Honest Universe

Superstition, pseudoscience, and scepticism

Fluoride in Onehunga

with 19 comments

In last month’s issue of my local community newsletter, Onehunga Community News, an article was published about water fluoridation. For those of you who are non-locals, Onehunga is a suburb of Auckland, and in general drinking water in Auckland is fluoridated.

Click to view the full image and read the article

Click to view the full image and read the article.

The article mentioned some of the recent national news about fluoridation, which I won’t get into here, and used it to bring up the fact that much of Onehunga’s water is not fluoridated. It gave links to the Ministry of Health for pro-fluoridation information and Fluoride Action Network New Zealand (FANNZ) for anti-fluoridation information, and it called for readers to send in their thoughts.

I decided to send in a message in response to the article. The May edition of this newsletter has just been released, and as part of it several responses, including a small part of mine, have been published:

Click to view the full image and read the article.

Click to view the full image and read the article.

I was happy to see that most of the responses were sensible, although there was still one talking about such rubbish as “chemicals” being synonymous with “poisons”. As only a small section of my message was published, I’ve decided to publish the entire message here. Here is the full message I sent in to Onehunga Community News:

To whom it may concern,

I was rather disappointed to see the article “To fluoridate or not to fluoridate…” mention the anti-fluoride group “Fluoride Action Network New Zealand” as though it were a reputable source of information on fluoride. This group relies largely on scare-tactics and misinformation, driven by ideology rather than evidence. In comparison, the Ministry of Health is driven by the available to evidence to find the best conclusion, which it believes is that fluoridating the public water supply is an effective, safe, and cost-effective way of improving dental health.

The Ministry of Health website has a page listing a number of websites that provide accurate information on water fluoridation. The FANNZ site is not on this list. That is not simply because FANNZ disagrees with the Ministry of Health on this issue, it is because FANNZ is not a reliable or trustworthy science-based source of unbiased information on this issue.

When I first discovered that Onehunga is not fluoridated I admit I was very disappointed. I had thought that all public water supplies in Auckland were fluoridated, and was sad to hear that I lived in one of the few areas in which this is not the case. I would be ecstatic to see the public water supply in Onehunga go through a process of fluoridation.

It is worth noting that the process of fluoridation is not necessarily as simple as adding fluoride to the water – it is ensuring that the levels fall within a particular range. As some locations have high natural levels of fluoride, this process can involve the lowering of fluoride levels in order to ensure it is maintained at a concentration that is safe and effective.

According to data from the New Zealand Institute of Chemistry (the data are from 1995, but I’m not aware of any more recent data. I have no particular reason to expect a large change since that date though) the level of fluoride in Onehunga drinking water is around 0.15-0.16 mg/L. In comparison, the fluoride level in Ardmore drinking water was increased from 0.04 mg/L to 0.86 mg/L. Onehunga water did have substantially higher natural levels of fluoride than that of the other Auckland areas sampled, but the final level after treatment was also significantly lower than those areas in which the water was fluoridated.

Water fluoridation to prevent dental caries is akin to the fortification of bread with folic acid to prevent neural tube defects in children, or iodine in table salt to prevent iodine deficiency. These are all safe and effective science-based preventive methods that improve public health.

I understand the journalistic urge to provide balance on all issues, but it is important not to establish a false balance such as this. This is a topic on which it is important to listen to the experts.

Sincerely,
Mark Hanna

The editor responded to defend their approach to pursue balance by saying that they shouldn’t only provide government resources. I didn’t find it convincing, but I do understand somewhat the urge for journalists to provide both sides of every story. There is some merit in that but, as I said in my message quoted above, it is possible to take it too far.

It feels relevant to note that, since I sent this message, 3 separate ASA complaints have been upheld against FANNZ on the basis that they failed to adequately distinguish opinion from fact. I wouldn’t be surprised to see a couple more in the future either.

When it comes to the fluoride debate there is a lot of misinformation out there, so you have to be extra careful that you’re getting yours from a reliable source. FANNZ is not a reliable source of information. The Ministry of Health is, and if you want a non-governmental source then you might want to check out Making Sense of Fluoride.

