Fluoridation Referendum Leaves Decision in Voters' Hands

While the signatures are still being counted, most analysts expect the fluoridation battle ultimately will be decided by Portland voters
The Lund Report

OPINION – October 17, 2012 -- There is one main benefit of Clean Water Portland's successful signature-gathering campaign to qualify for a city-wide referendum vote on fluoridation: It allows time for citizens to make an informed decision.

Take the question of fluoridation's effectiveness. Proponents often say there are "thousands" of studies showing this. The number itself is questionable but the quality is the larger issue.

The York (UK) University 1990 Report found zero fluoridation studies merited a Grade A for quality and only six longitudinal studies a Grade B or C. The vast majority were inferior.

When more recent, higher-quality studies are reviewed, a clear picture emerges - nearly all show the protective effects of fluoride are topical, NOT through ingestion.

The largest study done in the U.S., by the National Institute of Dental Research, was revealing. One study of the data (Yiamouyiannis 1990) found no significant statistical difference in children's cavity rates in permanent teeth between fluoridated and non-fluoridated areas. Another (Brunelle and Carlos 1990) found an average cavity prevention rate of less than one tooth surface per child from fluoridation.

Even the CDC, the main government promoter, acknowledged in 1999 that fluoride's actions are "primarily topical for both adults and children."

The strongest U.S. study is the ongoing Warren, Levy et al research (the "Iowa Study"), the only one that examines children's tooth decay as a function of total fluoride exposure, not just water level. In its 2009 report the authors repeated what so many others have found:  "The benefits of fluoride are mostly topical."

Studies from communities around the world (Finland - Seppa et al 2000), (Germany - Kunzel et al 2000), (Cuba and Canada - both Maupone et al 2001) all found that tooth decay didn't increase when fluoridation was stopped.

Finally, the National Survey of Children's Health (2005) reported the per cent of children in the U.S. that had very good/excellent teeth by income. When overlaid with a graph of all 50 states and their fluoridation rates, there is no correlation whatsoever between water fluoridation and very good/excellent teeth for either high-income or low-income children.

The lack of effectiveness shown by the graph has been underscored by numerous newspaper articles from cities all over the country that have been fluoridated for years, often decades.  Serious tooth decay reported in poor kids in Cincinnati, Boston, Pittsburgh, San Antonio, New Haven, New York and more reinforce the scientific data.

Ask yourself if you were aware of any of the above. I'm quite sure you weren't. Then you'll understand why we need the time to have a real debate with both sides given equal voice, not a one-month, one-sided public relations campaign.

Rick North is the former CEO of the Oregon American Cancer Society (1994-99) and former Project Director of Oregon Physicians for Social Responsibility’s Campaign for Safe Food (2003-2011). He retired in February 2011 to become a volunteer confronting undue corporate influence in elections and the government.

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Comments

I'm shocked that Mr. North would cite a study by Dr. Yiamouyiannis, a man who authored a book claiming HIV doesn't cause AIDS. Dr. Yiamouyiannis is not an unbiased researcher. He was a well known anti-fluoride activist who also opposed vaccinations. I wish Mr. North would look at the weight of evidence that overwhelming shows fluoridation as safe and effective. Instead he cherry picks studies that lack credibility.

Lang, I believe you have used an ad hominem argument. Please read this link for more information: http://en.m.wikipedia.org/wiki/Ad_hominem Feel free to let me know what you think. Thank you.

