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FLUORIDATTON, 1g7g
Scíentifíc Críticfsrds a.nd Fluoride Dangers
by
Phillp R.N. Sutton,
D.D.Sc.(MeIb.), T,.D.s. ¡ F.R.A.c.D.s.
Âcaderelc Âssociate, Ilniversity of Melbourne.
Formerly Senfor Lecturer ln Dental Science,
Seníor Rosearch Fellow
A personal eubnÍesíon to the Committee of fnquiry
Lnto the
Fluorlilatloa of Vlctorian Water Supplies
Conprf.eingl Dr D.lul. Myers¡ C,M.G., ChaÍrman,
Dr V.D. Plueckhahn, EtD: ancl Dr A.T,.G. Rees, O.B.E.
August, 1979
With an, Appendf.x
January t 1980
/
copyrJ.ght @ 19Bo by philip R.N. Sutton
rsBN o95949?6og
PRBITACE
Tliis subnrission was prepared opecificalJ.y to corlply with the
Terms of Reference of the Committce of Inquiry into the
Ftuoridation of Vlctori¿rn hJ¿¡.ter Supplies. 0f necessfty it
vras preparecJ. to meet the revised dead-l-ine specified by the
Comnittee.
New and important information which has come to hand
since this document v¡as submitted in August, 1979 ¡ has been
added as an Appendix.
For a serious consideration of fluorÍdation it is
necessary to consider a nuch wider coverage of several aspects
of this subject. It is suggested that at least three of the
more recently published boohs, mentioned in the references,
are essential- readin6: The Fluoride Question (Gotzsche , 19?5),
Environmental Fluoride . 1977 (Rose and. Marier, 19??) and,
Fluoridation: The Great Dilemma (Wala¡ott
ïn addition, tìre Report on the Quafitr¡ of
4' , 19?B) 'the Environment and
the Fluorj-dation of Drintcing Vrlater written by a minÍsterial
comrnittee appointed by the Government of Quebec, Canada, has
just been printed and will be available soon. Judging by the
abstract of its contents, this is a very important publicatj-on.
In my submission the discusoion of dental fluorosis
was in section XIX. Thj.s has norv been moved to section XIII,
therefore the originaÌ sections XIII to XVIII have become XIV
io XIX, respectively.
January, 1980 P,R.N.S .
TAI]LE O}' CON'.UJNTS.
I Tal¡.j-e of contente;.
Introduction.
Sumrnary.
I'age1
6
9
12
1L¡15
17
181g1g
20
II.III.
PAIÌT ONE
IV. Iuiethods used to prornote fluoridation.
Political- action to introduce fluoridation.Pronoti.on by rend.orsements | .
(a) The dominant role of the U.S.P.I{.S.in the promotion of arti_fÍcialfluoridation.
(U) Australian endorsements off luori.dation.The basis for endorsements.Scientific decision by najority vote.Scientiots and scientÍfic organizaülons
3)
opposing fl-uoridation,(f) A comment on endorsements by the
N.H.& M.R.C., A.Þ1.4., A.D.A., andA.F. C.0.
Repressive actions.(a) Discouragement of discussion on
fluoridation.(b) Repression and, abuse of opponents
of fluoridation.(c) The suppression of publisheu
evidence against fLuoridatùon.(A) Diffj-culties in publishing neb,
naterial which questíons fluoridation.The motives of those who prornote(4)
v.
(1)(z)
(c)(¿)(e)
fluoridatlon.a) Altruistic motives.b) Financial advantages
fluoridation.from promoting
(c ) personal_ prestige.
The nature of artificial fluoridation.(l ) The fund.amental difference between
water supplies.(-6) Fluori<iation is-ãompulsory medication.(?) Fluoridation may violate religious andpersonal convictions.(ö) Fluoridation -
fthe favoured, pollutantr.
((
2127
21
26
29
11
34t4ZÉ
37
39
39394o40
4r47
4546
1
VI. Fluoridatlon and dental manpower recluirements.
lage
4Z
4Z4B
4B
5o52
545656
6g7o71
73
7474
75
77
(r )Q)0)
Studies by l)rofessor B.L. Douglas.The dentists in Ilasel- (Switzerland).The number of dent,ists in fl-uoridated and
non- fluorfd¿rte d I r e pre sentativeArnerican cities | .
The number of dentists in U.S. fluoriclatfontrial cities.
Comment.
(4)
(¡)
VII. The increasing rejection of fluoridation overseas. 54
Vlestern Europe.The United Kingdom.the U.S.A.
VIII. Support for, and opposition to fluoridation byAustralian medical and dental- graduates.
IX.
X.
xI.
XTI.
(¡)
(B)
(e)
(ro )(tr)(z)0t)
(r )Q)3)
5B
The difficulty j-n controlling fluoride concentration.5g
Plumbj-ng problerns resultÍng from fluoridation. 6lFluoridation and the safety of the vrater supply. 66
PART TWO
The effica.cy of artificial fluorj-dation isquestionable.
69The determinatÍon of changes j_n d.ental carj_es
prevalence.Longitudinal trials of fluoridation.The need for controls in experi_nental trials.The premature estabLishment of fluoridation
trial s.The snall- number of fLuoridation trials with
experimental controls .Fluori-dation demonstrations .The terms tcontrolled stud.yr and rcontrolled
fluoridationr.Resu1ts, reports of results, and. opinions of
fluoridation trials.The gro6s errors in the main Arnerican/
Canadian trials ofartificial fl_uoridation.
Additional eruors in the Evanston trial data.The question of delayed eruption of teeth.Red.uction or retardatuon of dental caries.Reports from statisticians.
(r )
2t4
)
)
(((
(6)Q)
?B?98t8zBB
2
PART IIIRI:;E
XIII. Dental fluorosis.(t ) Dental fl-uorosis indicates chronic fluoride
polsoning.Q) The prevalence of dental fluorosis in a
fluoridated area.3) Factors affecting the degree of dental
fluorosis.The classification of dental fluorosís.The Index of Fluorosis.I Objectionable I fluorosis.Teeth with mottled enamel are imperfectly
formed.The appearance of dental fluorosis
-f rnottled teethr.The unknovrn prevaLence of dental fluorosis
in Victoria.The important factor of clinrate - daily
temperatureE.Short periods of chronic fluoride poisoning
produce dental fluorosj_s.The concentration of fl-uoride at which
fluorosis occurs.
(4)ç)(6)(?)
(B)
(e)
(ro)
(tr)
Uz)
(z)
3)
Page9t
9t
9t+
9B
99
100
101
102
103
106
112
112115115116
117
118123
127124126128
129
13t
142
9496979B
PART FOUR
XIV. The roptimumf fluorÍde concentration in dr inking
XV.
water.
Other sources of fluori_de.
(t ) Fluoride in food.(a) Fl-uoride 1n processed foods.(¡) Fl-uoride in Ëeverages.(c) Fluoride in watereã vegetables.(¿) FLuoride in sprayea frij-t and
vegetables.Fluoride in toothpaste, mouthwashes andtablets.Atnospheric fluoride.(a) Absorption of fluori.de fron the
(¡)(c)(a)(e)
atmosphere.ïndustrfal pollution.The spread of fluoride contamination.Diverse types of daraage from fluoride.Atmospheríc fluoride is not ¡nonitored
by the Environment protectÍonAuthority.
xvï.
XVIT.
The roptimurar total fluoride ingestion.The factor of ùemperature.
3
XVIII. The fluoride concentration epecified in the Actis an arbltrary one.
PART FIVE
xil. The toxicity of fluorid.ation - thc effect ofother constituents of the t^¡ater.
(1 ) The importance of other constituents ofthe water.
Q) The sof tness of Mel-bourne nater.(r) lVater hardness - cal-cium and rnagnesium.(4) Naturall-y fluorÍdatett water is usualLy hard.
xx.
XXI.
Ske1eùaL fluorosis.
FLuorLdation: Psychological reactionsfluorosia and direct effects onnetvous system.
dentalcentral
tothe
Page
1\6
149
158161162164
166
169
169
172
179
1?t+
1?4175
177
(r )Q)
ß)
Psychologica3. reactione to dental fluorosis.Direct effects of fluoride on the central
nervous system.Possible psychological results from
fluoridation.
XXII. Fluoridatj-on and cancer mortaì-ity.
(1 ) Early papers which suggest that fluorÍclenay affect cancer.
(¿ ) Co¡nments by Iìnof essor Al-bert Schatz.(t) Papers linlcing fluoridation nith cancermortality.
(4) Comments on the report by Drs Burli and,Yiamouyiannis re6arding a l-ínkbetween artificl-al fluoridationand lncreased cancer mortalíty.(a) stattstical aspects.
(b) Association and, causation.(c) the response 1n Australia to thesefluoridat ion/ cancer mortalityresults.
(a) tne U.S. court hearin6s and decision.(e) The visit of Dr Yiamouyiannis toAustralia.
(f) 19?9 pvblicattons relatÍng to thiosubject.
lo(rrr. Thê infl-uence of fruorrde in8estÍon on geneticchanges - mongolÍsm.
1?81
1
78?9
180181
187
184
4
18?
Page
191XXIV. Other nedical aspects of fluoridation.
(t ) Fluoridation and the thYroid.(z) The aorta.3) The kidneys.(4) Other conditions.
XXV. Intolerance to fluoridated water.
191193194196
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(¡)
(6)
(e)
XXVT.
Q)
3)(4)
$)
XXVII.
XXVIII. Conclueion.
Re ferences .
((7B
))
The denial by the Aurerican Acadeny ofAIlergy,
Fre-fluoridation evidence of intoleranceto fluoride.
Intolerance to artificially fluoridated,wate!.
ConfÍrmation of intolerance by double-b1lnd tests.
Recent conplaints in VictorÍa ofintolerance to fluoridated water.
The difficuJ-ty in d.íagnosing intole¡anceto fluoride.
Intolerance üo fluoridated toothpaste.The problen of l-ntolerance to fluoride
will grow.The great difficulty in obtaining
compensation for il-lness caused,by fluoridation.
The need for a large rnargin of safety forsubstances added to the watersupplies.
The recent marked decreases in therecommended dose of fluoride.
Fa1ee claime that there is a 1ar6e narginof safety wÍth fluoridatj-on.
MÍsplaced confídence in claims regardinga safety margin with fluoridation.
C1aÍns that there 1s a safety nargin withfluorÍdation are I patently naive I .
There Ís no margin of safety v¡ith artificialfluorídation.
(r )
The influence of fl-uoridation on manrs environment.
(1) The ffluoride circuitr arising fromfluorÍdation.
(Z) Fluoride d.amage to trees, plants and cutflowers.
\7) The synthesis of organic fluoride compounds.(4) Vüil1 fluoridation affect rnarine life inPort Philtip Bay?
AppendÍx
E
II. 6.
The Terms of Reference of thfs rnquiry instruct the comnÍttee
to receive tnew evidence concerníng the effects on hurnans
of fluoridation of water suppliest which rwould warrant
a review of the Health (Fluoridation) Act. r (victorian
Governnent, 1977).
The expressÍon rnew evidencer is vague, but istaken to refer, primarily, to naterial which was unrikery
to have been brought to the attention of the ¡¡embers ofthe vÍctorian Parlianent before the passing of the Hearth(Fluori.clation) Act in 1g?3, or whlch has been published
or become known since that tine. of course ít wirr be
necessary to nention earlier pubrications, in order tornake the Inev¡t naùeriaI intertigabre or to pl-ace it i.n
its proper context. unless earrier work is considered,
practÍcalIy all the evidence which is stilI cited infavou¡ of fluoridation, incruding the key experimental
trials, cannot be taken Ínto account.
common sense dictates that those who advocate the
compuloory nedication of whol-e popurations, such as the
victorian Health Departnent, shourd be required to prove,
beyond reasonabre doubt, that the process is efficaciousand is safe for every nenber of the conmunlty. However,
it appears that the Terns of Reference absorve the HealthDepartnent, and others, from that sensíble requireraent.
