Fluoridation debate: Responding to Tom O’Connor

This is the second article in the debate between Tom O’Connor and me. It is a response to his post Debating fluoridation and tyranny – Tom O’Connor responds).


I think Tom’s concept of “freedom of choice” is confused. He appears to be arguing for his own right to determine a social decision. But that is undemocratic, it imposes an individual’s wish on society.

We all have the freedom to influence, make submissions on, contribute to, etc., a social decision. In the end, that decision is made democratically. The minority does not have the right to use the individual’s “freedom of choice” argument to demand that decision not be democratic.

That is not the ‘tyranny of the majority”  Tom claims because on  most issues the individual still has the “freedom of choice” to make individual arrangments to satisfy their position. No one is being coerced and the individual can take personal responsibility for their own arrangements. This is particular true with community water fluoridation (CWF).

Tom and I have different values or politic outlooks underlying our different attitudes towards CWF.

Opposing values systems

I don’t want to put words in Tom’s mouth but in practically he is opposed to CWF despite the clear social benefits. He is claiming his personal “freedom of choice” is more important than the community’s – or at least the majority of the community.

In contrast, I support CWF because of its social benefits. However, I accept the obligation of governing bodies to consult the community when there is a controversy and support the decisions of the community (I also support the right of individuals and communities to make the wrong decision – within reason, of course).

In the most general terms, these boil down to issues of social responsibility vs individual or personal responsibility. Put simplistically, some would see the conflict a between a “socialist” or “libertarian” perspective. (I apologise for using labels.) These different values systems lead to different understandings of freedom of choice (and of being “forced”).

Given the stand of personal responsibility, as a personal values system, Tom should not need to seek the justification of advancing or questioning facts. He should simply stand on principle, and seek support for that principle. On the other hand, there is an obligation on people arguing for social responsibility. We need to show that the advocated social policy provides a net advantage to the community and/or individuals. If there are no advantages there is no point in such policies and the personal responsibility or “libertarian” position may as well stand.

Tom is welcome to his values system, and he no doubt says the same about me. We live in a pluralist society and most of us accept such differences are handled by the democratic process. I should also add that most people do not adhere to an absolutist “libertarian” or “socialist” approach and prefer a more balanced and sophisticated approach to social issues.

Society usually attempts to balance individual rights/responsibilities and freedom of choice against social responsibility. After all, individual rights and social responsibility are co-dependent. Our individual rights and freedom of choice cannot survive where our freedom, rights, health and well-being are not supported by sensible social policies.

A democratic social decision may appear to result in the loss of that freedom of choice. After all, I can express my freedom of choice to have a Green government, but after the election I have to accept that freedom is put on hold for another three years and in the meantime I have to put up with a National-led government. But that does not deprive me of the freedom to advocate for policies underlining my preference for the Greens – and under MMP such advocacy can be effective even between elections.

Similarly, the minority in a decision on CWF does not lose personal “freedom of choice.” If they are willing to take personal responsibility for their situation they can with very little effort, make personal arrangements. Those with a hangup about fluoride can use to filters or alternatives sources. Those who wish to use fluoride can resort to mouth rises or alternative water sources. In taking these actions we are exerting our freedom of choice.

Tom has stepped outside the ethical issues to argue some statements of fact which need challenging.

Raising doubt and the balance fallacy

Tom asserts:

“Both sides have accused the other of engaging in pseudo-science and scare mongering. Both are, to some extent, probably accurate and in agreement on that point alone. However, where doubts exist, it is probably better to err on the side of caution.”

Putting “both sides” into the same box of “engaging in pseudo-science and scare mongering” is a Clayton’s argument. A claim made without any substantiation but appealing to “balance” nad “fairness. Rather than relying on such “warm fuzzies” Tom should present the examples and evidence if he wishes to make such claims.

Similarly, unsupported claims of doubts and the need for caution can be a way of discounting the science and its quality. Hence, the emotional slogan “if in doubt, leave it out!” Society should make decisions based on evidence, not warm fuzzies and catchy slogans.

We are familiar with the financially and ideologically motivated purposeful raising of doubt on issues like the science regarding tobacco use and climate change.  Merchants of Doubt by Oreskes and Conway provide a good description of such dishonest tactics – and the title is very appropriate.

Drinking water standards

Tom claims:

“The principle responsibility of local authorities, as outlined in the Drinking Water Standards for New Zealand, administered by the Ministry of Health, is to ensure drinking water is as free from all other substances and organisms as possible.”

