Critiques. Sept 2002: Chris Holdcroft

A new collaboration - but the same old story

One look at the Medical Research Council’s (MRC) Working Group (see Appendix) on water fluoridation membership list and you immediately realise that there was little chance of impartiality on the final outcome.

Hypocrisy and spin

It was as early as the ‘Lay Summary’ (Page 2) of the Final Report that the bias of the Group was exposed. It was falsely stated that:

“The York review, published in September 2000, confirmed the beneficial effect of water fluoridation on dental caries (cavities),”

This ridiculous claim was also repeated on Page 4 (Chapter 1.1, para. 2). A similar claim was also made on Pages 18 and 19. What Professor Sheldon (Chair of the ‘York review’) actually said of the findings was that:

“… the quality of the studies was generally moderate …” [1]

“Moderate” evidence doe not constitute a confirmation – it only merits a suggestion. This is supported by the final report of the York Review (Page 12 and the Executive Summary) which clearly states:

“The best available evidence suggests that fluoridation of drinking water supplies does reduce caries prevalence, both as measured by the proportion of children who are caries free and by the mean change in *dmft/DMFT score. The studies were of moderate quality (level B), but of limited quantity. The degree to which caries is reduced, however, is not clear from the data available.”

* dmft: mean number of decayed, missing or filled teeth in the deciduous dentition (first teeth) DMFT: mean number of decayed, missing or filled teeth in the permanent dentition. (MRC).

Ironically, the MRC did admit on Page 18 that:

“In particular, many studies had failed to take sufficient account of confounding factors.”

Furthermore, and although Prof. Sheldon claimed that there was some evidence that ”water fluoridation is effective at reducing caries”, the claim was based on just four dubious studies. [2] At least one of these studies was considered to be open to bias, one was very poor and all four did not control for confounding factors. This is hardly a sound basis for claiming that water fluoridation reduces dental caries.

The situation is exacerbated on page 8 under the Chapter title: ‘2.3.2 Presenting to the public the inevitability of uncertainty in research findings’.

“In an era when ‘science’ is under increasing public and political scrutiny, and in which the media can generate unrealistic and unachievable expectations of certainty or ‘proof’, there is a need to communicate honestly and openly about the levels of certainty that can and cannot be inferred from research findings. Uncertainty is an inherent feature of science and medicine, but this is a concept that seems not to be well understood by the public.”

Two significant points are raised. The first is: “a need to communicate honestly and openly” and the second is: “Uncertainty is an inherent feature of science and medicine”.

These two statements do sit easily together. We are informed by the MRC’s Report that the effectiveness of fluoridation is “confirmed”. If “uncertainty” is an “inherent feature of science and medicine” then how can the effect of water fluoridation be proven? It can’t and therefore the MRC should “communicate openly and honestly” and admit as much – but they haven’t.

Another nail in the MRC’s coffin is the further claim in Chapter 2.3.3. It states:

“It is important to explain simply the concept of differing ‘strengths’ of evidence that can be derived from different types of research design, as well as the changing methodological standards that have been used in research over time. For example, it is unrealistic in many fields to expect a study carried out in the 1970s necessarily to conform to the methodological standards judged appropriate in the 2000s. Also, the quality of research published on the Web and in other non-peer reviewed sources is unlikely to match that of research published in the standard scientific journals, and therefore generally carries little weight. Some members of the public (and many health professionals) may not yet be used to these concepts.” 

In the four studies used to ‘confirm’ the benefits of fluoridated water, one study was published in 1965, two in the eighties (1981, 1984), and one in 1997. Brown’s 1965 Brantford / Stratford / Sarnia (Canada) study, [2]  as well as being condemned as being open to abuse, is 37 years out of date. Beals’ 1981 Scunthorpe / Corby, (England) study [2] is also outdated and open to question. These two studies alone constitute 50% of the claim that fluoridated water is efficacious.

Rubbing salt into the wound

The MRC’s Report is not just about politicized science, there are some very salient and truthful admissions. One of the first is the acceptance that:

“There has been limited dialogue with the general public on the fluoridation issue.”

So who’s fault is this? Water fluoridation schemes fall under two broad categories concerning consultation. The first is that any schemes not agreed prior to the enactment of the 1985 Water (Fluoridation) Act were subject to public consultation.  Schemes agreed before this time could proceed without any further consultation.

Both scenarios have been open to abuse by Health Authorities (HA[s]). In Worcester, the HA had already a pre-existing agreement to extend water fluoridation but did not consider it worthwhile or prudent to indulge in further consultation. It was stated that consultation had taken place in the 1970s and the Director of Public Health did not consider it necessary to indulge in any further dialogue. Essentially, the pre-existing agreement was sufficient to defeat any attempt to raise more contemporary concerns and issues.