ïnstead, the onus is placed on those who oppose
artificial fruoridati-on to produce Inewr evidence.
7
Ae the Deputy Speaker of the llouee of Lords, Lord Douglas
of Barloch, oald ln 1960:
rThe fact remalns that the onuti of proving thatfluoridatÍon ie beneflcial to the teeth rests upon
those who assert it, and so does the onus of provingthat the continuous ingestion of fluorides involvesno risk of cumulatÍve toxicity. This onus of proofhas not been satisfactorily discharged. I
The dÍfficulty in obtaÍning ans'b¡ers from official
bodles to queetions relating to fluoridation, is
illustrated by the fact that the Premier of Western
Australia wrote to the Nationar Health and Medical Research
council requesting infornation about raccepted safety lÍnits
for fruoride absorpt,ion, fluoridated water in hernodyalysie,
and /[ustralian research or soientific discussion on
fluorides. t Four and a half months later he had not
received a reply. (Cant | 19?Z),
Even more remarkable is the statement of the Hon.
Dr D. Everinghan (19??) tt¡at, when he was AustralianMínister for Health, 19?2 to 19?5, he requested his
Departmental advisers to produce for hin a statement of the
scíentific justification for water fluorídati-on. Afterreminders, two years later he finarly received, a short and
unsatisfactory reply. He said:I r indicated that r did not regard this as scientificevidence and requested the same; in partÍcurar claimsof !ùaldbott and Rapaport that fluoride allergy or Downrssyndrome (nongolisn) are found to be associated withwater fruorÍdatfon should, r suggested, be refuted Ínscientific fashíon, not by rhetoric or appeal toestablished authority. r an stiIl wai-ting to see suchrefutation. I
8
The Edftorlal Ln the rGeelong Advertlserr of l4ay
14, 19?9(¿) ¡ said that the Terms of Reference rseem to
be loaded Ín favour of the status quo. I
The case for artlficial fluoridation remains the
sane. It wae stated by Dr L.G. OrBrien, the President
of ühe Auetralian Denta1 Association, Vj-ctorian Branch,
on April 26, 19?9. He clained. that:rThe simple truth is that there Í.s no scientifíccontroversy over the safety or effectlvenees of
. fluoríclation. I
ï subnÍt that the evldence which will be docr¡¡rented
in the following pages clearly indicates that that
statement is incorrect and,, therefore, that the Act must
be, at least, revieweil - if not inmediately repealed.
IIÏ.
SUI'4MARY
9
1. tr'luorl.datlon has been pronoted by: (a) valuelessrendorsementsf by various organizations, based nain]-y on
hearsay, (b) ttre repression of opponents of fruoridation,and (c) the suppression of new eviclence against ít.2. Fluorldation conpursoriry medicates every member of the
cornnunity wj.th smaLr doses of a poisonous substance through
their domestic drínking water. rt contravenes med.icar ethicsand may vlolate religious and personal convictions. rtslould not be confused wlth chrorination, which is íntended.
to trea.t the wat,er, not the consumer.
1, claims that artificial fluoridaùion will reduce the number
of dentÍsts required by the comrnunity have not been proved.
4' There is an increasing rejection of fluoriclation overcreas.
fn western rìurope, plants which had been in operation for many
years were closed and there is now an alnost conplete reJectionof fluoridation.
5. Opposition to fluoridation i-s expressed in rnost of the
letters on the subject sent to tbe luiedical Journal of Aus tra]-Ía6, I'he concentraüion of fluoride in the domestie tap is veryitÍfficult to regurate and usually it is not at the specifÍed1eve1.
7, rt has been necesaary to add lime to the r.relbourne waterto eonbat the rsevere corrosionr whích fr.uoride produces ínwater pipee. -
B, Recent'pubIÍcations su¡3gest that i.ncreasing the
arkau-nÍty of water, by adding limer may be hazardous unlessthe water is also chlorinated.
a
10
9, Cl-aims that fluoridation w1Il produce a marked decrease
(approximately 60 per cent ) in the prevalence of dental caries
have proved to be, at least, grossly exapçgerated.
10. Dental fluorosis, due to chronic fluoride poisoning of
tooth-forming cells, will occur in at least ten per cent of
children who drink fluoridated water from the time of birth.
11 , The roptirnum I or I optimal I f luoricle concentration in
drinking water (said to be approxímately 1 p.p.m.) i" t¡r" on"
which promoters of fl-uoridation consider is the most favourable
one for teeth - they rarely consider its effect on the rest
of the body.
12. Fluoride is being ingested in increasing quantities from
sources other than water - f¡6¡ food, toothpaste and from
fluoride pollution of the atmosphere. Little is known of the
fluoride levels in the Melbourne air for the Environnent
Protection Authority does not monitor fluoride.
11. There cannot be an 'optimunr total fluoride leve1 for
every rnember of a communj-ty for this value varies with each
individuaL.
14. The irnportant factor of temperature variations between
seasons has been ignored rvhen fluoridating our water.
15, The fluorid.e concentration of drinking water which isspecifíed in the Act is an arbj-tTary one.
16, Despite the addition of lirne to Melbourne rs waters they
are still exceptionally rsoft I , wi.th 1ow concentrations ofcalcium which is the antidote for fluoride poisoning.
11
1?, Recent publicatlons suggest the possibility that cases of
ekeletal fluorosis may <levelop in victoria, particularly in
those who I1ve near fluoride-enittln6 factories.
18. Little is known of the psychological reactions of individuals
af flicted r^rith d.ental fluorosis, nor of the direct ef f ects of
fluoride on the central nervous system.
19. Recent discoveries SiVe support to the finding that an
increase in mongoloid births is associated with increasing
IeveIs of fluoride in water supplies.
20. ¡,tuori¿ated water, apart from affecting the teethr ñâI
have severe effects on other organs of the body. It should
not be used in kidney díalysie machinee.
21. It is now deflnitely established that some people cannot
tolerate fl-uoridated drinking water. They becone illt but
recover when distilled vrater is substituted for their domeetic
water for drinking and cookíng.
22. Clairns that there ís a large margin of safety with
fluoridation are false and are rpatently nal'vel '23. Fluoridation introcluces a rfluoride circuitr which has
an uncontrollable effect on man and his environment.
24. Despite clains to the contrary, the reported link between
artificial fluoridation and increased cancer mortality has not
been disproved. On the contrary, preliminary data from
Bírmingham, U.K., strongly support the presence of such a link.
rv.12
TIIE METITO DS USED TO PROMOTB FLUORIDA TTON.
rt fe eecentiar- for anyone who undertakes a study of thefruoridati-on of domestic water suppries to rearn somethfngof the methods used to promote this procedure. This shouldbe done before considering the scientific side of thiscontroversy for, without that knowledge, sone of the facetsof the fluoridation discueslon wilr be incomprehensible.
Nornally, scientific progranmes are accepted or-rejected on their nerite, as judged by studies of theorig'inal data by a group of scientists chosen so that eachof the many aspecte which nust be investigated is coveredby at reast one expert i-n each fier-d. Fr-uoridation departsfron that custom. rt was conmenced rnainly on the adviceof public health dentists and officials with littreparticipation in the trÍals by competent statistÍcians,chemÍsts, engineers, pharmacologists, toxicologists andphysiologists. rt is notabr.e that much of the criticism offruoridati-on comes fron scientists traÍned in those fields.
Fluoridatl0n ie the fi¡st measure designed to affectthe health of the population whÍch, instead of beingaccepted on the consensus of scientists, has been rsoldlto indj-viduals and governnents by propaganda and byendorsemente, as though it is a commercial product. In asense, of course, it is.Professor C.M. IrfcCay, in 1)Jl, said:
rrhe whole prograrn of fluoridation has been d.one withtoo much haste and lvfthout careful research and study.
1'
The trouble Ls that profits arc lnvolved for eome and
emotions have been created in others'r
Dr A. Aslander 9966) said:
rThe facü that fluoridation has Sained such prominence
iseasilyexplaj-ned.Itispronotedbyveryclever'very lavish and very unscrupulous propaganda' It is
adisplayofmasterlycommercia]ism.Andthepromotershave been able to engage the interest of politícians. I
The Victorian IIeaIth (Fluoridation) Act, of December
11, 1g?3, provides that the Inet capital costs and expensesl
will be rprovided by Parliamentr, and it makes fluoridation
compulsory for the whole State by stating that any person or
rany water suppì-y authority contravening or faiÌing to
comply with any of the provisions of this Act or of the
re6ulations thereunder shall be Suilty of an offence
against this Âct; and shall be liab1e to a penalty ofnot less than $2OO nor more than $'1 rOO0 and in the case
of a continuin6 offence, to a daily penalty not
cxceed,ing xi40. t
Less than a year prior to the passing of that Act, tlre
Secretary to the Premier of Victoria wrote:
rI arn directed by the Premier to acknowledge your letterof 9th December | 1972' concerning fluoridation ofVictorj-an rvater supplies.
I*Ír. llaner has ashed, me to say that the Government i-s
not prepared to nake fl-uorídation of water suppliescompulsory and will not direct loca1 bodies to introduceit.r (Greenr 19?3a),
As no signifi-cant nev¡ information j-n favour of fluoridation
was publishecl durÍng that yeart why did the Victorian
Governrnent completely reverse j-ts attÍtude on this matter?
14
prior to the passing of the Act, statements weremade that aII the experte had been coneulted. This wae
not the case. Ner-thcr or the political parties soughtinformation from any of those i-n victoria who were widelyknown for their opposition to artificial fluoridation.Even Professor Sir Arthur Amies, C.M.G., Dean of theuniversity of Melbourne Dentar schoor for more than thirtyyears, Ì¡ras ignored.
The nethods used to pronote fluoridation wirl beconsidered under four main headin6s:(t) Political action to introduce fluoridation.Q) honotion of fluoridation by rendorsementsr.
3) Repressive actions against those who question oroppose fluoridation.
(4) Motives of those who promote fluoridation.
(r )
Intion.
1961 | the
published an article by Dr D.R. McNeiI, who said:flùe cannot escape the fact that fluoridation has beenwrested fron the hands of the scientist and depositedsquarely in the middl-e of the political arena.FluoridatÍon is now a political problen. lrle arestriving to reach the nÍnds of men so that they willtake political action. r ,f have seen, and. und,erstood,the reluctance of citizens to become embroir-ed in avicious hate campaign often unparalJ-ed in the historyof the comnuni'ty' r He spoke of rmore funds all0ttedby the rl.s. public Health service to finance the battr-es.rI rn short the war should be carried out on a thousand,fronts einul-taneously. r
Po litic tion to Int roduce Fluori da
15
More rocently, an articlo ln the Brltleh Dental Journ¿rl
urged the dental profesefon to ror¿çanize for the next
battlesr (Burt and Petteroon, 1972) and said:
rFluorl-dation everywhere is a politicaJ- matter and thedental profession bas to be prepared to treat it asguch. I
In 1978 the U.S. Publ-ic Health Service journal
Public Health Re rts , published an artícIe entitledrFighting the Latest Challenge to Fluoridation in Oregonr.
It said that tn 19?6 Llne State fluoridation group rhired
an experienced campaj-gn director to coordinate efforts and
give fuJ-I-time oversight. Although costly, thj.s was
essential.r (Rosenstein et al., 19?B).
