As the city of Davis considers whether or not to add fluoride to its water, the Vanguard is going to have a few articles that highlight arguments for and against fluoridation. We have not taken an official position on fluoridation but have received some material on it and wanted to post some of that to promote further community-based discussion.
The following is a letter from Ambassador Andrew Young, a former ambassador to the U.N., dated March 29, 2011 to the Georgia Senate and House of Representatives.
Dear Senators and Representatives:
I am writing to convey my interest in seeing that Georgia’s law mandating water fluoridation for Georgia communities be repealed.
My father was a dentist. I formerly was a strong believer in the benefits of water fluoridation for preventing cavities. But many things that we began to do 50 or more years ago we now no longer do, because we have learned further information that changes our practices and policies. So it is with fluoridation. We originally thought people needed to swallow it, so the fluoride would be incorporated into teeth before they erupted from the gums. Our belief in the need for systemic absorption was why we began adding fluoride to drinking water. But now we know that the primary, limited cavity fighting effects of fluoride are topical, when fluorides touch teeth in the mouth. We know that fluorides do little to stop cavities where they occur most often, in the pits and fissures of the back molars where food packs down into the grooves. This is why there is a big push today to use teeth sealants in the molars of children. We also have a cavity epidemic today in our inner cities that have been fluoridated for decades.
So now we know that fluoride’s impacts are primarily topical and are very limited where needed most in the teeth. And on top of this we are learning that fluorides do not simply affect teeth, but can also harm other tissues and systems in the body. So we must weigh the risks to kidney patients, to diabetics, and to babies against the small amount of cavities prevented by swallowed fluorides. The National Research Council has acknowledged that kidney patients, diabetics, seniors, and infants are susceptible groups that are especially vulnerable to harm from fluorides. There are millions of these persons who have these health conditions or who meet the criteria for concern.
The National Center for Health Statistics says that 41% of 12-15 year old adolescents now have the teeth staining called “dental fluorosis” that shows overexposure to fluorides as a child, and that 3.6% have the very visible moderate and severe forms of the condition. This translates into millions of persons with disfiguring impacts from fluorides. How many of these persons can afford the tens of thousands of dollars to have veneers or other cosmetic dental work performed?
There is growing bipartisan support across the country for halting water fluoridation. And eleven unions of EPA workers, representing 7,000 EPA lab workers, scientists, and others have called for a halt to fluoridation. The recent suggested lowering of fluoride levels in water does not address the fact that we still cannot control the amount of fluorides that sensitive individuals ingest. People are calling for investigative Fluoridegate hearings, and one can understand why, given the fact that the story about fluorides keeps changing.
I am most deeply concerned for poor families who have babies: if they cannot afford unfluoridated water for their babies’ milk formula, do their babies not count? Of course they do. This is an issue of fairness, civil rights, and compassion. We must find better ways to prevent cavities, such as helping those most at risk for cavities obtain access to the services of a dentist.
Fluoride in Drinking Water: A Scientific Review of EPA’s Standards (2006) published in the National Academies of Science Press.
Authors
Committee on Fluoride in Drinking Water, National Research Council
Description
Most people associate fluoride with the practice of intentionally adding fluoride to public drinking water supplies for the prevention of tooth decay. However, fluoride can also enter public water systems from natural sources, including runoff from the weathering of fluoride-containing rocks and soils and leaching from soil into groundwater. Fluoride pollution from various industrial emissions can also contaminate water supplies. In a few areas of the United States fluoride concentrations in water are much higher than normal, mostly from natural sources. Fluoride is one of the drinking water contaminants regulated by the U.S. Environmental Protection Agency (EPA) because it can occur at these toxic levels. In 1986, the EPA established a maximum allowable concentration for fluoride in drinking water of 4 milligrams per liter, a guideline designed to prevent the public from being exposed to harmful levels of fluoride. Fluoride in Drinking Water reviews research on various health effects from exposure to fluoride, including studies conducted in the last 10 years.
Here are a few of the findings in the 530-page report.
“The damage to teeth cause by severe enamel fluorosis is a toxic effect that the majority of the committee judged to be consistent with prevailing risk assessment definitions of adverse health effects.”
There was some debate among their panel as to whether fluorosis represented something “judged to be aesthetically displeasing but not adverse to health.” They write, “This view has been based largely on the absence of direct evidence that severe enamel fluorosis results in tooth loss, loss of tooth function, or psychological, behavioral, or social problems.”
They continue, “The majority of the present committee finds the rationale for considering severe fluorosis only a cosmetic effect much weaker for discrete and confluent pitting, which constitutes enamel loss… Two of the 12 members of the committee did not agree that severe enamel fluorosis should now be considered an adverse health effect. They agreed that it is an adverse dental effect but found that no new evidence has emerged to suggest a link between severe enamel fluorosis, as experienced in the United States, and person’s ability to function.”
They also find, that “Severe enamel fluorosis occurs at an appreciable frequency, approximately 10% of average, among children in US communities with water fluoride concentrations at or near the current MCLG of 4 mg/L.”
a bit surprised the pro-fluoridation forces aren’t contesting some of this information, but it’s interesting to see the opinion of the national academy folks – albeit from seven years ago.
