Water fluoridation – what to expect in the near future

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Community water fluoridation (CWF) will persist in science news for the foreseeable future – not for any valid scientific reason but because of reaction to political pressures against it. This is particularly so in New Zealand where our parliament will be discussing legislative changes to fluoridation decision-making this year.

This is not to say that all the relevant news will be political. There is still ongoing research into the efficacy, cost-effectiveness and possible health effects of fluoridation. Although much of this is a response to pressure from opponents of this social health policy.

So what scientific and political news about CWF should we expect to see in the coming years?

The legislation

In the immediate future, this will be dominated by the new parliamentary legislation [Health (Fluoridation of Drinking Water) Amendment Bill– at least in New Zealand. However, US anti-fluoride campaigners are following this legislation very closely, and will probably become involved in submission on it, so I expect this will also get coverage internationally. At least in the alternative health media which has stong links to the US anti-fluoride activist organisation, Fluoride Action Network (FAN), and which routinely carry their press releases.

The NZ Parliamentary Health Committee is currently taking written submissions on the fluoridation bill. The deadline for these is February 2. Readers interested in making their own submission can find some information on the submission process in my article Fluoridation: members of parliament call for submissions from scientific and health experts.

The bill itself simply transfers the decision-making process for fluoridation from local councils to District Health Boards. But most submissions will inevitably be about the science and not the proposed changes to decision-making – and, considering the promise of the local anti-fluoride group to shower the committee with “thousands and thousands of submissions,” will misrepresent that science. I will be interested to see what allowance the committee chairman makes for such irrelevant submissions when it comes to the public hearings, which could begin as early as February.

The bill has support from all the parliamentary parties, except the small NZ First which apparently wants councils to keep responsibility for fluoridation decisions, but wants to make binding referendums obligatory. So, I predict the bill will be passed this year. However, there will probably be attempts at the committee stages to amend it to transfer decision-making to central government, probably the Ministry of Health. Such an amendment appears to be supported by the Labour Party, but not by the National Party.

The “IQ problem” – a current campaign

There will be some news about research on the question of possible cognitive effects of fluoride in drinking water in the next few years. Not because there is any concern about this among health professionals. But because the claim that fluoride causes a drop in IQ is pushed very strongly by anti-fluoride activists. While they have a long list of claimed negative health effects of fluoridation the IQ claim is currently central to their political campaigns.

The campaigners claim scientific support for this claim. But that support comes mainly from a number of poor quality papers outlining research results from areas of endemic fluorosis (where drinking water concentrations of fluoride are much higher than the optimum levels used for CWF), mainly in China. FAN has a lot invested in this claim because it financed the translation of many of these otherwise obscure papers into English.There is general agreement among health specialists that these studies are not relevant to CWF. Investigation of areas where CWF is used, and where natural fluoride levels are similar to those used in CWF have not shown any neurological effects due to fluoride.

There is general agreement among health specialists that these studies are not relevant to CWF. Investigation of areas where CWF is used, and where natural fluoride levels are similar to those used in CWF have not shown any neurological effects due to fluoride.

However, FAN is strongly pushing the idea that cognitive effects of fluoride (rather than very mild dental fluorosis) should be the main criteria used in determining the recommended maximum levels of fluoride in drinking water. They currently have a petition in front of the US Environmental Protection Agency (EPA) promoting this claim. This may make the news in the near future as the EPA must respond this month and the likely rejection of the petition will no doubt cause a flurry of press releases.

Paul Connett, who with other members of his family runs FAN, has also attempted to use the scientific publication path to promote this claim. His arguments and calculations defining an extremely low maximum concentration, are very naive and his draft paper has already been rejected by journals several times. However, he no doubt lives in hope for its eventual acceptance somewhere. If he is successful this will be trumpeted to the high heavens by his supporters because while they describe Paul Connett as the international authority of water fluoridation he actually has no proper scientific publications in that area.

Research on neurological effects

We expect some research publications in the next year or so from the current US National Toxicity Program research on claims that fluoride at the concentrations used in drinking water fluoridation could have neurological effects. This research is basically a systematic review – according to the proposal:

an “evaluation of the published literature to determine whether exposure to fluoride is associated with effects on neurodevelopment, specifically learning, memory, and cognition.”

The motivation for this work, apart from the political pressure arising from activist claims, is to attempt to evaluate possible effects at concentration relevant to CWF. (Most published animal and human studies have involved higher concentrations). As the proposal says:

“Previous evaluations have found support for an association between fluoride exposure and impaired cognition; however, many of the studies included exposure to high levels of fluoride. Most of the human evidence was from fluoride-endemic regions having high background levels of fluoride, and the animal studies typically included exposure during development to relatively high concentrations of fluoride (>10 mg/L) in drinking water. Thus, the existing literature is limited in its ability to evaluate potential neurocognitive effects of fluoride in people associated with the current U.S. Public Health Service drinking water guidance (0.7 mg/L).”