Thís determination to force in fluoridation is
also seen ín Australia. For instance, ín 1959, Professor
N.D. Martin said that before Sydneyrs water was fluoridated
a full-scale education programme would be held rto break
down public opposÍtion. I
If the decision regarding fluoridation rests on a
political rather than a scientific basis, then the often-
repeated false claim, that rlaymenr should have no part in
the decisi-on whether or not they are to be forced to
consu¡ne extra quantities of fluoride, obviously is not
va1id.
(Z) Pronotion of Fluoridation byl Endorsements | .
ArtificÍar fruoridation is now endorsed by a nultÍtud.e of
associatÍons and organizations, fron the trlorld Health
Organization to schooJ- parents clubs. This impresses
peopre who have not been tralned in ecientific methods,and also some ímpreooíonable ocicntistc. For i-nstance,in a speech in the House of Representatives, in 1g64, sirRobert Menzies mentioned no fewer than twenty-three ofthese endorsing bodieo. of course these endorsenrentsare announced by the executíve officers, it does notforro'u¡ that the majorityr or even a large number, of thenembers of an organization support fluorídatlon.
Iàofessor II.A. Schweigart (96Z) said that itshould be asked who was responsible for the German
organi'zation of dentists recluesting the government tofruoridate the drinkÍng water, despite the fact that mostof the t5 rooo membcrs had not been intcrviewed. to obtaintheir views on this problern. He said:
tfn a slmilar way the Deutsche Gesellshaft für Zahn_,Ìiund-unri Kieferheilkunde asked for the fruoridationof drinking water and defarned the oppons¡ls _ manyof them with highest scientific reputation _ as notcompetent and not qualifiecì. I
However the executive of that society failed to gain thesupport of its members for that action. He concluded bysaying that it is :r great pity that there are para1le1cases in other countries.Dr A' Irorton (lg?o) asked rwhy the hess seens to inferthat the A.Il.A. speaks for all- its menbersr when ilIettersto the editorr show that a nunaber of doctors oppose na6s¡nedication by fluoridation. ,lthy give fluoride in sucha haphazard rnanner to everybody? |
17
I do not know of a properly-conclucted b¿rl-lot being held to
determine the proportion of Victorian dentists who support
fluoridation. Some yearc! a8o there waß a ourvey of a
ornall and biassed samPle.
(a) The Dominant Role of the U.S. Pub1ic IIeaIth Service
in the Promotion of Artifíc ia1 FluoridatÍon. The U.S.P.H.S.
was the first, and, rernaÍns the nain, promoter of artificial
fluoridation. Its first endor¡:ement was on June 1r 1950¡
only five years and four months after the commencement of
the proposed 1o-year fírst fluoridation trial:. lAs a
reoult of new evid,ence from its Grand lìapj,ds project.t
(lotrr and Love, 1954). It was pointed out (Sutton and
Amies, 1958 ) tfrat, in children who had been drinking
fluoridatecl water all their IÍves, rat that time very few,
if any, of tlreir permanent teeth had even erupted. I
Therefore there vtas no evidence of either benefit or harm
to the permanent teeth, for they could not be examined.
Soon aftervrards, that key U.S.P.H.S. study was
effectively destroyed by the fluoridation of the control
city. The results reported frorn that study are still
vridely cited as evidence for ffuoridation. A report from
statisticians stated that, j.n that study, rThe authors
appear to have demonstrated an unfortunate disdain for some
of the pre-requisites of valid research. I ( De Stefano 11954) .
The ü.S.P.H.S. stil-I remains the main source of
financial support for the promotíon of fluoridation.
18
(U) Âustralian Endorsement s of Fluori_dation. The U.S.practice of rselr-ingr fr-uoridation to the pubJ_ic and togovernmento, by citing the names of cndorsing bodies, hasbeen adopted in Australia. The Federar vicL.-president ofthe Australian Dental Association (A.O.A.) recently mentionedas endorsers the r\ustrar-ian Department of llealth, the HealthCom¡nission of N.S.t^I . I the N.S.l,^J. Cancer Council and. seven
'overseas bodies. IIe said that spacc v¡ou1d not permit alistÍng of the rmultitucle of professionar associ_ations andrespected indÍviduar scientists who have encrorsedfluoridation. | (Australian Dental Âssociation, 1g?g).
The main endorsing bodies are the National Health andI'ledical Research Council_ (N.H.& M.R.ç. ), the A.D.A. andthe AustraÌian lrledical Association (A.M.A.). Recentlythey joined with the Austr¿rrian Federation of consurnerorganizations (A.r.c.o.) in a joint statement which atùackedwhat it doscribed as ran organized and ill__inforrned campaignagainst fluoridation. r
A.F.c.o., 1g?Ð. The
('tgzg) said :
0f course, as the for¡re¡ FederaLDr D.N. Everingham (lg?O) saíd:
rThe NII&I'fRC were u¡r,animous in their supportcontroll_ed fluoridation (where necessary)supplies a6 one of the greatest and safestments in public heal_th available to us. r
(l¡.11.& I,t.R.c. r A.M.Â. I A.D.A, andChairrnan of Council, N.H.& I.Í.R.C.
of theof water,improve-
rThe authoritieo mostly referred tofluorj-dation are political (Â.M.A.
,journaì-istic rather than scÍentificlike Britainfs Royal Society. r
Minister for llealth, Hon.
in supportingIIÍHO etc.) andresearch socÍeties
19
(c) The Basis for Endorsements. The endorsements of
fluoridation by these Australian an{ overseas bodies are
not based on studies which they have conducted. As Lord
Douglas of Barloch expressed it, when referring to the
IJritish Medical Research Council, the V'IIIO, and various
nedÍcal and dental associations:
rìtrone of these borìies has done any original rescarchwhich rvould justify recommending fluoridation. They
have rested themselves upon the opi-nion of ot,hers. r
tIn the cnd this J-arge and apparently authoritatÍvebody of opinion is seen to be an Ínverted pyramidrestlng mainly upon the interpretation by a few personsof a selection of statistics of the e>:perimentaltrials.r rIt is indeed characteristic that theopinions expressed upon this subject becorne
increasingly dogmatic as each one in turn is based
upon the opinion of another and become further removed
from the facts which ou6ht to be their foundation. I
(Douglas of Barloch, t96O). I
(a) Scj.entific Decision by lia.jority Vote. It is
frequently stated that the rnajority of scientists favour
fluoridation. The Editor of the Journar of the Denta1
Association of South Africa (959 ) said:rwhether the scientists who favour fruoridation are inthe vast majoríty we are not in the position to state.fn any case, numerical strength is no yardstíck bywhich to nreasure ríghtness or wronßrêss. The historyof medicine teems with exampÌes of one lone scientistbeing proved correct in the face of a hosü of opponents.f
I See appendix /e¡ p. 266.
20(e) Sc ntists and Sc ie ntific nizationsOFluo r da IOn. In the case of fluoriclation it i.s by no neansa cau,e of rone 10ne sclenti-st r, for a very large number ofscientists are opposed to that nro"uuu. * M^ny of these aresenÍor nen and. v/omen of conslderable standinS, some of whonhave a110wed thei-r nanes to be listed as opponents offl-uo¡idati-on. one rist contains the names of twerve NobelPrize winners who rhave expressed ¡eservations about the safetyof the artificial fluoridation of public water supplies.r(London Anti-FluorÍdation Campaj_gn) .
when endorserne¡ts of fruoridation are cited, trrere isnever any mention of these scientists, nor of the oppositionof prestigeous bodÍes such as the rnternatlonar_ society forResearch on Nutriti-on and Vital Substances. lrlhen it passedits Resolution 3g opposing fluoridation, its scientÍfic councilconsisted of rnore than 4Jo rnembers, sfxty per cent of thembeing professors, drawn îron lJ countries. (professor AIbertSchweitzer was the Honorary president for nine years. ) ALltheir resolutions were approved by the entire rnernbership, witha consensus ranging from 9i to .1Oo per cent of the votes.(International SocÍety , 1c)67).
professor H.A. Schweigart, the president, revealed.that the society had frequently dealt with the fr-uoríneproblem' and that the pros and cons had been carefuÌlyweig'hed' Experts fron several countri-es had rexamined
conscÍentiously the argunentationf before their resolution
See appendix /c, p. 265,
21
nurnber J) was publiohed. The translation from the German:
rThe Scientific Council of thc Intcrnational Society for
Reseat ch on Nutrition and Vital Substances recommends
thatallgovcrnmcnto'stateParÌiamcntsandCitycouncils, concerned with the problern of fluoridaüion
of drinkinS water and. protection fron dental caries I
should refrain from fl-uoridating d.rinking waterr which
measure is ¿.rctually a medication, as 1on6 as the
scientific aspects of this problem are not satis-
factoril-y clarified. | (International society, 1967).
(r) A Comrnent on the Endorsement of Fluoridatíon by the
National Health and lulertical Re search Council the
Australian l"fedical As sociation. the Àustralian Dental
Àssociation and the Aus+-ratian Federation of Consumer
or¡ranizations. An important insight, into the true value,
in fact the deceptiveness, of endorsements by organizatÍonst
even by those four lcacling Australian ones r was given
recently at a meetin6 at the Australian National University'
at which I was present. It v¡as called to hear an American
lecturer, Dr J. Yiamouyiannis, and to cliscuss the questi-on
of a ].ink between artificial fluoridation and cancer
mortality, revealecl by hím and Dr Dean Burlc (lgZZ). The
spokesrnan appointed to oppoe;e Dr Yiarnouyiannis v¡as I>r.ofessor
R. Thorp (who is, I u.nderstand, a retired professor of
pharmacy). A subsequent statement by Dr I'1. Dieeendorf
(lglg) described the outcome very accurately. He said:
rIn short, the rrdebaterr was a complete walk-over forDr Yíamouyiannis. This $tas sÌrrprising, because justbefore Dr Tia¡rouyíannís's amival in AustraliatProfessor Thorp, opeaking on the media on behalf ofthe NIIMRC, the AustraÌian l'ledical Associationt the
22
Austrari-an Dental Associatíon and the AustrarianFederation of Consumer Or6anizationo, haci made aetron6 attack on Dr yì-amouyiannis and statc.dpositÍveIy that there was no link betwcen fr-uorÍdationand cancer.
since the sporresman for these eminent authoritieswas unable to substantÍate his clains scientifically,it see¡ned fair to ask who in ÂustrarÍa assessed thescientifi.c papers on both sidcs of this controversyand advi-sed the lr'ilüìc¡ the ÀrrrÀ, the ÂD;\ and the
^Fcothat there is no li-nk betrveen fr-uoridation and cancer?To the amazement of the uncornmi-tted menbers of the
audience aü the ÂI{u crebate, rtofessor Thorp was unableto answer this question.
The answer, I suspect, ía sÍmply. There j-s no one.The NIIlffiC, ill4Â, AD/r and AFCO have sirnply, without
thinking, accepted the advice of their op¡:osite numbersovetseas. These in tu¡n have unthinkingly acceptedthe resul-ts of thc US l,lational Cancer fnstitute, DolIand Kin]-en, and olclham and lrer,¡er-r, rrhose rvork containsthe sarne werl-documented error ancr r.rìrich in adclitionhas
and
been scientifieally critÍcizecl by Dr YiamouyiannisDr Burk. I
Dr Diesendorf continueci :
fDoes fluo¡idation cause cancer ? I do not know, becauseit is very difficult to prove causal rinrcs inepidemioloBy.
However, I do know that Dr yiari:ouyiannis and hisco-author, Dr Dean Burk, have produced a substantialpiece of research (published in r.luoridefr volume 10,pa'e6 102-123) whÍch shows a correlation betv¡eenfluoridatÍon and cancer death rate and has not beenconvÍncingfy refuted in the two years since itspublication.
