On Thursday, the Water Advisory Commission listened to the opposition to fluoridation present their case. The meeting, which reportedly lasted three hours, had dozens of public commenters. The WAC will make their recommendation on whether Davis should add fluoride to its water supply at their next meeting.
But ultimately the Davis City Council will have to figure out how to handle this matter. A few weeks ago, we reported that councilmembers and staff may be inclined to put the matter to a vote. While some people have suggested such a notion is preposterous, ironically, this would not be the first public vote on fluoridation.
Professor Emeritus John Lofland, a sociologist by training but an historian of Davis, has posted an account of the 1960 vote on fluoridation in Davis that resulted in a narrow defeat. In fact, he notes on his blog, Davis History Today, this was the first of four episodes on the public debate on fluoridating water.
The January 14, 1960, Davis Enterprise reported that the council unanimously voted to adopt a proposal that would have called for authorization to fluoridate the municipal water supply in order “to prevent dental decay.”
The resolution received four votes, with one member being absent, and there was said to be “no debate.” The vote appears to have coincided with the 1960 council elections that saw five candidates for three council positions while the fluoridation issue was said to be “even more hotly contested.”
Wrote the Enterprise, “Measure B (fluoridation) has been hotly contested and is expected to be a nip-and-tucker at the polls.”
At the close of polls, the ballot measure was close enough that it was thought to be decided by the absentee ballots. At the close of polls, the measure received 966 votes in support with 1059 opposing it.
Wrote the Enterprise, ” ‘Almost anything can happen’ to close the narrow gaps in one of the most warmly contested elections of the city’s history.”
The final vote was razor thin – a margin of 32 votes, 1108 against to 1076 in favor. Professor Lofland notes one other thing of interest from the 1960, by way of context, that Davis favored Nixon for President while the nation narrowly went to President Kennedy. So the politics of Davis in 1960 were a little different from today.
The issue returned in 1964 – apparently twice. The paper reported, “The attorney allows that in April of 1964 voters here passed an ordinance that called for a supplementing Davis’ water supple (sic) with fluoride (sic) and that in November of the same year they defeated a proposition that would have repealed any ordinances that provided for fluoride.”
It does not appear that fluoridation was ever added, despite the close votes in its favor in 1964.
In contrast to 1960 and 1964, in 1971 the Davis Enterprise on January 11 reports, “Fluoridation of Davis water probably should be a decision for the city council and that body alone and not one to be handled by the initiative petition process,’ said the city attorney James Callaway, Jr., in a memo to council.
“There has always been considerable question in my mind – whether the initiative process is an appropriate one to direct an administrate task,” the city attorney told the council. “Other cities have done and of course we have done it in the past. However, my personal legal opinion is that it is inappropriate.”
On November 23, 1970, petitions on both sides of the issue were presented to council but those did not take the form of any legal petititon.
Meanwhile, the council the next day “left no doubt… that it will decide whether Davis water should be fluoridated but remaining in the wake of over an hour of sometimes stormy debate were strong indications that such a system – because of its high cost – is years away from installation here.”
The Enterprise reports:
“The initial cost is prohibitive,” observed mayor Vigfus Asmundson, who voted against plugging the system into the budget. “I’m not ready to support it at this cost to the community.”
Even councilman Norman Woodbury, who moved approval, had his doubts. “Cost appears to be one of the major items we face,” he said.
Councilman Maynard Skinner, who also favored trying to wedge the system into the budget, remarked the “city’s dwindling reserves could not stand the cost.”
The vote appears to have been 3-2 in favor of fluoridation, with Councilmember Ralph Aronson joining Mr. Skinner and Mr. Woodbury, and Mayor Asmundson and Councilmember Harry Miller dissenting.
The Enterprise reported, “Professor Harold S. Olcott, of UCD’s department of food sciences, was the sole out-and-out proponent of water fluoridation here. He was partially joined by Henry A. Rolewicz, a local dentist, who favored use of fluoride as a tooth decay preventative but opposed placing the chemical in the city water.”
“Olcott, citing several studies which he said found fluoridation a strong tooth decay preventative, stated that fluoridation is ‘the only reasonable thing for the children of Davis.’ He said he had come across no research that proved the chemical toxic to the body.”
On the other hand, Hubert Arnold, a professor of math at UC Davis, “cited numerous cases of studies that he said said either indicated flourides were potentially harmful or that drew erroneous conclusions.”
A statistics instructor, Professor Arnold pointed to what he called the use of faulty math “in its conclusion that most fluoride passes through the body and thus is harmless.”
He said, “Elementary statistics are enough to tell you that this is not the way to conduct an experiment.”
Councilmember Miller used an argument that some opponents of fluoridation have used today when he stated, “What troubles me the most is the ethics of forcing everyone to accept fluoridation of city water. The voters have indicated there is a large number of residents here against it.”
Given this contentious history in Davis, it is remarkable that forty years plus later, we are still revisiting this issue and using many of the same arguments, despite the fact that most of the rest of the nation has fluoridated water and has had it for some time.
—David M. Greenwald reporting
“Olcott, citing several studies which he said found fluoridation a strong tooth decay preventative, stated that fluoridation is ‘the only reasonable thing for the children of Davis.’ He said he had come across no research that proved the chemical toxic to the body.”
These observations have changed a bit over time. Today, I think a more reasonable statement would be :
1) fluoridation is the only reasonable option for those children of Davis who do not have ready access to healthy food, good dental hygiene, and
Preventive dentistry. To his credit, Alan Pryor has proposed using the money that would be spent on fluoridation on dental care for these
children. This however ignores the facts that this allocation of funds would likely not pass to begin with, would be unlikely to be sustained, and
does not address the stated lack of enough Communicare dentists to meet the need.
2) The second statement would more accurately read : there is no research that proves fluoride to be toxic with the exception of fluorosis.
Despite 60 + years of population exposure, there are no studies demonstrating human neurotoxicity, carcinogenic potential, or skeletal
fluorosis at the proposed quantity. There is no proof that fluoride serves as an endocrine disruptor of clinical significance.
Yet these myths are still being circulated by the opponents as though they had scientific merit.
I can and do respect the opinions of those who state that they oppose this for ethical or moral reasons while heartily disagreeing with the values that lead them to this conclusion. What I do not respect are the statements of those who choose to use pseudoscience, or selectively quote studies to “prove” their preconceived belief without any consideration of the validity, limitations, or applicability of those studies to our situation.
I thought this side comment interesting in Lofland’s blog referencing the 1960 fluoridation vote: ‘Also about Davis in 1960, in the words of the Enterprise: “Davis vote favors Nixon for president as county goes for Kennedy.”’
Apparently a comment made to take the political temperature of Davis relative to national politics at the time
.
off topic post, should be removed
Actually it’s not, both Professor Lofland and I referenced it in the article in part to show how while the community has shifted politically, this remains a contentious issue.
[quote]…. there is no research that proves fluoride to be toxic with the exception of fluorosis.
Despite 60 + years of population exposure, there are no studies demonstrating human neurotoxicity, carcinogenic potential, or skeletal
fluorosis at the proposed quantity. There is no proof that fluoride serves as an endocrine disruptor of clinical significance. [/quote]
[b]Incredibly, fluoride promoters are saying that the absence of study is the same as the absence of harm.[/b] An aspect of the inadequate scientific approach to fluoridation is how poorly potential health effects have been investigated and how poorly fluoride exposure has been monitored. Fluoride promoters like to state, “If there was any problem, we would have seen it by now. It’s been going on for 60 years.” [i][b][u]This is anecdotal, not scientific evidence.[/u][/b][/i] Ingested fluoride causes dental fluorosis by altering the biochemistry of growing teeth. It is logical that fluoride affects other cells by a similar mechanism. Damage to other tissues may be less visible and less obvious, but possibly far more dangerous. It requires careful study to see other effects. The only way fluoridating countries have been able to deny adverse health effects is by not conducting relevant studies. Fluoridation is a giant experiment, but those conducting the experiment are not even collecting the data. The government does not track potential harm from fluoridation, basic health studies in fluoridated communities are not performed, and there is no effort to monitor exposure. There has been no systematic collection of measurements of fluoride levels in the urine, blood, or bones of people living in communities with fluoridated water. Since 1950, when aggressive fluoride promotion began, no rigorous scientific studies have established safety or effectiveness. What we have instead from state and federal government and local health agencies is out and out promotion of fluoride, which has involved downplaying and ignoring health effects.
There’s a blind trust on the part of fluoride promoters that while drinking fluoridated water can damage growing tooth cells resulting in fluorosis, fluoride couldn’t possibly damage any other tissue in a child’s developing body or cause any damage whatsoever to adults after a lifetime of exposure to uncontrolled doses. Ingested fluoride causes dental fluorosis by altering the biochemistry of growing teeth. But fluoride promoters claim that this is merely [i]cosmetic[/i] and of no consequence. Suggesting that this is merely cosmetic is as irrational as saying that the blue-black line which appears on the gums due to chronic lead poisoning is also of no significance and is merely cosmetic.
There is ample scientific evidence that fluoride is harmful, and it is mind-boggling that fluoride proponents say with a straight face that there is not. Fluoridealert.org has compiled a comprehensive catalog of fluoride research, including detailed summaries and exhaustive references for over 80 aspects of fluoride toxicity. [url]http://www.fluoridealert.org/researchers/health_database/[/url] This is a gold mine of information for anyone interested in the science
[quote]What I do not respect are the statements of those who choose to use pseudoscience, or selectively quote studies to “prove” their preconceived belief without any consideration of the validity, limitations, or applicability of those studies to our situation[/quote]
Medwoman claims that all science that calls into question the toxicity or efficacy of fluoride is “pseudoscience” but that all of the questionable and sometimes outright dishonest and fraudulent studies proving the efficacy of fluoride in reducing cavities is “good science”
Questioning the scientific integrity of those who oppose their view is an old tactic refined to perfection by the proponents of fluoridation over decades. As medwoman so has adequately demonstrated in her opines in the Vanguard on fluoridation, it is much easier to label studies questioning the merits and risks of fluoridation as “pseudoscience” rather than offering up your own proof that fluoridation works and is safe.
Actually, medwoman is being kind compared to Dr. Wilkes characterizations of opponents of fluoridation as “alarmists and suggestion of conspiracy theorists” in his recent editorial to the Vanguard entitled “Health Council’s Support for Fluoridated Water” on May 10.
I think the reason proponents have to resort to such name-calling is because their factual case supporting fluoridation is so flimsy and getting weaker every year. This is apparent when one looks at how the different opposing sides presented their arguments to the WAC. In the case of the fluoridation proponents at the April 25 meeting, they had a slew of public health workers who essentially stand up and say “Trust us, we’re (insert profession here – doctors, dentists, nurses, etc). Don’t’ you think we would know if there is a problem or if it didn’t work by now” without offering up a shred of evidence supporting their case.
In fact, as amply shown by Dr Terri Leonard in her letter to WAC members which was published in the Vanguard on May 20, Dr. Lyman completely misstated that all Europeans “ingest” fluoride orally in water, salt, or milk when he attempted to justify the fact that many European countries have lower rates of decay that in the US. In fact, Dr. Lyman was flat out wrong and the only question was whether he knew it or not. Dr. Leonard clearly and factually demonstrated that many European countries have much lower rates of decay and do not ingest any fluoride in salt, milk, or water, or any other public means of ingestion. Well, I can not accuse Dr. Lyman of using pseudoscience here, though, because he is simple making stuff up with out even any shred of pseudoscientific objectivity.
