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The Case Against Water Fluoridation with supporting
documents
Paul Connett, PhD
Director, Fluoride Action Network
FluorideALERT.org
Brooksville, Florida
August 27, 2013
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Introduction
I have spent 17 years researching the fluoridation issue, first as a professor of chemistry specializing in environmental chemistry and toxicology, and now as director of the Fluoride Action Network.
In 2010 this research effort culminated in the publication of The Case Against Fluoride
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Book published by Chelsea Green
October, 2010
Can be ordered on Amazon.com
Contains 80 pages
of references to the
Scientific literature
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SUPPORTING DOCUMENTS
1. Paul Connett’s CV 2. Paul Connett’s publications 3. Chapter Summaries from “The Case Against Fluoride”
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Outline of my presentation1. Why fluoridation should not have started.
2. Key moments since 1990 that should have ended fluoridation.
3. Better alternatives for fighting tooth decay.
4. My challenge to fluoridation promoters.
(5. The lack of solid science to justify fluoridation and to justify forcing the practice on people who don’t want it.)
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Part 1.Why Fluoridation should
never have started: Ten common sense arguments
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1. We should never use the public water supply to deliver medicine. WHY?
2. You can’t control who gets the medicine.
3. You can’t control the DOSE people get.
4. It violates the individual’s right to informed consent to medical treatment (check AMA website for definition).
We are allowing communities to do to everyone what an individual doctor can do to no one!
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5) Fluoride is NOT a nutrient.
There is not a single process inside the body that needs fluoride to function properly, however
6) Fluoride is a known toxic substance that interferes with many fundamental biochemical functions
See Molecular mechanisms of fluoride toxicity by Barbier et al, 2010
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SUPPORTING DOCUMENTS
4. Barbier et al., 2010
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7) 1 ppm fluoride (1 mg/liter) is NOT small. It is 250 times the level in mothers milk in a non-fluoridated community (0.004 ppm, NRC , 2006, p. 40)
8) A bottle-fed baby in a fluoridated community is getting 250 times the fluoride dose that nature intended. Who knows more about what the baby needs?
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9) The fluoridating chemicals used are not the pharmaceutical grade chemicals used in dental products, but are arsenic-contaminated industrial waste products.
According to the US EPA arsenic is a human carcinogen for which there is no safe level. That’s why they set the MCLG for arsenic at ZERO.
We should not KNOWINGLY add ANY arsenic to the drinking water.
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10. The vast majority of countries do NOT
fluoridate their water
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97% of Western European population now drinks Non-Fluoridated Water
AustriaBelgiumDenmarkFinlandFrance
GermanyGreeceIceland
ItalyLuxembourgNetherlands
Northern IrelandNorwayScotlandSweden
Switzerland
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Austria*BelgiumDenmarkFinlandFrance*
Germany*GreeceIceland
ItalyLuxembourgNetherlands
Northern IrelandNorwayScotlandSweden
Switzerland*
*Some fluoridate their salt
97% of Western European population now drinks Non-Fluoridated Water
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According to WHO data tooth decay in 12-year-olds
is coming down as fast in F as NF countries
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SOURCE: World Health Organization. (Data online)
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SUPPORTING DOCUMENTS
5. Cheng et al. 2007 (an article in the BMJ)
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Part 2
Some of the events since 1980 which should have forced an end to water
fluoridation
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"The great tragedy of science -- the slaying of a beautiful
hypothesis by an ugly fact.”
Aldous Huxley
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The TEN ugly facts
that should have slain the water fluoridation
hypothesis
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The ten year prelude
to UGLY FACT #1
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Between 1980 and 1990
A number of articles began to appear in major journals indicating that there was very little difference in tooth decay between fluoridated and non-fluoridated communities
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Leverett in Science, 1982
Colquhoun, 1984,’85,’87
Diesendorf in Nature, 1986
Gray, 1987
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SUPPORTING DOCUMENTS
6. Colquhoun, J. (1993) “Why I Changed My Mind About Water Fluoridation.”
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UGLY FACT # 1
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Ugly Fact #1 In 1990, Brunelle and Carlos published
the results of the largest survey of tooth decay ever carried out in the US. The NIDR (1986-87) examined the teeth of over 39,000 children in 84 communities.
Brunelle and Carlos reported very little difference in tooth decay in children between F and non-F communities.
