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INTRODUCTION: This is Part 2 of a 3-part critique of the testimony given by Dr. William Bailey, of the Centers for Disease Control and Prevention (CDC), to the City Council of Fairbanks, Alaska, on March 6, 2008.  After citizens in Juneau, Alaska, overwhelmingly voted to stop fluoridation in October 2007, citizens raised the issue in Fairbanks, Alaska.  Four days after hearing from Dr. Bailey, the Fairbanks City Council voted 3 to 2 to continue their fluoridation program. A local citizen, Peggy DeSpain, kindly forwarded to Fluoride Action Network (FAN) an audiotape of Dr. Bailey's telephone presentation.  Dr. Bailey’s full title is William Bailey, DDS, MPH, Dental Officer for the Oral Health Division’s Program Service Team, CDC.

Because the authority of the CDC is so influential around the world, FAN has gone to some length to critique Dr. Bailey’s information and arguments. If ever a situation demanded the admonition “Question Authority,” this is it.

This critique is being forwarded to Dr. Bailey for his response, which FAN will make available when it occurs. (For an uninterrupted version of Dr. Bailey's comments, click here.)

DR. WILLIAM BAILEY (CDC): The CDC doesn’t investigate that we rely on the expert panels and other people who look at that. And a lot of people have looked at that.

PAUL CONNETT: In Part 1, I asked why an agency as large as the CDC, with so many scientists available to them, rely on others to track both the safety and effectiveness of the fluoridation program and also rely on unqualified personnel in the Oral Health Division to pass judgment on critical reviews on fluoride's dangers like the one done by the NRC in 2006. After all the CDC is the lead agency promoting fluoridation in the US and artificially fluoridated water is going to 170 million Americans every day. If there are dangers associated with this program shouldn’t the CDC be the first to know, not the last?  Why when the CDC released their infamous statement in 1999 that fluoridation was 'one of the top ten achievements of the Twentieth Century' (CDC, 1999) was the CDC relying on a review of health effects that was already six years out of date (NRC, 1993) in 1999?  Ironically, the body that told them in 1993 that everything was OK, the National Research Council, was the very same agency whose report in 2006 revealed many serious problems. The CDC used the first report (NRC, 1993) to assure the world that fluoridation was safe for over 6 years, and yet dismissed the dangers presented in the second (NRC, 2006) they dismissed in 6 days!

Not only is the CDC not tracking the relationship between fluoridation and osteoporosis and thyroid function, no other fluoridating country is! Moreover, as discussed above (see Part 1) there are many other health issues that fluoridating countries are not investigating in relation to fluoridation, including: arthritic symptoms in adults (and children), lowered IQ in children, increased bone fractures in children using dental fluorosis as a biomarker, earlier onset of puberty in girls, Alzheimer's disease, accumulation of fluoride in the bone and in the pineal gland and lowered melatonin production. Practically no work has been done on these concerns. Nor has there been any formal investigation of the many anecdotal reports that some individuals are highly sensitive to fluoride (see comments by Dr. Spittle in Part 1). Even the for areas that have been investigated like hip fractures in the elderly and osteosarcoma in young males, the work has been very limited and needs more investigation in other fluoridated countries.

DR. WILLIAM BAILEY (CDC): That’s why I really wanted you to have this report in brief because that was what the National Research Council was looking at – from the National Academies. They were looking at – and you are right the fluoride does accumulate throughout your lifetime, especially in your skeletal system – and so what this committee was looking at was people who drank excessive amounts of high natural fluoride – they were looking at people who drank 4 ppm or greater over a lifetime.

HARDY LIMEBACK: We looked at toxicity of fluoride in every aspect of intake (except from respiration of fluoride-contaminated air). We looked at all the studies we could find in the literature that examined the effects of fluoride intake, whether in the form of liquid, food, oral care product, even drugs such as anesthetics. The total intake is important since someone drinking fluoridated water could be pushed over the edge in terms of maximum tolerable dose.

DR. WILLIAM BAILEY (CDC): So what they came out with was three recommendations that could have an affect on – for sure it would have an effect on fluorosis – severe fluorosis for people who drank 4 ppm over a lifetime 10% would be expected to have severe fluorosis – they said that it was likely to cause an increase in bone fractures – they weren’t unanimous on that – they found mottling rather than observations

HARDY LIMEBACK: I don’t understand that last comment.

DR. WILLIAM BAILEY (CDC): – but that it could result in an increase in bone fractures and it could also result in skeletal fluorosis. Now in the US over the last decade the most we have seen as far as skeletal fluorosis is about six cases that have been diagnosed,

PAUL CONNETT: this does not include cases of the earlier symptoms of fluorosis which are identical to arthritic symptoms which affect 1 in 3 American adults (CDC, 2002).

DR. WILLIAM BAILEY (CDC): most of them from other things, for example from a person drinking a lot of concentrated iced tea. So they looked at a lot of other things, but they only came up with these three things.

HARDY LIMEBACK: There were many more serious health outcomes examined. We looked at 1.0 ppm fluoride for adverse health RISKS, such as:

- excessive intake in infants (neurotoxicity, dental fluorosis, osteosarcoma), especially using fluoridated tap water for infant formula
- contaminants (lead intake in children exposed to H2SiF6)
- excessive intake in growing children (bone effects, hypothyroid)
- excessive intake in diabetics, athletes
- hypersensitivity in a subpopulation that cannot tolerate even low daily doses of fluoride
- excessive retention kidney patients (and bone problems)
- potential for genetic damage (Down Syndrome)
- osteosarcoma in young boys (the Bassin study)

The committee could not agree that the science was solid enough to include all of these as definitive outcomes on which to base a recommendation to lower the fluoride in drinking water. This, however, does not negate that fact that there are many really well done studies pointing to an increased risk for other adverse health effects from fluoride intake.

DR. WILLIAM BAILEY (CDC): They studied the science for three and half years. They made recommendations that other things needed study, but even drinking 4 times the amount of fluoride in your water over a lifetime. The only thing was a sure thing was enamel fluorosis. The things that could be was bone fractures and skeletal fluorosis. But they compared the bone fractures with people who drank water and 1 ppm not zero. Not very low. Some studies –some really good studies –well they followed people over time – prospective studies – which have shown that there may be a protective effect at 1 ppm for bone fractures.

PAUL CONNETT: I believe the study that Dr. Bailey is referring to here is the study by Li et al. (2001). While it is true that they reported a protective effect for all bone fractures combined (in the elderly) they found no protective effect for the all-important issue of hip fractures in the elderly, and in fact found an approximate linear increase in hip fracture rates as the level of fluoride in water rose from 1 ppm to 4 ppm plus (while these results only became statistically significant above 4 ppm, the linear trend is clear and thus suggests that the increase between 1 ppm and 1.7 ppm was real).

DR. WILLIAM BAILEY (CDC): So if you have very low fluoride concentrations the bone fractures may be higher but as you come down to 1 ppm – about what we fluoridate the water – there may be a protective effect

PAUL CONNETT: for all bone fractures combined but not for hip fractures.