In contrast, at the May WAC meeting when I presented the case against fluoridation, I referenced many peer-reviewed studies published by the government or dental/public health journals that soundly rebuked the so-called science supporting water fluoridation. Vanguard readers can view my presentation to the WAC in its entirety by going to the City website (www.cityofdavis.org/media) where they can view my PowerPoint to the Mat 23, 2013 WAC meeting. Or they can access all of the materials and all of the sources I used to support my arguments on the Water Advisory Committee’s agenda webpage at http://city-council.cityofdavis.org/Media/CityCouncil/Documents/PDF/CityCouncil/Water-Advisory-Committee/Agendas/20130523/Item-5-Staff-Report-Meeting-Presentation-Outline-and-Items-Submitted-by-Presenters.pdf.
Fortunately, this pattern of name-calling by pro-fluoridationalists to question the integrity and expertise and motivations of the anti-fluoridationalists is now being widely recognized by the American public as evidenced by the recent “No” votes on fluoridation by progressive cities such as Napa, and Albuquerque. Indeed, only last week, the residents of Portland OR crushed a pro-fluoridation measure on their ballot by a 61% No to 39% Yes margin.
What should be done instead – Provide access to dental health care services by low income and disadvantaged people – mostly those of color. This could be easily done by eliminating the stranglehold by dentists on allowing dental hygienists to practice in the community without the dentists taking their cut of the pie. And perhaps more than 4 general practicing dentists in the whole county should accept new Denti-Cal patients instead of foisting them off on CommuniCare because the State of California will not pay them more money. This isn’t pseudoscience…it is just common sense.
It is easy to accept the studies you have come to believe and label the others “pseudoscience” even when those other studies cause most European countries and Japan to not fluoridate water and has the 1500 member US EPA scientists/professionals’ union voting unanimously to oppose water fluoridation despite their management’s decision to allow it. It is easy to make ad hominin arguments (support fluoridation because John Birchers first opposed it; support smoking because Nazi Germany led the first anti-smoking campaign). It’s easy to assume everything “naturally occurring” is safe (arsenic, for example).
It also seems easy to confuse lack of statistical significance with certain lack of effect. When a study finds there is “no significant effect” it means the authors are not at least 95% confident that any results they are seeing is not the luck of the draw in choosing experiment participants or is not the effect of unmeasured causes (like other toxicants). Maybe there is no effect or maybe the sample size is too small to tease out the effect. Maybe odds are in favor of an effect but not 20 to 1 in favor of it. It is notoriously hard to prove the effect of one toxicant in the environment dispersed among many – this is why you have plenty of mesothelioma lawsuits (based on visible asbestos exposure) and few other lung cancer lawsuits.
When individual samples are too small to show effects with 95% confidence, researchers may do meta-analyses, where they essentially combine the study samples into one supersample, after eliminating studies of dubious procedure. A 2012 Harvard meta-analysis did that and found that fluoride-contaminated water was statistically significantly associated with lower IQ. The average effect was size was small but the researchers wrote that with neurotoxins, small average effects tended to indicate a large effect on some populations (those of lowest and highest IQ) averaged with little or no effect on the rest. Their study addressed populations with fluoride at higher levels than the current EPA requirement, which leaves us hope – but not evidence – smaller dosages would be ok for drinkers of average amounts of tap water per pound of body weight.
Countering that hope, a 2011 study excluded from the Harvard meta-analysis because of low doses, found 331 children exposed to varying low levels of fluoride experienced a an average 0.6 point drop in IQ for each increase in 1 mg/L of urine fluoride (with 98.8 percent confidence the effect was real). http://www.ncbi.nlm.nih.gov/pubmed/21237562) To put this magnitude in context, Medical Therapeutics by G. S. Sainini, says “a range of 1.2-10 mg/24h is indicative of endemic fluorosi” so in the range of fluorosis listed, the expected average IQ differential is 15 IQ points.
Meanwhile, a 2012 study shows that children with more fluorosis are needing to produce more Thyroid Stimulating Hormone (TSH) to obtain the same levels of thyroid hormones, which could foreshadow thyroid problems. Thyroid illness is growing in the general population, and fluorisis is endemic and growing in the U.S., so common usage of fluoride does not prove it is safe for the thyroid. (Fluoride can take the place of the thyroid nutrient iodide.)
While true believers keep arguing the science is complete and fluoride is known to be safe, the National Research Council argued differently in 2006. As the working arm of the National Academy of Science, National Academy of Engineering, and Institute of Medicine, it called for further study because “it is apparent that fluorides have the ability to interfere with the functions of the brain” and suggested studying “ neurochemical changes that may be associated with dementia” with attention to chronic and “late-in-life” effects and “individual susceptibility.”
While we await proof or very high statistical likelihood that low dose systemic fluoride is safe and useful, let us spend the fluoridation money on dental care and supplies for populations at need, as Alan Pryor proposed.
Obviously in some places putting fluoride in the water is and has been very controversial. Good evidence of this is the recent vote of Portland citizens, who once again last week overwhelmingly voted down a proposal to fluoridate their water. Thus, regardless of the competing scientific, social, economic, and moral/ethical positions different persons take on the issue, the question should go to a vote of the people and not be decided by five members of the council or an advisory board. This is exactly what happened in Portland and it raised the ire of the voters, who then voted again the proposal. It never hurts to vote in a democracy on issues near and dear to the hearts and minds of the people.
Alan
[quote]Medwoman claims that all science that calls into question the toxicity or efficacy of fluoride is “pseudoscience” but that all of the questionable and sometimes outright dishonest and fraudulent studies proving the efficacy of fluoride in reducing cavities is “good science”
[/quote]
No Alan, I have never claimed that “all science that calls into question the toxicity or efficacy of fluoride is ‘pseudoscience'”. Nor have I ever made the claim that “all of the …..studies proving the efficacy of fluoride in reducing cavities is “good science”, I have claimed that much of what has been cited by the opposition is or is so selectively quoted as to completely alter the claims and reservations of their work as cited by the authors themselves especially with regard to the total disregard of the dosing issue in the Harvard meta analysis.
I do not believe that I have been “kind”, I believe that what I have been is fair.
What is demonstrated is that the only proven human adverse affect is fluorosis. As you have stated yourself here in the Vanguard is that all other adverse effects are at most “associations”. Which when worded differently is speculation about whether ( or not) fluoride might ( or might not) play a role in a given deleterious effect.
All of the other proposals for what fluoride might do are just that, proposals. Some are based on evidence of physical accumulation in the body, such as bone cancer or presence in neurons. The problem is that the presence of fluoride does not equate to the deleterious effect of fluoride as demonstrated in the very elegant study by Kim et al “An Assessment of Bone Fluoride in Osteosarcoma” in which actual tissue taken from bone affected by osteosarcoma and disease free bone from the same individual did not show a difference in the amount of fluoride in the samples.
Further illustrations of the lack of actual scientific evidence for the human toxicity are found in quotes from the opponents themselves and in articles from the Fluoride Action Network. Some examples:
1)” It is notoriously hard to prove the effect of one toxicant in the environment dispersed among many – this is why you have plenty of mesothelioma lawsuits (based on visible asbestos exposure) and few other lung cancer lawsuits.” I agree. So why would one make the assertion that a specific is a known toxicant when this has not been demonstrated ? Some of the opponents are claiming association, others are claiming they “know” what has never been demonstrated.
2) “Meanwhile, a 2012 study shows that children with more fluorosis are needing to produce more Thyroid Stimulating Hormone (TSH) to obtain the same levels of thyroid hormones, which could foreshadow thyroid problems. ” This is a typical comment. Note which [u]could[/u] ( or might not) foreshadow thyroid problems.
This is the hallmark of the opponents scientific evidence. Fluoride might affect this system, or may have a deleterious effect on that system often ignoring evidence to the contrary and other potentially beneficial effects.
For example, no where in the opponents comments about Europeans wisely avoiding fluoridation of the water supply have I seen any recognition that many in many European countries the fluoride patch is available for
prevention of osteoporosis but has not been accepted by the FDA because of efficacy and safety concerns totally going against their claim that the FDA is heedless about the effects of fluoride.
tleonard
[quote]There is ample scientific evidence that fluoride is harmful, and it is mind-boggling that fluoride proponents say with a straight face that there is not. Fluoridealert.org has compiled a comprehensive catalog of fluoride research, including detailed summaries and exhaustive references for over 80 aspects of fluoride toxicity. http://www.fluoridealert.org/r…_database/ This is a gold mine of information for anyone interested in the science[/quote]
I did exactly what you suggested that I do. I read the articles found on this site. What I found is that there is ample suggestion that fluoride might be harmful and precious little evidence that it is. As a matter of fact some of the evidence found on the data base is highly suggestive that water fluoridation at the proposed level is in fact safe or even beneficial.
1) From the much quoted Harvad meta analysis at least 1/2 the studies used 0.7 ppm of fluoride in the water
as their reference range, namely that associated with higher IQs. Is this an argument for fluoridation of our
water ? Of course not, but it is a strong suggestion that doing so would be safe from the point of view of IQ.
2) Another article listed on the FAN site which I found quite interesting was by Bhatnager et al publishing in
Molecular Cell Biochemistry. These authors were seeking a treatment protocol for fluoride toxicosis which
apparently occurs ( or is believed to occur) in areas where there is very high concentrations of fluoride
naturally occurring in the water. Their treatment protocol included the use of antioxidants as is common.
However, more pertinent to the current discussion is that they also recommended the “provision of safe
drinking water” defined by the authors as containing less than 1ppm of fluoride. Dose matters as
demonstrated by these authors who are suggesting that the level of fluoride we are recommending could
be used as part of a treatment regimen for fluoride toxicosis.
It is very important when analyzing the literature to consider all of the points made by authors including validity, confounding factors, applicability to diverse situations and strength of the evidence. Unfortunately, although neither side has a monopoly on ignoring that which does not support their point, it would seem to me that the bulk of the speculation and reliance on association lies on the side of the opposition.
I am well aware that there are differences of opinion on this. I speak only for myself.
medwoman…
You say [quote]I did exactly what you suggested that I do. I read the articles found on this site[/quote]
I seriously doubt your statement. There are hundreds of articles referenced in the fluoridealert.org bibliography [url]http://www.fluoridealert.org/researchers/fan-bibliography/authors01/[/url] I am certain that you have not read all of them. There were 500 new studies added in 2012 alone.
You also stated [quote]As a matter of fact some of the evidence found on the data base is highly suggestive that water fluoridation at the proposed level is in fact safe or even beneficial.
1) From the much quoted Harvad meta analysis at least 1/2 the studies used 0.7 ppm of fluoride in the water
as their reference range, namely that associated with higher IQs. Is this an argument for fluoridation of our
water ? Of course not, but it is a strong suggestion that doing so would be safe from the point of view of IQ. [/quote]
In response, I will quote from the debate you and I already engaged in on the comments section of another Vanguard article [url]http://davisvanguard.org/index.php?option=com_content&view=article&id=7277:would-a-vote-on-fluoridation-accomplish-anything&catid=60:water&Itemid=92&cpage=60[/url]
[quote]You go so far as to say that the Harvard meta-analysis
“supports the lack of demonstrable harm in the groups of children supposedly consuming 0.7 ppm or less daily.”
