|International Fluoride Information Network
August 20, 2000
IFIN Bulletin #143: Deconstructing Michael Easley
Many communities threatened with a a push for fluoridation are soon confronted with Dr. Michael Easley, either through newspaper articles where he is frequently quoted, or in person. On July 18, 2000 he appeared in a Forum in Wellington, Florida. He gave his prototypical presentation which probably impresses officials and citizens who have not read up on the issue.
To prepare citizens for future dealings with Easley, we have transcribed his presentation from a video tape of this meeting and made an attempt to deconstruct his argument point by point. When deconstructed, Easley’s argument can be seen for what it is: a lot of undefendable assertions, exaggerated claims, statements which are blatantly false, a methodology more suitable to a propagandist than a bona fide scientist and an almost childish disrepect for his opponents.
We have presented Easley’s presentation in full.
Paul and Mike Connett.
(For those unfamiliar with Michael Easley, he is the Director of the National Center for Fluoridation Policy and Research (http://fluoride.oralhealth.org), an advisor to the American Council on Science and Health, and one of the most active fluoridation lobbyists in the United States.)
DR. MICHAEL EASLEY’S PRESENTATION IN WELLINGTON, FLORIDA, JULY 18, 2000.
Community Water Fluoridation has been practiced in the United States for more than 54 years. Grand Rapids, Michigan, fluoridated its public water supply on January 25, 1945.
1) Our response:
Grand Rapids was indeed the first test community fluoridated in the United States. In order to test the efficacy of fluoridation, the government fluoridated Grand Rapids and planned to study cavity levels between it and an unfluoridated city, Muskegon (also in Michigan). However, despite the fact that the study was designed to last for 10 years, the non-fluoridated control city (Muskegon) was dropped after only six and a half years, when its water was fluoridated in July 1951. Dr. Phillip Sutton (1996), Senior Research Fellow at the University of Melbourne, has examined these studies in depth (which few have done) and has criticized it on many grounds: the large differences in sample size; different methods of sampling; changes in examiners; examiner variability not assessed; and the dropping of the control city before the trial was completed. When a firm of professional statisticians, The Standard Audit and Measurement, Inc, was employed to study the data published from the trial, they concluded: “the lack of sophistication shown in selecting the sample leads to complete bewilderment as to the precise effects or the extent of the effect of fluoridation” (De Stefano 1954).
At the time of the Grand Rapids and other early fluoridation trials, which included Evanston, Illinois and Newburgh New York, the Director of the New York Water Supply Laboratories, Benjamin C. Nesin, stated: “It must be emphasized that the fluoridation hypothesis in its entirety rests on a very narrow base of selected experimental information. It is this very base which is vulnerable to scientific criticism. And it is upon this very narrow base that the impressive array of endorsement rests like an inverted pyramid” (Nesin 1956).
Community water fluoridation has been described by US Surgeon General Luther Terry as one of the four great advances in public health. You may remember Dr. Terry he was the first surgeon general who came out with a report linking tobacco and lung disease and cancer.
Dr. Terry liked to describe the four horseman of public health as chlorination, pasteurization, immunization, & fluoridation.
Dr. Terry obviously held great importance for water fluoridation as one of the primary public health programs available.
2) Our Response:
We have no reason to doubt that Dr.Terry made this statement, other Surgeon Generals have been equally enthusiastic. But the support of the US Surgeon Generals for fluoridation has been somewhat predictable and unavoidable ever since the US Public Health Service gave its full endorsement of the measure in the early 1950’s. As many observers today now realize, and as many sociologists would understand, there is the issue of too much credibility (and liability) at stake for the Public Health Service to come out today and state that fluoridation is an un-needed health hazard after promoting it for so long.
One should further note that if the game in convincing someone that fluoridation is safe, effective and good public policy, is one of deferring to authorities, then that game can be equally played on both sides. For instance, Ralph Nader, one of the most respected consumer advocates in the US, is one of many people who approached the issue of fluoridation with an open mind and ended up rejecting the idea (Nader, 1971). In addition, at least 12 Nobel prize winners in medicine and chemistry have expressed their opposition or reservations about fluoridation.
But perhaps most importantly, most Western European countries, as well as Japan, after reviewing the evidence for and against, have discontinued and rejected fluoridation.
A more recent Surgeon General C. Everett Koop said that ‘community water fluoridation is the single most important committment a community can make to the oral health of its children and to future generations.’
3) Our response:
(See above) It is interesting to point out here that Dr. Koop has lately come under intense criticism for undeclared conflicts of interest which may have served to compromise his integrity. For example, Dr. Koop gave testimony before the US Congress on an issue which pertained to the product of a company for which he had recieved a huge consultancy fee, without declaring his interest in that company (Chicago Tribune, editorial, Nov. 2, 1999). Dr. Koop also works closely with the American Council on Science and Health (ASCH), a group which is widely regarded as a mouthpiece for the interests of the chemical industry. As well as being a strong promoter of fluoridation this group has attempted to downplay the significance of a number of carcinogens affecting industry including DEHP (an addditive to PVC plastic) and dioxins. (Read more about Dr. Koop at http://www.tompaine.com/features/2000/03/28/index.html).
The current Surgeon General David Satcher has stated:
‘Fluoridation remains an ideal public health measure based on the scientific evidence in preventing dental decay and its impressive cost effectiveness.’ He went on to say ‘One of my highest priorities as surgeon general is reducing disparities in health that persist among our various populations. Fluoridation holds great potential to contribute to the elimination of these disparities.’
4) Our reponse:
While Dr. Satcher’s intentions to eliminate these disparities is highly laudable, he is inadvertently advocating a policy which could further disadvantage the poor. It is well established from animal and human studies done in India by Dr. Chinoy and others that those most vulnerable to the toxic effects of fluoride are those suffering from malnutrition; particularly those who have protein, mineral and vitamin deficient diets. In this country the children most likely to have malnutrition are those who come from low income families.
The definition of community water fluoridation is the precise, and I emphasize the word precise, adjustment of the amount of the essential trace element fluoride in drinking water in order to provide for the proper development of teeth and bones and to insure protection of teeth in children and adults regularly consuming it. Community water fluoridation is a 20th century adaptation to a naturally occuring process. Literally all sources of drinking water in the United States contain some fluoride. Fluoridation is merely an upwards adjustment of drinking water fluoride levels to that which is optimum for health.
5) Our response:
a) PRECISION. First of all, if fluoridation was as precise as Easley claims, than the citizens of Wakefield and Norfolk Massachusetts wouldn’t have awoken recently to learn that the fluoride levels in their water had jumped from 1 ppm to 23 ppm due to a malfunction in the water plant’s fluoride pump (Boston Herald, August 9, 2000). Such malfunctions with fluoride pumps have been numerous in the past, resulting several times in citizen casualties. For example, in Kodiak, Alaska (May 1992), after fluoride levels accidentally rose to 150 ppm, one person died, one was airlifted to the hospital in critical condition, and 260 suffered symptoms of fluoride poisoning (Townsend Letter for Doctors, Oct 1994).