I don't think this is an ad hominem matter. John Yiamouyiannis Ph.D was a smart, perhaps even brilliant man. He certainly was a skilled public speaker. Readers can easily find examples of his speaking skills on YouTube. On the other hand, the life context of his science based beliefs about community water fluoridation is important. If he consistently made bad judgements generically with respect to applied science, that should give us pause when he advises against fluoridation. An obituary may be read at: http://www.quackwatch.org/11Ind/yiamouyiannis.html His book "AIDS: The Good News Is HIV Doesn't Cause It" without doubt has a false thesis. He lived on an isolated farm and bragged that the medical bill for his family for 20 years was only $500. He opposed vaccinations and speculated that vaccinated people would have a higher incidence of AIDS. His life was ended prematurely by colon cancer for which he avoided conventional treatments and sought Laetrile and other treatments in Mexican clinics. Yiamouyiannis sued to obtain the data which the important Brunelle and Carlos (1990) study used. As Mr. North states, Yiamouyiannis infamous reprocessing of the data found no difference in "cavity rates." Dr. Y got this result by using an egregiously misleading measurement. Brunelle and Carlos used Diseased Missing of Filled Surfaces (DMFS) Dr. Y used Diseased Missing or Filled Teeth (DMFT). Imagine one molar completely destroyed from cavities with an apical abscess and another with a tiny pinpoint cavity, perhaps visible only to the dentist using a diagnostic probe. Dr. Y's 's methodology score shows NO DIFFERENCE Totally Destroyed Tooth: 1 Tooth w Tiny Barely visible Cavity: 1 Score using DMFS (surfaces) shows a BIG DIFFERENCE Totally Destroyed Tooth: 4 Tooth w Tiny Barely visible Cavity: 1 Is it small wonder that a scoring system that makes these two teeth equal misses important benefits. Anti-fluoridationists continue the Yiamouyiannis slight of hand to this day using the phrase "cavity rates" as a synonym for DMFT scoring.

Fluoride is neither a nutrient nor essential for healthy teeth. No adult has ever walked out of their doctor's office with a prescription for the fluoride drug because it is deadly poison and the body has no known use for it. It is never included in any multi-vitamin formulation. Drinking it to prevent tooth decay is as foolish as drinking sunscreen to prevent sunburn. Every fluoride toothpaste tube carries the warning "if swallowed, call a poison control center immediately." As a top scientist and the premier international authority on fluoride, last year Dr. Paul Connett's published his most recent book "The Case Against Fluoride." It contains over 1200 peer reviewed studies (80 pages) and sound scientific reasoning showing the ineffectiveness and dangers to health including cancer, thyroid & pineal gland damage, broken hips from brittle bones, lowered IQ, kidney disease, and other serious health problems.

Jwillie6 and Mr. North are mistaken. While there perhaps is legitimate controversy as to the exact percentage of relative importance for the topical and systemic effects of fluoride, there is a very clear literature showing the systemic (swallowed fluoride while teeth are forming) effect is important. 1. Molars with fluorosis have fewer cavities than those without. There can be no argument that dental fluorosis is from young children swallowing fluoride 2. Epidemiological studies show fluoridation decreases grinding injury for both adults and children. This confirms experimental literature showing that fluoride swallowed during tooth development has a number of effects on tooth structure including harder enamel and dentin. Clearly only a systemic effect can create harder, more wear resistant teeth. 3. Careful epidemiological studies on humans, not merely test tube models, show fluoridation provides both systemic and topical effects in combination: a. Groeneveld's study from the Netherlands of the time of exposure to fluoride (both before and after tooth eruption) showed cavity reduction on smooth surfaces of permanent where upper and lower teeth come together was found to be equally due to systemic and topical effects. On the smooth surfaces not touching other teeth cavity reduction was mostly (75%) from topical effects. b. Cavity reduction in the irregular pits and fissures of molars was mostly (66%) from systemic effects.Australian children with optimal exposure to fluoridated water, both before and after tooth eruption had the lowest caries on all surface types. c. A number of studies have shown that fluoridated water consumed in childhood leads to better oral health as an adult. In Okinawa children who drank fluoridated water on an army base had fewer cavities as adults without fluoridated water. d. Neidell found that lack of community water fluoridation (CWF) during childhood was related to tooth loss in adults. The tooth saving impact of childhood fluoridation was larger for socioeconomic disadvantaged persons. The systemic effect caused a lasting improvement of economic disparities in oral health. Even if there were no evidence for a systemic effect, it would not matter because the data which shows community water fluoridation's benefit state regardless of the underlying mechanism for the effectiveness. I'll repeat that . . the mechanism of action is not important in the decision for CWF because the benefits have simply been shown, whatever might be the scientific reasons. Community Water Fluoridation is safe, effective and inexpensive. Portland's 600,000 citizens oral health is at stake. Mistaken arguments need acknowledging.

