Abuse of the Scientific Literature in an
COLLEEN A. WULF, R.D.H., M.P.H., SENIOR EDITOR
COMMUNITY PREVENTION PROGRAMS, DIVISION OF DENTAL HEALTH
DEPARTMENT OF HEALTH, COLUMBUS, OHIO
KAREN F. HUGHES, R.D.H., M.P.H., EDITOR, SCHOOL PREVENTION
DIVISION OF DENTAL HEALTH, OHIO DEPARTMENT OF HEALTH, COLUMBUS,
KATHLEEN G. SMITH, R.D.H., H.S., EDITOR, FLUORIDATION
PUBLIC HEALTH SERVICE, PHOENIX, ARIZONA
MICHAEL W. EASLEY, D.D.S., M.P.H., TECHNICAL EDITOR
CHIEF, DIVISION OF DENTAL HEALTH, OHIO DEPARTMENT OF HEALTH,
AMERICAN ORAL, HEALTH INSTITUTE
The Abuse of the
Scientific Literature in an Antifluoridation Pamphlet
is a special publication of the American Oral Health Institute,
Inc., a national, not-for-profit research institute founded in
1984 to promote and protect the oral health of America¡¯s
The publisher and
the authors gratefully acknowledge the support and assistance of
the Ohio Department of Health; the U.S. Public Health Service,
Centers for Disease Control, Atlanta, Georgia; and the U.S.
Public Health Service, Indian Health Service, Rockville,
1988, 1985 by American Oral Health Institute Press, P.O. Box
151528, Columbus, Ohio 43215
Congress Catalog Card Number 85-73271.
This book or any
part thereof may be reproduced by a recognized health agency for
the sole purpose of promoting fluoridation of public water
systems without obtaining written permission from the publisher
as long as proper credit is given to the authors and publisher.
binding: Port City Press, Inc., Baltimore, MD.
Printed in U.S.A.
LIST OF CONTRIBUTORS
INTRODUCTION, Dr. Stephen Barrett
FORWARD, Dr. Michael W. Easley
PREFACE, Colleen A. Wulf
RESPONSES TO MAJOR CLAIMS
------------------------------------------ contents below
are not in this version.
References That Could Not Be
Index of Authors and Titles
Common to Both "Lifesavers
Guide" and Fluoride, The Aging Factor
Index of Reference Numbers
Used in Four Versions of the
Division of Dental
Health, Virginia Department of Health, Richmond, Virginia
TAIMI M. CARNAHAN,
Bureau of Dental
Health, New York Department of Health, Albany, New York
Disease Prevention Activity, Centers for Disease Control,
LINDA S. CROSSETT,
Bureau of Dental
Health, Texas Department of Health, Austin, Texas
Environmental Health, Ohio Department of Health, Columbus, Ohio
JUDY HARVEY, M.Ed.
Division, Massachusetts Department of Public Health, Boston,
HELEN S. HILL,
Bureau of Dental
Health, Texas Department of Health, Austin, Texas
Health Dental Program,
of Health and Rehabilitative Services, Tallahassee, Florida
Division of Dental
Health, Illinois Department of Public Health, Springfield,
NOWJACK-RAYMER, R.D.H., M.P.H.
Division of Dental
Health, Ohio Department of Health, Columbus, Ohio
JOHN SCOTT SMALL
of Dental Research, National Institutes of Health, Bethesda,
Division of Dental
Health, Ohio Department of Health, Columbus, Ohio
WIRTHMAN, R.D.H., M.P.H.
Office of Dental
Health, Maine Department of Human Services, Augusta, Maine
Bureau, Utah Department of Health, Salt Lake City, Utah
Yiamouyiannis, Ph.D., calls himself "the world's leading
authority on the biological effects of fluoride." He appears
brilliant--and determined. Had he chosen a positive direction he
might well have made a valuable contribution to science. But he
has not. For more than 15 years he has been obsessed with the
idea that water fluoridation is dangerous. From 1974 through
1980 he served as "science director" of a health food industry
group which hired him to "break the back" of fluoridation in
America. Subsequently he founded the Center for Health Action,
described in its brochure as "a union of virtually every
effective antifluoridation group in the country."
I have seen Dr.
Yiamouyiannis in action. He is personable and appears sincere.
Though public health officials regard him as a terrorist, to the
uninformed he seems credible. His activities have frightened
many communities into opposing fluoridation. If he doesn't
appear in person, his presence--through his publications--will
still be felt wherever fluoridation is being considered.
fluoridation is actually quite simple. Just claim that it causes
cancer--or AIDS--or a hundred other diseases. Or suggest that it
is a form of pollution, will raise taxes, is undemocratic, or
hasn't been studied enough. Or use dozens of other ploys and
hope that at least one will work. It isn't necessary to convince
people that all antifluoridation arguments are valid. A single
doubt may be persuasive. Examination of these arguments one at a
time is an endless task. It is more practical to ignore the
"laundry list" and evaluate the credibility of those who
make the claims.
"Lifesavers Guide to Fluoridation" provides an opportunity to do
this. It packs a long list of arguments into a brief
text-supposedly backed by 250 scientific references. However,
thanks to painstaking investigation by the team of dental
scientists who produced this book, it is-clear that
Yiamouyiannis uses deception by omission and that the references
he cites do not support his claims. Skillful use of this
information should blow him out of the water.