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NIDR - Brunelle and Carlos (1990)
In Table 6, Brunelle and Carlos reported the DMFS (= decayed, missing and filled permanent SURFACES) of children aged 5-17 and compared children who had lived all their lives in either a fluoridated community or non-fluoridated community.
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Decayed Missing and Filled surfaces (DMFS)
There are 4 surfaces to the top six and bottom six cutting teeth and 5 surfaces on all the other teeth.
128 tooth surfaces in all.
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The average DMFS (children aged 5-17) for children who had lived all their
lives in a F-community
2.8DMFS
F
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The average DMFS (children aged 5-17) for children who had lived all their
lives in a Non-F community
3.4 DMFSNF
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3.4 DMFSNF
2.8DMFS
F
Comparing the two subsets (about 8000 children in each)
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Brunelle and Carlos, 1990
Average difference (for 5 - 17 year olds) in DMFS = 0.6 tooth surfaces (4 to 5 surfaces to a tooth)
3.4 DMFSNF
2.8DMFS
F
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Not only was this saving very small (0.6 of one tooth
surface) but it was not even shown to be statistically
significant!
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SUPPORTING DOCUMENTS
7. Brunelle and Carlos, 1990 (see Table 6)
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A word of warning
These very small savings in tooth decay (even if they are real) are often obscured by
reporting them as percentage differences
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Queensland Health’s promotion of “mandatory”
statewide fluoridation) (2007)
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Queenslanders were toldFluoridated Townsville has65% less tooth decay thanNon-Fluoridated Brisbane
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Qld Health “results - 65 % less tooth decay”
“ In Townsville, water supplies have been fluoridated since 1964, resulting in 65% less tooth decay in children than those in Brisbane”
“ fluoride, which is proven to be safe and effective ”
Qld Health newspaper ads Dec 2007
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How did they get the 65% less decay ?
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0.26 – 0.09 = 0.17 DMFS0.17/0.26 x 100 = 65%
fewer tooth surfaces decayedAn absolute saving of 0.17 of
one tooth surface in 7 year olds!
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This was an atrocious example of “cherry picking”
the data
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“ Teeth exposed to fluoridated water” Qld Health 2007
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“ Teeth exposed to fluoridated water” Qld Health 2007
“ Teeth without exposure to fluoridated water” Qld Health 2007
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Does this look like a difference in 0.17 of one tooth surface?
“ Teeth exposed to fluoridated water” Qld Health 2007
“ Teeth without exposure to fluoridated water” Qld Health 2007
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Does this look like a difference in 0.17 of one tooth surface?
Or is this fraudulent promotion?
“ Teeth exposed to fluoridated water” Qld Health 2007
“ Teeth without exposure to fluoridated water” Qld Health 2007
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UGLY FACT # 2
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Ugly Fact #2
Several modern studies (1997-2001) show that tooth
decay does NOT go up when fluoridation is stopped
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Modern studies indicate that Dental Caries has not gone up after Fluoridation Stopped
1. Former East Germany Kunzel, W. & Fischer, T. (1997). Rise and fall of caries prevalence in German towns with different F concentrations in drinking water. Caries Res 31(3): 166-73
2. Cuba Kunzel, W. & Fischer, T. (2000). Caries prevalence after cessation of water fluoridation in La Salud, Cuba. Caries Res 34(1): 20-5.
3. Canada Maupome, G. et. al (2001). Patterns of dental caries following the cessation of water fluoridation. Community Dent Oral Epidemiol 29(1): 37-47.
4. Finland Seppa, L. et. al (2000). Caries trends 1992-98 in two low-fluoride Finnish towns formerly with and without fluoride. Caries Res 34(6): 462-8.
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UGLY FACT # 3
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Ugly Fact #3
Warren et al. (2009)
found no relationship between the amount of
fluoride ingested daily by children and level of tooth
decay
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The authors state:
“These findings suggest that achieving a caries-free status may have relatively little to do with fluoride intake…”
Warren et al., 2009
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SUPPORTING DOCUMENTS
8. Warren et al., 2009
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UGLY FACT # 4
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Ugly Fact #4
In 1999, the CDC concedes that the predominant benefit of fluoride is TOPICAL not
SYSTEMIC.