Similarly, post-1985 schemes which were subject to consultation, were equally prone to abuse. Examples of HAs consulting with local authorities have demonstrated quite clearly that the consultation process is merely cosmetic. This is because consultation is not binding and regardless of the evidence presented against fluoridation, or the opposition of the local authorities involved, some HAs have abused their power and have attempted or proceeded with water fluoridation schemes against the will of the local authorities and their populations.

The MRC have gone some way to mitigating the situation by highlighting the following observation (Chapter 2.3.4: Public perception of fluoridation):

“A study with focus groups in three non-fluoridated areas of England (Hounslow, Leeds and Oldham) indicated that members of the public wish to be informed of water fluoridation plans but do not see themselves as being appropriate arbiters of decisions about implementation (Lowry et al., 2000). However, even where the public does not wish to make decisions, this does not imply that this opportunity should be withdrawn.”

Chapter 2.3.5: ‘Information needs’ adds:

“Listed below are some specific issues that could usefully be communicated to the public about water fluoridation:

• The actual coverage of water fluoridation in the UK at present (many assume it is more widespread than it is)
• The consequences of not preventing dental caries – costs, morbidity and mortality
• The strength of evidence on the efficacy of (and problems associated with) alternatives to water fluoridation
• The nature, effects and degree of aesthetic impact of dental fluorosis

The common sense view is that benefits should outweigh the risks (Chapter 2.3.6: What is most important to the public?). Both preventive benefits and potential harms must be set out clearly and consistently to avoid confusion and mixed messages to the public. Of course, the public may view the potential harm as more significant than the benefits, even though the numbers involved might be much smaller; people may feel that they are being asked to compare apples and oranges.”

The MRC appear to be ‘leading the horse to water’ but trying to imply that it should not be encouraged to drink unless it really is thirsty. By indicating that the general public should be informed of potential fluoridation schemes, but also indicating they may not wish to vote on the issue, merely reinforces what some HAs have been doing for quite some time – requesting implementation of fluoridation without giving the local population the final say.

It should also be questioned on who should be allowed to ‘educate’ a local population when fluoridation is proposed. Because it is a contentious issue it should be permitted for both opposing camps to present their arguments. It is feared, however, that the pro-fluoridation HAs may try to deceive the general public by pretending to present a ‘pro’s and con’s’ argument. This must not be allowed to happen but it has been demonstrated on many occasions that those who claim to be in the best position to decide are usually the HAs who will almost exclusively rig their argument to justify their decision to fluoridate.

One of the “specific issues” which has been subject to the biased views of the pro-fluoride lobby is the following:

“The consequences of not preventing dental caries – costs, morbidity and mortality”

Emotional blackmail and the inducement of financial gains have been employed on a regular basis by the pro-fluoride lobby without any regard to the accuracy or validity of their arguments.

As for ‘benefits and risks’, there is no argument. Because water fluoridation is an absolute measure, those who are sensitive to the chemical will not be able to escape it’s consequences. Where the risk is accepted, it must be for the individual to chose whether or not they wish to supplement their diets with fluoride. Mass medication (or supplementation) of a population would be a reckless step to take where any risk exists.

The Chapter concludes with a mention of opinions based on “outrage” rather than “the magnitude of the potential risk”.  Yes, water fluoridation is a volatile issue that does sometimes give rise to heightened emotions. But it is not so much the pros and cons of fluoridation as the issue of trust and civil liberties.

Because the ‘establishment’, the government, some dentists and their unions, and some doctors sometimes resort to dishonesty to defend fluoridation, it merely serves to ‘raise the hackles’ of those who feel threatened by water fluoridation.  If those who distort the truth on water fluoridation were to be completely open and honest then there would be less “outrage”. Unfortunately, the pro-fluoride lobby have on many occasions not shown any desire to be sincere and this is the main cause of public outcry.

Improvements in dental health since 1973

In Chapter 3.2: Sources of fluoride exposure, it is stated:

“… in the 1970s fluoride started to be added to toothpastes and by 1978 96% of toothpaste on the market contained fluoride, usually at a concentration of 1000 to 1500ppm (though it should be noted that in the UK lower fluoride toothpastes containing about 500ppm fluoride are now available for use by children).”

It is true that between 1973 and 1993 that dental health has improved dramatically in England and Wales, by (commonly) around 50%-75%. [3]

So how was this achieved mostly without the alleged benefit of water fluoridation? Whatever the impact of toothpaste one thing is certain – attitudes to dental health have changed and this will also have made some contribution to the observed improvements.

The MRC also observe on Page 18 (4.1.2: Implications):

“The reduction in sugar consumption in UK children since the 1960s and the introduction of fluoride toothpaste in the 1970s led to substantial reductions in dental caries (Todd & Dodd, 1985). However, these reductions were not uniform and led to widening social inequalities in children’s dental health.”