DR. WILLIAM BAILEY (CDC): and then  as you go up to 4 ppm or greater your bone fractures go up. That’s because fluoride is attracted to the bone, especially for the long bone, it accumulates in the outside of the long bones which makes them strong on the outside but easier to break if you have very high concentrations of fluoride. They are thicker but they break easier.  

HARDY LIMEBACK: There is no margin of safety for people who drink excess water or who cannot eliminate it efficiently (kidney patients). Kidney patients have never been included in bone studies. Fluoride is harmful to them. It contributes to osteodystrophy. Reducing fluoride in the water even down to levels of water fluoridation will still not protect the entire population and it is the moral duty of the EPA to work with the CDC to find the lowest, safest level of fluoride in the drinking water.

FAIRBANKS COUNCILOR: “The mayor asked you a question on is there a pill to remove fluoride from water. And my question is there any sort of filtering system which average households might be able to use to remove the fluoride or reduce the amount of fluoride?”

DR. WILLIAM BAILEY (CDC): There are point of use systems that you can put into your home. If you put in an activated charcoal filter or something like that on your faucet it won’t take out any fluoride. But there are point of use systems that actually work on a reverse osmosis or membrane type system that will take fluoride out – to some extent any way.

FAIRBANKS COUNCILOR: “And are those systems that are practical to use say in a single household in terms of cost – can you comment on that?”

DR. WILLIAM BAILEY (CDC): You know I am not an expert on that. I have heard that a number around $500 for those systems, but I am not an authority on that. That’s just something I have heard.

FAIRBANKS COUNCILOR: “I have two other questions. Those of us who are always  taught to brush your teeth after every meal and floss every night and use controlled Rx from time to time, are probably fine. I wonder if you would comment on people in Fairbanks who – through their upbringing or perhaps through socioeconomic reasons – don’t have the same knowledge and practices in terms of dental care – how the fluoride might impact these different groups?”

DR. WILLIAM BAILEY (CDC): Fluoride helps all groups but the higher the potential for caries the better the help.

BILL OSMUNSON: Potential is not reality.  In reality the poor have more decay, but fluoridation does not change that reality (Osmunson, 2007).

CAROLE CLINCH: As far as helping those in greatest need is concerned, it is important to point out that it is well established that, 1) Fluoridation has no effect in reducing cavities in pits and fissures where 80-90% of tooth decay occurs today and 2) Fluoridation cannot counteract the ravages caused by baby bottle tooth decay. Here are some quotes supporting these conclusions:

1. Fluoridation has no effect in reducing cavities in pits and fissures

“The type of caries now seen in British Columbia’s children of 13 years of age, is mostly the pit and fissure type. Knudsen in 1940, suggested that 70 percent of the caries in children was in pits and fissures. Recent reports indicate that today, 83 percent of all caries in North American children is of this type. Pit and fissure cavities aren’t considered to be preventable by fluorides, they are prevented by sealants.”  (Gray, 1987; my emphasis)

“Because the surface-specific analysis was used, we learned that almost 90% of the remaining [tooth] decay is found in the pits and fissures (chewing surfaces) of children’s  teeth: those surfaces that are not as affected by the protective benefit of fluoride.” (Koplan, 2000; my emphasis)

“Nearly 90 percent of cavities in school children occur in the surfaces of teeth with vulnerable pits and grooves, where fluoride is least effective.” (NIDR, 1992; my emphasis) 

“It is estimated that 84% of the caries experience in the 5- to 17- year-old population involves tooth surfaces with pits and fissures. Although fluorides cannot be expected appreciably to reduce our incidence of caries on these surfaces, sealants can.”  (JADA, 1984; my emphasis)

2. Fluoride is ineffective at preventing baby bottle tooth decay.

In circumstances of high acid challenge to the enamel of children’s teeth due to pooling of sugary fluids in the mouth for prolonged periods, called Baby Bottle Tooth Decay  (BBTD), all surfaces of the tooth are vulnerable and water fluoridation is not effective according to the CDC and others.  

“The prevalence of BBTD in the 18 communities of Head Start children ranged from 17 to 85 percent with a mean of 53%. The surveyed communities had a mixture of fluoridated and non-fluoridated drinking water sources. Regardless of water fluoridation, the prevalence of BBTD remained high at all of the sites surveyed.”  (Kelly, 1987; my emphasis)

“By either of the two criterion i.e., two of the four maxillary incisors or three of the four maxillary incisors, the rate for 5-year-olds was significantly higher than for 3-year-olds.  Children attending centers showed no significant differences based on fluoride status for the total sample or other variables.” (Barnes, 1992; my emphasis)

“Data from Head Start surveys show the prevalence of baby bottle tooth decay is about  three times the national average among poor urban children, even in communities with a  fluoridated water supply.” (Von Burg, 1995).

DR. WILLIAM BAILEY (CDC): You know I guess that is the beauty about water fluoridation you don’t have to remember to do anything, you don’t have to be compliant in any way, in a way it is the perfect public health measure. All you have to do is drink water or use it for cooking and so forth, and you will get some benefit of fluoride. So certainly those people who will benefit from water fluoridation – they wouldn’t benefit much as if they brushed their teeth twice a day and also had community water fluoridation, but they would benefit from the fluoride in the water.

BILL OSMUNSON: Dr. Bailey’s use of words like "beauty" and "compliant" is inappropriate. Fluoride for ingestion is a prescription drug.  Fluoridation is forced medication of a drug without a doctor's prescription.  A substance for the treatment or mitigation of disease is a drug.  Go to your pharmacy and ask for fluoride to ingest.  Every state in the US has laws that regulate controlled and legend (prescription) drugs, poisons and toxins.  Fluoridation is in violation of these laws.  Your doctor is the legal intermediary between industry/governments and you the patient.  You hire the doctor to legally protect and ensure the drug is appropriate.  Ask your city, water district or state, under who's prescription drug license is the fluoride drug being dispensed? None.  In effect, fluoridation is the dispensing of a prescription drug without a license and without the patient's consent.  Forced medication is no less a crime than forced sex.

FAIRBANKS COUNCILOR: “From some of the information that’s been brought to our attention, I am under the impression that in Europe for example there is very little fluoridation and yet – if my impression is correct – when you look at dental decay and all that the statistics are the same as the United States. Can you comment on that?”

DR. WILLIAM BAILEY (CDC): Sure. Europe uses a lot of salt fluoridation, so they have just had their fiftieth anniversary of salt fluoridation in 2005.

PAUL CONNETT: It is true that some countries in Europe fluoridate their salt but they are in a minority. This explanation by Dr. Bailey cannot be used to explain away the fact that tooth decay has been coming down as fast in non-fluoridated countries as fluoridated ones. Some of the best figures for low tooth decay come from countries which neither fluoridate their water nor their salt, e.g. Belgium, Denmark, Finland, Iceland, Netherlands, Norway and Sweden.  See http://www.fluoridealert.org/who-dmft.htm

FAIRBANKS COUNCILOR: “Are you talking about table salt? You are talking about a container of table salt which you purchase at will. Is that correct?”