Where do the standards say that, Tom? My checking of Drinking Water Standards for New Zealand produced these principles:

“all water suppliers have a duty to ensure their water is safe to drink.”

And:

“all drinking-water suppliers providing drinking-water to over 500 people must develop and implement a water safety plan (originally known as a Public Health Risk Management Plan, PHRMP) to guide the safe management of their supply. This quality assurance approach is complemented by the DWSNZ, which specify the maximum acceptable concentrations of harmful contaminants in the water.”

What these standards do is set maximum acceptable values (MAVs) for a whole list of possible “harmful contaminants” – occurring naturally or from the water treatment itself. Think about it – no realistic body would set standards demanding water was “free from all other substances and organisms as possible” – leaving interpretation up to the individual operator!

Of course, individuals may want to lower these MAVs (or even make them zero) – but they are derived from the best available science and practical considerations. If individuals are unhappy they can, of course, challenge the standards. But they do not have the “freedom of choice” to arbitrarily  replace them with their own personal values. They do have the freedom of choice to use other water sources or tap filters. That is the sensible and responsible thing to do, rather than childishly demand a change just to satisfy their own hangup.

Chlorination

This involves additions to water that Tom has absolutely no control over. Why does he not object to that addition on his ethical stance that he has the “freedom of choice” to control what goes into community water supplies?

Personally, I would oppose chlorination  long before I objected to fluoridation because irrespective of whether there is any detectable chlorine “at the end of the process” (there should be),  chlorine can react with naturally occurring organic material to produce possible hazardous or carcinogenic compounds. That is why local authorities check for these in our water.

My city uses UV irradiation for the early disinfection process and only adds chlorine at the end so that the tap water remains organism free. But if I lived in a city where the first disinfection use chlorine I would seriously consider using a tap filter to remove possible hazardous compounds.

Iodised salt

Tom is OK with the “mass medication or treatment” involved in iodised salt because there is “always un-iodised salt as a practical, convenient and affordable option on grocer shop shelves for those who did not want it.”

Does he bother to exert that “freedom of choice” when he shops? Has he even checked the availability of uniodised salt? I checked the other day and my supermarket had plenty of iodised salt but no specifically non-iodised salt. It had boutique salts (even “chemical free” salt) and I imagine the chemophobic shoppers might prefer those products to iodised salt – not realising they also contain iodine.

This can get silly. There are anti-fluoride people who treat their water by reverse osmosis – then replace the removed minerals by adding Tibetan salt which contains fluoride (and is sometimes sold as “chemical-free.”

Folic acid

I would willingly support mandatory folic acid fortification. More countries will probably do this in future because the evidence is pretty clear that it helps prevent the tragedy of neural tube defects. It seems a sensible approach because of the need for folic acid at the stage of pregnancy where the mother may be unaware.

At the moment, New Zealand has a voluntary folic acid fortification system. About 17% of packaged bread was fortified with folic acid in 2012. The industry is working towards fortification levels of 50%  – with at least 25% meant to be achieved by the end of 2014.

Tom, you appear to oppose folic acid fortification. Do you check your bread packaging to check it hasn’t been fortified? I suggest hardly anyone does so.

There are lots of things individuals can have hangups about. Some people object to chlorination. Some to pasteurized milk. Given that society does set standards for our food and water it is inevitable individuals may sometimes have to take personal responsibility and check the food and water they purchase. But I cannot understand the directed concern over fluoride as it is one of the easiest things to check and make personal arrangements for.

While I had plenty of choice at my supermarket if I wanted “fluoride-free” water. I had no choice if I wanted “iodine-free” salt” or unpasteurized milk. If I had a hangup about folic acid I would need to make the effort to carefully scrutinise bread packaging to find “folic-free” bread. And do that often because of plans to increase folic acid fortification of bread over time.

Removal and personal responsibility

Tom really should back up this claim:

“Suggesting that those who object to fluoride in the water they pay their local authority to deliver can obtain alternative supplies from a community tap or buy it from the supermarket is unacceptable. These options are not possible, practical, convenient or affordable for many people.”

What about some monetary figures to claim alternatives are not affordable? Frankly I do not think he has a leg to stand on here as people who choose to opt out of our secular education  and free hospital systems face far bigger financial costs. In my experience most anti-fluoride campaigners already take such steps for themselves and when pressed claim they are speaking up for others less fortunate than themselves. Yeah, right!

