The case against fluoridation

The following article was written by Doris Grant and appeared in The Cambridge University Medical Society Magazine, Cambridge University, England. We are reprinting it from Prevention Magazine of July 1960 by kind permission of the publisher.

This article has aroused so much interest since its appearance last August that we... are re-printing it. We feel sure that all those actively engaged in the fight against fluoridation will find it usefu.

The EDITOR

No physician in his senses would hand a potent drug to his patient with the advice: "Take as much or little as you please", but this is precisely the procedure implied in the government's proposal to add sodium fluoride to our drinking water.

Fluoridation, as this project is called, is intended to reduce dental caries in children from birth up to the age of 8 or 10. But it takes no account of the fact that it is quite impossible to assure that all these children will be given the correct and safe amount of this substance; some children drink a lot of water, some drink a little, and some drink none at all, taking all their liquids as milk or fruit juices. It also fails to reckon with the fact that there is no medical case for compelling the remaining 92 per cent of the population to drink water which contains a toxic substance, a substance which can do them no good and may well do them harm.

Should fluoridation be made nation-wide, millions will have to drink this water irrespective of diet, occupation, state of health, susceptibility, climate and sex, not to mention the present-day hazards of fluoride-polluted air and fluoride- contaminated food.

Sodium fluoride is one of the most lethal of the halogen salts, and according to the Condensed Chemical Dictionary it is largely used in fungicides, insecticides and some rat poisons. But the general public has not been informed of its true nature. A leading American proponent puts the official case crudely and bluntly in words which leave no doubt about official morality: "We are under no obligation to people to tell them the truth. They would not understand it anyway. Our duty is to tell them whatever is necessary to make them do what is good for them." The failure of public health authorities in this country even to admit that there might be a valid case against increasing the intake of a toxic substance for the whole population is doing great damage to confidence in the Health Service and in the medical profession generally.

The fact that the concentration proposed is as low as one part per million is useless as an argument, no acute poisoning or immediately obvious harm is expected by anybody. As with the addition of chemicals to food, it is the cumulative effects of an intake of minim quantities over a long period which constitutes the danger. It is generally agreed that sodium fluoride is cumulative in action.

In a letter to the British Medical Journal, a Harley Street specialist protested: "Even if the effects of fluoridation were less controversial than they appear to be, it is clear that this method of wholesale indiscriminate administration of what is undoubtedly a highly toxic substance is improper and constitutes a complete break with the medical tradition of individual care and responsibility." The Delaney Committee, in a report to the United States Congress, was equally emphatic indescribing this method as "Mass Medication without parallel in the history of medicine."

The proponents' vigorous denial of mass medication is nothing short of equivocation; medication is intended for curing, alleviating, or preventing disease. Fluoridation is intended to prevent tooth disease. Mass medication is an intolerable interference with freedom of thought and action, and ignores the right of the individual to determine what shall be done to and with his body. As sodium fluoride can be administered individually to those who require or wish it, there is no question of anyone's rights being denied if fluoridation is not adopted. The moral issue regarding fluoridation is therefore paramount.

Another aspect of fluoridation, which should be viewed by all of us with alarm, is discussed by Miss Margaret Kidd, in the Glasgow Evening News of 17th May, 1956. Miss Kidd, famous as the first woman Q.C., points out in a forthright article that fluoridation "is yet another example of the lamentable state of affairs in Britain today where the power is rapidly passing from the people and parliament to a few officials because of the apathy of the ordinary men and women." (Emphasis supplied - Ed.). She also says that "It is high time that the general public bestirred itself and stamped upon the busybodies who would thrust their ideas of what is good for us willy nilly upon us all". If we are not careful: the "experts" may soon be adding Epsom salts to our water because they think we are too constipated!

It should be remembered that the expert is not infallible and that a government department which has committed its prestige to the success of some technical procedure cannot always be relied upon as a source of impartial information about it. Let us never forget that it took 25 years to discover the possible connection between ogenised flour and nervous disorders in man, and no less than 150 years to discover that mercury-containing teething powders have been the cause of poisonings and deaths among babies.

It is as well to remember, also, that the official assurance of "no harm" after the Windscale disaster was belied by subsequent events; that the experts' conviction, till recently, of the safety to X-ray therapy has now been rudely shaken, and that many people have now developed a dangerous sensitivity to the supposedly "non-toxic" penicillin. The official expert has been proved wrong on so many occasions that in this matter of fluoridation the thinking public is looking to those other experts who have no axe to grind, whose prestige is not involved and who may indeed stand to lose materially by opposing officialdom where important principles are involved.