Secondly, there is the larger issue of controlling the DOSE of fluoride each person receives. This dose is highly imprecise because i) people’s consumption of water can vary by wide margins with age, activity, and health status (e.g. diabetics can consume much more water than others) and because ii) there are many other sources of fluoride that we are exposed to daily, such as food and beverages prepared in fluoridated areas, fluoridated toothpastes and mouthwash, pesticide residues in food, and pharmaceuticals. Controlling the level of fluoride intake is not precise:it is a crap shoot.
b) Lack of precision when it comes to dose is dangerous. This lack of precision in the delivery of a therapeutic agent is very serious, especially in the case of fluoride, because the margin of safety for long term health effects (e.g. brittle bones) is very low to non-existent. Normally, pharmacologists like to have a margin of safety of 100, and sometimes a 1000, for a therapeutic agent. This means that they like to have a therapeutic dose which is 100 or 1000 times less than the toxic dose. In the case of fluoride the safety margin, extrapolating from the Upper Intake (UI) figures presented by the Institute of Medicine (1997), is less than 10, and from the US EPA’s maximum contaminant level in water (4 ppm), is less than 4. Gordon and Corbin (1992) indicate that a daily consumption of water containing 4 ppm fluoride would yield bone levels of approximately 6000 ppm (as measured in bone ash), which is the level at which the Department of Health and Human Services (DHHS, 1991) indicates the first phase of skeletal fluorosis will occur.
c) PROPER DEVLOPMENT. Easley’s notion of the ‘proper development of teeth and bones’ is misleading in that ‘proper’ implies fluoride is necessary and essential for both healthy teeth and healthy bones. This is not true. Human beings do not need fluoride to have healthy teeth nor to have healthy bones, and there is not one one study Easley could cite to the contrary. The best that a proponent could argue is that fluoride is beneficial to teeth and bones (it may help but it is not necessary). While this is debateable, it as at least that, debateable. But calling fluoride esential is not a debateable point, it is simply not true.
d) ESSENTIAL ELEMENT. Fluoride is not an essential trace element. Teeth and bones can develop to their fullest and healthiest without ever having any fluoride treatment. No disease is likewise caused by a “fluoride deficiency”, which is the normal indicator of whether an element is essential, or not.
e) 20TH CENTURY ADAPTATION TO A NATURALLY OCCURING PROCESS. The fact that an element occurs naturally is no protection against it being toxic. By definition all elements occur naturally and many elements are toxic e.g. lead, cadmium and mercury, to name just three. In the case of the natural occurence of fluoride in water, it is usually accompanied by considerable quantities of calcium, which is protective to a certain extent of fluoride’s toxicity. However, artifical fluoridation of 90% of US waters is done using hexafluorosiliciic acid or its sodium salt, which are taken from the scrubbing liquids of the air pollution control devices of the superphosphate fertilizer industry. The fluoride we get from these pollution scrubbing devices does not have calcium present. What it does have however, are trace amounts of arsenic, lead and radioactive isotopes. As Tom Reeves, National Fluoridation Engineer for the CDC, recently stated, “Chuck Krepshaw of Cargill Fertilizer Inc, the producer of about 70-75% of the F chemicals used in the U.S., tells me now that in the newer vein of apatite rock (from which we get the fluosilicic acid) the impurities are very small amounts of lead, arsenic, mercury and barium.” In short, there is a world of difference between fluoride in the presence of a large excess of calcium and these silicofluorides in the presence of trace quantities of toxic metals and radioactive isotopes.
A better indication of what is natural comes from the levels of fluoride naturally present in mothers milk. These levels are 100 times less than the level added to the drinking water (0.01 ppm versus 1.0 ppm). If nature thought of fluoridation first, as Easley likes to say, than it sure had a different notion of what levels an infant should receive!
Fluoridation is really a form of nutritional supplementation. Adding fluoride to the drinking water is no different from adding vitamin c to fruit drinks to prevent scurvy, vitamin d to milk and breads to prevent rickets, iodine to table salt to prevent goiter, folic acid to grains, cererals, and pastas to prevent birth defects, and adding vitamins and minerals to breakfast cereals to promote normal growth and development.
6) Our Response:
These are outrageous comparisons. All these additives are either vitamins or minerals for which there are known deficiency diseases. There is no known disease associated with fluoride deficiency. Dental decay is due to a combination of poor diet (too much sugar, not enough minerals) and too little brushing.
Also, all the substances listed by Easley have to be swallowed to obtain their benefit, because they all aid various vital enzymatic processes inside the body. Fluoride, on the other hand, provides no beneficial effect once swallowed. It works topically and it works not by aiding enzymes but by poisoning them (i.e it inhibits the enzymes in the bacteria which convert sugar to acids which dissolve the tooth enamel).
A more adequate description of fluoride is that it is a therapeutic agent. As stated above, it acts topically on the surface of the tooth, not via ingestion. This position is supported by a growing list of dental researchers: Levine (1976), Fejerskov, Thylstrup and Joost (1981), Carlos (1983), Featherstone(1987, 2000), Margolis and Moreno (1990), Burt (1994), Shellis and Duckworth (1994) and Limeback (1998). The latest paper supporting and explaining this position was published in July, 2000 in the Journal of the American Dental Association by researcher John Featherstone. In his paper Featherstone states that fluoride “works primarily via topical mechanisms,” adding, “the fluoride incorporated developmentally – that is, systemically into the normal tooth mineral- is insufficient to have a measurable efect on acid solubility”.
As Featherstone explains, fluoride acts (like a pesticide) by killing the bacteria on the enamel which produce the enamel dissolving acids. A vital question concerning fluoride, therefore, is can you kill the bacteria in the mouth without poisoning other enzymes in the body, once it is swallowed? Based upon the increasing percentage of children impacted by dental fluorosis the answer appears to be no. However, the key point is that once the benefits of fluoride are recognized as being topical and the health risks recognized as being systemic, it simply does not make sense to swallow fluoride. If you think it is going to do some good to children’s teeth, TOPICALLY, then the sensible thing to do is to wait for your baby’s teeth to erupt and then very carefully apply the fluoride to the teeth in the form of toothpaste. The key thing is NOT TO SWALLOW IT, which is precisely what can’t be avoided once the fluoride is in the water!
Adding fluoride to your drinking water makes as much sense as adding nail varnish or skin ointment to your bread.
Fluoridation is Safe, it’s effective, it’s efficient, it’s economical,it’s socially equitable, it’s environmentally sound, and its good public policy.
7) Our response:
Easley loves this soundbite (7 arguments in one sentence!), he uses it again and again. However, saying something over and over doesn’t make it true. Each argument has to be defended separately with good research and good data. Easley is sadly lacking on the research and data to support each of these seven claims, as is indicated by the fact that at this point in his presentation he has yet to offer any documentation to support any one of these 7 positions.
The National Academy of Sciences, the Institute of Medicine, has established a minimal adequate intake level for fluoride: ‘this is a daily intake level that people need to properly develop and to properly prevent dental decay.’
8) Our response:
The notion that people need fluoride to “properly develop” teeth was addressed in a previous response. Fluoride does not help to develop teeth, it may only help to protect them topically once they have erupted.
People in fluoridated communities get about half their adequate intake from drinking water so its calculated to figure in fluoride that we get from other sources.
9) Our response:
The level of fluoride added to drinking water and advocated as the adequate “optimal” level since 1945 in the US is 1 ppm (0.7 – 1.2 ppm depending upon climate). 1 ppm is equivalent to 1 milligram of fluoride per liter of water, and 1 liter of water is considered to be the average daily consumption. So assuming that the average child consumes one liter of water they would get 1 mg of fluoride per day. 1 mg a day was believed to be the ‘optimal level’ i.e. the fine balancing point for fluoride exposure, where fluorosis was minimized and cavity prevention maximized. Interestingly enough, as the CDC (1999) explains, above 1 mg a day there is a decreased relationship between fluoride exposure and cavity reduction. According to the CDC, “Caries among children was lower in cities with more fluoride in their community water supplies; at concentrations greater than 1.0 ppm, this association began to level off.”
Since 1945, however, we are getting fluoride from many other sources. From the combined use and consumption of fluoridated toothpastes and dental products, food and beverages processed with fluoridated water, and food with fluoride containing pesticide residues, most children and adults are already exceeding the so-called ‘optimal level’ of 1 mg per day. This being the case, Easley should state here why we still need to give people an additional 1 milligram of fluoride a day via drinking water when we are getting 1 mg a day from these other sources. If institutions like the Public Health Service, ADA, and the CDC, had been more receptive and accomodating to such changing fluoride exposure trends, they would have lowered by now the “optimal” level needed in water to account for the significantly increasing levels of fluoride we are getting from these other sources.
Adequate intake (AI) is defined as the daily ‘intakes that have been shown to reduce the occurence of dental caries maximally in a population without causing unwanted side effects including moderate dental fluorosis’ (source: Dietary reference intake for calcium, phosphorous, magnesium, vitamin d, and fluoride, Institute of Medicine august 1997).
Community water fluoridation does not cause moderate dental fluorosis.