For the sake of full disclosure, I’m Facebook friends with some of the people in charge of Making Sense of Fluoride, and gave some advice on the ASA complaints submitted against FANNZ when they were being written.

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Written by Mark Hanna

2014/05/05 at 5:27 pm

19 Responses

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  1. Folic acid and iodine are added to foods because they are nutrients required by the body. Fluoride is a deadly poison which is not a nutrient. There are no conditions in the body which is fluoride deficient. It cures nothing or heals nothing. Exactly why would someone want to consume it in every glass of water every day of their life.
    No doctor or dentist has ever prescribed it to an ADULT. It is not included in any ADULT multi-vitamin.

    It is illegal for a doctor or a dentist to force anyone to take a drug or a chemical.
    It should be illegal for the government as well. Fluoride should not be added to drinking water, which forces everyone to consume it against their will.

    jwillie6

    2014/05/05 at 6:56 pm

    • Hi jwillie6, thanks for your comment. I’m afraid I think what you’ve said is a bit of an oversimplification. You’ve used words like “nutrient” and “poison” as though they’re much more precise and well-defined than they are.

      I can understand the temptation to oversimplify matters like this. I see it all the time when dealing with alternative medicine; if the cause or cure of disease were simple then that would make medicine so much easier. Unfortunately, however, biology is complicated. Horrendously complicated. Because of this, in order to understand how a particular substance affects people thorough testing needs to be undertaken.

      When undertaking such tests, one of the most important considerations is the dose. For example, if you look at the fact sheet for a substance, such as this Material Safety Data Sheet for folic acid, you will see the term “LD50″ under the toxicology information. This refers to the dose that is lethal 50% of the time (LD50; Lethal Dose 50%), i.e. when a substance is administered at that dose, 50% of the subjects given that dose will die. Of course, such tests are not carried out in humans, we usually use a rat or mouse “model” (this means a rat or mouse is used as a “model” or stand-in for a human) instead.

      In this example, the LD50 for an oral dose of folic acid in a mouse is 10,000 mg/kg. That means if, for every kg of mouse 10,000 mg of folic acid is administered orally, there is a 50% chance the mouse will be killed by it. Substances with a lower LD50 are more toxic, whereas those with a higher LD50 are less so. As you can see, there is no clear line between “poison” and “not poison”; everything is poisonous at a certain level. The Wikipedia page has a table containing various examples, such as sucrose (29,700 mg/kg given orally to rats, so not very toxic).

      You characterising substances as “nutrients” is a similar oversimplification, although it can often be a useful one. Basically what you have to look at is, again at a particular dose, how is the body affected by a substance? If the body use the substance for something useful, such as iron being used for the formation of haemoglobin, then that sounds pretty much like a nutrient. Fluoride ions interact with the hydroxyapatite enamel of your teeth to form fluorohydroxyapatite, which is more resistant to decay. That sounds pretty useful to me.

      So the question becomes “is way to administer fluoride in a particular way and at a particular dose that we can benefit from it without any harmful effects?”. And, like biology, the answer is complex. The best way to do this that we know of is via topical application, mainly through fluoride-containing toothpastes. However, fluoridating drinking water, which involves treating the water to ensure that the fluoride concentration is with a certain narrow band.

      Fluoridating the community water supply benefits everyone who drinks it. Although I’ve heard many argue that those who want to consume fluoride in this way should buy fluoride supplements of some sort, that argument misses the point that unfluoridated water disproportionately affects those who cannot afford such luxuries, and members of lower socioeconomic groups may also miss out on other sources of fluoride such as fluoride-containing toothpaste.

      If you’re interested in learning about the legality of community water fluoridation, a decision was recently made in the High Court of New Zealand that it is legal in New Zealand. The entire decision is freely available if you’d like to read it: New Health New Zealand vs. South Taranaki District Council.

      Mark Hanna

      2014/05/05 at 8:40 pm

      • Hello Mr. Hanna:
        You present some well thoughtout comments. You are correct that my comment is over simlified. It is impossible to offer more in a few sentences. However, there are many studies done by research scientists which indicate a variety of health dangers associated with water fluoridation. Many of them are presented at the site below. It begins with a statement from Dr. Phyllis Mullenix, PhD in pharmacology:

        “fluoride exposures today are out of control,” and “.. there are no advantages to water fluoridation. The risks today far exceed the hoped for benefit.” Dr. Mullenix cites data from 18 clinical studies in her analysis.