DR. WILLIAM BAILEY (CDC): Yes. A container of table salt like most salt has iodine in it. A lot of the salt in the Caribbean and South America. There are 27 countries in South America and the Caribbean which have salt fluoridation. And then Austria, Czech Republic, France, Germany, Hungary, Slovak Republic, Spain and Switzerland have fluoridated salt. So fluoridated salt  works to reduce tooth decay as well. Normally they fluoridate salt at about 250 ppm. The problem with fluoridated salt is that with water fluoridation you look at the natural amount of fluoride in the water and you adjust it up to a level which is optimal for health in the region. With salt fluoridation there is going to be some parts – different water sources –which have differing amounts of fluoride in them which people are drinking but the salt remains consistent throughout the region. Sometimes you will read from the opponents that Europe is totally against all (fluoridation) so forth but in fact the European Union passed a resolution in 2006 - I believe - that talked about the use of fluoride – in fact it was  16th May 2006 - the European parliament voted 526 in favor and 126 against this resolution that says ‘that the addition of fluoride to food practice or the addition of fluoride to drinking water or salt or milk is now authorized in the countries of the European Union.’ So that’s something which is very recent from 2006 and was voted on by the parliament there.

PAUL CONNETT: For a list of reasons why most European countries have rejected water fluoridation go to http://www.fluoridealert.org/govt-statements.htm

FAIRBANKS COUNCILOR: “I just have three more questions. I would like to ask you if you don’t mind Dr. Bailey if I could have time to prepare them and email them to you and have the answers for Monday’s meeting. Would you amicable for that?”

DR. WILLIAM BAILEY (CDC): Well, I will be glad to help. But I would rather that you work through your State dental director. Normally the CDC doesn’t hold ourselves out…

FAIRBANKS COUNCILOR: “That’s Brad. I’ll send it to Brad. The questions I have: Are you aware that in Canada the maximum contaminant level for the fluoride was 4 ppm but they reduced it? And reduced it all the way down to 0.6 ppm and since we have it naturally occurring at 0.5 ppm  and that is an incremental difference and I understand from brad that fluoridation only provides an incremental benefit to begin with. Do we have to supplement it with everything on the market, everything with fluoride in there and is it really when we have such naturally occurring fluoride?”

PAUL CONNETT: The councilor is confusing the maximum contaminant level  - 4 ppm in the US, and 1.5 ppm in Canada - with the level recommended for fluoridation. Carol Clinch below discusses these levels.

DR. WILLIAM BAILEY (CDC): Well, I believe that Canada’s maximum level is 1.5 ppm and is also the World Health Organization’s maximum level.

FAIRBANKS COUNCILOR: “I have some documentation that indeed have lowered it for Canada. That might be a new revelation.”

DR. WILLIAM BAILEY (CDC): Maybe you could share that with me. I would be interested in the source to see whether it came from the Canadian government or rather from some sort of group that opposes fluoridation.

CAROLE CLINCH: US PHS recommended guidelines for artificial water fluoridation is 0.7-1.2 mg/L.  Health Canada recommended guidelines are 0.8-1.0 mg/L as of 1999 – decreased from  1.0.-1.2 mg/L.  Ontario Ministry of Environment recommended guidelines are 0.5-0.8 mg/L as of 2000 –  decreased from 1.0-1.2 mg/L.  

These guidelines were reduced because of the 1999 Ontario Ministry of Health and Long Term Care Report on Water Fluoridation which stated (Locker 1999):  

1)  “The magnitude of [fluoridation’s] effect is not large in absolute terms, is often not statistically significant, and may not be of clinical significance... Canadian studies do not provide systematic evidence that water fluoridation is effective in reducing decay in contemporary child populations.  The few studies of communities where fluoridation has been withdrawn do not suggest significant increases in dental caries as a result.”   

2) “Current studies support the view that dental fluorosis has increased in both fluoridated and non-fluoridated communities. North American studies suggest rates of 20 to 75% in the former and 12 to 45% in the latter.” 

 3)  “In Canada, actual intakes are larger than recommended intakes for formula-fed infants and those living in fluoridated communities. Efforts are required to reduce intakes among  the most vulnerable age group, children aged 7 months to 4 years.”

Two years later the same author (Dr. David Locker) stated:

“In the absence of comprehensive, high-quality evidence with respect to the benefits and risks of water fluoridation, the moral status of advocacy for this practice is, at best, indeterminate, and could perhaps be considered  immoral” (Cohen & Locker, 2001).

Currently, the Ontario Ministry of Environment and Health Canada are both reviewing all policies and guidelines regarding water fluoridation. 

FAIRBANKS COUNCILOR: “OK. The other thing I wanted to ask and I think we all have hit on it. I want to do so again. Washington, DC, is fluoridated but they are having a dental decay crisis.”

DR. WILLIAM BAILEY (CDC): Yes.

FAIRBANKS COUNCILOR: “So are we back to the argument that the number one thing for good oral health is diet- and I think we can all agree that the direct application of fluoride is most beneficial?”

DR. WILLIAM BAILEY (CDC): Well, actually any body who has better economic status usually has better dental health in all areas. And so if we look at poor areas – especially pockets of poor areas – we know that for children  80% of the tooth decay for children is in 25% of the population but that subgroup is always the poorest segment of the population. So having community water fluoridation won’t eliminate tooth decay, it will help reduce tooth decay but it doesn’t overwhelm  all the other things that can  happen.

FAIRBANKS COUNCILOR: “Yes but this is an increase. They are having a crisis even with it in the water.”

DR. WILLIAM BAILEY (CDC): Sure. Because they don’t have access to dental care – because they – you know – they have a very low social economic status. You know any kind of disease – especially oral health – is multi factorial disease – you just can’t say because of what you eat, you can’t just say its because say  the carie you get, that’s its because your other health, but there’s a lot of things which enter into oral health. So community water fluoridation helps to reduce tooth decay and that’s in children in study after study

CAROLE CLINCH: Dr. Bailey should read the studies more carefully. For example, the Brampton-Caledon Study, Ontario, Canada. This study observed tooth decay in 1,047  7-year old children in 25 schools over the 2001-2 period. (Ito, 2007).

The authors found that 50% of children from non-fluoridated Caledon had cavities.  37% of children from the fluoridated Brampton had cavities.  Does this prove that water fluoridation CAUSED the difference in cavity rates?   NO. Statistical analysis of the data showed:  Factors that did affect cavities were: Good Dental Hygiene, Good Nutrition, Dental sealants, Breast Feeding vs. Infant formulas.   Water fluoridation did not influence the rate of cavities. The authors clearly state:

 "The effect of fluoridation on caries in these communities was not evident" 

Many Public Health Officials are using raw data and using it as "proof" that water fluoridation is CAUSING the EFFECT (difference in cavities). This study demonstrates that you cannot use raw data to prove anything. 