10) Our Response:
When Easley says that “water fluoridation does not cause moderate dental fluorosis” he is doing two things: a) he is ignoring the “mild” and “very mild” forms of dental fluorosis and b) he is attempting to exploit the fact that it is a combination of fluoride exposure from all sources that is causing dental fluorosis, i.e. from fluoridated water, food and beverages processed with fluoridated water and dental products etc. Fluoride is the only known cause of dental fluorosis and the fluoride used in fluoridation programs cannot be conveniently excluded from being a key contributing factor in fluorosis, both directly in the water and indirectly via food contaminated with it. Swallowing toothpaste by young children also contributes to dental fluorosis, hence the increase in dental fluorosis in non-fluoridated communities.
Recent large studies in the U.S. confirm the fact that fluorosis is increasing in both fluoridated and non-fluoridated communities, but more so amongst the fluoridated.
Heller et. al, for instance, when looking at 15,532 U.S. schoolchildren aged 7-17 years who had a history of a single residence in a fluoridated community, found that 29.9% of the children had dental fluorosis i.e.approximately 1 in 3. However this figure reflects those children with at least TWO teeth impacted by dental fluorosis. If we include the children which may have had signs of dental fluorosis on one tooth, the percentage of children jumps to 66.4%. This figure is certainly in line with other studies in the US. For example:
a) Williams (1990) found that 81% of a sample (n = 374) of 12-14 year olds in Augusta, Georgia (a fluoridated community) had dental fluorosis.
b) Lalumandier (1995) found that 75% of a sample (n = 233) of 5 to 19 year olds had fluorosis in Asheville, North Carolina (fluoridated).
c) Morgan (1998) found that 69% of a sample (n =197) of 7 to 11 year olds in surburban Boston (fluoridated) had fluorosis.
Also on page 108 of Dental Fluorosis – A Handbook for Health Workers by Ferjerskov, Baelum, Manji and Moller, Munksgaard, 1988, it states: “…we have shown that a daily intake of fluoride as low as 0.04 mg/kg body weight can result in dental fluorosis of the permanent dentition. This amount is considerably below that which is usually referred to in the literature (0.1 mg/kg body weight). This is hardly surprising since a ‘magic borderline’ below which the signs of dental fluorosis are totally absent from all people does not in reality exist.”
While Easley, and other proponents of fluoridation, like to dismiss dental fluorosis as merely a “cosmetic effect”, it is far more serious than that. It is a clear indication that fluoride has been ingested and got inside the growing tooth cells. Pam DenBesten (1999) has showed that fluoride causes dental fluorosis by poisoning enzymes which lay down the tooth enamel. To be precise fluoride inhibits enzymes called proteases which normally digest the little amount of protein left between the mineral prisms immediately before they fuse to form the smooth enamel surface. The little pieces of protein left cause the fluorotic white patches on the tooth. What this means is that dental fluorosis, when it occurs, is signalling to us that fluoride has entered the body and poisoned an enzyme. Those concerned about human health, should now ask, what other enzymes is fluoride likely to poison in the body, for which there is no visible telltale sign such as our teeth?
This issue of fluoride poisoning enzymes was the reason why Nobel Laureate, Dr. James Sumner, the key biochemist of his day, was concerned about fluoridation’s safety. Sumner expressed caution, stating that
“We need to go slowly. Everybody knows fluorine and fluorides are very poisonous substances…We use them in enzyme chemistry to poison enzymes, those vital agents in the body. That is the reason things are poisoned; because the enzymes are poisoned and that is why animals and plants die” (see Connett 2000).
Well, why use public water supplies as the vehicle for providing this public health activity?
* Treatment of water for public consumption is a tool used by public health agencies to prevent disease as far back as the 1840’s.
* Water treatment for disease prevention is a primary public health activity.
* Water treatment prevents diseases such as:
*enteropathogenic diarrhea (e coli)
& many other diseases, including dental caries.
11) Our response:
Once again Easley is mixing up apples and oranges here. It has been pointed out many times that there is a huge difference between treating water to kill pathogens and using the water as a vehicle to deliver medication. The diseases being combatted at the water treatment facility are those that might be carried by the water and poison the consumer. On the other hand dental decay is not a disease which originates at the water treatment facility, it begins in the mouth. It is best treated there, or prevented there, by the consumer, not by any engineers –acting as dentists–at a water plant.
The American Water Works Association and the National Sanitation Foundation have established standards for chemicals that are added to public water supplies. The various fluoride chemicals used by water treatment plants are approved by these organizations and are safe for all.
Water treatment chemicals are used for a number of things
12) Our response:
Beyond the fact that all these chemical treatment processes (except fluoridation) are treating the water and not the human, all the chemicals used (except fluoride), are accomplishing goals which would not be practical or feasibly accomplished by the individual, i.e. an individual can brush their teeth to prevent cavities. That is feasible. An individual can not pour a host of chemicals into their cup or kettle to perform the various other functions Easley describes. That is not feasible.
Also, citing a lengthy list of chemical uses in the water, says nothing of the safety or effectiveness of fluoride. We could use the same list and end with mercury, and say well we already use a bunch of other chemicals so what’s the big deal about using one more?
Community water fluoridation is the cornerstone of dental caries prevention for over 54 years because fluoridation is:
*environmentally sound &
*good public policy
13) Our reponse:
Instead of citing a study here which demonstrates that fluoridation is the “cornerstone of dental caries prevention” over the last 54 years, Easley attempts to support this assertion by referring back to his unsupported refrain. In continually repeating this packaged refrain, Easley is following Goebbels’ key recommendation for propagandists: repeat the lie enough times and people will eventually believe it.
Community water fluoridation is an example of a perfect public health intervention, because
*it does not discriminate against any group
*large groups are protected continuously with no conscious effort on their part to participate
*it works without requiring individuals to gather in a central location
*it does not require costly services of health professionals to deliver
*there’s no daily dosage schedules to remember
*there’s no foul-tasting oral medications to endure
*there’s no painful inoculations to experience
*and all the public has to do is go about their normal daily routine to be protected.
14) Our response:
Fluoridation does discriminate.
*It discriminates against people who do not want to be forced to ingest fluoride, and the other waste products from the superphosphate fertilizer industry’s scrubbing water (even if it has been diluted).
* It discriminates against those who are particularly sensitive and vulnerable to fluoride’s toxic effects. As described earlier, those sensitive to fluoride’s toxic effects include those who have deficinencies in either vitamin C or calcium, or protein. In its toxicological profile on fluoride, the Agency for Toxic Substances and Disease Registry (ATSDR, 1993), stated that there are particular subsets of the population which are “unusually susceptible to the toxic effects of fluoride and its compounds”, these populations include:
“the elderly, people with deficiencies of calcium, magnesium and/or vitamin C, and people with cardiovascular and kidney problems…Impaired renal clearance of fluoride has also been found in people with diabetes mellitus and cardiac insufficiency. People over the age of 50 often have decreased renal fluoride clearance…Poor nutrition increases the incidence of dental fluorosis and skeletal fluorosis..” (page 113).
* It descriminates against mothers’ who bottle feed their babies. According to the Institute of Medicine, based upon the natural levels of fluoride found in breast milk, the appropriate level of fluoride for infants under 6 months of age is 0.01 mg per day, which is 100 times less than the so called optimal level of 1 mg per day, which would be obtained from one liter of fluoridated water (Alberts & Shine, 1998). Even the American Dental Association (Pendrys, 1995) recommends that infants under six months not receive any fluoride supplementation to their diet. Therefore, any mother bottle feeding a child living in a fluoridated area is faced with a dilemma of not being able to safely use fluoridated tap water to make up her baby formula.
Moreover, people can’t really expect to just “go about their normal daily routine (and) be protected” from dental decay. Even applied topically, fluoride is not a magic bullet. Parents in fluoridated communities, just as parents in non-fluoridated communities, still need to make sure that their kids don’t overdose on sugar, aren’t exposed to lead, get a good diet, brush their teeth regularly and don’t swallow their toothpaste.
Fluoridation is extremely cost effective.
The average US average cost for fluoridation equals fifty cents per person per year.
So if you assume a 75 year life span, that’s $37.50 for a lifetime of protection for one person.