Tap filtration practical and convenient. “Fluoride-free” water is readily and cheaply available (more so than unpasteurised milk and non-iodised salt I have found). And the slight inconvenience involved is of little consequence to someone who really believes the anti-fluoride story.

Incidentally, several cities provide “fluoride-free” community taps. the fact these get very little use suggests to me that those who are really concerned already have more convenient arrangements.

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22 responses to “Fluoridation debate: Responding to Tom O’Connor

  1. Bill Osmunson DDS, MPH

    A valiant try Ken, but I’m not persuaded.

    Chlorination is added to public water with the intent to treat water. Chlorination is not added to treat people, fluoride does not treat water, the intent is to treat humans. A huge difference, because the intent of use determines the nature of the product and jurisdictional oversight control. For example, the agencies responsible for making water potable and safe, treat water and not people. If a substance is used with the intent to treat people, then it is a drug and jurisdiction for safety, efficacy and dosage are with a different agency, in the USA the Food and Drug Administration has jurisdiction.

    Your examples of Iodine and folic acid are not analogous. Neither fit within the definition of “highly toxic” or “poison” laws, while fluoride does fit into “highly toxic” and “poison” laws regardless of dilution.

    Iodine is primarily used for thyroid function and to prevent goiter. Most goiter cases are found in high fluoride areas in part due to too much fluoride. Fluoride has been used for years to reduce thyroid function, ADHD, etc (and still is). In other words, if a person reduces their fluoride intake, they don’t need as much iodine. Reduce fluoride intake and iodine supplementing is not necessary.

    Folic acid is a synthetic product added to food with the assumption the human body converts it to folate, required by the body for many functions, and essential nutrient. In contrast, dental caries is not the result of inadequate fluoride intake. Fluoride is not an essential nutrient. No physiologic process is known which requires fluoride. Unfortunately, we are having more concerns folic acid is not replacing folate as well as we would like–folic acid supplementation is not a best practice, but it is safe (we think). Best to eat the dark green veggies and oranges for folate.

    Folic acid is water soluble, excreted easily by the body and not considered toxic. Fluoride is highly toxic with as little as 15 mg considered lethal for some humans (5 mg/kg BW).

    Ken, our governments cannot dose us with vitamins/chemicals/toxicants and fully counteract the effects of poor diets. We need to put our time, effort and money into promoting good natural diets rather than chemical supplements.

    Like tobacco, we need to put a tax on highly refined sugar products like soda pop rather than use tax payer money to subsidize the manufacturing of sugar. A “sin” tax raises money which could be used for eduction.

    On another note, you made a valiant effort to wash away individual freedom of choice, and failed. Forced feeding foods, vitamins or drugs without individual consent is like placing occlusal fillings on all first molars for all seven year olds to prevent caries in those teeth. . . bad public health policy. Not every first molar needs a filling or will get dental caries and not every person reacts the same to foods, vitamins and drugs. I agree a well done sealant is good, but not all first molars need sealants. A diagnosis should be done first.

    The holes in fluoride research are serious and must be considered. Fortunately the Office of Health Assessment and Translation, a branch of the US National Toxicology Program agreed last fall to review the toxicity of fluoride. Their first report will be out within a few weeks. Part of the report will present gaps in research which need to be done. Fluoride research has many holes and assumptions. Public health policy should not be built on assumptions.

    And on another note, they just reported higher brain cancer rates in rats exposed to RF at doses similar to cell phone use.

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  2. I get really angry at being forced to accept the provision of public roads , public hospitals, and all other public infrastructure.
    Where’s my choice in all this? It’s my human right not to have it.

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  3. Bill has a scale of toxicity he applies:

    Fluoride (when its not naturally occurring is always poisonous, at all levels, no exceptions), Iodine (Bill avoids calling this one – because who needs Iodine anyway? after all if we get rid of fluoride and Iodine is irrelevant and magically non toxic),

    Chlorine (Biil reckons is poisonous, but gets a free pass on grounds of its usefulness as disinfectant and because it is added to kill micro-organisms magically makes its toxicity to humans irrelevant).

    Folic acid can apparently cause pernicious anaemia but hey, we won’t mention that either.

    So that’s all very consistent.