They also find, that “Severe enamel fluorosis occurs at an appreciable frequency, approximately 10% of average, among children in US communities with water fluoride concentrations at or near the current MCLG of 4 mg/L.”
Correct me if I am wrong, but isn’t it Davis’ plan to use a MCLG of 0.7 mg/L?
so there is a critical point of difference.
[quote]a bit surprised the pro-fluoridation forces aren’t contesting some of this information[/quote]
All of these points have been addressed in posts on previous threads. For the sake of brevity, just one point for clarification. In virtually all of the articles that are honestly portraying the real and potential harms of fluoride, the recognized safe level is 1 mg/L. The Davis proposed level is well below this.
so the opinion is that fluoride might be harmful, but not at the level davis is proposing?
DP
To the best of my knowledge, there is only one scientifically demonstrated harm from fluoride and that is fluorosis. Fluorosis, especially as compared with dental decay and subsequent gum disease and potential facial bone loss, is a minor cosmetic problem. Every other purported harm including “sensitivity” , has not yet met scientific standards for causality. While true that this does not mean that it could never be demonstrated in the future, it has not been demonstrated to this point.
And yes, even those who are the most adamant about the potential harms from fluoride ( if they are adhering to the principle that level is significant, consider 1 mg / L , more than the 0.7mg / L proposed by Davis as a safe
level.
I was recently talking with a proponent of fluoridation, and asked him a couple of key questions that Vanguard participants might like to address. Paraphrasing:
Me: did you think that the cost of fluoridation was something that the voters, or the Prop 218 process, addressed?
— No.
Then how do you propose it be paid for?
— Don’t know. There are funds available.
But if it isn’t fully funded, both in implementation and ongoing expenses, how do you suggest it be paid for?
— It is a very cost-effective means of providing a specific health benefit to the community. That’s easy to prove. The cost is low, and the benefits are provable.
But how should it be paid for if not from the rate increase?
— By raising taxes.
So: to the fluoridation proponents here. Do you advocate raising taxes to cover the cost of fluoridation?
i’m not a proponent of fluoridation. i’m not against it in concept, but believe it’s too messy politically. that said, my understanding is that the cost is small enough it could be covered under the debt financing and therefore not require an additional tax or prop 218. i’m sure matt will correct me if i got that wrong.
One of the main problems with the entire proposal to fluoridate our drinking water is that total fluoride dosages to a person are not taken into account.
Davis’ plan is to fluoridate at 0.7 – 1.2 ppm depending on the temperature – this is the so-called “optimal” fluoride dosage according to proponents. The thinking for establishing a range of concentrations is that at higher temperatures people drink more water hence the fluoride concentration can be less and still deliver the same dose.
But the entire concept of delivering a precise fluoride dosage to every person (in terms of mg fluoride/kg of body weight) through drinking water fluoridation is technically bankrupt in the real world. How can anybody possibly control the dosages when you may have a very large man drinking less water than a very small child? Or what about summer athletes that drink 4 x or more the amount of water as a normal child. Or how about diabetics that must drink copious amount of water AND have a hard time excreting fluoride from their bodies. What about people that drink lots of tea that is high in fluoride. Or what about people who never drink tap water but live on sodas and juices, or bottled or filtered water that can be either very high in fluoride or almost fluoride free.
The point is that tap water consumption per person per day is all over the map depending on the person. A person’s other extraneous sources of fluoride also vary widely so total fluoride intake (including from tap water and from other extraneous food and drink containing natural fluoride and fluoridated pesticides) widely varies.
And you have the problem in variability in concentration of the fluoridated water itself due to inaccuracies in pump delivery rates and metering variability. This in itself will cause a 2 x variability in dosage. And can we rely on the City to let us know when the concentration of fluoride gets too high so that it may actually be acutely toxic? Well the City is only proposing to alert the public that there may be a problem when the fluoride dosage in the delivered water exceeds 10 ppm which is 8-15 x what is the proposed “optimal” concentration! Sorry but I just do not have that level of confidence that our City water department can control the dosage that carefully from multiple wells or the JPA private operator can control the fluoride dosage that carefully when they are delivering the water to our Davis borders. There is just way too much potential for human error or mechanical problems that could result in overdosing the water. Remember that the current maximum allowable concentration is 4 ppm and the EPA is proposing to drop it to 2 ppm soon. 2 ppm is only 60% greater than the 1.2 ppm upper concentration proposed to be used. That is hardly a sufficient margin of safety for a public utility to go from safe to unsafe.
Also, consider this: If a doctor or a dentist prescribed fluoride pills or droplets to a person and told them it really doesn’t matter how much you take (1 pill or 10 pills a day) no matter if you are an adult or child or a diabetic or an athlete or a person with hypothyroidism or a person with fluoride allergies or hypersensitivities, that health worker would lose their license in a heart beat.