The proponents' case

This has been based upon the evidence of the caries inhibiting effect upon young children of water supplies containing fluoride at approximately 1 p.p.m. The proponents claim that water to which fluoride is added at 1 p.p.m. (1 part per million Ed.) will have the same effect as water in which it is naturally present. When critics point out that the added fluoride is entirely different from that occurring naturally, the proponents reply that a fluoride ion is a fluoride ion no matter what the source.

Leading water toxicologists and biochemists do not question the identity of the fluoride ion but maintain that in naturally fluoridated waters, there are minerals which unite with it and affect its absorption and toxicity, and which may also in themselves contribute to caries-resistance. The naturally occurring calcium-fluoridated water has been proved to be 85 times less toxic than sodium-fluoridated water; this was determined by comparing lethal dosages in animals. For obvious reasons the effect on dental caries of other minerals present in drinking water has been denied by the proponents; in the much quoted Newburgh-Kingston experiment, fluoridated Newburgh, which claims a 60 per cent reduction in caries, has five times more calcium in its water than fluoride-free Kingston. One questionable premise upon which the case for fluoridation has been built that artificially and naturally fluoridated waters are biologically identical has been seriously questioned by many informed and responsible experts including the Medical-Dental ad hoc Committee, a group of American dentists, physicians, and scientists who have been studying the problem.

In their recent detailed and critical analysis of the Report of Councils (Conclusion No. 1) adopted by the A.M.A. (Philadelphia, Dec. 3-6, 1957), they draw attention to statements in this report which in effect, cast doubt on its conclusions: "It is too early to know what the effects of artificial fluoridation will be"; "what is reported a reduction may be a delay in the recognition of caries"; "that reasons given for believing that artificially fluoridated water will have the same effects as water with natural fluoride are not valid". The Medical-Dental critique also points out that the Report makes it clear that some people will be harmed by fluoridation. Nevertheless the A.M.A. "endorsed" fluoridation. This fact is eloquent of the "steamroller" tactics of the American proponents.

It is extraordinary that a project which claims to be scientific rests mainly on "endorsements", "parroted opinions", and "statistics" rather than on accurately documented scientific data. Lack of a convincing case has led some proponent scientists, on occasions, to resort to unseemly personalities, and even to slandering and censuring their opponents. Typical of this persecution is the ultimatum recently received by Dr. Jonathan Forman, for many years editor of the Ohio State Medical Journal: "Resign your editorship or strop opposing fluoridation". He resigned. An example of the way in which fluoridation has been promoted with the help of "parroted opinions" was published in Northwest Medicine (54, p. 44, 1955): "Drs. H. R. Dean and F. J. McClure started (to be recognized as experts)... by quoting themselves and each other. Soon they were quoted by others and they could quote in support of their conclusions others who were merely parroting them."

Misinterpreted statistics

In The Lancet of 6 th December, 1958, on article entitled "Danger! Doctors at work" contained the following statements which might have been written with fluoridation in mind: "We are liable to be led astray by ideas that are based on unsound premises or on fallacious reasoning... Communal bonnet-swarming is liable to occur when large numbers of doctors are sold on idea which is attractive in theory. In therapeutics a new myth is born every moment... Misdirected enthusiasm is common in the sphere of public health and preventive medicine. The peculiar danger here is the keen medical administrator with a passion for planning, liason... and lots of statistical data."

Fluoridation is so attractive in theory that many well-meaning and public-spirited do-gooders regard it as another giant step forward in this age of chemical progress. But the "lots of statistical data" upon which it is built have recently been devastatingly queried in Australia, America, France, South Africa, New Zealand and Britain.

In the Medical Journal of Australia, February 1st, 1958, two Melbourne University scientists revealed disturbing features of fluoridation promotion that, contrary to the aim of all true scientists, the proponents quite obviously set out to prove a pre-conceived theory; that the statistics were frequently manipulated to conform with this theory; that in the clinical survey no attempt was made to devise a randomisation procedure which would have eliminated bias on the port of the examiner; that "bias is suggested by the presentation of some results, so that the reader may be misled"; that "the results are not those which would be expected if the fluoridation theory is correct."

An outstanding case of "manipulation" can be found in the figures from Sheboygan, Wisconsin, before fluoridation and afterwards. Out of one hundred children examined, the number with decayed teeth fell from 97 percent to 94 percent, that is there were originally 3 percent free of decay; but after eight years there were 6 per cent. This was reported as 100 per cent improval, whereas in actual fact it was only 3 percent of the total.

In Orthodontologisk Revy (3 240-254, 1957) Dr. Palfer-Solier of the French National Institute of Hygiene criticises the fluoridation statistics particularly in connection with the DM.F. (decayed, missing, filled) index by which the proponents measure the condition of the children's teeth. Determining D.M.E. tooth surfaces per person, he says, has no value whatever "because caries not only affects the tooth surface but develops in depth as well". The weakness of the D.M.F. index in this respect has also been pointed out by other experts.

