation with silicofluorides in place of sodium fluoride, based largely on cost factors, and using the biological rationale that fluoride uptake by teeth from water treated with Na2SiF6 would be equal to that from NaF;

And recognizing that the US PHS 1950 Health Report declared water treated with NaF or Na2SiF6 biologically equivalent although animal studies conducted in 1930s had shown that even when the amount of fluoride ingested was equal and the total amount of fluoride excreted was also equal, nevertheless animals exposed to fluoride from NaF eliminated more fluoride in feces, while animals exposed to the SiF compounds eliminated three-fold more fluoride in urine;35 and

Reasoning that animals exposed to fluoride in SiFs therefore would be expected to have up to three-fold higher blood levels of fluoride as well, since three-fold higher urine excretion implies at least momentary peaking of blood fluoride --- if not continuously higher circulating blood fluoride levels; and

Further noting that in 1983 when the Surgeon General appointed an expert panel to review “non-dental health effects” of ingested fluoride, the panel was instructed to ignore dental fluorosis because an earlier panel had concluded that fluorosis was merely “cosmetic” so it limited the scope of its review to “death (poisoning), gastrointestinal hemorrhage, gastrointestinal irritation, arthralgias, and crippling fluorosis,” given the essential absence of information about other possible effects in children; 36

Noting also a 1974 German study which found that acetylcholinesterase inhibition, the intended action of the high-risk organophosphate and carbamate pesticides widely used in agriculture and around residences, is exaggerated in the presence of SiF as compared to NaF which is itself an acetylcholinesterase inhibitor;37 and

Recognizing that the prevalence of dental fluorosis, (pre-eruption tooth enamel malformation due to ingested F), expected in 1945 to be 10-12 percent in “optimally fluoridated” areas,38 is now over 25 percent and in some fluoridated communities exceeds 80 percent including a substantial amount of moderate to severe fluorosis;39 and

Noting conclusions from three studies, analyzing data collected from 400,000 children in New York, Massachusetts and elsewhere where NHANES III was carried out, which found evidence that exposure to water fluoridated with SiFs somehow increases blood lead levels, even when these analyses controlled for race, housing age, poverty, congestion, and parental education (p<0.001);40, 41and

Recognizing that elevated blood levels have been found responsible for adverse health effects inflicted in utero such as impaired immune capacity,42 brain damage and developmental problems,43, 44, 45 as well as in early childhood,46, 47, 48, 49, 50, 51and into puberty and adolescence as cognitive impairment and loss of impulse control,52, 53and into adulthood as nephropathy and hypertension,54, 55and into geriatric life;56 and

Recognizing that elevated blood lead has also been found to impair tooth enamel integrity,57 thereby off-setting the intended benefits from exposure to fluoride; and

Finally, acknowledging that in contrast to potential risks from exposure to SiFs added to water supplies, the prevalence of dental caries in “optimally fluoridated” communities today is barely distinguishable from the prevalence of dental caries in non-fluoridated communities;58, 59, 60, 61, 62, 63, 64and the Journal of the American Dental Association recently published a comprehensive study showing that fluoride does not benefit teeth by ingestion, but only via by topical contact;65 and

Citing the American Public Health Association’s explicit endorsement of the precautionary principle as a cornerstone of preventive public health policy, especially in “order to protect the health and well-being of all developing children;” and

Citing Executive Order #13045 which calls upon all federal agencies to ensure that all federal environmental health policies and regulations consider the special sensitivities and vulnerabilities of children; therefore the legislature of the state of New Hampshire:

1. Calls for the immediate cessation of water fluoridation using silicofluorides on the basis that they have never been tested for health safety in humans and may be particularly hazardous to children, the aged and the chronically ill;
2. Calls for the National Institute of Environmental Health Science to undertake a full battery of chronic health effects testing of silicofluoride treated water; and
3. Calls for the US. EPA to establish new standards for the safe level of fluoride exposure with particular reference to children and the results of the recommended NIEHS study

Submitted:

Myron J. Coplan, P.E. Roger D. Masters
Intellequity Consulting Nelson A. Rockefeller Professor
Natick, MA of Government and
508-653-6147 Research Professor
Department of Government
Dartmouth College
Hanover, NH 03755
603 646 1029