(Dr. Barrett, a practicing
psychiatrist and a consumer advocate, edits Nutrition Forum
Newsletter and has produced more than 20 books on health
topics, including The Health Robbers--How to Protect Your
Money and Your Life. In 1984 he received the FDA
Commissioner's Special Citation Award for Pu@lic Service in
fighting nutrition quackery.)
medical or scientific advance has been the victim of as much
irresponsible journalism and abuse of the scientific literature
as has community water fluoridation. Armed with literally
volumes of pseudoscientific propaganda and inaccurate media
portrayals, antifluoride zealots have inappropriately influenced
city council decisions, state legislative initiatives, and
citizens' referenda. Their spokespersons have repeated the many
baseless claims at judicial proceedings and regulatory agencies'
hearings. Unfortunately, much damage has been done to the
public's psyche because of repeated inaccurate and perverted
portrayals of community water fluoridation appearing in
newspapers, magazines, "health food" pamphlets, and other lay
publications, as well as in articles appearing in "textbooks"
and "journals" published by the antifluoride press. Many
citizens have been denied the benefits of an effective,
economical, and safe public health measure because of the
misguided, but effective, efforts of a small, vocal minority.
A number of
specific technics have been used by antifluoridationists in
their attempts to prevent fluoridation of public water supplies.
For instance, by repeatedly alleging that fluoride causes
cancer, kidney disease, heart disease, and other serious
maladies, fluorophobics persuade some people that their claims
are true, even though no scientifically valid evidence exists to
corroborate their allegations. The public tends to believe such
claims, assuming that their repeated appearance in print, most
often in letters-to-the-editor columns, is evidence of their
validity and that "authorities" would "never" allow uproven
claims to be printed.
Antifluoridationists have also become masters of the use of
half-truths and innuendo. Examples of their use of half-truths
are provided by the following:
"Fluoride is a poison, so don't let them put it in our
water." Opponents of fluoridation fail to inform the
public that toxicity is primarily related to the dose of
a substance and not merely to the substance itself.
Chlorine, vitamin D, table salt, and water are examples
of substances harmful in the wrong amounts, but
beneficial in the correct amounts.
"Fluoride causes dental fluorosis or mottling." By
itself, this statement fails to take into account either
the level of fluoride in the water or the time of
exposure as related to the dental age of the intended
majority of AIDS victims come from fluoridated cities."
AIDS has been associated for the most part with choice
of lifestyle in certain populations. Most major
metropolitan areas in the U.S., including San Francisco,
New York, Chicago, and Miami, while fluoridated, contain
significant percentages of those populations considered
most at risk for AIDS.
Antifluoridationists also continue to utilize innuendo
effectively as part of their marketing arsenal. They allege that
while one glass of fluoridated water will not kill anyone it is
the "glass after glass of fluoridated water, as with cigarette
after cigarette, that takes its toll in human health and
life.111. In addition to this guilt-by-association ploy,
opponents of fluoridation assert that insufficient research has
been carried out to prove safety and urge consumers and
government officials to wait until all doubt about the safety of
fluoridation has been "scientifically"resolved. Such an argument
continues indefinitely because of the impossibility of ever
proving absolute safety. Other technics successfully employed by
antifluoridationists include neutralization of politicians, use
of the "big lie" and the "laundry list," quoting of
self-proclaimed "experts,@' allegations of consipiracy, and use
of scare words. These technics have been comprehensively
reviewed by several authors and will not be explored further.2,3
Among the most
serious violations of the scientific ethic are those with which
this monograph focuses and which can be categorized as abusive
uses of the scientific literature. Opponents of fluoridation
frequently quote statements that are out of date, taken out of
context, or misrepresentations of legitimate scientific
research. Numerous examples of this technic are apparent when
one reviews closely the popular antifluoride pamphlet,
"Lifesavers [sic] Guide to Fluoridation".' As will be
illustrated repeatedly in the following pages, many references
for the pamphlet's claims of hazard are from obscure or
hard-to-locate journals. Those articles referred to as
containing the most convincing antifluoride arguments are
usually not from recognized peer-reviewed journals and often are
authored by the same antifluoridationists editing the
controversial journals. Painstaking library research by Wulf and
colleagues has shown that many of the references used actually
support fluoridation, with works of respected fluoride
researchers selectively quoted and misrepresented in order to
appear to discourage the use of fluorides. The average consumer,
unable to properly evaluate misinformation and
misrepresentations in the antifluoride literature, falls prey to
what amounts to a marketing fraud. Nothing summarizes the
situation better than the often-repeated quotation from
The simple truth
is that there's no "scientific controversy" over the safety of
fluoridation. The practice is safe, economical, and beneficial.
The survival of this fake controversy represents, in CU's
[Consumers' Union] opinion, one of the major triumphs of
quackery over science in our generation.
No amount of
rationalization on the part of antifluoride propagandists will
alter the reality of their misuse of legitimate scientific
research and their misrepresentations of scientific facts. No
recantation of their fraudulent claims could ever repay the
millions of American citizens for the pain, suffering,
nutritional compromise, economic loss, and social estrangement
resulting from the widespread existence of dental disease that
could have been prevented if every community water system in the
U.S. had been fluoridated during the nearly 40 years in which
the process has been available. No amount of civil damages
exacted from antifluoridationists could ever reimburse local,
state, and federal governments for the millions of dollars spent
to repeatedly defend such a well-accepted, scientifically valid
public health measure as community water fluoridation in courts
and public hearings.
It is hoped that
the information provided in the following pages will enable
public health officials, educators, public and private decision
makers, and private citizens to evaluate the legitimacy of
antifluoridationists' technics and claims. Once the validity of
the claims and the ethics of the technics are examined closely,
it should become apparent that many American citizens have been
victimized by antifluoride health quacks as defined by
Consumers' Union. This extensive work by Wulf and colleagues
should continue to provide a basis for the rejection of
antifluoride arguments for years to come and could lead to the
provision of fluoridated water to many Americans, a benefit
already enjoyed by over 123 million of their fellow citizens.