As a top scientist and the premier international authority on fluoride, last year Dr. Paul Connett's published his most recent book "The Case Against Fluoride." It contains over 1200 peer reviewed studies (80 pages) and sound scientific reasoning showing the ineffectiveness and dangers to health including cancer, thyroid & pineal gland damage, broken hips from brittle bones, lowered IQ, kidney disease, and other serious health problems.

Rick North, as is so very common amongst community water fluoridation (CWF) opponents, lists so many accusations, half truths and outright mistakes that a complete reply is not possible on a blog. A persuasive argument, both to legislators and to the general public, is to call for a public vote. On the surface, this appears to be the democratic way to settle the issue. Sadly, those who need fluoridation the most, the children, do not vote. It is not difficult to confuse voters by flooding the community with scare propaganda. Average citizens, including Mr. North who has no credentials in medicine, dentistry or public health, do not have the educational background to sort out claim and counterclaim or to judge which "authorities" to believe. To turn against fluoridation, they don't need to accept all the arguments, only one. The sheer scope of this essay is likely to arouse doubt in the minds of many voters. Saying, "Let the people decide," may sound as the proper democratic process for the decision, but experience in many cities has shown otherwise. If the attempt to overturn the City Council's unanimously passed ordinance fails, it is likely the opponents response will be to work for a prejudicially worded one like was done in Hood River where "industrial waste byproducts" will likely be the proxy issue. Portland has already repeated referendums; fluoridation passed in 1978 and was repealed in 1980 in a vote which required a "NO" to support CWF. Referendums can lose even in communities where public opinion favors fluoridation. The cause is either a prejudicially worded ballot title or special elections when people seeking to vote against what they don't like turn out in larger numbers. One of Mr. North's points is representative of the entire essay. He reveres Dr. Yiamouyiannis whose 1990 "paper" (it appears in no peer reviewed journal) "found no significant statistical difference in children's cavity rates." Dr. Yiamouyiannis, is the most effective anti-fluoridationist to have ever lived. His book "AIDS: The Good News Is HIV Doesn't Cause It" without doubt has a false thesis. He lived on an isolated farm and bragged that the medical bill for his family for 20 years was only $500. He opposed vaccinations and speculated that vaccinated people would have a higher incidence of AIDS. His life was ended prematurely by colon cancer for which he avoided conventional treatments and sought Laetrile and other treatments in Mexican clinics. Yiamouyiannis sued to obtain the data which the important Brunelle and Carlos (1990) study used. As Mr. North states, Yiamouyiannis infamous reprocessing of the data found no difference in "cavity rates." Dr. Y got this result by using an egregiously misleading measurement. Brunelle and Carlos used Diseased Missing of Filled Surfaces (DMFS) Dr. Y used Diseased Missing or Filled Teeth (DMFT). Imagine one molar completely destroyed from cavities with an apical abscess and another with a tiny pinpoint cavity, perhaps visible only to the dentist using a diagnostic probe. Dr. Y's 's methodology score shows NO DIFFERENCE Totally Destroyed Tooth: 1 Tooth w Tiny Barely visible Cavity: 1 Score using DMFS (surfaces) shows a BIG DIFFERENCE Totally Destroyed Tooth: 4 Tooth w Tiny Barely visible Cavity: 1 Is it small wonder that a scoring system that makes these two teeth equal misses important benefits. Anti-fluoridationists continue the Yiamouyiannis slight of hand to this day. Connett, NYSCOF and Osmunson thus all claimed "Fluoridation is Money Down the Drain" in response to the very important paper which showed molars with fluorosis have fewer cavities than those without. Mr. North's statement that " no significant statistical difference in children's cavity rates in permanent teeth between fluoridated and non-fluoridated areas" is junk science at is flagrant worst. There is not a single claim nor idea in this essay with more scientific substance than the Yiamouyiannis reference. The Brunelle and Carlos study referenced showed that in the Pacific Region, then fluoridated at the same rate as today's Oregon, had 61% fewer cavities with fluoridation. Table 9 in J Dent Res. 1990 Feb;69 Spec No:723-7; Recent trends in dental caries in U.S. children and the effect of water fluoridation. Brunelle JA, Carlos JP. One would have hoped that the Lund Report would have had sufficient scientific sophistication to not give Mr. North this important soapbox. While Mr. North is dead wrong on so many fronts, the political impact has little to do with the scientific validity of his arguments. Oregonians commonly feel enormous outrage that a chemical they believe (mistakenly) to be contaminated which originates from the hated phosphate fertilizer industry and which enters both home and their very persons uninvited. The outrage overpowers the fact that CWF enjoys overwhelming professional support. The outrage overpowers that CWF is an important social justice issue. The outraged ignore that 2/3rds of the operations for terrible cavities in preschoolers are avoided; that cavities on the root surfaces of the elderly are prevented and that adults avoid about a tooth surface cavity about every 3 years of drinking fluoridated water. The outrage leads otherwise normal people to believe what the Oregonian Editorial called "crackpottery." Quoting: "To believe such crackpottery is implicitly to believe the following: That state and federal health agencies are, for some mysterious reason, hiding the truth and helping to poison more than 200 million citizens, aided by the American Dental Association and, we guess, credulous editorial boards like The Oregonian's. While we don't consider any of these groups infallible, or even close, it's far more likely that fluoridation receives so much mainstream support because it does exactly what it's supposed to. It reduces the incidence of cavities." Portland needs to take a deep breath, think clearly, consult with scientific experts and do the right thing.