References

-
United States Department of Health and Human Services; Centers for Disease Control (CDC)
Fluoridation Census, 1992, Sept 1993.
Reeves TG; "Water Fluoridation; A Manual for Water Plant Operators"; US Public Health Service, CDC
Division of Oral Health, April 1994.
Council on Dental Health , American Dental Association; "Fluoridation in the Prevention of Dental
Caries"; Third Edition, 1953.
Letter to the Honorable Ken Calvert, Chairman of the Subcommittee on Energy and the Environment of the House Committee on Science, from EPA Assistant Administrator J. Charles Fox, June 23, 1999.
Personal letter to Dartmouth Professor Roger D. Masters, from Robert C. Thurnau Chief, EPA Treatment
Technology Evaluation Branch, November 16, 2000.
Wollan M; "Controlling The Potential Hazards of Government-Sponsored Technology": The George
Washington Law Review; V 36 No. 5; pages 1105-1119, July 1969.
Bucher JR, et al; "Results and conclusions of the National Toxicology Program's rodent carcinogenicity
studies with sodium fluoride" Int J Cancer; 48(5):733-7, July 9,1991.
Heindel JJ, et al; “Developmental toxicity evaluation of sodium fluoride administered to rats and rabbits in drinking water”; Fundam Appl Toxicol;30(2):162-77, Apr. 1996.
Sprando RL, et al; "Testing the potential of sodium fluoride to affect spermatogenesis: a morphometric
study"; Food Chem Toxicol.; 36(12):1117-24, 1998.
Sprando RL, et al; "Testing the potential of sodium fluoride to affect spermatogenesis in the rat"; Food Chem Toxicol.;35(9):881-90, 1997.
Collins TF, et al; "Developmental toxicity of sodium fluoride in rats"; Food Chem Toxicol. ;33(11):
951-60, 1995.
Dunipace AJ et al: "Chronic fluoride exposure does not cause detrimental, extraskeletal effects in nutritionally deficient rats"; J Nutr;128(8):1392-400, 1998.
Dunipace AJ et al; "Effect of chronic fluoride exposure in uremic rats"; Nephron; 78(1):96-1031, 1998.
Dunipace AJ et al, "Effect of aging on animal response to chronic fluoride exposure"; J. Dent Res;74 (1) 358-368, 1995.
Li YM, et al; "Genotoxic evaluation of chronic fluoride exposure: sister-chromatid exchange study"; J Dent Res;68(11):1525-8, 1989.
Jackson RD et al; "Lack of effect of long-term fluoride ingestion on blood chemistry and frequency of sister chromatid exchange in human lymphocytes"; Environ Mol Mutagen;29(3):265-71, 1997.
Feldman I, Morken D and Hodge HC; "The State of Fluoride in Drinking Water"; J. Dent Res. Vol 36 (2); 192-202; 1957.
Crosby NT; "Equilibria of Fluosilicate Solutions with Special Reference to The Fluoridation of Public Water Supplies"; J Appl Chem; v19; pp 100-102, 1969.
Busey RH et al; "Fluosilicate Equilibria in Sodium Chloride Solutions from 0 to 60 o C"; Inorg. Chem V 19; pp 758-761, 1980.
Ciavatta L, et al; “Fluorosilicate Equilibria in Acid Solution”; Polyhedron Vol 7 (18); 1773-79; 1988.
Gabovich RD; "Fluorine in Stomatology and Hygiene"; translated from the original Russian and published in Kazan (USSR); printed by the US Govt Printing Office on behalf of the Dept of Health Education and Welfare. US Public Health Service, National Institute of Dental Health; DHEW pub no (NIH) 78-785, 1977.
Roholm K; "Fluorine Intoxication; A Clinical-Hygiene Study"; H. K. Lewis & Co. Ltd, London; 1937.
Lewis RJ, jr.; "Hazardous Chemicals Desk Reference": Van Nostrand Reinhold; Fourth Edition.
Matheson Gas Products; 30 Seaview Drive, Secaucus, NJ; "Effects of Exposure to Toxic Gases" and MSDS for CAS # 7783-61-1; created 1/24/89.
Voltaix, Inc.; Material Safety Data Sheet for Silicon Tetrafluoride (SiF4).
Rumyantseva GI et al; "Experimental Investigation of The Toxic Properties of Silicon Tetrafluoride"; Gig Sanit ;(5):31-33, 1991.
Ricks GM et al; "The Possible Formation of Hydrogen Fluoride from the Reaction of Silicon Tetrafluoride with Humid Air": Am. Ind. Hyg. Assoc. J. (54); 272-276, 1993.
Craig JM; "Fluoride Removal from Wet-Process Phosphoric Acid Reactor Gases"; Ph. D. Dissertation; Univ. Fla. at Gainesville, 1970.
Murray RL; “Understanding Radioactive Waste”; Third Ed.(ed Powell JD); 1982.
Becker Pierre; "Phosphates and Phosphoric Acid: Raw materials, technology, and economics of the wet process"; Marcel Dekker: New York (First ed.) 1983, Second ed., 1988.
Slack AV; "Phosphoric Acid"; Part I; Marcel Dekker: New York, 1968.
Greek BF, Allen OW, and Tynan DE; "Uranium Recovery from Wet Process Phosphoric Acid"; Industrial & Engineering Chemistry; vol 49 (4); 628-636, 669-671, 1957.
Rahn FJ, et al; “A Guide to Nuclear Power Technology”; John Wiley & Sons; New York; 1984.
McClure FJ: "Availability of Fluorine in Sodium Fluoride vs, Sodium Fluosilicate"; Public Health Reports vol 65 No 37; 1175-86; 1950.
