Wednesday, 30 May 2012

The anti-fluoridationist threat to public health

Sometimes it seems Cairns has more than its fair share of anti-fluoridation loonies, and they regularly pop up on the Letters to the Editor page in the Cairns Post. They are a tiny but vocal minority that pops up more or less all over the world, often overlapping anti-vaccination and alternative medicine groups.

The Institute for Science in Medicine has released a white paper that neatly summarises some of the lies and distortions of the anti-fluoridation nuts. It includes one of my favourites, claims about European countries not fluoridating their water:
Engaging in Misleading Spin about Europe and Fluoride, an anti-fluoride website managed by Canadian activist Elke Babiuk, contends that “99% of western continental Europe has rejected, banned, or stopped fluoridation due to environmental, health, legal, or ethical concerns.” There is no citation for this statement, and this assertion is a classic example of spin. Based on this language, one would conclude that virtually nobody in Western Europe regularly receives systemic forms of fluoride. The reality is very different.

First, the insertion of the word “continental” is a way of ignoring that millions of Irish and British people drink water that is optimally fluoridated. In fact, fluoridated water is provided to 12 million Europeans, mostly reaching residents of Great Britain, Ireland, Spain and other countries.

Second, this statement by obscures the fact that fluoride is widely used in Europe. In fact, at least 70 million Europeans consume fluoridated salt, and this method of fluoridation reaches most of the population in Germany and Switzerland. These two countries have among the lowest rates of tooth decay in all of Europe. Fluoridated milk programs reach millions of additional Europeans.

Italy has not tried to create a national system of water fluoridation, but there are logical reasons for this. Firstly, many Italians regularly drink bottled water. Secondly, a number of areas in Italy have water supplies with natural fluoride levels that already reach the optimal level that prevents decay.
I would also add that political decisions are not always based on sound evidence, and any decision by a government to end fluoridation is not a valid argument against fluoridation. At first this would appear to be the argument from popularity fallacy, but it is not even that good an argument - political decisions can be made to satisfy a tiny but vocal minority. It is for that reason that publications such as The Anti-Fluoridationist Threat to Public Health are important.

The white paper can be read at


  1. Dear Mike, couldn't the EU method of fluoridated salt, which efficiently and effectively, delivers fluoride to anyone who wants it, or needs it, while still preserving everyone's choice, and not wasting this valuable miracle drug, be the best path? I know you don't support the nanny stae, and surely everyone who finds it simpler to keep the medicine cabinet separate from the water supply can't all be kooks, none of us believe that the effective dose of fluoride, or any drug, for a large adult is always going to be correct for an infant, why not leave it up to the individual or a parent to choose? Do you really think a mandate is the best? As you said the continental EU has great dental health, best in the world really, and sees no difference in oral hygiene since ending water fluoridation. Also those who take fluoridated prescription drugs like prozac, paxil or suffer from kidney or thyroid disease have to worry about their health more than they already do with fluoridated water. Even toothpaste manufacturers don't recommend fluoride for infants, so doesn't fluoridated water put the most vulnerable populations at more risk than adopting the EU method? Since we're all adults we realize this is a more complicated issue than you portray, surely their are just as many in any population that would be better served, at least at some point in their lives, with un-fluoridated water, denying that simply leaves you exposed. The people who you call looney don't want to restrict your right to fluoridate yourself, just ask you to do it discretely, why do you want to restrict their personal choice to abstain? Which view is more tolerant, which is more loonie? I appreciate your desire to help, and the best way to do that would be to advocate a European system. Since the EU system doesn't infringe anyone's rights, is cheaper, just as effective and allows anyone who wants it cheap access to fluoride, we wonder why you would waste your precious editorial space advocating differently, veering from your normally balanced views on such an easily solved topic. It's hard to imagine who would gain from water fluoridation that wastes 99% of the medicated tap water that goes down the drain, on lawns, and isn't ingested, can you imagine this with any other valuable medicine, what pharmaceutical company could keep up with demand if 99% of it's production was wasted. And who could afford that? Surely you can let us know why this is the one drug that doesn't have any production constraints, risks to health or efficacy based on dose or existing health, or require medical monitoring. Any other position makes us wonder what other motive$ could be at play? Please let us know why we should pay more than the EU per capita, get no better results per capita, cause medical suffering for those who already have fluorosis, hypo-thyroidism or kidney disease, have young children, or are expecting, and take away the individuals medical choice? We'll all decide for ourselves on the efficacy and safety for that we don't need your help, please clear up the part about why we should give up the right to choose ourselves, that's the piece of the puzzle where you loose most of us.
    Sincerely curious, Linda, Manchester, UK, Clinical Toxicologist, Epidemiologist

  2. Linda

    I agree that there may be better ways to fluoridate, and that there should be consideration of those other methods to see which is the most effective means of achieving the goal. An argument about cost effectiveness of water fluoridation vs other methods of fluoridation is a valid argument to have. This would include the differing costs AND the number of people it gets to. You are arguing against a claim I didn't make (Does the term "straw man" mean anything to you?).

    "Since we're all adults"? The main argument for fluoridation is that it needs to get to children, and I fail to see why adults should have the freedom to deprive their children of its benefits. I'll add that I believe the same with vaccination, which should be compulsory except in those cases with a medically confirmed contraindication. I feel the same about people who withhold treatment (e.g. blood transfusions, organ transplants, or indeed all treatment except prayers) from children for religious reasons. You should not have complete freedom when it comes to the health care of your children.

    Many of your health claims are addressed in the paper to which I linked, and are misrepresentations of the evidence. Perhaps you should actually read it.

    Where exactly did I say that fluoride "is the one drug that doesn't have any production constraints, risks to health or efficacy based on dose, or require medical monitoring"? I didn't and don't believe any advocates of fluoridation do. Again, do you know the term "straw man"? Fluoride does have production constraints, does have a dose response curve, and does need ongoing monitoring (through doctors, dentists and the public health system). None of this is controversial.

    The people I call loonies are those who deny the evidence that fluoridation is safe and effective at the levels used. The people I call loonies are those who believe that the world's leading health and science bodies (Academies of Science, WHO, etc) are schills for Big Pharma (e.g. "motive$"). The people I call loonies are those who claim that fluoridation is a communist mind control plot (not that you did, but it's an amusing claim I've found from some Birchers and the like).

    Why should you give up the right to choose yourself? Because you are not an island. We do not and cannot have complete freedom if we live within a society. Sometimes our freedom needs to be constrained to serve a greater good.

    Oh, and do you really think adding "Clinical Toxicologist, Epidemiologist" after your name impresses or makes you more believable or authoritative? I have no reason to believe your claimed qualifications, and even those with qualifications can be wrong, misinformed, illogical, deluded or dishonest.

    Sincerely inviting you to read the paper to which I linked, not argue against claims I did not make, and also learn where your Enter key is.

    Cairns, Australia
    Chief Medical Officer, Deputy Prime Minister, Supermodel