        The list presented at this site is supported by over 40 scientific references. I urge everyone to visit this site to investigate the evidence which is counter to your presentation. Then they can make up their minds.

        http://www.nofluoride.com/scientific_studies.cfm

        jwillie6

        2014/05/06 at 8:38 am

      • Remember, as I stated in my previous comment, the process of water fluoridation involves limiting the concentration of fluoride to be within a narrow band. In areas with a high concentration of fluoride prior to processing, this involves removing some of it. The statement “fluoride exposures today are out of control” would make considerably more sense in an unfluoridated context.

        As I stated previously, the most important factor to consider is dose. The effects of a substance and their strength, whether helpful or harmful, are dependent entirely on dose. I’m aware, for example, that there are studies linking the consumption of fluoride through drinking water to lowered IQ but this effect is not observed at the levels of fluoride occurring in regularly fluoridated drinking water.

        Unfortunately, the list you’ve linked to doesn’t contain any links to any of the studies, and I’m not particularly interested in finding all 40+ studies manually and reading through them (assuming they’re freely available to the public) in order to see if they live up to the claims made about them.

        If you have a specific criticism regarding the effects of water fluoridation, then please provide it along with a reference and we’ll be able to have a discussion about it.

        Mark Hanna

        2014/05/06 at 2:17 pm

      • Mr. Hanna:
        I tried to reply to your interesting comments, but my response was not accepted. Too bad, because we are all searching for the truth.

        jwillie6

        2014/05/06 at 8:41 am

      • Hmm, I’m not sure what might have happened there. I haven’t had a comment come into the moderation queue, I’ll have a look and see if it might have been caught by the automatic spam filter.

        Mark Hanna

        2014/05/06 at 10:37 am

      • Yeah, it looks like your comment was caught in the spam filter. I’ve let it through now, but I’m afraid I won’t have time to read it through or reply for a while yet.

        Mark Hanna

        2014/05/06 at 10:40 am

    • “Fluoride is a deadly poison which is not a nutrient.”

      *HEADDESK*

      Mike Drake

      2014/05/06 at 1:43 am

      • jwillie6 re Mullenix,
        Big problem with using this paper as “evidence” is that her study exposed rats to drinking water concentrations of 0, 75, 100, or 125 ppm! Behavioural effects were observed at the high concentrations. But community drinking water is fluoridated to only about 0.7 ppm F!

        chris

        2014/05/07 at 8:36 pm

    • It’s not true that no dentist has ever proscribed fluoride to an adult. I was recently proscribed PreviDent (http://www.colgateprofessional.com/products/Colgate-PreviDent-5000-Plus-Rx-only/details), a prescription toothpaste designed to provide fluoride.

      Anon

      2014/05/06 at 6:21 am

      • Anon:
        What is wrong with you? Prevent is a tooth paste. A treatment applied to the outside of the tooth might help, but no one should swallow fluoride.

        jwillie6

        2014/05/06 at 6:33 am

      • jwillie6, please keep your comments civil. Anon’s response to your comment was directly relevant to your claim that “No doctor or dentist has ever prescribed [fluoride] to an ADULT”.

        If you want to point out the distinction between a topical application and an oral dose then feel free to do so, but we can do without insults thank you very much.

        Mark Hanna

        2014/05/06 at 2:15 pm

  2. What Jwillie6 was saying is that fluoride is not required by the body. Consuming a fluoride-free diet does not cause tooth decay. Fluoride is a choice and a drug with side effects. In the US, the Food and Drug Administration regulates fluoride in toothpaste for topical application; but it has never tested fluoride for safety or efficacy when ingesting it. The FDA calls fluoride an unapproved drug. Since fluoride changes body parts in ways nature didn’t intend, it is a drug. Like all drugs, fluoride has side effects – some of them quite nasty. It’s foolhardy at least and hazardous at most to add fluoride drugs into the human digestive system via the water supply without regard for an indivdual’s age, weight, height, health or need. The level of fluoride in water supplies does not equate to an individual’s dose. Fluoridation delivers fluoride doses based on thirst – which makes no sense.

    nyscof

    2014/05/06 at 9:04 am

    • Hi nyscof, thanks for your comment. Like jwillie6’s first comment, I’m afraid you’ve oversimplified matters.