 Without a statistical analysis of raw survey data, no conclusions can be drawn as to which factors may be causal.  A recent review  of the literature on fluoridation’s effectiveness (“The York review,” McDonagh et al., 2000) could find no grade A research on the matter.

A recent (2007) Italian review of fluoridation concluded that:

1) “It is now accepted that systemic fluoride plays a limited role in caries prevention.”  

2) “Several studies conducted in fluoridated and nonfluoridated communities suggested that this method of delivering fluoride may be unnecessary for caries prevention, particularly in the industrialized countries where the caries level has become low. Although water fluoridation may still be a relevant public health measure in poor and disadvantaged  populations, the use of topical fluoride offers an optimal opportunity to prevent caries  among people living in both industrialized and developing countries."  

3) "In the past decades, a number of authors focused their attention on caries trend of the communities that interrupted water fluoridation in comparison to communities without  water fluoridation (Kuopio and Jyvaskyla, Finland; Chemnitz and Plauen, Germany; Tiel  and Culemborg, Holland; La Salud, Cuba). In these communities, during the years of water fluoridation, a caries reduction had been observed, but after the cessation, caries prevalence did not rise, remained almost the same or even decreased further. These findings do indicate that the interruption of CWF had no negative effects on caries  prevalence.”  

4) "to date, there is limited evidence to support the view that fluoridation reduced the [social] disparities in caries." (Pizzo et al.)   

CAROL KOPF: Poverty is often associated with poor diet. Fluoride is neither a nutrient nor essential for healthy teeth (1-3). However, the evidence is solid that lack of essential nutrients makes teeth more decay susceptible.

Good dental health begins in the womb (4). Specifically, calcium, protein, phosphorus, vitamins A, C and D help construct babies’ primary teeth, according to the American Dental Association.

Additionally, protein-calorie malnutrition, iodine deficiency and excessive fluoride increase susceptibility to dental caries, according to the U.S. Surgeon General (5).

Americans are deficient in calcium (6), magnesium (7), vitamins C (8) and D (9). No evidence indicates any American is fluoride-deficient. In fact, American children are fluoride overexposed (10).

In the past fluoride was credited with the substantial cavity decline. However, "No clear reasons for the caries  decline have been identified," according to the 1999 Dental Textbook, Dentistry, Dental Practice and the Community, by Burt and Eklund .

However, fluoridation and the explosion of fluoridated dental products coincided with many health-preserving trends.  For instance, milk was vitamin D fortified to prevent bone and teeth damaging rickets; cereals and breads were vitamin and mineral enriched; dental care and insurance was encouraged and affordable; and Americans became more nutritionally aware. No valid science proves fluoridation was the cavity-killing culprit.

According to a large federal study

(NHANES III) children without deciduous caries experience had significantly higher fruit, grain, sodium, and total Healthy Eating Index’s than children with deciduous caries experience while children without permanent caries experience had significantly higher dairy, cholesterol, fruit, grain, sodium, variety, and total Healthy Eating Index’s than children with permanent caries experience (11).

In fact, American kids who don't eat the recommended five servings of vegetables and fruits -- every day -- up their risk of cavities more than threefold (12).

Burdened with the worst oral health, U.S. children in poverty are also the least healthy, most food insecure, least likely to ingest recommended levels of vital nutrients, least likely to have dental insurance or care, and most likely to have unfilled cavities.

Is fluoridation going to help these children?  Common sense and science says, no.  But the American Dental Association (ADA) and the U.S. Centers for Disease Control (CDC) say yes, using claims and endorsements not backed with valid science (13).

Weston Price in Nutrition and Physical Degeneration reported long ago what dentistry needs to re-learn. Children with the best diets have the best teeth without fluoride. Children with the worst diets have the worst teeth even with fluoride.

There’s a constant movement of minerals into and out of teeth.  Fluoride is said to enhance the re-mineralization process.  Without essential minerals available, fluoride is useless. Many low-income children are deficient in required tooth building and repairing nutrients, such as calcium, that also moderate fluoride’s toxic effects.

Fruits and vegetables offer a substantial amount of essential nutrients which may be why vegetarians have less tooth decay (14). Only 23% of Americans comply with recommendations to eat 5 – 9 servings of fruits and vegetables, daily (15).

Maybe produce should be government subsidized to repair nutritionally starved kids instead of wasting multi-millions of dollars on fluoride and fluoridation programs each year at the local, state and federal levels. Unlike fluoridation, fruits and vegetables deliver essential nutrients that teeth and bodies require.

Well-meaning but misguided dentists thought fluoride was their magic bullet to prevent tooth decay at a time when nutrients were discovered to prevent diseases, such as vitamin C preventing scurvy. The bad news is that there’s no magic bullet to cure or prevent tooth decay.  The good news is that tooth decay is highly and easily preventable - with a nutritious diet and regular dental care.

DR. WILLIAM BAILEY (CDC): but that does not mean that it is going to overwhelm other factors. For example, I have worked with the Indian Health Service for 14 years. We did community water fluoridation and sealant programs and still we were overwhelmed in certain ways and a lot of it comes from poverty.

FAIRBANKS COUNCILOR: “I have checked here in the clinic here and the other facility we have. They have a sliding scale – they have dental available – they have fluoride tablets available to folks at the lower end of the socioeconomic scale.”

DR. WILLIAM BAILEY (CDC): Well they shouldn’t because if you have fluoridated water they shouldn’t be giving out fluoridated tablets because that’s what causes dental fluorosis.

CAROLE CLINCH: Overexposure to fluoride (from any source) causes dental fluorosis. Since fluoridated water is the single largest source of fluoride (NRC 2006), fluoridated water is the single largest cause of dental fluorosis.

"for typical individuals, the single most important contributor to fluoride exposures (approaching 50% or more) is fluoridated water and other beverages and foods prepared or manufactured with fluoridated water" (NRC 2006, p 87)

"In 1997, the EPA estimated that Americans were ingesting nearly five times more fluoride than in 1971 - from food and drinks alone." (Smith, 2001)

FAIRBANKS COUNCILOR: “That leads into the next question. You said that in Northern climates you recommend higher levels. Well in the winter we have lots of tea here made with hot water. Heating water causes the greater concentration of fluoride. Fluoride comes through to us in fruits and products, backed goods from other parts of the US, which use fluoride. So we are getting such a multitude area of fluoride that like you said it is hard  to pin down and having been told that it provides an incremental benefit taken systemically do you have any thoughts on how if are at 0.5 ppm natural occurring fluoride, what would it take to make up the incremental difference of the bottom of the scale that is recommended – even at the 2.2 ppm. Would that be using the mouth wash?”

DR. WILLIAM BAILEY (CDC): I am not sure that I totally understand your question.

FAIRBANKS COUNCILOR: “If you are going to replace the value of fluoride that is taken systemically which was told to me to be of incremental value – if I understand incremental value it means small…”

DR. WILLIAM BAILEY (CDC): Progressively greater. You are going to get more value at fluoridating at 1 ppm than you are at 0.5 ppm. In  other words, the higher the fluoride goes up you get an incrementally greater benefit the higher the fluoride goes up.  