And on Page 21:

“Diets of more socially deprived children are more caries conducive than diets of more affluent children, and more affluent children brush their teeth with a fluoride toothpaste more often than do more socially deprived children (Hinds & Gregory, 1995).”

The salient point is this: if dental health can be improved dramatically without the use of fluoridated water, and one scheme in Lanarkshire, Scotland in recent years has demonstrated this, then how much impact would fluoridated water have on a community? One of the concepts employed in Lanarkshire was to reduce the consumption of sugary products.

It is also distinctly possible, and in some cases probable, that when fluoridation has been introduced in certain communities, efforts outside of fluoridation have been employed to improve dental health. Brown’s comments on his 1965 study certainly implied this:

“the recordings  so far obtained indicated both a high treatment level and an apparently better oral hygiene status of the Brantford children when compared with the controls, and it is therefore suggested that caution should be exercised in the interpretation of the rates shown. The lack of a prefluoridation survey on a comparable basis is a further limiting factor in interpreting the results.” [Ecologist, vol. 16, no. 6, 1986]

Geography and ethnicity

No one would argue that there are wide variations in dental health throughout the UK. Ethnic origin will also have some impact, especially where there are relatively large population concentrations.

The MRC’s slant on this issue is:

“The British Dental Association has suggested that water fluoridation should be targeted to high risk communities in order to try to reduce the widespread geographical and social inequalities in dental health.”

What appears to have been missed, despite its glaringly obvious presence in every BASCD annual study [4] of dental health, is that strong geographical variations exist between similarly socially deprived non-fluoridated areas. For example, while some communities in the North West of England may have high levels of tooth decay, there are some similarly deprived communities in the Central London area with much less ‘dmft’. Ethnic variations in local populations will also add another dimension to geographical variations.

The MRCs “Research recommendations” (Chapter 4.1.3) ask for “further studies”. This is a dangerous proposition. There are already enough fluoridated communities in which to analyse the effects of fluoridation. It would also be possible to de-fluoridate certain communities and compare them to local populations where fluoridation still exists. It has already been demonstrated in other studies that where fluoridation is stopped, there is no real change in the dental health of such communities.

In a nutshell, the MRC are just using the “further studies” argument to bring in more fluoridation schemes by stealth – not that this has come as a surprise to those who are more informed about the measure.

Fluorosis

One of the oldest tricks in the book is to provide an opposite argument to a proposition which cannot be readily disproved.

This is especially true of fluorosis with the MRC making the following comment (4.2.2: Research recommendations):

“There are discrepancies between the dental fluorosis data reported by the York Review and recent data from the UK and Europe.”

The MRC are quite happy to misrepresent the York Review by making misleading claims about the efficacy of fluoridation and not giving due consideration to any opposing arguments. But when it comes to fluorosis, where evidence showing that the use of fluoride is clearly linked to the condition, the MRC attempt to defuse the situation by trying to undermine the Review’s evidence.

There is also the question of the ‘meaning’ of fluorosis. The MRC appear to propose that it is merely a cosmetic issue 

“Further studies should determine the public’s perception of dental fluorosis with particular attention to the distinction between acceptable and aesthetically unacceptable fluorosis.”

Prof. Sheldon of the York Review stated:

“The review found water fluoridation to be significantly associated with high levels of dental fluorosis which was not characterised as 'just a cosmetic issue'.” [1]

It has been said that the teeth are the ‘windows of the skeleton’ and that the presence of fluorosis can suggest possible skeletal problems at some later stage of life. That is unless the dental fluorosis is so severe that it may already be accompanied by some form of skeletal disorder (as seen in India).

Regardless of the severity of dental fluorosis, it still represents a warning sign for those affected and is NOT just a cosmetic issue.

There is also the issue of psychological and physical trauma. Children who are too afraid to smile because of their stained teeth or children who’s permanent dentition is pitted and damaged by fluorosis are just two examples. This is of course not to mention the high cost of repairing or cosmetically altering teeth damaged by fluoride.

The only reasonable conclusion is that the MRC’s statement on “acceptable” fluorosis is both disgraceful and insulting to those afflicted.

Nailing their colours to the mast

In ‘Chapter 4.3: Effects of social class’, the MRC show their true nature:

“Water fluoridation has advantages over other possible caries preventive measures in that it reaches everyone in a community who is on a public water supply. It is therefore seen as an equitable public health measure, and there has been considerable interest in the question of whether water fluoridation benefits most those people at greatest risk of dental caries, ie the more deprived members of a community. If so, water fluoridation could be an important means of reducing inequalities in oral health.”

