CLEANWATERGSO.ORG

Janet Nagel

​I appreciated the opportunity to address the Infrastructure Committee on May 10. As you no doubt recognize, the question of fluoridation is complex and difficult to address in three-minute soundbites.
Fluoridation is always done with the best of intentions, and unintended consequences have not been immediately apparent.  Having been immersed in fluoridation debate for many years, I know that the fundamental issue is neither science nor ethics, but rather credibility.  Who should we believe?
Like many fluoridation objectors, my commitment to ending fluoridation arises out of personal experience of harm to a loved one, as well as indignation that as a health professional I was--and so many others continue to be--systematically misled on this issue.
As I suggest in the conclusion of this letter, ending the unsafe and ineffective practice of fluoridation does not mean abandoning attention to the needs of those without current access to professional dental care.  On the contrary, more targeted measures will produce much more positive outcomes.

A Matter of Perception
Most of the world sees fluoridation for the mistaken public policy that it is.  But belief in the safety and effectiveness of fluoridation is deeply ingrained in the consciousness of Americans, as is the fear of speaking out against it.  I don’t think anyone can change her or his perception of fluoridation without taking time to evaluate the conflicting claims for and against it.  I hope I can provide you with some reasons to do that. 
It’s true that “establishment” science supports fluoridation—the CDC, the ADA, and a string of others who repeat the pronouncements of those two.    But, just as establishment science was once wrong about asbestos, and wrong about lead in paint and gasoline, so it was wrong about fluoridation. Fluoridation is a product of that same industrial science era which was also the time when eugenics was countenanced and the US Public Health Service was secretly conducting the Tuskegee Syphilis Study. 
Support for fluoridation is the result of 70 years of mass mind-molding with classic advertising techniques like the earnest pronouncement by the white-coated health authority. And there was the amazing impact of the 1964 motion picture, Dr. Strangelove, which convinced most people that anyone opposed to fluoridation must be an anti-science wacko.  Acceptance of fluoridation is the phenomenon of the emperor's non-existent new clothes.  So many people still believe it's a mark of intelligence to support fluoridation because they haven't looked into the science for themselves or considered the issue of healthcare ethics. Anyone who has the audacity to do so quickly finds that the claims of fluoridation promoters have little basis in fact and the pronouncements of government bureaucrats are seriously flawed by misstatements and intentional omissions.
It’s undeniable that bureaucrats within our federal government can be susceptible to undue influence from industrial interests as well as the weaknesses of personal ego and lack of competence.  Unfortunately, a bureaucratic culture with deeply entrenched interests in maintaining fluoridation has created a morass of overlapping and contradictory policies spread through many federal offices.
For two decades EPA administrators have refused to comply with the requirements of the Safe Drinking Water Act to disallow fluoridation in light of evidence that fluoride is a carcinogen.  Instead they illegally fired their chief science advisor, William Marcus, for blowing the whistle on falsified data and incorrect conclusions in a published report. The media did not report on Dr. Marcus’ successful lawsuit against the EPA; and the EPA did not correct the report.  In response to the EPA administration’s failure to act, the professionals’ union at EPA headquartersapproved a resolution in 1998 calling for an end to fluoridation. As Dr. Marcus’ EPA colleague, Robert Carton said, "Fluoridation is the greatest scientific fraud of this [20th] century and perhaps of all time."   

