If you are reading this page you probably have heard or read claims from Fluoridation Opponents (FOs) that the fluoride ion is a deadly poison that causes a wide range of adverse health effects, and it is ineffective at preventing dental decay (caries). You may have been convinced that Community Water Fluoridation (CWF) is irresponsible, ineffective, harmful to health and should be discontinued immediately, or preferably never implemented in the first place. These opinions can be extremely passionate, the evidence can seem persuasive, and you might be wondering how those individuals responsible for recommending and implementing fluoridation programs can be so uncaring, ignorant, uninformed and/or incompetent to even consider fluoridation - if the allegations of fluoridation opponents are true.
You have no doubt also heard or read claims from Fluoridation Proponents (FPs) that exposure to the fluoride ion at optimal levels (around 0.7 parts per million) in drinking water is a safe and effective method of protecting a community against dental caries (decay) and associated health problems.
What is the truth in this confusing web of claims, counter claims and accusations, and how can you decide which position to believe?
As a scientist and an educator, my primary goal is to help you understand the complexities of the fluoridation controversy and explain why I continue to support CWF after more than 20 years studying the subject.
Investigating this topic will be an educational journey to: explore the available evidence and appreciate how science works; learn how emotions and biases can hijack the process; understand why scientists can never guarantee complete freedom from all risk; and discover how to accurately, unemotionally and fairly evaluate the available evidence on the safety and effectiveness of drinking water fluoridation - and hopefully learn how to evaluate different positions in other controversial scientific topics as well.
Critical Thinking is a process of evaluating information and evidence about any topic so you can determine whether or not it is valid and accurate and make informed decisions about what choices to make. (A summary of Critical Thinking)
If the evidence actually demonstrated that exposure to the fluoride ion in drinking water at 0.7 ppm was, in fact, a deadly poison that has a significant risk of ruining teeth, lowering IQ and causing a range of other adverse health effects including hypothyroidism, weakened bones, arthritis, osteosarcoma, bladder and lung cancer, dementia, diabetes, kidney disease, reduced fertility, skin eruptions, gastrointestinal problems, hyperactivity and/or lethargy, headaches, kidney issues, chronic fatigue, disrupted immune system and weakness, then it would indeed be unconscionable to support fluoridation.
So, on that note, let the journey begin to understand why I and many thousands of others continue to support CWF. If you have been persuaded that fluoridation is a dangerous, unethical practice, I request that you suspend your current beliefs while you read my commentary - you can always pick them up again when you leave.
|Fluoridation of drinking water at approximately 0.7 to 1.0 part per million is believed by most members of the scientific, dental, governmental, medical and water treatment communities to be effective at reducing the rate of dental caries (decay) in a treated population and safe for the general public. Fluoridation References - I admit I have selected resources specifically to counter the claim that there is no reliable evidence to support the scientific consensus that fluoridation is a process that is both safe and effective. The risks that have been identified are not ignored by the scientific, dental and medical communities, but overall, most individuals who are responsible for public health believe the majority of evidence demonstrates the benefits of fluoridating water are far greater than the risks.|
|There is a relatively small, but passionate, group of individuals who hold the opposite belief, that drinking water fluoridation at any level is neither safe nor effective; instead, it contributes to a significant number of severe health problems. Many in this camp also consider fluoridation to be a form of unethical mass medication.|
|There are two ways to decide which viewpoint to
believe (this applies to other science-based controversial topics
besides fluoridation). You can either:
|Read Einstein's quote at the top of this page.
Consider the ideas below if you are not a subject matter expert
and must rely on the interpretation and presentation of evidence
by others (who you accept as experts and authorities) to form or
justify a position in which you believe.
|Description of the tab content:
|1||Which political party has the best, most accurate
understanding of economics and the best, most effective plan for
economic stimulation, Republicans or Democrats?
How do you know?
|2||Which religious denomination has the best, most
accurate understanding of God and the scriptures, Catholics or Baptists?
How do you know?
|3||Are water boarding and other forms of 'aggressive
questioning' immoral, ineffective and never justified or are the
techniques ethical, effective enough and justified in certain situations
in which one life (or thousands of innocent lives) may depend on
gaining critical information quickly?
How do you know?
|-||Drinking water fluoridation is moral, safe, cost effective and beneficial and should be continued.|
|-||Drinking water fluoridation is unethical, dangerous, not cost effective and ineffective and should be discontinued.|
If you already believe one of these positions is true, reflect on your beliefs as you continue to read this discussion, and consider the following questions:
How strongly held are your beliefs about the fluoridation issue?
Which of the four claim components mentioned above (morality, cost, safety, effectiveness) were most important in forming your decision?
Why do you believe that the evidence that's used to support your position is more compelling and convincing than the evidence used to validate the other position?
What is the source of the evidence you use to support your beliefs - did you gather and evaluate the evidence yourself, or did you accept someone else's evaluation of the evidence?
Do you know enough about experimental science, chemistry, physiology, toxicology, etc. to understand and evaluate the published experiments on health effects of fluoride ingestion, or are your beliefs based primarily on accepting the conclusions of another person or group?
There is not a more contentious issue in the discussion of drinking water contaminants and treatment methods than municipal water fluoridation.
The "contention" however, comes from a relatively small contingent of anti-fluoridation activists who are able to rally support to prevent or discontinue drinking water fluoridation programs by convincing community leaders and citizens that water fluoridation is not only ineffective and expensive, but it will significantly increases the risk of contracting a variety of severe health problems.
Books have been published that condemn drinking water fluoridation and implicate corporate greed and government conspiracy (or at least complacency) in the process. Anti-fluoride websites: list published papers that "prove" fluoridation is ineffective and harmful; print testimonials of important individuals who are against fluoridation; and post grotesque pictures of teeth ruined by dental fluorosis and bodies contorted by skeletal fluorosis to drive the point home. The sites are often impressive - and alarming to those who visit them looking for information about fluoridation.
This discussion is a follow-up to the extensive list of fluoridation references I researched and published in 2011 in response to claims by some website visitors that there was NO evidence to support the effectiveness or safety of water fluoridation.
My discussion below will probably have no effect on those who already hold strong beliefs on the subject - besides angering some. I hope it will help others who are still trying to understand the controversy and formulating their own beliefs. Fluoridation is one of the better examples of how difficult it is to examine, evaluate and discuss the scientific evidence for a controversial scientific topic - particularly when a specific belief is influenced by strong moral biases.
There have been two antagonistic, mutually exclusive camps, the Fluoridation Proponents ((FPs) and Fluoridation Opponents (FOs), since the initiation of community fluoridation in the United States in 1945.
Anyone uninitiated in the details of the fluoridation debate who begins to examine arguments of the opposing sides will quickly feel as though they have followed Alice down the rabbit hole into a universe where the antagonists each depict a completely different view of 'reality'.
It is important to understand when reading the beliefs in the Battle Lines section that both groups have access to exactly the same body of evidence described in thousands of published studies on the health benefits, risks and costs of fluoridation (as well as basic experiments on the effects of exposure to the fluoride ion) from over seventy years of research and observations on humans and other animals.
There is no cache of secret documents that provides different or better evidence to one group or the other - yet the beliefs and conclusions based on the this evidence are completely different and, for the most part, mutually exclusive. The best symbol of this conundrum was suggested by my wife, Carol, who mentioned that Allan Gilbert's 1892 painting, All is Vanity, (shown to the right) perfectly illustrates how the same evidence can be used to support opposing beliefs. Which of the image interpretations depicts your view of drinking water fluoridation?