Michael W. Easley
"Lifesavers [sic] Guide to Fluoridation"' was first thrust into
my hands by a concerned citizen, I promised to read the flyer
and prepare some materials that would refute the
antifluoridation claims found in it. As I read it and
cross-checked a few of the references, I became angry at the way
the scientific literature was abused. Calling fluoridation "the
greatest medical fraud in history", the author of the pamphlet,
John Yiamouyiannis, claimed that fluoridation did not reduce
dental caries and that drinking fluoridated water would
interfere with one's ability to have children as well as
increase one's chances of getting cancer and a host of other
question and answer format, the author cited 250 references from
a variety of journals, court cases, books, newsletters,
symposia, and newspapers, as well as several personal
communications. He made literally hundreds of charges in this
eight-page pamphlet and used a pseudo-scientific approach that
could, at first glance, fool the casual reader.
In early 1983, I
attended a city council meeting in a small Ohio community where
governing officials were contemplating passage of a local
fluoridation ordinance. John Yiamouyiannis was present and spoke
to the members of council about the alleged dangers of
fluoridation. One astute councilman, who had received a copy of
the "Lifesavers Guide" a week before the meeting, had consulted
his chemistry journals and researched a few of Yiamouyiannis'
references. He had found "nothing to do with water fluoridation"
and chastised Yiamouyiannis publicly for his inappropriate use
of the scientific literature.
It was at that
time that I decided that it might be worth the time and effort
to look up all of the references and determine just how much
fact and how much fiction this pamphlet contained.
At the same time,
colleagues who were also engaged in grass roots fluoridation
activities were finding it increasingly important to have facts
at their disposal to counter what we have perceived as a more
technical and scientific attack on the safety and effectiveness
of community water fluoridation. For example, if an opponent of
fluoridation claimed that fluoride was harmful@ in some way, and
based this claim on a special research project, it was important
to know what fluoride compound was used in the study, what type
of subjects were used (animal, human, or plant?), and most
importantly, what concentration of fluoride was used in the
research. We have tried to provide this kind of information for
all of the laboratory and clinical studies cited in the
J. Lifesavers guide to fluoridation. Risks/benefits evaluated in
this 1982 question and answer report. Delaware, Ohio, Safe Water
Foundation, 1982. 8p.
Throughout this document we will simply refer to the pamphlet as
the "Lifesavers Guide". Please note that we have chosen, for the
sake of simplicity, to maintain Yiamouyiannis' lack of
possessive punctuation in Lifesaver's rather than insert "[sic]"
after every use of the word.
instances, certain authors or resources consulted by
fluoridation opponents must be evaluated by the public health
professional and the lay person before trustworthy conclusions
can be drawn. Can the experiments be repeated by other
researchers using accepted scientific methods, and more
importantly, will the same results accrue? Can the author or the
organization be relied upon for objectivity, technical accuracy,
and reputability? Again, we have tried to provide this kind of
information for the references used in the pamphlet.
For many of the
references, particularly those found in foreign language
journals, contributors found it appropriate to include the
summary of the article or the abstract as it appeared in the
journal. This proved particularly helpful when esoteric studies
reporting highly technical results were cited, or when all but
the summary of the study was published in another language. We
did not correct grammar, punctuation, or abbreviations in these
instances, although style and clarity (particularly for the
translated studies) often left much to be desired.
succeeded in obtaining all but 19 of the 250 references cited in
the 1982 pamphlet. Local, state, and national libraries were
contacted, as were state officials who were in possession of
some of the articles. Chemical Abstracts Services had a large
number of the foreign articles, and when it was possible, we
obtained translations of non-English studies. A very large
percentage of the references were in outdated or obscure foreign
journals that are not part of the collections of most libraries.
Several "personal communications" cited in the "Lifesavers
Guide" were not obtainable, nor were we successful in locating
all of the transcripts or exhibits used in a Scotland court
case. Appendix A lists the references we were unable to obtain.
The Table of References lists the numbered documents according
to the question used in the "Lifesavers Guide".
Since the project
began, two documents have been published that have a direct
bearing on how this refutation will be used. In July 1983, the
Safe Water Foundation began to circulate the 1983 "Lifesavers
Guide to Fluoridation". It contained many of the references
found in the 1982 version, but the citation numbers are
different as a result of some minor changes in the text. For
this reason, this document lists both 1982 and 1983 "Lifesavers
Guide" reference numbers with each abstract.
In July 1983, the
author of the "Lifesavers Guide" published a book entitled
'Fluoride, the Aging Factor2. Yiamouyiannis once again used
many of the same references from his previous pamphlets.
Therefore, this compilation of abstracts may be helpful in
responding to claims made in Fluoride, The Aging
Factor. Unfortunately for those of us who rely on the accepted
and traditional scientific reference format, Yiamouyiannis did
not use superscripts, footnotes, or numbered references in his
book and only listed information sources in an, appendix for
each chapter. This makes it difficult to attribute a specific
claim to its source in the literature. Appendix B lists the
references from the "Lifesavers Guide" that coincide with
references in Fluoride, The Aging Factor.
J. Fluoride: the aging factor. Delaware, Ohio, Health Action
Press, 1983. vi+210p.
In 1986, and
again, in 1988, Yiamouyiannis published revised versions of the
'Lifesavers Guide." Appendix C contains an index of the
reference numbers used in all four versions of the "Lifesavers
Guide." Special thanks to Tom Reeves of the Centers for Disease
Control for helping to compile this index.
appears before the lengthy section on individual references. I
hope this summary will be useful to boards of health, governing
councils, educators, and citizens' groups who need a concise
analysis of antifluoride propaganda. My collaborators on the
project recognized the need to summarize our findings
succinctly, since there is rarely enough time to address every
reference cited by antifluoridationists and respond thoroughly
to each scare tactic used.