35 Kick CH et al; "Fluorine in Animal Nutrition"; Bulletin 558, Ohio State Agricultural Experiment Station, Wooster OH, November 1935.
36 Koop CE, Letter to William D. Ruckelshaus, Administrator, EPA, dated Jan 23, 1984 and transcript of Proceedings of Surgeon General's Ad Hoc Committee on "Non-Dental Health Effects of Fluoride"; April 18-18, 1993, Jay R. Shapiro, Chairman.
37 Westendorf J; "Die Kinetik der Acetylcholinesterasehemmung und Die Beeinflussung der Permeabilitat von Erythrozytenmembranen durch Fluorid und Flurocomplex-Jonen"; Doctoral Dissertation, Universitat Hamburg Fachbereich Chemie; Hamburg; 1975.
38 Dean HT; "Endemic Fluorosis and its Relation to Dental Caries"; Public Health Report 53; 1443-52; 1938.
39 National Research Council; "Health Effects of Ingested Fluoride"; Subcommittee on Toxicology, Board on Environmental Studies and Toxicology, Commission on Life Sciences, National Academy Press: Washington, DC, 1993.
40 Masters RD and Coplan MJ; “Water Treatment with Silicofluorides and Lead Toxicity”; Int. J. of Environ. Studies; 56; 435-449, 1999.
41 Masters RD, Coplan MJ, Hone BT, and Dykes; "Association of Silicofluoride Treated Water with Elevated Blood Lead"; NeuroToxicology 21 (6), 2000.
42 Miller TE et al; “Developmental Exposure to Lead Causes Persistent Immunotoxicity in Fischer 344 Rats”; Toxico Sci. 42; 129-135; 1998.
43 Chanez C, et al; “Effect of lead on Na+,K+ATPase activity in the developing brain of intra-uterine growth-retarded rats”; Neurochem Pathol; 5(1):37-49; 1986.
44 Dietrich KM et al; “Low-Level Fetal Lead Exposure Effect on Neurobehavioral Development in Early Infancy”; Pediatrics; Vol 89 no. 5, 1987.
45 Aschengrau A et al; “Quality of Community Drinking Water and The Occurrence of Late Adverse Pregnancy Outcomes”; Arch Environ Health ; vol 48 no. 2; 105-13, Mar-Apr 1993.
46 Needleman HL; “Low-Level Lead Exposure and the IQ of Children”; JAMA ; Vol 263 no. 5;
Feb 2, 1990.
47 McMichael AJ et al; “Port Pirie Cohort Study: Environmental Exposure to Lead and Children’s Abilities at the Age of Four Years”; New Eng J of Med ; vol 319 no. 8; Aug 25, 1988.
48 Kim R, et al; “A longitudinal study of chronic lead exposure and physical growth in Boston children”;
Environ Health Perspect ; 103(10):952-7, 1995.
49 Leviton A, et al; “Pre- and postnatal low-level lead exposure and children's dysfunction in school”;
Environ Res ; 60(1); 30-43, 1993.
50 Schoen EJ; “Neuroendocrine effects of toxic and low blood lead levels in children”; Pediatrics ;
vol 92 (3), 1993.
51 Eppright TD, et al; “Attention deficit hyperactivity disorder, infantile autism, and elevated blood-lead: a possible relationship”; Mo Med ; 93(3); 136-8, 1996.
52 Walker SW III; “The Hyperactivity Hoax”; St. Martin’s Press; New York, Dec 1998.
53 Bellinger DC, et al; “Low-level lead exposure, intelligence and academic achievement: a long-term follow-up study”; Pediatrics ; vol. 90 (6); 885-61,1992.
54 Loghman-Adham M; “Renal effects of environmental and occupational lead exposure”; Environ Health Perspect ; 105(9); 28-39; 1997.
55 Korrick SA, et al; “Lead and hypertension in a sample of middle-aged women”;
Am J Public Health; 89(3); 330-5, 1999.
56 Vig EK, and Hu H; “Lead toxicity in older adults”; J Am Geriatr Soc ;11):1501-6, 2000.
57 Watson GE, et al; “Influence of maternal lead ingestion on caries in rat pups”; Nat Med;3(9):
1024-5, 1997.
58 Brunelle, JA and Carlos JP; "Recent Trends in Dental Caries in US Children and Effect of Water Fluoridation"; J. Dent. Res 69 Spec Iss; 723-27, 1990.
59 Kobayashi S et al; "Caries Experience in subjects 18-22 years of age after 13 years' discontinued water fluoridation in Okinawa"; Community Dent Oral Epidemiol; 20(2):81-3; 1992.
60 Kumar JV et al; "Changes in Dental Fluorosis and Dental Caries in Newburgh and Kingston, New York"; Am. J. Pub. Hlth. Vol 88, No 12; 1866-70, Dec 1998.
61 Kumar JV and Greene EL; "Recommendations of Fluoride Use in Children"; NYSQJ, Feb 1998.
62 Kunzel W and Fischer T; “Caries prevalence after cessation of water fluoridation in La Salud, Cuba”; Caries Res; 34(1):20-5; 2000 Jan-Feb.
63 Burt BA, Keels MA, Heller KE; “The effects of a break in water fluoridation on the development of dental caries and fluorosis”; J Dent Res.;79(2):761-9, 2000.
64 Seppa L, Karkkainen S, Hausen H; “Caries in the primary dentition, after discontinuation of water fluoridation, among children receiving comprehensive dental care”; Community Dent Oral Epidemiol;28(4):281-8, 2000.
65 Featherstone JDB; "The Science and Practice of Caries Prevention"; JADA Vol 131; 887- 1002, 2000