You ignore the fact that one of the studies showed decreased IQ at a water fluoride level of .88 ppm, 6 of the studies showed decreased IQ at levels of 1-2 ppm, and 10 of the studies showed decreased IQ at fluoride levels of 2-4 ppm. In conventional risk assessment, the U.S. EPA uses a default margin of safety of ten. This means the EPA seeks to limit exposure to chemicals to levels that are ten times less than the levels that cause adverse effects. Margin of safety is a deeply rooted cornerstone in all modern risk assessments, yet you act as if you don’t even know the concept exists. [/quote]
The 2006 National Research Council report was the first U.S. report to look at low-level fluoride toxicity in a balanced way. The report concluded that the maximum contaminant level goal (MCLG) of 4 ppm in drinking water was too high and should be reduced. Since 4 ppm is too high (by an unspecified amount) to be acceptable as a contaminant, it is not sensible to deliberately add fluoride to our drinking water to bring the level of fluoride in our water up to .7 ppm. That implies a margin of safety of less than 5.7 times, and possibly much less, which is absurdly low by toxicological standards. Acceptance of such a small margin of safety indicates a disregard for public health.
Fifty percent of the daily intake of fluoride is absorbed by and accumulates in bone. An important study from China (Li et al.,2001) indicates practically no margin of safety sufficient to protect a whole population with a lifelong consumption of water at 1 ppm from hip fracture.
More information concerning the Portland vote against fluoridation can be found at:
http://d3n8a8pro7vhmx.cloudfront.net/cleanwaterportland/pages/14/attachments/original/1369241854/FOR_IMMEDIATE_RELEASE-Portland_OR_votes_to_reject_water_fluoridation_v9am.pdf?1369241854
To medwoman re:
[quote]All of the other proposals for what fluoride might do are just that, proposals.[/quote]
You are incorrect in saying that fluorosis is the only proven side-effect of fluoridation. Hypersensitivities are well established including the side-effects and reactions occurring in gravid women and in children of all ages including the dermatologic, gastrointestinal and neurological systems. Eczema, atopic dermatitis, urticaria, epigastric distress, emesis, and headache were all observed and disappeared when fluoride exposure was removed.
See Feltmnn, R. and Kosel, G., Prenatal and Postnatal Ingestion of Fluorides — Fourteen Years of Investigation — Final Report, Journal of Dental Medicine, 16:190, October 1961.
Further, the main proposal on which the entire case of fluoridation is based – that being it reduces caries rates – is far from proven and amounts to nothing more than speculation based on the largest meta-studies.
tleonard
[quote]I seriously doubt your statement. There are hundreds of articles referenced in the fluoridealert.org bibliography http://www.fluoridealert.org/r…authors01/ I am certain that you have not read all of them. There were 500 new studies added in 2012 alone.
[/quote]
You are correct. I have not read them all. I have only read those relevant to the positions I was taking. There is much about this topic that I have not read, just as I am sure that you have not read 60 years worth of research in peer reviewed journals either supporting or debunking your claims. I apologize if anyone was misled by my lack of clarity.
Alan
[quote]You are incorrect in saying that fluorosis is the only proven side-effect of fluoridation. Hypersensitivities are well established including the side-effects and reactions occurring in gravid women and in children of all ages including the dermatologic, gastrointestinal and neurological systems. Eczema, atopic dermatitis, urticaria, epigastric distress, emesis, and headache were all observed and disappeared when fluoride exposure was removed.
[/quote]
This is suggestive evidence, but hardly proof. In order to demonstrate conclusively that hypersensitivity is due to a given substance, one needs additional evidence besides the alleviation of the symptom when a substance is removed. One does not know the symptom would not have resolved on its own even in the continued presence of the proposed toxicant. The way to truly make this determination is to re challenge with the same substance to see if the identical symptoms recur. To the best of my knowledge, this has not been done. Are you aware of articles to the contrary ? As always, just because I have not found them does not mean they do not exist and I am open to reading anything you suggest.
Many people falsely attribute rashes and many other symptoms that they encounter in close temporal proximity to antibiotic ingestion to the antibiotic. In the case of a true allergy or hypersensitivity, this same reaction would occur
with repeat ingestion which is frequently not the case.
Also, if fluoride is responsible for hypersensitivity reactions, we should see higher incidences of these reactions stratified by quantity of fluoride in water supplies. I have found no evidence that this is the case. If you have,
please send me the references.
I doubt that the Davis City Council will be looking forward to voting up or down on the fluoride issue in the near future. The pending campaigns between Councilmen Krovoza and Wolk could be revealing on this issue though.
you really think people are going to decide who to vote for in the assembly race based on such a parochial and peripheral issue?
Medwoman, you state
[quote]Also, if fluoride is responsible for hypersensitivity reactions, we should see higher incidences of these reactions stratified by quantity of fluoride in water supplies. I have found no evidence that this is the case. If you have,
please send me the references. [/quote]
Please see my comment above at 11:41 AM. I will repeat it here [quote][u][b]Incredibly, fluoride promoters are saying that the absence of study is the same as the absence of harm. An aspect of the inadequate scientific approach to fluoridation is how poorly potential health effects have been investigated and how poorly fluoride exposure has been monitored.[/b][/u] [u][b]Fluoride promoters like to state, “If there was any problem, we would have seen it by now. It’s been going on for 60 years.”[/b][/u] [u][b]This is anecdotal, not scientific evidence.[/b][/u] Ingested fluoride causes dental fluorosis by altering the biochemistry of growing teeth. It is logical that fluoride affects other cells by a similar mechanism. Damage to other tissues may be less visible and less obvious, but possibly far more dangerous. [u][b]It requires careful study to see other effects. The only way fluoridating countries have been able to deny adverse health effects is by not conducting relevant studies. Fluoridation is a giant experiment, but those conducting the experiment are not even collecting the data. The government does not track potential harm from fluoridation, basic health studies in fluoridated communities are not performed, and there is no effort to monitor exposure. There has been no systematic collection of measurements of fluoride levels in the urine, blood, or bones of people living in communities with fluoridated water. Since 1950, when aggressive fluoride promotion began, no rigorous scientific studies have established safety or effectiveness. What we have instead from state and federal government and local health agencies is out and out promotion of fluoride, which has involved downplaying and ignoring health effects.[/b][/u]
To medwoman re:
[quote]This is suggestive evidence, but hardly proof. In order to demonstrate conclusively that hypersensitivity is due to a given substance, one needs additional evidence besides the alleviation of the symptom when a substance is removed. One does not know the symptom would not have resolved on its own even in the continued presence of the proposed toxicant. The way to truly make this determination is to re challenge with the same substance to see if the identical symptoms recur.[/quote]
This is exactly what the study showed. All of the symptoms occurred with the use of fluoride and disappeared upon the use of placebo tablets, only to recur when the fluoride tablet was, unknowingly to the patient, given again.
This sounds like exactly what you are looking for to demonstrate proof.
Sorry Alan, I will go back and look at the study. I obviously misunderstood.
tleonard
[quote]Incredibly, fluoride promoters are saying that the absence of study is the same as the absence of harm. [/quote]
I certainly am not making this claim. Again, I speak only for myself.
Absence of study does not equate to absence of harm. And suggestion of potential harm likewise is not the same as proof of harm. Many of the opponents have stood up and stated unequivocally that fluoride is a neurotoxin.
This is simply not substantiated at the levels proposed within the measurement error of the item being studied as
Dr. Canning pointed out in his statistical analysis as presented before the WAC.
Lack of evidence of harm however is at least as suggestive of safety as is the suggestion of potential harm without
substantiating evidence. We can disagree on this, but many of the articles cited on your link either pose only the suggestion of potential harm, or have limitations many of which make them irrelevant to our situation.
Alan
I read the abstract of the Feltmann article and was unfortunately only able to access the abstract. When evaluating any article in which I have more than passing interest, I do not rely on a summary or abstract but want to see the methodology used and the authors statements of limitations of their own study, none of which was available to me.
As is pointed out the misuse of the Harvard meta analysis, it is very important to read the entire article, evaluate the methodology and carefully consider the authors own assessment of its limitations prior to making sweeping statements based only on their conclusion, a synopsis, or abstract.
While it may be that review of the entire article would resolve these issues for me, I have several concerns based on the abstract only.
1) The dosage amounts were higher than those one would encounter at our proposed level of fluoridation.
2) The abstract does not specify what if any covariates were controlled for.
3) The abstract does not make clear which specific symptoms each subject encountered and whether or not those
were the exact same symptoms that each subject experienced on repeat exposure. When so many adverse
consequences are being attributed to a substance, it is critical to ensure that it is exactly the same symptom
complex. I have had women in my clinic erroneously believe that they were allergic to a drug because they
believe it was related to a rash at one point, and nausea and vomiting at another point in time. This does not
support any kind of allergic or hypersensitivity reaction.
4) The abstract does not make any statement about timing of onset of symptoms after initial exposure nor about
duration of symptoms from discontinuance to resolution.
This is a common confounding factor in determining whether or not a substance is related to any given adverse
effect. Many people will erroneously attribute symptoms to a substance when the time line does not support that
conclusion. Unfortunately, once documented, either in a chart or study protocol, it tends to become accepted
as truth even if the substantiation is not there.
I have no interest in purchasing the article myself, but if you have the full article, I would appreciate you providing me with a copy. I would then be happy to tell you if it does meet the standard I would set for “proof”.
Medwoman,you oppose a precautionary principle, many of us support it. My view: before you add a chemical to the water supply you must demonstrate with a very high degree of probability that it is safe for the various population groups and the environment. Your view, I infer: before you forbid adding a chemical to the water supply you must “prove” it is unsafe.
Responding to your earlier comment: the fact that I carefully use words like “could” harm the thyroid does not mean thyroid harm can be dismissed without further study. Low-dose fluoride was used as medication for overactive thyroid in Europe and South America before better drugs came along. And unbalanced TSH levels at a young age are worrisome.
Offer each family dental care plus topical fluoride (toothpaste, mouthwash, dental applications) with instruction to rinse well. You may offer them oral fluoride (pills or salt) to choose or not based on their own preferences of risks vs. benefits given their own situations. People without good dental hygiene habits might favor the swallowed fluoride – if they are convinced oral fluoride helps, a decision I won’t make for them.
But a diabetic might choose no fluoride, for example, since as the National Research Council wrote in 2006, “The conclusion from the available studies is that sufficient fluoride exposure appears to bring about increases in blood glucose or impaired glucose tolerance in some individuals and to increase the severity of some types of diabetes … [at] serum or plasma fluoride concentrations of about 0.1 mg/L or greater… In addition, diabetic individuals will often have higher than normal water intake.”
medwoman…
[quote]Lack of evidence of harm however is at least as suggestive of safety as is the suggestion of potential harm without
substantiating evidence. We can disagree on this, but many of the articles cited on your link either pose only the suggestion of potential harm, or have limitations many of which make them irrelevant to our situation. [/quote]
I doubt that you have even begun to scratch the surface in your analysis of the hundreds of studies at [url]http://www.fluoridealert.org/researchers/health_database/[/url] and [url]http://www.fluoridealert.org/researchers/fan-bibliography/[/url]. There is indeed ample evidence of harm from fluoride. And no, the hundreds of citations at fluoridealert.org are not “irrelevant to our situation.”
The precautionary principle posits the notion that when there is reasonable doubt about safety, we should err on the side of caution, and not insist on absolute evidence of harm before eliminating or rejecting a substance or practice. If there is uncertainty, yet credible scientific evidence or concern of threats to health, precautionary measures should be taken . In other words, preventive action should be taken on early warnings, even though the nature and magnitude of the risk are not fully understood.