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  4. Thanks for your comments, Bill.
    Not surprised you are not persuaded – after all you are on the FAN Team – which requires a certain amount of ideological (and maybe commercial) commitment to “natural”/alternative health big business. However, it is important to counter the misinformation you presented – for the sake of the less ideologically committed.

    Tom O’Connor and I are attempting to direct this discussion towards the ethical/”freedom of choicer” issues and have purposely excluded discussion of the scientific aspects I will leave your diversionary comments for another time. This is not avoidance as you know well that I fully covered these in my debate with Paul Connett.

    1: Chlorination.

    It never ceases to amaze me that when chlorination is mentioned in the ethical/”freedom of choice” discussion anti-fluoride propagandists react in a typical Pavlovian way. They mention the obvious (chlorine is added to disinfect the eater, fluoride to correct a deficient element in the water) which is just a diversion. It is an irrelevant knee jerk reaction suggesting the proponent really has not considered the” freedom of choice” issue properly.

    The point is that the same ethical and “freedom of choice” arguments are as applicable to chlorination as they are to fluoridation.

    So, Bill, do you deny the public (or the individual) freedom of choice on chlorine in their water? I know some anti-fluoride activists openly campaign against chlorination, others say they will campaign once they have “knocked off” the low-hanging fluoride fruit.
    Where do you stand on this freedom of choice issue Bill? Do you go as far as saying you have the personal right to insist that it not be added to water no matter what the majority of the community says (as seems to be Tom’s position)?

    2: Iodine and Folic acid.
    Thaw freedom of choicer/ ethics situation here is almost exactly the same as in the cases of chlorination and fluoridation. The mitigating factor is that not all salt or bread is fortified. Although, as I have pointed out it is actually difficult to find uniodised salt (at least in my supermarket) and checking bread labels is a finicky task (it is likely folic acid fortification could become mandatory eventually anyway). It is actually far easier to find alternative “fluoride-free” water than it is to find unfortified salt and bread.

    3: Force feeding
    Bill you refer to “forced feeding foods, vitamins or drugs without individual consent” but you don’t provide a single example.
    This is not happening with either fluoridation, chlorination, iodine fortification or folic acid fortification. In all cases these social actions are well documented and the knowledge of them is available to the community. In the case of folic acid and fluoridation the issues are widely discussed – the public are consulted.
    In New Zealand folic acid fortification is currently voluntary – although as most of the opposition is from the baking industry and based ion convenience rather than health issues, I would not be surprised to see it become mandatory in future.

    Fluoridation in New Zealand is decided on a community basis – depending on the health situations, feasibility and attitude of the community. Most referenda in NZ have supported fluoridation.

    In these four cases there are alternative for those with hang-ups – so no one is forced. Removal of chloride and possible retraction products, and fluoride, can be done with tap filters. The alternatives for iodine and folic acid are more problematic, although the persistent person should be able to find alternatives.

    4: Democracy
    Bill, do you deny the right of the community to influence or even make decisions on these matters? Do you insist that the minority should childishly “have their own way” and to hell with democracy? Do you oppose the sensible approach that the minority should make their own arrangements when the vote doesn’t go way?
    Finally, your cell phone comment is completely off topic – but it does say something about your own attitudes towards the scientific process and your avoidance of the real issue of the articles by Tom and me – the ethics/”freedom of choice” aspects of community water fluoridation.

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  5. Reading through these comments it is easy to confuse this debate with an exercise in splitting hairs. Both Drs. Osmunson & Perrott probably have their heels dug in a bit and are tugging on the medication/freedom of choice issue from their prospective sides.

    Osmunson: ” . . fluoride does not treat water, the intent is to treat humans.” This, then, is the definition he chooses to use to identify fluoride as a “medicine.” And then he goes into jurisdictional oversight issues in the United States, which is interesting because this is a dialogue between a Canadian & a New Zealander.

    Perrott: “They mention the obvious (chlorine is added to disinfect the eater, fluoride to correct a deficient element in the water) which is just a diversion. It is an irrelevant knee jerk reaction suggesting the proponent really has not considered the” freedom of choice” issue properly.

    The point is that the same ethical and “freedom of choice” arguments are as applicable to chlorination as they are to fluoridation.”

    Although that may be true, Dr. Perrott didn’t specifically address the issue of fluoride being a “medicine.”

    Is it a medicine? I guess that would depend on your definition of the word “medicine.” Again, Osmunson says, “If a substance is used with the intent to treat people, then it is a drug . . ”

    That’s twice he’s used the same definition, so he seems consistent and confident with THAT definition. “A substance used with the intent to treat people.”