The MRC make it quite clear of their support for fluoridation. This is not surprising since the Working Group is so heavily loaded with established pro-fluoridationists. The consequences are that any further research projects will be distorted by misguided preconceptions of the value of water fluoridation.

Fluoride and Cancer

The MRC resort to the lowest denominator of unscientific deceit. On Page 29, the MRC says:

“Several studies have analysed data sets from ten fluoridated and ten non-fluoridated cities in the USA (Yiamouyiannis & Burk, 1977; NHMRC, 1999; NHS CRD, 2000). With the exception of the analysis by Yiamouyiannis & Burk, which did not adjust appropriately for sex, age and ethnic group, none of these analyses has suggested that overall cancer mortality rates were positively associated with fluoridation.”

The remarks made about the Yiamouyiannis & Burk study is not just a half-truth, it is also a ‘half-lie’. In his book, Fluoride: The Aging Factor,  Dr Yiamouyiannis pointed out that after making the necessary corrections for “sex, age, and ethnic group”, that:

“… approximately 10,000 excess cancer deaths per year could be attributed to fluoridation in the United States.”

The full extract is given below:

“Chapter 18 (Pages 164/5). The Conspiracy: ‘Containing’ the Cancer Link

In 1975, Dr. Yiamouyiannis published a preliminary survey showing that people in fluoridated areas had a higher cancer death rate than people in nonfluoridated areas. When this material got into the hands of Mr. Small, he enlisted the aid of Drs. Robert Hoover and Marvin Schneiderman of the National Cancer Institute to refute these findings. Dr. Hoover's first claim was that the nonfluoridated areas (Los Angeles and Houston) had relatively clean air and that the increase in cancer death rate in these areas was lower than in fluoridated areas because their lung cancer rates were lower. First, it is obvious that Los Angeles and Houston did not have clean air and secondly, Dr. Yiamouyiannis showed that the increase in cancer death rates in fluoridated areas was not due to lung cancer but to other cancers.

In 1975, Dr. Dean Burk, chief chemist of the National Cancer Institute (1939 to 1974), joined with Dr. Yiamouyiannis in performing additional studies which were published in the Congressional Record by Congressman James J. Delaney, author of the Delaney amendment prohibiting the addition of cancer-causing substances to food used for human consumption. Both of these reports confirmed the existence of a link between fluoridation and cancer.

In attempting to refute these findings, Dr. Hoover and Dr. Schneiderman claimed that Drs. Burk and Yiamouyiannis had not corrected their figures for age, race, and sex and that when such corrections were made, the increase in cancer death rate found by Burk and Yiamouyiannis disappeared.

In the fall of 1977, two full hearings on fluoridation and cancer were held before Representative L.H. Fountain's Congressional Subcommittee on Intergovernmental Relations. At these hearings, Dr. Yiamouyiannis showed that Dr. Robert Hoover's group and Dr. Donald Taves of the University of Rochester, in adjusting for age, sex, and race, had left out 80 to 90% of the relevant data.

In addition, he pointed out that Dr. Hoover's group had made an error in its calculations. When these errors and omissions were corrected, the very same age-sex-race corrections used by Dr. Hoover and Dr. Taves, confirmed the results of Drs. Burk and Yiamouyiannis showing that approximately 10,000 excess cancer deaths per year could be attributed to fluoridation in the United States.

During the hearings, Congressman Fountain, chairman of the subcommittee, showed that Dr. Hoover and other National Cancer Institute officials had purposely withheld information from Drs. Burk and Yiamouyiannis and clandestinely sent erroneous data to Dr. Leo Kinlen and Sir Richard Doll, professors at Oxford University and representatives of the Royal College of Physicians, who published the erroneous data as if it were their own. Not content with this duplication of data, Dr. Kinlen passed the data on to Dr. David Newell and Peter Oldham, representatives of the Royal Statistical Society, who again republished the same erroneous data. As in the original Hoover study, when errors and omissions in these studies were corrected, they also confirmed the results of Drs. Burk and Yiamouyiannis showing that approximately 10,000 excess cancer deaths per year could be attributed to fluoridation in the United States.”

The MRC should hang their heads in shame at trying to deceive the reader with their own brand of propaganda. However (and conversely), the MRC do make the following admissions (despite the usual tactic of trying to prove the opposite) in Chapter 5.2.6: ‘Plausibility of effect’:

“Very high levels of fluoride have long been known to be toxic, but the features and consequences characteristic of fluorosis in humans and other animals have not included the occurrence of cancer. Most agents that cause cancer directly do so because they are genotoxic, although some (non-genotoxic) agents can cause or promote cancer by other mechanisms, for example by stimulating cell division.