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CDC, MMWR, 48(41); 933-940, Oct 22, 1999
“Fluoride’s caries-preventive properties initially were attributed to changes in enamel during tooth development... However, laboratory and epidemiologic research suggest that fluoride prevents dental caries predominantly after eruption of the tooth into the mouth, and its actions primarily are topical…”
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If fluoride works on the outside of the tooth not from inside the body
Why swallow fluoride and expose every tissue of the body to a toxic substance, when you can brush it on your teeth and spit it out?
And why put it in the drinking water and force it on people who don’t want it?
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SUPPORTING DOCUMENTS
9. CDC, 1999
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UGLY FACT # 5
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Ugly Fact # 5 The U.S. National Research Council 3-year review (NRC,
2006) clearly shows that fluoride can cause harm at relatively low
levels and there are many unanswered safety questions.
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The NRC (2006) review
In 2002 the US EPA asked the National Research Council (NRC) - to review the safety of its drinking water standard for fluoride (4 ppm).
The NRC selected the most balanced panel ever assembled to look at fluoride’s toxicity
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The National Research Council
This panel of 12 experts spent 3 and half years reviewing the literature and has produced a 507 page report with over 1000 references (NRC, 2006).
This review is THE textbook on the toxicology of fluoride
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National Research Council (2006)
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NRC found that fluoride could cause many harmful effects on the teeth, bone, brain and endocrine system especially in countries with high natural levels of fluoride in their water like India, China, Mexico etc.
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National Research Council (2006)
The NRC panel has foundthat the US EPA’s 4 ppm safe drinking waterstandard is unprotective of health.
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National Research Council (2006)
And recommended to theUS EPA that they do a newhealth risk assessment to find a lower Maximum Contaminant Level Goal (MCLG).
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A new MCLG If the EPA Water Office does a standard
toxicological assessment using the information provided in the NRC review (exposure analysis, end points and applies adequate margins of safety as required by the Safe Drinking Water Act to protect all members of society from known and reasonably ANTICPATED health effects) the new MCLG will have to be set at far less than 1 ppm - and probably zero - which will force an end to fluoridation
After 7 years the EPA has not completed this toxicological risk assessment
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ADA & CDC response to NRC report
On the day that the NRC released its report (March 22, 2006), the American Dental Association declared that it was not relevant to water fluoridation!
ADA argued that NRC review only looked at the effects of NATURAL fluoride at 4 ppm, not ARTIFICIAL fluoridation at 1 ppm.
Six days later (March 28, 2006) the CDC (Oral Health Division) declared that the NRC findings were consistent with their claim that fluoridation at 1 ppm was “safe and effective” and continues to promote fluoridation.
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Both the ADA and CDC (Oral
Health Division) are confusing concentration and dose. They are also ignoring the exposure analysis in Chapter 2 of the NRC review.
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This exposure analysis shows that subsets of US population drinking F -water (including bottle-fed infants) are exceeding EPA’s safe reference dose (0.06 mg/kg/day)
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See Figure 2-8 on page 85 (NRC, 2006)
FIGURE 2-8 Estimated average intake of fluoride from all sources, at 1 mg/L in drinking water
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SUPPORTING DOCUMENTS
10. NRC (2006). Figure 2.8, Chapter 2
(The whole 500 page report is available ONLINE)
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UGLY FACT # 6
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Ugly Fact # 6
ADA admits babies
shouldn’t be getting fluoride
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According to the ADA,infants should not drink fluoridated water.
"If using a product that needs to be reconstituted, parents and caregivers should consider using
water that has no or low levels of fluoride." SOURCE: American Dental Association, Nov 9, 2006
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SUPPORTING DOCUMENTS
11. ADA’s eGRAM of Nov 9, 2006
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UGLY FACT # 7
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Ugly Fact # 7
Fluoridation may actually be killing a few young boys
each year
Bassin et al., 2006
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Osteosarcoma
Bassin found that young boys exposed to fluoridated water in their 6th,7th or 8th years, had a 5-7 fold increase in developing osteosarcoma by the age of 20, compared to non-exposed boys.
Her 2006 study has never been refuted.The study promised by Douglass (Kim et
al., 2011) failed to do so.
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SUPPORTING DOCUMENTS
12. Bassin et al., 200613. Kim et al., 2011
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UGLY FACT # 8
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Ugly Fact # 8
CDC (2010)
Confirms that American kids are being hugely over-
exposed to fluoride
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Background
Early promoters thought that at 1 ppm F they could reduce tooth decay and limit dental fluorosis to 10% of children in its very mild form.