Fluoridation Is A False Promise
It cannot be emphasized enough that all people have a right as human beings to healthcare, including dental care.  For far too long, fluoridation has been falsely promoted as a legitimate substitute for professional dental care when, in fact, it is ineffectual as a preventative measure and has disproportionately negative health impacts on poor people of all ages.  
In 2015, consumer advocate Erin Brockovich wrote,
“My career has been about making people aware of harmful exposures and the deception that often accompanies those exposures. Drinking water fluoridation is harmful, we’ve been deceived to believe it is safe, and with new found knowledge we must all act now to stop it.” 
Brockovich and a number of associates have addressed formal letters of concern to the Institute of Medicine of the National Academies of Science, to the American Thyroid Association, and to the National Governors Association.    
Last month Mark Hyman, MD, Cleveland Clinic physician and best-selling author, made this statement: 
 “There are numerous mechanisms by which uncontrolled dosing of fluorides through water fluoridation can potentially harm thyroid function, the body and the brain. A malfunctioning thyroid often leads to weight gain. And diabetics and patients with kidney disease are often thirsty, causing them to consume increased amounts of fluorides if they have access to only fluoridated water. Communities of color and the underserved are disproportionately harmed by fluorides because most rely on municipal water sources, many of which continue to add fluoride, despite research showing the potential harms and negating the potential benefits. I support federal investigative hearings looking into why our cities and towns are allowed to continue to add fluoride to public water sources and why the whole story about fluorides is only just now coming out.”
 In 2011, former Atlanta mayor Andrew Young wrote to the Georgia legislature:
“My father was a dentist. I formerly was a strong believer in the benefits of water fluoridation for preventing cavities. But many things that we began to do 50 or more years ago we now no longer do, because we have learned further information that changes our practices and policies. So it is with fluoridation.
“We originally thought people needed to swallow it, so the fluoride would be incorporated into teeth before they erupted from the gums. Our belief in the need for systemic absorption was why we began adding fluoride to drinking water. But now we know that the primary, limited cavity fighting effects of fluoride are topical, when fluorides touch teeth in the mouth. We know that fluorides do little to stop cavities where they occur most often, in the pits and fissures of the back molars where food packs down into the grooves. This is why there is a big push today to use teeth sealants in the molars of children. We also have a cavity epidemic today in our inner cities that have been fluoridated for decades . . . .
“I am most deeply concerned for poor families who have babies: if they cannot afford unfluoridated water for their babies’ milk formula, do their babies not count? Of course they do. This is an issue of fairness, civil rights, and compassion. We must find better ways to prevent cavities, such as helping those most at risk for cavities obtain access to the services of a dentist.”
And Dr. Alveda King wrote on her blog,
“Generally people with built-in biases in support of fluoridation have been controlling the discussion about harm from fluorides. The Centers for Disease Control has clearly been trying to preserve fluoridation at all costs, but the facts about fluoride harm are coming out anyway.  This is a civil rights issue. No one should be subjected to drinking fluoride in their water, especially sensitive groups like kidney patients and diabetics, babies in their milk formula, or poor families that cannot afford to purchase unfluoridated water. Black and Latino families are being disproportionately harmed.”  
Before Portland, Oregon’s rejection of fluoridation in 2013 by 60% of the vote, NAACP leader Clifford Walker wrote,
“As the Chair of the Portland NAACP’s Veteran’s Committee and in my past position on the Oregon Commission on Black Affairs, I have seen well-meaning plans that do not actually achieve meaningful progress on the problem they claim to address. Fluoridation is just such a plan.  If Portland voters want to help low-income children we should reject fluoridation and focus on providing equal access to dental care.”   