|Fluoridation Proponents (FPs) Believe||Fluoridation Opponents (FOs) Believe|
|1||Effectiveness: Most scientific evidence demonstrates that fluoridation is effective in reducing tooth decay. Originally it was believed that ingestion of ¤fluoride ions (F-) protected teeth, but more recent studies suggest that most (though not all) of the protection is from external exposure - killing cavity-causing bacteria in the mouth and aiding the remineralization of eroded enamel. Recent studies show the decreased difference in dental caries rates between fluoridated and non-fluoridated regions is due to better dental care in the last 70 years and wider availability of the fluoride ion from sources other than municipal drinking water - use of fluoridated toothpaste, food, other beverages and dental treatments.||Effectiveness: Scientific evidence actually demonstrates that fluoridation is much less effective in reducing tooth decay than FPs claim. Early estimates of a 60% reduction in dental caries were wildly exaggerated. Differences in dental caries rates between fluoridated and non-fluoridated regions today are modest, at best.|
|2||Safety: Nearly all available scientific evidence demonstrates that fluoridation is safe at recommended levels of about 1 part per million (ppm). Some individuals will develop mild dental fluorosis with regular exposure to drinking water containing 2 ppm of the fluoride ion, and more extensive and severe dental fluorosis can be expected as levels increase. People with kidney disease or who regularly drink a gallon or more of water a day may need to limit their intake of fluoride. Evidence compiled over 70 years that other health problems are caused by long term exposure to the fluoride ion at recommended levels is still not compelling to most individuals in the scientific, dental, medical, government regulatory and public water treatment communities. Much of the evidence presented by fluoride opponents is either irrelevant to the topic or is low quality research that can't survive the peer review process required for publication.||Safety: Evidence that fluoridation is dangerous to health, even at low doses over years of exposure, has been systematically ignored and suppressed by the dental, scientific and medical communities. In fact, long term exposure to water fluoridated at 1 ppm is liable to cause: adverse effects on the male reproductive system, IQ deficits, behavioral problems, cancer, impairment of learning and memory, allergic/hypersensitive reactions, impaired pineal gland function (causing early onset puberty, postmenopausal osteoporosis, psychiatric disease and negatively impacting calcium metabolism and parathyroid function), impaired thyroid gland function (causing obesity, lethargy, depression, and heart disease), interference with many important biological processes and vital cellular constituents (including enzymes and G-proteins), skeletal fluorosis, renal osteodystrophy (in those with kidney disease), bone fracture in children, increased hip fracture in the elderly, bone cancer (osteosarcoma), bladder cancer, and damage to gastric mucosa. http://www.fluoridealert.org/health/|
|3||Proponents: Most dentists, scientists, medical practitioners, government regulators and water treatment professionals who are involved in the practice of (or research into) drinking water fluoridation, support the practice.||Opponents: FAN Professionals Statement - initiated in 2007 collected about 4,700 signatures worldwide by March, 2015, and by December 2018 a whoppin’ 4,804 signatures had been collected out of the millions of practicing and retired medical, dental and scientific professionals worldwide. That includes (practicing and retired) just 582 MDs, 378 dentists and 537 PhDs. Consider the fact that, just in the U.S., there are over 900,000 practicing MDs, over 199,000 practicing dentists, and over 4 million with a PhD. Those few who signed the petition represent a small fraction of a percent of relevant experts worldwide.|
|4||Ethics: The fluoride ion occurs naturally in water supplies around the world, and adding it to municipal water at optimal levels is a reasonable, inexpensive way to ensure that all members of the community have some protection from dental caries (cavities) and health issues that result from chronic dental problems. Fluoride levels are adjusted so most people in a community will receive an optimal dose. The underprivileged benefit the most because they may not have the resources or education to take advantage of voluntary fluoride treatments.||Ethics: Artificially adding the fluoride ion to municipal water without the consent of all those who drink the water is an ethically unjustified form of medical treatment. The dose individuals receive is completely unregulated and there is no way to opt out of the treatment. Since fluoridation causes health risks, people should be allowed to make their own decisions about fluoride treatment the same way they make decisions about taking a pain killer for a sore back. The underprivileged suffer the most because they can't afford home treatment methods to reduce fluoride ions.|
|5||Risk/Benefit: The benefits of municipal water fluoridation for community health outweigh the small risks of significant dental fluorosis in communities with optimally fluoridated water and the yet unproven (after 70+ years) risks of other possible health problems.||Risk/Benefit: The health risks of municipal water fluoridation for community health far outweigh the miniscule (if any) benefits of reduced tooth decay. Since there are now many sources of the fluoride ion besides drinking water, more people are exposed to higher than recommended levels with accompanying greater health risk.|
|6||Cost Effectiveness: All residents of a community can enjoy community water fluoridation's protective benefits simply either by drinking fluoridated water or by consuming foods and beverages prepared with fluoridated water. A person's income level or ability to receive routine dental care is not a barrier to receiving its health benefits. The average cost for a community to fluoridate its water is estimated to range from approximately $0.50 a year per person in large communities to approximately $3.00 a year per person in small communities. For most cities, every $1 invested in water fluoridation saves $38 in dental treatment costs.||Cost Effectiveness: Fluoridation cannot be cost-effective since it does not prevent tooth decay. Fluoridation is also a financial hazard to the electronics industry who rely on pure water. Lucent Microelectronics states it will probably cost them $5,000,000 to remove fluoride from the water they buy from the city.|
|7||Source of Fluoride Ions: The fluoride ion has the same action in the water distribution system and the human body regardless of whether the fluoride ion is naturally occurring or sodium fluoride, fluosilicic acid or sodium fluorosilicate is added to the water. The fact that fluoridation chemicals can be byproducts of another industry does not automatically disqualify them as safe and useful products. Contaminant levels in the fluoridation chemicals are closely monitored and regulated.||Source of Fluoride Ions: Chemicals used for fluoridation are often unnatural, toxic waste products from the fertilizer industry that can't be easily disposed of on land or sea. Instead, Industry conveniently gets rid of these hazardous waste products by selling them to municipalities for addition to drinking water. These noxious waste products are not pharmaceutical grade, not approved by the FDA, contain other harmful contaminants, increase the ability of water to dissolve lead from pipes and react differently in the body from natural forms like sodium fluoride.|
|8||Evidence: As noted elsewhere,
the scientific evidence available on the health effects, effectiveness,
safety, costs and risks of drinking water fluoridation that's available
to both parties in the fluoridation controversy is identical.
However, when you study literature from individuals and organizations
representing the FPs and the FOs you will quickly notice that the
available evidence is not selected nor used in the same manner by
the opposing sides.
The traditional use of scientific literature to support a position or to explain opposing hypotheses is to present ONLY the relevant studies, and where there are differences, discuss specifically why one set of evidence is more reliable than the other for a specific topic. That practice makes it relatively straight forward to evaluate the evidence (although it still requires expertise in a subject to actually evaluate the quality and relevance of any given study). As I discuss elsewhere on this page, the FOs tend to provide a subset of the available evidence that shows the harm of fluoride exposure at any level as an argument to stop fluoridation all together.
The Bias & Evidence section will explore how the same body of available evidence can be used to support such contradictory and mutually exclusive positions.
So, how can such contradictory positions described in the Battle Lines section be supported by exactly the same body of evidence? I direct your attention to my questions at the beginning of this discussion:
Political: Which political party has the most accurate understanding of economics and the best, most effective plan for economic stimulation - how do you know? If you happen to be a Republican you will answer, Republican - if a Democrat, the answer will obviously be Democratic. If you are of another political persuasion the answer would likely be 'neither - my way is correct', or perhaps, 'both parties have some valid points'. The evidence for the current economic situation and the effects of past efforts to stimulate the economy that's available to people of all political persuasions is essentially identical - with some dedicated digging.It is possible to collect new evidence (experimental and observational) on how different economic approaches and policies have impacted the economy. Unfortunately though, each step of the process; The choice to ask specific questions, the decision to collect specific evidence (and ignore other data), the methods of evidence collection, analysis of the evidence and any conclusions about what the evidence actually demonstrates all can be biased and the results interpreted completely differently by people with different pre-existing political beliefs. It is ultimately impossible, though, to use the methods of science to answer the question "which political system is BEST" because there is no universal agreement on what would constitute the BEST (and most effective) political system. The bottom line: You know what is political truth based on your beliefs.
Spiritual: Which religious denomination has the best, most accurate understanding of God and the scriptures, Catholics or Baptists - how do you know? Consider the evidence Catholics and Baptists (or any other religious group) have available to support their positions. All first-hand evidence for the Christian faith is at least 2,000 years old. There is, of course, considerable debate on how that evidence is to be evaluated, but ultimately, interpretation is based entirely on a person's underlying belief system and biases. And, of course, there are a substantial number of other religious/spiritual/non-spiritual beliefs in which potential 'supporting evidence' is evaluated according to those beliefs. It is fundamentally impossible to use the methods of science to answer the spiritual question, "which religious denomination (or belief system) has the best, most accurate understanding of God?" - or, for that matter, "does a god or spiritual realm even exist?". The bottom line: You know what is spiritual truth based on your beliefs.
Moral: Is 'aggressive questioning' (a.k.a. torture) justified in any circumstance (to potentially save a single innocent life - or perhaps to stop a plot intended detonate a nuclear bomb in a large city where your family lives) - how do you know? This is ultimately a moral question for which no scientific evidence can be provided to prove either position is ethically justified. Evidence can be (and has been) collected and presented to suggest that the practice is/isn't effective in various situations. Like politically driven evidence, however, the questions that are asked and all phases of data collection, analysis, presentation and interpretation are judgment calls and will be influenced by (possibly entirely controlled by) underlying moral and ethical beliefs for which science can't provide answers.
There are many other human issues; abortion, contraception, capital punishment, gay rights, euthanasia, slavery, etc., where scientific observation and evidence can be collected to demonstrate consequences of actions based on a particular moral belief, however, it is impossible to use the methods of science to define or prove what constitutes a moral absolute. The bottom line: You know what is moral truth based on your beliefs.
In the above scenarios the complete body of evidence obtained by observation or experiment could be presented to everyone on all sides of an issue, and most individuals would pick, choose, and interpret the information in a way that would support their beliefs and biases.
Think about your answers to the three questions above and consider some of your own beliefs. What new observational or experimental evidence would cause you to change your fundamental political, spiritual, or moral beliefs?
More importantly, because your political, spiritual and moral persuasions are based entirely on your beliefs and convictions, there is no scientific experiment or set of observations that can be designed to prove that your political persuasion, your spiritual faith or your particular moral compass are true or false - they are not even positions that can be classified as true or false, they are your beliefs. The processes of science can be used to collect reliable evidence about a subject, but the interpretation of that evidence can be a judgment call based on powerful beliefs.
The point is, that in some circumstances, the available scientific evidence has very little influence on someone who already holds strong, specific beliefs. They will seek out (and believe as true) evidence that confirms their beliefs and not pursue evidence that opposes their beliefs (Confirmation Bias). If they encounter contrary evidence, the tendency will be to ignore it or dismiss it as false - unless, of course, some completely unavoidable 'reality-shifting' event or new, incontrovertible evidence forces a change of belief.
Please note, the examples above are only illustrations of how strongly held beliefs and agendas can trump any available scientific evidence. I do not mean to imply that I believe the fluoridation controversy is equivalent to political debates, where there is a more or less equal distribution of evidence and supporters on each side, or to religious beliefs, where it is not possible to obtain scientific supporting evidence, or that fluoridation is as serious a moral/ethical issue as torture, abortion, contraception and the other situations noted above.
From what I have experienced, though, aspects of the fluoridation controversy do seem to have their roots in the moral/ethical - even political - categories described above, where evidence can be of secondary importance to a strongly held belief, as I will discuss below.
I know that I find it difficult to even consider the possibility that a new idea is valid if it conflicts with one of my strong pre-existing beliefs. I try to be aware of my biases, however, and I try to evaluate new ideas and evidence fairly and as impartially as I can.
