Fluoridation Update

(Below is the full report on fluoride; the printed copy in the August 2003 Sound Consumer reflects a summary.)

(August 2003) — Fifty-eight years ago, government officials in Grand Rapids, Mich., decided to put something in the water. It was called fluoride, it was a toxic byproduct of the aluminum and fertilizer industries, it was used in production of the A-bomb, and dental researchers swore it would transform teeth into a living, gleaming white fortress against tooth decay. Opponents said it would make us sick, or make us think like Communists, or, at least, subject us to a government program of mass medication.

Now, with about two-thirds of the country drinking fluoridated water, you would think that fluoridation would be embraced as something as American as apple pie but better for your teeth.

Yet the fluoridation controversy appears to be like fluoride itself: It doesn’t biodegrade. It doesn’t evaporate. Instead, it sticks around.

The persistence of fluoride doubts locally was demonstrated in 2002, when the Tacoma/Pierce County Board of Health decided that water providers in the area must fluoridate their water supplies — rather than have the issue come to a public vote. The board’s action unleashed controversy about fluoridation’s alleged affects on human health and the environment.

Civic groups and city mayors articulated their opposition. (“I think that a jury still is out on whether fluoride is good for people,” said Edgewood Mayor John Powers.) Legal action soon followed, including a suit filed by Pierce County-area water providers that will, if nothing else, delay the region’s fluoridation project, which was slated to begin Jan. 1, 2004.

What’s happening in Pierce County exemplifies why the American Dental Association, which has been telling people since 1950 that fluoridation is okay, is still repeating that mantra. In 2000, the ADA bothered to publicly reaffirm its endorsement of fluoridation. Its Web site (ada.org) expends thousands and thousands of words reassuring us with the entire text of its recently published, 56-page booklet, Fluoridation Facts, which posits, “After 50 years of research and practical experience, the preponderance of scientific evidence indicates that fluoridation of community water supplies is both safe and effective.”

The ADA knows that fluoridation opponents, who represent a minority of the population and a fraction of the scientific community, are still out there, noisily decrying fluoridation, often with a degree of credibility, even as 160 million people in the United States drink fluoridated water. That 160 million likely includes you, unless you only consume bottled water or have a filtration system: Seattle Public Utilities, which has 1.3 million customers in the Seattle area, has fluoridated its water supply for 33 years.

Despite the ongoing dissent in Pierce County, the official, most frequently heard and believed line on fluoridation remains relentlessly pro: Fluoridation’s supporters include not only the ADA, but the American Medical Association, the American Cancer Society, the Centers for Disease Control and the World Health Organization.

The Environmental Protection Agency has also endorsed fluoridation as safe and effective-but a union of EPA employees has questioned those claims on the sort of scientific grounds that characterize today’s fluoridation opposition. A 1995 study “showed that rats given fluoride in drinking water at levels that give rise to plasma fluoride concentrations in the range seen in humans suffer neurotoxic effects”-despite that rats are more resistant to fluoride than humans, wrote the union’s then-Senior Vice President J. William Hirzy in a 1999 union statement.

“Another 1998 publication …” wrote Hirzy, “reported on the brain — and kidney damaging effects in rats that were given fluoride in drinking water at the same level deemed ‘optimal’ by pro-fluoridation groups, namely 1 part per million,” which is the ratio used in Seattle’s water supply. “Two epidemiology studies from China that show decreases in I.Q. in children who get more fluoride than the control groups of children in each study … The type of cancer of particular concern with fluoride, although not the only type, is osteosarcoma, especially in males … Five epidemiology studies have shown a higher rate of hip fractures in fluoridated vs. non-fluoridated communities …” The list doesn’t end there.

Dental fluorosis, a mottling of the teeth from exposure to fluoride, is another problem says the EPA union and other fluoridation opponents. Even the ADA acknowledges that dental fluorosis is a fact of fluoridated life-but says that it’s preferable to tooth decay.

So opposition to fluoride, once associated with mind control and the Red Scare, today is largely about a disquieting litany of health concerns related to fluoridation. Aware of this, the ADA and other fluoridation proponents have made a point to discount studies that question the safety of fluoride. “[T]wo scientists who reviewed the 1995 study” in which rats seemed to suffer neurotoxic affects from fluoride “… found inadequacies in experimental design that may have led to invalid conclusions,” reads the ADA’s Fluoridation Facts, which boasts about 200 references.

It also insists that “there is no connection between cancer rates in humans and adding fluoride to drinking water,” that “two studies were published demonstrating that exposure to fluoridated water does not contribute to an increased risk for hip fractures,” and that “[g]enerally accepted scientific knowledge suggests that the consumption of optimally fluoridated water does not cause or worsen human kidney disease.”

Anti-fluoridation groups have alleged that not only is fluoridation unsafe, it’s ineffective.

One survey, conducted from 1986 to 1987, looked into the mouths of babes-nearly 40,000 kids in the United States between the ages of 5 and 17-and set the statistical foundation for two answers to the same question: Does adding fluoride to the water we and our kids drink, cook with, bathe in prevent tooth decay? No, averred the president of the anti-fluoridation Safe Water Foundation: “The average number of decayed, missing and filled permanent teeth (DMFT) per child was 2.0 in the fluoridated areas, 2.0 in the nonfluoridated areas, and 2.2 in the partially fluoridated areas.”