The response of the nedical and dentar authoritieshas been to produce 10ng lists of au'roritÍes vrhichhave endorsed fluoridati.on, and to marre ÍnsÍnuatÍons
2t
about ths char¿rctor and j.ntegrlt,y of Dr YlamouylannÍo
and Dr Burk. I
lle concluded:
rDoes fluoridation cauõe cancer? I do not l"nowt but
one thing io clear: neither d'o the NIIMRCt AMt ADA
and AFCO.T (Diesendorf' 19?9).
3) ReDres sive Actions.
Recently the more reprehensible sicle of the fluoridatj-on
promotion is becornin6 widely known. This comprises four
elements: (a) fne discoura6ement of acientific discussion
on fl-uoridation and involvement in it. (b) ttre repression
and even abuse of scientists and others v¡hose findings and
publications cast doubt on any aspect of fluoriclation.
(c) The suppression or disregard of evidence against
fluorídation. (¿) Actions to ensure that new evídence
against fluoridation is difficult to publish.
(a) The Discouraf,ement of Discussion on Fluoridation.
The United States Publ-ic liealth Scrvi.ce (U.S.P.II.S. )
clistributes enormous funds to íts many agencies. (U.S.
Congress , 197?) . It also finances many researcb. grants,
both ín the U.S. and in other countries. This control
of grants has a restricting effect on the scientific
discussÍon on fluoridation, which is a process strongly
pronoted by the U.S.P.H.S. American professors have
admitted to ne that they have to thinlc of their 6rants
and, therefore, avoid the subject of fluoridation. This
is understandable for, apart from the financial aspects,
24
there is the dÍstinct possibiJ-ity that, if they questioned
fLuoridation, they would be abused and rdamned by
assocÍationr . (fnts matter will be nentioned l_ater. )
Mr Ralph Nader said:I r think the way out is first to reco6nize that thereare a 6reat nurnber of scientists in this country andabroad who are afraÍd to speal< out on the subjectffluoriaationJ . the II.E.1¡r. Illealth, tducation and.viierfare Department, u.s.p.fl.sJ has been known to dearwith this kind of person rather harshly in thedissemination of research grants. r And ryou justdonrt expect to be treated well by H.E.!rl. in Ítsmassive research granting if you come out against thÍstype of thing. rtrs a matter of professionaì_intlmidatlon here. r (lrlader, 19?1).
Dr F.H. Quimby (lgzo) cited an article v¡hich said thatDr A.A. London (who had investigated fluoridation for manyyears) sought a chance to speak at an American Dentar.Association symposium on fluoridation. IIe v.,¡rnted tomention new evidence on side ef fects. llis rec¿uest wasrefuoed on the grounds that: rlhe theme of the symposiunis not controversy, but additional crocumentation of theuniversarity of experÍence of the safety and effectivenessof fl_uoriclation, world wide. presentation of the type ofpaper you propose would be an insult to the scientifÍccorurunity today. r
T'e Assistant chief, Division of Dentar publicHealth' u's'p'H'S.r advised Austrar-ian dentists not topermit fluoridation to become a subject for public debate.(Ga1agan, 1g5g). comrnenting, sir stanton llicks said thatthat advice discl0ses rvr.hat in ny opÍnion is a dangerous
25
trend in our day and a6¡e. This is the tcndency of the
pseudo-scj-entific expert to use his authority to impose
his viewc. r (ltict<s | 1961).
InAustraliaracademícsandinstitutionsare
refuctant to become involved in the fluorid'ation discussion'
In ny eleven years at the university of Melbourne Dental
school, except for many discussions with sir Arthur
Amies, the subject of fluoridation was üaboo, at least in
rny hearing. This reluctance cxtends to instj-tutions.
In 19?4 the Victorian branch of the Australian Kidney
Foundatj-on $tas asked to cornment on the safety of usin6
fluorÍdated water for dialysis. The enquiry was passed
to ùheir AustraÌlan Meilical Advisory Comnittee, which said:
r...r¡r€ would not contemplate getting involved in a
question such as this whÍch has generated so rnuch
controversy. I
lwo years later the Foundation said:rThe AustraLÍan Kidney Foundation has no specificstatement to make re6ardin6 the fluorÍdation of waterin relation to patients with kÍdney dj-sease. I (Kincaict-Smith | 1976).
On April 21, 19?9, the Australian Broadcasting
Conmission presented both sides of the fluoridation
discussion ín a segment of its progranme fFour Cornersr,
and was subjected to tremendous criticism for havinE aired
the subject. The Bxecutive Producer of rFour Cornersf
cor¡mented on those who clain that fluoridatÍon isrperfectly safer, saying:
26
fFew oel-f-respecting scientiste would be so dogmaticin disnfssing the poosibility of evidence to thecontrary emerging in the future. r rAnd when expertsdisagree over natters of public safety, surely Ítrsa legitinate subject for debate in programs rike FourCorners . I rDr Kraner even blanes For:r Corners forfilming ba6s of fluoride bearing poison labels.Fluoride Ís a poison. such warning labers are requÍredby law. To have deliberater.y conceared these rabers oravoided fi-lming them wourd have consti-tuted the verybias of which Dr Kramer accuses us., (Reid, 19?9).
(u) Re ession and Àbuse ofOpponents o f Fluoridat ion.Many attenpts have been, and are, nade to denigrate thosewho question the officiar clair¿s for fluoridation. * Thisprocess haa been goin6 0n for nany years. For Ínstance,the Assistant chief, DivÍsion of Dentar pubric llealth,U.S.P.II.S. r (Ga1a6an, 195Ð saÍd that ,the oppositio¿r
r... seems to be composed, of four distinct riinds ofpeople.r These he terned: rthe hatemonger, the pseudo-health beriever, and the person who opposes fluorÍdationfor personal notorietyr ancl rthe fourth, or ruggedindividualist, groupo I
The Arnerican Dentar r\ssociationrs Bureau of pr¡br-ic
rnformatÍon, in a re-issue of a publication entÍtr_edtOornments on the Opponents of Fluoridationr , (196l) groupedseveral reputable scientÍsts with alleged nembers of theJohn Dirch Society, the Ku Klux Klan, an escapee froma nental hospitar-, and others, in an obvl0us attenpt totdann by associationr. That dossÍer condemned the JOO
members of the Medicar-Dental co¡rmÍttee on the Evaruation* See appendix /d, p. 266,
27
of I'IuorldatLon, eo1ely because thoy woro euclr a sma1l
proportl-on of bhe JOOTO0O phyeLcÍans an<l dentleüe ln the U.S.
Dr A.A. London 396?) rccounted how, in the early
195os :
rPromotional zeal threw caution to the winds and lent
itself üo the use of smeaf, derision and, defamation
with intent to stifle and drive out opposition. Thus
physicians and dentists rather than chancin6 this type
of abuse are kept in line for fear of becoming
tlinvolve dlr . I
Dr G.!. I'laldbott (924a) stated that he could supply the
names of more than twenty highly conpetent physicians lit
the U.S.] - one a Nobe1 Prize winner - who have either
diagnosed or confirned the cliagnosis of serious illness
from fluoridated v¡ater. However:
rThese men are reluctant to present their data to the
medical profession: they d,o not wish to become en8aged
in a controversy characterized by personal disparage-
ment, threats, and reprisals, to which every scientistwho openly opposes fluoridation has been subjected.By merely reporting datã unfavourable to fluoridationthey woul-d become known as ilantifluoridationistsrr a
designation v¡hich would alienate them from many of theircollea6ues and interfere with their practice.r
Thís repreosion aleo includes journalists wbo have
been victimized for having the temerity to assume that the
consumers of fluoridatect water, the publicr should have
the right to be inforned of both sides of the quest5.on.
For instance, the well-known nedical Journal-ist Anne-
Lise Gotzsche, fornerly of the rGeneral hactitionerr,
wrote a tvro-page Special Report on Fluoridation for the
2g
London rsunday Times r (September 2 , 197j) , Despite thefact that her article presented both si.des in a factualnanner, and hras accurate, she lost her job. In a ]etterto the Lancet (¡rov. 71 1g?3b) she saíd that she had tarked
r.. to dentists who have had to give up their researchto other medi-car researchcrs who feel it necessary topublicly decrare themserves in favour of fruoridationand yet privately insist that they arc against. r
she mentioned that oppositi-on to fr-uoridation is growing
in American universitíesr'.to trre point where at l-east one research pro jecthas been started investi6ating the crairns by scíentists
. who insÍst that they have becn intimiclated. r
fn the llouse of Representatives, IIon. D.J. I(il1en (19Ø)saÍd:
tr object wi-th bitterness to the way i-n vrhich peoplewil-1 set out deliberately to smear and to slander thoseindividuals who have reservations about fruoridatÍonor who may have clear-cut opposj-tion to it, r
At the Tasmanian Royal commÍssion on Fluoridation,professo¡ J.B. polya eg6?) Ín his subnission said:
|... ny status and, IivLihood have been repeatedlythreatenecl by zeal0us supporters of fluoridation., *
Such smear tactics, unfortunaùe1y, st111 occur.Dr J' Yiamouyiannís, the co-discoveror of a link betweenartificial fluoridation and increased. cancer mortality(Tianouyiannis and Burk, 1g??) visited Austral_Ía recently.After a ttomid Sydney press conferencer (Eckers]ey, 1g?g)he (not his data) was attacked in full_page nevrspaper
advertisnents (Nicholas, 19?9) in Nowra, where he had
¡l See appendlx,1a, p. 253.
29
been asked to discuss his findlngs prior to a referendum.
The Actin6 Chairman of the Fluoridation Sub-Committee,
A.D.A. (Victoria), described himr over the radio, as
fsome crank doctorr from America. (Oakley, 19?9),
One of the resuLts of hÍs visit. was the decision
to end the fluoridatíon of the Queensland Gold, Coastrs
water aupply after it had been in operation for ten years.
An Bditorial ('t9Z9a) comment was: rYet, once again, Ioca1
bunbledon preferred to heed the unscientific twaddle and
superstitious scârê-rongering of the anti-fluoride Iobby. I
lrJhen he was here Dr Yiamouyiannis said:rThey have lost out on the science - all they have 1eftis character assassination. ¡
(c ) The .s ession of Published Bvidence Against
Fluoriciati-on. Ever since the premature endorsement of
f.ì-uoridation by the u.s.P.II.s. in 195o, cletermÍncd attenpts
have been made to suppress or to dísregard published
evidence which can be considered to question fluoridation.One technique is to cite only the first study by an author,
ignoring later and more damaging ones. (e.g. Taylor, 1954
not 1965¡ Rapaport , 1956 not 1959; Sutton, 1959 not 1!6O;
ïianouyÍannÍs and Burk, prelirninary data, not 19?? and,
19?8,) Anne-Lise Gotzsche ?gZlV) said. that she
had rtarked to despairin6 doctors [in ttre u.K.J who have
found it necessary tp wrÍte off to sweden to obtain the
fu1l factsr on fluoridation.
to
Dr E.C. Iiamlyn, Medical Officer to the llouse ofcomrnons Ar1 party conmittee on Freedom of rnformation,U.K. r oaid in 19?8t
I r am now a confirmed opponent of the idea of addingfluoride to public water ouppties, and. having 100kedinto it r regard the campaign being carried out by theDepartment of Hearth and others in favour of waterfluoridation as perhaps the best possible evidence ofthe need for a Freedom of rnformation Âct to ensurethat pubric authoriti-es rnake available to the publicsuch lnfor¡nation as they have a riSht to possess. , *
A recent and very important case is the attemptby the u.s. cancer rnstitute to neutrarize the cr-aim byDrs J. yj-anouyiannis and D. Burk (lgZZ) ttrat there j.s alink between arti-ficiar fruoridation and, cancer mortarity.A U.S. Congressional Inquiry, in 1)ll, revealed that theInstitute, which received more than g gOOTOOOTOOO annuallyas a part of the u.s.p.rl.s., although it had en<rorsed and,promoted fr-uoricl¿rtion for more than 2J years, had neverundertaken an experirnental investigation to test whetherfluoride in vrater is carcinogenic. The rnstitute thenannounced that it was about to cornmence a three-year studyon experimental animals. The American cancer researcherDr A. Taylor published studies on animals more than twentyyears ago, in 1954. fn ß6j he and LIe1l C. Taylorreported ùhat as litt'e as 1.o p.p.m. fruoride in drinkingwater consi-derably sti¡rulated the growth of tumourtransplants Ín mice.