The Centers for
Disease Control very aptly describes the dilemma that we face in
our efforts to responsibly educate the public about the benefits
and safety of fluoridation:
unfortunate that irrelevant, unreplicated, or refuted
research is purposefully presented to the detriment of
the health of this nation's children. It is also
unfortunate that misinterpretation of actions in foreign
countries and out-of-context statements continue to
circulate and create unnecessary fears. For every report
which casts doubt on fluoridation, there are innumerable
reports attesting to its safety and efficacy. It is not
surprising that some differences of opinion among
scientists and professionals in research and medicine
may occur. What is surprising, however, is their almost
universal agreement on the safety and effectiveness of
fluoridation. Fluoridation is not a controversy in any
scientific sense. There are few public health measures
which have had the scientific endorsement and broad base
of research which supports its use as does fluoridation.
Fluoridation has the support of the U.S. Public Health
Service and, in the more than 30 years that the program
has been in effect, there has been no valid evidence of
harm to anyone from drinking optimally fluoridated
water. There is no valid reason why the benefits of
fluoridation should be denied to the citizens of any
Special thanks go
to my co-editors, each contributor, Petta Khouw for
extraordinary library "sleuthing", Beverly Wargo, Janet Pierson,
and Molly Frazier for patient proofreading, and dozens of other
librarians and translators who kindly assisted the contributors.
A special note of appreciation is due to Ann Malone, whose
exceptional word processing skills and commitment to excellence
helped bring this project to completion.
Colleen A. Wulf,
3 Dental Disease
Prevention Activity, Centers for Disease Control, U.S. Public
Health Service. Water fluoridation: a training course manual for
engineers and technicians. CDC, Atlanta. 1982. P. 13.
The task of
summarizing this document is not an easy one, but we have made
an attempt to categorize the types of citations used in the
"Lifesavers Guide to Fluoridation" and discuss the various ways
these references have been used and abused.
Types of References
Only about 48
percent of the articles cited by Yiamouyiannis come from
reputable journals that, to the best of our knowledge, utilize a
panel of referees to screen articles submitted for publication.
Needless to say, some of the more obscure foreign journals may
employ this screening technique, but we have separated out the
non-English articles into a different category.
The author of the
"Lifesavers Guide" did not limit himself to the use of refereed
journals but relied on a large number of non-scientific, rather
anecdotal articles to support his claims. The chart below
categorizes the types of references used in the "Lifesavers
TYPES OF REFERENCES USED IN THE
"LIFESAVERS GUIDE TO FLUORIDATION"
||Number of References
||Number of References
|Foreign Language Journal
||Periodical (Private corp., prof. group)
||Published Abstrace only
22 of the above
references were authored by well-known antifluoridationists or
found in antifluoride documents.
of the types of references used in the "Lifesavers Guide"
indicates that many plant and animal models are used in some of
the references cited.
Conducted on Various Plants or Animals
||"Bufo bufo" tadpoles
In determining if
references are used appropriately, the reader of the scientific
literature should observe closely a number of factors:
Was the research conducted in vivo*
or in vitro**?.
the references used in the "Lifesavers Guide" were articles that
reported the results of some type of laboratory study. Of these,
26 were in vitro studies and 58 were in vivo
studies. Only seven of these studies reported laboratory results
on human tissues (blood cells, dental enamel). In addition, 58
references described findings based on evaluation of large human
populations or based on community trials. Eighteen of the
articles cited were case histories or clinical evaluations of
small groups of patients, workers, or clients--many of whom were
exposed to unnaturally high levels of fluoride.
What fluoride compound is being used and are the
effects of that compound comparable to the
effects of drinking optimally fluoridated water?
used in the "Lifesavers Guide" report the effects of fluoride
compounds that are not used in either water fluoridation or
topically applied fluoride products. For example, in reference
#63, a researcher examines the effects of 3 micrograms per cubic
meter of hydrogen fluoride gas (HF) on tomato plants. The
results cannot be extrapolated to human beings who consume 1 ppm
fluoridated water! The results should not even be extrapolated
to inhalation of fluoride by humans, since urban air usually
contains less than 1 microgram per cubic meter. Thirteen
references in the "Lifesavers Guide" report on the effects of
airborne fluoride--one study cited by Yiamouyiannis is clearly
used inappropriately since it reports on the biologic effects of
fluoride-containing rocket propellant. Nearly half of the
references (124) had no relevance to community water
Are the fluoride levels used excessive or comparable to
those found in either optimally fluoridated water
or the body fluids of a person who consumes
optimally fluoridated water?
utilized fluoride in excessive doses (not including the
fluorosis-related references). Optimally fluoridated water
contains 1 mg fluoride (F) per liter (L). At 1 mg F/L an adult
(60-72 Kg) ingests about 0.028 to 0.033 mg/Kg from 2 L of water.
Several studies cited in the pamphlet report the use of 10-50 mg
F/Kg of body weight! Often researchers expose the experimental
animals to almost lethal doses of fluoride in order to measure
New Collegiate Dictionary defines in vivo as "in the
living body of a plant or animal."
New Collegiate Dictionary defines in vitro as "outside
the living body and in an artificial environment."
The reader should also be careful
not to confuse fluoride levels in body fluids with fluoride
levels in drinking water. In other words, consuming 1 ppm
fluoridated water results in fluoride levels in body fluids that
are much lower --approximately
.019 mg/100 ml. Therefore, if a researcher tests the effects of
fluoride on blood or other tissues by exposing the cells to say,
1 ppm fluoride, this fluoride concentration is far in excess of
the levels found in body fluids of normal human beings.
Therefore, such results must be interpreted with caution.