For fluoride, in vitro genotoxicity data are mostly for doses much higher than those to which humans are exposed. Even at these high doses, genotoxic effects are not always observed (NRC, 1993), and fluoride is consistently negative in the Ames test (DHHS, 1991). Some in vivo studies have shown that fluoride can in some circumstances induce mutations and chromosome aberrations in rodent and human cells.

Overall, the evidence available has not established that fluoride is genotoxic in humans, and most of the studies suggest that it is not, but the possibility of some genotoxic effect cannot be excluded (DHHS, 1991; NRC, 1993).

Fluoride can have a mitogenic effect on osteoblasts (Bucher et al., 1991); this could provide a mechanism by which fluoride could increase the risk for osteosarcoma.”

Allergy

Regarding allergy (Chapter 5.3.1: ‘Immunological effects’) the MRC says:

“Page 32: 5.3.1 Immunological effects: Information regarding the allergic potential of fluoride in drinking water is sparse. A paper by Spittle (1993) concluded that some individuals exhibit an allergic/hypersensitivity reaction to fluoride, but reviews by NRC (1993), NHMRC (1991), and Chalacombe (1996) all concluded that the studies undertaken do not support claims that fluoride is allergenic. They considered the weight of evidence to show that fluoride is unlikely to produce hypersensitivity or other immunological effects. There is no information on the immunotoxicity of fluoride. Further work in this area would be useful, but in the absence of obvious toxic mechanisms for such an effect is considered to be of low priority.”

Again, the MRC cannot disprove allergic-type effects but attempt to suggest the opposite effect. Interestingly, during the passage of the 1985 UK Water Fluoridation Bill, a speech was delivered by former Member of Parliament, Sir Ivan Lawrence. He said:

"I now come to a report that I received during the Committee stage from ... Mr C W M Wilson, MA, MD, B.Sc, D.Ph, Fellow of the Royal College of Physicians, Edinburgh and Fellow of the Royal Society. "We carried out some animal experiments in Strathclyde University. This controlled investigation demonstrated that sensitivity to fluoride ions could be induced in guinea pigs and that the resulting allergic effects could be equally effectively produced by fluoridated tap water. This fluoride sensitivity could be potentiated by simultaneous challenge by food protein. Attention is drawn to the possibility of enhancement of food-induced allergic symptoms by preparing and cooking food in fluoridated water. The major scientific conclusion which can be drawn from these results is that evidence is now available which shows that fluoride can exert pathophysiological disordered function effects by virtue of its immune sensitising action rather than through its toxic action. A relatively high proportion of the population is food and water contaminant sensitive and in consequence is potentially vulnerable to allergic challenge. These allergic individuals are not protected by limiting fluoride ion concentrations in mains water to one part in 1 million." [Commons Hansard, 1985, column 973]

Will the MRC now reconsider their position?

The Kidneys / Stomach

Chapter 5.3.4: ‘Renal effects’, reads as follows:

“The kidney is a potential site of acute fluoride toxicity because of its exposure to relatively high fluoride concentrations (NRC, 1993). It has been established from human studies that the kidney removes fluoride from the blood more efficiently than it removes other halides. In addition, renal clearance of fluoride decreases in individuals with renal insufficiency or diabetes mellitus. However, several large community-based epidemiological studies found no increased renal disease associated with long term exposure to drinking water with fluoride concentrations of up to 8mg/l (DHSS, 1991; NRC, 1993).

It is plausible that the kidney could be a target for fluoride toxicity, and there is limited evidence for kidney effects in experimental toxicity studies in animals. Further investigation is therefore warranted to determine the level of toxicity, if any, following low level intakes in humans. However, in view of the negative results in the epidemiological studies mentioned above, this is not considered to be of high priority.”

Chapter 5.3.5: ‘Gastrointestinal tract’ reads:

“With the exception of monofluorophosphate, high concentrations of fluoride releasing compounds form hydrogen fluoride on mixing with hydrochloric acid in the stomach. Hydrogen fluoride can be irritating to the gastric mucosa, resulting in dose-dependent adverse effects. The data for human effects at low exposure are limited, but the indication is that gastrointestinal effects are not a problem at optimal drinking water fluoride concentrations (DHSS, 1991; NRC, 1993).

… The effects of fluoride on the gastric mucosa have been described in detail by Whitford (1996). Gastric irritation, by release of hydrogen fluoride in the stomach at high doses of fluoride intake, is plausible. However, it is unlikely that sufficient hydrogen fluoride will be released from the low concentrations of fluoride in drinking water in the UK to cause irritation in healthy individuals. It is possible that individuals who have an existing stomach disorder may be susceptible to irritation following ingestion of fluoridated water, but there is no published evidence for this. This issue is considered to be of low priority for further research.” 