The precautionary principle puts fluoride promoters in a very awkward position, and causes them to make extreme statements that are difficult or impossible to defend. An example of this would be the statement you made regarding the Harvard meta-analysis that investigated the relationship between fluoride and IQ. The Harvard scientists who authored the peer-reviewed, published study stated [url]http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3491930/[/url] “Although the studies were generally of insufficient quality, the consistency of their findings adds support to existing evidence of fluoride-associated cognitive deficits, and suggests that potential developmental neurotoxicity of fluoride should be a high research priority.” And, “In conclusion, our results support the possibility of adverse effects of fluoride exposures on children’s neurodevelopment.” You stated [url]http://davisvanguard.org/index.php?option=com_content&view=article&id=7277:would-a-vote-on-fluoridation-accomplish-anything&catid=60:water&Itemid=92&cpage=60[/url] (emphasis mine)[quote]However, this meta analysis using poor quality studies [u][b]does nothing what so ever to suggest any harm[/b][/u]… [/quote] I took great exception to your statement that it does “nothing what so ever to suggest any harm.” However, fluoride promoters have to make such extreme statements, because to admit that any study does indeed suggest [i][u]any harm whatsoever[/u][/i] is to invite the demise of water fluoridation programs, since such programs are indefensible when there is [u][b]any[/b][/u] evidence of harm.
This is the reason that pro-fluoridation presenters made such extreme statements at the April Water Advisory Committee meeting. They expressed no reservations about the safety and effectiveness of water fluoridation; they issued no caveats and suggested no doubts. They said that there are absolutely no dangers and that there is [u][b]no debate[/b][/u] on the matter. Such extreme statements are important when fluoridation is being aggressively promoted. Promotion does not sit well with uncertainty. Neither does the precautionary principle.
There is ample scientific evidence of harm, and water fluoridation programs should be halted in accordance with the precautionary principle.
medwoman….
Here you go again, in your analysis of the Feltmann article.
[quote]1) The dosage amounts were higher than those one would encounter at our proposed level of fluoridation. [/quote]
Yet again, you make these statements that completely ignore the concept of “margin of safety.” I will say it to you again: [u][b]Margin of safety is a deeply rooted cornerstone in all modern risk assessments, yet you act as if you don’t even know the concept exists. [/b][/u]
It is not sensible to deliberately add fluoride to our drinking water to bring the level of fluoride in our water up to .7 ppm. That implies a margin of safety which is absurdly low by toxicological standards. Acceptance of such a small margin of safety indicates a cavalier disregard for public health.
Ms. Kandel notes that meta-analyses are often used to aggregate studies so that effect sizes can be pooled and possibly indicate a truer effect size. Unfortunately, when you have poor studies to begin with, no amount of meta-analyzing can make an effect appear out of thin air (or water, in this case). The study cited (usually called the Harvard study because the first author is from there) is a poor example of meta-analysis. The authors themselves admit right up front in the discussion that the studies they aggregated were of uneven and even poor quality. They make matters worse by suggesting that their results may be within the margin of error of the IQ tests used. These limitations doom any broad generalizations that can be made from this one study. And there have not been anymore attempts like this one. One could suppose that is because there is nothing there to measure. Opponents of fluoridation have used this weak evidence to suggest that there is an affect of fluoridation on IQ. The evidence simply does not stand. Reliance on one study (even though it aggregates 20+ others) does not prove the point. If it had been done here in the U.S. and compared non-fluoridated with fluoridated populations, that would be a different story.
Adrienne
[quote]Medwoman,you oppose a precautionary principle, many of us support it. [/quote]
I do not oppose a precautionary principle. Where we differ is that I believe that there is ample evidence of safety of fluoride at the proposed level and you apparently do not.
I am not opposed to more research. As a matter of fact, I strongly support more research regarding all of the potential benefits and risks associated with fluoride. I also am aware that there are limitations on the amount of dollars available for research and therefore feel that those precious research dollars should be spent where they will have the greatest impact. Therefore it makes a great deal of sense to me for countries such as China and Iran with their very high naturally occurring levels of fluoride in the water to spend money on this kind of research. As Choi
et al have pointed out, it makes little sense to do these kinds of studies in countries where the level rarely exceeds 1 ppm. Likewise, I consider that the bone fluoride studies comparing fluoride levels in bone with osteosarcoma with bone free of osteosarcoma done by Chin et al to provide enough reassurance that this does not need to be revisited. As I stated at the WAC, there is no substantive evidence that fluoride at the proposed level is a fetal neurotoxin. I have asked Alan for primary sources as regards hypersensitivity and so far have only a single abstract.
I have not reviewed the primary, peer reviewed literature with regard to endocrine function and thus have not chosen to speak to this issue. I have only consulted with my Internal Medicine colleagues three of whom did not feel there was evidence of concern, however, they are not endocrinologists. My intent is to consult with my endocrine specialist colleagues. If you are aware of any such articles, you could save me a lot of time by sending me the references.
rdcanning…
[quote]And there have not been anymore attempts like this one. One could suppose that is because there is nothing there to measure. [/quote]
Oh come on. Four more studies found an association between fluoride and reduced IQ in 2012 [url]http://www.fluoridealert.org/studies/brain01/[/url]
From fluoridealert.org [url]http://www.fluoridealert.org/issues/health/brain/[/url]
[quote]Fluoride’s ability to damage the brain is one of the most active areas of fluoride research today. In the past three decades, over 100 studies have found that fluoride exposure can damage the brain. This research includes:
Over 40 animal studies showing that prolonged exposure to varying levels of fluoride can damage the brain, particularly when coupled with an iodine deficiency, or aluminum excess;
37 human studies linking moderately high fluoride exposures with reduced intelligence;
19 animal studies reporting that mice or rats ingesting fluoride have an impaired capacity to learn and remember;
12 studies (7 human, 5 animal) linking fluoride with neurobehavioral deficits (e.g., impaired visual-spatial organization);
3 human studies linking fluoride exposure with impaired fetal brain development.
[/quote]
tleonard
[quote]They expressed no reservations about the safety and effectiveness of water fluoridation; they issued no caveats and suggested no doubts. They said that there are absolutely no dangers and that there is no debate on the matter[/quote]
This is simply not a true statement. Perhaps you were not there at the presentation of the proponents of fluoridation when I made my first 3 minute statement. At the start of the current debate, I made very clear that I had started out neutral on this subject. I explicitly stated that I felt that a fair hearing of all concerns was important and should be addressed. I have read with a great deal of care those articles that the opponents have specifically suggested to me as well as a large number of articles from peer reviewed journals not suggested to me by either side. Both of my presentations have addressed doubts and why I do not think that the one’s I addressed were of concern. I have also been careful to state why, when I do not feel there is a lingering concern about an issue that has been raised. Perhaps you were not hearing the repeated comment that there is universal agreement that
excess amounts of fluoride are associated with fluorosis.
It is true that I have not addressed every point that you have raised, just as you have not addressed all that I have raised, or even at any point conceded that any of my points might have some validity. Perhaps you, like I, do not see a need to address every point and choose to remain within the limits of our own knowledge. I thoroughly respect that position and will not make a statement if I can not substantiate it myself or with a credible consultant who I consider an expert in the field.
Medwoman….
I said [quote]This is the reason that pro-fluoridation presenters made such extreme statements at the April Water Advisory Committee meeting. They expressed no reservations about the safety and effectiveness of water fluoridation; they issued no caveats and suggested no doubts. They said that there are absolutely no dangers and that there is no debate on the matter. [/quote]
My statement is absolutely true. Your statement can be viewed here [url]http://archive.cityofdavis.org/media/[/url]. Your statement starts at 57 minutes 42 seconds. Note that you were not one of the pro-fluoride presenters. You were simply one of the public commenters. I was specifically talking about the pro-fluoride [u][b]presenters[/b][/u].
You are correct that presenters mentioned fluorosis. But perhaps you were not hearing that presenters who mentioned fluorosis also were exceedingly adament that fluorosis is only a [u][b]cosmetic[/b][/u] concern. They were wrong. Fluorosis is an indication of a systemic adverse effect on the body. It is the result of fluoride’s interference with growing tooth cells. What other developing tissues may have been affected while the tooth cells were being damaged? Of particular concern are the skeletal system, the brain, and the endocrine system, where damage could be happening without visible telltale signs. Fluoride promoters offer no evidence that other tissues have not been affected while dental fluorosis is occurring.
references, per medwoman’s request:
National Research Council. Fluoride in Drinking Water: A Scientific Review of EPA’s Standards, Chapter 7. 2006. They address the pineal gland and glucose tolerance.
Hosur (2012): Dental Fluorosis & Thyroid Hormones. http://www.ncbi.nlm.nih.gov/pubmed/22509122/ The good news here is all subjects but one had acceptable levels of all hormones. The concern warranting further study, as visible in their graph, is that TSH levels were positively associated with fluorosis, with 95.5 percent confidence. I would like to see a follow up study with varied and recorded lengths of time of exposure to fluoridated water to see if people with a lifetime of exposure get more thyroid illness as they age.
Dose-response IQ study: http://www.ncbi.nlm.nih.gov/pubmed/21237562
Adrienne
Thank you for the references. I appreciate your addressing the issue in an evidence based manner.
I do have some comments about the articles you have cited.
First with regard to the Hosur article.
There are a number of issues here that do not make the article either of major concern, nor a source of major reassurance. First the number of subjects is very small. There is no statement of potential confounders, either genetic, familial or environmental. We do not know whether or not these individuals were taking any other medications or substances that could affect endocrine function, nor are we apprised of any other medical conditions that they may have had. There is no statistical analysis provided. There is no statement supporting that there is any clinical significance between the measured levels of any of the three hormones. There is no statement of the authors assessment of the limitations of their study. I agree that there is room for further study.
With regard to the dose -response IQ study, I would need the help of my consultant psychologist to arrive at any realistic appraisal of this article. However, my initial concerns are much the same as those I have stated that I feel apply to any abstract when presented alone. It does not allow for a critical review of the methodology which is very important in deciding the validity of the study.
Dr. Leonard: Here are some of my observations about the FAN page on Neurobehavioral Effects
Human Studies:
[b]Yazdi[/b]: no mention of amount of fluoride dose or exposure. No confounders (education, other toxins, etc.) mentioned. Are they matched?
[b]Rocha-Amador et al. (2009) [/b]No breakdown by exposure – could be to any of several chemical; didn’t use norms for the ROCF. This is a norm-based test. Simple group differences without controls means little.
[b]NRC (2006) [/b]report specifically noted that its findings apply only to 204mg/l levels of fluoride and NOT to that typically found in drinking water –
rdcanning continued:
Li et al (2004) No mention in extract of other factors that could have accounted for the effect.
Guo et al. (2001) Methods not discussed, no confounders listed. What was controlled for? Were the groups matched? How much exposure?
Calderon (2000) “IQ scores were not influenced by fluoride exposure.”
Calvert et al. (1990) Was it the sulfur in the sulfuryl fluoride or the fluoride? Is the chemical compound the toxin rather than it’s component parts?
[b]Anger (1986)[/b] Inconclusive.
[b]Rotton et al. (1983)[/b] Not really about effects of fluoride in drinking water..
[b]Letter Col. Warren (1944)[/b] It’s the readioactivity, not the fluoride that causes problems.
Here are some of my comments about the FAN Fluoride and Intelligence: The 37 Studies page:
[b]Chen YX et al. (1991)[/b] The problem here is that 4 points of IQ is not clinically significant. Even though the authors found a significant difference between the groups, it may very well be within the standard error of the test – which is typically about 3-4 points. So there was probably no differences between the groups.
[b]Guo et al (1991)[/b] Again IQ differences of less than five points are probably meaningless. Was there a Chi Square test of the different groups that they cite (IQ
rdcanning, part 3:
The vast majority of these studies are what McDonough would have called Grade C or less. Even when aggregated, the poor controls, various forms of exposure, lack of control for exposure, and no apparent matching render, in my opinion, them of little use overall.
Given the poor quality of the research from China, the cultural differences, and the overall poor controls in both sets of results, I’m surprised you have such confidence that they show solid evidence for neurobehavioral and IQ effects.