Michael Shermer states, in a 2011 Scientific American article: (https://michaelshermer.com/2011/07/the-believing-brain/), "We form our beliefs for a variety of subjective, emotional and psychological reasons in the context of environments created by family, friends, colleagues, culture and society at large. After forming our beliefs, we then defend, justify and rationalize them with a host of intellectual reasons, cogent arguments and rational explanations. Beliefs come first; explanations for beliefs follow. In my new book, The Believing Brain (Holt, 2011), I call this process, wherein our perceptions about reality are dependent on the beliefs that we hold about it, belief-dependent realism. Reality exists independent of human minds, but our understanding of it depends on the beliefs we hold at any given time. Once we form beliefs and make commitments to them, we maintain and reinforce them through a number of powerful cognitive biases that distort our percepts to fit belief concepts."
Shermer then describes five types of bias he believes everyone uses to filter and evaluate any new information: Anchoring Biases (relying too heavily on one reference anchor or piece of information when making decisions); Authority Bias (valuing the opinions of an authority, especially in the evaluation of something we know little about); Belief Bias (evaluating the strength of an argument based on the believability of its conclusion); Confirmation Bias (seeking and finding confirming evidence in support of already existing beliefs and ignoring or reinterpreting disconfirming evidence); In-group Bias (in which we place more value on the beliefs of those whom we perceive to be fellow members of our group and less on the beliefs of those from different groups).
It is my contention that there are really two independent issues in the fluoridation controversy that should be discussed and resolved independently - but they seldom are:
When these two components of the controversy are untangled, an important difference should be apparent.
The first issue is scientific and evidence-based. Scientists can design (and have designed for decades) experimental and observational studies to measure and analyze the safety, effectiveness, costs and objective risks of fluoridation. Not everyone might agree on the quality or published results of those studies, but at least real data (available to everyone) can be accumulated and debated to support a position.
The second issue is ethical. Our individual beliefs about what is right and wrong are based entirely on our political, spiritual & moral values. These fundamental beliefs in rights of the individual vs. governmental obligations cannot be tested or resolved by any form of scientific study. There is no possible experimental, scientific study that can provide evidence about whether or not (or how aggressively) government should be involved (some would say interfere) with any human activity.
The basic situation, it seems to me as I have studied pro/anti fluoridation materials for the last two decades, is as follows:
Fluoridation opponents frequently define the fluoride ion as a drug and allege it is consumed to prevent disease. Based on that premise, they argue that any artificial fluoridation program exposes everyone in the community to a forced medical treatment. They hold a strong conviction that adding this drug to drinking water is a violation of medical ethics and human rights. Dosage is unregulated so those who drink a lot of water (athletes, those who work outside in hot climates, etc.), who have kidney disease (which reduces the body's ability to excrete excess fluoride ions), or who ingest the fluoride ion from sources besides drinking water (other beverages, food, swallowed toothpaste, etc.), may be exposed to harmful levels even if the drinking water is 'optimally' fluoridated. Once the fluoride ion has been defined as a drug, the argument continues that the chemicals used for fluoridation must be treated the same way as other drugs that require full-scale clinical trials to demonstrate effectiveness and safety, FDA approval, and constant monitoring for side effects.
Since fluoridation is, by their definition, inherently unethical, it is easy to understand the moral outrage and political activism that is frequently part of the anti-fluoridation movement. It is also to be expected that any evidence which describes ineffectiveness and harmful effects of the fluoride ion will be embraced.
proponents, on the other hand, consider the available evidence
conclusive that the fluoride is no more a drug than other naturally
occurring elements found in water, like calcium, potassium, sodium or
oxygen, and exposure to low levels the fluoride ion throughout the day
(in drinking water) is an optimal strategy to reduce the levels of dental
decay (and resulting health problems) in a community with minimal health
risks. The Linus Pauling Institute describes the status of fluoride:
"Although its role in the prevention of dental caries (tooth decay)
is well established, fluoride is not generally considered an essential
mineral element because humans do not require it for growth or to sustain
life. However, if one considers the prevention of chronic disease (dental
caries) an important criterion in determining essentiality, then fluoride
might well be considered an essential trace element." (https://lpi.oregonstate.edu/mic/minerals/fluoride).
In 2005 The American Dietetic Association (ADA) "reaffirms that fluoride is an important element for all mineralized tissues in the body. Appropriate fluoride exposure and usage is beneficial to bone and tooth integrity and, as such, has an important, positive impact on oral health as well as general health throughout life.." (https://www.ncbi.nlm.nih.gov/pubmed/16183366)
The ADA continues to support fluoridation - 2018 Fluoridation Facts
The fluoride ion is also no more a drug than are the other chemicals added during typical water treatment processes to:
The goal is to provide water to the community that is safe and affordable to drink. It is physically and economically impossible to produce and distribute municipal water that is completely free of all contaminants that might be harmful at some level to someone. Every decision about water treatment must balance benefits against costs and health risks to individuals in the community. Fluoride is added to reduce or reverse dental diseases caused by bacteria in the mouth in the same manner chlorine is added to reduce a number of infectious diseases caused by bacteria, viruses, protozoa and other pathogens. Since fluoridation, by their definition, is just another water treatment process, it is easy to understand the lack of moral outrage and political activism employed by FPs in defense of fluoridation.
I believe the seemingly irreconcilable differences between the FOs and FPs is actually caused by those beliefs that have little to do with any hard evidence specifically related to drinking water fluoridation. I also believe that the only way that any discussion of the actual evidence regarding the safety, effectiveness, costs and risks of fluoridation can be accomplished is if the moral outrage of the FOs is disconnected from the science - and, of course, that the FPs fairly evaluate all valid evidence without letting their 70+ year investment in fluoridation bias their views.
So, if the fluoridation dispute actually does have its roots in an ideological conflict that is unlikely to be resolved by examination and interpretation of the available evidence (or the results of additional studies), how can those who don't already have strong views on the topic of fluoridation, or who are new to the dispute, figure out what to believe?
Is there anything to help decide whether one of these positions is more 'true' or valid than the other?
I am quite aware that there is a very small difference between fluoride levels in drinking water, historically around 1.0 part per million (ppm), that are presumed to be safe and effective and levels that have been demonstrated to produce significant levels of dental fluorosis in the population (greater than about 4.0 ppm). That's not much 'wiggle room'. Fluoridation also seems to be a victim of its success - there are far more sources of the fluoride ion available today than in the 1940s (fluoride toothpaste, fluoride in the food, fluoride washes and varnishes, etc. were not available then), so people's exposure is often greater today. And what about the alleged harm to systems throughout the body from drinking fluoridated water for a lifetime - am I not understanding some critical piece of evidence? I don't think so...
Before I explain the reasons I have not embraced the anti-fluoridation position I will provide some background on normal exposure to the fluoride ion (F-). As noted elsewhere, for most substances we eat, drink, breathe, or absorb through the skin, it is the dose (the amount actually absorbed into the body over time) that determines whether it is beneficial, harmful or neutral to our short or long term health.
How much of the fluoride ion might an average person be expected to receive from drinking water fluoridated at current optimal levels of 0.7 ppm - that is equal to 0.7 milligram (mg) of the fluoride ion per liter of water? If a person were to drink a gallon and a half of water per day they would consume about 4 mg of the fluoride ion - and perhaps another milligram or two from other sources.
Age and size also influences how a person will respond to a given dose - and will determine how much water they will probably drink - a 200 pound adult will drink more than a 10 - 50 pound child. So in studies you will frequently see exposure to a substance described as the amount per kilogram (Kg) of body weight. A 100 pound (45.5 Kg) individual who drinks 1.5 gallons of optimally fluoridated water every day (and received another 2 mg elsewhere) would receive a dose of 0.169 mg of F- per Kg of weight per day. A person weighing 200 pounds (91 KG) would receive a dose of 0.084 mg of F- per Kg of weight per day drinking 1.5 gallons. A 50 pound child, for example, might be expected to drink half a gallon of water per day (and perhaps absorb another milligram of F- from other sources) and thus receive a dose of 0.127 mg F- per KG body weight per day. A range of from about 0.08 to 0.17 mg F- per KG body weight, then, would probably cover most people's exposure who drink optimally fluoridated water.
Remember these exposure ranges when examining research papers that are used to support conclusions about safety, effectiveness and risk of exposure to the fluoride ion.
The intent of this argument is not to cause any fear or get people
worried about the safety of chlorination, but I believe it is important
to clearly illustrate the fact that every decision comes with risks,
benefits and costs that must be carefully evaluated by those who make
the decisions for the community wellbeing. It is up to those in charge
of making the decisions to completely, carefully and accurately examine
all relevant evidence and to not be swayed by unsubstantiated
Why are fluoridation opponents only concerned about personal choice when it comes to fluoridation? Their arguments apply equally well to the well-established practice of chlorination or other disinfectant processes. If their arguments against fluoridation are legitimate, then for exactly the same reasons described below, chlorination should be halted and everyone should be given the personal choice to chlorinate (or otherwise disinfect) their own water. Fortunately, the fear-evoking claims against fluoridation are not legitimate and are not supported by the vast majority of scientific evidence or endorsed by the medical, dental or scientific communities.
Scientific beliefs and theories are based on the Hierarchy of Evidence, the Strength & Weight of Evidence and Scientific Consensus Not on Public Opinion: Despite claims to the contrary by Fluoridation Opponents (FOs), nearly all the evidence and the scientific consensus support drinking water fluoridation as a safe, effective and economical process for helping to reduce the incidence of dental caries in the community and the secondary health problems that can be caused by tooth decay. More...