Picture 1	Picture 2	Picture 3

Three pictures of a stomach wall. Picture 1 is a healthy stomach. Picture 2 shows that some of the microvilli are missing (F at 1.2 ppm). Picture 3 is the ‘cracked clay’ appearance of a stomach badly damaged by the ingestion of fluoride (F at 3.2 ppm). Pictures from Prof. A K Susheela.

In 1985, the year the Water Fluoridation Bill was rushed through Parliament, the Department of Health & Social Security issued a Safety Information Bulletin (ref: SIB [85] 2). Item 3 states:

"Where haemodialysis is undertaken with fluoridated water, serum fluoride levels in the patient could be considerably higher than in the case of persons consuming the water in the normal way." 

Although Item 4 states that no documented cases of fluoride toxicity have been reported, it goes on to say that:

"... minimum exposure by this route is desirable."

Dialysis treatments can use in the region of 120 litres of water. This makes 120 mg of fluoride if the water has been fluoridated. However a manufacturer of water purification systems for hospitals has said that while he has never been officially requested to provide a system to remove fluoride from water, his company's equipment would in fact do the job quite well. What he actually said was that the equipment would remove 95% of all fluoride. This means that 5%, or 6 mg, will remain in 120 litres of treated water. If the water is not treated, then 120 mg of fluoride passes through the patient’s body.

A further dangerous scenario exists where there is a possible breakdown of fluoridation equipment. Although most media stories on such breakdowns have originated in the USA, it is always a possibility that fluoride concentrations in water may far exceed the 1 part per million level. The dangers therefore posed to fluoride-sensitive individuals is enormous.

Brain (Intelligence) / Thyroid

While fluoride’s effect upon the brain is open to many disturbing theories, based on both animal and human studies, the issue of thyroid-related problems has been well investigated by the organization known as Parents with Fluoride Poisoned Children (PFPC).

A visit to the PFPC website (http://64.177.90.157/pfpc/) will yield much information on the subject, including the serious allegations made about the conduct of the York Review.

What’s in the water? (Chapters 5.3.9 through 5.3.13)

The MRC reports:

“Chapter 5.3.9: ‘Indirect effects of adding fluoride to water’. In addition to any direct impact on health resulting from increased uptake of fluoride by the body, it is possible that fluoridation of water supplies could influence health through other mechanisms. In particular it is necessary to give consideration to the possibility of:

• toxicity from other substances added to water as part of the fluoridation process;
• an effect of higher fluoride in water on dietary exposure to toxic metals (eg through leaching of copper from pipework and dissolution of aluminium from cooking pans); or
• an effect of fluoride in drinking water on the uptake / bioavailability or toxicity of metals in the gut.

The importance of these theoretical hazards will depend on the inherent toxicity of the substances concerned and the impact, if any, of fluoridation on the dose of the toxins. In addition, it is possible for the presence of other substances in water and food to affect the absorption of fluoride (see also Exposure section) and therefore reduce the effectiveness of an intended caries preventive dose.”

Chapter 5.3.10: ‘Substances added during the fluoridation process’. The UK’s Water (Fluoridation) Act 1985 allows hexafluorosilicic acid (H2SiF6) and disodium hexafluorosilicate (Na2SiF6) to be used to increase the fluoride content of water.

Chapter 5.3.11: ‘Dietary exposure to metals’: Enhanced leaching of metals from water pipes and cooking utensils can occur if the fluoridation process significantly alters the pH of the water. This can happen in abnormal (accidental) circumstances. For example, incidents in Westby, Wisconsin and New Haven, Connecticut USA, resulting in peak fluoride levels of 150ppm and 51ppm respectively, reduced the pH value of the water and caused copper to be leached from plumbing [http://www.fluoridealert.org/accidents.htm].

Studies on the leaching of aluminium from cooking utensils at standard fluoride concentrations in the region of 1ppm have indicated a small (5%) increase in leaching compared to non-fluoridated water (Moody et al, 1990).These studies indicate that aluminium leaching resulting from water fluoridation is not a significant cause for concern.

A number of observations:

1.      The addition to water of either H2SiF6 or Na2SiF6 is covered by Section 87(4) of the Water Industry Act 1991. However, Section 88(1) also states that:

“The Secretary of State may by order amend section 87(4) above by – (a) adding a reference to another compound of fluorine;”

Essentially, this means that any fluorine-related substance can be added to water. This can include drugs (tranquilisers, etc.), nerve gases (such as Sarin - but which would likely become diluted into the chemicals constituent parts), other industrial wastes, etc. The total list of possible ‘references of fluorine’ could be quite long.

2.      The silicofluorides licensed for use in the UK come straight from the smokestacks of the (mostly, if not exclusively) phosphate fertilizer industry. They are not purified and they are not ‘pharmaceutical’ grade. The Irish group Fluoride Free Water (http://www.fluoridefree.com) managed to obtain the following documents which were accessed under the Freedom of Information Act 1997. They expose the contaminants in H2SiF6.