You mention in one of your earlier posts that this is a grand experiment, yet the experimenters are not collecting the data. Then how can it be an experiment? The lack of evidence for the ill effects may very well suggest that there is no ill effect of fluoride in drinking water at the levels delivered in municipal water supplies. You seem to imply that there is an active effort to suppress research on this topic. Can you show me where this has been suggested? You suggest that because dental fluorosis occurs that “it is logical that fluoride affects other cells by a similar mechanism.” But this does not follow because how fluoride interacts with other cellular or organ systems may be quite different.
“Damage to other tissues may be less visible and less obvious, but possibly more dangerous.” Or possibly less dangerous. Your outcome does not follow from your premise. Simply because an effect is less visible, it does not follow that it is more dangerous.
You claim that there is “ample” scientific evidence that fluoride is harmful. Simply stating that there are 80 or 20 or 30 studies on the FAN site does not evidence make. FAN is a site devoted to the anti-fluoride position. It’s not a site one would go to if they wanted a balanced review of the arguments pro and con for fluoridation of water.
You’ve made false statements in your literature that went to the WAC. The multi-million dollar study you cited did not make the claims you said it did. As I noted in my comments to the WAC on Thursday, that study made no formal between-group comparisons and had no statistical tests. How can you make such a statement in good faith. You claim to rely on science yet you distort the intent and findings of a study in a public forum.
The notion that the meta-analysis is confirmatory evidence for IQ differences is not supported by the discussion in the article. How can a study which admits its findings may be within the margin of error purport to support its hypotheses? Again, you and the anti-fluoride proponents use a study that is weak at best, and invalid at worst.
Science demands skepticism. And the anti-fluoride folks have none. The scientific evidence, as I read it on FAN and in the literature presented to the WAC, is thin, poorly supported by replication, and not generalizable to the people who matter the most – the people in Davis who ought to have access to a proven and safe.
To be honest, both sides in this dispute are prone to confirmation bias. We all seek out information and interpret that information as supporting our side. It’s hard not to see that at work. I came in believing that fluoride was a good public health tool. I’ve read many articles, reports, and studies since this all started. I am still in favor of fluoridation of domestic drinking water. My hunch is that you came in believing in the dangers of fluoride, and will remain so long after the furor in Davis has died down. Too bad we couldn’t have a civil and rational debate.
Davis Progressive05/27/13 – 02:06 PM… “you really think people are going to decide who to vote for in the assembly race based on such a parochial and peripheral issue?”
The SWP, Measure I, fluoridation, and other Project related issues are not “parochial and peripheral.”
Medwoman: Please post the citations for the trials that prove the efficacy of water fluoridation for prevention of dental caries at the proposed usage levels. I anticipate that you have several double blind trials with dose response curves and complete control of confounding factors such as regular dental care and fluoride containing toothpaste. Thank you.
rdcanning…
Well, I guess I will begin with this little gem:
[quote]You’ve made false statements in your literature that went to the WAC. The multi-million dollar study you cited did not make the claims you said it did. As I noted in my comments to the WAC on Thursday, that study made no formal between-group comparisons and had no statistical tests. How can you make such a statement in good faith. You claim to rely on science yet you distort the intent and findings of a study in a public forum. [/quote]
Nice try to discredit me. As you are well aware, I sent a very lengthy 10 page email to WAC members and to city council members before the April 23 WAC meeting, in which I discussed my opposition to fluoridation of Davis’s water. I stated [quote]Given that forced ingestion of a medication is unethical, I wish that I could end this email here, since the unethical nature of water fluoridation should be enough reason to oppose water fluoridation in Davis. However, there are so many additional reasons to oppose water fluoridation that I feel compelled to enumerate them. Unfortunately, it is an overwhelming task to exhaustively elucidate in an email the vast amount of evidence regarding the dangers of water fluoridation. Therefore, I would ask that you please take a look at 50 Reasons to Oppose Fluoridation at the Fluoride Action Network website [url]http://www.fluoridealert.org/articles/50-reasons/[/url]. The article is well referenced, with citations to the scientific and medical literature which support the very compelling reasons for opposing fluoridation. I want to highlight some of the reasons to oppose fluoridation which are excellently summarized in the article. You can go to the article to view citations for all of the studies that I mention. [/quote]
Although I only sent my email to WAC members, city council members, and two city staff members, and my email did not appear in the staff report for the April 25 WAC meeting, I received an email from you. I had no idea who you were. Your email stated the following:
“I recently received a copy of the letter that you sent to the Davis City Council and the Water Advisory Committee opposing fluoridation of municipal drinking water in Davis.
Can you provide me the citation for the NIH-funded study that found no “no significant relationship between tooth decay and fluoride intake among children”?
Also can you send me the references for the “three human studies have reported an association between fluoride exposure and impaired visual-spatial organization, while four other studies have found an association between prenatal fluoride exposure and fetal brain damage”?”
Robert, I am curious as to who forwarded my email to you, and why he or she did so. Can you please answer this for me?
Despite wondering who you were, I emailed you the citations you requested, even though you could have found them yourself by reading the article [i]50 Reasons to Oppose Fluoridation[/i] as I requested of the people to whom I sent my email.
Anyway, you know full well that my email was a summary of the [i]50 Reasons to Oppose Fluoridation[/i] article, and your statement “How can you make such a statement in good faith. You claim to rely on science yet you distort the intent and findings of a study in a public forum,” is total nonsense. The two sentences from my 10 page email that appear to have you up in arms are “A multi-million dollar, U.S. National Institutes of Health (NIH)-funded study found no significant relationship between tooth decay and fluoride intake among children. This was the first study ever conducted to examine tooth decay as a function of individual exposure (as opposed to mere residence in a fluoridated community).” Those two sentences are all I said about this study in my 10 page email, and those two sentences were the conclusion of Paul Connett, PhD, the author of the [i]50 Reasons to Oppose Fluoridation[/i] article. If you have issues with these two sentences, then I suggest that you email Dr. Connett and express your concerns to him.
Anyone who would like an in-depth analysis of this study should go here [url]http://www.fluoridealert.org/studies/ifs/[/url].
rdcanning….
[quote]You claim that there is “ample” scientific evidence that fluoride is harmful. Simply stating that there are 80 or 20 or 30 studies on the FAN site does not evidence make.[/quote]
Nope, I didn’t say that there are 80 or 20 or 30 studies on the FAN site. I said that there are [u][b]hundreds[/b][/u] of studies, 500 of which were added in 2012 alone.
It’s amusing to watch you attempt to discredit every single study that you read that shows any harmful effect of fluoride. To keep yourself busy, I suggest that you read the hundreds of studies on the fluoridealert.org website and get back to us regarding all of your comments.
Dr, Leonard, I received a copy of the letter from a local physician who received a copy from a member of the Yolo Health Council who is also on the WAC. Although you mention Paul Connett in this current post, you did not attribute your conclusions to him but simply made what I consider an overly broad and false statement about the study’s conclusions.
Mark West – Here is a good place to start on studies showing a positive effect for fluoridated water on dental caries:
Slade, GD, Sanders, AE, Do, L, Roberts-Thomson, K, & Spencer, AJ. (2013) Effects of fluoridated drinking water on dental caries in Australian adults. [i]Journal of Dental Research, 92[/i]. 376-382.
You will not find the kind of study you desire. Double-blind studies of that kind have never been completed. And for good reason – one cannot randomize fluoridation. That does not mean there is not a positive effect for fluoridation. Withholding efficacious treatments for purpose of randomization is not considered ethical research. That’s why most of the research in this area is population-based epidemiological studies – case-control studies such as the one cited above.
Mark West
[quote]Medwoman: Please post the citations for the trials that prove the efficacy of water fluoridation for prevention of dental caries at the proposed usage levels. I anticipate that you have several double blind trials with dose response curves and complete control of confounding factors such as regular dental care and fluoride containing toothpaste. Thank you.[/quote]
I truly wish that I had such studies to give you. Large scale, randomized, double blind trials would indeed represent the gold standard, and to the best of my knowledge do not exist. As far as I can tell, there has been no claim from the proponents that such studies exist.
That does not mean that there is no value in assessing the relative strengths and weaknesses of studies that are in existence. As I stated during my initial comments to the WAC at the proponents presentation, I think it is in the best interest of everyone concerned to do a thorough evaluation of both the risks and benefits of fluoridation as currently found. My evaluation has led me to favor fluoridation. Others disagree and have had the opportunity to present what they consider their best information. I respect this process and since I wrote a piece on fluoride for the Vanguard, feel that I have an obligation to honestly assess, within the scope of my knowledge, the issues people bring to me. On those topics that I have no ability to assess, or no expertise, or frankly not enough interest to do the research, I have remained silent or deferred the response to someone else. If you have other constructive comments on how I might better approach this issue, I would be happy to hear them.
tleonard
[quote]Nope, I didn’t say that there are 80 or 20 or 30 studies on the FAN site. I said that there are hundreds of studies, 500 of which were added in 2012 alone. [/quote]
The volume of studies is not the only point. Quality of studies matters more. This is one of the major deficits facing both sides as Mark West point out in his request for double blinded studies on efficacy. Some on both sides of this issue have chosen to make their presentations as though they have absolute fact and absolute certainty on their side. Others on both sides have taken a more nuanced approach. It is the latter than I personally find most valuable. All studies have strengths and weaknesses and it is only in the evaluation of all that a true picture of the value of a study can be assessed. I believe it is the responsibility of both sides to present their best case, including what they see as the weaknesses in materials presented.
Here is a recent article published in the Portland Tribune: http://portlandtribune.com/pt/9-news/152986-portland-voters-reject-water-fluoridation
Measure 26-151 to fluoridate the water supply of the City of Portland lost by a resounding 3-2 margin, the fourth time in five tries that Portland voters have turned down the idea of fluoridating the city’s water supply.
“At a very fundamental level, people understand that we don’t want more chemicals in our water,” said Kim Kaminsky, leader of Clean Water Portland, at a campaign party for fluoride opponents at the On Deck sports bar.
The nonprofit Upstream Public Health brought the idea of fluoridating Portland’s water to city councilors last year, quietly building majority support on the council before the public really caught wind the fluoride issue was back on track in Portland.
The council unanimously approved fluoridating Portland’s water last September, but the stealth campaign by supporters may have backfired.
Fluoridation opponents, with little money or professional political help, quickly gathered enough signatures to force a public referendum on Tuesday. “In 30 days, we put together an operation to gather 43,000 signatures,” said Rick North, a member of Clean Water Portland’s steering committee.
Portland is the last major city in the U.S. without fluoridated water, and, now that voters have spoken, will remain
As a daily user and consumer of Davis tap water I will pay [b][i]extremely close attention [/i][/b]to how our elected leaders act on this matter.
Sonoma County is going through the water fluoridation issue right now.
[quote]Based on preliminary estimates, the project could cost up to $8.5 million in capital upgrades to the county’s central water system, plus ongoing upkeep starting at $973,000 a year, according to a county report.[/quote]
[url]http://www.pressdemocrat.com/article/20130226/ARTICLES/130229619[/url]
I cannot believe Davis and Woodland are thinking about taking something on like this.
What if instead of water fluoridation we budgeted money to hand out free fluoride toothpaste and mouthwash to kids who qualify for subsidized meals at their schools, and used the rest of that money to hire back some teachers and reduce class sizes.
With all due respect Ernesto, your proposal would not come close to the impact and positive affect of fluoridating the water. You are talking about behavior and attitude change which is some of the hardest kind of changes to make. Simply handing out fluoride toothpaste and mouthwash will probably not bring down the rates of caries. Do you have data that suggests that a program like this would work? Can you cite literature in which rates of dental caries came down in the affected population?
medwoman, any comments on why the National Kidney Foundation withdrew its support for water fluoridation in 2008?