Yet we are being asked to functionally allow the City to perform that same prescriptive function by allowing them to fluoridate our water to be delivered in a manner wherein you could have a real-world 10-fold variability in dosage per person depending on circumstances.
Combined with the fact that only 3% of water delivered to Davisites is actually drunk (meaning 97% + of the fluoridated water is otherwise just released into the environment without even passing through a human body) and I cannot imagine a less efficient means of providing a supposed public health benefit with less safeguards to protect against individual over dosages.
Plus, we now know that the primary determinant of dental health in subpopulations is socioeconomic levels and has little to nothing to do with fluoride levels in water. And it is also now known, as stated by even the CDC, that the primary benefits of fluoride on dental health are when it is topically applied through the use of fluoridated toothpastes, mouthwashes, and dental lacquers and not through ingestion by taking fluoride pills or drinking fluoridated water.
In summary
1) There is a high potential for widely varying dosages being delivered to people through water fluoridation and thus a high potential for over dosages,
2) There is a proven lack of efficacy of water fluoridation in reducing caries rates in low income populations,
3) Davis’ dental health is overall quite good compared to surrounding communities,
4) Fluoridation of water has proven side-effects including fluorosis and proven risks of allergies and hypersensitivities to fluoride in 1-2% of the population,
5) There is a real potential for other adverse health risks (albeit not yet definitively proven) such a neurological impairment, bone embrittlement, hypothyroidism, and others,
6) There are proven adverse bioaccumulative effects of fluoride in the environment,
7) The cost to rate payers will be $1,000,000+ capital cost and $250,000+ annual operating budget for fluoridating Davis water over and above our current rates, and
8) The fluoridation chemicals used are only industrial grade waste byproducts of the phosphate fertilizer industry and the known heavy metal contaminants in these chemicals are not disclosed by the sellers
When one considers all of these factors, it is pretty easy to see why other US cities and countries worldwide are moving away from fluoridation in droves. Just last March, residents of Portland OR overrode their City Council and rejected fluoridation by a 61% – 39% margin. Other recent voter defeats for fluoridation were in Wichita KS and Albuquerque NM. Within the last few years, the provinces of Ontario Canada and Queensland Australia have ended mandatory fluoridation laws causing dozens and dozens of cities to immediately opt out of the practice. And 2 month ago, the nation of Israel prohibited their previous mandatory practice of fluoridation entirely.
Alan: perhaps you could expand on two of these items.
[quote]1) There is a high potential for widely varying dosages being delivered to people through water fluoridation and thus a high potential for over dosages, [/quote]
Is this because of the delivery system; i.e., the surface water project + the wells, difficulty calibrating, etc.? Or some other issue?
[quote]7) The cost to rate payers will be $1,000,000+ capital cost and $250,000+ annual operating budget for fluoridating Davis water over and above our current rates …. [/quote]
What is your source for this number?
I see we posted over each other, and you answered #1. Will it be possible to accurately calibrate the fluoride in the water supply in a system which uses both well water and surface water?
That isn’t just directed at you; anyone who knows the answer please feel free to chime in.
Two points:
(1) Heavy-handed, top-down, strong-handed government is on the way out. The pro-fluoride rhetoric is redolent of dated catch phrases such as “we [u]know[/u] what is best for you”, and “don’t worry your pretty little heads about this!” This close-minded thinking should be on the way out too!
(2) Economic justice cuts both ways. Just because some people are poor doesn’t mean they automatically lose the right to vote on the fluoride issue.
Somewhat off topic, but someone rang my bell today wanting me to sign the ‘put the water rates on the ballot’…..when I asked her to lobby me, she said amongst other things, that the city of Davis, Willowbank and El Macero were all drilling wells so they were backing out of the water project. When I heard that I said it was too early for me to decide. Huh??? Doubt this is true. All I heard was the Village Homes MIGHT consider wells for irrigation……tho if the City dug their own, maybe they wouldn’t have to bill themselves for the water they use??!!
Don Shor said . . .
[i]”Will it be possible to accurately calibrate the fluoride in the water supply in a system which uses both well water and surface water?”[/i]
Don, the dosing issue has virtually nothing to do with well vs. surface water sourcing. Based on my discussions with Herb Niederberger the regulations require that the fluoridation levels in mg/liter have to be substantially uniform throughout the water delivery system. The dosing issue is that the exact same mg/liter [u]concentration[/u] produces very different [u]doses[/u] depending on how many liters of water are ingested. An athlete who needs to constantly rehydrate himself/herself as a byproduct of exercise may well ingest more than twice as many liters of water as a non athlete, thereby doubling the dose of fluoride received.
medwoman can give us some insight about whether dosing is or should be dependent on the mass of the human being being dosed. If it is, then a child who weighs half as much as an adult may be getting a substantially higher [u]dose[/u] from the same fluoride [u]concentration[/u] as an adult gets. medwoman may also be able to give us some insight into the average water consumption needs of a child versus an adult. That is meaningful because if a child weighing half as much as an adult typically ingests half as much water, the fluoride doses would be equivalent.
SODA said . . .