I trust the processes of science despite the annoying tendency of periodic theory modifications and reversals caused by the evolution of scientific knowledge and the fact that all research is conducted by foible-prone humans. As new knowledge is gained, evaluated, and integrated it is inevitable that change in theories and resulting beliefs will occur. As inconvenient as the process is, there are no alternatives to well conducted scientific observations and experimentation for gaining an accurate understanding of the world we inhabit. The basic theories that support drinking water fluoridation have evolved, but they have not changed significantly in over 70 years of intense study and scrutiny. More...
I trust the integrity, education and competence of those involved with fluoridation studies, promotion, regulation and implementation who support the process: I believe the scientific, medical, dental, governmental and water treatment professionals who are charged with studying water treatment processes, caring for patients, regulating water quality and providing safe and affordable drinking water to our homes are overwhelmingly competent, intelligent, informed, well intentioned and trustworthy - and are not part of conspiracies to dispose of toxic waste products in our drinking water or deliberately increase the number of children with dental fluorosis to provide more business for the dental profession as alleged by FOs. If bias, mistakes or fraud do occur in scientific endeavors it is the processes of science and the integrity of the majority or scientists that eventually expose the problems. More...
Discussions about the political, moral, economic and ethical issues of fluoridation are separate from evaluation of scientific evidence for the effectiveness and safety of fluoridation: FOs frequently define fluoridation as an unethical medical practice and then evaluate the evidence in that context rather than impartially assessing safety and effectiveness and then using that information to evaluate the benefits, risks and costs to the population of fluoridation. More...
My own observations and experiences do not support the claim that water fluoridation is harmful at levels typically experienced in drinking water: The primary, immediate consequence (recognized by proponents and opponents of fluoridation alike) of children who ingest too much of the fluoride ion (the equivalent of continually drinking water containing more than about 2 - 4 mg/liter fluoride) is the development of noticeable dental fluorosis - mottling and staining of the teeth. Look around you in any of the cities that practice responsible water fluoridation (0.7 - 1.0 ppm) or that have naturally, optimally fluoridated water - how many children and adults have noticeable dental fluorosis? How likely is it then they have overdosed on fluoride? More...
I do not agree
with the anti-science tactics used by FOs to promote their message:
Carefully examine the evidence presented by both sides.
Positions that are arrived at based on a scientific assessment of the
evidence are not usually emotionally driven, and their proponents present
an evaluation of all the evidence available, not just that which supports
their beliefs. On the other hand, FOs (possibly because they have
been unsuccessful convincing the scientific, medical and dental communities
of their strongly held beliefs) often resort to direct manipulation
of the media and public opinion by deploying alarming and sensational
headlines, providing emotional arguments and only disclosing 'evidence'
that can be made to support their position (regardless of how irrelevant
or poor quality) while ignoring or dismissing all contrary evidence.
If the methods used to promote a message are not scientific or used
fairly, how can one trust the message to be accurate? It is my
contention that FO propaganda and the way it is presented completely
buries any legitimate concerns within the mass of irrelevant and misleading
More... (This topic is discussed in a separate tab.)
Ideally all available evidence on a given subject (effectiveness or safety of fluoridation, for example) is evaluated by others in the field for quality, the appropriate methodology, analysis and conclusions before publication in a recognized scientific or medical journal - this process is called Peer Review. It is not a perfect process, and FOs will quickly describe all of its shortcomings (real and imagined), but it is the only process I am aware of that provides at least some quality control for helping evaluate the results of many thousands of research projects each year. 2015 update - over the last few years the number of journals has exploded. Some of them provide some peer review, others publish any article an author (with or without credentials) pays for. It is becoming more and more difficult and time consuming to evaluate the quality of studies and resulting evidence. See inset below.
There are three fundamental concepts to consider when evaluating whether a claim is scientifically valid or which of two competing theories (or conclusions) is judged more valid than the other. These concepts apply regardless of whether the theories under consideration are completely outside the realm of traditional science (energized water, alien abductions, existence of telekinesis or other psychic powers, astrology etc.) or within the boundaries of mainstream science (gradual vs. punctuated evolution, benefits and risks of fluoridation, an expanding or contracting universe, etc.)
Hierarchy of Evidence: Not all scientific research designs and experimental or observational studies are created equal. Excellent quality, peer reviewed research that controls for bias and other possible sources of error contributes more to the Strength & Weight of Evidence and the Scientific Consensus than poor quality research distributed with no review process. As noted in the sidebar, it is becoming more and more difficult for experts (never mind non-experts) to identify legitimate scientific journals - which makes the process of evaluation far more difficult, because one can't be sure anyone has actually reviewed a published paper in a low-quality journal.
Strength & Weight of Evidence: According to Thomas F. Schrager, Ph.D., "Weight of Evidence is somewhat of a misnomer; more accurately it's the fit of evidence that is key rather than its weight. It is how pieces of evidence fit together, complement one another, create a picture larger than themselves that is the determinant, rather than the weight. Weight goes more to a proper interpretation of the quality of each piece of evidence. A high quality piece of evidence has the potential to add to a fit with other high quality data and/or to put into better context lower quality data." More Information. Schrager's definition also includes elements of the concept of Strength of Evidence, which can be defined as a subset of the totality of evidence that includes only positive and statistically relevant &/or only unbiased evidence.
Scientific Consensus: To paraphrase Schrager, the scientific community as a whole supports a specific theory and the body of supporting evidence, not as the result of a vote, but due to a long process of testing, retesting, considering, hypothesizing and observing results of experiments.
Unlike mathematics where 1+1 will always = 2, the study of cause and effect relationships in nature is often messy. Many components of a scientific observation or experiment can influence the outcome and conclusions drawn. Depending on how a scientific experiment is designed, executed, and analyzed, even studies that examine the same phenomenon can come to very different conclusions.
That's why it's usually necessary for scientists in a given field to carefully examine all aspects of many experiments, determine the quality of each one, establish the validity of the conclusions, and figure out how each piece fits into the overall puzzle to establish a Consensus.
It is extremely easy to find research papers with conclusions that differ from the Scientific Consensus. What is not easy, particularly for those who are not experts in a given field, is to examine individual papers and evaluate the reliability of the journal, the quality of the experimental design, bias controls, methodology, data collection processes, analysis, and interpretation of the results (read the discussion on the right).
Problems can (and do) occur at every step of the experimental process that can compromise the results and conclusions of a given study, and it seems to be easier and easier to publish studies of questionable scientific validity.
That is why it is crucial never to place too much faith in theories and positions supported by relatively few published papers, and why it is important not to simply dismiss the consensus of experts in the various fields because they have been denounced as mainstream, conformist scientists by those who hold passionate beliefs that are different from the mainstream consensus.
Despite vigorous claims to the contrary by FOs, both the Strength & Weight of Evidence and the Consensus of the scientific, medical, dental, governmental, and water treatment communities are currently pro-fluoridation and have been since the 1940s.
One can evaluate fluoridation research against the hierarchy of evidence, count the papers that conclude fluoridation is safe and/or effective, follow the process by which a significant majority of evidence has been shown to support fluoridation, read pro-fluoride position and opinion papers from nearly all mainstream scientific, medical and dental organizations, and survey the medical and dental practitioners.
Among most who study fluoridation issues there is no 'Scientific Controversy or Debate' surrounding municipal water fluoridation - the process is safe and effective enough to support and promote.
Over 70 years of fluoride research has, however, produced some observational and experimental evidence that fluoridation might be ineffective or might pose health risks at low concentrations. This evidence has been carefully evaluated by the scientific, medical, dental, governmental and water treatment professionals and weighed against the evidence that fluoridation is effective and safe.
No other water treatment processes has generated as much research. So far, however, the contrary evidence has been insufficient to change the Consensus that drinking water fluoridation is safe and effective.
Of course it is possible new evidence will be discovered to demonstrate convincingly that the current Consensus beliefs about fluoridation are wrong, but that has not yet happened. The claims and evidence of the FOs have not changed much from those used in the 1950s.
As mentioned in the Placebo Based Health Merchandise discussion, it is always the responsibility of those who propose new or different claims (theories) about how the natural world behaves to provide convincing evidence that supports those claims. Until the FOs provide sufficient quality evidence to support their claims, neither the Strength & Weight of Evidence nor the Consensus will change.
Evidence has, in fact,
demonstrated that people are exposed to more sources of the fluoride
ion today than when fluoridation began. Overall exposure has increased
even in non-fluoridated communities resulting in a rise in the incidence
of mild to moderate dental fluorosis. This observation and the
fact that "no association was found between fluid intake among children and adolescents and outdoor ambient temperature" prompted a
2915 recommendation by the US Department of Health and Human Services
(HSS) to establish the optimal level of drinking water fluoridation to 0.7
ppm for most communities (instead of the previous range of 0.7 ppm
to 1.2 ppm depending on ambient temperature.
As noted elsewhere, one of the most essential strengths of the scientific process is the ability to modify or reverse theories in response to new evidence. That fundamental strength, however, is frequently portrayed as a fundamental flaw by FOs and others who have agendas contrary to the scientific process.
A useful, though fairly trivial, example of changing scientific beliefs is whether eggs are healthy or whether they contribute to a higher risk of cardiovascular problems. Eggs were a dietary staple until the 1960s when research began to link high cholesterol levels with heart disease. Egg yolks contain significant amounts of cholesterol, and the medical community advised people to avoid eggs and egg products (or to not eat the yolks).
After thirty years of egg-cholesterol-fear, research in the late 1990s seemed to indicate that dietary (as in eggs) cholesterol did not contribute to either heart disease or stroke, except perhaps for diabetics, and eggs were in favor again. After another twenty years of so of guilt free egg indulgences, a 2010 review article in the Canadian Journal of Cardiology concluded that, "The evidence presented in the current review suggests that the widespread perception among the public and health care professionals that dietary cholesterol is benign is misplaced, and that improved education is needed to correct this misconception." Aaaaaarrrrrrg - What's a person to believe - how on earth can science be trusted?