    That is a very vague definition, Dr. Osmunsun. You will have to come up with something better than than if you want to engage in this particular debate and support your side; i.e., fluoride being a “medicine/drug” which is one of the foundations of the “freedom-of-choice” issue.

    Ok, let’s look at your definition – a substance used with the intent to treat people.

    Water is used with the intent to treat people. It prevents dehydration. By your definition, that you have confidently used twice now, municipalities are drugging their citizens by simply preventing them from going thirsty.

    Come up with a better definition than that. Split that hair a little finer. And then you can continue with this discussion.

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  6. soundhill1

    “Bill, do you deny the right of the community to influence or even make decisions on these matters? Do you insist that the minority should childishly “have their own way” and to hell with democracy?”
    When my dentists are thinking they should treat me in a certain fashion they always make it known to me and get agreement before continuing. I can choose another treatment or none or pay off little by little in advance. If I have pain and a low income the DHB may pay for me. Democracy or its agent has decided that that is how it should be. I can object to the city council to glyphosate being used in the street outside my house and alternatives can be found. I don’t have to pay.
    Unfortunately sometimes the food I eat may not be labelled as to scrambled genes which happens to GMO food. And the goverment may decide to allow a whole lot more glyphosate in it than before. Sometimes corporates are stronger than democracy which is happening in USA with glyphosate. But with the combined effort of environmental groups, scientists and consumer watchdogs pressuring authorities for a ban on glyphosate, democracy got a majority of European governments to abstain or oppose the extension of its permit, and the vote was cancelled — twice!
    In the USA strong pressure from corporates works hard to create the perception that glyphosate is safe. Is that democracy? Some people call it so.
    As for fluoridation the campaign has drastically changed. What people were persuaded to be optimum/safe decades ago has changed. It is much lower now. And varies with temperature which in NZ I do not think fluoridaters bother about.
    Parents are feeding their babies on milk formula without being properly in control or having the knowledge to control how much fluoride their babies are getting. “Democracy” has come to the conclusion in NZ that fluoride should not be added to baby milk formula. So babies in non-fluoridated areas will get very little and parents who make the formula using water from the kettle which has been left simmering down in a fluoridated area will be dosing their babies at maybe twice or more the maximum allowable.
    What will “democracy” do in the future? It needs improvement.

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  7. soundhill1

    http://www.health.govt.nz/our-work/preventative-health-wellness/fluoridation/fluoride-and-health/infant-formula-and-fluoridated-water
    Our govt reports ADA info:
    “”If liquid concentrate or powdered infant formula is the primary source of nutrition, it can be mixed with water that is fluoride free or contains low levels of fluoride to reduce the risk of fluorosis ” ADA indicated that more research is needed before definitive recommendations can be made on fluoride intake by bottle-fed infants.”

    Using bottled water will double the cost of infant feeding.
    Filters may not do what they claim:
    http://fluoridefree.org.nz/information/resources/fluoride-free-water/

    After 6 months infants will also be drinking water: ” In the past, acute health problems were reported in mountain climbers who had prepared their beverages with melted snow that was
    not supplemented with necessary ions. A more severe course of such a condition coupled with brain oedema, convulsions and metabolic acidosis was reported in infants whose drinks had been
    prepared with distilled or low-mineral bottled water (11).

    http://www.who.int/water_sanitation_health/dwq/nutrientschap12.pdf

    Our NZ Govt health advice is lacking on such info.

    https://www.healthed.govt.nz/resource/feeding-your-baby-infant-formula

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  8. Brian, you are simply trolling now – none of your recent comments are related to the articles.

    Now, you and your mates don’t allow me to discuss issues on your social media pages – why should I allow such brainless trolling here?

    I suggest you post these trolling comments on the FFNZ pages – they will love you.🙂

    But I may resort to moderation again to cut back on such trolling.

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  9. I know you want points on the topic, but some points are never made public. Some points are strictly kept personal or the government gathers the information but never releases it.

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  10. Taimana, could you please provide examples? As it is I have absolutely no idea what you are referring to.

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  11. I think you’ll find Taimana’s contention is essential to arguments commonly advanced by conspiracy theorists.

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  12. …and the specifics are never disclosed, because,… you know,….the nefarious they are controlling us through hidden means.

