Lies, damned lies and fluoridation

Background

Adding fluoride chemicals to water supplies for dental purposes commenced in the USA in the 1940s, based on incomplete trials and minimal safety testing. Regardless, most Australian capital cities followed America introducing fluoridation in the 1960s and 1970s. Brisbane though, and numerous regional cities around the country, never embraced the fluoride enthusiasm. Doubts and concerns have long been voiced both in the scientific community and from the public. Dentistry associations and state governments run regular public relations campaigns to try to bolster public support. The ethics of these PR campaigns need to be examined.

Fluoridation as medication

Fluoridation is administered as a “medication” since it was marketed as a substance to combat a disease, tooth decay. Indeed it is a “mass medication” as it is not given to individuals according to need, but given to all regardless. Furthermore it is a “compulsory mass medication” because no amount of home filtration or purchasing bottled water can screen a person from the fluoride - a normal life includes eating and drinking in restaurants, workplaces and other homes.

Prescribing medication for individuals, and certainly for an entire population, must be subject to strong ethical principles. These principles have been enshrined in internationally accepted codes of ethics since the Nuremberg Trials at the end of World War II. Here is a short exerpt from the British Medical Journal that describes the Code:

• The judgment by the war crimes tribunal laid down 10 standards to which physicians must conform when carrying out experiments on human subjects in a new code that is now accepted worldwide.
• This judgment established a new standard of ethical medical behavior for the post World War II human rights era. Among other requirements, this document enunciates the requirement of voluntary informed consent of the human subject. The principle of voluntary informed consent protects the right of the individual to control his own body.
• This code also recognises that the risk must be weighed against the expected benefit, and that unnecessary pain and suffering must be avoided.
• This code recognises that doctors should avoid actions that injure human patients.
• The principles established by this code for medical practice now have been extended into general codes of medical ethics.

Foremost is the concept of “informed consent”. This means that medication can only be given to someone with their clear, unambiguous consent, and only after they have received full, truthful information about that medication and demonstrated that they have understood.

Mass fluoridation clearly violates the consent rule. In fluoridated Australian cities nobody is asked for their consent, rarely when fluoridation commences and certainly not on an ongoing basis. I have not met a single person in fluoridated Melbourne who has been asked if they consent to the treatment since fluoridation began in 1977.

The water authorities charged with fluoridating their consumers do not know whether they consent or not. A referendum can not solve the problem because consent is an individual matter, not for 51 per cent to tell the rest what they must swallow.

Informed consent means truthful information

Telling the truth to patients and the public is a cornerstone of medical ethics. That is the meaning of “informed” in the concept of informed consent.

To assess the truthfulness of information given to the public, and even professionals, it is instructive to look at fluoridation promotional literature produced by the Australian Dental Association and state Health Departments. These booklets and leaflets have monotonously paraded the same set of assertions for the last 30 or 40 years. I contend that the majority of these assertions are non-truthful by omission and commission, with the exception of a single accurate item, the instruction that people should brush their teeth. The following analysis outlines three striking areas of non-truthfulness: claims about benefits; claims about safety; and claims of worldwide acceptance.

Truth decay regarding benefits.

The Victorian Branch of the Australian Dental Association, in 2002 produced a package for politicians and decision makers called Fluoridation - Nature Thought of it First. The package claims that hundreds of studies (even thousands, on one page) show huge reductions in tooth decay resulting from fluoridated water. There is a simplistic, coloured graph of tooth decay rates being higher in non-fluoridated Victorian towns. But these data are not referenced to any peer reviewed, scientific publications. Right in the back of the package, perhaps only meant to be read by the very diligent, is a 1996 scientific study by Professor A.J. Spencer comparing fluoridated and non-fluoridated communities in South Australia and Western Australia. The reductions in tooth decay due to fluoridation found by this study are quite tiny and clinically insignificant. Why is that not announced in this or other fluoride promotional literature?

The package also fails to mention other studies, including the very large population study by the US National Institute of Dental Research, reported upon twice in 1990 that found very little difference in decay rates between fluoridated and non-fluoridated children. How is it that Australian fluoride promoters can claim to have their own non-scientific surveys showing huge benefits, when published, scientific studies show almost none?

Promotional literature uniformly fails to present the most telling scientific evidence of all, tooth decay rates in cities that have ceased fluoridation. According to the alarmist claims of promoters if we quit fluoridation tooth decay rates would go through the roof. Yet the studies show that where fluoridation has been discontinued in Canada, Germany, Cuba and Finland decay rates have decreased over the following decade.

Non-truthful portrayal of safety

Under “Safety of Water Fluoridation”, The Victorian Department of Human Services document Water Fluoridation - Information for Health Professionals (2004) claims, “With the exception of dental fluorosis, scientific studies have been unable to link community water fluoridation with any adverse effects”. To be truthful this would have to be worded very differently. There is in fact a large scientific literature linking fluoridation with adverse effects. Were they meaning to say that they, along with other fluoridation agencies, don’t accept these studies?

If so they need to critique the studies and show where they err, rather than use slogans and appeals to other agencies to negate the evidence of harm.