At the fourth International Health Conference at Essen, in October 1958, Dr. Steyn, Professor of Pharmacology and Toxicology at Pretoria University, warned that the fluoridation statistics, considered as evidence, are "unconvincing to the point of absurdity".

Dr. C. G. Dobbs, a University microbiologist, has pointed out in the British Dental Journal and elsewhere that the idea constantly put forward that the safety of fluoridation is proved by the absence of significant difference in the statistics of mortality and disease between low and high fluoride areas betrays a shocking ignorance of the range of normal variation in such statistics. This is so wide that only the crudest effects, such as could not possibly be caused by fluorides at 1 p.p.m., could be distinguished. For instance a doubling of the death-rate from one year to another from a disease such as cancer is quite common in restricted locales. The failure of public health officials to appreciate this is more dangerous than fluoridation itself. The only  reply, so far, to this criticism has been a stream of disparaging letters about the critic's lack of medical qualification, which is somewhat impertinent as many university biologists must be better qualified in statistics than most medical men.

Fallacious reasoning

Nothing revealts the weakness of the fluoridation case more clearly than the "fallacious reasoning" which has accompanied its promotion. The following examples speak for themselves:

Fluoridation is compared with chlorination (reference note No. 9, M.O.H. 1955): This is a false analogy. Chlorine is put into the water to make it safer to drink; fluoride is put in to effect a physiological change in our bodies. When chlorinated water is heated the chlorine is evapored, but when fluoridated water is boiled, the fluoride is progressively concentrated. As most cooking processes involve the reduction of liquids, the stipulated daily "safety" dose of 1 milligram (2 milligrams is regarded as the danger point) could soon be exceeded, especially as the factor of safety is admittedly very low - in fact, it is a "calculated risk". When a proponent M.O.H. was asked at a public meeting in the Caxton Hall on January 9th, 1959, how this danger could be overcome, he denied it existed; by his reply that if one took a glass of fluoridated water and reduced it to half by boiling, the amount of fluoride in the glass would be exactly the same as in the beginning. This is quite correct, but the learned doctor either underestimated the intelligence of his audience or made an outsize "shoolboy howler". For people to consume their habitual amount of liquid they will have to take a full glassful of this same boiled water and this glass would then contain twice the amount of fluoride in the same way as water boiled down to one fifth would contain five times as much.

Excess of sodium fluoride is compared to that of salt and Vitamin A or D. (letter to the Jersey Evening Post, Jan. 29th, 1959). This is contrary to the accepted fact that the margin between the therapeutic and toxic actions of sodium fluoride is narrow in some people while there is a high threshold of tolerance in most people where salt or one of the vitamins is concerned. It is to be hoped that no proponent would commit suicide by accepting a challenge to swallow a teaspoonful of sodium fluoride, which is approximately equal to the lethal dose of 4.5 grams, while his challenger swallowed the same amount of salt or vitamin A or D!

Without sodium fluoride our bones and teeth would be in a sorry state (Some source as above): This contains two such howlers: Fluoride does not occur in food as sodium fluoride but as calcium fluorophosphate. Sodium fluoride however has been testified by researchers to cause increased bone density. "Misdirected enthusiasm" of proponents has interpreted this to mean "stronger" bones, whereas it may mean brittle bones. At the Watford Press Conference of 1955 I heard the local Medical Officer of Health claim that storage of a small amount of fluoride salts would strengthen up the skeleton thereby preventing fractures in old people. (Press conference report, pp. 6-7).

Exhaustive tests on animals by Drs. Maurer and Day have proved the non-essentiality of fluoride to health, to teeth and to bones (Journal of Nutrition, 62. Aug. 1957). It is significant that excellent dental health has been found in communities drinking. fluoride-free water and that appalling dental decay and cases of bone abnormality have been found in communities drinking water fluoridated at, and under, the "magic" concentration of 1 p.p.m.

Fluoride cannot harm at 1 p.p.m. (Waterford press conference, 1955). This claim is contradicted by the proponents'own admission that 10-15 per cent of children drinking fluoridated water will have mottled teeth. An A.M.A. report acknowledges that mottling is the most delicate criterian of harm but that mottling at 1 p.p.m. is minimal and that its importance is outweighed by the caries-inhibiting effect. However "minimal" the "harm" the proponents are adopting an intolerable position in respect of their claim to have the right to inflict it on the public.

The many aspects of fluoridation

Never in the history of medicine has a public health procedure cut across so many different fields; it concerns not only the physicians but the toxicologists, nutritionists, dentists, water engineers, statistical experts, food processors, housewives, politicians, the Church and the Law. The well-informed layman may therefore be better qualified to see the picture as a whole thant the expert who sees in a problem only that small part to which he has devoted his life's study; the expert is more apt than most of us to suffer from the modern disease of "fragmentation". Fluoridation is eloquent of this disease: it treats the part instead of the whole. Some physicians, dentists and nutritionists are agreed that the problem of tooth decay is primarily a nutritional one and concerns the whole body. They maintain that our refined foods and the greatly increased consumption of sweets and sugared foods are the main cause of the appalling dental decay in children today.