Worse than flipping positions, there have been instances where science initially got something horribly wrong. Sometimes the problems included lack of proper trials and/or inaccurate evaluation of available evidence to determine risk. This was the case with Thalidomide, an apparently safe and effective sedative prescribed to pregnant women in the late 1950s. The drug eventually caused over 10,000 birth defects in 46 countries before the danger was widely recognized in 1961 and the product was recalled. The refusal of FDA reviewer, Dr. Kelsey, in 1960 to approve the sale of Thalidomide without additional studies limited the number of birth defects in the US.
Another example of science-gone-wrong is Vioxx, a nonsteroidal anti-inflammatory drug developed by the pharmaceutical company, Merck, to treat osteoarthritis and acute pain. The drug was given FDA approval in 1999 based on clinical trial results and withdrawn in September, 2004 amid allegations that the drug was linked to an increased risk of heart attacks and strokes and a possible cover-up of evidence that Vioxx use caused cardiovascular problems. Depending on the source, there is still considerable disagreement on the extent of fault that can be assigned to Merck and the groups responsible for investigating its safety.
These examples underscore six important truths about science based theories and practices.
Science is constantly evolving:
Science is not a collection of static disciplines where physical laws are discovered, written in stone, then believed and taught as Gospel Truth forevermore.
Scientific knowledge builds on knowledge gained previously. New experiments are designed by different individuals with different training, perspectives, ideas and tools - nature is approached differently and may provide different answers to the questions that are asked.
Science can only provide provisional truth and theories with no guarantee of their stability. You can only count on theories to provide answers as long as most evidence continues to support them.
Even high quality scientific experiments and observations on a given subject frequently produce evidence that can be interpreted several ways by experts, and that can lead to controversy within the scientific community.
Research done in the name of (and using the processes of) science can produce incorrect and harmful results and interpretations. This can be caused by anything from good research that investigates the wrong questions to poor experimental design, to incorrect interpretation of results to sloppy, incomplete or biased scientific studies to outright fraud.
It is, however, the tools and processes of science that eventually identify and correct the errors and resolve controversies. So, science is self correcting and has created our modern world with benefits undreamed of just several centuries ago. As with any human endeavor, though, these benefits of modern civilization come with costs and risks.
The greater the impact of new scientific theories, discoveries or products on society the greater is the scrutiny by others in the field and the greater the chance that self-correction processes will kick in if there are problems. In the examples above, Thalidomide and Vioxx had severe negative impacts that triggered scientific review and recall of the products.
There are many theories, discoveries and products, however, with relatively minimal impacts on society (or supporting evidence is difficult to obtain or interpret), where there is no clear scientific consensus, and popular beliefs drift back and forth over time - the egg-cholesterol debate seems to illustrates that situation.
Thankfully there are many scientific theories that have a significant impact on society (and considerable evidence to support) them that do not ordinarily change over time even though they are subject to ongoing review and evaluation.
It can often require time and effort to understand currently accepted theories - or the benefits, risks and costs that might be associated with them. It is seldom sufficient to consult a single source and be assured that you can understand and fairly evaluate either the evidence or the consensus for a given theory.
It is understandable that non-scientists might become upset, overwhelmed and impatient with theories and beliefs based on scientific inquiry. They always want science to 'get it right'. People want Truth, security and stability and the comfort of certainty in their beliefs. Insecurity and complexity can be frightening. Although many scientific theories are stable for long periods of time with minimal controversy, there is no guarantee that will always be the case.
It is no surprise then that those who promote non-standard health beliefs and treatments (and other beliefs contrary to traditional science) emphasize the fact that mainstream scientific theories and practices can change over time, and then highlight every mistake ever made in the name of science or any evidence that generates scientific controversy.
These individuals or groups then claim to be Scientific Authorities worthy of providing their own alternative theories. Their theories are presented as TRUE, easy to understand and unchanging. No inconvenient qualifications or messy, conflicting evidence are presented to confuse the issue. So, if you just take the word of these 'experts', there is no need to understand or evaluate any troublesome scientific theories or processes or worry that their Truth might change based on new evidence.
FOs exemplify this practice.
Their literature suggests that any changes in theory, any evidence of
poorly conducted research or any disagreements over interpretation of
evidence during 65 years of study proves fluoridation is not based on
valid scientific evidence. Evidence is then presented that the
fluoride ion is a harmful medication and fluoridation is ineffective
and unsafe - conveniently no conflicting evidence is offered to complicate
the decision making process. Obviously, then, according to FOs,
no moral, honest, right thinking person could possibly fail to conclude
that fluoridation is a worthless, dangerous, unethical process.
I believe, however, that the vast majority of the scientific, medical, dental, governmental and water treatment professionals who are charged with studying water treatment processes and health effects of various substances, caring for patients, regulating water quality and providing safe and affordable drinking water to our homes are overwhelmingly competent, intelligent, informed, well intentioned and trustworthy,
These professionals are not part of conspiracies to dispose of toxic waste products in our drinking water or deliberately increase the number of children with dental fluorosis to provide more business for the dental profession as alleged by FOs. If bias, mistakes or fraud do occur in scientific endeavors it is the processes of science and the integrity of the majority or scientists that eventually expose the problems.
On August 9, 2007, the Fluoride Action Network released the Professionals' Statement calling for an End to Water Fluoridation. According Connett, "The Professionals' Statement is the rock on which we will build the rest of our campaign." The petition concludes:
We call upon Members of Congress (and legislators in other fluoridating countries) to sponsor a new Congressional (or Parliamentary) Hearing on Fluoridation so that those in government agencies who continue to support the procedure, particularly the Oral Health Division of the CDC, be compelled to provide the scientific basis for their ongoing promotion of fluoridation. They must be cross-examined under oath if the public is ever to fully learn the truth about this outdated and harmful practice.
We call upon all medical and dental professionals, members of water departments, local officials, public health organizations, environmental groups and the media to examine for themselves the new documentation that fluoridated water is ineffective and poses serious health risks. It is no longer acceptable to simply rely on endorsements from agencies that continue to ignore the large body of scientific evidence on this matter -- especially the extensive citations in the NRC (2006) report discussed above.
For me, there are two extremely troubling claims (both explicit and implicit) that FOs make in this petition and in their other literature.
A. Every one of the scientific, medical, dental, government employees and water treatment professionals who support fluoridation (many with family members that drink fluoridated water) and who are charged with studying water treatment processes, caring for patients, testing &/or regulating water quality and providing safe and affordable drinking water to our homes blindly rely on endorsements of the safety and effectiveness of fluoridation without carefully and continually examining the fluoridation evidence for themselves.
B. The professional leadership of all the agencies and organizations (list 1 list 2) that support fluoridation, like the American Dental Association, Center for Disease Control, American Academy of Pediatrics, American Medical Association, American Water Works Association, World Health Organization, continues to ignore the scientific evidence.
The only reasons I can think of to explain these two claims are that FOs seriously believe fluoridation supporters have one or more of the following characteristics - we are all:
too incompetent to design and carry out high quality research on fluoridation issues.
too lazy to have really examined and accurately evaluated the available evidence - just go with the flow.
too ignorant or stupid to understand the research and evaluate the evidence and implications correctly.
too biased in our fanatical support of fluoridation to evaluate the evidence impartially.
too arrogant to admit that we could be wrong.
too scared to speak out against majority beliefs even though we really believe fluoride is dangerous at recommended levels.
so gullible that we believe other fluoridation supporters without question.
part of the greedy, unscrupulous government, industry, or dental interests who stand to profit either by disposing of toxic waste products in our drinking water or deliberately increasing the number of children with dental fluorosis to provide more business for the dental profession.
lackeys, who are under the control of special government or greedy industry interests to save money by dumping hazardous wastes in our drinking water.
too apathetic to take a stand to protect society (including our friends, neighbors and families) from the evils of fluoridation even though we actually believe fluoride is dangerous at recommended levels.
so cruel and deceitful we enjoy feeding false information about fluoridation to the public and relish watching the resulting pain and suffering.
Why else would FOs would create such a sweeping petition statement? What other reasons could explain the widespread acceptance of fluoridation as a safe and effective treatment by most experts and professionals?
These are serious implicit accusations. Is it reasonable to believe that the majority of scientists, medical professionals, governmental officials, water treatment professionals in the United States and World Wide have one or more of the above characteristics?
The only alternative to the FOs petition statement claims is that they are mistaken in their beliefs, and the large body of evidence has not been ignored, but has been (and continues to be) fairly examined by competent experts and found to support fluoridation.
Personally, I find it easier to believe that a few thousand FOs might be misinterpreting the evidence and exaggerating the risks of fluoridation because of their strongly held ethical and moral beliefs than the alternative; that most members of the scientific, dental, and medical communities who study fluoridation issues and those who regulate and treat our drinking water are ignorant, incompetent, misguided or deliberately evil.
If there were a real fluoridation debate in the scientific community;
if the weight of evidence did not strongly favor the pro-fluoridation position;
if there were no strong scientific consensus favoring fluoridation;
if the scientific, dental and medical communities were more-or-less evenly split on the benefits and risks of fluoridation (like the relatively equal division of people into the main political parties);
then I would be
more sympathetic to the anti-fluoridation position.
Drinking water regulations
that require drinking water providers to meet safety and quality
(↑) Enables nearly all residents of countries with strict drinking water regulations the luxury of being able to drink their tap water with a reasonable expectation that it's safe.
(↓) The more stringent the regulations and the greater the number regulated contaminants, the more difficult and expensive it is for water companies to meet the standards and the more expensive the treated water becomes.
Addition of chlorine,
other disinfectants and other chemicals to drinking water:
(↑) Drinking water disinfection by chlorine and other disinfectant methods save countless lives by reducing water-borne illnesses. Other treatment processes reduce other harmful contaminants, adjust pH to produce safer water.