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  13. Bill Osmunson DDS, MPH

    Ken and Richard,

    Thank you for your response. In every country, state, province that I have searched, the laws are consistent. For NZ, check http://www.medsafe.govt.nz/Medicines/policy-statements/definition-of-med.asp
    Direct quote:
    “Medicine –
    means any substance or article that –
    is manufactured, imported, sold, or supplied wholly or principally for administering to 1 or more human beings for a therapeutic purpose; and
    achieves, or is likely to achieve, its principal intended action in or on the human body by pharmacological, immunological, or metabolic means; and
    includes any substance or article –
    that is manufactured, imported, sold, or supplied wholly or principally for use as a therapeutically active ingredient in the preparation of any substance or article that falls within paragraph (a); or
    of a kind or belonging to a class that is declared by regulations to be a medicine for the purposes of this Act; but
    does not include –
    a medical device; or
    any food within the meaning of section 2 of the Food Act 1981; or
    any radioactive material within the meaning of section 2(1) of the Radiation Protection Act 1965; or
    any animal food in which a medicine (within the meaning of paragraph (a) or (b)) is incorporated; or
    any animal remedy; or
    any substance or article of a kind or belonging to a class that is declared by regulations not to be a medicine for the purposes of this Act”

    There is not dispute, the intent of fluoridation in water is with the intent to prevent disease, dental caries. Fluoride when used to prevent caries is called a medicine in NZ and a drug in the USA.

    The question must be asked, is fluoride a food/nutrient?

    1. A nutrient is required for physiologic function. The absence of the nutrient results in a disease. For example, scurvy is the result of an inadequate intake of Vitamin C. Dental caries is not the result of an inadequate intake of fluoride.

    2. Fluoride is highly toxic and fits within the legal definition of poison or highly toxic substances, as little as 5 mg/kg is estimated as lethal for humans. Nutrients are not “highly toxic” “highly hazardous” substances. Concentrating any substance can make any substance hazardous. Fluoride compounds are used for many toxic purposes, pesticides, post-harvest fumigants, etc.

    3. Mother’s milk usually contains no detectible amount of fluoride. Infants do not need fluoride.

    4. NZ law requires a precautionary approach when scientific and technical uncertainty exists.
    “Precautionary approach
    All persons exercising functions, powers, and duties under this Act including, but not limited to, functions, powers, and duties under sections 28A, 29, 32, 38, 45, and 48, shall take into account the need for caution in managing adverse effects where there is scientific and technical uncertainty about those effects.
    Section 7: amended, on 31 December 2000, by section 4 of the Hazardous Substances and New Organisms Amendment Act 2000 (2000 No 89).”

    5. There are no randomized controlled trials of fluoridation’s efficacy. The US FDA once again, Jan. 2016, notified a manufacturer of fluoride supplements to stop marketing the unapproved sodium fluoride tablets as they are unapproved. In 1975 the FDA ruled the evidence was incomplete and over the last 40 years the FDA has still not approved fluoride for ingestion with the intent to prevent dental caries. Why? Evidence is incomplete. Lack of scientific evidence creates serious uncertainty.

    The US courts have ruled the ethics of public health interventions includes freedom of choice, unless the disease is lethal and highly contagious.

    Dental caries is not considered a lethal disease. More die from treatment than lack of treatment (both underscore the need for prevention.) Dental caries is not highly contagious. Therefore, the use of police powers to force everyone to ingest fluoride is unethical.

    Fluoride is not a nutrient. Fluoride is a medicine.

    Ken and Richard. Pause. Ask yourself some basic scientific questions.

    Safety? Do we want to protect everyone or just the mean/median/90th percentile?

    Dosage? What is the highest dosage ingested by the top 1% of those ingesting fluoride? Is that dosage safe? Some drink over 10 times the “average” amount of water. Where is the evidence that dosage is safe? Please provide the developmental neurotoxic animal and human studies and endocrine studies on safety.

    Efficacy? Where are the RTC studies on efficacy? Why does the US FDA consistent reject the ingestion of fluoride based on lack of evidence of efficacy?

    A substance which is unapproved by most of the highest medicine/drug regulatory agencies in the world (Europe, Australia, USA) given to people without their consent or knowledge, is not ethical.

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  14. Bill, your argument that CWF fluoride is medicine , which I do not accept, has no bearing on the separate issue of whether or not fluoride is harmful.