[quote]
NEW YORK, June 9 /PRNewswire-USNewswire/ — The National Kidney Foundation
withdrew its support of water fluoridation citing the 2006 National Research
Council (NRC) report indicating that kidney patients are more susceptible to
fluoride’s bone and teeth-damaging effects.
The kidney-impaired retain more fluoride and risk skeletal fluorosis (an
arthritic-type bone disease), fractures and severe enamel fluorosis, which may
increase the risk of dental decay, reports the NRC.
Fluoride is added to US water supplies ostensibly to reduce tooth decay.
Fluoride is also in foods, beverages, drugs and dental products.
The National Kidney Foundation’s (NKF) former fluoridation position statement
also carried surprising cautions. The NKF advised monitoring children’s
fluoride intake along with patients with chronic kidney impairment, those with
excessive fluoride intake, and those with prolonged disease. But NKF now
admits, “exposure from food and beverages is difficult to monitor, since FDA
food labels do not quantify fluoride content.” [/quote]
[url]http://www.reuters.com/article/2008/06/09/idUS123736+09-Jun-2008+PRN20080609[/url]
As wonderful as it would be to reduce dental disease, it is not fair or proper to do it at the expense of the health of substantial numbers of other people.
Ernesto
[quote]medwoman, any comments on why the National Kidney Foundation withdrew its support for water fluoridation in 2008?
[/quote]
Fair question. I do not know why they made this decision. I am happy to do the research to see if there are any strong arguments that were made. I will also be happy to consult with a nephrologist to get their opinion on this decision. In order to save me some time, are you aware of any of the primary studies that they used in making their decision ? If so, would you be able to send me some of these as it is quite time intensive to do the research in fields outside my area of expertise ?
Ernesto
I am not familiar with the National Kidney Foundation and a quick Google search did not get me to any evidence based information. Could you possibly have meant the National Kidney Association? What I did find, I have put in quotes below. I do not think this is what you intended but does illustrate the inadequacy of relying on what various associations, foundations, organizations…etc. have to say about a topic unless they include their reference sources for how they have arrived at their conclusions.[quote]National Kidney Foundation
On its newly revised Fluoride Web page, NKF notes, “The benefits of water and dental products containing fluoride is the prevention of tooth decay and dental cavities in people of all ages.” In discussing potential health risks NKF states, “The risk is likely greatest in areas with naturally high water fluoride levels.” Due to the limited available research on the topic, NKF has not issued specific recommendations regarding fluoride intake and kidney disease and currently has no official position on the optimal fluoridation of water. NKF recommends that “Dietary advice for patients with CKD should primarily focus on established recommendations for sodium, potassium, calcium, phosphorus, energy/calorie, protein, fat, and carbohydrate intake. Fluoride intake is a secondary concern.”
National Kidney Foundation – Fluoride
Kidney Health Australia
In a position statement issued in March 2007, Kidney Health Australia concluded 1) there is no evidence that consumption of optimally fluoridated drinking water increases the risk of developing CKD, although only limited studies addressing this issue are available; and 2) there is no evidence that the consumption of optimally fluoridated drinking water poses any risks for people with CKD, although only limited studies addressing this issue are available.
[/quote]
These are very generalized statements regarding a lack of position taking and position taking which would seem supportive of fluoridation without any studies of any type cited to support their position. As such they are simply not helpful, nor would a position statement without citation of the reason for the position against fluoridation be meaningful. Again, I will attempt to find actual studies either in support of, neutral to or against fluoridation as regards kidney disease.
Ernesto
[quote]NKF’s fluoridation support was dropped when a lawyer, an academic dentist and
public health professional, Daniel Stockin, alerted it to NRC’s findings.
“An easy way to reduce the uncontrolled flow of fluoride into our bodies is to
stop water fluoridation,” says attorney Paul Beeber, President, New York State
Coalition Opposed to Fluoridation. “But it takes political will to reject
fluoridation.”[/quote]
Still seeking more information when I ran across this from an article from Reuters which might lend some insight into why the NKF withdrew its support. When you have a lawyer, named as President of the New York State Coalition Opposed to Fluoridation, it is at least suggestive that part of the reason may have been political as opposed to strictly scientific. While I respect the right of individuals to oppose fluoridation for any reason they like be it political, medical, social or economic, my personal interest is in preventive medicine and public health. This is where I choose to concentrate my efforts, and where I hope our public health decision makers will focus their attention. I will continue to look into what the science actual supports and will respond when I have something substantive to say.
medwoman, you have a lot of time to devote to this issue. Are you being paid, either as a consultant, or as part of a salaried job (i.e. during work hours, on a work computer), to post here?
medwoman, you have a lot of time to devote to this issue. Are you being paid, either as a consultant, or as part of a salaried job (i.e. during work hours, on a work computer), to post here?
Ernesto, why would you be concerned about the amount of time that medwoman spends commenting on this?
Ernesto
I think that this is a fair question. The answer is no. My sole source of income is as a gynecologist with a large multispecialty group practice and a rental property. My children are grown and no longer in need of much of my time.
A major focus of my career, in addition to providing individual patient care, has been on preventative health care especially as it relates to public health. As stated previously, fluoride was a relatively new topic for me, and I started out with no opinion on water fluoridation. As a new member of the Health Council, I took it upon myself to research the topic and the more I read, the more I have become convinced that given the specifics of our situation here, the amount of fluoride proposed for our water supply, the way our society has chosen to distribute health care, the unequal distribution of both dental caries and access to dental care in our community, that the benefits of water fluoridation out weigh the actual risk of fluorosis and the other potential but as of yet unsubstantiated risks.
Another reason that I have spent so much time in addressing concerns is that on a previous thread ( not related to fluoride) one commenter had mentioned that the author of the article did not take the time to address questions that were made in comments. This resonated with me. Since I chose to write a brief article on fluoride which appeared in the Vanguard, I decided that I would respond to as many of the questions and issues raised as possible.
Finally, Alan Pryor had made the statement that the proponents of fluoride were attempting to suppress debate and stifle concerns about the risks of fluoridation. As I stated at the WAC, I believe strongly that public health decisions should be evidence based, not driven by political preferences or ideology, and that all concerns should be addressed. Since evaluation of medical evidence is part of my job and since I have ready access to many original articles and sub specialists I felt that it would be logical for me to address not only concerns that arose from my article, but also any health concern that is brought forth regarding fluoride. Because this is quite time intensive, I have focused my efforts initially upon my area of expertise, and have been working my way out from there.
On a lighter note, I would sincerely expect that if anyone had hired a paid consultant, they would expect far better than my last post to you in which I stated ” I’ll look into it and respond when I have something to say” ; )
Oops !
I failed to address two of Ernesto’s concerns.
1) I do not use my work computer to research this issue which largely accounts for the frequently long lag
between a question and my response. I personally subscribe to Up to Date which can be
used, with a full personal subscription to access many original articles. My only overlap with work is that
we are provided with secure computers for home use that are capable of accessing our on line Clinical
Library and I do sometimes use this computer at home when I cannot access a particular article on my own.
I do not recall having done this regard to fluoride, but I also believe in full disclosure.
2) Any consultation I do with sub specialists is being done on my own time ( and theirs) as before work,
lunchtime, or after work “curbside “consultations.
I’m back at this site so late I don’t know if anyone will read it, but…
I think medwoman is doing a great job of volunteering her limited time to read every opinion and research the issue. I’m surprised Ernesto seemed to criticize the time she dedicated but perhaps he wanted to ascertain there wasn’t a paid lobbyist blogging here. It’s always easy to worry about monied interests.
I appreciate medwoman’s generous intentions but prefer to address the dental health of lower income people directly rather than by fluoridating the water supply and ecosystem. Let’s not assume people are unwilling to pay before trying. Many fluoride questions remain unresolved and if we keep putting it in our water and putting our water on our soil eventually we may have unhealthy soil and water table concentrations of fluoride and then learn that fluoride was a bad idea. Medicate the individuals needing medication, as individually and topically as possible.
While cancer was not my concern it’s nice to know from medwoman that someone did a study comparing fluoride concentration in cancerous and non-cancerous bones and found no effect. Further detail would be nice if convenient to obtain: sample size as biopsies per person as well as number of people, for example. Was the existence of fluoride or not blind to the person evaluating the biopsies for cancer, by chance? Does “no effect” mean not 95 percent confident of an effect, or not, say, 51 percent confident of an effect? (Is there a listed p-value?)
Hats off to many others for polite and thoughtful debate including (but not limited to) Alan Pryor and rdcanning and Alan Pryor.
Thanks.
Adrienne
[quote]I appreciate medwoman’s generous intentions but prefer to address the dental health of lower income people directly rather than by fluoridating the water supply and ecosystem. Let’s not assume people are unwilling to pay before trying[/quote]
I appreciate your kind words and would like to reiterate that my preferred approach to the problem of tooth decay would not be fluoridating the water. I would prefer a health care system in which every individual had access to dental care throughout their life. This is the route than many European countries have taken and the wisdom of universally accessible health care regardless of ability to pay is seen in their superior health outcomes. Unfortunately, I do not share your optimism about “addressing the dental health of lower income people directly”. It is not that people have not been trying to change our health care system and make affordable care available. I have worked on this project, to greater and lesser degrees the entire 30 years that I have been in medicine. This is not “before trying”. This is where we sit after many years, and countless people’s efforts attempting to establish universally available health care in a country in which we simply and consistently chose not to do so. What we have here is an opportunity to provide a demonstrated health benefit to a vulnerable population and are seeing opposition largely based on unsubstantiated fears about what might happen, even though it has not been demonstrated that it does happen even after 60 years of public water fluoridation in this country or because some people feel erroneously that they are being “forced” to do something they do not like. This, I feel, is a real shame.
Regarding your questions about the osteosarcoma study, I have house guests inhabiting the room in which my references are kept and so cannot access them tonight. I will try to get the references tomorrow and provide it to you along with my thoughts about the non statistical portion of the article. As you probably know by now,
I do not do my own statistical analysis and my consultant will not be available ; )
Medwoman, is your statistical consultant rdcanning?
Adrienne Kandel, if you are interested in learning more about the osteosarcoma study that medwoman mentions, then read this [url]http://www.fluoridealert.org/articles/kim_fan/[/url] and this [url]http://www.fluoridealert.org/researchers/harvard/timeline/[/url]. This study that medwoman mentions [u][b]does not[/b][/u] disprove a a previous study (Bassin et al., 2006) which linked water fluoridation to osteosarcoma. Other good sources of information regarding fluoride and osteosarcoma are this [url]http://www.fluoridealert.org/studies/cancer05/[/url] and this [url]http://www.fluoridealert.org/issues/health/cancer/[/url].
Adrienne
The following link will get you to the Kim article I referenced, “An Assessment of Bone Fluoride and Osteosarcoma
[url]www.ncbi.nlm.nih.gov › Journal List › J Dent Res[/url]
tleonard is correct in stating that this study does not “disprove” the Bassin study. It is rare in medicine that any single study will completely disprove the assertion of a previous study. I would consider the Kim study to be a logical response to the Bassin study which actually called for exactly this type of study using bone samples to either strengthen or weaken the possible association they had found. The Kim study was the type of direct assessment of fluoride in bone of tumor patients which had been suggested by Bassin et al, and it did not support the association of fluoride with cancer. A nice and I believe balanced summary of what these studies actual found is in the following link:
[url]http://www.ada.org.au/app_cmslib/media/lib/0703/m50781_v1_osteosarcomaandfluoride.pdf[/url]
I would be interested in hearing your thoughts after you have read the Kim entire article including the statistical analysis which is provided.