(↓) Treatment affects the taste, and the resulting disinfection byproducts may increase the risk of some cancers or cause other health problems.
Seat belt laws and
(↑) Saves many lives directly by protecting individuals in most crashes, and indirectly by possibly helping the driver maintain control after impact to prevent additional collisions.
(↓) Seat belt use inconveniences some people and may kill or injure others in certain types of accidents.
Smoking laws and
(↑) Save lives and medical costs if kids mature enough so their brains can make rational decisions by the time they can legally purchase cigarettes, and help protect innocent non smokers from the invasive stench and potential risks of second hand smoke.
(↓) Smokers are inconvenienced and the profits of tobacco companies are reduced.
Laws against driving
while drunk, texting or talking on cell phones:
(↑) Prevent inebriated and distracted individuals from attempting to drive a potentially lethal weapon. Protects innocent citizens from death and injury.
(↓) Drunks, texters and phone users are inconvenienced and often subject to legal action.
or mandates for Immunization against communicable diseases:
(↑) These measures are critical to prevent or minimize outbreaks of potentially devastating epidemics. Countless lives have been saved since immunization programs were developed and initiated.
(↓) There may be a risk of harmful (generally undefined) side effects for a very few individuals who receive vaccinations.
FDA approval on medications that claim to treat specific diseases:
(↑) Helps protect consumers from ineffective or harmful products.
(↓) Inconvenience and reduced profits of those who would like to legitimize and sell products to the public for which there is no scientific evidence of effectiveness beyond the placebo effect.
Eminent Domain Laws
give the government power to take (with compensation) private property
against the owner's wishes:
(↑) These laws provide some beneficial public use.
(↓) This action may not be perceived as beneficial (or the compensation fair) by the land owner affected by the judgment.
Some of the governmental interventions described above are accepted nearly unanimously as justifiable, while others are more controversial. Public acceptance depends on how the risks, benefits and costs of regulations or interventions are defined and perceived. In each of these cases, however, the risks, benefits and costs of the proposed government intervention must be clearly understood, defined and accurately evaluated separately from (and before) the discussion about whether or not the government should act.
Another consideration of a science-based evaluation of whether or not to pursue intervention is a thorough consideration of the benefits, risks and costs of not intervening. In each of the above examples there would be real, measurable consequences if no action was taken by the government. In the case of fluoridation, there is significant evidence that without fluoridation there would be more individuals with health problems related to an increase in dental decay. Evidence-based decisions are often a balancing act where benefits are maximized for a greater number of people while minimizing risks for as many individuals as possible while keeping costs reasonable - there are no, no-risk options.
However, if a person deeply believes that government has almost no business interfering with a person's life or personal decisions, it is unlikely that any evidence about risks, benefits and costs will change their mind about whether or not government should or should not act in a situation they perceived to be an individual right or government interference.
The political beliefs and ethical concerns that fluoride is a drug and that the government has no business 'medicating' any citizen without their consent appear to be of primary importance to many FOs and would probably be held even if there were no evidence of any risk from fluoridation. Consequently, it seems impossible for FOs to separate the discussion of fluoridation safety and effectiveness from their moral principles. Evidence that does not support the anti-fluoridation position must be dismissed, not on its own merits, but because it does not support a belief which must be defended at all costs by any evidence that can be found. The normal assessment process of risks, benefits and costs to the affected population do not apply.
FOs will counter that
all the doctors, dentists, scientists, government representatives and
water industry professionals who support fluoridation have an equally
strong moral conviction to force medications on the public regardless
of consequences, and some individuals and groups also have a financial
motive to poison citizens by disposing of toxic waste in their drinking
water. FOs will also claim their anti-fluoridation evidence is
dismissed, not on its own merits, but because it does not support a
position which must be defended at all costs by any evidence that can
be found. I simply do not buy those arguments.
I live in a large city, Denver Colorado, and the municipal water provider (Denver Water) has been adjusting fluoride levels to average about 0.9 mg/L from 1953 until 2011 when a new standard of 0.6 - 0.7 mg/L was adopted. I have lived in Denver since about 1948, and the period during which my permanent teeth were developing, 1948 - 1952 drinking water was not fluoridated.
My permanent teeth were very susceptible to decay. The dentist scene from the 1986 movie, Little Shop of Horrors, perfectly illustrates my memories of enduring pain from tooth drilling without Novocain while hearing the high-pitched whine of the drill and smelling the associated odor of burnt tooth enamel during early childhood visits to the dentist. Memories run deep, and dental visits are still not one of my favorite outings even though my teeth now appear to be far more resistant to decay.
Obviously, I can't state with absolute certainty that my decay-prone teeth were a result of low levels of the fluoride ion in my drinking water or that the significantly lower decay rates I have experienced in the years after fluoridation was implemented and Crest was introduced in the mid 1950s has been a result of exposure to the fluoride ion. I can say, however, that my personal experience confirms the published evidence in which numerous studies demonstrate protection from dental carries and a very low risk of harmful health issues.
I have not seen evidence of significant dental fluorosis in the fluoridated community in which I live. Dental fluorosis is mottling of the teeth that can range from barely noticeable white spots to very noticeable brown staining. This is the most obvious indication that children in a community with fluoridated water have been exposed to truly excessive and harmful levels of the fluoride ion - this risk is acknowledged by both fluoridation supporters and opponents. It is no hidden secret - if you have too much exposure to the fluoride ion while your permanent teeth are developing your risk of dental fluorosis increases.
It is an extremely well established fact --- The greater the concentration of the fluoride ion you are exposed to, the greater the risk of very noticeable staining. Studies typically describe the percentage of individuals with very mild to mild fluorosis at consistent exposure to fluoride levels of 1.0 ppm or below (natural or fluoridated) as very low.
Fluoridation opponents have presented no good evidence I am aware of to demonstrate a significant percentage of individuals have noticeable levels of fluorosis in communities with fluoride levels of 1.0 ppm or below. In communities with natural fluoride levels of 2 ppm fluorosis becomes noticeable in a larger percentage of residents, and in communities with natural fluoride levels of 4.0 ppm or above a significant number of individuals will have moderate to severe fluorosis and perhaps other health issues. Note: Community water fluoridation has never been used to raise the fluoride ion levels above 1.2 ppm, and the current recommended level is 0.7 ppm.
If drinking water with around 1.0 ppm fluoride is as harmful as alleged by FOs, then fluoridated communities, like Denver, should be filled with far more individuals suffering from obvious dental and skeletal fluorosis, brain damage, fractures, low IQ, thyroid damage, cancer, reproductive problems, increased lead exposure, and a host of other problems attributed to fluoride exposure than residents of communities with negligible fluoride levels - that has not been shown to be the case.
As you read materials provided by FOs you will notice (if you dig deeply enough behind the alarming headlines) that evidence provided to support claims of the alleged serious effects of long term exposure to levels of fluoride below 1.0 ppm are generally prefaced with 'may cause', 'a possible correlation', 'a possible association', or 'may increase'. There is a reason for those qualifications - the actual evidence really does only suggest possible relationships, and does not provide sufficient proof of cause and effect to generate fear in most people or to change the scientific consensus.
If the fluoride ion were as dangerous at low exposure levels as claimed by FOs (or if a significant number of people were actually exposed to dangerously high levels), why is it not obvious to the casual observer, never mind researchers who are searching for both beneficial and harmful consequences of fluoridation? At this point in time I believe careful fluoride research should continue, but I do not believe the evidence which suggests fluoridation is ineffective or dangerous that's available, more than 70 years after fluoridation began in the U.S., is significant enough to cause the anti-fluoride hysteria I observe on the Internet.
FOs have, however, taken their message directly to the media and public with tactics designed to panic, confuse and misinform average citizens who do not have the time nor the background to critically evaluate the available evidence. Even if I believed the evidence clearly demonstrated the devastating health effects claimed by FOs or believed fluoridation was unethical, I would not endorse the disinformation and fear provoking tactics employed by FOs. Use of these tactics ultimately destroys any credibility I might otherwise find in anti-fluoridation arguments.
It is important to understand that
It is impossible to make an informed decision in the absence of all the evidence - but then, from what I can determine, FOs do not want you to make an informed decision, they prefer that you make a decision 'guided' by their Authority. If you have heard the argument that there is no evidence to support the claim that drinking water fluoridation is safe and effective, you can review the resources I assembled that include actual research papers as well as summaries that will quickly demonstrate that argument is false.
Flawed and False
Fluoride is a poison that should never be added to our drinking water: A common tactic used by FOs is to state that the fluoride ion is a poison and therefore should never be consumed by humans. A typical statement (FAN) is, "Due to its high toxicity, fluoride has long been used as a pesticide. In the United States, there are currently two fluoride-based pesticides that are allowed to be sprayed on food. These are: cryolite and sulfuryl fluoride."
The statement that fluoride has, "high toxicity", is irrelevant to the discussion of whether or not fluoridation is safe. It is the dose (the amount eaten inhaled or absorbed over a given period of time) and not the substance which makes something poisonous. That truth was recognized in 1567 by Von der Besucht, Paracelsus, "All substances are poisons; there is none which is not a poison. The right dose differentiates a poison from a remedy.."
For example, inhalation of a common substance at just 4.8 times the normal, beneficial dose can cause oxidative damage to cell membranes, the collapse of the alveoli in the lungs, fluid accumulation in the lungs, retinal detachment, and seizures. The poison? Oxygen (O2)
Drinking 4 to 8 times the recommended, beneficial amount of this substance in a day can cause difficulty breathing, muscle weakness, twitching, or cramping, nausea, vomiting, thirst, bradycardia, cerebral edema, seizures, brain damage, coma or death. Accidental inhalation of small amounts of the liquid form of this substance causes over 6,000 deaths in the U.S. per year. Prolonged exposure to the solid form of this substance can cause severe tissue damage and death. The poison? Water (H2O) (http://www.dhmo.org/).