Table 1 (Importer: Albatros Fertilizers Ltd, Wexford)

Table 2

(Chemical Analysis by: Cal Limited, 95 Merrion Square, Dublin 2, Ireland. Tel: Dublin+ 353 1661 3033. Fax: Dublin + 353 1661 3399)

NB. The following report has been reformatted as a spreadsheet for ease of use and each contaminant has been listed in alphabetical order:

CHEMICAL ANALYSIS CONFIDENTIAL REPORT No. W8158 

3.  On April 25, 2002, The USEPA (United States Environmental Protection Agency) placed an appeal on the internet for assistance to establish how silicofluorides behave when added to water. The document can be found at: http://www.epa.gov/ORD/NRMRL/wswrd/rfa-fluoride.pdf.

The disturbing issue is that after so many decades of water fluoridation, the USEPA does not know what happens to silicofluorides when they are introduced to water. It has always been alluded by supporters of fluoridation that when silicofluorides are added to water they break down completely and form fluoride ions. But silicofluorides appear NOT to completely disassociate. In layman's terms this means you do not always get a simple fluoride ion when adding silicofluorides to water. The only research mentioned to date suggests that only about 2/3rds (4 of the 6 parts of fluorine in H2SiF6) will actually form fluoride ions (see: http://www.dartmouth.edu/~rmasters/FOREWO~3.DOC).

Aluminium / Lead (Chapter 5.3.12)

The MRC appear to be a little nervous about the possible effects of the interactions of fluoride with aluminium and lead. The only suggestion made is that “… this area be kept under review.” This is not sufficient. If the MRC were as interested in this area of research as they are in propagandising the alleged benefits of fluoridated water, then they would take the potential dangers from these two metals more seriously.

Further Research

Chapter 6 of the MRC Report concentrates on conclusions and research recommendations. It is the research recommendations that demand further comment.

[1] Natural and artificially fluoridated water.

The MRC says:

“… if the bioavailability is the same, many of the findings relating to natural fluoride can also be related to artificial fluoridation.”

The next two tables to help the reader comprehend the differences between different fluorides. The first is Professor Kaj Roholm's three categories of inorganic fluorine compounds.  It should be noted that Prof. Roholm is the author of the first and most comprehensive monograph on fluorine toxicity.

Table 3

This table is former Aston University chemist Malcolm Harris' table of solubility ("... a critical aspect of toxicity") of 1971;-

Table 4

Calcium fluoride	natural	Solubility = 16 ppm at 18ºC and 17 ppm at 26ºC
Sodium Fluoride [1]	artificial	42,200 ppm at 18ºC
Sodium fluosilicate	artificial	6,520 ppm at 17ºC
Hydrofluorosilic acid [2]	artificial	miscible liquid

These data suggest that you cannot compare natural and artificial sources of fluoride. This should also influence the second recommendation of the MRC concerning bioavailability of the two sources of fluoride.

[2] Dental caries

The section on dental caries uncontroversial providing it is based on existing fluoridation schemes and not as a consequence of introducing new populations to this measure.

[3] Dental fluorosis

Regrettably, the MRC again refer to the recommendation on dental fluorosis, describing it as being either “acceptable” and “aesthetically unacceptable fluorosis”.

[4] Social class

Social class is one area where improvements in non-fluoridated communities can yield important results using other interventions.

[5] Bone health (hip fractures) and cancer

These are serious issues and must be dealt with intelligently, honestly and impartially. Unfortunately, and because of the pro-fluoride agenda, it is feared that the work conducted in these areas may be subject to bias. Although this will be interpreted by some as a cynical view, history is littered with stories of various institutions concealing evidence of harm from various research projects. Presented below is an article on ‘sleazy’ research tricks which may make the layperson think more carefully about the value of scientific research.

Sleazy Research Tricks

According to the rules, theories attain the status of facts after they have been rigorously tested by reliable, replicable, high-quality research. In practice, a substantial body of studies supporting a given theory, published in the best journals (e.g. New England Journal of Medicine, Science, and the Journal of the American Medical Association), establishes that theory as 'fact'.

Often, however, the harried researcher, pressed for time in the pursuit of lucrative grants or frustrated by studies that refuse (for unknown reasons) to produce the desired results, has recourse to certain shortcuts.  It is important to note that the underlying active Ingredient in any of the following ploys is usually a powerful 'tell us what we want to hear' effect.  If your study 'proves' something that the prospective funder wants to believe, there will rarely be any problem.

Big-Naming:  Get a big- name scientist as co-author, and the backing of a prestigious research institute or university ('backing', in this case, can be as minimal as use of a Ietterhead and address) and you're in business.