According to a 1998 national dental cost survey it costs $62.00 for one small filling on one tooth.
Thus, it costs less for a lifetime of protection from fluoridation for one individual than it costs for one small dental filling for that same individual — $37.50 vs. $62.00.
Fluoridation has an 80:1 benefit-to-cost ratio.
On average, for every $1 spent on fluoridation, $80 in dental treatment costs are saved (source: CDC).
15) Our response:
When one hears these statistics, they sound impressive. However, it bears considering that when the CDC first published this 80 to 1 estimate (1992 – see http://fluoride.oralhealth.org/papers/00016840.htm ), they had available to them the results of the largest survey on dental health ever conducted in the United States. In 1986-87, the National Institute for Dental Research, at a taxpayers’ expense of $3.6 million, examined the teeth of over 39,000 children in 84 different communities. In the study, the NIDR’s own statisticians determined that the average difference in DMFS (Decayed, Missing & Filled Surfaces) for children aged 5-17 living in fluoridated vs. non-fluoridated areas, was only 0.6 (2.79 DMFS vs. 3.39 DMFS). This is a difference of approximately a half of one tooth surface, of which there are 128 in a child’s mouth! (Brunelle & Carlos, 1990).
How the CDC could calculate their 80 to 1 ratio, in light of this study, is difficult to understand. For if the CDC’s estimate is right, than a restoration of a half tooth surface costs $680.00, which is obviously not the case.
The math for this $680 figure is as follows:
1) $0.50 a year for fluoridation.
2) 17 years multiplied by $0.50 equals $8.50.
3) $8.50 multiplied by 80 (every dollar spent saves 80) equals $680.00
4) restoration of 0.6 tooth surface equals $680.00
It’s indeed difficult to understand how fluoridation is providing an 80 to 1 cost benefit, when it is now known that decay rates are declining at similar rates in both fluoridated and non-fluoridated communities (Diesendorf, 1986, WHO online – see http://www.whocollab.od.mah.se/euro.html). According to Hardy Limeback, Past-President of the Canadian Association for Dental Research, and Head of Preventive Dentistry at the University of Toronto,
“Even when very large sample sizes are used to obtain statistically significant results, the benefit of water fluoridation is not a clinically relevant one (the number of tooth surfaces saved from dental decay per person is less than one half). Recent studies show that halting fluoridation will either result in only a marginal increase in dental decay which cannot be detected or no increase in dental decay at all” (Limeback, 2000).
Likewise, Kunzel (1997), who performed a study in former Eastern Germany after fluoridation had ceased (when the two Germanies united), found, to his surprise, that dental decay continued to decrease after fluoridation was stopped. In his paper he states “…it is obvious that the relation between varying F concentrations of the drinking water and the caries level, being valid between 1959 and the mid-eighties, is no longer true”.
A particularly interesting study confirming this fact in the US is the recently published paper by Kumar and Green (1998). Their paper deals with the state of children’s teeth in Newburgh and Kingston, NY. These cities are very significant from the historical perspective of the fluoridation issue because the earlier 1945-55 study of Newburgh-Kingston is still cited today as evidence for the efficacy of fluoridation. Newburgh was the second city that was fluoridated in the US (in 1945) and Kingston was the control city. To this day Newburgh has remained fluoridated, and Kingston has remained unfluoridated. The children’s teeth were examined in 1945, before fluoridation, 1955 (10 years after fluoridation), 1986 and 1995. Kumar and Green summarize the data for ’45, ’55, ’86 and ’95 in graphical form. In 1955, the teeth of the Newburgh children showed a dramatic decline in DMFTs compared with those of Kingston. However, when the teeth were re-examined in 1986, there was little difference between the two communities. By 1995, the teeth of the children of unfluoridated Kingston had slightly better average DMFTs! Dental fluorosis, meanwhile, was about twice as high in Newburgh as it was in Kingston. In sum, based upon this 50 year experiment, we can now say, that the children of unfluoridated Kingston have got better teeth on two counts: a) they have slightly better DMFTs and b) they have about half the dental fluorosis of fluoridated Newburgh.
Another problem with the 80 to 1 cost-benefit ratio is that it doesn’t take into account the increased costs of treating fluorosis, incidences of which are increased by fluoridating the water. This is a particularly significant omission considering that Dr. Limeback has stated that we are spending more money treating dental fluorosis than we would be spending treating the “clinically irrelevant” increase in dental decay that would result if fluoridation were halted. According to Limeback, treating dental fluorosis has now become a multi-billion dollar industry.
Nor has Easley taken into account the huge potential costs of increased hip fractures in the elderly which are possibly associated with fluoride exposure. There have been 18 studies (4 unpublished, see references below) in the last decade examining the issue of whether fluoridation contributes to hip fracture. While the results are mixed (not at all unusual in human epidemiological studies), 10 of the studies show an association, and 8 do not, the issue is of one of grave concern. The US spends up to $10 billion a year treating hip fractures, and one in four of elderly patients suffering from hip fracture are dead within a year of their operation. If it is confirmed that fluoridation does contribute towards an increase in hip fracture, the costs could dwarf the suggested savings from fluoridation.
Those fortunate enough to have had access to community water fluoridation experience 40-60% percent fewer dental cavities.
16). Our response:
Note that no source is given for this 40-60% reduction claim. Being that this is perhaps the most fundamental assertion made by Easley in his presentation (upon which he will extrapolate many other claims of cost-saving benefit) this is a glaring omission. It is also a technical inconsistency, as Easley throughout the presentation cites sources for other less significant data such as population sizes and dental school enrollment.
We suspect Dr. Easley doesn’t cite a source for this 40 to 60% reduction claim, because there are no modern studies which support these figures.
For instance, in the NIDR’s 1986-87 study (the largest ever done in the US) the differences in DMFTs (Decayed, Missing and Filled Teeth) between children living in fluoridated and nonfluoridated communities was 1.97 and 2.05 respectively, which represents a difference of just 0.39% (Yiamouyiannis, 1990 – see http://www.fluoridealert.org/DMFTs.htm). In terms of the difference in DMFS, Brunelle and Carlos (1990) found an 18% difference (2.79 DMFS vs. 3.39 DMFS) which as mentioned above amounts to an approximate average of one half of a tooth surface.
This is what the Department of Health and Human Services said about the NIDR study in a press release dated May 1, 1989, “Children who had always lived in fluoridated areas had about 18% less tooth decay than children who have never lived in a fluoridated community…when some of the effects of topical fluorides were taken into account, the difference rose to 25 percent”.
The 40-60% reduction claim, along with being contradicted by the NIDR’s data, is not supported by the findings of Mark Diesendorf published in Nature (1986). Diesendorf, and likewise Colquhoun (1987, 1994) found that levels of dental decay were falling in many communties before fluoridation was introduced, has continued to fall in both fluoridated and non-fluoridated communities and further continued to fall in fluoridated communities even after both the benefits of fluoriation and the use of fluoridated toothpaste would have had been maximized. Bette De Liefde (1998) has also found a convergence between the quality of children’s teeth in both fluoridated and non-fluoridated communities in New Zealand, and that improvements have continued there even after the assumed benefits of fluoridation and fluoridated toothpaste had been maximized. She hypothesizes that it may be the preservatives (antibiotics) in processed food which also serve the purpose of killing the decay-causing bacteria in our mouths.
A good question, therefore, to ask when Dr. Easley claims fluoridation reduces cavities by 40 to 60% is on what study does he base this claim, how large was the study, and when was it done? Also, it would be instructive to ask Easley how he claims fluoridation reduces decay by 40 to 60% when the Department of Health and Human Services, based on data from the largest modern U.S. study on teeth, claimed that there was only an 18% reduction.
17) Our response:
Again, Easley makes a blanket statement which he does not support with accompanying research data. But here we will focus on why fluoridation does not benefit infants, and why it very much stands to harm senior citizens, particularly those having lived in fluoridated communities for many years.