Correction: My apologies for an error in my posting, 13 February, in the webpage address for Fluoride: quarterly journal of the International Society for Fluoride Research. The correct address is: http://homepages.ihug.co.nz/~spittle/fluoride-journal.htm
It can be reached by clicking on the yellow house in the homepage symbol below.

Questions to Rix & Donahue, Feb 10, 2005 'The Case for Fluoride'

Lack of corroborating evidence, and deficiencies in the logic employed by Rix & Donohue (R&D), lead to a breakdown in their argument that Dr Diesendorf is wrong and that fluoridation has somehow been proven to be safe and an effective public health measure.

In paragraph 3 they defend fluoridation by likening it to chest X-rays. Yet compulsory chest X-ray programs have been discontinued due to being found to be unsound. Later they liken fluoridation to adding Vitamin D to margarine, or folic acid to cereals. The programs are not alike. People have a choice about whether to use margarine, or what cereal to use, or whether to consume packaged cereals at all (some eat eggs for breakfast – if I use cereals I cook up porridge from the raw ingredients). With water though, there is only one piped water supply. If silicofluoride chemicals are added to it as medication, the consumer has no choice. We do not have a filtering system in our mouths with which to exercise choice and strain out the fluoride. Low income people certainly cannot afford plumbed-in filters or bottled water.