[i]”Somewhat off topic, but someone rang my bell today wanting me to sign the ‘put the water rates on the ballot’…..when I asked her to lobby me, she said amongst other things, that the [b]City of Davis, Willowbank and El Macero were all drilling wells[/b] so they were backing out of the water project. When I heard that I said it was too early for me to decide. Huh??? Doubt this is true. All I heard was the Village Homes MIGHT consider wells for irrigation……tho if the City dug their own, maybe they wouldn’t have to bill themselves for the water they use??!!”[/i]
You are right. City of Davis = might Willowbank = might El Macero = definitely will not be Village Homes = might.
The reason that El Macero definitely will not be drilling a new well is that they already have/own a well on Mace Boulevard (Well EM-3). The challenge for El Macero is putting together the underground water distribution system to get the water from EM-3 to the 410 individual locations of irrigation demand. The estimate for that purple piping infrastructure is approximately $7-8 million. In addition they will need to install irrigation water meters at each residence.
To Don Shor:
Re: Fluoride injection – [quote]Will it be possible to accurately calibrate the fluoride in the water supply in a system which uses both well water and surface water?[/quote]
Both the JPA and each well will have their own flow meters and fluoride injection pumps and a separate downstream fluoride monitor. Each of these devices have their own inherent inaccuracies making a precise concentration of fluoride very, very difficult to maintain within +/- 50% of the desired concentration. I have had over 20 years of experience treating water on a large scale basis so know this subject pretty well.
Re: Costs – [quote]What is your source for this number?[/quote]
From Staff report presented at the June WAC meeting
“Capital Cost Summary
The Water Treatment Plant cost added to the cost for the wells results in a range of capital cost from $1,077,800 to $2,368,400 for the addition of fluoride.”
“Operations and Maintenance
Combined with the O&M cost at the wells, this is a total annual cost of between $228,800 and $240,700 per year”
Matt
[quote]medwoman can give us some insight about whether dosing is or should be dependent on the mass of the human being being dosed. If it is, then a child who weighs half as much as an adult may be getting a substantially higher dose from the same fluoride concentration as an adult gets. medwoman may also be able to give us some insight into the average water consumption needs of a child versus an adult. That is meaningful because if a child weighing half as much as an adult typically ingests half as much water, the fluoride doses would be equivalent.[/quote]
It is actually much more complicated than body mass. One would have to have much more extensive knowledge than I of physiology to give a definitive answer. However, based on the basics of physiology it is not only mass, but clearance within the body that counts. Since the vast majority of fluoride is cleared through the kidneys this is the principle organ system of concern. The glomerular filtration rate of children, being higher than that of adults ( normal physiologic slowing with age), children would be anticipated to be at less risk than adults. Further, having discussed this with at 5 pediatricians, all of whom do not see this level as a danger, even to infants.
Again, I would stress that fluorosis is the only condition that has been linked causally to fluoridated water, and then only at amounts higher than 1 mg/ L. This has been demonstrated across populations, presumably some who are athletes, some who have kidney disease, and some who have other sources of fluoride. These are theoretical, not demonstrated risks. While I do not denigrate people’s concerns, I do prefer that decision making be made on the basis of actual evidence, not theoretical concern.
Thank you medwoman. Very helpful.
I agree with your final two sentences 100%. I would add though that the scientific studies regarding fluoride sensitivity appear to me to rise to the level of demonstrated risks; however, here too the levels of exposure are very important. For instance, the Davis existing well water system has an ambient level of fluoride concentration that is significant (between 1/3 and 1/2 the recommended levels. To the best of my knowledge there has not been a single documented case of fluoride hypersensitivity in Davis at those ambient levels. Further, the scientific tests regarding fluoride hypersensitivity were conducted at concentration levels significantly higher than what is being contemplated for Davis. Like the evidence for severe fluorosis, the applicability of the potential incidence of hypersensitivity is greatly mitigated by the anticipated concentration levels.
Matt
[quote]Further, the scientific tests regarding fluoride hypersensitivity were conducted at concentration levels significantly higher than what is being contemplated for Davis.[/quote]
The problem that I see with the “hypersensitivity studies” is that they are done on self reporting of a wide array of symptoms and did not document well the occurrence of the identical symptoms per each subject. This is quite similar to deciding that a medication should not be made available to the entire population on the basis of a consistent reporting of multiple and frequently vague symptoms with many potential causes ranging from headache, fatigue, mild mood alterations, GI symptoms, generalized weakness, nasal congestion…..you name it…. and accepting causation of the substance or medication you are testing based on the self report of the symptom by a low percentage of the population.
I will stand by my assessment of fluorosis as the only proven adverse consequence with all others as potential or associative at best.
Steve Hayes
[quote]”we know what is best for you”, and “don’t worry your pretty little heads about this!” This close-minded thinking should be on the way out too!