Recently in Austraria there have bee,n attenpts tosuppress important evÍdence. Many articles have appeared.
I See appendÍx 6a, p. 264.
t1
in newspapers denyÍng the, unrefuted, IÍnk between
artiflcial fluoridation and cancer mortalityt whi.ch was
<ilscovered by Dr J. Ylamouyiannis and Dr Dean Burk the
eminent cencer researcher (see American lien of Science
and l"larouis Vlhors V'lho in the l{orId , Vo}. II).
The recent visit of Dr Yiamouyiannis provided an
ideal opportunity for his critics to rcfute hís claims
on scientific or statisüical grounds. However, despite
many invitations, not one of them t¡ras prepared to discuss
his data with him. His lecture at the Australian
National University was reduced to half an hour r the
rem¿rining lecture tine bein6 wasted, because the retired
profesr;or, who used the time, admitted that he knew littLe
of cancer.
(¿) Difficulties Ín Publ-ishin New Material which stions
F1uori-dation. There have been many cases reported of thc
refusal to publish letters and papers which were considerecl
to questlon fluoridation. A letter to the Editor of the
British Dental Journal (Mummer yr 1974) cited instances of
its failure to publish letters v¡hich questioned
fluoriclation. In 1974 f .R. Bertrand wrotc:
tThe freedom of the press does not apply to the B.D.,J.,and its dictatorial policy on fluoridation; one resul-tof which is that no article against fluoridation has
been publíohed for over 16 years. I
Anne-Lise Gotzsche Q9?5) saÍd that the Journal
of the Ameriean Denta1 Association had refused to publish
papers by Dr R. Zielgelbecker of the Institute of
Environ¡¡ental Research.- Graz; and letters from Professor
3?
Al-bert schatz, on the grounds that he shourd not be arr-owed
to use tho qqurnal rrr; ,, rplatf orm for his unti-.truoricr¡rti.onviews.r Recently professor R.S. Scorer (lgZg) stated thatthe paper by Drs J. yianouyiannis and Dean lìurk, revealinga rink between artificial fr-uoridation and cancer mortality,was refused publication by a rprestigious BrÍtish journarrin case Ít caused public al-arm.
such difficulties apply even to books. Two case6
may be mentioned.. professor Albert Schatz (1g6j) reported:rTwo years elapsed between the 1!62 symposium firufa i'Bern, Switzerl_and on 15-1? October | 1962, after beingtransferred frorn Holr-and rbecause of opposition fromdentar interests in that countryif and publication ofThe Toxicology of Fluorine in i964 because of effortsthat were made to suppress the book. For example, onepublishing house, which puts out dental and medicalliterature, agreed to print The Toxicolo of FIuorÍneand invested some IO'OOO Swiss franks in setting thetext up in type. But it was then warned that if itwent ahead and published this particular book thedental community would stop patronizin6 it. In theface of this threatened econonic boycott and enticedby an offer of compensation to cover al-l expensesincurred (approximately IOrOOO Swiss franks), thepubJ-ieher trdroppedn the book. r
It was later published by Schwabe & Co.
My monograph Fluorida tion: Errors and Omi_s si-onsin Exper imental Tríals was pubJ-ished by the Melbourneuniversity press ín i959 and copies were sent to Anerica.(a) The agents there, cambridge university press, vrereÍmmediately approached by the Executive Director of theNut¡ition Found.ation Inc. of park Avenue, N.y. (letterJan. 20, King, 196e). His retter said:
tt
rThe profeeslonal etanding of the Camlrrld6e University
Press among scientists anrl educators would seem toto preclude publication of such a boolc by Cambridge
Universl-ty Press. I
(u) The three rBook Reviewsr in the Australian Dental-
Journal were wrítten by authors whose work the monograph
criticized and by their associates. (Their comments urere
quoted at length in the second editionr and replies 6iven
to the 8l points raised Ln the reviews - Suttonr 1960).
(c) The rstackr of type at Melbor¡rne University Press,
at ühat time always held for at l-east six monthst was melted
down 6oon after pubJ-Ícation, without authority. It cost
M.U.P. €40O to reset the type for the second edition.
(a) Neither the first nor the second edition was (as would
normally be the case) included ín the Index t ntal
Li-terature ( publ-ished by the American Dental- AssociatÍon)
nor were favourable conmentaries - but thc adverse
criticLsns v¡ere Índexed.
(e) In November, 1959r the Dental Research Advicory
Connittee of the N.H.& M.R.C. referred the first edition
to a Sub-conniùtee consisting of Associate Profesçor N.D.
Martin and the statistlcians Professor II.O. Lancaster and
Professor M. BeIz. (Professor BeIz, vrith his staff, had
checked all fts conputations príor to publication. ) More
than three year6 later Professor Martin nas instructed to
subnit a report for the next neetíng of the Dental
Advf.sory Connittee. (N.H.& M.R.C. | 196Ð. Access to
tbat report was refueed.
,4hofeesor Albert Sohatz (1965) quoted, fn capital
Ietters, the words of Thonas Jefferson:frF ÎIIE B00K rs FALSE rN rrs trAcrs, REFUTB THüM. rFrT rs FALSE rN rTs RBAsoI¡rItrc, DrspRor¡E rT. BUT FoR
GOD'S SAKE LET US T'REELY }IEAR BOTII SIDES.,
(4) The Motives of Those Vùho Promo te Fluoridat ion.lVhat are the ¡rotlves engendering ifriu promotional
fervour? They nay be divíded into: (a) Altruistf.c,(U) financial, and (c) prestige considerations.
(a) Altruistic tîlotives. The dÍscussion on fl_uoridationstarted in victorÍa in the earry 195os. At that time rwas a mernber of the ten-man Dentar l{ealth BducationCor¡nittee which was set up by the A.D.A. to devise andconduct educational programmes to reduce the prevalenceof den'bal cari'es. rt was a thankless task, d.ue mainlyto the aLmost total lack of response fron the community.Then came the concept of fluoridation, strongry advocatedby a well-known Anerican clinician who was vÍsÍtingvictorÍa. The idea was enthusiastÍcar'y adopted by theConnittee
- although two of us had reservations _ a¿dwe enpl'oyed a public relations firn to advance the id,ea.The response from the public r{a6 practÍca11y nil.
I an convfnced that the nafn notive of noetdentLsts who advocate fruoridation is stÍlI their desireto reduce the dental caries pr,oblen, havin' been asen¡ed
q
t,
by thelr own AesoclatLon, the A.D.A. I tho A.M.Â., the
N.H.& M.R.C. and others, that artificial fluorÍdation is
both very effective and conpletely safe. Of course there
are Eone who have addLtfonal nrotives. As Sir Arthur Amies
saÍd, epeakÍng of fl-uoridation ín 19592
rThe paesLon to regulate the llves of others ís deep-
eeated J.n nany individuals. V'lhen this is based on
political. expedlency i.t is bad t and, when it is inspireclby an ldealisn whfcb wíshes to infLict benefit on
others it can becone d,angerous.r
As early. as 1956 dentfsts were told:rThe groundwork has been carried out, ancl it now falIsto the lot of the lndividual dentist to become a
fanatical protagonist of fluoridation. I (Christensen,1956).
,
( rI'anatic | -
rPcrson fill-ed wf th exccsoívc & r¡¡:lstalçen
enthusiaemr. Oxforil Dictionary).
(u) tr'lnancial Advantages from Promotinn Fluoridation.
Durín6 the early days of fluoridation in the U.S. ¡
rChenLcal lrleekt saÍd that:r.. the narket potentiaL has the fluoride chemicalnakere goggle-eyed. t rStanding to benefit fron theboom are chenical companíes and equipnent firms. r ALso
lany apathy or opposÍtion on the part of the publíc ionade up for by the USPHSTs zeal in drumning up theprogran. It ls asking for federal rnoney to developíntereet. I (EditorÍal, 1951),
Many nore statenente lndÍcating the financial gain have
been mad,e. In 1976 the Roya1 College of phy.sicians
Conr¿ittee on the FluorÍdation of Pubric Ttater suppries said
that nost of the fluorlde added to water suppJ-ies rwould be
t6derived from sources that would otherwisc have been
dlochar6ed into the soa ac wa6te.r
The Íjentor Executlve Engineer, Operations and
Ivlalntenance, Vl-ctorian State RÍvers and V,later Supply
CommissÍon (Hirth, 19??) saÍd:rrhere is a tendency at the presenü tine for watersupply authoríties to buy fluoride powders to aprice, taking what is virtr.¡al1y an incidentalby-product fron an industrial process, rather thanfixing a specification to suit the rear need,s of theauthority. t
He said that Merbourne use6 a sodium siricofruoride slurry.Drs Gabovich and Ovrutskiy (lgZÐ said that ¡
rÎhis reagent is a by product of ühe fertilizer industry,so that it is readÍ-ly available and. cheaper than otherreagents. r
More important than the direct financiar gain fromthe sale of fluoride chemicals is the question ofdecreasing the probÌen of the disposal of toxic wastes.thi's is a grave problen, and a spokesman for the Reynolds
AlunÍniun cornpany is quoted as saying that it is cheaper
to pay fines than to control fluorides. (Caldwell and
Zanfagna, 1974). rThe manufacturerrs problem isdisposing of acid that has been produced
- he must shipit, sel-1 itr get rid of it.r (Harper, 1951).
The Swedish scj-entist, Dr A. Aslander (1966) said.:rrhe rear nature of fluori-dation is that it is a vastcornmercíar enterprise. Fluoride is a very obnoxior¡swaste product extrenely difficult to díspose of. Theyearly productÍon of fluorine in the u.s.A. has beenestinatea at Sorooo tons a year. Fronr the commercfaL
,?
polnt of vlew fluoridation is brilliant. By
spreading fluorine ovor very large areaa, unblushlnglyprocrai.min8 - agalnot ccientific r-aws - that dentarcarles is caused by fluorine deficiency, and just asunbrushingry rnaintaining that fruorine is harmress,a very difficult waste problern has been converted toa very profitable enterprÍse. r
(c) PersonaL Prest iAe. A strong motive, possibly the
maÍn one, which accor.r¡ts for the tactics which have Justbeen outrined - the contÍnued promotion of fluoridationdespite the rapidly rnounting evidence against it, and theabuse and repression of scientists and others who oppose
it - is the queetion of personal prestige. persons and.
organizations endorsing fluoridation, saying that lt Íssafe and effective, fear the ross of prestige which wirlresurt when the dangers of fluoridation become more wideryknown and force its aband,onmcnt.
Professor A1bert Schatz (lg6S) said:rrhere are po$rerful forces which now have a vestedinterest in perpetuatÍng fruoridati-on because theirreputations depend on its continuation. For manyyearsr certain individuals have claÍ¡red and insÍstedthat fluoridation is absolutely safe andr consequently,there Ís neither merit nor purpose in considering toxiceffects of fluorÍde i-n connection with fluoridation.1o acknow]_edge, at this 1ate date, that the subject Ísopen and fit for discussion would be an adraissÍon ofserious errors Ín judgenent on the highest levels. r
unfortr:natery, a sÍmilar position has developed
in Australia. There are many r-ndÍviduars and senior
a
endorsing organizatùons and assocíatione who must consfd,et
that their reputati.ons are threatenecl by the increasÍng
rejection of f,luoríclation.