FAIRBANKS COUNCILOR: “Do we know what that incremental benefit is across the board when you are looking at fluoridated toothpaste, mouth wash and diet? What role does that value make systemically? Is that 10% of it, is it 5% of the whole value that you need from fluoride?”

DR. WILLIAM BAILEY (CDC): I don’t know. I haven’t seen any studies on that. But you know that you are getting from fluoride (fluoridated water) is 1 ppm; toothpaste has 1000 ppm, the amount that rinses have is over 1500 ppm, so you are looking 1 thousandth of what’s in the water right now. I am not diminishing that you are getting a lot of your intake from drinking water and other beverages but you have to also keep in mind that some of these other things that you are talking about – for example tooth paste, which have concentrations 1000 times the concentration that’s in water.

PAUL CONNETT: Yet again we see a confusion between concentration and dose. The concern is how many milligrams of fluoride you ingest. To ingest 1 mg of fluoride from water you would need to consume 1 liter of water at 1 ppm. To consume 1 mg of fluoride from toothpaste at 1000 ppm, you would need to swallow 1 gram of toothpaste.

FAIRBANKS COUNCILOR: “And they are directly applied? So you want me to send these questions onto Brad - the remaining questions that I have? – There is one thing I want to be clear about – Dr. Bailey - I am  talking about the Fairbanks community not sweepingly across the world – I am saying that this community has it naturally. I don’t want you to think I am just spreading it.”

FAIRBANKS COUNCILOR: “The impact on bones – I am not talking about the naturally occurring fluoride – makes the bones hard on the outside but weaker on the inside. Are you talking about the added fluoride?”

DR. WILLIAM BAILEY (CDC): Any fluoride actually. The York study looked at this in 2000 and said that they could find no difference between natural fluoride and fluoride that is added to the water. There’s been studies- the latest by Finney, in 2006 - they’re water chemists- and they looked at the dissociation of the various fluoride additives and they said that in the end it is all just the fluoride ion that is working in  the water but so it doesn’t matter where it comes from. The fluoride ion is the fluoride ion and is the same whether it is naturally occurring or put in using an additive.

CAROLE CLINCH: There is far more to this discussion than Dr. Bailey implies.

Scientific evidence does not support the contention by the CDC that by the time the hexafluorosilicate ion (silicon ion with 6 fluoride ions attached in H2SiF6 or Na2SiF6) reaches the tap it will have been completely converted into silica and the free fluoride ion and that they will never re-associate.

The ability of silicofluorides to separate/dissociate into their component parts (silicon, fluoride) is dependent on several known factors: pH, presence of other substances (metal cations), water hardness and temperature. In low pH environments such as are found in acidic beverages (e.g. fruit juices, tea, coffee) which use fluoridated water, acidic foods and more importantly, in our gut where low pH levels occur, re-association of fluoride and silicon ions is likely to occur.

Although the reports are sparse, historically authors have found that “natural fluoride” (i.e. calcium fluoride), sodium fluoride and the silicofluorides have not behaved the same in mammals. See the following table from (Kick et al., 1935).

FLUORIDE VS FLUOROSILICATE: RELATIVE TOXICITY

TABLE 1: Availability of Fluorine in Various Forms (Table 39, Kick et al. 1935)

Fluorine Supp	Time on Ration	Fluorine Ingested	Fluorine in Feces	Fluorine Absorbed	Fluorine in Urine	Fluorine Balance	Fluorine Retained
	Days	Mg.	Mg.	Mg.	Mg.	Mg.	Pct.
Rock phosphate (untreated)	11	217.2	128.7	88.5	31.5	+57.0	26.2
Rock phosphate (untreated)	10	213.6	131.5	82.1	20.5	+61.6	28.8
Sodium fluosilicate	23	269.9	94.3	175.6	93.6	+82.0	30.4
Sodium fluosilicate	22	259.9	94.4	175.5	90.2	+85.3	31.6
Sodium fluoride	18	211.2	116.5	94.7	25.8	+68.9	32.6
Calcium fluoride	11	229.6	225.5	4.1	4.2	-00.1	0.0

The results from Zipkin’s study in 1956 imply that soft tissue of young male mammals suffer more exposure to fluoride from H2SiF6 and Na2SiF6 than from sodium fluoride (Zipkin, 1956).

Two recent papers on the toxicology and behavior of the silicofluorides have been published in Neurotoxicology (Maas et al., 2007 and Coplan et al., 2007). These authors demonstrate that the silicofluoride ions:

1. are associated with increased lead levels in drinking water
2. are associated with increased blood lead levels in young children, and
3. do not behave the same as "free fluoride ions" in biological systems 

Coplan et al. (2007) review the research which demonstrates that silicofluorides interfere with neurotransmission. Specifically, silicofluorides inhibit acetylcholinesterase, an enzyme responsible for dismantling the neurotransmitter acetylycholine after it has delivered its message (such interference is how nerve gases work). They explain that the mechanisms of silicofluoride and fluoride inhibition of this key enzyme are different. Thus it is not enough to rely on studies of sodium fluoride and the brain, additional studies need to be done with silicofluorides.

Coplan et al. also review the work of Machalinski et al. (2003), who reported that the four different human leukemic cell lines were more susceptible to the effects of silcofluorides ( the compounds used in water fluoridation) than to sodium fluoride (NaF). According to these authors:

“Silicofluoride complex (SiF) has biological effects that are even more potent than those of simple fluoride released by sodium fluoride.”

"The early response effect of Na2SiF6 was greater, and in several cases significantly greater, than NaF on clonogenic growth and the induction of apoptosis in all four cell lines."

 “In conclusion, our findings revealed that human leukemic cells can be influenced and damaged by different forms of fluorine compounds. A substantially more evident effect was caused by silicofluoride complex (SiF) compared to simple fluoride ion released by sodium fluoride.”

Based upon the above, and other studies cited by Coplan et al., it is clear that sodium fluoride and silicofluorides do not behave in identical ways in biological systems. To protect the public it is essential that full toxicity studies (as opposed to theoretical calculations and hand waving exercises) are required for the silicofluorides - the actual products put into our drinking water. In the absence of toxicity studies demonstrating safety, the practice of water fluoridation using these chemicals should not be permissible.

FAIRBANKS COUNCILOR: “So Dr. Bailey all water has natural fluoride in it or is that correct?”

DR. WILLIAM BAILEY (CDC): Yes it is in everything.

FAIRBANKS COUNCILOR: “Is our naturally occurring fluoride in water more than any where else in the country? Different levels?

DR. WILLIAM BAILEY (CDC): There are different levels. In 2006 the National Research Council report says that there is about 1.6 million people in the US that have over 2 ppm naturally occurring in their water. So it is not – you know – when you look at 1.6 million people out of 300 million that’s not a great amount percentage wise but 1.6 million is still a lot of people. So we would like to see those people with 2 ppm or greater try to find alternative water sources for their children before their teeth are developing.