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Prevalence and Severity of Dental Fluorosis in the United States, 1999-2004
November 2010: CDC update on fluorosis by Beltrán-Aguilar et al.
They found that 41% of ALL American kids aged 12-15 had dental fluorosis
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CDC, 2010
41%
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Mild Dental Fluorosis
Impacts up to 50% of tooth surface
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Mild Dental FluorosisImpacts 8.6% of American
children 12-15 years
Impacts up to 50% of tooth surface
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CDC, 2010
41%
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Moderate- Severe Dental Fluorosis
Impacts 100% of tooth surface
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Moderate- Severe Dental Fluorosis
Impacts 3.6% of American children 12-15 years
Impacts 100% of tooth surface
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SUPPORTING DOCUMENTS
14. CDC, 2010.
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A KEY QUESTION
When fluoride is damaging the baby’s growing tooth cells (causing dental fluorosis) what is it doing to its other developing tissues?
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UGLY FACT # 9
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Ugly Fact # 9
There is extensive evidence that fluoride damages the developing (and possibly
aging) brains of animals and humans
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Over 40 animal studies show that prolonged
exposure to fluoride can damage the brain.
19 animal studies report that mice or rats ingesting fluoride have an impaired capacity to learn and remember.
12 studies (7 human, 5 animal) link fluoride with neurobehavioral deficits
3 human studies link fluoride exposure with impaired fetal brain development
37 out of 43 published studies show that fluoride lowers IQ
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To access any of these brain studies
1) Go to FluorideALERT.org
2) Click on RESEARCHERS
3) Click on Health Data Base
4) Click on Brain Effects
Or go direct to
FluorideALERT.org/issues/health/brain
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Xiang et al. (2003 a,b)
Compared children in two villages ( <0.7 ppm versus 2.5 - 4.5 ppm F in water)
Controlled for lead exposure and iodine intake, and other key variables (NOTE: both lead exposure and low iodine also lower IQ).
Found a drop of 5-10 IQ points across the whole age range
The whole IQ curve shifted for both males and females
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Xiang et al. (2003 a,b) MALES
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Xiang estimated that the threshold for lowering IQ was at 1.9 ppm fluoride in the water
This offers no adequate margin of safety to protect all American children from 1) the large range of doses and 2) large range of sensitivity expected in a large population
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SUPPORTING DOCUMENTS
15. Xiang et al., 2003a Xiang et al., 2003b
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11 of the 37 IQ studies found an association between lowered IQ and
fluoride levels in the urine
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Xiang finds an association between lowered IQ and PLASMA fluoride
levelsXiang et al., 2011
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SUPPORTING DOCUMENTS
16. Xiang et al., 2011
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Ding et al. 2011
Xiang (2012). Children’s IQ versus Levels of fluoride in the serum (children from both villages combined, personal communication with Paul Connett) . Thehigher the levels of fluoride in the plasma the lower the levels of IQ.
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UGLY FACT # 10
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Ugly Fact # 10
A Harvard team makes Chinese IQ studies available
to a wider scientific audience
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The Harvard review
Choi et al (the team included Philippe Grandjean) did a meta-analysis of 27 studies comparing IQ in “high” versus “low” fluoride villages .
The study was published in Environmental Health Perspectives (published by National Institute of Environmental Health Sciences NIEHS)
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Harvard meta-analysis of 27 studies
The Harvard team acknowledged that there were weaknesses in many of the studies, however…
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…noted that the results were remarkably consistent
In 26 of the 27 studies there was lower average IQ in the “high” versus low-fluoride villages.
Average IQ lowering was about 7 IQ points.
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Choi et al. 2012
The Harvard scientists concluded that further investigation of fluoride’s lowering of IQ should be a “high research priority”
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Promoters claim that the fluoride levels in the “High Fluoride” villages were so high that they
are not relevant to fluoridation programs.
THIS IS NOT TRUE. In 8 of the studies the “high fluoride village” had concentrations less than 3 ppm
These studies offer no adequate margin of safety to protect all children (including the most vulnerable) drinking uncontrolled amounts of fluoridated water and getting fluoride from other sources.