      I’m sure you realise that nature doesn’t actually have intentions, and no such concept is used in the definition of what is or is not a drug. With regard to the FDA, they have issued a health claim notification stating that, from October 14 2006, they have approved the following claim for use:

      “Drinking fluoridated water may reduce the risk of [dental caries or tooth decay].”

      To state that “fluoride changes body parts in ways nature didn’t intend” honestly seems like a rather disingenuous oversimplification to me. Surely either nature’s intention is a metaphor for the laws of physics and anything that happens as a result, such as the biological effects of fluoride, qualify as “intended by nature”, or nature similarly didn’t intend other useful technologies such as vaccines or antibiotics, in which case we would do well to ignore nature’s intentions as they are obviously not in out best interests. The only other option I can think of is that the effects of fluoride are somehow miraculous, and I’m certain that’s not what you mean.

      The fact is that fluoride, like any substance, has certain effects on the human body. These effects are determined by the dose and method of administration. The goal of community water fluoridation is to elicit the beneficial effects that fluoride has with regard to reducing the incidence of dental caries without also seeing any negative effects.

      You are correct in that the dose of fluoride delivered by community water fluoridation depends on thirst, but thirst is self-limiting (and related to the size of a person) and the level of fluoride in fluoridated water is low enough that it would be difficult to consume enough fluoride to see negative effects through the consumption of fluoridated water alone. It’s not a consideration that is ignored in the determination of the upper limit of fluoride concentration to be allowed in a water supply.

      Mark Hanna

      2014/05/06 at 2:13 pm

  3. Hi Mark, I understand that you endeavour to take a scientific approach with good intentions by making health supplements available to everyone. In Germany and most other European countries, the caries prevention is regulated via toothpaste and salts on a voluntary basis. What is your motivation to treat everyone as a minor who cannot discern what is best for him/her? It is demeaning to take away responsible decision-making from those who choose not to consume any added fluoride in their drinking water. A sustainable solution would be to make this “supplement” available in appropriate form to those who feel that they need to drink fluoride to strengthen their teeth.

    Joe

    2014/10/17 at 5:17 pm

    • Hi Joe, thanks for your comment. I get the impression we will agree that the matter of whether or not the effects of community water fluoridation (CWF) are supported by science and the matter of whether or not CWF is ethical can be considered separately for the most part.

      I think CFW is quite similar to some other public health measures that generally go quite unchallenged, presumably because no one finds an ethical issue with them. The measures I am thinking of are the fortification of bread with folic acid and with iodine.

      Folic acid supplementation prevents neural tube defects in newborns, but in order to be most effective it must be started earlier than women may discover they are pregnant. I believe iodine fortification was originally put in place in preparation for nuclear attack but it’s now in order to reduce the number of people who are insufficient in iodine.

      Interestingly though, in both these cases the fortification is not entirely mandatory. The fortification of bread with folic acid was previously mandatory, but since 2012 it has become voluntary. Also, organic and unleavened bread is exempt from iodine fortification. However, in both cases the Ministry of Health has gathered evidence regarding intake levels of the substances and has found they haven’t suffered under a voluntary regulation scheme.

      In the case of fluoride, though, it’s important to note that it has a disproportionate effect on lower socioeconomic areas. For example, a 2014 study from Korea which examined 1446 11 year old elementary school students concluded that:

      This study supported that water fluoridation could not only lead to a lower prevalence of dental caries, but also help to reduce the effect of [socioeconomic status] inequalities on oral health.

      A Canadian study from 2012, which analysed data from 1,017 children aged 6-11, had similar findings, concluding that:

      The robust main effect of fluoridation on [decayed, missing (because of caries or periodontal disease) or filled teeth, either deciduous or permanent] and the beneficial effect across socio-economic groups support fluoridation as a beneficial and justifiable population health intervention. Fluoridation was equitable in the sense that its benefits were particularly apparent in those groups with the poorest oral health profiles, thouhg the nature of the findings prompts consideration of the values underlying the judgement of health equity.