Accuracy and Completeness
A total of 21
references (9%) were incorrectly cited by the author of
the "Lifesavers Guide". In many cases, incorrect pages, years,
or volume numbers are utilized, requiring painstaking title or
reference was incompletely cited. It is common practice
to include authors and titles for journal articles, yet these
were not available for easy verification. Legal citations were
incomplete and Yiamouyiannis failed to utilize a standardized
format for legal referencing. In addition, books that were cited
rarely included a publisher's name and for many references,
certain page numbers, volume numbers, and years of publication
were selectively omitted.
method of placing superscripts is used throughout the
"Lifesavers Guide". The author selectively references only
portions of statements and then fails to reference the
conclusions) he draws. For example, on page 3 of the "Lifesavers
Guide" the following statement is used: "The amounts of fluoride
used to fluoridate public water systems lead to soft tissue
fluoride levels (122,123). which damage biologically important
chemicals, such as enzymes (4,124,125), leading to a wide range
of chronic diseases." This statement could lead the casual
reader to erroneously conclude that because 1 pm fluoride
affects enzymes, it causes a variety of chronic diseases. This
is untrue. Many agents (including penicillin) will negatively
affect enzymes in vitro. However, to assume that these
effects are found at appropriately low concentrations, or that
an in vitro effect of 1 ppm translates directly to an
effect in vivo is totally unsubstantiated.
It can be
concluded that based on the types of references cited and the
accuracy and completeness with which they are used, the author
of the "Lifesavers Guide" repeatedly fails to demonstrate a
fundamental knowledge of proper scientific documentation.
Responses to Major Claims
In his pamphlet,
Yiamouyiannis makes a variety of allegations that the editors
have condensed into categories that are discussed below.
(#17-25) are cited to support the claim that fluoride weakens
the immune system. Four of them could not be located, but the
five that were reviewed and abstracted report results of
extremely esoteric, in vitro research that has no relevance to
the consumption of optimally fluoridated water by humans. For
example, three references examine the effects of high levels of
fluoride on rabbit, mouse, and human white blood cells or
polymorphonuclear leukocytes (PMN's), which play a role in the
host-parasite relationship. In each article, the authors
carefully qualify their conclusions to avoid impugning water
fluoridation or they make no attempt to relate their findings to
normal fluoride blood levels in humans. One author specifically
states, "There is no evidence that the levels of fluoride found
in the plasma of persons living in a fluoridated community could
cause inhibition of any of the PMN functions tested."
Two of the
articles report that very high fluoride levels cause an
elevation in cyclic-AMP levels in certain rat tissues.
Cyclic-AMP, a compound that is formed in most cells in the body,
can inhibit phagocytosis and leukotaxis, which are basic
cellular defense mechanisms. In an effort to correctly interpret
these findings, the editors contacted one of the coauthors of
this research, Dr. D.W. Allmann. Dr. Allmann indicated that
extrapolating his data to the immune system of human beings is
premature, since "we rig the system" in the laboratory. He
further noted that some human hormones, glucagon, and
epinephrine can also increase cyclic-AMP levels in body tissues.
scientific literature cited was inappropriately used by
Yiamouyiannis and fails to support the claim that fluoride
weakens the immune system.
One of the
"newest" claims made by fluorophobics is that fluoridated water
leads to a breakdown of collagen, a structural component of
skin, ligaments, muscles, and bone. Yiamouyiannis infers in his
pamphlet that this breakdown of collagen can lead to wrinkled
skin, arthritis, and torn ligaments which are likely to be more
common in fluoridated areas. The articles he cites, however, do
not support this claim.
Eight of the ten
references used in the "Lifesavers Guide" have no relevance to
optimal fluoridation, since most of them use excessive levels of
water or airborne fluorides. One reference is a magazine article
from a German weekly tabloid that presents no scientific basis
for its claims, relying solely on interviews and testimonials.
This magazine article is emphasized in the first chapter of
Yiamouyiannis' book, The Aging Factor, as
evidence that fluoride causes premature aging.
In an effort to
determine just how Yiamouyiannis could make. this seemingly
ridiculous claim based on scientific research, the editors
personally contacted two of the researchers who authored studies
that are cited in Yiamouyiannis' publications. Dr. L.J. Ream and
Dr. P.B. Pendergrass of Wright State University's School of
Medicine were informed about the manner in which their studies
were used in the "Lifesavers Guide". Both reseachers insisted
that their findings could not be extrapolated to human beings
because the research was with laboratory rats at very high
fluoride concentrations. Dr. Pendergrass noted that rat bone is
very different from human bone: it does not have Haversian
systems or the compact bone formation found in humans. Dr. Ream
states, "We don't want to infer that 1 ppm fluoridated water is
doing any harm." He expressed his concern that his research was
misused for the purpose of impugning community fluoridation.
While it has been
demonstrated that skeletal changes may be produced by toxic
levels of fluoride, these changes occur only after
long-continued exposure to extremely large amounts of fluoride,
ranging from 20 to 80 mg. or more per day.
recent studies have demonstrated some dramatic results from the
use of therapeutic levels of fluoride in the treatment of
osteoporosisi and otospongiosis (2), bone-thinning diseases.
Deregulation of Blood Sugar Levels
(#46-51) are cited to support the claim that fluoride
deregulates blood glucose. In fact, five of the references
provide absolutely no data on blood glucose levels. One
reference could not be located due to incomplete referencing,
and one reference had no relevance to the consumption of
optimally fluoridated water by humans.
concerning possible relationships between waterborne fluorides
and diabetes have been reported. Data comparing vital statistics
were compiled by the Department of Public Health of the State of
Wisconsisn.(3,4) These data show a complete lack of correlation
in rates of death for diabetes between cities whose water
contained fluoride in amounts ranging from 0.5 to 2.5 ppm.
Moreover, in a 10-year study in Sheboygan, Wisconsin, the rates
for diabetes actually dropped from 32.5 to 24.4 per 100,000
after fluoridation of that city. These statistical analyses are
in agreement with separate studies made by the Department of
Public Health of Illinois.(5,6)
1Riggs, B.L., et
al. Effect of the fluoride/calcium regimen on vertebral fracture
occurrence in postmenopausal osteoporosis. New Eng. J. Med.