The Scientific Nitty-Gritty
It’s very common for dentists to say they see a marked difference in tooth decay between children in fluoridated communities and those in non-fluoridated communities.  That is what’s known as anecdotal evidence, as opposed to scientific evidence.  The reason for double-blind studies in science is to avoid the influence of observers’ expectations on what they perceive. We know that the influence of expectation on perception is problematic in community policing, for example.  One dentist testified, in all sincerity, that he knew fluoridation worked because his patients’ teeth were harder when he drilled them! (An anecdote, of course, but if fluoridation works why was he drilling? And why didn’t he see the irony?)
There has never been a double-blind study of the incidence of tooth decay, meaning that the dentists recording the decay status of people in epidemiological studies always have known if the subjects were living in a fluoridated community or a non-fluoridated community. Nevertheless, in studies that are considered adequate enough to be considered, no statistically significant difference in tooth decay incidence has been found.*
On the other hand, studies of the health effects of fluoride exposure have been numerous and of high quality, despite the efforts of dental interests to discount them. Those epidemiological, animal, in vitro, and clinical studies document lifetime increases in learning disabilities when exposure to fluoridated water is in utero or during infancy and young childhood. They document increased rates of low thyroid in the general population, increased risk of renal damage to kidney patients, worsening inflammatory symptoms for those with inflammatory or endocrine disease, increased risk of hip fractures, increased risk of osteosarcoma, and other adverse health effects as well. Furthermore, African Americans, Hispanic Americans, and Indigenous People have been shown to have higher risks of many of those adverse effects than white Americans. 
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What’s The Right Thing To Do?
Recommendations of the CDC regarding fluoridation are non-binding, and no agency of the federal government is responsible for any adverse consequences. Indeed, federal agencies continue to deny that there are adverse consequences, although the National Toxicology Program has just undertaken a study of the evidence of fluoride neurotoxicity which will take several years to complete.  The only reason for following federal recommendations is adherence to an outdated and discredited belief that ingested fluoride increases resistance to decay. A belief that the CDC renounced in 1999.
Likewise, state and local public health authorities who recommend fluoridation are not responsible for adverse consequences. Responsibility for prescribing and administering non-consensual fluoride treatment via the community water supply rests with those who actually implement the policy.  The fact that evidence of harm has been made known to the implementers might someday be problematic, given increased concerns about water safety and the growing body of science documenting adverse health effects of ingested fluoride.
But today the City of Greensboro can accept its responsibility and assert its authority.  It can recognize that all of its citizens are entitled to professional dental care and to community water in its most pristine possible form, free of any substance added as a putative dental treatment that’s not related to making the water safe to drink.
The Guilford County Health Department recently received a small grant of $5,000 to provide dental services to Guilford County residents who do not qualify for Medicaid coverage.  Ending fluoridation would reduce water treatment costs by about $90,000 a year.  The City could allocate that savings to an ongoing grant to the Guilford County Health Department for expanded dental services to low-income residents and/or an expanded dental health program in schools.  Scotland and several European countries conduct highly successful dental health programs in their schools.
Justifying such transfer of funds is the fact that by fluoridating city water the City of Greensboro has had a fifty-year commitment to addressing the dental health needs of poor people. Shouldn’t those funds be redirected to programs that effectively meet the needs of the people fluoridation was intended to help?
The science makes it clear that targeting those funds to professional dental services and education will produce more successful outcomes for those who currently do not have access to professional care.  At the same time, ending fluoridation will end misdirected fluoride treatment of those who do not want it, do not need it, and should not have it.
I submitted a fluoridation reader and reference material to City Council Members in January and there is additional creditable information on the Clean Water Greensboro website cleanwatergso.org and at the links it provides to other sites.  Thank you for your attention to this important human rights and public health and safety matter.
 
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*An Example Of How Public Health Data Can Be Manipulated
The 1986-87 study of over 39,000  children aged 5-17 for the National Institute for Dental Research (NIDR) failed to show a statistically significant difference in tooth decay between children who had been exposed to fluoridated water all their lives and children who had never been exposed to fluoridated water. Initially the NDIR excluded some of the data and published the study as proof of fluoridation’s effectiveness.  (Removing inconvenient data is unfortunately not uncommon when researchers want to prove a pet theory.) 
When all the data were obtained with a Freedom of Information Act request and all the data were analyzed together, there was no statistically significant difference between the DMFT (Decayed, Missing, and Filled Teeth) rates of children living in fluoridated communities their whole lives and the DMFT rates of children living their whole lives in non-fluoridated communities. No statistically significant difference means there is no scientifically justified reason for concluding that there was any difference between the two groups attributable to fluoridation.
Undeterred, the NIDR then came back with the claim that there was 18% less decay in the fluoridated group. This result was obtained by looking at the Decayed Missing and Filled tooth Surfaces (DMFS) rather than Teeth (DMFT). There are 28 teeth in a child’s mouth and 128 tooth surfaces: 16 teeth with 5 surfaces and 12 teeth with 4 surfaces (6 front top and bottom) = 80 + 48 = 128.  The data showed the average DMFS score for children in fluoridated communities was 2.79 tooth surfaces, while the average score for children in non-fluoridated communities was 3.39 tooth surfaces. (Remember one tooth has either 4 or 5 surfaces so in both cases we’re talking about one tooth and one cavity.)  Subtracting 2.79 from 3.39 yields a difference of  0.6 tooth surface.  NIDR calculated this as a relative difference of 18% (i.e., 2.79 is 18% less than 3.39).  Looked at in a more logical way, the actual difference was 0.6/128  or less than one half of 1% of all tooth surfaces. Bear in mind that the difference is not statistically significant, meaning not a scientifically valid proof of any real difference. And the dentists recording the data knew whether the children they examined lived in a fluoridated or a non-fluoridated community, so who’s to say if the expectations of the examiners could have caused them to perceive less decay in the fluoridated community? Of course that’s pure conjecture.