In paragraph 4 we find “Fluoride compounds in air rank third in air pollutants.” You might think R&D would see that as an argument AGAINST exposing populations to yet more fluoride by adding it to water supplies. Indeed, much of our knowledge of fluoride toxicity comes from workers exposed to airborne fluoride in industry, and the effects of fluoride air pollution on crops, livestock and people living in the vicinity of fluoride emitting industries.

R&D are surely exaggerating in paragraph 10 when they state that health concerns about fluoride were “reviewed extensively and exhaustively” in the NHMRC review of 1999. Wasn’t that 1999 review most notable for its very cursory look at health concerns? Incidentally, are R&D the very same Rix & Donahue who were authors of that review? They do not confess to such in their Online article, but I imagine they are (R&D, any comment?). In the 1999 review the authors even failed to comment on the call by the NHMRC in their 1991 review, that levels of fluoride in the bones of Australian citizens should be studied. By 1999 there is no indication of any government agency following up on the call, yet the 1999 reviewers (R&D included) are as quiet as mice, and no doubt severely embarrassed, about the neglect of that urgent safety procedure.

In the next paragraph, 11, R&D claim that the NHMRC have explicitly examined Diesendorf’s arguments about fluoride. Really? When I looked at 1991 and 1999 NHMRC reviews of fluoridation they failed to even cite articles by Diesendorf, let alone examine his arguments and those of numerous other scientists concerned about fluoridation’s ineffectiveness and dangers. For example, Diesendorf’s landmark study of comparisons of tooth decay reductions over time, in fluoridated and non-fluoridated cities and countries (Diesendorf 1986) is completely neglected. Yet at that time, and still today, it is the most important and comprehensive study of that kind. Could the reason for its omission be that it did not make a very positive finding for fluoridation?

In paragraph 12 they state “Toxic effects may occur at moderate levels of exposure”, a remarkably accurate statement. However, R&D do not draw any of the obvious conclusions.

In the following paragraph R&D state that skeletal fluorosis is not an issue in Australia, and only occurs when people are exposed to water of 8ppm or more. I believe that they are making the mistake here of confusing ‘skeletal fluorosis’ with ‘severe, crippling skeletal fluorosis’. Skeletal fluorosis is exhibited in a number of clinical phases, and it is the mild and moderate phases that we need to be studying in Australia. At that end of the spectrum the symptoms can be indistinguishable from osteoarthritis, which occurs in Australia in epidemic proportions. It has formerly been claimed that there is no skeletal fluorosis in the USA (by fluoridation promoters, mind you). That is now known to be wrong. There have been numerous cases documented. Many clinicians believe that there may be 100s of thousands of cases wrongly diagnosed due to lack of education about the problem. A most recent case has been reported in the American Journal of Medicine (Whyte et al, 2005) in which a patient’s severe spinal pain and hyperdensity was traced to drinking excessive amounts of high fluoride tea made with fluoridated water. How many people in Australia or USA drink tea made with fluoridated water we might ask, and have also developed arthritis (possible fluoride-induced arthritis)?

Moving along to paragraph 18, R&D claim that European countries don’t practise fluoridation “for technical reasons”!!! They appear to be suggesting that European engineers are incompetent, unlike our brilliant Australian and American engineers who have no trouble with fluoridation. That is an absurd proposition. The official government statements from most European countries on why fluoridation is not practised, are that it violates human rights and has serious unresolved toxic problems. No countries offer the explanation of “technical reasons” or “incompetent engineers”.

In fact many European countries did practice fluoridation for periods of time, and abandoned it. It is from studies of those cities that we know that cessation of fluoridation does NOT lead to increases in tooth decay rates. In paragraph 20 R&D claim the very opposite, but can provide no reference for their claim. Let me give some references for studies of fluoridation cessation (Kunzel et al 2000; Kunzel & Fischer 2000; Maupome et al 2001; Seppa 2000). In most cases tooth decay rates continued to decrease in the 10 years following cessation, leading very suggestively to the inference that any decreases in tooth decay during the fluoridation period were nothing to do with fluoridation, but were related to other factors.