PRE-ERUPTION INFANTS. As mentioned earlier, leading dental researchers like Featherstone (2000) are now realizing that fluoride does not work systemically. It was their belief in systemic benefit, however, which has led dentists and doctors, for the last 55 years, to prescribe fluoride tablets for pregnant mothers and new born infants. It was their belief that fluoride would make its way through the body into the developing teeth, get incorporated there and then provide greater protection for the teeth against acid attack. However, as Featerstone states today, “The fluoride incorporated developmentally – that is, systemically into the normal tooth mineral- is insufficient to have a measurable effect.”
Any city council member considering fluoridation as a result of Easley’s testimony, should ask him therefore, if systemic exposure to fluoride has insufficient effect on the pre-erupted tooth, why is fluoridated water a good idea for an infant before their teeth have erupted?
And if it isn’t a benefit, but instead, increases their risk of dental fluorosis and possibly other health problems, how will councils which fluoridate the public water supplies, ensure that mothers who bottle feed their babies do not use fluoridated water to make up their formula. What are the legal liabilities here?
SENIOR CITIZENS. As far as senior citizens are concerned, any benefits which may or may not have accrued to their teeth over and above what can be obtained from fluridated toothpaste, has to be balanced with the daily accumulation of fluoride in their bones. How brittle will those bones be after 50, 60, 70 or even 80 years of accumulation? The US government is not tracking the level of fluoride in our bones, but, as noted above, there have been 18 studies conducted since 1990, from the US, France, Finland, Canada and China, probing the possible relationship between exposure to fluoride via water and increased hip fracture. 10 of the them show an association. The study from China (Li, 1999, unpublished) shows an almost linear increase with fluoride levels in the water (1 ppm to 7 ppm) on hip fracture.
Fluoridation Reduces the Number of Missed Work Days, Saves Employers Money, Lowers the Cost of Medical Insurance, and Lowers the Cost of Consumer Goods & Services.
18) Our reponse:
Again this argument hinges on the proof that the reduction in tooth decay is as substantial as Easley is claiming and that the reductions that have taken place are not due to other causes as discussed above.
Who benefits from dental treatment cost savings?
*taxpayers who support public programs
*employers who pay prepaid dental care fringe benefits for their employees
*employers who normally absorb costs for employees missed days from work
*consumers who will pay lower prices for consumer goods because of lower employer costs for insurance and employee absences
*Patients who will pay lower health care bills & lower insurance premiums because of fewer numbers of hospital emergency room visists for dental emergencies
*patients who will pay lower health care bills, lower dental care costs, & lower insurance premiums because of lower costs incurred by providers for uncompensated care, costs which are often passed on to those who can pay.
*lower health care costs
*lower insurance costs
*lower tax-supported costs for public programs
*lower business costs for employers
*lower costs for consumer goods and services.
19) Our response:
Note again, that Easley doesn’t provide one study to support these assertions. For these claims to have merit, he would need to show studies which have compared:
*Insurance rates in fluoridated vs. non-fluoridated areas
*Tax rates for fluoridated vs. non-fluoridated areas
*Business costs for fluoridated vs. non-fluoridated areas
*Inflation rates for fluoridated vs. non-fluoridated areas.
Just to give you an example of the impact that community water fluoridation has had on the dental education system and the practice of dentistry in the United States:
*7 Dental Schools have closed since 1985
*Enrollment reductions in the remaining dental schools since 1980 are equivalent to the closure of another 20 average size dental schools (source: Institute of Medicine 1995).
We’re graduating about half the number of dentists today each year than we graduated back in 1980.
20) Our response:
This is an interesting fact, but more revealing would be a study comparing the number of dentists in fluoridated areas compared to non-fluoridated areas. With cavities declining in both fluoridated and non-fluoridated communities, it does not follow that fluoridation is the reason why dental school enrollment is down.
Currently in the United States 145 million Americans drinking water from community water systems with optimal fluoride levels. This represents 62.2% of the population having access to a community water supply. Now this is really a little bit misleading because this is based on a 1992 national fluoridation census which was the last one that was conducted. We know that we’ve added so many more communities. That many, many more americans, many millions of more americans, are having access to optimally fluoridated water now.
Currently in the United States:
* 14,300 community water systems fluoridate
* these systems serve 10,500 American communities
* 45 of the 50 largest U.S. cities fluoridate their water system
10 states, Puerto Rico, & the District of Columbia mandate statewide fluoridation through legislation — California, Connecticut, Delaware, Georgia, Illinois, Minnesota, Nebraska, Nevada, Ohio, South Dakota
4 states have 100% of the population served by community water systems benefiting from fluoridation:
*District of Columbia
13 states have greater than 85% of that population served by community water systems benefiting from fluoridation:
List of Communities Recently approving fluoridation [U.S. Bureau of Census 7/1/98 Population estimates]:
|Los Angeles, CA
|Las Vegas, NV
|San Diego, CA
|Escambia County, FL
|Pompano Beach, FL
|Boynton Beach, FL
|Sacremento Co, PA
|Canon City, CO
Just in the last year and a half we have added 7.9 million people (7,926,690) to the rolls of people recieving optimally fluoridated water. So many of your counterpart cities around the country are choosing to fluoridate their water systems.
21) Our reponse:
While many of these states do fluoridate much or most of their water, and while other cities have indeed begun fluoridating recently, it is important to note the following countries which over the past two to three decades have reviewed and rejected water fluoridation and which have not, somehow, suffered the consequences of high cavity levels.
The following statements are from some of these governments concerning fluoridation:
Japan: “Japanese government and local water suppliers have considered there is no need to supply fluoridated water to ALL users because 1) impacts of fluoridated water on human health depends on each human being so that inappropriate application may cause health problems of vulnerable people, and 2) there is other ways for the purpose of dental health care, such as direct F-coating on teeth and using fluoridated dental paste and these ways should be applied at one’s free will” (Toru Nagayama, Environment Agency, Government of Japan, Tokyo, March 8, 2000). (You can read full letter at: www.fluoridation.com/c-japan.htm).
Belgium: “This water treatment has never been of use in Belgium and will never be (we hope so) into the future.” (Chr. Legros, Directeur, Belgaqua, Brussels, Belgium, February 28, 2000 — www.fluoridation.com/c-belgium.htm).
Denmark: “We are pleased to inform you that according to the Danish Ministry of Environment and Energy, toxic fluorides have never been added to the public water supplies.” (Klaus Werner Royal Danish Embassy, Washington DC, December 22, 1999 – www.fluoridation.com/c-denmark.htm).
Norway: “In Norway we had a rather intense discussion on this subject some 20 years ago, and the conclusion was that drinking water should not be fluoridated” (Truls Krogh & Toril Hofshagen, Folkehelsa Statens institutt for folkeheise (National Institute of Public Health) Oslo, Norway, March 1, 2000 – www.fluoridation.com/c-norway.htm).
Sweden: “Drinking water fluoridation is not allowed in Sweden…New scientific documentation or changes in dental health situation that could alter the conclusions of the Commission have not been shown.” (Gunnar Guzikowski, Chief Government Inspector, Livsmedels Verket — National Food Administration Drinking Water Division, Sweden, February 28, 2000 – www.fluoridation.com/c-sweden.htm).
Germany: “In the Federal Republic of Germany there was in about 1952 a drinking water fluoridation experiment. But it was stopped after one or two years” (Geschaftszeichen (Bei allen Antworten bitte angeben), Bonn, Germany, February 11, 2000 – www.fluoridation.com/c-germany.htm).
Finland: “We do not favor or recommend fluoridation of drinking water. There are better ways of providing the fluoride our teeth need.” (Paavo Poteri, Acting Managing Director, Helsinki Water, Finland, February 7, 2000 – www.fluoridation.com/c-finland.htm).
Austria: “Toxic fluorides have never been added to the public water supplies in Austria.” (M. Eisenhut, Head of Water Department, Osterreichische Yereinigung fur das Gas-und Wasserfach Schubertring 14, A-1015 Wien, Austria, February 17, 2000 – www.fluoridation.com/c-austria.htm).
The U.S. Surgeon General’s year 2010 Health Objectives for the Nation include a fluoridation objective to get 75% of the population fluoridated by the year 2010.
The U.S. is currently at 62.2% but as I said that’s a bit misleading…we think that we’re somewhere around 70% right now and we’re going to more than achieve the 75% objective by the year 2010.