Ae the Director of f,aboratorfes, New york Depa:rt-
ment of l¡üater ¡ Gas and. Electrie ity (Nesín , 1956) pointed
out nore than tr,lenty years ago:
fOertainly the pf,oponente of fl-uoridation a¡e not intentupon poLsoniug or harmíng anyone, however the d,itennaof presùige is a very dj-ffÍcu1t matter to resolve. r
v.39
TIIIì NATUIìD OF ARlIFICIAT, FLIJORID,ÀTION.
(r) r e Fundamenta Difference between Chl-orination
n<l FI dation.
At the tine of the passing of the Act the nature offluoriclation was widely misunderstood. l"lany considered itto be sÍmilar to chrorinatlon, not realizing that there is a
fundamental difference between those two processeso The
purpose of chl0rination is to treat the r¿ater to renderit safe for use, whereas the purpose of fruoridation isnot to treat the water, but to compulsorily medicate everyindividual in the community through their water supply.rt does this both directJ-y, throu.h their drinking vrater,and indÍrectly, when they consurne watered. or water_
containing products. Âs Dr J.tV. Ilogarth (9eZ) said:tchlorination and fruoridation are i' no rvay analogous,nor are they relat,ed cases, except in the sirnilarityof words, and therc it ends. I
Q) Is Fl-uorine an Essentia I Element?
The question whether fr-uorine is an essential element,in manr has not yet been decided. In 1963 the V.S. Foodand Drug Adnfniotration stated that fr-uoride is notestablÍshed to be essential to human nutrition and v¡our_cr notbe classified as a nutrient. ÍL,he VIIIO (lg?Oa) said that itis not known wj-th any certainty whether fluorine
| ,. , Ís an essential element in aninal (includj.ng hurnan)netabolísfi,r". rit has not yet been possible to producean othe¡wise adequate fluorine_free diet forexperinrental animals. r
4o
In any caoe this questÍon is not Írnportant for:
rThe need is infinltesimal and the supply in common
food must be sufficlent. Fluoridation mcans a
surplus of fluorino. | (Aslander | 1966>.
3) TerminoloÃv - Fluorine. Fluoride.
In 1958 l]ne V'JIIO Expert CommÍttee on lrlater Fl-uoridation said:rF1uorÍdation of water-supplies employs the fluorideion as the active agent; a nu."nber (at Least six) ofsimple and conpLex inorganic fluoride salts serve as
sources. The element fluorine is not used as such;for this reason rrfl-uoridationrr rather than rrfluorÍnationrtis the preferred term. I
The Corunittee repeatedly used. the term r1 p.p.nl¡ fluorider.
Professor D. St,eyn, a pharmacologist, when comnenting on
that report, said: rI take it that trfluoridet should read
{}uori4e as 1 ppm rrflucriderr woul_d mean less than 1 ppÍl
fluorine. | (Steyn, 1958b).
Ilowever, in the fLuoridation literature thÍs inexact
expreesion has been widely adopted (but not j-n Europe),
and t1 ppm fluorider or 11 p.p.m. fluorider means a fluoridesalt solution which contains 1 p.p.m. fluorine.
(¿r) Fluoridation Contravenes Me dical Ethics.
The revoLutionary process of artificial fluoridationcontravenes standarcl nedical practice and ethics. rt was
first introduced in the u.s.A. in 1945, without prior testson animals and without the assent of the individuals who
were used in the experiment. (Hurme, 1952i Taylor, 1g5Z).
4r
sir stanton Hicks (956), formcrly professor ofIluman Physlology and pharmacolo8y, univcrsity of Aderaide,
and Advisor to the Âustrarian Army on Foodstuffs anil
Feeding, said that:I r sub¡nit that nedication of a whore popurace variabreÍn individual- response, regardless of ind,ividuar age,state of teeth, of generar health, rate of consumptionof water, and 60 on, is quite unscientific ancr unethical,and that Fassive acceptance of the ri6ht of agovernment or muníclpal authority to impricate suchnedication through its water suppry ís to sacrifÍcea funda¡¡ental principle of nedicar practice. Thi-snay welr redound to our disconforture at a rater date. I
$)r Conce ration of Fluoride in Natural V'Iater Su Lies.Proponents of fruoridation frequently say that it ís onlythe radjustmen!t of the fluoride lever to the roptimarr one.They brand arl drinlcíng water whlch contains l_ess thanapproxinately 1 p.p.m. fruoride as rfluoride deficientr.For instance, professor Linus pauling (196?) said thatrwater that is deficient in fluorÍde I should be rbrought
up to this leveI by the addition of fluoride t uniit itreaches rthe avera6e for natu¡aI waterf. Surprisingl¡rrhe did not specify that raveraget concentration.
Before artificial fruoridation schemes commenced,
approxinaj:eIy 4.J per cent of the popuÌation of the u.s.had raccess to conmw¡al vrater suppl5_es containingfluorine in the a¡nount of 0.5 ppn or more. r (giff et af. ¡
1949)' However they did not necessarily drink suchwater. For instance, in Colorado Springs, which had
r..about 2.6 p.p.m" Fr, due to the ¡high prevalence ofdentar fl-uorosisr dentists and pecliatricians rhave
42
reconnended eLnce 1)JJ fbat parento provicle theirchildron wfth low fluorfde water during thc development
of the pormanent teeth a6 a preventlve measure agaÍnotthíe disoase. The loca1 dalrÍes have cooperated by
supplying low-fluoride (O.2 p.p.m. r.) bottled water. I
(Gerrle and Kehr , 195?\,
ArtÍficial fluoridatÍon ls a nrechanical process
which produces an unusuaL condition in the water. As lorcl
Douglas of Barloch said in 1960:
rIn the first place fluorides in the quantities advocatedare not usually found in natu¡al water supplÍes. lrlhere
they occur, it rnost commonly is in water from deep wells.It j-s conseguently prÍna facie improbable that thebiological evolution of hunan beings has resulted in aconetítutÍonal need for fluorides. t AIso rcomnunÍtÍes
can exist whose dental heaÌth is excellent although thewater supply contains l-ittLe or negligable amounts offluoride. I
Surveys of the natural fluoride content of N.S.Vtr. and
Tasnanian waters show that less than o.2 p.p.m. fruo¡ide
was found ín 91% (Jones, 1949) and 93?1o (nei¿ and lrfartin,
1946) of surface watets. Almost all the higher concêr-
trations vrere in supplies fron springs and, wells. This
appears to be the case in all countrÍes. The l'¡lio chronicre
Ín 1970(a) saicl that 'surface v¡aters are generally lovr ín
fl-uorÍdes. t
rThe nornal fluoritle level for nost waters rangeÊbetween 0.1 and o.J ppra. This is true throughout theworld and 1s the'environment in which ¡nan has evolvedand adapted himself to. This Ís reflected by theblood level of fluorícle whÍch Ís 0.1! ppn. r
(Tianouyiannts. 1g?B) .
4t(6) Ftuo ridat fon fe Compulsorv Medic ation.homotera of fr.uoridation frequently otatc that it providesa nutrlent, iù fs not nass medfeaüion. rherefore severarof the many contrary views wj.Il be cÍücd.
TestÍfying before a u.s. conmittee on chemicalsin Foods, Dr A, Tayl0r (gsz) stated that rfluorÍdationis very definÍtely a type of nedication, whereas
chlorinatÍon i.s not. t
Dr F.B. Exner ín 1961 said: rrrlhether a substance fs a foodor a drug is deterrnined by the purpose for which it Ís used. ¡
Ihe U.S. Food and Drug Administration stated, .ín 1963, thatfluo¡Íde fused, for its therapeutic effect io a d,rug. r
fhe rnternational society for Researcrr-on Nutrítion andVital Substances (1967) said that fluorfdatlon fis fnreality a r¡edication. t
In 1962, Dr R. Kerr saÍd:tFÌuoridation of public water supplÍes amounts tocompulsory nÞss medication and. is morally quiteunjustÍfiab1e. ft infringes human freed.om _ thefreedon of a doctor to treat his patients as he thfnksbest, and the freedon of the patient to choose whetherto accept or reject the nedication advised,. -/tny doctorcan -nov, treat h o young patÍents with fruoride rf hethÍnks ft desirable. Ând every child can have it inaccurate dosage if hís doctors and parents wish it,but there is no need to force the rest of the
population to ingest a toxic subctance every day oftheir lives in uncontrollable doses, knowing that itwill quite certaÍnly harm so:ne people, and having noidea whatever wrrat the effect v¡il' be on the rest.,
l.
44
The fact that artiffcial fluoriclatLon fs a form
of medicatlon ie also acknowlodgecl ln Australia. In 19?O,
Dr R. llorüon sald that letters to the Australian MedicaIJournal show that ra number of doctors regard maos
nedication as uncertain, unfaÍr, ínaccurate ancl unethical.r
Dr I.R. McDonal-d (1968) of Toowoomba said: rIt would appear
that water is an inappropriate vehicle for fluoride
nedication in this connunity. I
Professor Sír Ârthur Amies said, ín 19592
rrluoridation of domestic water supplies invorves theadministration with therapeutic intent of a chemicalpreparation to young and o1d, dentate or edentulous,v¡ell and Íl-1, vrithout individual_ examination andregardless of individual d.esire. r
Some 1_ega1 aspects of fluoridation are stated Ína 1977 nremorandum by Paul M. l,lccorrnick, Research Felrow,
Nuffield Coll-ege, Oxford. He stated:rFrom the lega1 point of view fruorictation i-s compursorymed,icaüion. rü is done without the permission of theperson at the receiving end. rn English Law medicaltreatment without consent is onry permitted by courtorder or for the mentally írr or for minors with theconsent of their guardians. rt therefore irnpties thateíther a person has forfeited his lega1 rights bycriminal activity or that he is unfit through youth orinsanlty to exercise them. Fruoridation of the watersupply puts every individual in this positÍon. It Ísan affront to the human dignity r¿hich is explicitryrecognized as a najor objective in the uni-ted l.iationsuniversar Decraration of Hr¡man Rights. The foundationof the 1e6a1 rights and liberties of the individuaÌ isis the prlnciple of his responsibility for his
4S
conduct and his own interests, chief among rphich ishis health. As John Stewart MiIl wrote, nover hisown body and mÍnd, the individual is sovereignn. r
He concluded by saying that the principle that the st,ateÍs sovereign over the mínd and body of the individual,I however benevorent Ín any given ca6e, ít is the principreof totalitarÍanism. r
Q) Fluorfdat late Re ious and Pers onalConvicti ons a Compulsory medÍcation j.s abhorrent to many
Drpeople. Writing in the Christi-an Science Monitor,F.B. Exner (tgû) said:
r.. if the fluoride, ín fluoridation, Ís used. asdrug it violates the religious rights of all whoreligious objections to the use of drugs. r
a
have
Professor Douw Steyn stated that:rrhe fluoridation of drinking-water Ís irlegar, imnoraland unethicar- and seriously infringes the religiousconvictions of nany ní1r10ns of peopr-e throughout theworld. vrre dare not deny any individuar- the right todecide for hinserf, or herself, in this matter as theirattitude constitutes no d,anger to their ferlow-beingsor to communitiesr fãe denta{tdecay is not a d.Íseasewhích is transmissable. ? (Steyn | 1g5ïb).
In the House of Representatives, Ìlr J.R. Fraser (A.C.T. )
in a debate in 1)6J on t.'e decision to fluoridate canberrarswater eupply, said.:
rr strr-l maintain my very strong personal 0bjection tothe means by which it is proposed to adnini-ster thefluoride, namely by adding it to the water supply.r object to beÍng requi-red to take a med.Ícation whichI would not myself choose to administer. r
(The vote was given 55 Ayes and, 55 Noes ).