PAUL CONNETT: Again, we see the confusion between concentration and dose.  The difference between 1 ppm and 2 ppm may seem large to some, but that would only be the case if you could control how much water people drank. Someone in a 1 ppm community could easily get a larger dose of fluoride than someone in a 2 ppm community, e.g. if they drank more than twice as much water.

FAIRBANKS COUNCILOR: “ I too would like to forward a few questions. Here there is not time – so Brad is that the gentleman to email them to?”

DR. WILLIAM BAILEY (CDC): Yes

FAIRBANKS COUNCILOR: “Will Brad be able to respond within a day or two – if the questions are not too difficult?

DR. WILLIAM BAILEY (CDC): Brad : “If you can get me questions, I will try to respond to them by tomorrow. Etc

FAIRBANKS COUNCILOR: “ Dr. Bailey you mentioned that there were two types of studies – scientific studies - one in where you follow people through time and the other is you compare one city against another city or one area against another area. One having had fluoride the other not. The first one you said you follow people through time and I didn’t hear a follow up statement by you as to what study might have done that. I assume that has probably been done that people have been followed through time or questionnaires have been delivered to people on a broad enough scale to make it somewhat reliable. Do you know of any studies like that?”

DR. WILLIAM BAILEY (CDC): Yes for example a study done by Kathy Phipps in the Northwestern part of the United States. She followed over 9000 post-menopausal women because at the time there was some concern that fluoride was related to fractures, especially hip fractures. And so she followed these 9000 women and recorded there fractures and what she found was that there was that there was not an increased risk for hip fractures.

PAUL CONNETT: There are some serious limitations with this paper. To get this relationship Phipps had to control for 12 variables. Moreover, she found an increase in wrist fractures in the fluoridated population, which in the draft of her paper she indicated was statistically significant but in the final version stated that it was not (Connett, 2001).

FAIRBANKS COUNCILOR: “In that study was there a finding on the benefit of fluoride to teeth?”

DR. WILLIAM BAILEY (CDC): No she just looked at bones.

FAIRBANKS COUNCILOR: “So, I am looking for that one. Were there any where people were followed through time where the benefit to teeth was examined?”

DR. WILLIAM BAILEY (CDC): Normally – there probably are studies like that but I don’t know of any of the top of my head – normally what they do is they look at – they almost always used children because – at the beginning they thought fluoride was only good for children. Also it is an easy group that is in a school. Normally they look at 12 year old children – then they look at 12-year old children – 5 years later but they would be different groups.

FAIRBANKS COUNCILOR: “The second issue one was one city or area versus another. You mentioned that those were difficult because you know whose drinking who isn’t, whose taking artificial and who isn’t – regressional analysis could… (side 1 of tape ended)… any of that you might know of?” 

DR. WILLIAM BAILEY (CDC): Sure. We can go all the way back to when they started water fluoridation. What they did there they used pairs of cities one of which was fluoridated and the other that wasn’t…

FAIRBANKS COUNCILOR: “if you would just tell us the one… (Bailey continues to talk about the early trials)… I am looking for one that is recent, because in the old days we didn’t have fluoridated toothpaste. Could you give me the best study that you can come up with that’s recent that shows pretty clearly that an area without fluoridation where they used fluoridated toothpaste versus an area that doesn’t. Do you know of a recent study like that?”

DR. WILLIAM BAILEY (CDC): There was a school children in the late 80’s - Brunelle and Carlos’s paper from 1989 – where they reported – it was a national study – that was when toothpaste was in full use – just about – and they reported – this was a national study - and they reported about a 25%  reduction in the difference between the  fluoridated and non-fluoridated areas when you adjusted for other …

FAIRBANKS COUNCILOR: “I can find that if I look up national schoolchildren in 1989 I can find that?”

DR. WILLIAM BAILEY (CDC): I can send you a copy of the Brunelle and Carlos report.

FAIRBANKS COUNCILOR: “Thanks I appreciate that. OK thank you.”

PAUL CONNETT: It is worth adding a few words about the important study by Brunelle and Carlos (1990). If it had worked out differently, this might well have become the bible of the pro-fluoridation forces – as it is, it contributes greatly to their undoing - at least, for those who actually read the literature.

The study resulted from a huge multi-million dollar survey conducted by the NIDR (I have already alluded to this study when discussing dental fluorosis) in which the teeth of 39,000 children in 84 communities were examined. The study came on the heels of several prominent reports that researchers were finding little difference in tooth decay when comparing fluoridated and non-fluoridated communities and countries (Leverett, 1982; Colquhoun, 1985 and Diesendorf, 1986).

The motivation behind this study may well have been to demonstrate once and for all that fluoridation worked. If that was the motivation behind the exercise it failed. When John Yiamouyiannis obtained the raw data from this study under the Freedom of Information Act (FOIA) he found that there was no statistical difference in tooth decay in the permanent teeth as measured by DMFT (Decayed, Missing and Filled Teeth) for children aged 5-17 whether they had lived their whole lives in fluoridated, or non-fluoridated communities or part of their lives in fluoridated communities   (Yiamouyiannis, 1990).

When Brunelle and Carlos published their analysis they used a more stringent and sensitive metric – they used DMFS (decayed missing and filled surfaces on the permanent teeth). As there are five surfaces to most of the teeth (the ones without a cutting edge) this measure is up to five times more sensitive than the DMFT measure.

However, Brunelle and Carlos were only able to report an average saving of 0.6 of one tooth surface (see Table 6), when comparing children who had lived all their lives in a fluoridated (Average =2.6 DMFS) versus non-fluoridated (average 3.2 DMFS) community. However, what Brunelle and Carlos reported in the abstract to their paper was an 18% saving. 18% is considerably less impressive than the rates that were being claimed at the time by promoters (40-60%). It is even less impressive when one finds out that the absolute saving amounted to just 0.6 of one tooth surface. This amounts to about one cavity or filling.

One wonders what health risks most people would take to secure an overall average saving of 0.6 of one tooth surface? But it gets worse.

Subsequent studies have found even less absolute savings in tooth decay. Spencer et al. (1996) in a study of two Australian states found an average saving of 0.12-0.3 DMFS and Armfield and Spencer (2004) in a study of 10,000 children in South Australia found NO significant difference in the permanent teeth between children who had lived all their lives drinking fluoridated tap water and those who had drunk rain water or bottled water. Despite these meager findings Spencer and Armfield still aggressively promote fluoridation, even advocating the addition of fluoride to bottled water!

FAIRBANKS COUNCILOR: “I have my last question. You had made the comment that the fluoride which was natural is the same as the added fluoride. Where does added fluoride come from? Where is that product derived from that we put into our water supply?”

DR. WILLIAM BAILEY (CDC): It mostly comes from the fertilizer industry. Phosphorous fertilizer industry. It’s a by-product. They do this with a lot of industrial things they take – gypsum is also another thing that comes from  that phosphorous fertilizer industry but – that’s where the majority comes from – that’s the fluorosilicic acid. You’ll see things about they scrub it out of the smokestacks- well they don’t scrub it out of smokestacks – they use a reclaiming process and they get the fluorosilicic acid that way.  (Discusses other source for the computer industry). But almost of it comes from the Phosphorous fertilizer industry.