306(8):446-459, Feb. 25, 1982.
J.R., et al. Enzymology of otospongiosis and NaF therapy. Amer.
J. Otology 1(4):206-213, April 1980.
fluoridation. Report of the Committee of the St. Louis Medical
Society. Summary. P. 338-60. (In U.S. Congress, House, Committee
on Interstate and Foreign Commerce, House of Representatives,
83rd Congress, 2nd Sess., on H.R. 2341, a bill to protect the
public health from the dangers of fluorination of water. May 25,
26 and 27, 1954. Washington, Government Printing Office, 1954.
State Board of Health. Continuous-resident data, 1951: death
rates per 100,000 population in cities with varying
concentrations of fluorides in public water supplies 1945-9.
Death rates in cities with varying concentrations of fluorides
in public water supplies 1940-4.
cites 14 references to support his claim that fluoride causes
chromosomal (genetic) damage in various plants and animals. Six
of the studies examine the effects of either sodium fluoride or
hydrogen fluoride gas on plants (barley, onion root tips, maize
seedlings, tomatoes). It is improper, however, to rely on
research involving plants and hydrogen fluoride gas to imply a
possible genetic hazard to humans. In October 1972, the U.S.
Public Health Service (U.S.P.H.S.) criticized the research in
plant genetics by Dr. Aly Mohamed, who Yiamouyiannis relies upon
heavily to substantiate his alleged claims. The U.S.P.H.S.
states: "The effects reported cannot reasonably be extrapolated
to human genetics and the conclusions reached are not relevant
to the consumption of optimally fluoridated water by humans,
animals, or plants."
references used by Yiamouyiannis describe research on fruit
flies. It is essential to realize that results cannot be
extrapolated to effects on human health because of weight
differences, fluoride concentration variations, species
differences, and other mitigating circumstances specific to each
study. In several cases, Yiamouyiannis errs in his use of the
literature: for example, one study notes that fluoride inhibits
the effects of mutation-causing chemicals. Interestingly, one of
the articles cited discusses research on automobile emissions,
making no mention of fluoride!
Elsewhere in the
"Lifesavers Guide" Yiamouyiannis again uses studies on fruit
flies to substantiate claims that fluoride induces tumor growth.
Once again the use of a fruit fly animal model is inappropriate
because the "melanotic tumors" induced in the flies are not the
same as a cancerous tumor in a human or mammal. They are more
akin to scar tissue, and, unlike a cancerous tumor, are not
malignant or harmful.
5. Hodge, H.C.,
and Smith, F.A. Some public health aspects of water
fluoridation. p. 79-109. (In Shaw, J.H., ed. Fluoridation as a
public health measure. Washington, American Association for the
Advancement of Science, 1954. v+232 p.)
Department of Public Health, Bureau of Statistics. Mortality in
fluoride and non-fluoride areas. Springfield, Illinois,
Department of Public Health, Health Statistical Bul., Special
release. No. 20, April 1, 1952. 8 p. processed.
A study by Burk
and Yiamouyiannis was initially circulated in 1975 (7) claiming
to have demonstrated a link between water fluoridation and
cancer. Upon examining the data, reputable scientists found
obvious shortcomings in the statistical methods used by Burk and
Yiamouyiannis. Burk and Yiamouyiannis made minor changes in the
data and published it again in 1977, claiming to have corrected
any statistical shortcomings. (8) Since 1977, no fewer
than 17 published scientific reports refute their claims and
verify that there is no association between fluoridation of
community water supplies and cancer.
employs an interesting technic in his pamphlet. In an apparent
effort to lengthen as well as legitimize his bibliography, he
uses a surprisingly large number of references that are actually
favorable to fluoridation. The most obvious example is found on
page 3 of the "Life-savers Guide" where Yiamouyiannis cites 18
references that refute his fluoride-cancer link. He goes on to
claim that after corrections for errors and omissions these
studies do not adequately refute his research, but he can base
this statement only upon his own "corrections."
well as other fluorophobics, repeatedly claim that harmful
effects of fluoridation have been proven in the courts. During
approximately 35 years of litigation, the legality of
fluoridation has withstood the challenge of repeated legal and
constitutional objections. Fluoridation cases have been heard in
over half of the states and this public health measure has been
upheld by the highest court in over a dozen states. Moreover,
the U.S. Supreme Court has denied review of fluoridation cases
over 12 times because no substantial federal or constitutional
questions were involved.
No court of last
resort has ever rendered an opinion adverse to fluoridation on
the grounds of safety, efficacy, or constitutionality. This may
be a reason why Yiamouyiannis and other opponents of
fluoridation have dramatically cut back litigation efforts in
the last few years. In a particularly insightful decision, a
judge in the Court of Common Pleas of South Carolina stated:
Dr. Yiamouyiannis' participation
in this case was that of an advocate rather than an unbiased
expert. In addition, Dr. Yiamouyiannis must be viewed as having
a direct interest in this case since he has, in the past,
emphasized his court appearances and victories in his
solicitations for contributions.9
Federation (John A. Yiamouyiannis). A definite link between
fluoridation and cancer death rate. March 25, 1975, 9 p.
(circulated, not published).
J.A. and Burk, D. Fluoridation and cancer: age-dependence of
cancer mortality related to artificial fluoridation. Fluoride
Committee for Safe Water v. Commissioners of Public Works, No.
82-CP-1666 (S.C. 1982).
cites 17 studies to support his claim that kidney disease is
likely to be aggravated by fluoride. Several references are
misinterpreted or have no relevance to consumption of optimally
fluoridated water. Six references recount the effects of
higher-than-normal fluoride exposure. Two references could not
be located and one reference is a magazine article that shows a
serious lack of objective reporting. In five references the
kidney disease preceded the effects of fluorides. The use
of these references demonstrates a lack of fundamental knowledge
about causation versus effect.