    If you argue that fluoride is harmful because it is toxic then you must argue the same for all other substances that are also toxic, at any level of ingestion. This leads to absurdities, and that is why you avoid examining your position in this regard.

    If CWF fluoride is harmful (it’s not) you are also left in the awkward position of having to deal with naturally occurring fluoride in water supplies, that life forms have been ingesting since the Cambrian era.

    On the big issues your positions are internally consistent and ludicrous. And finally, cherry picked studies do not overturn scientific consensus.

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  15. There was an obvious typo in my final sentence above, missing the prefix ‘in’. It should have read

    On the big issues your positions are internally inconsistent and ludicrous. And finally, cherry picked studies do not overturn scientific consensus.

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  16. Bill, you are mistaken in claiming there have not been any RCTs of the efficacy of fluoridation. See for example this for fluoridated milk:
    Stephen, K. W., Boyle, I. T., Campbell, D., McNee, S., & Boyle, P. (1984). Five-year double-blind fluoridated milk study in Scotland. Community Dentistry and Oral Epidemiology, 12(4), 223–229.
    Yes, I know you meant CWF. But I suggest you cite the RCT for chlorination of community water supplies. The fact you cannot find such studies is surely an indication to the person of average intelligence that such studies may not be possible. Justy imagine attempting the randomisation involved for households receiving reticulated water.

    The recent Cochrane Review made the point:

    “The majority of the studies did not blind outcome assessors. This is perhaps unsurprising when considering the efforts that may be required to blind assessors for this type of study.”

    And

    “However, there has been much debate around the appropriateness of GRADE when applied to public health interventions, particularly for research questions where evidence from randomised controlled trials is never going to be available due to the unfeasibility of conducting such trials. Community water fluoridation is one such area.”

    The American Academy of Pediatrics has commented in their article on the Cochrane review:

    “it would be a logistical nightmare to try creating a public water system that pumps fluoridated water to the first house on the block, delivers non-fluoridated water to the following two houses and then provides fluoridated water to the 4th and final house on that block.”

    This issue was discussed thoroughly in the debate here between me and Paul Connett – you participated in that discussion and it would seem it had no effect on you as you are peddling the same old tired (and debunked) arguments.

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  17. Ken you said my last comment was trolling when I thought it was comment on your words: “Similarly, the minority in a decision on CWF does not lose personal “freedom of choice.” If they are willing to take personal responsibility for their situation they can with very little effort, make personal arrangements. Those with a hangup about fluoride can use to filters or alternatives sources.”

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  18. Haven’t the faintest idea what you refer to, Brian

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  19. Ken, using alternative sources can double the cost of infant feeding. As for filters they may not be effective, or, they may reduce the mineral content to a dangerously low level as I said 4:23pm June 4.

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  20. Bill Osmunson DDS, MPH

    Richard and Ken,

    You simply do not make sense. You (and so was I) have been so blinded by a belief system of faith that fluoride is “safe and effective,” that you can not challenge your belief system. It is your religious belief.

    For 70 years proponents kept saying fluoridation was safe and effective at 1 ppm. Then proponents drop the concentration in water to 0.7 ppm, a direct and clear admission too many people are getting too much fluoride and 1 ppm is not safe for everyone.

    An RCT is possible, although I agree it would be difficult and perhaps costly. Those claiming an RCT is not possible (so did I, and the Cochrane review did not say it was not possible) have not thought the possibilities through. There are remote areas which have water delivered by truck. These could be double blinded and used in an RCT.

    Fluoride, when used with the intent to prevent disease, is a medicine (drug). The US FDA has testified to congress it is. In January of this year the FDA shut down a fluoride supplement manufacturer because the intention of sodium fluoride with intent to prevent disease has not been approved. When I was prescribing fluoride, I did not know the FDA had shut down many fluoride supplement manufacturers because the evidence of efficacy was incomplete. First, efficacy must be shown and then safety at the dosage which efficacy has been demonstrated.

    Measured evidence of cost effectiveness is certainly an easy study for insurance companies to do. They have the costs of dental treatment on their computers and know exactly the costs for each community, city, etc. Insurance companies for years have said they would release the data and have not. Instead, proponents use estimates of assumptions (estimates of costs and assumptions fluoridation is effective) small groups of cohorts, fail to control for numerous confounders and end up with gee whiz gossip rather than studies.