PAUL CONNETT: Let me cut through Dr. Bailey’s attempt at semantic detoxification here. The chemicals used in over 90% of fluoridated public water supplies in the US are the silicon fluorides: hexafluorosilicic acid (H2SiF6) or its sodium salt (Na2SiF6).  These substances are generated in the wet scrubbing systems of the phosphate fertilizer industry, which in the US is largely located in Polk and Hillsborough Counties, Florida.  Phosphate rock is mined from the earth and then heated with concentrated sulfuric acid to produce phosphoric acid which in turn is used to make “superphosphate” a soluble form of phosphate used in agriculture.  The phosphate rock contains between 2 and 4% fluorine (as the fluoride ion, F-), and when it is heated with sulfuric acid, the fluoride generates hydrogen fluoride gas, which in turn reacts with silica in the rock to produce silicon tetrafluoride. 

Until about the mid-20th century, the production of these two highly toxic gases caused significant damage to vegetation, cattle and human health in the vicinity of the phosphate manufacturing plants.  With the advent of new environmental regulations, wet scrubbing systems were utilized to lower these emissions.  So strictly speaking Dr. Bailey is correct: the industry does not scrape this substance from the smokestacks, they trap the toxic gases in a spray of water before they enter the smokestacks. The resultant liquor generated in the scrubbing process is a 20-25% solution of hexafluorosilicic acid.

This solution is a toxic waste. It cannot be dumped into the sea by international law and it cannot be dumped into local waterways because it is far too concentrated. Officially it is classified as a hazardous waste but it is one of the vagaries of hazardous waste laws in the US that if someone is willing to buy this stuff it drops the hazardous waste label and becomes a “product.”

Thus, unpurified hexafluorosilicic acid (with many toxic contaminants) is the primary chemical now used to fluoridate public water supplies in the US.  For some regulatory officials, the use of this scrubbing liquor for fluoridation is considered a positive development.  In 1983, Rebecca Hammer, the Deputy Assistant Administrator for Water at the US Environmental Protection Agency (EPA), described the practice as:

 “…an ideal solution to a long standing problem.  By recovering by-product fluosilicic acid from fertilizer manufacturing, water and air pollution are minimized, and water authorities have a low-cost source of fluoride available to them" (Hammer, 1983).

However, Dr. William Hirzy, an EPA scientist, argues that the public water supply should not be used as a means of getting rid of hazardous waste and in recent testimony before the US Senate, described Hammer’s views as “linguistic detoxification” (Hirzy, 2004).

Clearly, being able to convert a hazardous waste material into a saleable product is very attractive for the phosphate industry.  It would be extremely expensive to send this material to hazardous waste sites.  It would also be cost prohibitive for communities to use pharmaceutical grade fluoride compounds in fluoridation programs.  Others have suggested that a better way to deal with the waste fluoride would be to convert it into calcium fluoride, which could then be used as feedstock for the many industries that use this material (Moriber, 1974).  However, it has proved difficult for the phosphate industry to remove the silica from the product and an alternative proposal is to use the fluoride waste in cement production (Lavanga). But as long as communities are prepared to pay for this material and put it into their water supply there is relatively little incentive for the phosphate industry to find more sensible and responsible solutions to their waste problem.

FAIRBANKS COUNCILOR: “If as a community we took the fluoride out of our water how long would it be – a generation, 20 years – before we would see an impact from it. Statistically?”

DR. WILLIAM BAILEY (CDC): I can’t give you an answer on that. Some of the studies that did that – I don’t have any recent ones. These were all years ago – decades ago. Antigo, Wisconsin, in 1949 fluoridated and they fluoridated till 1960 and they discontinued. Five and half years later – and now this was before (fluoridated) toothpaste – five and half years later they saw a 70% increase in caries.

PAUL CONNETT: I am surprised that Dr. Bailey singled out this very old Antigo, Wisconsin, study to support this claim, because it was a particularly poor study from a scientific point of view. More recent and well conducted studies have shown that where fluoridation has been discontinued in communities in Canada, the former East Germany, Cuba and Finland, dental decay has not increased but has actually decreased (Maupome 2001; Kunzel and Fischer, 1997, 2000; Kunzel 2000; Seppa 2000).

DR. WILLIAM BAILEY (CDC): The community guide (2002) talked about discontinuation of fluoride as well. This study came out in 2002 and this was a systematic review and they looked at the studies and  they said stopping water fluoridation resulted in a median 17.9% relative increase in  caries – tooth decay. But they don’t say how many years.

FAIRBANKS COUNCILOR: “I would like to know - you said that the non-natural fluoride comes from fertilizer – which companies and what’s in it and where can I get that information?”

DR. WILLIAM BAILEY (CDC): If you go to our website – I can send the link to that as well – we have a whole section on additives – questions and answers about additives and so forth. The other thing that it explains there is the fluoride additive – it isn’t just something that somebody is collecting and dumping in your water. There are regulations which relate to the additive too – they have to be of a certain purity. The American Water Works Association has standards that are national standards for the additives – for any additives which go into our water – and NSF international has standards and those are all talked about there as well - on our website - as well. I can send you this link if you like on the additives.

PAUL CONNETT: NSF International (National Sanitation Foundation International) is a private corporation with fluoridating chemical industry representatives on their board. Getting information from them is like getting gold out of Fort Knox. The incredible thing is that when one pursues the ultimate question of who can vouch for the safety of water fluoridation and the fluoridating chemicals used, one is eventually led to NSF International. The EPA does not regulate water fluoridation as such (the EPA regulates fluoride as a contaminant); the FDA does not take responsibility for regulating fluoride for ingestion and, as we saw above, when it comes to the safety of fluoridation the CDC refers questioners largely to reviews by other bodies. Thus the issue of safety has been outsourced to this private entity. One of the things that the law requires NSF International to do is to provide the toxicological studies, which demonstrate the safety of the chemicals added to water. When recently asked to provide this information for the silicofluorides by officials in Southern California, the NSF refused, claiming that they didn’t have to because they were a private corporation! Another serious question is how frequently these chemicals are tested by the NSF for their contaminant levels and whether or not an adequate statistical analysis has been applied if each batch is not tested.

FAIRBANKS COUNCILOR: “So what else is in water besides fluoride?”

DR. WILLIAM BAILEY (CDC): I am not an industry person but of course chlorine is in the water. They add things to reduce iron in water, because iron can stain fixtures – I wish our fluoridation engineer was here because he knows all of that. If you have specific questions about engineering questions I can forward…

FAIRBANKS COUNCILOR: “That’s OK, I just know that if we were to remove fluoride they would add something else to maintain the pH balance. So take out one additive and get another it seems like.”

FAIRBANKS COUNCILOR: “ I think certain additives are for the purity of the water but this (fluoride) is actually an additive for medication for a physical aspect rather than for safety of the water.”