[/quote]
Agreed. And I see no evidence that this has been the attitude taken either by the proponents, or by anyone in the city. The proponents have make efforts to address concerns as they have been raised according to our own area of expertise. I have chosen to address medical concerns as I am completely ill equipped to deal with any other aspect. Others have turned their attention to environmental and economic concerns. For their part, our city and county leaders have spent a great deal of time listening to both sides of this issue. Do you disagree with this ? If you agree, what is the purpose of your statement ? And if you disagree, what is the basis for your belief that this has been “a closed minded way of thinking” ?
steve: let me answer you in another way – do you believe that anti-smoking campaigns have been successful and ultimately are for the good? what about seat belt laws? isn’t there actually something to the idea that experts, in this case doctors, really do know what is better for the health of individuals than individuals do themselves?
You can add mandatory automobile insurance to the list . . . and mandatory motorcycle helmets . . . and mandatory bicycle helmets.
What say you Steve?
Where are the studies that show that fluoride in the water is effective at fighting dental caries, with the appropriate dose/response analysis demonstrating the optimal dosage?
I am not concerned about the safety of the additive, my concern is the effectiveness. If the treatment hasn’t been proven to be effective at fighting the disease at the proposed dose, why are we considering using it?
… still waiting for an answer as to how it’s going to be paid for.
[quote]The cost to rate payers will be $1,000,000+ capital cost and $250,000+ annual operating budget for fluoridating Davis water over and above our current rates ….[/quote]
Anyone? Seriously, is this not worth an answer?
Mark West
I regret that I cannot give you the particular efficacy information that you are looking for since that was not my area of review. I can however direct you to the material that was presented to the WAC at the first and third of the meetings devoted to the issue of fluoride as I believe that they are a matter of public record.
I would like to say however, that it is true that there are no gold standard studies utilizing large double blinded prospective studies. This is not because the proponents are indifferent to such information or are blindly following “expert opinion” but rather because such studies cannot be conducted since there is no way to
“double blind” a population about the content of its water supply or to control the amount of consumption or to limit consumption of substances which might be deleterious as has been previously pointed out.
Don, I don’t think anyone has formulated an answer to your question as yet.
medwoman, great answer to Mark’s question. Spot on.
So, we have vigorous proponents of fluoridation debating its merits and advocating for the city to proceed with it, but they won’t say how they want us to pay for it?
Wow.
Don Shor
[quote]So, we have vigorous proponents of fluoridation debating its merits and advocating for the city to proceed with it, but they won’t say how they want us to pay for it?
Wow.[/quote]
[quote]Anyone? Seriously, is this not worth an answer?[/quote]
It is absolutely worth an answer. And I don’t believe that this is a matter of “won’t” say, but rather a matter of
“can’t say”.
As someone who has dedicated by time to providing medical care one patient at a time, I have neglected the areas of financing, fund raising, taxation, grants and the like and am thus aware that any suggestions I might make are likely to be naive and possibly unrealistic and maybe some not even legal. However, I am willing to give it my best shot at putting out some suggestions that have been successful with other initiatives as an opener for the conversation. So here is the best I can do off the top of my very non financially oriented head.
1. How about directly taxing ourselves as we frequently do for school funding ?
2. Maybe taxing certain items such as sugary beverages or snacks much as was done for tobacco in the hopes of decreasing the deleterious effects of the substance itself while using the funds for primary and secondary prevention of the undesirable dental outcomes. Perhaps we could ask our local merchants to donate a percentage of their profits from the sale of such items to the fund for fluoridation ?
3. How about applying for grant money to fund fluoridation ?
4. Perhaps partnering with the university for granting funds to study the effects of fluoridation in longitudinal studies of our community with regard to dental health and the purported adverse effects of fluoride ?
5. Brett Lee has proposed volunteer donation with the funds being provided to CommuniCare to support their efforts in the provision of dental care. Why not have such a fund that would support fluoridation thus providing the benefits to the entire community rather just those who obtain their care there.
So Don, that’s the best I can do without research of funding possibilities. Your thoughts ?
medwoman: how do you respond to the concern that the people who most need the fluoride are the ones least likely to get it because they are simply not drinking tap water, which also may account for the charts that show virtually no difference in decay rates comparing communities with and without fluoridated water?
I suppose I should have gotten used to it by now, but nevertheless I continue to be surprised at the fluoride proponents complete disregard for the concept of margin of safety. In conventional risk assessment, the U.S. EPA uses a default margin of safety of ten. This means the EPA seeks to limit exposure to chemicals to levels that are ten times less than the levels that cause adverse effects. Margin of safety is a deeply rooted cornerstone in all modern risk assessments, yet fluoride proponents will state that they are not concerned about studies that show adverse health effects at fluoride levels of, say, 2 ppm or 4 ppm, because Davis water will be fluoridated at a level of .7 ppm.
The 2006 National Research Council report was the first U.S. report to look at low-level fluoride toxicity in a balanced way. The report concluded that the maximum contaminant level goal (MCLG) of 4 ppm in drinking water was too high and should be reduced. Since 4 ppm is too high (by an unspecified amount) to be acceptable as a contaminant, it is not sensible to deliberately add fluoride to our drinking water to bring the level of fluoride in our water up to .7 ppm. That implies a margin of safety of less than 5.7 times, and possibly much less, which is absurdly low by toxicological standards. Acceptance of such a small margin of safety indicates a disregard for public health.