What is important for me in assessing evidence is what are the strengths and weaknesses of any given study, what studies are supportive of or detract from the findings of the study in question, are there a diversity of studies related to the topic looking at the question from a number of different perspectives, and what is the relevance of the findings of the study to the current situation and what are the authors perceptions of the strengths and weaknesses of their own study. I also take into account whether or not the authors appear to have taken an unbiased approach and have done their own research with regard to the relevant preceding studies. In the case of the Kim article, the authors have cited 29 previous articles from a diverse perspective including animal studies, human studies, reviews of methodology. I have not read all of these, but include this comment for the perspective it provides.
Another article you might find of interest is :
[url]www.aanos.org/epidemiologyboneca.html[/url]
This is a review and summary article and not primary research. I have included it because it addresses many of the factors that are demonstrated related to bone cancer and fluoride is not amongst them. It is from a very different perspective and published in a peer reviewed article.
One other thing that I think is important in the assessment of the value of studies is variety. The vast majority of articles cited by most of the opponents of fluoridation are straight off the pages of FAN. These tended to be listed without any suggestion that there might be any valid countervailing studies or arguments with validity.
I do not believe that anyone including the opponents of fluoridation would claim that FAN is an unbiased source of information. I personally would suggest reading from a wider variety of sources than those that have been chosen specifically for their antifluoride perspective.
tleonard
My primary statistical consultant is a Phd psychologist a large portion of whose job is to assess statistics applicable to a very large in state patient population.
However, since almost any psychologist or doctor has greater statistically competency than I do ( a freely admitted weakness of mine) I have asked a number of my colleagues to weigh in on the strength of studies.
I believe that I have addressed at length my areas of competency, my motivation, my lack of previous bias prior to researching this area and my own strengths and weaknesses. I will be happy to continue to address any concerns or questions about these subjects that are accompanied by the motive for the question, and under the condition that the person posing the question has made as thorough a disclosure as I have.
Adrienne
I really appreciate your thoughtful approach to this discussion.
One thing that you said resonated with me in a way which I know was not what you intended, but which I think has a great deal of relevance to this discussion. You said :
[quote]It’s always easy to worry about monied interests. [/quote]
The part that struck me is ” It’s always easy to worry…”
In my thirty years of experience, this has held very true with the patients who come to see me, and is true and a constant challenge in my own life. It is far easier to worry about what might be the case, or what might happen, than it is to do the actual hard work of truly assessing that evidence about whether something is likely to happen or harder still whether there is any credible evidence that it will happen of that it will affect any given individual. What I advise my patients and myself is to calm down, not let fear drive decision making, and use the best evidence available rather than speculation about what might occur. We all live with calculated risk every day of our lives. We do not stop driving our cars or riding our bikes because we are aware that disabling or fatal accidents occur. We make an assessment about whether or not the benefits of the contemplated action out weight the potential risks. This is how I have approached this topic, it is the approach that I would encourage others to take, and it is certainly the approach that I am going to encourage the WAC and City Council to take.
Medwoman, you state [quote]My primary statistical consultant is a Phd psychologist a large portion of whose job is to assess statistics applicable to a very large in state patient population. [/quote]
That’s rdcanning. Correct me if I’m wrong.
Regarding the Fluoride Action Network (fluoridealert.org), I would encourage folks to read a bit about FAN’s accomplishments here [url]http://www.fluoridealert.org/about/accomplishments/[/url].
“While institutions that promote water fluoridation and other fluoride products have infinitely more resources than FAN will ever have, FAN has proven capable of taking on, and winning, the big battles. FAN’s outsized effectiveness is highlighted by the fact that the largest dental organization in the United States (the American Dental Association), has deemed it necessary to purchase the domain FluorideAlert.com as a means of diverting would-be FAN visitors to their pro-fluoride website.
The following are some of FAN’s accomplishments:
Convinced EPA to Phase Out Sulfuryl Fluoride as a Fumigant on Food:
For ten years, FAN challenged an attempt by Dow AgroSciences to add a fluoride-based pesticide (sulfuryl fluoride) to the U.S. food supply. Although Dow is a corporation with no shortage of power and influence, and although it won most of the battles during the ten years, FAN persisted and won the war, convincing the EPA in January 2011 to phaseout all food-based uses of sulfuryl fluoride in the United States. While FAN was grossly outspent, we continually maximized our only two advantages — the law and the facts — by filing detailed submissions to the EPA and soliciting the support of the Environmental Working Group, Beyond Pesticides, and the New York Attorney General’s Office. As a result of FAN’s effort, hundreds of foods that would have become contaminated with high levels of fluoride, will remain free of fluoride.
Successfully Lobbied for Nation’s First Infant/Fluoride Warning Bill:
In June of 2012, New Hampshire’s Governor signed into law a bill that requires water departments in the state to warn customers of the risk fluoridated water poses to infants. The bill, which was the result of a prolonged outreach and lobbying campaign by FAN’s Campaign Director, requires that New Hampshire water suppliers provide their customers the following warning: “Your public water supply is fluoridated. According to the Centers for Disease Control and Prevention, if your child under the age of 6 months is exclusively consuming infant formula reconstituted with fluoridated water, there may be an increased chance of dental fluorosis. Consult your child’s health care provider for more information.” Previously, in 2005, FAN convinced the City of Burlington Vermont to issue a similar warning. New Hampshire, however, is the first state to pass this law on a statewide level. FAN is currently working to pass similar legislation in other states.”
FAN’s accomplishments, continued:
“Triggered NIH Investigation into Scientific Misconduct at Harvard Dental School:
In 2005, FAN researcher Michael Connett uncovered documents indicating that Dr. Chester Douglass, a Colgate-affiliated dental researcher at Harvard Dental School had suppressed and misrepresented the results of his NIH-funded study on fluoride and bone cancer in boys. The discovery sparked national headlines, and an NIH-ethics complaint by the Environmental Working Group. Although a year-long investigation by Harvard concluded that Douglass did not “intentionally” misrepresent his data, the national scrutiny helped ensure that a Harvard doctoral dissertation linking fluoridated water to bone cancer was published in a scientific forum where it had always belonged — rather than gathering dust, as it had done for four years, in the basement of the Harvard Medical Library.
Provided Extensive Information on Fluoride Toxicity to National Research Council (NRC):
Between 2003 and 2005, FAN submitted extensive analysis and documentation to a panel of the National Research Council (NRC) that was charged with reviewing the adequacy of the EPA’s safe drinking water standard for fluoride. The panel invited FAN’s Executive Director, Dr. Paul Connett to give a presentation alongside a dentist, Dr. William Maas, from the CDC. Maas argued that EPA’s standard was safe and appropriate, while FAN’s Director argued it was dangerously outdated. The CDC has far more resources than FAN, but FAN won the argument. In 2006, the NRC issued a groundbreaking report concluding that EPA’s drinking water standard for fluoride is unsafe and should be lowered.
Translated Previously Inaccessible Chinese Studies on Fluoride and IQ:
FAN researcher Michael Connett has conducted extensive searches of the Chinese literature on fluoride toxicity. In 2007, Connett accessed and arranged translations for 20 studies investigating fluoride’s impacts on the brain, including 10 studies finding reduced childhood intelligence. In 2008, 18 of these 20 studies were published in the English-language journal Fluoride, thus helping to ensure that the findings would be considered by US regulatory agencies and the larger scientific community. In July of 2012, a team of Harvard scientists published a meta-review of fluoride’s impact on IQ which cited and discussed 10 of the studies that FAN translated.
Helped Many Local Groups Defeat Water Fluoridation Programs
In addition to being the most comprehensive source of fluoride-related information on the internet, FAN has helped many local groups end or fend off water fluoridation programs since its formation in 2000. While the success of a local campaign is quintessentially the product of the local group’s own efforts, FAN has provided, and continues to provide, timely information, advice, and public presentations to communities trying to reduce their fluoride burden.”
[quote]I would consider the Kim study to be a logical response to the Bassin study which actually called for exactly this type of study using bone samples to either strengthen or weaken the possible association they had found. The Kim study was the type of direct assessment of fluoride in bone of tumor patients which had been suggested by Bassin et al, and it did not support the association of fluoride with cancer.[/quote]
In response, FAN says it best:
“A paper in the Journal of Dental Research by dentist Chester Douglass and colleagues, “An Assessment of Bone Fluoride and Osteosarcoma,” (7/28/11) claims to show no association between fluoride bone levels and osteosarcoma, a form of bone cancer. However, Douglass’ study has serious scientific flaws and is incapable of disproving a previous study (Bassin et al., 2006) which linked water fluoridation to osteosarcoma, reports the Fluoride Action Network (FAN).
Bassin found a 500% to 600% increased risk for young boys, exposed to fluoride in their 6th to 8th years, of later developing osteosarcoma. Douglass’ study does not address exposure during this critical period because it measured the level of fluoride in bone, which accumulates fluoride over a lifetime. These bone levels provide no information about when the person was exposed to fluoride.
Not only does Douglass’ study fail to refute Bassin’s main finding, it suffers from other serious weaknesses:
1) Douglass’ study was much smaller and weaker than Bassin’s. It had only 20 control subjects under age 30, a fifth of Bassin’s. For this key age group, Douglass’ study was so small it could provide no reliable conclusions. Even Douglass admitted this serious limitation.
2) Douglass’ choice of comparison group is suspect. Douglass compared the bone fluoride level of patients with osteosarcoma to “controls” with other forms of bone cancer. If fluoride also causes these other bone cancer types, then one would not expect to find any difference in bone fluoride between these groups. It is biologically plausible that fluoride could cause other bone cancers because it reaches such high concentrations in bone. One of the only studies of fluoride and non-osteosarcoma bone cancers did find a link, but this evidence was never mentioned by Douglass.”
FAN’s analysis of the Douglass study, continued:
“3) The controls were severely mismatched to the cases. Controls were much older (median 41 yrs) than the cases (18 yrs). The risk of osteosarcoma is highly age-dependent. Also, fluoride builds up in bone with age. Given Douglass’ small sample size, it is unlikely he could have adequately compensated for the gross mismatch in age, especially because of these two simultaneous age dependencies. The groups were also mismatched on sex ratio, and osteosarcoma risk is well known to be sex dependent. Properly adjusting for sex and age would be virtually impossible.
In 2001, Douglass signed off on Elise Bassin’s Ph.D. dissertation which found the strong association between fluoride and osteosarcoma. When it was later published in a peer-reviewed scientific journal in 2006, Cancer Causes and Control, an accompanying letter from Douglass claimed that his “larger” study would eventually refute Bassin’s findings. But Douglass also told a Fox News reporter that Bassin “… did a good job. She had a good group of people advising her. And it’s a nice—it’s a nice analysis. There’s nothing wrong with that analysis.”
Now that Douglass’ study is finally published, it is clearly incapable of refuting Bassin’s work. According to FAN director, Paul Connett, Ph.D., “Bassin’s study was a high quality product, Douglass’ study was not.”
Chris Neurath, FAN’s Research Director, points out “Even though Douglass collected extensive fluoride exposure histories from hundreds of other controls, that data was ignored in this paper. FAN is calling for the release of all of the Douglass data. The only way to get to the bottom of Douglass’ two decade’s study is to make the data available for any independent researcher to check and do the analyses which Douglass has failed to provide. The public has paid millions for this data, why is most of it still behind locked doors?”
One reason is suggested in Douglass’ conflict-of-interest declaration where he says he has “… written reviews of the literature for several companies that sell, reimburse for, or do research on preventive dentistry products, most notably GlaxoSmithKline, Colgate-Palmolive, Dentsply, Quintile, Delta Dental Plans….”