Hodge and Taves
have determined that human kidneys are not damaged even after
hea and continued over-exposure to fluoride under industrial
conditions (10) Data from Bartlett, Texas (8 ppm) showed no
effect on kidney status.(11) In addition, according to the
National Research Council, based on a large body of data from
animal studies it has been calculated that the minimal fluoride
concentration (in water) necessary to induce kidney changes in a
number of animal species is 100 ppm ingested daily over a long
period of time.(12)
Finally, it is
important to note that since many of the references
Yiamouyiannis uses were published, much progress has been made
in the prevention of problems associated with long-term
hemodialysis. At the recommendation of the National Institute of
Arthritis and Metabolic Disease, it is now a common practice to
purify water used for hemodialysis by reverse osmosis and/or
deionization processes in order to clear it of calcium,
magnesium, copper, fluoride, and other mineral content. Many
normal constituents of water, even at quite small
concentrations, can be harmful to dialysis patients, since their
blood is exposed to 50-100 times the amount of fluid that a
healthy person consumes.
references are cited to support the claim that fluoride
aggravates hypothyroidism. Eleven of the articles were written
prior to 1968, before many of the advanced biochemical studies
were done on the effects of fluoride on thyroid activity. Two of
the articles could not be located and five are written in
foreign languages with either no or limited English-summaries.
One reference related to fluoride used as a rocket propellant
and several other references dealt with excessive levels of
fluorides or research on tadpoles, rats, and dairy cattle.
10. Hodge, H. and
Taves, D. Chronic toxic effects on the kidneys. In World
HealthOrganization, Fluorides and Human Health (monograph series
no.59). Geneva, Switzerland, World Health Organization, 1970, p.
11. Leone, N., et
al. Medical aspects of excessive fluoride in a water supply.
Pub. Health Rep. 69:925-936, October 1954.
Academy of Sciences, National Research Council. Biologiceffects
of atmospheric pollutants: Fluorides. Washington, D.C., The
Academy, 1971. xii+295p.
In 1971, the
National Research Council of the National Academy of Sciences
thoroughly reviewed research on the biological effects of
fluoride.(12) They-concluded that there is no harmful effect of
fluoride on thyroid function. In addition, the World Health
Organization's monograph, Fluorides and Human Health,
(13) contains an extensive literature review and analysis of the
effects of fluoride on thyroid activity. The conclusions reached
were that, " ... fluoride does not accumulate in the thyroid
gland, that its presence does not decrease the uptake of iodine
by the thyroid and that it has no effect on the synthesis of
The authors of
this monograph also concluded that, "Consumption of drinking
water containing fluoride, either naturally or artificially,
does not impair the thyroid function, nor does it change the
morphology and histological structure of the thyroid gland. Even
the consumption throughout life of water containing 6 or 7 ppm
fluoride does not affect the thyroid function."
Fluoride Overdoses Through the Food Chain
cites 13 references to support the claim that fluoride overdoses
by means of food consumption among children and adults are now a
concern. On closer examination it's clear that Yiamouyiannis
once again selectively interprets the scientific literature.
Two of the
studies report questionable conclusions because of bias or poor
methodology. Seven references are clearly misinterpreted by
Yiamouyiannis, and one other has no relevance to consumption of
optimally fluoridated water by humans. This latter reference
describes a study conducted on rats who were fed varying amounts
of high-fluoride water. There is absolutely no mention of
fluoride levels in foods and the author makes no attempt to
impugn community fluoridation. Three of the references cited
could not be located--one of which was missing from both the
National Library of Medicine and the National Institutes of
symposiums (14), special commissions (15), and more recent
research (16) have confirmed that dietary intake of fluorides
has not significantly increased in recent years.
W.D., Gedalia, I., Singer, L., Weatherall, J.A. and Weidmann,
S.M.Distribution of fluorides.P. 93-139, in World Health
Organization. Fluorides and human health. Geneva, Switz., the
Organization, 1970. 364 p.
14 Wei, S.H. ed.
National symposium on dental nutrition. Iowa City: Univ. Iowa
Department of Public Health. Policy statement on fluoridation of
community water supplies and synopsis of fundamentals of
relation of fluorides and fluoridation to human health. Lansing:
The Department. 1979. 63 P.
16 Rao, G.S.
Dietary intake and bioavailability of fluoride. Ann. Rev. Nutr.
A common but
erroneous claim often made by opponents of fluoridation is that:
"No laboratory experiment has ever shown that 1 ppm fluoride in
the drinking water is effective in reducing tooth decay."
Yiamouyiannis makes this claim on page 4 of the "Lifesavers
Guide" as well as on page 101 of The Aging
Factor. Unfortunately, an individual with limited knowledge
of research methodology could be concerned by this alleged lack
lack of laboratory studies on the effectiveness of 1 ppm
fluoride in preventing caries in humans is due to the fact that
low concentrations have no discernible effect on the teeth of
small animals used in dental research. Because these animals
have shorter life spans, more rapid tooth development and
maturation, and faster metabolic and excretion rates than
humans, higher concentrations of fluoride must be provided to
them to produce caries preventive effects similar to those
gained by children who regularly use water supplies with a
fluoride concentration near one part per million.