Apart from dental fluorosis, which fluoridation enthusiasts admit is a large problem and try to downplay as “merely cosmetic”, another problem a biochemist might expect is bone damage, including fractures. The Victorian government document cites just two reviews and one other study to conclude that there is no evidence linking fluoridation with bone fractures. It fails to state that there have been many studies. Eleven of these since 1990 found an association between fluoridation and hip fracture, while eight did not. This omission is a case of non-truthfulness. It is also insulting to professionals who read the publication, to be treated as incapable of handling an analysis of conflicting studies. Publications for professionals, or the public, are not supposed to be outright propaganda pieces.

None of the promotional literature does justice to the toxic sensitivity symptoms experienced by a proportion of consumers, such as abdominal pains, joint pains, mouth ulcers, headaches, visual disturbance, asthma-like symptoms and skin rashes.

The booklet for professionals devotes just a few lines to the problem, and dismisses its importance with a reference to a US Academy of Allergy statement in 1971, and then a comment from the Australian NHMRC (1991) review of fluoridation. It fails to mention the most important comment by that NHMRC review, page 142, that health authorities are receiving numerous complaints from people who believe they are being made sick by fluoridated water. The review calls for these cases to be studied rigorously. “These claims are being made with sufficient frequency to justify well-designed studies which can properly control for subject and observer bias.” Fourteen years later and has this been done anywhere in Australia? No, the recommendation has been ignored.

On November 25, 2004 a delegation from Water Quality Australia Inc met with a team of “experts” led by Dr Robert Hall, Chief Fluoridation Officer for Victoria at the Department of Human Services. Dr Hall and team could not provide any reference for this concern about toxic sensitivity symptoms being addressed, since the NHMRC made that call in 1991 (see meeting report (pdf file 35KB) online). Not only is the publicity literature untruthful about this subject, but the failure to investigate may well be a serious breach of the duty to safeguard vulnerable consumers by Health Departments around Australia.

The toxic sensitivity symptoms suffered by people when water is fluoridated was well documented by the team of Dutch doctors whose research led to fluoridation being abandoned in the Netherlands after a few years experiment in the 1970s.

Space does not permit discussion of the effects of fluoride exposure on the endocrine and nervous systems and so on, nor how official fluoridation literature deals with them (a listing of some hundreds of references is found at  http://www.slweb.org/bibliography ).

How many countries fluoridate their citizens?

For many years Dental Association and Health Department literature have made the bold statement that 60 countries practise, or “enjoy” water fluoridation. The intended implication is that fluoridation must be right because it is accepted everywhere. The 60 countries are never named. From the 1970s Dr Philip Sutton, senior dental researcher at the University of Melbourne frequently asked the ADA to show their list of these countries, to no avail. The statement remained an article of faith.

I and others have repeatedly asked authorities to see the names of these alleged 60 countries, to check the lists validity. Finally after written requests and a meeting with a senior medical advisor, the decades long promotional claim came crashing down with a departmental letter that included:

The number of countries that fluoridate their drinking water is not intrinsic to this (fluoridation) policy development. The exact number is dependent on how the “fluoridation” is counted, but our policy is derived on the basis of best available science. I am bemused by the persistent discussion about “how many countries’ and consider it of little importance in policy development.

More than 30 years of using “60 countries” in every letter, booklet or press release for public consumption and it is dismissed as “of little importance”. Not a word of apology or “someone was telling fibs and has now been fired”.

What then is the number of countries? Best efforts to ascertain nations’ fluoridation status from World Health Organization data online and other sources reveal the following. Countries with more than 50 per cent of the population receiving fluoridated water are Australia, Columbia, Singapore, Ireland, New Zealand and USA. Sixty? No, six so far, but stay with me. Hong Kong has most of its population on fluoride, but in 1988 reduced it to 0.5 parts fluoride per million parts water, half the standard amount. Malaysia may be on the list, but is hard to get exact figures for.

Next we have some countries with smaller proportions of people getting fluoridated via their water. This includes Canada, Britain, Brazil and possibly Israel. At best we are now up to around 12. To get much further we have to include countries with minor amounts of fluoridation, often a relic from an earlier time not yet decommissioned. For example Switzerland dropped off the list in May 2003 when they shut down their only fluoridation experiment, in the city of Basle. If we include every country that may fluoridate water in even one town, the list can possibly be stretched up to nearly 25.

For 30 years Australian dental and government authorities had no qualms telling the public that the number was 60. The Victorian government medico was “bemused”. Sure you can chuckle, but it does represent systematic misinformation to the public designed to influence acceptance of mass fluoride medication. It is a violation of informed consent.

Where to for the truth?

Other areas of misinformation promulgated by fluoridation authorities are too numerous to discuss here, and include the nature of the industrial, contaminated, non-pharmaceutical grade chemicals used.

Unethical conduct and provision of spin in place of accurate information is nothing new in healthcare. We particularly see it where profits of medical/pharmaceutical corporations are involved. Government health departments though are supposed to be the watchdogs that expose these shenanigans and protect the public. They are not supposed to be the agency peddling the spin.

It is time that state governments, or better the Federal government, undertook a completely independent, far reaching enquiry into fluoridation, including the motives and ethics behind its promotion. For the second time ever in Australia this enquiry should include a good representation of experts not beholden to any agency already involved in defending and promoting fluoridation. The 1997 the Brisbane Lord Mayor’s Taskforce was so constituted and brought down a recommendation against fluoridation. A decision about mass medication must be subject to scientific rigour, ample open public debate, and the highest standards of ethics and truthfulness.