Omitted was his paid editorship of Colgate’s promotional dental newsletter, which regularly contains advertisements for Colgate’s fluoride products.
The International Association of Dental Research (IADR), publishers of The Journal of Dental Research, has a history of promoting fluoridation.
Connett says, “In my opinion, it seems that Douglass is more interested in protecting fluoride than investigating this issue objectively. Bassin’s work suggests fluoridation may be causing a frequently fatal cancer in teenage boys. Douglass, after five years of trying, has failed to refute this disturbing evidence. How long will fluoridation promoters be allowed to continue to spin this issue?”
“Why are dentists – especially those who have shown a strong interest in protecting the water fluoridation program – conducting and publishing cancer research, anyway?” asks Connett.”
“Douglass’ study was much smaller and weaker than Bassin’s. It had only 20 control subjects under age 30, a fifth of Bassin’s. For this key age group, Douglass’ study was so small it could provide no reliable conclusions. Even Douglass admitted this serious limitation.”
The two study types are not directly comparable. Of course, a study that relies on the ability to actually obtain actual tumor material from a rare tumor type ( diagnosed approximately 400 times per year in the US) will have smaller numbers than a population based study. No doubt this is a limitation of the study. However, in medicine a demonstrated pathology offers a more definitive type of evidence than population studies which force one to make assumptions about which individuals may or may not have been consuming the same amount of fluoride from the water supply over what amount of time. You know for certainty which individuals did and did not have osteosarcoma and are able to directly measure the amount of fluoride in the associated and not directly affected bone. So while there are numerically less patients, there is also certainty about the presence of absence of the particular disease by tissue diagnosis ( always a more certain indicator than following symptoms ) and speculating about how much fluoride exposure there may have been. In medicine, when in doubt about a diagnosis or symptom set, pathology and direct tissue measurement of substances trumps all indirect evidence.
Having said that, I am unaware that any one was claiming that this study “disproved” the Bassin study. I see it as an attempt to address the specific issue that Bassin et al had raised in their statement that due to the limitations of their study, tissue sample studies should be obtained. I merely offered it for the consideration of those who are interested in taking a broader look at what the research shows.
[quote]“Why are dentists – especially those who have shown a strong interest in protecting the water fluoridation program – conducting and publishing cancer research, anyway?” asks Connett.”[/quote]
Perhaps this could be, at least in part, because the opponents of fluoridation have cited repeatedly the lack of study in this area ?
Medwoman. Thank you for your disclosure. For the record , I have no financial interests, current or deferred in the outcome of this matter.
medwoman…
You wrote[quote]Having said that, I am unaware that any one was claiming that this study “disproved” the Bassin study. I see it as an attempt to address the specific issue that Bassin et al had raised in their statement that due to the limitations of their study, tissue sample studies should be obtained. I merely offered it for the consideration of those who are interested in taking a broader look at what the research shows. [/quote]
On the contrary, you have in fact taken a very aggressive stance on osteosarcoma. You stated during the public comment period at the April 25 Water Advisory Committee meeting (which can be viewed here [url]http://archive.cityofdavis.org/media/[/url]–medwoman’s, aka Tia Will’s, statement regarding osteosarcoma starts at 59 minutes 45 seconds)[emphasis mine]:
“[u][b]There is no evidence whatsoever that fluoride is associated with osteosarcoma.[/b][/u] There is only one environmental factor that is, and that’s ionizing radiation. [u][b]Fluoride has zero to do with it.[/b][/u]”
This is in stark contrast to something you said earlier in this thread:
“Some on both sides of this issue have chosen to make their presentations as though they have absolute fact and absolute certainty on their side. Others on both sides have taken a more nuanced approach. It is the latter than I personally find most valuable.”
So far, I am not seeing a nuanced approach from any members of the Yolo County Health Council, an organization which is aggressively trying to literally shove fluoride down our throats in our drinking water. Medwoman (Dr. Tia Will), rdcanning (Robert Canning), and Dr. Michael Wilkes are all on the health council. Dr. Michael Wilkes wrote the following statements in another Vanguard article [url]http://davisvanguard.org/index.php?option=com_content&view=article&id=7274:health-councils-support-for-fluoridated-water&catid=60:water&Itemid=92[/url]:
“I write on behalf of the Yolo County Health Council, the group appointed to advise the Yolo County Board of Supervisors on all aspects of health in the County. Over the past several years we have carefully considered aspects related to the fluoridation of drinking water in our county. We have looked at current scientific evidence, read scholarly reports by learned bodies, and considered potential opposition to fluoridation from community members.”
“While there is still much medicine does not understand, water fluoridation is not one of them.”
“Despite cries from alarmists and suggestions of conspiracy theories, when used at the recommended levels of 0.7 parts per million there are no harms, dangers or side effects.”
“For all of these reasons the Yolo County Health Council unanimously voted to encourage you to strongly promote our children’s health, reduce health care costs, and improve growth and development by supporting the fluoridation of our community water. We urge you to stand strong on this issue knowing that the medical, dental, and public health communities strongly support this important intervention and will back you as you vote to improve the health of the public.”
Frankly, the statements I have read and heard from members of the Yolo County Health Council thus far cause me to question whether members of the Health Council have indeed “carefully considered” aspects related to the fluoridation of drinking water in our county. What I am seeing is out and out promotion of fluoridation, not “careful consideration.” I have seen aggressive attempts to discredit folks who oppose fluoridation (conspiracy theorists? Come on.), and cavalier dismissal of [u][b]every single[/b][/u] study that shows harmful effects of fluoride. Fluoridation is promoted with absolute confidence and certainty. Such certainty simply does not exist regarding fluoridation. But certainty is important when a policy is being aggressively promoted. Promotion does not sit well with uncertainty.
Of course, any concession at all, even a tiny one, that fluoride could even [i]possibly[/i] be harmful, will not be heard from members of our Health Council. It has to be that way. Any concession whatsoever would invite the demise of water fluoridation. Almost by definition then, promotion of the program requires statements that there are absolutely no dangers, that the practice is extremely effective, and that there is no debate on the science of the matter.
Dr. Will (medwoman), you stated at the April WAC meeting [url]http://archive.cityofdavis.org/media/[/url], at 59 minutes 49 seconds “I came to this as a skeptic. I really wasn’t sure whether or not there should be fluoride in the drinking water, not because I thought there was any doubt about its ability to prevent cavities, but because I just wasn’t convinced that this was the right way to go, and I knew that there were some health concerns from a number of people and I think it is really important to address all of those concerns.”
After that statement, you went on to emphatically dismiss any potential effect of fluoride on IQ, any relationship of fluoride to osteosarcoma, and any effect of water fluoridation at .7 ppm on osteoporosis.
rdcanning wrote earlier in this thread, “Science demands skepticism. And the anti-fluoride folks have none. The scientific evidence, as I read it on FAN and in the literature presented to the WAC, is thin, poorly supported by replication, and not generalizable to the people who matter the most – the people in Davis who ought to have access to a proven and safe.”
I’m not seeing much skepticism on the part of members of our Health Council. What I am instead seeing from members of our Health Council is unapologetic promotion of fluoridation.
The Yolo Health Council asserts itself as an advocate for a public health approach to improving the overall well-being of the citizens of Yolo County. What many members of the Health Council object to is the generally anti-scientific and biased approach of many (but not all) of the opponents of fluoridation. Statements that misinterpret scientific studies (“A multi-million dollar, U.S. National Institutes of Health (NIH)-funded study found no significant relationship between tooth decay and fluoride intake among children.”) or overstate a study’s findings (suggesting that the meta-analysis of IQ and development shows that fluoride is a neurodevelopmental toxin) do not help their position. Speakers at the recent WAC meeting railed against fluoridation and one speaker even went so far as to assert that most deaths in the U.S. are due to the side effects of medications.
The scientific evidence in favor of the positive benefits of fluoridation of domestic drinking water, in my opinion, outweighs the evidence for its harm. This is not about individual personalities but about the preponderance of evidence. There is no good evidence of effects of fluoride on IQ or osteosarcoma. There is good evidence for the benefit of fluoride on dental caries. There is also evidence that too much fluoride can produce dental fluorosis, which on balance many communities have chosen to live with.
The Health Council represents a broad spectrum of groups and individuals engaged in advising the county Board of Supervisors and the public on important public health issues. Fluoridation of domestic drinking water has been, in balance, a successful public health initiative in the U.S. and many other countries. Members of the Health Council believe it is an important function of the Council to weigh in on public health policy in the public forum, and that is what we have done.
rdcanning….
[quote]What many members of the Health Council object to is the generally anti-scientific and biased approach of many (but not all) of the opponents of fluoridation. [/quote]
Well, what many Davis citizens object to is the generally anti-scientific and biased approach of many (but not all) of the proponents of fluoridation. Mark West asked [quote]Medwoman: Please post the citations for the trials that prove the efficacy of water fluoridation for prevention of dental caries at the proposed usage levels. I anticipate that you have several double blind trials with dose response curves and complete control of confounding factors such as regular dental care and fluoride containing toothpaste. Thank you. [/quote]
You answered [quote]You will not find the kind of study you desire. Double-blind studies of that kind have never been completed. And for good reason – one cannot randomize fluoridation.[/quote]
Hmmm…..Of course researchers can create double blind trials with dose response curves and complete control of confounding factors such as regular dental care and fluoride containing toothpaste. This just simply has not been done. Your answer doesn’t make sense. One cannot randomize fluoridation? One can certainly create double-blind randomized clinical trails for fluoride. It just hasn’t been done.
You go on to say [quote]That does not mean there is not a positive effect for fluoridation. Withholding efficacious treatments for purpose of randomization is not considered ethical research. That’s why most of the research in this area is population-based epidemiological studies – case-control studies such as the one cited above. [/quote]
So, you are saying that fluoride is so fantastic, so wondrous, that it would be unethical to study fluoride in a double-blind randomized clinical trail, because it would be unethical to withhold the fluoride ion from those in the control group. [i]Interesting[/i]……and you say that those opposed to fluoridation are generally anti-scientific and biased?
Is anyone else’s head spinning from this logic?
As I stated at my initial presentation to the WAC. I am a newly appointed member of the Health Council.
I am not yet a voting member.
I have never met with the Fluoridation SubCommittee of the Health Council and had never met Michael Wilkes prior to my first meeting of the Health Council.
I have made clear at each of my presentations to the WAC my identity and that I am speaking as a private citizen and not as a representative of any group.
One thing that really is making my head spin, is how this thread seems to have devolved into a series of personal comments, insinuations,and implications that someone may have some nefarious ( or financial motive)
or that anyone is attempting to hide something.
Given that I had already identified myself by name on my first post, and rdcanning has identified himself at the WAC, I do not really see the point, but also do not find it particularly offensive for tleonard to have linked our names with our login names. However, I believe this “outing” of posters without their expressed permission is against Vanguard policy and such posts may be removed.
medwoman and rdcanning….
I think that you are both genuinely convinced that fluoridation is good for the dental health of our community, and that you are convinced that there are no risks. I don’t think that you have any nefarious motives, or that you are attempting to hide anything.
Unfortunately, however, you and I disagree on just about everything fluoride-related. This disagreement can cause the Vanguard comments to get pretty heated at times. I’m afraid that this is difficult to avoid, given the passion on both sides.
Please understand that I am a mother of four children, and I do not want my children’s water supply to have added fluoride. The prospect of having our drinking water fluoridated against our will is very upsetting.
I apologize for my comments that have been sarcastic.
tleonard
Thank you so much for your comments. I am very committed to the principle of free and open discussion and I am also committed to having that conversation be based on values, ideas and evidence and free of personal deprecation. I very much appreciate your willingness to work within this framework.