There are many
studies on record done in laboratories using the higher
concentrations appropriate for the animal species which clearly
demonstrate the decay preventive benefits of fluorides in
It must be
emphasized that laboratory experiments on the effects of varying
levels of a therapeutic agent are often conducted because it is
impossible or unethical to test the agent on humans in community
trials. Early researchers on fluoridation, however, did not
experience such difficulties. In the early 1930's it was
determined that hundreds of "natural laboratories" already
existed. In other words, there were entire communities where
natural fluoride levels ranged from .1 ppm to 8 ppm, allowing
researchers to conduct retrospective studies as well as initiate
controlled community trials.
simple fact remains that there has never been a single
legitimate laboratory or epidemiological study that showed that
drinking water with fluoride levels at 1 ppm caused cancer or
any of the other multitude of diseases claimed to be caused by
Diet, Not Fluoridation, Will Improve Oral
references are cited in the pamphlet to support the claim that
proper diet, not fluoridation, is necessary for good dental
healh. Yiamouyiannis notes that studies on Mexican Indians,
Bedouins, Nigerians, Aborigines, and several other ethnic groups
demonstrate that fluoride is ineffective. Several illogical or
impractical suggestions are made':
caries experience among members of some primitive societies
in fluoride-deficient areas proves that there is no need for
the use of fluorides for caries prevention.
caries rates among members of societies in high fluoride
areas prove that fluorides are ineffective.
3.) Steps to
control the dietary consumption of refined carbohydrates
will result in reduced decay and serve as an alternative to
Two of the seven
references cited by Yiamouyiannis indicate that fluoride levels
were not actually measured. Two other references actually credit
fluoride for the noted reductions in caries.
The simple fact
is that proponents of fluoridation have consistently stressed
for over 40 years that proper diet AND fluoridation are
essential for optimum dental health. Neither measure in and of
itself will eradicate dental disease.
Caries Rates Are Declining in
dental practitioners, and public health workers in developed
countries have noted in the last few years a secular decline in
caries rates in both fluoridated and nonfluoridated areas. This
trend is explained, in part, by the availability of both topical
and systemic fluorides. The antifluoridationists inappropriately
use this data in an attempt to support their view that
fluoridation is ineffective or unnecessary and therefore should
be discontinued. Since lower caries rates are, to a great
extent, the result of widespread use of fluoride products and
fluoridated water, it would be illogical to discontinue their
use. It should also be noted that in many developing countries,
where access to refined carbohydrates have increased and
availability of topical and systemic fluorides is minimal,
caries rates have increased at alarming rates.
Among the most
ridiculous charges made by antifluoridationists are those that
imply that by accident or design, a community's water system
could be flooded with enough fluoride to kill the entire
population. Yiamouyiannis cites nine articles to support his
claim that fluoride spills due to malfunctioning equipment pose
a danger to people drinking fluoridated water. Yiamouyiannis
goes so far as to state that spills have occurred in other
places and are probably occurring in every fluoridated area but
are not being reported. This is not true.
According to the
Centers for Disease Control in Atlanta, Georgia, only 17
overfeeds have been documented in 35 years of fluoridation
involving over 7,000 water systems: 12 caused by equipment
malfunction and five by human error. Two should not have been
reported, Since they did not exceed the federal Environmental
Protection Agency standard of two times the optimum. In three of
the incidents, the fluoride level never exceeded natural
fluoride levels found in this country.
As regrettable as these few
incidents are, the rareness of the occurrence and the mild
transitory nature of the resulting illnesses from drinking the
water continue to substantiate that fluoridation enjoys a wide
margin of safety. In this country, the fluoridation apparatus,
chemicals, and mode of operation are so arranged that it would
be very difficult to administer a dangerous dose to a whole
community. When a fluoridation system is properly designed, the
type of pump used for operating near its maximum capacity would
add fluoride solution at the rate of only 2 ppm. Moreover, the
fluoride content of the water is checked routinely so that any
deviation from the desired level would be found quickly and
Is Fluoride an Essential Nutrient?
The question of
the essentiality of fluoride is really one of semantics. Most
researchers consider fluoride essential for proper development
of bones and teeth. Whether it is essential for reproduction,
growth, and other body functions has been difficult to determine
because of the difficulties in developing a totally
capitalizes on this dilemma by selectively interpreting a number
of scientific articles as indicating that fluoride is not an
essential nutrient. On reviewing the full texts of the reports
cited in the "Lifesavers Guide" it is obvious that three of his
nine citations actually confirm that fluoride is essential. Two
of the references make no specific claims either way and
methodological errors were obvious in another source listed.
While we do not
claim to have responded to every allegation made in the
"Lifesavers Guide" we've tried to address the major scientific
issues raised in the document as well as evaluate the types of
references used by Yiamouyiannis. It doesn't take a scientist to
see that there is no legitimate basis for the author's warnings
based on experimental or historical experience. It is essential
to consider that almost 116 million people in the U.S. have
access to fluoridated water. Over nine million of these people
have used drinking water for generations with natural fluoride
levels that range from 1.5 to 8.0 ppm. No definite evidence has
been forthcoming that continued consumption of such water is in
any way harmful to health.
Yiamouyiannis relies on a lower standard of proof for his claims
than anyone should rely on in an issue of this importance. The
author makes very superficial observations and leaps to some
conclusions which are unwarranted even by the data he presents.
Bias pervades his evaluation of the data and as other authors
have noted, opponents of fluoridation take scientific findings
out of context or erroneously inter-pret them to fear and
confusion among the general population. (17, 18, 19)
Since the early
part of this century, literally thousands of scientific studies
have examined the safety and effectiveness of fluoride. The
"Lifesavers Guide to Fluoridation" is simply an attempt to
create the illusion of a scientific controversy, that, in
reality, does not exist.
17 Richmond, V.L.
Thirty years of fluoridation: a review. Amer. J. Clin. Nutr.
41:129-138, January 1985.
18 National Dairy
Council. Nutrition misinformation. Dairy Council Digest
52(4):19-24, July-Aug. 1981.
19 Bernhardt, M.
and Sprague, B. The poisonmongers. p. 208-219, in Barrett, S.
ed. The health robbers. Philadelphia, G.F. Stickley, 1980.