I
46
An Editorial (1964) in the Melbourne rAge I said that:r.. the problem is not sinply one of bad, teeth, butalso of pure water and personal rights, The rgmedymust be one that treats the teeth, not the watersupply, the individual, not the comnunity. r
(B ) ¡'I datÍon - rThe Favoured. PoIlutantl.
A wIIo rechnicar Report on Environmentar pollution prepared.
by fi-ve !Ill0 scientific Groups in 1968, risted fluorideamong the rwater pollutants having potentiar rong terneffects. I
In 1972, Dr C.G. Dobbs called fluorid.ation f the most
wídespread and permanent act of polrution of the hurnan
environ¡nent ever contemplated. r
VI 4Z
FLUORIDATION AND DENTAL }ßNPO!ÙBR RNOUIRF,}4NNTS.
rt has been claíned for nany years that fruoridation wirrreduce the number of dentj-sts required by the cornmunity.
That cl-ain was strongly pressed at the time the Act was
being considered. Natural_ly it has a strong appeal togovernments which are faced with meeting the shortage ofdentists. (The graduate output of the Merbourne Denta1
school has remained essentialJ-y static for many years.)
(t ) studies Professor B . ïr. Do l-as.
Ín 1972 Professor B.L. Douglas and his co-workers studiedthe rrrnpact of water fruoridation on dental practice and
dentar manpovrerf in seven towns in the u.s. These had
water supplies containing o.?-1.z p.p.*¡ fluoride naturally,and were fmatchedr with seven towns with tfluoride-deficient,
water supplies. contrary to their expectation they foundthat although dentists in the naturarry fruoridated townsserved 14 per cent more people rtheir cha¡acteristics andpractices appear to be vj-rtually unaffected by fluoridationr.
Seven years earlier professor Douglas, with SylvÍaCoppersnith, reported on a survey by rEealth Bulletin, ofthe number of practisi-ng dentists in fr-uoridated and non-fLuoridated cÍties. Newbr.rrgh (fLuoridated in 1g4Ð in1965 ¡aa a population of ,OTOOO and. JJ dentists, compared
with Kingston which had a similar popuration and JB dentists.(rt may be mentioned trat J4 years after Kingston served, asthe nearby untreated rcontrolr town ia the Newburgh trialit stil1 rejecùs proposals to fluorid.ate.) Grand Rapids
48
(fluoridated in 1945) had 115 dentists per l0orooo
population, but nearby unfluoridated FLint had only fO
dentists per 'lOOrOOO. Fl-uorldated Toledo had 80 dentists
per IOO'OOO, but unfluoridated Dayton had B/ dentists per
10OrOO0. They concluded:
tThis indicates that there is apparently not a lesserneed for dentists in those cities with fluoridationas compared v¡ith fLuoride-deficÍent cities. I (Douglas
and Coppersruith , 1965) .
(Z) Denti-sts in BaseI (Switzerland).
The German Association of Gas and trlater Bxperts reported,
ín 1jlJ, on l,he ef fect of f luoridat.ion in Basel (switzerl-and).
They saicl that in 1960 Protessor Gutherz predicted that by
1967, as a result of fluoriclation, of the 1O dentistspractiain6 in 1960 only 6 would be reciuired. Hovrever, by
196? tha number of dentists had increase ð, to 11, and three
years later, after 1O years of fluoridation, there were 18
dentists and 5 practisin6 dental auxiÌiaries. In 19?5,
the swiss Health Department suggested that fluoridati-on
should be dlscontÍnued due to Íts ineffeqtiveness.
3) The Nunber of Dentists in Flu orid¿rted and Non-
Fluoridated rRepre sentatíve Arnerica n Citiesr.
T]ae 19?6 (but not the 192? or t]ne 19?Ð edition of C.B.S.
Itlews Âlmanac r published fi6ures shovring the nr.¡mber ofdentists per loorooo population in rRepresentatÍve Anerican
cities r. These includea 30 of the 40 most populous cities(lgzo census), 16 of which had been artificially fluorÍdated
-to\o
llumber of Dentists per IOO'OOO PopulationJ J
N)o-¡+oo ll+:ccooooooõ
Þrc
EHÉo4l-Lp,'pcùoÈ<)lJ.cilJ.oo
zoFIH)HÉoFJ
P.I,F'cfoÈC)H.cfP.oo
lJ-ittljHFtOP.hCÈJFr.otroH.Þl-¡O,æ'dctTdæFÈfoP.pÒoorrjzoryPIOo(0ctr(tO^€.P..l-&<'f¡Jl+¡oifooHP.ÞPoooat
È| Oq -l h'l l-å ¡.ctoÞfPpoìfH. l-¡P-ÉH€pÞÞFtoHt-¡ctütrÞJc4Ì'
<t 'cÞ \O l+ 09l-+, rr Þl lö o\ Ê l-1,HOOO\rIPlJctÉFr-ctË5OSHTP.OOÞloHz9roBP.ÞÉo5öP.Þq-ro€q,ÈÊÞr-+¡FJoP=CfHl-¡.Ht,O<fC'P.çÈooÊlooOOÊtFJci-ËttuTÞtìtct'>íFJ(Dlr-ooËßror-Jp¡ÈFrH.olr,ùo$tþcro9,ÞctO9,oP.,9,ÉoH. looP,ctt-rdoÞoP.o\ooÞ.rAtOOc|'O\clll¡.
þ(¡tFr\l€ltgtc+OO.(DPctÈJ.['HP'oÉmO.P.cl-ÞO
UlvtjóÈct<OOcrO\Oo,\SEp,vFJvtF,FrÈto(DNcf-rÞoll.oo9,(tÞÞcl-Fra,oOÉÈ¡.Þ-ÞctF'ÊtÈ-Oop,ÌrdÞltory9tOor<(fr-ttu\oöP-Ê¡ÞO\tlP.hJoPoo\ooÞ095rr<cÞtj'ÞoPËP.<øoÊroFJXÊtcl-OÞr,Oqc+CDIJctOop..o€H.ftdøo
P,tflcreþø(f
r/¡
tJashingtonLouisvilleOklahona CityNew ïorkMinneapoJ.isSan trlanciscoPhiladelphiaCleve].and.ChicagoBuffa]-oPittsburghlÍil-war¡keeDenverIndianapolisDetroifBa]-ti¡rore
SeattlePortlandBostonlos AngelesCo]-tz:busSan DiegoPhoenixl,lenphisAtl-antaKansas CityNer¿ OrleansEousfonCincinnaùiNev¡ark
V2a
c)HBHf'Jv,a
¡suttrt
ohc
t,r-1
HH(t)É(t)
õFJ
tJIt.iÞl.a,ÞJ
oËt
c)au,Ü)
o{oÞH5p5p()
J\o{o\
ooo
+\o
EHoz
FdoUF{Þ
5o
prlor to Dcccrnber 71 , 1969, 14 between 1951 anct ,195?¡ New
Yorlc in 1965 and Detroit j-n 196?. (U.S. Dcpartment of
H.E.l'tr. | 19?o). The renainin6 ten largest citiee comprísed
Dallas (naturally ftuoridated, with 57.5 ð.cntists per
IOO'OOO people, and nine cities which were not listed inthat Almanac I two of vrhich vrere naturally and J artificial-Iyfluoridated and 4 non-fluoridated cities.The nunber of dentists per lOOrO0O population r¡rere:
oridated Cities llon-fluoridated Citie s , at Dec.1969
New YorkChicagoPhiladelphiaDeüroitBaltinorellashingtonC]-evelandIndianapolisMilwaukeeSan FranciscoPittsburghDenverBuffaloMinneapolisOklahonra CityLouisvill-e
Los AngelesIIoust onSan DiegoBostonMemphisNew OrleansPhoenixColumbusSeattleKansas CityAt].antaCincinnatiPortlandNewark
88.6?.?1.53.49.
1t6.67.55.64.?t.64.61 .66.77.89.
105.
B
2o96295426471
21
6j.44.61.72.55.46.58.62.96.50.Éz
37,90.t6.
559o4636ooo51
0
An estinate of the totar nunber of dentists in each citywas obtained by calcuÌatin6 the number of dentists per
lO0rOOO x population + 10O'OOO. The mean number ofdentists per IOOrOOO population vrere:
Fluoridated citiês - ?6,?; Non-fruoridated cities - 59,2,Theee data are displayed in Fig. j.
,1
TllïJ NUI,IBDR
TEST CITIES. IN
OF DENTISTS PIIN 1OO OOO POPU TTOII IN ARTIr'TCÏALLY TL IJOIìIDAl'¡:D
Tlm u.s.A. . AND IN I\iEL.BOURNE AND VICTORIAN COUNTRY ANEAS.
200
180
160
140
120
100
8o
6o
4o
20
ño'rl+,(ú
-lá9top{
ooooorßro)Ra+,o
.r'l+)ÉqJ
rd
çto¡{opEJ
Dvanoton
1955
1971
GrandRapids
Iüewburgh
1971
197t 1955
1955
mber of yearsI artfficial.uoridatfon - 10
Avercrgefor U.S.A.
1955 1971 lielbourne
19?9 Vjctoriancountry
1979
o
261026924
Fig. 2, conparison between the number of dentists per loorooopopuLation in the three rnain American fluorÍdation trial citÍes,ín 1955 after ten years of fluori-dation, and in 1921 after ?4_26year6 fluo¡idation. Also, the average ín 1)JJ and 1g?1 for thewhole of the U.s.A., and, ln 19?9 for Melbourne ancl for Victoriancouatry area6.
After 24-26 year6 of artificiar fluoridation the nunberof dentísts per loorooo people in these three tri.ar citieo showedan overarr rncreaee since 1g55¡ although the u.s. aveiage hadremaíned the sane. rt was twice the u.s. average, and morethan 2lâ times a6 many dentists per loorooo popuration thaü arefound ln Mel_bourne.
7
52
(4) The Nunber of Dentists 1n U.S. Fluoridation Tria1
Clties.
Tn 1977 I wrote a letter to the Lancet which nullified
one of the claims which it had made in a Leading Article
(19?3), My letter, which was not publÍshed, pointed out
that, by 1955, the fluoridation trial-s at Grand Rapids
and Newburgh had been in progress for approximately ten
years and the Bvanston one for eight years. More than
fifteen years later, in 1)11, in the whoLe of the U.S.
the number of dentists per IOO'OOO people was the same as
ín 1)JJ (i.e. 59), Ilowever, in these tb¡ee artifícial1y
fluoridated cities the nr¡nber of practicing dentists per
IOO'OOO had íncreased from 1lJ to 121. (Data from the
American Dental Directory 1971 Statístical Abstracts U.S.I
1971 and ldorld A1manac. 1973 - including all practfsing
dentists but omitting acadenics and adrninistraüors.)
These three cíties, after approximately 2J years
of artificíal fluoridation, then had more than twice the
number of dentists per IOO'OOO people as $ras the average
for the whole U.S. Evanston¡ after 2J years of
fl-uoridation, had the remarkably anall number of 665
people per dentÍst. This is less than a third (O.J) ."
many people per dentist as there are in Melbourne and
suburbs QZSZ) and about a fif th (O.2'l ) as many (31?l) as
in the rest of the State. (Victorian fígures, Dental
Board, June, 1979.)
These data are shown in Fi-g. 2.
5'
$) [email protected]/populatlon ratioe are deternined by nany factors.
Ilowever, the fact that there wa6 a hÍgh proportion of
dentists in the three mai.n trial U.S. citi-es after
approxlnateJ-y 2J yeare of artificial fluoridation (andl. the
other cla.ta nentioned above) does not suppo¡t the contention
that the demand for dental rnanpower wilL d,ecrease after the
introduction of fluoridation.