It is irresponsible to continue promoting fluoridation when studies indicate thyroid function may be lowered at 2.3 ppm, IQ in children may be lowered at levels as low as 1.9 ppm (or at 0.9 ppm if there is borderline iodine deficiency), and hip fractures in the elderly may be increased at levels as low as 1.5 ppm. Unless all of the relevant studies have been shown to be fatally flawed, there is clearly no adequate margin of safety to protect the whole population from these effects.
Fifty percent of the daily intake of fluoride is absorbed by and accumulates in bone. An important study from China (Li et al.,2001) indicates practically no margin of safety sufficient to protect a whole population with a lifelong consumption of water at 1 ppm from hip fracture.
It is important to remember that we are talking about mass medication, not a drug that is prescribed after due consultation with an individual patient. A risk of harm estimated at, say, 1 in 10,000 may be entirely acceptable in the case of an individual patient. In fact, we accept far higher risks of undesirable side effects if we are seriously ill. But if we are giving a drug to nearly 400 million people worldwide, that risk translates into 40,000 cases of harm from one cause. The risks for some harms due to fluoridation are probably much higher.
Proponents and opponents of fluoridation carry different burdens of proof. Proponents need to have conclusive proof of substantial benefit and very strong evidence for an extraordinarily low risk of harm. They have neither. For opponents, it should suffice to show that there is an identifiable risk of serious harm. Even small risks are indefensible when deliberately imposed on a large population. This is common sense, but it eludes the proponents of fluoridation, who continue to talk about small risks as if they are acceptable.
The onus is on proponents to demonstrate that there is an adequate margin of safety between the doses that cause harm and the huge range of doses that may be experienced by those drinking uncontrolled amounts of fluoridated water and at the same time receiving unknown amounts of fluoride from other sources. And, such a margin of safety should be large enough to protect everyone in society, not just the average person. The very young, the very old, those with poor nutrition, and those with impaired kidney function are more susceptible to fluoride’s harmful effects.
One of the problems with water fluoridation is that, even if you control the concentration of the fluoridation chemicals added to the water, you couldn’t control the dose each person gets because different people drink very different amounts of water.
The dose of a person drinking 5 liters of water containing 1ppm of fluoride would be the same as that person drinking 1 liter of water containing 5ppm of fluoride.
The issue widely varying doses is examined in great detail in the 2006 NRC publication “Fluoride in Drinking Water,” particularly in the “High Intake Population Subgroups” subsection of “Section 2, Measures of Exposure to Fluoride in the United States.,” starting on page 30 here: http://www.nap.edu/openbook.php?record_id=11571&page=30
It starts with this:
“EPA, in its report to Congress on sensitive subpopulations (EPA 2000b), defines sensitive subpopulations in terms of either their response (more severe response or a response to a lower dose) or their exposure (greater exposure than the general population). Hence, it is appropriate to consider those population subgroups whose water intake is likely to be substantially above the national average for the corresponding sex and age group. These subgroups include people with high activity levels (e.g., athletes, workers with physically demanding duties, military personnel); people living in very hot or dry climates, especially outdoor workers; pregnant or lactating women; and people with health conditions that affect water intake. Such health conditions include diabetes mellitus, especially if untreated or poorly controlled; disorders of water and sodium metabolism, such as diabetes insipidus; renal problems resulting in reduced clearance of fluoride; and short-term conditions requiring rapid rehydration, such as gastrointestinal upsets or food poisoning (EPA 2000a).”
The section goes on to state, on page 30, about the high fluid intake of physically active people:
“Hourly intake can range from 0.21 to 0.65 L depending on the temperature (McNall and Schlegel 1968), and daily intake among physically active individuals can range from 6 to 11 L (U.S. Army 1983, cited by EPA 1997).”
On page 32 they present information people with diabetes. They start with information about how many people are estimated to have diabetes and how many of them don’t know they have it, and they then go on to discuss the high volumes of fluid intake and urine output in people with diabetes. These include people who “might ingest “enormous” quantities of fluid and may produce 3-30 L of very dilute urine per day (Beers and Berkow 1999) or up to 400 mL/kg/day (Baylis and Cheetham 1998),” (p. 32) . It also reports that “Patients with primary polydipsia might ingest and excrete up to 6 L of fluid per day (Beers and Berkow 1999).”
Clearly physically active people and people with diabetes are taking in such high quantities of fluids that their doses (dose = concentration X fluoridated fluid intake) are, indeed, high enough to be cause for concern.
Add to that the impaired fluoride excretion that comes with impaired kidney function (which diabetes can lead to), and there is cause for a great deal of concern.
Given that diabetes rates are historically higher in some minority groups than in the population of the United States overall, it is not hard to understand why Andrew Young, friend and supporter of Dr. Martin Luther King, Jr., and the League of United Latin American Citizens oppose water fluoridation.