Rick, considering that you are a volunteer confronting undue corporate influence in elections and the government...I thought that you and others would find this article interesting, especially in regards to the one-month, one-sided public relations campaign that you've addressed here: "Portland City Council calendars don't show meetings reported by fluoride lobbyists: Portland City Hall roundup" Brad Schmidt, The Oregonian 10/19/2012 8:12 AM http://mobile.oregonlive.com/advorg/pm_29233/contentdetail.htm?contentguid=6B5gzwW1 Excerpts: Fluoride lobbyists reported meeting personally with all five members of the Portland City Council in July or August but only one of those initial meetings appears on public calendars -- under a vague heading -- leaving lingering questions about the effectiveness of the city's lobbying and reporting requirements. [...] In 2005, when the City Council approved Adams' lobbying and reporting plan, he said it would shine a "disinfecting light" on decision-making that "will make the city government a sunnier place, not just for the political class, but for all Portlanders, even on the rainiest day."

Excerpt: As for Upstream Public Health, it didn't register as a lobbying group until Aug. 16. The Oregonian broke news of the fluoride push, and the group's stealth lobbying efforts, Aug. 9. According to city code, lobbyists are required to register with the city "within three working days after a lobbying entity has spent 8 hours or more or estimates that it has spent cumulative 8 hours or more during any calendar quarter lobbying." From: The Oregonian 10/19/2012 http://mobile.oregonlive.com/advorg/pm_29233/contentdetail.htm?contentguid=6B5gzwW1