      For a more local example, here is a New Zealand study published in the New Zealand Dental Journal in 2004 (here’s a link to the full study. It looked at 8030 5 year olds and 6916 12 year olds, and concluded that:

      This [sic] results of this study show children living in a fluoridated area to have significantly better oral health compared to those not in a fluoridated area. These differences are greater for Maori and Pacific children and children of low socio-economic status.

      There are two different ways in which consumers can be given a choice of whether or not to consume fluoride: an opt in system or an opt out system. In an opt in system, as you have described, fluoride consumption could be in the form of voluntary supplements. In an opt out system, products such as water filters that remove fluoride could be used.

      In a perfect world, an opt in system may indeed be more beneficial, but in the world we live in this is not the case. Those who most benefit from CWF are also those who are least able to afford to opt in. I do think that it is a balancing act between freedom of choice and benefits to health, but I also think the evidence shows that the balance comes down squarely in favour of community water fluoridation.

      Mark Hanna

      2014/10/18 at 2:03 pm

  4. Thank you for answering my question as to what motivates you to dispense fluoride centrally. You seem to have a genuine desire to help those that cannot afford healthy lifestyles. You hit the nail on the head, the fortification of bread with folic acid and with iodine is sustainable because it is on a voluntary basis. Sufficient alternatives are available in the market place to those that choose not to go there. I am sure you would agree that this is not the case with our drinking water and thus bears no relevance to the water fluoridation debate. Regarding your cited results from surveys, too much emphasis is placed on the alleged protection fluoride supposedly provides than on the detrimental dental effects of a “couldn’t care less about health” attitude which honest studies also show are prevalent amongst members residing on the lower tiers of the socioeconomic ladder. Consumption of excessive amounts of soft drinks is proven to be the key contributing dietary component that ALWAYS leads to poor oral health, regardless. Scientific studies are patchy at best and by no means conclusive regarding overall health benefits from water fluoridation. As a genuinely caring community we cannot condone the attitude of “I always get drunk senseless and if I can remember I’ll pop in a pill that will make my headache the next day more bearable”. The pill may reduce the symptom, i.e. the headache but what additional strain (on top of the consumed alcohol) it puts on the liver for example is not entirely explored. From your expressed views, fighting against symptoms is as good as we need to get to “help” the under privileged. Let the underprivileged carry on with their unhealthy lifestyles and we will enforce on everyone a token of a remedy in form of fluoride without knowing entirely the other effects it has on the rest of the human organism. The socioeconomic class you are concerned about needs more than fluoride and those who don’t drink soft drinks but water instead, don’t want to treat fluoride related ailments later on in life. I doubt not that you also see the irony – taking out those who contribute into the social network (the discerning working class) and continuing to keep the others dependant on it short sighted at best.
    Please, don’t get me wrong, I do not endeavour to change your mind as little as you will succeed in making water fluoridation acceptable to the growing number of people with sustainable health awareness.
    As a final thought I just want to mention that fluoride is not naturally found in the human biological code in any shape or form, never was and never will be. We could be debating GMO for that matter and I’m certain no surprises there too, we’d find ourselves on opposite sides of the fence. Fortunately the choices individuals make cannot yet be centrally dispensed but we are headed there and some are already further down the track than others.

    Joe

    2014/10/20 at 12:26 pm

    • As I mentioned in my previous comment, it is possible to “opt out” of CWF if you buy a filter to remove the fluoride from your water. Yes, this involves a cost, but an opt in system also involves a cost and as I explained in my last comment that cost targets those least able to afford it.

      It feels worthwhile raising the High Court decision from earlier this year, in which New Health New Zealand challenged the legality of community water fluoridation. The relevant part of the judge’s decision as it regards the right to refuse treatment, which I agree with, is:

      Provided it does not have consequences for public health a person has the right to make even the poorest decisions in respect of their own health. But where the state, either directly or through local government, employs public health interventions, the right is not engaged. Were it otherwise, the individual’s right to refuse would become the individual’s right to decide outcomes for others. It would give any person a right of veto over public health measures which it is not only the right but often the responsibility of local authorities to deliver.