22) Our response:
Again, it is interesting to note here how specific Easley gets with population data, in light of how general, to its detriment, the rest of his presentation has been. To his critics, this may be because Easley is more preoccupied with ardently promoting fluoridation than he is with dealing with the evolving science on the matter.
Who supports water fluoridation?
The public does, the American public.
1998 National Gallup Poll of Consumers’ Opinions on Whether Community Should be Fluoridated
Don’t Know 12%
1991 National Gallup Survey of Parents:Gallup, Dec 1991
Question asked: Whether or not you presently have fluoridated water, do you approve or disapprove of fluoridated drinking water?
Don;t Know: 12%
So an overwhelming majority of American citizens when surveyed, year in and year out, agree that community water fluoridation is what they want and approve of it.
23) Our response:
As with all polls, one needs to keep in mind that the results of a poll depend upon the way a question is asked. The above question, considering that most Americans are not very knowledgable about the fluoridation issue (for example how many Americans know that 90% of the water which is fluoridated, is fluoridated using a hazardous waste product of the superphosphate fertilizer industry?) does not say that much. Contrast this American poll with one carried out in Britain in 1993 (O’brien, OPCS, 1993), where people were asked how one attains good dental hygiene. In the poll the majority of people mentioned common sense things like, brushing teeth, visiting the dentist, and limiting sugar in the diet. Only 3 to 5% metnioned either fluoride or fluoridation as a key factor.
Moreover, if the question was asked in a way which gave the respondent a better sense of the controversy concerning dental benefits vs health risks, the poll would undoubtedly have much different results. Such a question might have been, “Some claim adding fluoride to the public water supply benefits people’s teeth, while others claim it can cause adverse health effects. Do you believe a community’s water should be fluoridated?”
Secondly, if there really is “an overwhelming majority of Americans” who want fluoridation, why do so many communities when given a chance to vote on the issue, vote against it? Take for instance, the recent referendum (August 9, 2000) in Ste. Genevieve Missouri where residents voted no to fluoridation 54 to 46 percent. Such a vote is not uncommon. For instance, according to a 1990 letter from the Florida Department of Health and Rehabilitative Services, “the statistics are that 3 out of 4 fluoridation referenda fail.” It’s interesting to note here, that in this letter they prefaced this point by suggesting that communities should “avoid a referendum” if they wish to fluoridate (Acess letter at: www.fluoridealert.org/low-profile.htm).
One explanation for the discrepancies between the national polls Easley cites versus the results of community referenda is that people generally become more ambivalent about fluoride once they learn about possible health effects and that they and their children will have to ingest the substance every day for the rest of their lives.
But, in sum, it is clearly inaccurate to say that the “overwhelming majority” of Americans support fluoridation. If anything, the overwhelming majority of Americans neither approve nor disapprove, but are instead inadequately informed about either side of the issue. In our view, opinion polls would only tell us something meaningful if they were preceded with a thorough discussion of both sides of the issue.
Who supports fluoridation?
Newspaper editorials strongly supporting fluoridation since 7/1/99:
Abilene (TX) Reporter-News
Colorado Springs Gazette
Cumberland (MD) Times-News
Las Vegas Sun
Olympia (WA) Olympian
Salt Lake City Deseret News
Salt Lake City Tribune
San Diego Union-Tribune
St. Louis Post-Dispatch,
among many, many many other newspapers.
24) Our response:
We agree that many newspapers do. This is both true and problematic. Because all too often we have found that editors are excessively polemical on the issue, often clumping all citizens concerned about fluoridation’s safety into some 1950’s John Birch Society camp of paranoid right wing conspiracy theorists. Not only does this approach to the issue fail to properly educate people about both sides of the issue, it does a real disservice to efforts made by concerned citizens and independent scientists to raise reasonable concerns based on peer reviewed literature. There are few groups of citizens in this country, we believe, who are treated as disrespectfully and unfairly as those groups concerned about fluoridation. Take for instance, the following examples from recent editorials:
|* From the St. Louis Post-Dispatch, March 10, 2000:”IN the 1950s, opponents of fluoridation of public water supplies saw good dental health as part of a communist plot to eliminate cavities and capitalism in one fell swoop.Half a century later, the world has changed. Communism has all but disappeared, but ignorance and fear persist among the anti-fluoridation crowd. They still see bogeymen where others see benefits. Now that the once-mighty Soviet Union has crumbled — and with it, presumably, its plans for world domination through America’s teeth — they have seized upon the supposed adverse health effects of fluoride as their latest weapon.”
|* From the San Diego Tribune April 4, 2000, in a presumed attempt to show off the editor’s assumed intellectual savvy and wit:”You insist that fluoridated water wasn’t a Commie plot? OK, pinko, explain this:Since 1954, no fluoride has been added to San Diego County’s water supply. Not one drop.Throughout these additive-free years, guess how much territory we surrendered to the Red Army? Not one inch.”
Those who have actually been with, and listened to what people opposed to fluoridation are talking about, will know that communist plots are as irrelevant to them as the Monica Lewinsky scandal is. But somehow or another, it is almost formulaic, that editors begin their piece by making some self deemed witty statement about how wrong those 1950’s John Bircher’s were.
But what makes it all worse, is that these same editors, who make sweeping and blanket statements (sound familiar?) about the lack of scientific credibility behind fluoridation concerns, turn around and make ridiculously flawed statements themselves about the science. Take for instance, the following two editorials from the Honolulu Advertiser, which claim that fluoridation is essential because fluoride’s primary benefits come from systemic exposure, which is exactly the opposite of what, as discussed above, is now understood by the dental community itself. According to the editors,
“Community water fluoridation has been shown to safely prevent up to 70 percent of dental cavities. It does this by hardening teeth from the inside, preventing cavities and tooth decay that topical applications cannot prevent. There are other ways to take fluoride, in pills, for example, but none are as effective as adding it to water (March 10, 2000).”
In an earlier editorial (Feb 25, 2000), the editors stated:
“It is fluoride’s hardening from within that makes their teeth resistant to attacks from caries-producing influences. Painting or brushing it on affects only the surface. It helps, but marginally by comparison, and it doesn’t help the kids who don’t get it.”
If these editors had read the CDC to whom they often refer, they wouldn’t have made such a large mistake about the way fluoride works. As the CDC (1999) states, “laboratory and epidemiologic research suggests that fluoride prevents dental caries predominately after eruption of the tooth into the mouth, and its actions primarily are topical for both adults and children.”
It is interesting to note, however, that it’s not only editors who make the mistake about how fluoride works, Easley does it himself in his own published papers. In his paper “Fluoridation: Triumph of Science over Propaganda,” Easley states, “the fluoride in the water is incorporated into the enamel of developing teeth in children below the age of 16, making their teeth more resistant to decay for a lifetime.”
Who supports community water fluoridation?
*American Medical Association, established in 1847 with 296,000 members
*American Dental Association established in 1859 with 141,000 members
*American Dietetic Association established in 1917 with 70,000 members
*American Academy of Pediatrics established in 1930 with 49,000 members
*American Academy of Family Physicians established in 1947 with 84,000 members
*American Public Health Association established in 1872 with 50,000 members
*National Academy of Sciences (1863) Institute of Medicine
*U.S. Public Health Service (1798)
*National Institutes of Health (1891)
*Centers for Disease Control (1946)
*World Health Organization (1946)
Also the American Water Works Association (1881) with 52,000 members, who represent water plant operators, water engineers, and public water system administrators.
25) Our Response:
While this list sounds impressive, and is doubtless the reason many citizens, councilors and editors believe that fluoridation is safe and effective, (without bothering to do their own reading of the scientific literature on this issue), one has to ask whether each of these organizations have done their own homework or independent analysis and research. If not, on whose analysis are they relying?
What one is likely to find is that many of these organizations have not done their own independent review but support fluoridation because the US Public Health Service supports it (the CDC & the NIH are a part of the US Public Health Service, others receive funding from the US PHS). Brian Martin articulated this point in his book, Scientific Knowledge in Controversy: The Social Dynamics of the Fluoridation Debate. “Most of the endorsements,” Martin writes, “have been made on the basis of earlier endorsements by a few key organizations, in particular the USPHS and the ADA. At best, endorsing bodies relied on advice from a small number of experts, almost all of whom were committed promoters of fluoridation.”