Additional reflections on doses, toxicity and nutrients:
As mentioned elsewhere, chlorine disinfection of water creates disinfection byproducts that can, according to some reputable studies, increase the risk of some cancers for a few individuals even at ordinary exposure levels. That risk has been determined to be an acceptable tradeoff for protecting the vast majority of citizens from illness and death by water born diseases.
Complicating that statement are the facts that the human body is better able to eliminate excess amounts of some substances than others, people have different abilities to eliminate excess amounts of a substance, and different people respond differently to the same doses of a substance.
Science is messy - it is unwise to make sweeping generalizations.
folic acid is essential to health and proper doses help prevent several birth defects and may reduce the risk of cancer. Too much folic acid may actually increase cancer risk, although evidence is far from conclusive. Consuming several times the recommended dose of fats and carbohydrates, of course, can lead to excessive weight gain and a variety of resulting health problems. The correct dose of vitamin A is critical to a number of metabolic functions, but chronic intake greater than two times the recommended dose may pose risks to bone health. Larger doses can turn the skin yellow and cause birth defects, bleeding in the lungs, liver abnormalities, decreased thyroid function, osteoporosis, increased risk of lung cancer and central nervous system disorders. Meat is a good source of protein, but grilling meat forms heterocyclic amines (HCAs), which several studies have shown may cause cancer, and the meat can also absorb carcinogens (polycyclic aromatic hydrocarbons - PAHs) from the smoke. Copper is an essential nutrient, but excessive doses can cause nausea, vomiting, and kidney and liver damage.
People in areas with less fluoride tended to have no fluorosis and more cavities while people in areas with more natural fluoride tended to have fewer cavities and progressively greater staining. As fluoride levels increased above 4.0 ppm tooth structure becomes weaker and other health problems begin to occur. At that time no one noticed evidence that demonstrates long term exposure to drinking water containing 1.0 ppm fluoride caused chronic health (or dental) problems relative to those who lived in areas with lower fluoride levels and who had more cavities and dental problems.
A headline from Fluoride Alert screams, "Reported Poisoning Incidents from Fluoride Toothpastes, Supplements, & Mouthrinses: As a result of the FDA’s warning, there are now over 20,000 reports each year to Poison Control Centers in the United States due to excessive ingestion of fluoride toothpaste."
Another example was a tragic accident from 1993 reported by Fluoride Alert as "Fluoride Blamed in 3 Deaths: Traces found in Blood of U. of C. Dialysis Patients". In fact, according to the Medical Devices Bulletin, a FDA investigation (or here), the three were hemodialysis patients whose deaths were caused by the failure of a deionizer. The “fluoride concentration in the dialysate was reported to be 15-25 ppm; the ANSI/AAMI standard identifies 0.2 ppm as the acceptable level of fluoride in dialysate.” That is a level of fluoride ions over 75 times greater than safe levels. The high concentrations occurred because the "deionizer used to remove fluoride and other contaminants had become exhausted". The level of other contaminants was probably equally high.
It is completely irresponsible, irrelevant and disingenuous to try and use unfortunate accidents to try and "prove" drinking optimally fluoridated water is harmful. Think of what would happen if every activity that could be linked (even remotely) to an accident was banned. This is one of the more irrational anti-F tactics.
A fear-inducing sound bite, headline or statement by FOs that fluoride ions cause a specific health risk (like fluoride reduces IQ or causes cancer) can't be dismissed with an equally brief statement by supporters that fluoride causes no harm. There are well understood health risks of excess fluoride exposure, so a scientist who defends fluoridation cannot simply say the process is completely without risk. Similarly, no scientist or thinking person would ever state that any human activity is without some potential risk
Refuting a one sentence anti-fluoride statement like "Of particular concern are a series of studies indicating that fluoride can cause osteosarcoma..." can take time and include a detailed and technical discussion of epidemiological studies, risk assessment, the process of evidence evaluation and validation and the relevance of the study to fluoridation that will quickly put many people to sleep.
Here's a headline from the fluoride Action Network:
Headlines like the example from the Fluoride Action Network website are an excellent example of how completely irrelevant but sensationalistic news articles are used by FOs to try and link any harm done by any product containing fluoride with drinking water fluoridation.
Fear is a very effective motivator. If you were walking alone along an isolated mountain path at night and heard an ominous rustling sound behind the trees, your response to the fear of what might be causing the sound would probably cause your instincts to immediately trigger a flight response or prepare your mind and body for a possible fight. You probably would not pull out your i-phone and check wind velocity and direction to see if the sound was wind-caused, evaluate the statistical probability that the rustling was made by a squirrel instead of a mountain lion, or consider how the majority of your neighbors might respond. You would most likely automatically prepare for the worst case alternative. If you fled or prepared for a fight and the rustling was caused by the wind or a squirrel no great harm. If the rustle were caused by a hungry mountain lion and you ignored it, you can guess who will become the dinner.
The Fear Response - an unthinking protective reaction to perceived threats - is hard-wired into our brains, and it is regularly hijacked by marketing programs that try to scare you into buying an idea or product. Fortunately, when unwarranted fear is employed to try and sell an idea or product, there is really no emergency, and you have time to study and evaluate the actual risks. Examples, The Guardian, Political Fear, Fear Sells
Data Overwhelm: FOs take the term, Weight of Evidence, literally. It appears that every study ever published (and many that weren't) that shows any detrimental effect of any fluoride compound at any strength under any circumstance is listed in anti-fluoridation literature. In addition, any study that fails to show a benefit of fluoridation is referenced. Any accident that involves compounds that contain fluorine or fluoridation (or fluoride toothpaste, mouth washes, etc.) is also presented, presumably to emphasize the dangers of the poison. One Example: Gumi Designated as Gas Leak Disaster Zone Source - A blast at the factory of chemical maker Hube Global on September 27th 2012 killed five people and led to the leakage of EIGHT tons of hydrofluoric acid. FA Link
Now, Hydrofluoric acid production has absolutely nothing to do with the safety and effectiveness of drinking water fluoridation, and the inclusion of the article on one of the primary antifluoridation sites just adds to the fear mongering and adds nothing relevant to the arguments against drinking water fluoridation.
I find it nearly impossible to wade through this mass of 'evidence' because studies that might actually be pertinent to the discussion are completely tangled up with and buried by the mass of unpublished observations of questionable value, opinion pieces, sensational news reports and experiments and studies that are of questionable quality or irrelevant to the primary argument that ingesting several milligrams of the fluoride ion through water fluoridation is harmful.
FOs have even established their own journal, Fluoride, to publish papers of anti-fluoride experiments that are not accepted by mainstream journals - these 'published' papers are then added to the list of anti-fluoride references. The Data Overwhelm issue is related to the Misuse of Information discussed below
There are at least two reasons fluoridation debates are generally refused. First, a debate often gives the impression that two equally valid positions are under consideration, and FPs do not wish to promote that illusion. Second, and probably more important, there is no way to provide the information required for the general public to understand, the fluoridation issue within the time limits and format constraints of a debate - just look at the length of this discussion, and it is only a summary of the issues, not a detailed examination of the specific evidence.
Debates that are accepted
simply become an extension of the shock and scare and data overwhelm
tactics - a sanctioned platform for rapid-fire presentation of negative
'evidence' that can't possibly be countered in the few minutes allotted
for rebuttal. With debate invitations for emotionally charged,
complex topics like fluoridation you're double-damned if you debate
and and only damned if you don't.
This is an interesting 2013 online-debate between Ken Perrott and Paul Connett:
This debate sort of works because arguments are not presented live in a short amount of time where claims can be stated without sufficient time to present effective counter-claims. However, this debate also illustrates the problem with throwing claims of evidence and counter evidence around for everyone to read - unless you have the training and experience to analyze the evidence yourself, it is still difficult to know who's presentation of the evidence is more accurate and truthful. This article is reviews a number of debate topics.
These references provided a context and background for the current investigation that help explain why the research was performed and what results might be expected based on previous studies. The references might also provide a theoretical background for the research. In any case, the expectation is that the author will not list irrelevant or obviously poor quality articles and will use the information in the referenced articles fairly and not misrepresent conclusions of the papers or take content out of context.
Many anti-fluoridation references violate those expectations. In their zeal to demonize fluoridation, it seems that FOs will identify and list as many references as possible that contain any content which appears to support their position.
The two most serious breeches of scientific conduct in the use of references are:
Use of references that demonstrate harmful effects of exposure to high levels of the fluoride ion to support their claim that fluoride is dangerous at optimal fluoridation levels.
Extracting content from a study to support anti-fluoridation claims when the actual conclusions of the studies are opposite of how the FOs used them - either showing no harm or confirming the effectiveness of fluoridation.
In the mid 1980s, Dr. Michael Easley decided to assemble a team that would evaluate all 250 anti-fluoride references in the 'Lifesavers Guide to Fluoridation' published by one of the leading FOs of the time, John Yiamouyiannis, who also coauthored the 1995 book, AIDS: The Good News Is HIV Doesn't Cause It.
The report, "Abuse of the Scientific Literature in an Antifluoridation Pamphlet" is a summary of Easley's findings on Yiamouyiannis' "Lifesavers Guide to Fluoridation". Another evaluation of Yiamouyiannis' "Guide"
Unfortunately the references
analyzed are now more than 30 years old, most of the papers referenced
by FOs in the early 80s are no longer referenced by current FOs, and
the pamphlet is no longer available - but the tactics used today are
exactly the same. It would take another team of experts in fluoride
research, epidemiology, toxicology and statistics with a lot of free
time to compile a complete review of all the current references used
in attempts to discredit fluoridation and to separate the legitimate from the bogus.