DP
[quote]how do you respond to the concern that the people who most need the fluoride are the ones least likely to get it because they are simply not drinking tap water, which also may account for the charts that show virtually no difference in decay rates comparing communities with and without fluoridated water?[/quote]
I agree that this is a possibility, but it is speculation as we just plain don’t know that this is the case now, or that it will be in the future. However, I would say that our county, and many health care systems, and individual providers are now making substantial efforts to educate our students and patients about the hazards of sweetened beverages and the advantages of water. It is important to me that no one interprets my support for fluoridation as an isolated step. I see it rather as part of a comprehensive strategy to inform, educate, and provide healthier choices for all of our population.
tleonard
[quote]I continue to be surprised at the fluoride proponents complete disregard for the concept of margin of safety.[/quote]
And I would be too if I believed that were the case. But I am not disregarding it, I simply do not believe that it is applicable. For the concept of margin of safety to apply, you have to believe that there is a pre existing demonstration of causality of the harm your are concerned about.
Since I do not believe that there is proven causality for any of the conditions that you have listed with the exception of fluorosis, “margin of safety” becomes a moot point. I am not ignoring it, I simply don’t believe it applies.
The best analogy I can think of for this at the moment is the now thoroughly discredited notion that silicon breast implants caused autoimmune disease. The concept of “margin of safety” could have been used to imply that a certain amount of silicon leakage was safe, whereas a larger amount might not have been. However since silicon implants are not causal in autoimmune disorders ( which occur at the same frequency in users of silicon implants as they occur in age matched control women without the implants ) the concept of “margin of safety” becomes irrelevant as I believe it is for all of the conditions with the exception of fluorosis, which has already been stated by the proponents.
Also, I completely disagree with the notion that fluoridation is in any way forced medication. It is certainly the responsibility of any governing body that chooses to fluoridate to inform the population that they are doing so.
It is the responsibility of health care professionals to advise those who might be at some theoretical risk ( though I am not sure of what condition ) if they have known renal compromise to avoid drinking tap water. It is then up to the citizen to decide whether or not to drink or cook with the water and at what levels. I can virtually guarantee you that there will be no government agency charged with going from home to home to ensure that you are drinking the tap water as is implied by “forced medication” or “mass medication”.
There’s a blind trust on the part of fluoride promoters that while drinking fluoridated water can damage growing tooth cells resulting in fluorosis, fluoride couldn’t possibly damage any other tissue in a child’s developing body or cause any damage whatsoever to adults after a lifetime of exposure to uncontrolled doses. Ingested fluoride causes dental fluorosis by altering the biochemistry of growing teeth. But fluoride promoters claim that this is merely cosmetic and of no consequence. Suggesting that this is merely cosmetic is as irrational as saying that the blue-black line which appears on the gums due to chronic lead poisoning is also of no significance and is merely cosmetic.
There is ample scientific evidence that fluoride is harmful. Fluoridealert.org has compiled a comprehensive catalog of fluoride research, including detailed summaries and exhaustive references for over 80 aspects of fluoride toxicity. [url]http://www.fluoridealert.org/researchers/health_database/[/url] This is a gold mine of information for anyone interested in the science.
This is a ridiculous debate on so many levels.
Water fluoridation is an old, out-dated treatment that the world is abandoning as we speak. Israel, until recently a strong fluoridation supporter, has now moved to legally ban it due to health concerns (http://www.livescience.com/38796-israel-outlaws-water-fluoridation.html ).
Water fluoridation is a beautiful in theory terms of its intention of helping the less well-off, but in practice it a) doesn’t work and b) causes harm to many people.
Finally, the money for fluoridation doesn’t exist, and it isn’t going to come. It’s hard to find extra public funds right now and, it’s even harder when many people don’t want the thing that those funds would buy.
Fluoridation isn’t going to happen in Davis.
[quote]There’s a blind trust on the part of fluoride promoters that while drinking fluoridated water can damage growing tooth cells resulting in fluorosis, fluoride couldn’t possibly damage any other tissue in a child’s developing body or cause any damage whatsoever to adults after a lifetime of exposure to uncontrolled doses[/quote]
This is not my position. Fluorosis has been demonstrated to be related to fluoride for many, many years. None f the other deleterious effects claimed as possibilities have been demonstrated over the same amount of time.
This is not blind faith. This is what the evidence shows.
Ernesto
[quote]Water fluoridation is an old, out-dated treatment that the world is abandoning as we speak. Israel, until recently a strong fluoridation supporter, has now moved to legally ban it due to health concerns [/quote
In my opinion, this change in most of the areas in which it is being made is for political concerns. And in quoting other countries that have stopped water fluoridation as their delivery method, all are adopting another strategy, or better yet, comprehensive, universal health care for their populations. Once you all have stepped up and joined me in supporting and implementing such universal health measures, I will happily stop advocating for water fluoridation.
tleonard said . . .