What this list more accurately represents, therefore, is not the outcome of thorough up-to-date objective analysis of the issue, but rather a superficial appearance of a strong scientific consensus, where, in actual fact it does not exist. What we have is a political consensus. Such an explanation is quickly confirmed when one seeks to find the basis of these, and other organizations, support for this measure. Very few of these organizations can present a coherent defence of their position without resorting to other “authorities”.
Who supports fluoridation?
*credible & respected scientific & professional organizations that have been around for a long time;
*organizations with real offices & peer reviewed journals; and
*organizations that can be found in the phone book! – today and tommorrow
26) Our response.
This is nice rhetoric but it doesn’t actually substitute for good scientific data and arguments.
Who opposes fluoridation?
Not any credible scientific or professional organizations.
Groups you never heard of,
groups with a few members;
groups using multiple names to try to make it look like there is “overwhelming opposition”;
groups who misinform and threaten;
groups who fraudulently market self-published propaganda as science;
groups who believe that fluoridation is a conspiracy;
groups with no professional credibility or scientific standing;
groups with no history;
even a labor union, controlled by a couple of members whose sole selfish motives are to undermine the consumer protection activities of their federal employer; and
groups who won’t be around tomorrow to be held accountable for the results of their propaganda.
27) Our response:
If Easley really believes this, then he must believe that countries like Austria, Belgium, Denmark, France, Germany, Greece, Italy, Netherlands, Norway, Sweden and Japan, were only recently formed, have no credibile scientific organizations, no offices, no telephone numbers and won’t be around tomorrow to pay for their mistaken rejection of fluoridation!
Also, it is ironic that Easley made these comments at the Wellington Forum, because there on the same panel with him were both Dr. Hardy Limeback, D.D.S, Ph.D., President of the Canadian Association for Dental Research and Head of Preventive Dentistry at the University of Toronto and Dr. William Hirzy, a Ph.D. in organic chemistry, health risk assessment scientist for the EPA and Senior Vice-President of the EPA’s Headquarters Professionals Union, which represents over 1600 scientists, and incidentally has an office and a telephone! Both Limeback and Hirzy believe fluoridation’s health risks far outweigh any marginal benefits.
Moreover, Easley’s comments on citizens groups are unbecoming. Why insult citizens who have worked so hard for many years to raise awareness on this issue, and who, unlike Easley, have had to work without the benefit of taxpayer funds. While we suspect Easley may not be aware of this, most movements towards greater social and environmental justice start with exactly those kinds of “groups you never heard of” which don’t have expensive offices and paid staff. Easley’s contempt of such “unofficial” groups does not reflect well on his notion of a participatory democracy.
Community water fluoridation is an example of a perfect public health measure:
It is safe, it is effective, it is efficient, it is economical, it is socially equitable, it is environmentally sound, & it represents good public policy.
28) Our Response.
Repeat a lie enough times and…
I’d like to close with a quote from John Harris, who is Director of the Centre for Social Ethics and Policy at the University of Manchester, which I think very nicely summarizes the issue around fluoridation:
“In considering the ethics of fluoridation, one might legitimately reverse the question and ask if fellow citizens are entitled to impose not only a disadvantage on the community at large, but impose actual deaths and the risk of death on children for the sake of a minor dimunition in the range of choices available?
We should ask not are we entitled to impose fluoridation on unwilling people, but are the unwilling people entitled to impose the risks, damage & costs of the failure to fluoridate on the community at large. When we compare the freedoms at stake, the most crucial is surely the one which involves liberation from pain and disease.”
29) Our response:
This assertion is ridiculous. Whose imposing death on anyone? We would be interested for any citation for deaths of children or adults which have resulted from lack of fluoridated water. On the other hand there are well documentated cases of deaths from malfunctioning of fluoride delivery equipment (see www.fluoridealert.org/accidents.htm).
Moreover, by denying water fluoridation as an option one does not deny the right of anyone to seek fluoride treatment if they so desire it. Fluoride is readily available in the form of fluoridated toothpaste. In fact, it is so readily available it is very hard in the US to purchase toothpaste which does not have fluoride in it.
Easley’s single-minded and zealous promotion of fluoridation prevents him from giving an objective analysis of this issue.
* He inaccurately characerizes fluoride as an essential nutrient, which it is not.
* He exaggerates the benefits of fluoridation by claiming a 40-60% reduction in dental decay in fluoridated versus non-fluoridated communities, when the largest recent study done on U.S. teeth was only able to cite an 18-25% reduction (a reduction found by using a more stringest standard than DMFTs). Other recent major studies from New Zealand indicate very little significant difference between dental decay in fluoridated and non-fluoridated cities.
* He greatly underestimates the seriousness of dental fluorosis in fluoridated communities, and while claiming safety no less than three times, cites not one single study to rebut the concerns about oesteosarcoma in young males, hip fractures in the elderly, damage to the central nervous system, interference with the pineal and thyroid glands and the plight of those supersenstive to fluoride.
* Nor does he address the key finding by many leading dental researchers that the benefits of fluoride are topical not systemic.
Thus he offers no cogent argument as to why anyone who wishes to use fluoride to fight tooth decay would flush their whole bodies with fluoridated water when they can simply apply fluoride in toothpaste directly to their teeth. Such an approach minimizes the risks and maximizes the benefits.
By remaining entirely focused on the US, Easley is able to point out the number of communities being fluoridated, without acknowledging that the majortiy of West European countries as well as Japan do not fluoridate their water, and have not suffered the dreaded consequences of which Easley warns.
Much more of Easley’s argument rests on unsupported and dubious economic analysis than on considerations of safety or the ethics of forcing fluoride on people who don’t want it, don’t need it or are particularly supersensitive to it. The same apparent disdain Easley exhibits for the recipient of this misguided policy, is reflected in his dismissal of citizen involvement in the debate about fluoridation and his childlike dismissal of the credentials of his opponents.
For someone, so dismissive of a body of opinion which has included 12 Nobel Prize winners in medicine and chemistry, as well as many European countries, his own ability to handle his arguments in an objective and scientific fashion is embarassing.
In short, Michael Easley is a propagandist, not an objective scientist. Of course, in the US which champions the right to free speech he has every right to be a propagandist, to promote his own particular point of view. However, we hope that we have shown enough to encourage any citizen or decision maker that Easley’s presentation falls far short of what is necessary to win an argument, either in the arena of common sense or in science. Hopefully they will avail themselves a more balanced view of this serious issue.
Dr. Paul Connett,
Professor of Chemistry,
St. Lawrence University,
Canton, NY 13617.
The Fluoride Action Network,
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Martin, Brian. (1991). Scientific Knowledge in Controversy: The Social Dynamics of the Fluoridation Debate. State University of New York Press; Albany, New York.
Morgan L et al (1998). Investigation of the possible associations between fluorosis, fluoride exposure, and childhood behavior problems. Pediatric Dentistry – 20:4, 244-252.
Nader, R. (1971) Ralph Nader Discusses Fluoridation. Let’s Live. June. www.fluoridealert.org/nader.htm
Nesin, B.C. (1956) J. Maine Water Util. Assn. 32:33.
O’brien, M. (1993). Children’s Dental Health in the United Kingdom. Social Survey Division, Office of Population, Census and Surveys (OPCS).
Pendrys, David. (1995). Risk of Fluorosis in a Fluoridated Population: Implications for the Dentist and Hygienist. Journal of the American Dental Association. Vol 26. 1995.
Reeves, Thomas. (2000). Manufacture of F chemicals. Letter. (June 1, 2000).
Steelink, C. (1982). Letter to Chemical and Engineering News, July 27, pp 2-3.