Also, the information on the antifluoride sites change frequently as
well, so it is nearly impossible to keep up with and document concerns
I have. Several excellent references have been developed that
do a good job of keeping up with the constantly changing studies FOs
claim support their position and refuting claims as they are made:
> The 2018 ADA reference, Fluoridation Facts
> Ken Perrott's constant and thorough scientific evaluations of Anti-F claims and studies
> The American Fluoridation Society
I do not claim to be an expert in any of the specialties I mentioned, but I have sufficient experience evaluating scientific papers to provide some examples from the fluoridealert website during October, 2011 that highlight my frustration with the way references are used by FOs [My comments are bracketed]:
[The fluoride levels that showed a significant difference were 25 - 100 times higher than normal, recommended fluoridation levels. The abstract suggest that the lowest dose studied was 25 times higher than normal fluoridation levels. So, the study did not even evaluate levels considered to be safe.] FA Link PM Link
[The quote used did not mention that the dose used was 20 mg/kg/24 hours - equivalent to a 200 pound (90.7kg) human consuming 1,814 mg of sodium fluoride (about 820 mg of fluoride) in a day - rather more than people receive from fluoridated water. The study also used female rats whose ovaries had been removed (ovariectomized) That's not exactly relevant to drinking fluoridated water - except in the opinion of fluoridation opponents]FA Link PM Link
[However, the first sentence quoted actually reads, "The highest fluoride intake (50 mg/L) significantly diminished vertebral strength, but there was no effect of lower fluoride intakes on bone strength." The second part of the sentence, that lower fluoride levels had no effect, was conveniently ignored.] FA Link PM Link
This is interesting considering page one of the 2006 NRC report clearly states, "Because fluoride is well known for its use in the prevention of dental caries, it is important to make the distinction here that EPA's drinking-water guidelines are not recommendations about adding fluoride to drinking water to protect the public from dental caries. Guidelines for that purpose (0.7 to 1.2 mg/L) were established by the U.S. Public Health Service more than 40 years ago. Instead, EPA's guidelines are maximum allowable concentrations in drinking water intended to prevent toxic or other adverse effects that could result from exposure to fluoride." and on page 85 of the report the statement is made that, "Evidence on caries prevention at water concentrations below the SMCL of 2 mg/L is not reviewed."
[If the report actually states that "fluoride is well known for its use in the prevention of dental caries", and the purpose of the report is not to review evidence of fluoridation, how can FOs possibly conclude that it provides scientific evidence that fluoridated water is ineffective at caries prevention?]
The other apparent claim made in the Professionals' Statement is that the 2006 NRC report clearly states that fluoridation is "dangerous". However, page 9 of the report states, "The committee's conclusions regarding the potential for adverse effects from fluoride at 2 to 4 mg/L in drinking water do not address the lower exposures commonly experienced by most U.S. citizens. Fluoridation is widely practiced in the United States to protect against the development of dental caries; fluoride is added to public water supplies at 0.7 to 1.2 mg/L. The charge to the committee did not include an examination of the benefits and risks that might occur at these lower concentrations of fluoride in drinking water." However, the NRC committee was charged with evaluating any health risks from drinking water with fluoride levels at 2 and 4 mg/L and made absolutely no recommendations to lower the Secondary Contaminant Level belos 2 mg/L for any reason.
That said, the committee did review numerous studies and reviews (over 1,000) on health risks of the fluoride ion on various health categories. I summarized the findings here along with a comparison with the 1993 report conclusions. In none of the health categories did the reviewers conclude that drinking water containing less than 2 mg/L of fluoride (nearly three times the recommended fluoridation levels) posed health risks. The only relevant overall report conclusion was, "In light of the collective evidence on various health end points and total exposure to fluoride, the committee concludes that EPA's MCLG of 4 mg/L should be lowered. Lowering the MCLG will prevent children from developing severe enamel fluorosis and will reduce the lifetime accumulation of fluoride into bone that the majority of the committee concluded is likely to put individuals at increased risk of bone fracture and possibly skeletal fluorosis, which are particular concerns for subpopulations that are prone to accumulating fluoride in their bone."
The only reasons given for this one recommendation were concerns with severe dental fluorosis and possible bone fracture with chronic ingestion of water with a fluoride content of 4.0 ppm or greater. If the committee had any other concerns that fluoride levels below 4.0 ppm were a threat to the public health, it would have stated them. It did not. Also, the committee made no recommendation to lower the secondary level of 2.0 ppm. Additional research in a number of areas was recommended, but there was nothing in the report to suggest that fluoridation at 0.7 - 1.0 ppm was ineffective or unsafe or should be abolished. Claims to the contrary by FOs are simply distorting the facts.
A related issue are quotes by the 2006 NRC Committee on Fluoride chairman, Dr. John Doull in a 2007 Scientific American article that suggested additional research on health effects of fluoride should be conducted. Anti-fluoridation groups immediately began taking these quotes out of context and using them in to create the false impression that he is deeply concerned about the safety of fluoridated water.
in March of 2013 Matt Jacob of the Pew Charitable Trusts contacted Dr. Doull to clarify his views on optimally fluoridated water. In his response, Dr. Doull made the following statement: "I do not believe there is any valid, scientific reason for fearing adverse health conditions from the consumption of water fluoridated at the optimal level."
Ever since the paper, Developmental fluoride neurotoxicity: a systematic review and meta-analysis, (often referenced as the Harvard IQ Study) was published in October of 2012, FOs have been implying, and often stating as fact, that it provides conclusive evidence that fluoridation has a significant negative effect on human intelligence. Frightening headlines like those to the right have been used regularly.
When you read through the paper, though, you might begin to wonder, as I did, why bother to write a paper that describes the alleged findings of these papers. The qualifications the authors make about the data quality throughout the paper should be sufficient to give you pause - for example, "The estimated decrease in average IQ associated with fluoride exposure based on our analysis may seem small and may be within the measurement error of IQ testing.", "Although most reports were fairly brief and complete information on covariates was not available, the results tended to support the potential for fluoride-mediated developmental neurotoxicity at relatively high levels of exposure in some studies.", "Our review cannot be used to derive an exposure limit, because the actual exposures of the individual children are not known.", "Still, each of the articles reviewed had deficiencies, in some cases rather serious ones, that limit the conclusions that can be drawn.", "The fact that some aspects of the study were not reported limits the extent to which the available reports allow a firm conclusion. Some methodological limitations were also noted."
In a later summary statement, (9/11/2012) the primary authors, Anna L. Choi and Philippe Grandjean, added a significant qualification they failed to mention in the original paper, "These results do not allow us to make any judgment regarding possible levels of risk at levels of exposure typical for water fluoridation in the U.S."
Yet FOs continue to cite this study in their efforts to portray fluoridation as a poison forced on unwilling citizens of fluoridated communities. These exaggerated headlines are much more effective at instilling fear of fluoridation than an accurate headline which might read, "A review of 27 poor quality studies, mostly from China, shows that exposure to fluoride at high levels (or to other un-documented contaminants like lead and arsenic) might possibly be very slightly correlated with a lower IQ." I discuss the limitations of this paper and provide links to more detailed critiques on my fluoridation reference page.
The paper actually concluded: "Since the occurrence and mean number of symptoms were fairly similar during actual and supposed fluoridation, the results do not support the theory that the symptoms considered in this study are caused by the physical effect of fluoridated water. On the other hand, the significant reduction in the number of symptoms only after the respondents had become aware of the discontinuation of fluoridation reveals that fluoridation may have psychological effects which present as perceived symptoms." In other words, the symptoms were likely a placebo/nocebo response - a conclusion completely contradictory to the way it was represented on the fluoridealert allergy page. (the entire paper can be read here)
weak disclaimer above does not
excuse the fact that FOs are using research meant to demonstrate
how people can mistake cause and effect relationships to support
their biased, fear-based beliefs.
As an aside, most of the papers listed on the fluoridealert allergy page are 40 years old or more and many are published in Fluoride - a 'journal' created by anti-fluoride activists.
This list could be endless, but I'll close with a final example to illustrate how comments are taken out of context to imply a negative conclusion that is in completely contradicts that of the actual study. The statement that, "The report included two arguments against fluoridation: Opponents of water fluoridation of community water supplies cite two major issues to question the effectiveness of the program; a comparable reduction in dental caries in non-fluoridated communities and the improved availability of fluoride-containing products make the treatment of community drinking water unnecessary." is accurate - the two issues are, Effectiveness of Water Fluoridation to Prevent Dental Caries and Potential Health Concerns.
What is missing, however, is actual the conclusions about those concerns. You can read in the report, "...this argument ignores the diffusion effect of fluoride containing products including food, beverages, dietary supplements, and dental products that were manufactured in fluoridated communities and sold in non - fluoridated areas. Therefore, the non - fluoridated communities also experience an indirect benefit derived from water fluoridation programs resulting in the comparable reduction of dental caries observed in these areas. This argument also ignores the benefit repeatedly reported when the study populations are classified by income level; larger benefits a re observed at lower income levels. ...The use of water fluoridation has provided an effective and cost efficient method to deliver preventative services to promote oral health to all residents within a community served by municipal water supplies, regardless of socioeconomic status or access to care." In other words, these are not legitimate concerns. The report then concludes, "Careful review of the scientific literature and consultation with local and national experts has identified no evidence for adverse health effects associated with water fluoridation at recommended levels." A 2019 update concluded, "Careful review of the scientific literature and consultation with local and national experts has identified no evidence for adverse health impacts associated with water fluoridation at recommended levels. This fact and the continued high prevalence of dental caries and associated pain, expense and potentially serious medical consequences make the continuation and expansion of well controlled drinking water fluoridation a public health necessity in Dane County."
Copyright - 2005, Randy Johnson. All rights reserved.
Updated January 2020