Undaunted, in 1990, dental researchers from the pro-fluoridation National Institute of Dental Research, an arm of the Public Health Service, which oversaw the study, triumphantly declared in the Journal of Dental Research, “Children who had always been exposed to community water fluoridation had mean DMFS scores” (the number of decayed, missing or filled permanent tooth surfaces) “about 18% lower than those who had never lived in fluoridated communities”-a difference of about one cavity per child.

Another article in the same edition of the journal concluded that fluoridated water does fight tooth decay, but not because you’re swallowing it. Instead, said researchers, the benefit comes the topical application of fluoride, from bathing your teeth in it every time you take a drink of water. Fluoridation still made sense, the article concluded; there was no cheaper way to ensure that fluoride is used consistently by large numbers of people, including the poor, who frequently lack access to dental care. The anti-fluoridationist’s rebuttal: Boston, where the water is fluoridated and the frequency of tooth decay is high among the city’s most impoverished residents.

So whose side are you on?

Fluoridation was once a contentious issue in Seattle, as in other cities. Voters here nixed adding fluoride to their water in 1952 and again in 1963. But in 1968, a citywide vote approved fluoridation, despite opponents’ health concerns and worries about forcing a treatment on people who didn’t want the water they drank, bathed in and cooked with to become an anti-decay elixir.

The recipe for that elixir, which flows from your faucet and that of 1.3 million SPU customers, is, as noted above, 1 part fluoride per million parts water, a ratio deemed safe and effective in fighting tooth decay by the Centers for Disease Control and other pro-fluoridation organizations.

SPU purchases fluoride from Lucier Chemical Industries, a Florida-based chemical supplier that provides fluoride to water providers across the country. The utility pays about $200,000 a year for its fluoride. (An additional $250,000 is needed each year to carry out Seattle’s fluoridation program.) Lucier Chemical buys its fluoride from phosphate fertilizer plants, which produce fluoride as waste. Although fluoride occurs naturally in some water sources, the fluoride that people drink in fluoridated communities is largely obtained from the fertilizer industry. Without fluoridation, manufacturers would have to pay to dispose of their fluoride waste; the fluoride compounds are a toxic industrial byproduct.

Instead, they can sell it to chemical suppliers like Lucier, which in turn sell it to water providers like SPU. This business relationship is suspiciously cozy for many fluoridation opponents. A 1998 Earth Island Journal investigative report (http://www.earthisland.org/eijournal/spring98/sp98b_fe.htm) alleged that adding fluoride to the water supply was initially designed to prove the substance’s safety and thus deflect criticism about industrial fluoride pollution-criticism that could financially hamper industry with lawsuits.

Another Earth Island Journal report, from the winter of 1997-98, suggests that the link between litigation and fluoridation goes even further-quietly weaving its way into the history of the atomic bomb. During and after World War II, government officials feared that fluoride-poisoning lawsuits could derail the United States’ then-nascent nuclear-weapons program, observe reporters Joel Griffiths and Chris Bryson. Atomic development needed fluoride, and the U.S. government figured it needed atomic development to ensure national security. This fact, conclude Griffiths and Bryson, may have created a conflict of interest, compromising the integrity of studies vouching for the safety of fluoride and fluoridation.

They build their investigation with a slew of government documents, including once-secret fluoride studies and a report spelling out at least one reason why the government looked closely at Newburgh, N.Y., when it was fluoridated in 1945 at the behest of a state health department committee-headed by the Manhattan Project’s chief of toxicology, Harold C. Hodge. “Subsequent members included other leading members of the Pentagon group that sired the Manhattan Project,” Griffiths and Bryson note.

Hodge, a dental researcher, had previously advocated alleviating fluoride fears by educating the public about fluoride’s positive impact on dental health. According to a classified report from 1948, a study of Newburgh residents’ blood and tissue samples was conducted to “supply evidence useful in the litigation arising from an alleged loss of a fruit crop several years ago” during World War II, when a New Jersey DuPont factory polluted the surrounding farming community with fluoride used in atomic production.

“Medical researchers who have reviewed … recently declassified documents fear that Cold War security considerations may have prevented objective scientific evaluation of fluoride’s true impact on public health,” Griffiths and Bryson write. (Their Earth Island Journal article is available online at http://www.earthisland.org/eijournal/win98/fe_win98fluoride.html.)

In 1973, three years after Seattle began to fluoridate its water supply, fluoridation programs in the Netherlands ceased when a high court ruled that the Dutch government had no legal basis for fluoridating water supplies. Opponents to fluoridation in the Netherlands had brought the issue to court; they’d questioned whether the government should be medicating an entire population by putting something in the water.

So, again, whose side are you on? Is fluoridation a benevolent public-health service or forced medication? Is it a conspiracy or a sound policy? Is it good for you, or does it put your health at risk? To a degree, it doesn’t matter what you think in Seattle, where you have swallow fluoride if not the arguments for it.

For further reading:

• ada.org/public/topics/fluoride/fluoride.html, The American Dental Association’s extensive, pro-fluoridation message
• www.cdc.gov/OralHealth/topics/fluoridation.htm, Information from the pro-fluoridation Centers for Disease Control
• fluoridealert.org, Produced by the anti-fluoridation Fluoride Action Network
• fluoridation.com/calgaryb.htm, An anti-fluoridation report with citations from the Health Action Network Society, submitted to the city government of Alberta, Canada