Sutton PRN, The Failure of Fluoridation (editorial), Fluoride, 1990 January, 23:1, 1-4.
The ultimate failure of fluoridation was inevitable because it was founded on two fallacies, namely that fluorine is an essential element for man and that water containing less than approximately 1 ppm fluoride is “fluoride deficient.”
The major factor which has sustained the push for fluoridation is the widely held belief that, where it operates, it has attained its objective — that it has been shown to reduce substantially the prevalence of dental caries. This belief is based on faith in the honesty and accuracy of statements made by so-called “authorities,” not because the published evidence from fluoridation trials had been investigated with the assistance of an academic statistician.
In 1978 Justice John P. Flaherty, of the Supreme Court of Pennsylvania, presided over a long (2,800 pages of testimony) court case involving fluoridation. He stated:
I seriously believe that few responsible people have objectively reviewed the evidence (1).
An early review which pointed out many of the errors in the four main trials in Grand Rapids, Newburgh and Evanston, U.S.S. and Brantford, Canada, was published by the present author as a monograph (Fluoridation: Errors and Omissions in Experimental Trials, Melbourne U.P., 1959) (2).
So great was the intolerance of some officials to any criticism of fluoridation, that Cambridge University Press (the distributor of the book in America) was approached by the Nutrition Foundation Inc., and others, in an attempt to suppress the monograph in the U.S.A. Also, the printer’s type at Melbourne University Press was destroyed without authority, thus almost succeeding in preventing publication of the second edition the following year.
Having failed to suppress the monograph, it was omitted from the list of recent books and pamphlets in the Index to Dental Literature (published by the American Dental Association) and the errors it pointed out were simply ignored. Not until fairly recently have errors in those trials been tacitly acknowledged by some fluoridation promoters. In 1987 Jackson (3) stated:
On the question of efficacy, we do not have to rely on the inadequate studies of the past.
Emphasis was then placed on what were claimed to be approximately 100 more recent fluoridation trials which were stated to have “proved” the efficacy of fluoridation. For instance, in 1984 the most recent WHO book on this subject (4), Environmental Health Criteria for Fluorine and Fluorides, was written by a ten-member task group. These scientists gave as their reference, and apparently accepted without investigation, the data displayed in a poster by Murray and Rugg-Gunn in 1979 (5). They stated that “… 120 fluoridation studies from all continents showed a reduction in caries in the range of 50 to 75% for permanent teeth.” These data obviously came from the same source as those in a table in a well-known book by the authors of that poster which listed 128 studies (6).
Mention of such a large number of studies Impresses the scientifically naive, who do not realize that it is not the volume but the quality of research which counts. As the statistician Sir Ronald Fisher stated many years ago (7):
If the design of an experiment is faulty, any method of interpretation which makes it out to be decisive must be faulty too.
In 1988, the scientific status of these studies was investigated. The preliminary results were published in January, 1989, in a letter to Chemical and Engineering News (8) (the official organ of the American Chemical Society) which was publishing a series of letters on fluoridation, including one from the U.S. Surgeon General. My letter stated that in 23 of those 128 fluoridation studies named by Murray and Rugg-Gunn (6) the data from the deciduous and the permanent teeth were listed separately — as 46 studies.
Two studies which included data from more than one town were listed as six studies, and in seven cases reports in different years from the same study were listed as 14 studies. Therefore, more than a quarter of the studies were recorded more than once by Murray and Rugg-Gunn (6) to give the fictitious total of 128 studies.
The most important claim made for fluoridation is that it decreases dental caries in the permanent teeth. Contrary to the statement in that WHO book, 20 studies listed did not present any data for those teeth.
This leaves 74 studies for permanent teeth, but most of these were of very poor scientific quality. One did not refer to fluoridated water, two were anonymous, three were personal communications, and eight were essentially progress reports. Fourteen were not published in a journal but were short communications in newsletters and bulletins issued by state health departments. These obvious deficiencies, not mentioned by this WHO task group (4), were revealed by merely reading the references and a table in the book by Murray and Rugg-Gunn (6).
Four of the remaining 46 studies were the original trials, all of which were mentioned prominently in this WHO book (4), although for 25 years they had been known to be faulty (2). Sixteen of the remaining studies were short reports in state dental newsletters and journals.
A further disturbing fact in the table of Murray and Rugg-Gunn (6) which lists the studies, is that one column, with 128 entries, is headed: “Nonfluoridated Community Caries Experience,” implying that each of the 128 studies listed had a control. This was not the case. Even in the remaining 26 studies — now less than a quarter of the 120 mentioned by this WHO task group (4) — almost every study failed to attempt to use a control or used one which was obviously unsatisfactory. These studies were not designed to estimate examiner error or to eliminate examiner bias.
An attempt was then made to examine each of the remaining 26 studies to see whether they established the claim that fluoridation decreases the prevalence of dental caries substantially. Unfortunately four of the papers listed by Murray and Rugg-Gunn (6) could not be obtained (two could not be found in the Index to Dental Literature or in the Index Medicus.) None of these studies was mentioned by this WHO task group.
Further examination revealed that three more of those 26 studies were obviously incapable of demonstrating that fluoridation is efficacious. A detailed examination was then made of the remaining 19 studies which could possibly have demonstrated the efficacy of fluoridation. Five were held in the U.S.A., five in Australia and New Zealand, three in the United Kingdom and six in other countries. However, on examination of these reports none of them showed in a scientifically-acceptable manner that fluoridation is efficacious.
Therefore, Murray and Rugg-Gunn (6), in what appears to have been comprehensive world-wide search, were unable to locate even one study which demonstrated that fluoridation reduced dental caries.
In contrast, the evidence that it has failed to reduce the number of decayed teeth Is mounting. In their 1972 paper (9) entitled “The Failure of Fluoridation in the United Kingdom,” Schatz and Martin “graphed” the official results from the U.K. Department of Health’s eleven-year study and showed that the slopes indicating increase in caries with age in the treated and control areas were almost identical. Their conclusion:
The official report is valuable because it so clearly reveals the failure of fluoridation in Great Britain.
The alleged benefits are thus nothing more than a statistical illusion.
More recently, Colquhoun and Mann in New Zealand (10) and Diesendorf in Australia (11) have demonstrated that fluoridation has failed in their countries. Data from a recent survey by the National Institute of Dental Research of 39,207 children aged five to seventeen years from 84 areas in the U.S.A. has shown that fluoridation has failed in America also. The number of decayed, missing and filled teeth in children who had been fluoridated all their lives was no fewer than those who had been brought up in non-fluoridated areas (12).
The original claim, made in innumerable promotional statements, was that fluoridation would reduce the prevalence of decayed teeth by about sixty percent. One of these was a WHO Press Release (WHO/45, September 4, 1957). In 1956, the authors of the Grand Rapids study (13) stated:
In children born since fluoridation was put into effect, the caries rate for the permanent teeth was reduced on the average by about 60 per cent.
It has taken forty-five years to overcome the propaganda claim that fluoridation is very efficacious. However, in 1990 it is now clear that fluoridation has failed.