    We can do better. We put a man on the moon, certainly we can measure the cost of dental expenses comparing fluoridated communities with non-fluoridated communities. Yes, there are some welfare studies which were very poorly done. The best was comparing Portland vs Vancouver (Maupome) and they found enough savings to pay for the equipment repairs. But look at the data. Children in the non-fluoridated Portland had fewer caries than the fluoridated Vancouver.

    The AAP excuse of piping two water systems is simply a poor excuse. Take a developing community or a community which needs water upgrades to piping and in the same trench put two pipes. The cost of pipe is a relatively small cost of the water system. If we put a man on the moon, we can do an RCT of water fluoridation.

    You simply evade and minimize serious problems with fluoridation if they don’t fit your belief system.

    We have 50 human studies showing harm to the brain with fluoride ingestion. Many of the studies well within the dosage of many people on fluoridated water. But then dosage seems to fly over your head. The concentration of fluoride in water is not a dosage for the person drinking the water because many drink more than the mean amount of 1 L of water a day. What about those drinking 5 or 10 liters of water a day? Their dosage is 5 to 10 times the “mean.”

    The US EPA uses the 90th percentile of water drinkers. In other words, to hell with the 10% drinking more water. And ignoring the 10% drinking more than 2 liters a day, ignoring infants, and claiming people can have a third more fluoride and all is safe, the EPA admits a third of children will still exceed the EPA’s theoretical “safe” dosage. Which fits quite will with 41% of adolescents having dental fluorosis.

    Many are ingesting too much fluoride. Water is not a controlled dosage.

    And you jump back to chlorine for defense. . . which is not used to treat people but to treat water.

    And you totally miss, do not comprehend, toxicity and the definition of poisons and their regulation. There are many uses of fluoride. Lubricants, etching glass, pesticides, post-harvest fumigants, water fluoridation, medications, toothpaste, etc. Different agencies have regulatory oversight depending on the intent of use. If the intent is a pesticide, then the EPA (in the USA) regulates it. If the intent is as a medicine, then the FDA regulates it. In all 50 US states, sodium fluoride fits within the legal definition of poison, or highly toxic substance. No one disagrees. However, dilution of the poison does not change the definition. Just a tiny amount of arsenic does not change the regulational jurisdiction of arsenic. The same for fluoride. Fluoride, regardless of concentration is a poison, unless it is regulated as a medicine.

    You raise the argument of naturally occurring fluoride. Just because a toxin is found naturally in water does not make it safe Many places have lead, arsenic, and other toxins in their water. These are reduced or eliminated because they are not safe.

    There is some serious research reviews in the works and I do not know the conclusions, but stand by for some interesting fireworks on fluoride over the next few weeks.

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  21. Bill, your water delivery by truck is strictly not a reticulated water system used in community water fluoridation. However, if you are suggesting that – then go for it. The same for your double reticulation systems. And realise that the fluoridated milk study I cited does exactly what you are suggesting.

    The evidence for the efficacy of fluoridated water, milk or salt is so good such an RTC would be stupid and probably not approved by a sensible funding agency. If you disagree then make your proposal some funding agencies.

    Your attribution of religious views to me is something I have experienced often from religious people who object to my rational atheism and scientific approach. I don’t hold any respect for such stupid arguments.

    I have a background of scientific research requiring the ability to test ideas against reality. This process has enabled me to actually find some of my ideas were wrong – and to change them. It is not a new process to me.

    I have no ideological commitment to my current understanding if the science – I am happy to consider any scientific evidence you can produce to counter my understanding – but I will not change my views because an ideologically committed (and presumably commercially committed) person objects to them. Just show me how my understanding is out of step with reality – that is the most convincing arguments you could use.

    The fact you cannot or will not do this really discredits you comments.

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  22. Bill,

    You said: “And you jump back to chlorine for defense. . . which is not used to treat people but to treat water.”

    Tell us, then, what benefits the water has from it’s “treatment.” Is it healed from an illness? Does it have a longer, healthier life? No? Then perhaps it’s quality of life is improved?

    Both chlorine and fluorine are added to reticulated water supplies for the benefit of humans, not for the benefit of the water. Fluoride for the benefit of teeth in humans, chlorine to reduce the incidence of water-born illnesses in humans. If you define either of them as a medicine, then that definition also includes the other.

    Unfortunately for your belief/faith, the courts of the USA, New Zealand, and other countries, have independently decided that neither fluoride nor chlorine is a medicine when added to reticulated water supplies.

    You need to update your definition of “medicine” with that in mind.

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