[i]”I suppose I should have gotten used to it by now, but nevertheless I continue to be surprised at the fluoride proponents complete disregard for the concept of margin of safety. In conventional risk assessment, the U.S. EPA uses a default margin of safety of ten. This means the EPA seeks to limit exposure to chemicals to levels that are ten times less than the levels that cause adverse effects.”[/i]
Terry, your statement above is worthy of Tom Sawyer. There is no such universal margin of safety standard. Each drug is analyzed on an efficacy curve that simultaneously charts at specific dosges both the drug’s proportional efficacy and its proportional adverse effects.
To put that reality into simple practical context, Acetaminophen’s recommended dosage is to take no more than eight 500 mg caplets in a 24 hour period. So if we apply your “ten times” rule, then taking eighty 500 mg caplets in a 24 hour period should be within the margin of safety. You are a doctor, what would happen to a human being if he/she took 80 acetaminophen caplets in a 24 hour period? The warnings also say that you shouldn’t take acetaminophen for more than 10 days. What would happen if you took eighty 500 mg caplets for 100 days?
In the words of one of our dinner guests this evening, who is the retired Vice Chair of the Pathology Department of a prominent University Hospital, [i]”Your margin of safety assertion is pure poppycock.” [/i]
medwoman said . . .
[i]”In my opinion, this change in most of the areas in which it is being made is for political concerns. And in quoting other countries that have stopped water fluoridation as their delivery method, all are adopting another strategy, [b]or better yet, comprehensive, universal health care for their populations. Once you all have stepped up and joined me in supporting and implementing such universal health measures, I will happily stop advocating for water fluoridation.[/b]”[/i]
Amen
Ernesto
[quote]Water fluoridation is an old, out-dated treatment that the world is abandoning as we speak.[/quote]
I would like to paraphrase.
Free market, fee for service medicine, is an old, out-dated treatment strategy that the developed world is abandoning as we speak.
We would do best by adopting some universal, single party payer system with an emphasis on a preventative, integrated, collaborative, and public health oriented medical system. I would invite all of you both proponents and opponents of fluoridation to join me with as much enthusiasm, dedication and time as you have spent on fluoridation and perhaps we would stand an even better chance of improving health outcomes at a real cost savings beyond our current lack of health care delivery system. Matt would seem to be on board.
Anyone else ? tleonard, Ms West, Adrienne, Ernesto, Alan, Frankly….anyone ?
In a full length video produced by the Fluoride Action Network, respected professional researchers, scientists, and health practitioners openly discuss their experience and opinions concerning the adverse health effects and ethical problems associated with the public health policy of water fluoridation.
Featuring a Nobel Laureate in Medicine, three scientists from the National Research Council’s landmark review on fluoride, as well as dentists, medical doctors, and leading researchers in the field, http://www.youtube.com/watch?v=88pfVo3bZLY
medwoman
I think a single-payer system would be great. Throw out the insurance racket and the healthcare dollar would go a lot further.
There are a lot of inequities and corruption in the current healthcare system. But that doesn’t mean an ineffective, dangerous, and expensive response like water fluoridation for Davis is a good idea.
We should deploy our resources for effective responses, not symbols.
Matt Williams said,
[quote]”Your margin of safety assertion is pure poppycock.” [/quote]
From [u]The Case Against Fluoride[/u]:
The concept of margin of safety is normally used by toxicologists, pharmacologists, and regulatory officials when establishing so-called safe levels of a known toxic substance to which the public may be exposed. Such a margin of safety is set to ensure protection for everyone from an identified or anticipated harmful effect. This margin of safety has to take into account the full range of sensitivities to a toxic substance that can be anticipated in any human population (intraspecies variation). In the case of fluoride, an extra safety factor will be needed when setting a safe level for fluoride in water (either natural or added) to take into account the full range of exposure for a population drinking uncontrolled amounts of water and getting fluoride from other sources as well.
Typically, to take into account intraspecies variation, the lowest level or dose at which toxicity is observed (i.e., [i]lowest observable adverse effect level[/i], or LOAEL) is divided by 10 to set the margin of safety. This factor of 10 assumes that the most sensitive person is ten times more sensitive than the least sensitive.
Sometimes more conservative regulatory agencies insist on working from a [i]no observable adverse effect level[/i], or NOAEL. If that is not available, they require that a margin of safety of 100, not 10, be applied to the LOAEL.
Based on current levels of exposure and the levels at which effects were shown to occur in the 2006 NRC report, it is hard to see how a scientifically defensible safety factor could yield a safe level for fluoride in water of more than .1 ppm. Indeed, Dr. Robert Carton, a former risk assessment specialist at the EPA has argued, based on the NRC findings, that the maximum contaminant level goal (MCLG) for fluoride should be set at zero, as has been done for both lead and arsenic.
Those who claim that the practice of water fluoridation is safe for everyone have a clear obligation to demonstrate that by performing a careful margin-of -safety analysis for the adverse health effects reviewed and summarized in the 2006 NRC report. Such a demonstration would have to include the rationale for choosing the most appropriate (i.e., most sensitive) end point and LOAEL for that end point (the end point being a known or reasonably anticipated health effect) for all those health effects discussed by the NRC report.