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’t just smoke anywhere. Because smoking is bad for your health. So smokers have to go some where else.

Why isn’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!