DR. WILLIAM BAILEY (CDC): It’s not considered a medication it’s er…

PAUL CONNETT: It is a pity that Dr. Bailey was cut off here because it would have been interesting to hear how he classified fluoride if it was not considered a medication. There is no scientific evidence that demonstrates that it is a nutrient. To do this you have to deprive an animal or a human of the suspected nutrient from the diet. If a disease results then the substance is declared an essential nutrient. This has not been done for fluoride. Furthermore, it would be a huge surprise if fluoride were a nutrient because that would mean that nature was wrong on baby’s first meal where the level of fluoride in mothers' milk is remarkably low (0.004 ppm, NRC, 2006). Nor am I aware of any other nutrient whose main action is topical not systemic.

FAIRBANKS COUNCILOR: “It’s curious when we speak about it and we talked about doses or suggested amounts that people should drink – pregnant, young etc – I am a large woman so I drink one glass so I am under-dosing and I have a skinny friend who exercises all the time and they are drinking 20 glasses a day so. To be in the system you get doses for people of different sizes, weights and activities – so it is a curious thing that we are trying to decide what is healthy and we have got that stated.    Then habit. Then personal choice comes into play. So…”

DR. WILLIAM BAILEY (CDC): Yes it does. But for over 60 years there have been people of all kinds of medical conditions and of all kinds of different sizes and different intakes and so forth and for over 60 years we have not seen an adverse effect. Other than fluorosis that’s related to intake of all levels – so….

PAUL CONNETT: And this is the hub of the matter and I will use this opportunity to summarize some of the arguments we have made above. The countries that fluoridate their water have not done the critical health studies of the communities they have fluoridated. This allows proponents like Dr. Bailey to assert they do not see any effects, while opponents are left complaining that governments promoting fluoridation have seriously neglected their job of investigating the matter. Absence of study does not mean absence of harm.

This is what Dr. John Doull, the chairman of the NRC (2006) review said about the matter in a January 2008 article in Scientific American:

“What the committee found is that we've gone with  the status quo regarding fluoride for many years-for too long, really-and now we need to take a fresh look," Doull says. "In the scientific community, people tend to think this is settled. I mean, when the U.S. surgeon general comes out and says this is one of the 10 greatest achievements of the 20th century, that's a hard hurdle to get over.  But when we looked at the studies that have been done, we found that many of these questions are unsettled and we have much less information than we should, considering how long this [fluoridation] has been going on. I think that's why fluoridation is still being challenged so many years after it began. In the face of  ignorance, controversy is rampant."  (Fagin, 2008)

It is important to note that to complete their comprehensive review of the subject the NRC (2006) panel had to reach out to the scientific literature from countries that do not fluoridate their water, and particularly those like India and China which have high natural levels in the water causing undeniable health problems.

We have a Catch-22 situation here. Those countries that practice fluoridation have not done the most basic and obvious studies to check to see if fluoridation is harming their populations. If you don’t look, you don’t find!  So when this weak database is used to do a “systematic review” it is little wonder that “panels of experts” cannot find much evidence of harm (York Review, 2000 and NHMRC, 2007). What the NRC (2006) panel did – which few panels have done before – was to scour the studies done in countries, like India and China, with relatively high background levels of fluoride in the water. These studies are available because the countries do not have an interest in protecting an artificial water fluoridation programs – far from it, their interest is to remove fluoride down to a level that they consider safe. Thus there is a government willingness and money available to do the studies. Moreover, there is no pressure on researchers not to find “embarrassing” results. Promoters of fluoridation in the US and elsewhere were not happy when Mullenix and Bassin published their seminal findings on the brain and osteosarcoma respectively (Mullenix et al., 1995 and Bassin et al., 2006) and reacted accordingly: Mullenix was fired and Bassin’s work was hidden from the public and scientific community for three years (Bryson, 2004). There are many other earlier examples of politics trumping science on this issue.

To complete the Catch-22 argument. In India and China, most of the population studies are drinking water above 1 ppm, which enables promoters to maintain the “illusion” of safety for fluoridation, by claiming that results at higher levels are not relevant to populations' drinking water at 1 ppm.  This is what the ADA and the CDC did, and this is what health authorities in Australia, Canada, New Zealand, Ireland, Israel and the UK have done. However this is a rather silly argument because, as any toxicologist will confirm, we are often forced to make judgments about dangers to human health based upon high dose animal experiments.  In the case of fluoride we have the “luxury” of human observations at doses equal to or very close to the doses experienced by some, if not all people, living in fluoridated populations.

The NRC (2006) report has demonstrated emphatically that fluoride can damage health – not just the teeth and bone – but many other tissues as well. What is required now is the determination to see if there is an adequate margin of safety between the doses that have caused harm in these studies and the full range of doses that people are getting in fluoridated communities.

Most importantly, in going from small population studies to extrapolating to whole populations we have to introduce a “margin of safety" (or safety factor) to allow for the full range of sensitivity towards a toxic substance in any human population. In the case of fluoridation we have to protect the very young, the very old, those with poor kidney function, those with diabetes, and those with poor nutrition, particularly those with borderline iodine deficiency. For this purpose regulators usually use a safety of factor of ten and sometimes an extra safety factor to account for the extra sensitivity of infants and young children.

The NRC (2006) report found that the current MCLG of 4 ppm is not protective of human health and recommended that EPA’s Office of Drinking Water perform a new health risk assessment to determine a safe MCLG. This determination will require the EPA to examine all the health effects reviewed by the NRC and determine at what doses these effects occurred and then apply an appropriate margin of safety which will protect the whole population. After two years the US EPA has not begun the health risk assessment.  For the record: at a 2007 meeting convened by Jonathan Fleuchaus, General Counsel for US EPA’s Pesticides Division, with the Fluoride Action Network, Environmental Working Group and Beyond Pesticides, EPA put forward the recommendation that they would expedite the fluoride health risk assessment if the groups would drop their formal Objections against EPA’s approval of sulfuryl fluoride as a fumigant on post-harvest food.  EPA told the groups that if they didn’t agree, the health risk assessment could be put off for as long as 10 years. The groups responded that they would not drop their case against sulfuryl fluoride, which EPA has estimated will be the second largest exposure source to fluoride after fluoridated drinking water.

Meanwhile, as far as the dangers posed to those who appear to be particularly sensitive to fluoride, even when independent researchers like Dr. George Waldbott do studies, they are ignored. Excuses are made but the simple fact is that no fluoridating country has ever attempted to put the issue of some people being sensitive to fluoride to rest by conducting scientific studies on the matter. This is just part of the politics overruling science on this issue. For over 60 years bad science has been used to support a bad policy.   For a fuller discussion for the history of this issue see The Fluoride Deception by Christopher Bryson. A 28 minute interview with Bryson can be viewed at http://video.google.com/videoplay?docid=-3949434744498031545&hl=en

MAYOR: “We thank you Dr. Bailey very much.”

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PART 3 (Appendix & References)
PART 1