Finally, in paragraph 19 R&D state: “Dental health in fluoridated areas is significantly better than in nonfluoridated areas”, but again they give no reference. This is a very debatable proposition. It includes no explanation for the low decay rates in many European non-fluoridated countries, lower indeed than most of the long fluoridated USA. In addition, one does not need to look for very long at the “Australian Child Dental Health Surveys” [http://www.adelaide.edu.au/spdent/dsru/] to see that numerous non-fluoridated areas have lower decay rates than many of the fluoridated cities, and also that differences in tooth decay are far closer related to income levels (poverty) than to whether or not the drinking water is fluoridated.

For the above reasons, particularly Rix & Donahues’ inability to provide original research as evidence, their conclusion seems extremely dubious (“it would be remiss of government to deny the community the public health benefits from water fluoridated at the optimal levels”. A more reasonable conclusion might be, as most European health departments have concluded: “it would be unethical to impose daily consumption of state sanctioned fluoride medication on our entire population, when there are so many unanswered questions about toxicity and such ambiguity in the evidence-base on effectiveness”.

I would be most pleased if R&D could show that my arguments are wrong in a detailed manner and by citing some original evidence. It is not sufficient to simply state that others (or themselves) have conducted reviews, or that the CDC gives fluoridation a top 10 rating. That kind of slapdash approach to approving public health programs leads to serious errors being perpetuated over time, often with grave consequences.

David McRae
Health Promotion Worker, Geelong, Australia

REFERENCES

Diesendorf M (1986). The mystery of declining tooth decay. Nature;322:125-129.
Kunzel W, Fischer T, Lorenz R, Bruhmann S. (2000). Decline of caries prevalence after the cessation of water fluoridation in the former East Germany. Community Dentistry and Oral Epidemiology 28: 382-9.
Kunzel W, Fischer T. (2000). Caries prevalence after cessation of water fluoridation in La Salud, Cuba. Caries Research 34: 20-25.
Maupome G, Clark DC, Levy SM, Berkowitz J. (2001). Patterns of dental caries following the cessation of water fluoridation. Community Dentistry and Oral Epidemiology 29: 37-47.
Seppa L, Karkkainen S, Hausen H. (2000). Caries Trends 1992-1998 in Two Low-Fluoride Finnish Towns Formerly with and without Fluoridation. Caries Research 34: 462-468.
Whyte MP, Essmyer KE, Gannon FH, Reinus WR. (2005). Skeletal fluorosis and instant tea.
American Journal of Medicine 118(1):78-82.

Correction:

In my response to "MF" I made the comment that: "Despite the millions of dollars spent by the Australian government on promoting fluoridation they have not sponsored one primary study on health effects on any organ but the teeth." In my reading I have just come across one study from Australia which went beyond the issue of dental caries and dental fluorosis. This was a study by Richards and Ford, who in 1979 examined cancer mortality in selected NSW localities with and without fluoridation. The full citation is: Richards, G.A. and Ford, J.M. (1979) Cancer mortality in selected New South Wales localities with fluoridated and non-fluoridated water supplies. Med. J. Aust. 2, 521-523.

However, I believe the main point I was making remains sound, namely, that the Australian authorities have spent a disproportionate amount of money and time promoting fluoridation and conducting studies on teeth, rather than conducting serious observations on the health of those living in fluoridated communities. This imbalance has been especially apparent with their failure to follow up on the 1991 NHMRC panel's recommendation that they investigate two issues: fluoride bone levels and possible individual hypersensitivity to low levels of fluoride and of course, the failure of the 1999 NHMRC to acknowledge this.

I would appreciate any of your readers pointing out any other studies conducted in Australia which I may have overlooked in this matter.

Meanwhile, I am puzzled why neither Rix and Donohue nor MF have responded to my criticisms of their arguments. This slow response is in sharp contrast to their espoused confidence in fluoridation, but it is completely in line with my finding that when avid Australian promoters of fluoridation are challenged (as I have done on three separate visits to Australia) to debate the science of the issue in public, their confidence rapidly appears to evaporate.

How confident should scientists and citizens be in a practice for which those who promote it most ardently are unable to fully engage in a scientific debate either on a public platform or -apparently -in written exchanges? What does this say about the role of genuine science in establishing sound public health policy?

Dr. Paul Connett

February 27, 2005.