Billy Budd debunked several points by Mr. North. Mr. North states: "Ask yourself if you were aware of any of the above. I'm quite sure you weren't. Then you'll understand why we need the time to have a real debate with both sides given equal voice." Public health and many issues in science are not something that should be decided by debate by the general public. Issues like global warming are discussed amongst scientists and their concensus opinion is what counts. Sure there are some global warming deny-ers, just as there are fluoridation deny-ers. It is the consensus of mainstream science that global warming exists and shouldn't be voted on by the public. Fluoridation is no different. I want to add a comment about Mr. North's discussion of the National Survey of Children's Health. This graph that he discusses is a fake, home-made graph by Dr. Bill Osmunson trying to show that fluoridation doesn't work. It overlays data from this national survey assessing parental attitudes regarding their children's health. when you go to the site: http://mchb.hrsa.gov/oralhealth/state.htm. then, click on a state, that is where it says at the top "all data based on parental reports". Not only were there no trained dental examiners to do callibrated oral exams on these children, but the universal indice used by all dental public health researchers to determine cavities: "decayed, missing, filled, tooth surfaces" (DMFTS) was not applied to each of the children examined. What makes this particularly egregious is the fact that in April, 2009, I presented this information at a meeting at Physicians for Social Responsibility in Portland to both Mr. North and Dr. Osmunson, showing them exactly how fallacious this information is. Guess what? They continue to try and pull the wool over the public's collective eyes in their attempt to end fluoridation in Oregon and to prevent Portland from ending the statistic of being the largest city in the Unitied States that hasn't moved forward with bringing this proven, safe, public health forward to the citizens of Portland. When someone continues to use fallacious data and they know it to be so, they are either a liar or delusional.

Fluoride lobbying scandal at Portland City Hall (Jack Bog's Blog) Monday, October 22, 2012 http://bojack.org/2012/10/fluoride_lobbying_scandal_at_p.html#comments

In response to “Billy Budd” and “ToothTruth,” again, I’ll skip the name-calling and stick to the science. Readers can decide for themselves who has the strongest arguments. Aside from Budd’s ad hominem attacks on Yiamouyiannis, his main criticism is that he used the Decayed (not “diseased,” as Budd states), Missing or Filled Teeth (DMFT) index instead of the Decayed, Missing or Filled Surfaces (DMFS) index, calling it “an egregiously misleading measurement.” Actually, the DMFT index was the standard measurement until the 1990’s, used by both advocates and opponents of fluoridation. There’s nothing misleading about the index or Yiamouyiannis’s reporting. Using standard methodology, he states correctly that the National Institute of Dental Research data shows no statistically significant difference in cavity rates between fluoridated and non-fluoridated areas. This finding is indisputable. Budd’s assertion that Yiamouyiannis’s study didn’t appear in a peer-reviewed journal is simply incorrect. To fact-check, I’d recommend anyone looking at the study itself. It’s at http://www.fluoridealert.org/studies/caries03/?print=1 along with an excellent comparison of the two systems of measurement. The criticism from “ToothTruth” centers around the graph I cited, calling it “fake” and the data “fallacious.” Actually, the data came from the 2005 government survey The Oral Health of Children, which documented low-income and high-income children’s dental health. The overlay was the percentage of a state’s population drinking fluoridated water. The terms on the graph used the same ones cited in the government survey – very good or excellent teeth. It’s all a matter of public record. It’s accurate that the definitions came from parents’ ratings of their children’s teeth. However, they cited cavities far more than any other factor in evaluating their kids’ teeth. I’d agree that it’s not as precise as DMFS data, but that doesn’t diminish the obvious significance of the graph – there was no correlation whatsoever between the dental health of low-income and high-income children and water fluoridation. Yiamouyiannis’s study and the graph show what so many other studies have shown in the past twenty years – water fluoridation has virtually no effect on cavity rates in children. Again, even the CDC acknowledged that fluoride’s main effect is topical. That was my main point and it’s not even in dispute. “ToothTruth,” whoever he is, said he brought up his criticism at a meeting I was at a few years ago. Maybe he thought his argument was valid. I’m not sure how many others did. Pro-fluoridationists robotically repeat the mantra that the practice is safe and effective. In fact, it’s neither. There are significant scientific data that show this, no matter how many cities in the U.S. have allowed it. Scientists and government officials in most other countries who have studied this data, especially in Europe, have come to the same conclusion I have. One final point – I have to wonder why these critics are hiding behind pseudonyms. I stand behind the quality of the numerous sources I cited showing fluoridation’s ineffectiveness – in my own name.