I discuss the background to the US National Toxicity Program fluoride research in my article Fluoride and IQ – another study coming up.

Canadian Professor Christine Till will soon start a study looking at cognitive and behavioral factors using a data set for pregnant women exposed to contaminants. She intends to investigate the possibility of relationships with markers for fluoride consumption (see ). Anti-fluoride campaigners hold out great hope for results from this study because Till’s previous research is widely used by them to claim that fluoridation causes increased prevalence of attention-deficit hyperactivity disorder (ADHD). However, that research was flawed because potential confounders were not considered properly. In fact, her reported statistically significant correlations disappears when the confounders are included (see  ADHD linked to elevation not fluoridation).

Problems in areas of endemic fluorosis

Health effects including cognitive deficits: The World Health Organisation recommends that drinking water fluoride concentrations should not be higher than 1.5 mg/L because of negative health effects of high concentrations. Many areas of the world do have high drinking water fluoride concentrations and those areas suffer from endemic fluorosis – dental and skeletal fluorosis. This is, of course, a serious problem and there is a continuous stream of research papers devoted to these areas.

This research is not relevant to CWF (where the optimum concentration of 0.7 mg/L or similar levels is used). But, of course, anti-fluoride campaigners will continue to cite these papers as “evidence” against CWF. We may even see an expert on endemic fluorosis being toured in New Zealand to provide scientific credibility to the anti-fluoride campaign. Dr. Ak.K. Susheela, who works on endemic fluorosis in India and has links with FAN, has been speaking at meetings organised by the anti-fluoride movement in North America and has been suggested as a speaker the local anti-fluoride campaigners should bring to New Zealand.

I expect there will be more papers reporting IQ deficits in areas of endemic fluorosis and these will most probably continue to use a chemical toxicity model to explain their results. I personally am interested in the possibility of researchers considering other models, such as the psychological effects of dental and physical deformities like dental and skeletal fluorosis (see Perrott et al. 2015. Severe dental fluorosis and cognitive deficits). Unlikely, considering how research can get locked into pet paradigms, but one can but hope.

Defluoridation: Another big issue in areas of endemic fluorosis is the need to lower drinking water fluoride concentrations. This if often done by finding alternative sources but there is continuing research on treatment methods to do this.

Again, not relevant to CWF – but I do follow this research and find some of it interesting chemically. Perhaps it reminds me of my own research many years ago.

Conclusions

The controversy around CWF is not going to go away. The opposition is strongly grounded in the “natural”/alternative health industry. It has plenty of financial and ideological resources and its message appeals to a significant minority of the population.

Most of the public interest this year will relate to the new legislation – expect plenty of press releases from the anti-fluoride groups as they organise to make and advertise their submissions, and express their anger at the probably inevitable decision that will go against them.

However, there will be a continuing dribble of research reports of relevance to CWF and to the claims advanced by anti-fluoride campaigners. While it is normal for a social health policy to be continually monitored and its literature reviewed, some of this research is a direct result of concerns raised by campaigners and activists.

Many in the scientific community find this sort of political activity annoying. But it does have its up side. CWF has been one of the most hotly contested social health programmes. Consequently is has received more than its fair share of literature reviews and new research.

And that is a good thing. Anti-fluoride activists often claim there is little research on the health effects of CWF. But that is just not true. Ironically it is the very political activity of such campaigners which has led to CWF being one of the most thoroughly researched social health policy.

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2 responses to “Water fluoridation – what to expect in the near future

  1. A helpful essay. Thanks.

    You have to wonder what new scary claims the anti-fluoridationists could yet make against fluoride. They have already pulled out the big guns — claiming it makes your kids dumb and your family fat.

    It is my opinion that the US HHS did a real disservice by needlessly changing the recommendation to 0.7ppm. Just like when thimerosal was removed from vaccines solely because of public fears, it made it look like the government had been allowing children to be harmed all along. That sort of reaction to public concerns doesn’t build trust; it destroys it.

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  2. Actually, Ken, since CWF has been around for decades, at least in Europe, USA, Canada, Australia, New Zealand, etc, the information is there, on the ‘net, to enable the anti-fluoridationists to demonstrate the effect of CWF on human intelligence.

    Most of those places that started CWF have been also been conducting school examinations for much longer than CWF has been around.

    So, it’s simple to compare exam results between non-fluoridated areas and areas with CWF. Or maybe compare exam results in single areas before and after CWF was introduced.

    I’m amazed that the anti-fluoridationists haven’t done so and published the results. Or maybe shouted out the results of others who have done so.

    Oh, wait…

    No difference in exam results between otherwise comparable CWF and non-CWF areas. Uniform gradual improvement in exam results in all areas, with no change in the rate of improvement when CWF was introduced.

    Data in the real world demonstrates no effect on school examination results from CWF.

    Perhaps that’s why the anti-fluoridationists continue to use (and translate) obscure papers from populations with endemic fluorosis rather than use data from populations that use CWF?

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