By treating the symptom of caries instead of removing the cause faulty nutrition and too many sweets the proponents are denying the children not only for better dental health than fluoridation could ever achieve, but also for better physical health. It is ironical that the children whom this experiment with our water is intended to help may be the ones to suffer most from the effects of fluoride, for dental caries is produced by faulty feeding, and this faulty feeding has been shown by investigators to increase the severity of fluoride-intoxication. (Paper 9, Steyn, Essen Conference, 1958).

The opposition

In order to discourage opposition, the proponents have labelled as fanatics, cranks and nitwits all those who have dared to oppose them. Nevertheless the opposition includes internationally recognized research scientists, biochemists, dentists, physicians, editors of medical journals, university professors, water engineers, toxicologists and women's organizations throughout the world. The proponents' contention that "competent authority" means only those in favour of fluoridation is absurd. There is now considerable opposition in America from medical and dental associations en bloc e.g.. The Association of American Physicians and Surgeons. In March, this year. Ontario's Minister of Health, Dr. Dymond, announced that no further fluoridation will be permitted as "no one knows for sure what the effect is to persons given fluoride throughout a lifetime." (Edmonton Journal, March 6th, 1959): "When I prescribe treatment for my patients", says Dr. Dymond, "I prescribe a stated amount. It is not possible to prescribe a stated amounted of fluoride by introducing it into the water supply."

When experts disagree as they do concerning this experiment, it behooves the layman to be very skeptical of it. That he is indeed very skeptical is apparent by the fact that over 1,000 communities in America have rejected fluoridation including 81 communities which have stopped it; that in Great Britain fluoridation ceased in the "demonstration" town of Andover last July, that Cardiff, Darlington, and Norwich rejected it some time ago and that Sheffield has just recently done so. Said a Sheffield councillor: "We don't know enough about it. Opinion is divided on the benefits and disadvantages of fluoride and nobody has proved that it does no harm." (Sheffield Telegraph, Jan. 15th, 1959)

Opinion is not divided, however, on the possible caries-inhibiting effect of fluoridation, although opposing experts qualify this as being "a delaying of caries with ultimate injury to the teeth and bones". "The crux of the matter is the possible harmful effects on the health of human beings drinking water containing added sodium fluoride from infancy for 30, 40 or more years. This is not the concern of the dental profession but entirely that of the medical profession, and of the toxicologist and nutritionist in particular. If the medical or nutritional case for increasing the fluoride intake of the entire population had ever been discussed by properly qualified and unbiased people at official levels, fluoridation would never have been heard of again.

At the Essen Conference of 1958, Professor Steyn warned: "It is the author's considered opinion, as a toxicologist and pharmacologist of 30 years' experience, that under certain conditions, especially with certain types of water, artificial fluoridation of public water supply can, and does, constitute a grave danger to human health. "This view is shared by many other authorities including Dr. Sinclair, lately Reader in Human Nutrition at Oxford. In an address reported in the B.M.J. of Dec. 14th, 1957, he says: "I believe this is one of the many examples. where a little learning is a dangerous thing, and where health may be injured and science brought to disrepute by the incautious and premature application to public health of insufficiently investigated procedures."

A lighter but none the less effective note is sounded in the warning of Mr. H. B. Foxwell, the Waterford schoolmaster who is secretary of the local anti-fluoridation committee. According to him, fluoridation is:

Medically controversial

Dentally doubtful

Scientifically spurious

Legally questionable

Economically wasteful

Promotionally unscrupulous,

and Politically dynamite!

I have shown, I hope, that there is reason for some members of the public to object to being forced to take additional fluoride through their drinking water. Many middle-aged people are already worried about the increase in chronic disease of uncertain origin, notably cancer, heart disease and rheumatism; and it is surely not unreasonable to suppose that a permanent, daily increase, in the intake of a substance known to be toxic, might tend to increase rather than decrease the danger of such diseases. Whether these people are right or wrong, they have a perfect right to entertain such a reasonable belief, and those medical men who would deliberately impose this added anxiety upon them are acting in a manner quite contrary to the best traditions of their profession. Incidentally, as events in Andover, where the council was voted out on this issue alone, shows very clearly, they are also amalganizing a large proportion of the population whom they are supposed to serve.

Such warnings from such a variety of authorities will be disregarded at our peril. Let us hope that the doctors of tomorrow will lend all adoption of fluoridation before too much irretrievable damage is done.