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SUPPORTING DOCUMENTS
17. Choi et al., 2012
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Dr. Philippe Grandjean
“Fluoride seems to fit in with lead, mercury, and other poisons that cause chemical brain drain. The effect of each toxicant may seem small, but the combined damage on a population scale can be serious, especially because the brain power of the next generation is crucial to all of us.” (Harvard Press Release)
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IQ and population
100
Number of KidsWith a
Specific IQ
IQ
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IQ and population
Very BrightMentallyhandicapped
100
Number of KidsWith a
Specific IQ
IQ
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IQ and population
95 100
Number of KidsWith a
Specific IQ
IQ
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IQ and population
Very BrightMentallyhandicapped
95 100
Number of KidsWith a
Specific IQ
IQ
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Summary: 10 Ugly Facts That should have ended fluoridation
1) US NIDR survey shows little difference in tooth decay between children who have lived all their lives in a Non-fluoridated versus a Fluoridated communities (Brunelle and Carlos, 1990)
2) In several modern studies (1997-2001) tooth decay does not go up when fluoridation is stopped.
3) No relation found between tooth decay and amount of fluoride swallowed by children (Warren, 2009)
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4) CDC concedes in 1999 that the predominant benefit of fluoride is TOPICAL not SYSTEMIC (CDC, 1999).
5) NRC (2006) report many harmful effccts of fluoride and many unanswered safety questions. Subsets of population drinking fluoridated water are exceeding EPA’s safe reference level (ONLINE).
6) ADA acknowledges that babies shouldn’t get fluoride (ADA eGram, Nov 9, 2006)
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7) Fluoridation maybe killing a few young males (Bassin, 2006). This study has not been refuted.
8) The CDC (2010) shows that American children are grossly over-exposed to fluoride. 41% of children aged 12-15 have dental fluorosis (CDC, 2010).
9) An extensive database indicates that fluoride impacts the developing brains of both animals and humans. ( key IQ study, Xiang et al., 2003 a,b)
10) A Harvard team makes IQ studies available to a wider scientific audience (Choi et al, 2012).
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Part 3.The Better Alternatives For
Fighting Tooth Decay
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Better AlternativesIf you want fluoride use fluoridated
toothpaste (96% toothpaste sold in US is fluoridated)
Better still use XYLITOL toothpaste. Xylitol toothpaste has been used for over 30 years in Finland
Give Xylitol mints (not chewing gum) to kids in school (e.g. Wichita, Kansas).
Give free toothbrushes and free toothpaste to low-income families (e.g. Scotland)
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Fluoridation and Equity Fluoridation does not reduce inequities in our
dental or health system In fact, it makes it worse It is precisely low-income families who
cannot afford avoidance measures in fluoridated communities
It is well established that fluoride’s toxic effects are made worse by poor diets.
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Better Alternatives Most of tooth decay is concentrated in low-
income families But 80% of dentists will not treat children
on MedicAid. Low-income families need better diet,
better dental education and better care The ADA opposes the use of dental
therapists to provide some basic interventions
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Better Alternatives Many large cities in the US are reporting a
dental crisis in low-income areas even though they have been fluoridated for over 30 years
The most devastating tooth decay is called Baby Bottle Tooth Decay
This abuse cannot be rectified with fluoridation
It is dishonest to imply otherwise
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Better Alternatives LESS SUGAR! MORE BRUSHING! MORE FRUIT AND VEGETABLES! MORE EARLY INTERVENTIONS! STRATEGIC USE OF XYLITOL Less sugar means less tooth decay and less
OBESITY…less diabetes, fewer heart attacks
Education is a GOOD INVESTMENT !!! The SUGAR LOBBY has always been a
strong supporter of fluoridation!
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Part 4. My Challenge to
Fluoridation Promoters
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The challenge to fluoridation promoters
Provide a list of primary studies (not second-hand endorsements) that refute the 10 Ugly Facts that I have documented.
Identify one randomized clinical trial that demonstrates that swallowing fluoride reduces tooth decay.
Identify one randomized clinical trial that demonstrates that swallowing fluoride is safe.
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The challenge to fluoridation promoters
Identify one study that shows that swallowing fluoride is safe for:
People with poor kidney function People with poor thyroid function People with borderline iodine intake Have any studies been undertaken in the US
to investigate the impacts of fluoride on these three subsets of the population?
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The challenge to fluoridation promoters Identify one government agency, professional
body or trade association that endorses water fluoridation
that accepts legal liability for any harm fluoridation by itself, or in combination with other sources of fluoride, may cause.