      To be honest, your comments regarding soft drinks sound a bit like victim blaming. Yes, poor dental hygiene and overconsumption of soft drinks increase dental decay and are problems that we should also try to solve. This does not change depending on whether or not CWF is in place. It’s not a matter of choosing one or the other, they are different measures that can be used together toward the same goal.

      To refuse others access to an effective healthcare measure because you think their misfortune is somehow their fault is not useful. We don’t refuse healthcare to smokers because their health problems are a result of their habit, and I don’t think we should. Instead, the appropriate course of action is to take measures to protect people, such as placing restrictions on the sale of tobacco and providing support for people attempting to quit.

      Your comment that “Scientific studies are patchy at best and by no means conclusive regarding overall health benefits from water fluoridation” is incorrect. The science on community water fluoridation is quite clear: it significantly reduces dental caries, and there don’t seem to be any clinically significant side effects. Here are links to several reviews of the evidence, all of which found that CWF reduces the prevalence of dental caries:

      Griffin et al. 2007
      NHMRC 2007 (direct PDF link)
      Yeung 2008
      NFIS 2011 (direct PDF link)
      Rugg-Gunn and Do, 2012
      Parnell et al. 2009
      Public Health England 2014 (direct PDF link)
      Royal Society of New Zealand 2014 (direct PDF link)

      I’m also not sure what you mean by this part of your comment:

      fluoride is not naturally found in the human biological code in any shape or form, never was and never will be.

      I assume you’re not talking about DNA when you refer to “the human biological code”, as the same could be said there about something like iron but I’m sure you wouldn’t make the equivalent argument for iron. I’m not sure what else you could really be referring to though. The human body will simply use whatever fluoride is available to it, and the overall effects will depend on how much fluoride is available. There is no intention or design in this, and even whether or not something can be considered “natural” is not relevant. It’s simply how things work.

      This is the same for just about every element found in nature, not just fluoride. If you have too little, something bad will happen. If you have too much, something bad will happen. How much is too much and how little is too little, as well as what bad things might happen, depend on the substance. For the example I just mentioned, iron, too much can result in iron toxicity whereas too little will result in anaemia.

      For fluoride, too much can result in negative effects such as significant dental fluorosis and decreased IQ, whereas too little can result in an increased risk of dental caries. The levels of how much is too much and how little is too little are such that we can safely provide an appropriate amount of fluoride through community water fluoridation to make use of the benefits without compromising safety. It’s not enough to stop dental caries entirely, and no one claims that it is, but it does significantly reduce their prevalence in a cost-effective way.

      Mark Hanna

      2014/10/22 at 10:29 am

  5. “For fluoride, too much can result in negative effects such as significant dental fluorosis and decreased IQ, whereas too little can result in an increased risk of dental caries.”

    It’s encouraging to see that you accept that there are consequences re consumption of fluoride albeit under the precursor of dosage and that you believe there are dental risks if fluoride did not form part of the diet.

    That is a small start for common ground. I also applaud the common sense approach enforced by the high court here, ASSUMING councils act responsibly: Local authorities have the responsibility to deliver public health measures in order to avoid any person’s veto to bar sensible services to the multitude.

    Numerous researches have been cited in this blog which would suggest that water fluoridation decisions have been made responsibly. There is however reason to believe that due processes have been skewed here and internationally. In the US for e.g. research reports are being exposed to have been misleading and councils are increasingly coming under pressure and have to face research that proves that even small doses of fluoride are seriously harmful.

    I, like every other fluoridation sceptic, take a simplistic view. If fluoride is not naturally found in any food, common or exotic, and it is not in our biological makeup as you do find with iron for example, then you have to ask yourself why dispense fluoride centrally? Where does this substance come from, who are the stakeholders, who paid for the research, who establishes what dosage can be considered healthy or at least harmless? Putting scientific, holistic biological and objective research together, and you end up being alarmed about the poor level of responsibility lavished on this key health issue. What evidence is there for example, and I’m not talking about statistics here, that Fluoride fortifies teeth if ingested? Any scientist will agree that you can make statistics tell any story. Until these questions are answered objectively, no one serious about health will be convinced by all research cited above.

    I have made my point, you have made yours. Over and out. Thank you for meaning well and debating this.

    Joe

    2014/10/22 at 12:53 pm


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