As a practicing dentist for 25 years I promoted fluoridation of public water, over the last 10 years looking at both sides of the science and laws, I am now opposed. A. Freedom for each person to chose the chemicals, drugs, substances, contaminants put into their bodies is a fundamental right which fluoridation violates. All codes of human treatment and research require informed consent by the patient, i.e. PARQ or SOAP. B. Congress in the FD&C Act define substances used with the intent to prevent disease as a drug and lists fluoride in the US Pharmacopeia as a drug. Read the toothpaste label, "DRUG FACTS." Go to a Pharmacy and ask the Pharmacist for fluoride to ingest and you will need a prescription to purchase the drug. The FDA confirmed to Congress that fluoride is a drug. FOI requests to the FDA have confirmed fluoride is a drug. HHS has confirmed fluoride is a drug. And the FDA has never approved the ingestion of fluoride for the prevention of caries. 1975 Drug Facts reported FDA had rejected fluoride supplements for lack of evidence of efficacy. Unapproved, off-label drugs are called "illegal" by the FDA. C. Many are ingesting too much fluoride. About 80% of infants ingest too much fluoride. EPA DRA reports about 1/4 to 1/3 of children under the age of 7 are ingesting too much fluoride. Proponents refuse to provide measured evidence of serum or urine fluoride concentrations to demonstrate the need for fluoridation. D. EPA scientists are correct when they reported the purported benefits are so small. Certainly fluoride changes the tooth and makes the tooth harder, but harder is not necessarily better and fluoridation does not show a life time benefit with better dental health. E. The risks of excess fluoride exposure are many and serious. The brain is more important than teeth. Consider the following from Harvard School of Public Health, quote; "July 25, 2012 For years health experts have been unable to agree on whether fluoride in the drinking water may be toxic to the developing human brain. Extremely high levels of fluoride are known to cause neurotoxicity in adults, and negative impacts on memory and learning have been reported in rodent studies, but little is known about the substance’s impact on children’s neurodevelopment. In a meta-analysis, researchers from Harvard School of Public Health (HSPH) and China Medical University in Shenyang for the first time combined 27 studies and found strong indications that fluoride may adversely affect cognitive development in children. Based on the findings, the authors say that this risk should not be ignored, and that more research on fluoride’s impact on the developing brain is warranted. The study was published online in Environmental Health Perspectives on July 20, 2012. The researchers conducted a systematic review of studies, almost all of which are from China where risks from fluoride are well-established. Fluoride is a naturally occurring substance in groundwater, and exposures to the chemical are increased in some parts of China. Virtually no human studies in this field have been conducted in the U.S., said lead author Anna Choi, research scientist in the Department of Environmental Health at HSPH. Even though many of the studies on children in China differed in many ways or were incomplete, the authors consider the data compilation and joint analysis an important first step in evaluating the potential risk. “For the first time we have been able to do a comprehensive meta-analysis that has the potential for helping us plan better studies. We want to make sure that cognitive development is considered as a possible target for fluoride toxicity,” Choi said. Choi and senior author Philippe Grandjean, adjunct professor of environmental health at HSPH, and their colleagues collated the epidemiological studies of children exposed to fluoride from drinking water. The China National Knowledge Infrastructure database also was included to locate studies published in Chinese journals. They then analyzed possible associations with IQ measures in more than 8,000 children of school age; all but one study suggested that high fluoride content in water may negatively affect cognitive development. The average loss in IQ was reported as a standardized weighted mean difference of 0.45, which would be approximately equivalent to seven IQ points for commonly used IQ scores with a standard deviation of 15.* Some studies suggested that even slightly increased fluoride exposure could be toxic to the brain. Thus, children in high-fluoride areas had significantly lower IQ scores than those who lived in low-fluoride areas. The children studied were up to 14 years of age, but the investigators speculate that any toxic effect on brain development may have happened earlier, and that the brain may not be fully capable of compensating for the toxicity. “Fluoride seems to fit in with lead, mercury, and other poisons that cause chemical brain drain,” Grandjean says. “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.” * This sentence was updated on September 5, 2012. --Marge Dwyer"