Identify one government agency, professional body or trade association
That has offered to pay for the treatment of dental fluorosis developed by someone living in a fluoridated community.
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Please Note My Brooksville presentation
ended here. But I left a copy of the rest with the council
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Part 5. The lack of solid science to
justify fluoridation and to justify forcing the practice on people
who don’t want it.
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1) There have been NO randomized clinical trials to demonstrate either effectiveness or safety
2) There has been NO systematic monitoring of fluoride in urine, blood or bones of citizens drinking fluoridated water
The most basic science has not been done.
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3) There has been NO investigation of a possible relationship (in F-countries) between fluoridation &
a) Arthritis; b) Hypo-thyroidism; c) Alzheimer’s disease; d) lowered IQ; e) behavioral problems in children; f) earlier onset of puberty or g) bone fractures in children
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4) There has been NO attempt in any fluoridated community to investigate the many complaints by citizens that they are super-sensitive to fluoride exposure and suffer symptoms that are reversed when they avoid fluoride.
The science supporting fluoridation has been very poor
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The science supporting fluoridation has been very poor
5) There has been NO attempt to reproduce studies of harm found in countries with high natural levels of fluoride
6) There has been very little effort to use the severity of dental fluorosis as a biomarker of exposure to fluoride in children to investigate many childhood problems.
7) The absence of study is being used to suggest the absence of harm
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The science supporting fluoridation has been very poor
8) Many research questions on aspects of safety and health remain unanswered
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John Doull (chairman, NRC, 2006 Review)
“What the committee found is that we’ve gone with the status quo regarding fluoride for many years—for too long really—and now we need to take a fresh look . . .
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John Doull (chairman, NRC, 2006 Review)
“In the scientific community people tend to think this is settled. I mean, when the U.S. surgeon general comes out and says this is one of the top 10 greatest achievements of the 20th century, that’s a hard hurdle to get over…
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John Doull (chairman, NRC, 2006 Review)
But when we looked at the studies that have been done, we found that many of these questions are unsettled and we have much less information than we should, considering how long this [fluoridation] has been going on.”
Scientific American, Jan 2008.
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SUPPORTING DOCUMENTS
18a. Doull quote 18b. Trevor Sheldon Letter on York Review
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Fluoridation promoters use endorsements not science
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The ADA admits that dentists do not need to be familiar with the
scientific literature!
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American Dental Association White Paper – 1979 On Fluoridation
Excerpt, Pg. 10-11
“Individual dentists must be convinced that they need not be familiar with scientific reports of laboratory and field investigations on fluoridation to be effective participants in the promotion program and that nonparticipation is overt neglect of professional responsibility.”
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AQuestionable Endorsement
In October 1999, the CDC claimed that fluoridation was “one of the ten great public health achievements of the 20th century.”
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CDC (1999) statement is Hollow
This statement from the CDC (and all statements on fluoridation from the CDC) comes from the Oral Health Division – consisting of about 30 – largely dentally trained personnel – whose key mission is to promote fluoridation.
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1) This claim was based on a report written by two people. One a dentist (Scott Tomar) who had not published anything on fluoridation before this and the other an economist (Sue Griffin).
2)This report was not externally peer-reviewed.
3) It was six years out of date on the health studies cited for safety.
4) The evidence cited to demonstrate effectiveness was trivial and embarrassing
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CDC MMWR, October 22, 1999
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SOURCE: World Health Organization. (Data online)
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SUPPORTING DOCUMENTS
9. CDC, 1999
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More on IQ studies
Since 2008,
Over 100 communities have ended
waterfluoridation
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1. Nov 2012, Queensland lifted mandatory requirement
2. April 2013, Israel MOH announces lifting of mandatory requirement in one year
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3. May 21, Portland Oregon voted 61% to 39% to reject fluoridation despite being outspent 3 to 1.
The promoters spent nearly $1 million – which included paying several groups $20,000 for their support!
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More on IQ studies
RESOURCES
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National Research Council (2006)
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Book published by Chelsea Green
October, 2010
Can be ordered on Amazon.com
Contains 80 pages
of references to the
Scientific literature
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Please watch the 29 minute DVD
“Professional Perspectiveson Fluoridation”
Can be viewed ONLINE atwww.FluorideALERT.org
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Please watch the 20 minute DVD
“TEN FACTS on FLUORIDE”PLUS BOOKLET
atwww.FluorideALERT.org