Circular Referencing:  Researcher A mentions in a footnote that Compound X as been "proven" completely harmless.  Researcher B quotes A, and is In turn quoted by Researchers C, D and E.  The next time Researcher A discusses the topic, he cites the papers by B, C, D and E as further proof of his ori8i al claim.  If someone tries, to pin you down on your original footnote, cite a "personal communication" (e.g., phone call or unofficial letter) with another scientist.  It's best if your personal communicant lives far away, is difficult to reach, doesn't speak English or, better still, is dead.

Step-Wise Exaggeration:  Researcher A publishes a study proposing that smoking is responsible for 8% of all lung cancer.  Researcher B cites the study, saying that smoking is responsible for "nearly a tenth” of all lung cancer.  Researcher C translates this to 10% and Researcher D points out that since smokers are only half the population, this 100% is really 20%.  Researcher E casually refers to D's paper, giving the statistic as "almost a quarter" of the population, having forgotten that it was only smokers that D was talking about.  Finally, Researcher A, upon, reading E's report, notes that current studies now show that smoking is responsible for three times as much of the lung cancer as he originally thought, i.e., 25% instead of 8%.  When A's statement is published prominently in several major daily newspapers, Researchers B, C, D and E all triple their previous estimates, citing the highly respected A.  Thus the original 8% has ballooned up to 75% in E's revised estimate.

Naive Subtraction:  Researcher A decides to estimate the environmental causes of cancer by taking the known cancer rate and subtracting all 'proven' sources of cancer from it.  By using generous estimates for these causes (preferably lifestyle factors like smoking and diet), Researcher A finds that only 2-3% of all cancers are “unexplained”.  This tiny residual thus becomes the ceiling figure for environmentally caused cancers.

Dry-Labbing:  To ‘dry-lab’ a study means to fake it; to make up the numbers without actually bothering with all those test tubes and things.  The chances that anyone will ever ask you to produce your original lab reports and notebooks are pretty slim.  Recent experience shows that even if a lab worker sells out and denounces you, he or she is unlikely to be believed.  Of course, someone could replicate your study and fail to get the same (i.e. faked) results; but you simply accuse him or her of screwing up somewhere.  It will take, at the very least, several years for anyone to sort it all out.

Competing Toxicity: The FDA has demanded, as a pre-condition to licensing, that DeathCo's new product, Liquid Death, be tested for its potential to cause cancer.  So DeathCo gives Liquid Death to 17,000 mice - but at a dose so high that they all die within weeks.  Since It usually takes several months for a tumour to develop, very few cancers are reported.  Such a high death-rate could be some cause for concern.  However the FDA didn't ask, "How many mice will drop dead in weeks?”; it asked, “How many will develop cancer if they are given Liquid Death?".  DeathCo's study is published as 'proof' that Liquid Death doesn't cause cancer, “even when very high doses are administered".  This 'proof' stands unchallenged until someone with 17,000 spare mice is able to replicate the study.

(Source: Hippocrates Newsletter, late 1997; Hippocrates Health Centre, Elaine Avenue, Mudgeeraba Qld 4213, Australia.)  http://www.doctorsaredangerous.com/

Appendix

MRC Working Group Membership:

Professor Anthony McMichael (Chair; London School of Hygiene & Tropical Medicine – left the Working Group July 2001);

Dr. Paul Harrison (Deputy Chair; MRC Institute for Environment and Health, Leicester);

Professor David Coggon (MRC Environmental Epidemiology Unit, Southampton);  

Ms Ailsa Harrison (MRC Consumer Liaison Group);

Dr.Timothy Key (University of Oxford);

Professor Michael Lennon (University of Liverpool);

Dr. Peter Mansfield (Lincolnshire – left the Working Group September 2001);

Professor Stephen Palmer (University of Wales College of Medicine);

Dr. Mark Petticrew (MRC Social and Public Health Sciences Unit, Glasgow);

Professor Nigel Pitts (University of Dundee);

Professor Andrew Rugg-Gunn (University of Newcastle);

Professor Elizabeth Treasure (University of Wales College of Medicine);

Dr.Alan Glanz (Department of Health);

Dr. Michael Waring (Department of Health);

Mr Jerry Read (Department of Health);

Dr.Anthony Peatfield (MRC Head Office, replaced by Dr Declan Mulkeen in September 2001),

Dr.Angela Cooper (MRC Head Office, replaced by Dr Matthew Wakelin in July 2001).

References

[1] Commons Hansard, 29 Jan 2001 : Column 147.

[2] Brief Analysis of the York Review (on this site).

[3] Children’s dental health in the United Kingdom 1993 (OPCS).

[4] www.dundee.ac.uk/dhsru/bascd/bascd.htm.

Recommended further research

www.fluoride.org.uk