Schuld, A. (1999). How Do Fluorides Interfere With Thyroid Function. Fluoride Watershed, Journal of the National Pure Water Association, 5, 3-6, NWPA, 12 Dennington Lane, Crigglestone, Wakefield, WF4 3ET, UK, see also Schuld’s web site: www.bruha.com/fluoride/
Susheela, A.K. (1993). Prevalence of endemic fluorosis with gastrointestinal manifestations in people living in some North-Indian villages. Fluoride, 26, 97-104.
Susheela, A.K. (1998). Scientific Evidence on Adverse Effects of Fluoride. Presented to Members of Parliament & LORDS, House of Commons, Westminister, London, October 20, 1998.
Sutton, P.R.N. The Greaatest Fraud: Fluoridation. Kurunda Pty. Ltd., Lorne, Australia, 1996. ISBN 0 949491 12 8
Teotia, S.P.S. and M,Teotia (1994) Fluoride, 27 (2) 59-66.
Townsend Letter for Doctors (1994). Middletown, Maryland Latest City to Receive Toxic Spill of Fluoride in their Drinking Water. October. 1124-1125. www.fluoridealert.org/accidents.htm
Waldbott, G.L., Burgstahler, A.W. and McKinney, H.L. Fluoridation: The Great Dilemma. Coronado Press, Inc., Lawrence, Kansas, 1978.
Williams JE et al (1990). Community Water Fluoride Levels, Preschool Dietary Patterns, and The Occurrence of Fluoride Enamel Opacities. J of Pub Health Dent; 50:276-81.
Yiamouyiannis, J.A. (1990). Water Fluoridation and Tooth decay: Results from the 1986-87 National Survey of U.S. Schoolchildren. Fluoride, 23,
Yiamouyiannis, J. (1998). Presentation given at the ISFR XXII conference, Bellingham, Washington, August, 1998.
The 18 studies on Hip Fracture and Fluoride Exposure since 1990.
1. Cauley, J., P. Murphy, et al. (1995). “Effects of fluoridated drinking water on bone mass and fractures: the study of osteoporotic fractures.” J Bone Min Res 10(7): 1076-86.
2. a) Cooper, C., C. Wickham, et al. (1991). “Water fluoridation and hip fracture.” JAMA 266: 513-514 (letter, a reanalysis of data presented in 1990 paper).
2. b) Cooper, C., C. Wickham, et al. (1990). “Water fluoride concentration and fracture of the proximal femur.” J Epidemiol Community Health 44: 17-19.
3. Danielson, C., J. L. Lyon, et al. (1992). “Hip fractures and fluoridation in Utah’s elderly population.” Jama 268(6): 746-748.
4. Hegmann, K.T. et al (2000) the Effects of Fluoridation on Degenerative Joint Disease (DJD) and Hip Fractures.Abstract #71, of the 33rd Annual Meeting of the Society For Epidemiological research, June 15-17, 2000. Published in a Supplement of Am. J. Epid.
5. Hillier, S., C. Copper, et al. (2000). “Fluoride in drinking water and risk of hip fracture in the UK: a case control study.” The Lancet 335: 265-269.
6. Jacobsen, S., J. Goldberg, et al. (1992). “The association between water fluoridation and hip fracture among white women and men aged 65 years and older; a national ecologic study.” Annals of Epidemiology 2: 617-626.
7. Jacobsen, S., J. Goldberg, et al. (1990). “Regional variation in the incidence of hip fracture: US white women aged 65 years and olders.” J Am Med Assoc 264(4): 500-2.
8. Jacobsen, S.J. et al (1993). Hip Fracture Incidence Before and After the Fluoridation of the Public Water Supply, Rochester, Minnesota. American Journal of Public Health, 83, 743-745.
9. a) Jacqmin-Gadda, H. (1995). “Fluorine concentration in drinking water and fractures in the elderly.” JAMA 273: 775-776 (letter).
9 b) Jacqmin-Gadda, H., A. Fourrier, et al. (1998). “Risk factors for fractures in the elderly.” Epidemiology 9(4): 417-423. (An elaboration of the 1995 study referred to in the JAMA letter).
10. Karagas,M.R. et al (1996). “Patterns of Fracture among the United States Elderly: Geographic and Fluoride Effects”. Ann. Epidemiol. 6 (3), 209-216.
11. Keller, C. (1991) Fluorides in drinking water. Unpublished results. Discussed in Gordon, S.L. and Corbin, S.B,(1992) Summary of Workshop on Drinking Water Fluoride Influence on Hip Fracture on Bone Health. Osteoporosis Int. 2, 109-117.
12. Kurttio, P., N. Gustavsson, et al. (1999). “Exposure to natural fluoride in well water and hip fracture: A cohort analysis in Finland.” American Journal of Epidemiology 150(8): 817-824.
13. Lehmann R. et al (1998). Drinking Water Fluoridation: Bone Mineral Density and Hip Fracture Incidence. Bone, 22, 273-278.
14. Li, Y., C. Liang, et al. (1999). “Effect of Long-Term Exposure to Fluoride in Drinking Water on Risks of Bone Fractures.” Submitted for publication. Contact details: Dr. Yiming Li, Loma Linda School of Dentistry, Loma Linda, California, Phone 1-909-558-8069, Fax 1-909-558-0328 and e-mail, Yli@sd.llu.edu
15. May, D.S. and Wilson, M.G. Hip fractures in relation to water fluoridation: an ecologic analysis. Unpublished data, discussed in Gordon, S.L. and Corbin S.B.,(1992), Summary of Workshop on Drinking Water Fluoride Inflruenbce on Hip Fracture on Bone Health. Osteoporosis Int. 2, 109-117.
16. Phipps, K. R. (1999). Community water fluoridation, bone mineral density and fractures. R01DE10814-02. HSR/96101800. USA, Oregon Health Sciences University, 611 SW Campus Dr, Portland, OR 97201, IR: (503) 494-8895,. 199309: National Institute of Dental Research (NIDR) – Grant: Noncompeting Continuation (5). To be published in the British Medical Journal.
17. Sowers, M., M. Clark, et al. (1991). “A prospective study of bone mineral content and fracture in communities with differential fluoride exposure.” American Journal of Epidemiology 133: 649-660.
18. Suarez-Almazor, M., G. Flowerdew, et al. (1993). “The fluoridation of drinking water and hip fracture hospitalization rates in two Canadian connunities.” Am J Public Health 83: 689-693.
See also: Riggs, B.L. et al (1990). Effect of Fluoride treatment on the Fracture Rates in Postmenopausal Women with Osteoporosis. N. Eng. J. Med., 322, 802-809.
References on fluoride’s TOPICAL versus SYSTEMIC mechanism of action.
Burt, B.A. (1994). Letter. Fluoride, 27, 180-181.
Carlos, J.P. (1983). Comments on Fluoride. J.Pedodontics. Winter, 135-136.
Featherstone, , J.D.B. (1987) The Mechanism of dental decay. Nutrition Today, May/June, 10.
Featherstone, J.D.B. (2000). The Science and Practice of Caries Prevention. Journal of the American Dental Association. 131, 887-899.
Fejerskov, O. et al (1981) Rational use of fluorides in caries prevention. Acta. Odontol. Scand., 241-249.
Levine, R.S., (1976). The action of fluoride in caries prevention: a review of current concepts. Brit. Dent. J. 140, 9-14.
Limeback, H. (1999). A re-examination of the pre-eruptive and post-eruptive mechanism of the anti-caries effects of fluoride: is there any caries benefit from swallowing fluoride? Community. Dent. Oral Epidemiol. 27, 62-71.
Limeback, H. (2000a). Why I am now officially opposed to adding fluoride to the water. Letter. www.fluoridealert.org
Limeback, H. (2000b) Videotaped Interview. available from GGVideo, 82 Judson Street, Canton, NY 13617. Tel: 315-379-9544. Fax: 315-379-0448. E-mail: firstname.lastname@example.org and www.FluorideAlert.org/limeback-video.htm
Margolis, H.C. and Moreno, E.C. (1990). Physicochemical Perspectives on the Cariostatic Mechanisms of Systemic and Topical Fluorides. J. Dent. Res 69 (Special Issue) 606-613.
Shellis, R.P and Duckworth, R.M.(1994). Studies on the cariostatic mechanisms of fluoride. Int. dent. J. 44, 263-273.
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