It has now been over two weeks since I and others (including Dr. Mark Diesendorf, Dr. Bruce Spittle and Dr. Roger Masters) posted responses to the article by Rix and Donahue defending water fluoridation and their one lone voice of support (MF).

Can we assume from their silence that they have conceded the points we made -or are they just hoping that we -and readers of your columns -will forget all about this important issue?

Either way I hope that the editors of Chemistry in Australia will have the professional integrity to investigate this issue further. Surely, if the very scientists who co-authored the NHMRC (1999) review, on which Australian health authorities largely rely for their continued support of this practice, can no longer provide a coherent support for it, which stands up to critical review, it must be time for them to abandon that support -and Australia along with them.

Hopefully, in addition to the editors of this journal, there are many other professional scientists in Australia who, hitherto, may have taken the bland assurances of fluoridation's "safety and effectiveness" at face value, will now begin to examine the science carefully and with an open mind. They can review a large chunk of that literature at http://www.SLweb.org/bibliography.html

Dr. Paul Connett

I came across this older article and didn't know if it was still being debated somewhere else.

After much reading of various for-and-against articles over many years, I have come to the conclusion that fluoridation of our water supply in Australia is unethical and unnecessary.

Does anybody who has written above know of who I can speak to, and perhaps organise a lobby?

I live in the Blue Mountains in NSW and many years ago all the rate payers were asked to fill in a survey regarding fluoride in our water supply. According to my father, nearly everyone said THEY DIDN'T WANT FLUORIDE IN THE WATER SUPPLY ANYMORE. It was promptly ignored.

Any advice would be greatly appreciated.

Bindi may obtain some further information from Ailsa Boyden E-mail: boydens@mrbean.net.au

Last time I checked smoking was bad. You can&#8217;t just smoke anywhere. Because smoking is bad for your health. So smokers have to go some where else.

Why isn&#8217;t fluoride the same. ?. I brush my teeth once or twice a week. Regularly eat sweets and chocolate. Currently the water I drink is not fluorinated. My teeth are fine.

Fluoride is a waste product? Why should I be forced to drink it?
Why is everyone dumb as fark and things it is good thing?

Smoking is bad
Flouride is bad. Most of Europe wouldnt ban it unless it was.
then again look at DDT aus was using it after the Yanks and the brits banned it!

Mmmm...I agree with the last post, especially about the Europeans trying to get rid of this poison.
I came from Holland to Aus in '69 they were just (I believe) clearing their pipes of this chemical input. So that makes about 18 yrs of ingestion until I was Armytilized (Dutch army)were I lost all of my (silver/mercury) fillings due to dental breakdown.No..I wasn't a sweet-tooth either. They (the Army) literally poured one continues strip of the same silver stuff on each side of my jaws which came out as one piece after I arrived at this beautiful country's shore, after which I received more fluoride until 2years ago.So that makes about 35 yrs of fluoride acid intake.No friggin' wonder about my Rheumathoid arthritis,ankolozing spondalitis,IBS,General pain with weather changes (the list goes on but I won't bore'ye)
More dental repairs but to no avail.Dentures was the next step. Here comes the clinger...Did anyone EVER do a study on:
1.Interaction between different metals and chemicals within a human frame?
i.e.Mercury (from most vaccinations)+ Mercury from fillings interacting with fluorides (water treatment acids) and aluminium (water treatment) residue with intake of zinc (for the prostate)

2.Research on growing your own supposedly organic vegies in your backyard with fluoridated tapwater?
Great exercise this one:Try carrot,endive and lettuce in three seperate batches of three in same medium.Seed the same day (under New Moon) add tap water in first three (mark as you go along) Rain water in second and last with natural spring water.
Shock horror...1st batch (tapwtr) grew only lettuce,2nd (rainwtr) grew endive ,carrot the lettuce last, 3d(springwtr)grew all together very nicely thank you.
So..the moral question of this story is this, why the hell do they keep on poisoning us and the environment on which we so depend in this already dry continent? Who gives a stuff about people with dentures who take'm out to brush'm anyhow, do we need to be MASS-Medicated for our teethers we haven't got? Or should we just take part in the overpopulation program and brittlelise our bones for the hell of it?
FOLLOW THE MONEY TRAIL