Footnote.
Old fallacles die harcl. Â l-etter, dated August 1, 1979t
written by the Secretary of the Victorian Branch of the
Australian Dental Association, stated:tIn a conrnunity with a fluoriclated water supply thedental manpovrer required to naintain a good standardof dental heal-th ín a community is almost halved. I
VTI.
TiIE INCREASII'IG REJECTION OF FI,UORIDATION OVBRS E/\S.
l\t the time of the passin6 of the Act artificial fruoridationwas said to be widely, and increasinß1yr accepted overseas.
Its acceptance is now definitely on the wane.
(1 ) l¡lestern lluropq.
Fl-uorÍdation has always been treated with scepticism inEurope. A senior European dental professor, in 1)11,
described lt to me as ran Âmerican madnessr.
Since then it has been cìiscontinued in Sweden,
Beì-giumr llolland and I'Iest Germany. rt has now been rejected,
alnost entirely, Ín l'Iesüern Europe, and fruoridatíon plants
which had been in operatíon for nany years have been
closed. Sir G. Sinclair 39ZZ) asked the Britishsecretary of state for social- services whether he woulcl
reconsider the advisability of continuing fruoridation inview of the fact that ühe swedish parl.iament had repealed
the l-aw permitting fluoridatÍon and, after 1/ years oftrial, the only fluoridation project in Germany had stopped.Iie stated that France, Germany, ftaly, Luxenbourg, Norway,
Denmark, Sweden, Austria, Spain, yugoslavÍa and Greece had
decided against fluoridation.
The secretary of state for social services querÍed
ùhe cases of sweden and Germany, saying that he understood
that in sweden the repear of legislation was not based on
medical- or scientific evidence, and that in Gerrnany
fruoridation tras 6uspended because of doubts about its
54
,5
lega1lty, doubto which the Federal' Government was oeeking
to romove vrith amending legislation. (Sinclair, 1972).
lgg¡]gt in fact, bd dlscontinued fluoridation in
1969 after a ten-year experimental progranme. They aslced
the 1¡üorIcì llealth Organízation (wttO) to produce evidence
that fluoridation is safe. No evidence was produced,
and fluoridation v¡as nade Íl-Iegal on November 18, 19?1 .
(Sweden , 19?1).
In the FederaL Republic of Gernany fluoridation
was a6ain rejected, as recently as December, 19?8, on the
advice of the panel, which advises the governnent on
scientifie natters. (German Consul , 1979),
Ilolland was the most fluorídated country in Europe, with
approximately half of the population drinking fluoridated
water. In 19?6, after 2J years of fluoridation, all plants
were closed down on medical and 1e6a1 grounds. (l'ioolenburgh,
19?t+t 19??>. In 19?6, a study of the opinions of adult
Danes found that more than twice as many Ì'Iere opposed to
fluoridation as were in favour of it and that rcompared,
with an earlier Danish etudy, a shift towards nore expressed
opposition to water fl-uoridation seens to have taken place. I
(Schwarz and Hansen, 19?6).
It has been suggested.that this general rejection
of fluoridation Ín I'Iestern Europe was because of legal
diffLculties. Surely, if there vlas any desire toÍntroduce fruoridation any such difficurtíes courd bave
been removed by legislation.
The present posÍtion in Vlestern Europe is:Reiected fluoridation:
Auetrla, Delgi.wn, Denmark,
Luxenbourg, Norway, Spain,
One snall exnerimental town
56
France, Greecc, Ilol1and, Italy,Sweden, lrl .Gernany and YugosLavÍa.
fluoridated:
Finland, Portugal, Swltzerland.
fn December, 1975¡ the Swiss llealth Departmcnt su66ested
that this one town should cease fluoridation rdue to Íts
ineffectiveness | .
Q) The united KinAdom.
In the U.K. two of the original four treated towns have
dj-scontinued frt¡oridation. More ühan 2J years after those
four prants vrere installed the British have not accepted
fluoridation. (Special V,lriter, 19?9), Tn 19?6, Dr M.
Bresler said that only 8.6% of Britainrs population drinlc
fluoridated rater. # IIe pointed out that:rSelective fluoridation can be used everyl.;here at afraction of the cost of waüer fruoridation. surelythis is a more scientific, economic, and acceptableway of preventin6 dental caries. r
3) The u.s.A.
Even in the u.s. r which is its home, fluoriclation appears
to be on the wane despi-te the continued strong promotional
pressure by the u.s. h.rL¡lic llealth service, which.wae
responsible for the introduction of this process in 1945,
rn Ju1y, 1978, fconsuner Reportsr said that since 1)lJ,
þtren the victorian Act was passea] voters in hundreds of* see appendix 6b, p. 264,
,?
U.S. citiee and towne have reJected fl-uorldation.
(Anonynous, 19?B).
In Australia, the proportion of the population
drínklng 'fl-uoritlated water probably ie now higher than
in any other country.
Recently Professor Arvid Carlsson (19?8) of
Sweden, said:' tl am quíte convlnced that water fluorídationr in the
not-too-clj.oüant fuüure wiLl be consigned to medical
hisüory. I
VIII. 58
EIJ-!!ORT rORi AND oPrÐsITION To FLUORIDATION BY AUSTRALIAN
- -
MT]DICAL ANI) DENTA L GIIADUATES.
Corres pondence in the MedicaÌ Journal of Austral ia. 1955-1979.
The suggestion is frequently made that the number ofmedicaL graduates who ad.vocate fluoridation greatÌy
exceeds the number who are opposed to this ¡redication.
If the very 6ma11 number of 1etters on fluoridationpubÌished ín the l,ted aI Journal of AustraLia during
the past 24 years is any indication, very few physicians
have taken a real interest in this subject.
Apart from severar Ineutrarr letters, the corres-pondence comprised:
From dental graduates -14 letters (from B aentists) in favour of fluoridation.J letters (fron 2 dentists) opposing this measure.
Fron medical graduates -t letters (from 6 physicians) in favour of fruoridation.
33 retters (from 14 physicians) opposing this process.
The statements an. counter-stat,ements mad.e duringthis correspondence make one thing clear
- in Australia,as well as overseas r there is a marked difference ofopinion amongst dentar and, nedicar graduates in regardto the safety of artifj-cial fluoridation.
IX 59
T DITFICULTY IN CONTROLLING FLUORIDE CONCENTRAT ION.
The Heal-th (Fruoridation) Act decrees that the lever towhich fluorides are to be built up is to a roaximum faverage
optÍmun concentrationt of 1 p,p.m¡ fluoride. (victorÍan
Governmenü, 197t). No permÍssibJ_e range of concentration
is statedr nor the period over which the average is to be
determined. The rmaximum concentratlon deter¡nined by the
þeaft$ Conmissiont is not stated.
When the Act was passed the considerable
difficulty in carrying out that Ínstruction does not
appear to have been appreciated. This difficurty was
pointed out by the Gerrnan Association of Gas and vlaterIìxperts (gZ4), who said:
rcertainly it is technically possible to adhere tosuch a dosafge in r-arger works, but the maintenance ofÈhe optÍmar concentration of fruoride throughout thenetwork of pipes to the ultimate consumer cannot beguaranteed,. r
They added that:rrhe impossÍbirity of r:egulating the total quantity offruorides ingested by any incrividuar nakes nonsenseof the demand for very precise dosage added at thewaterworks. r
This difficulty in the distribution of fruorÍdesin reticulated water also occurs in Inaùura11y fluoridatedlwater supplies. The authors of the Evanston trialreported that:
I rn some Ínstancea reportÍng comnunities have ind,icated
6o
that the fluorine content of the v¡ater, when d¡av¡n
from its source, dÍffered from the fluorine contentof the same water when it was collected at some pointin the distrj-bution system.f (giff 9t al. , 1949).
Professor J.B. Polya (96?), of the University of Tasmania,
said that:rSince al-I but the most expensive materÍa1s for theretÍcuration of fl-uoridated water (rubberised pipes orl'lonel netar) react with fruorides, the concentrationof fruoride at delivery points may differ greatly fromfrorn concentrations at the mixing point. r I
Failure to obtain the specified concentration of
fluoride at the taps of the consumers has been re ported
nany tines from the U.S. In the Evanston study (one of
the four key studies held in the U.S. and Canada), elevenI
years after the commencement of the study the authors
reported that:rExcept for the time ímmediately after the introductionof the Chtcago fluoridation program, the F.contentof the western suburbs has been well below the
desj-red optimum l-eveI of '1 .O ppil.r (Uiff gt aI. , 19DB).
Many other cases of failure to attain and maintain
the desired level of fl-uoride have been reported. For
ínstance, the booklet Current Status o f the I'IuoridationDiscussion (tondon et al. , 196j) l-ists 1J citÍes withleveIs of from O.O to 1.6 p.p.rn. fluoride. (The Ieve1
of 1.6 p.p.n. ie higher than the permissÍble ,maximum. )
chicago had values of o.o to 1.2, r,ong rsrand, o.o to 1.J,and Balti-more.- o,3o to 1.40, but the average at that plant
I see appendix 4i, p. 262.
6t
wae O.99 p.p.m. fn Hastings, New Zealand, 66% of t]ne
readings were below the permitted range at the plant (with
51% below 0.5 prp.mr) ancl 2J/o wete greater than 1.11. Thc
apparatus vraci then replaced with new equipmenù, but stil_Ialmost 25% ot the reading.s at the treatnent plant were not
within the required range (with 8.4% too 1ow and 1 6Õ% toohigh - how high was not reported). (Ludwig , 1g5g). *
In Victoria in 1977, the Hea1th Inspector of tbe
town of Merton (Mr ¡,.c. Morrís) reported to the councilthat sanrples had reveaLed fluoride concentrations of. 1,? ¡
1.8 and 2.6 ppn, aIr three levers being above that which
is pernissible in the u.s., and 2.6 p.p.m. is definitelyin the toxic range. He arso told the councir that,as many peopre did not rear-ize that their water vras beingfluoridated, they were stilr admj-nistering fruoride tabretsto their children and usÍng fluoridated toothpastes.(Many people in Merbourne stirl do not know that the wateris fruoridated, and. fruoricle-containing toothpastes are
eti-Il perrnÍtted to be sord and, Ín fact, constitutepractically the total sales. )
This difficurty Ín re8ulating the concentrationof fluoride has arready been d.emonstrated in !Íerbourne.
I'fonitoring the fruoride concentration suppried through a' donestic tap , by an electro-chennicar method using an
orion el-ectrode (epecífied in lrlHo, International Stanclards
for Drínking lrlater . 19?1) has shown a range of readings,ín 1979, from virtuall_y O.O p.p.mo to O.9 p.p.m.r v¡ith a
rl See appendix 4j, p. 263.
6z
mean value of approxJ.matoly O.J prprmr fluorÍde.
The questlon lvhich aríses is ühis: If the M.M.B.td.
on¡glneero are adding 1 p.p.m. ffuorido at the water worko,
where is the renaining fluoride 6olng? Are 6ome areas
of MeLbourne, fronr the same dam and outLet staüion, obtaining
more than 1 p.p.m. orr as has been observed in the U.S., isfl-uoride accunulating on the walls of pipes?
The Director of Laboratories, New York Water Supply, said:rAt the ínterface with the walls of the pipes the flowof water is virtuaJ-ly nilr and, concentratlons of ttrace,elenents rnight bc several hundred times that ín the .
movÍng $¡ater. r (Nesin, 1962).
Ana1ysÍs of the lncrustation in pipes rernoved, in Seattle
showed 1 rO44 pop.n. fluoride on the inside of a pipe and
476 p.p.m. in sluilge. (peniston | 1g?Z),
Overseas reports (e.g. Plunbine Jlngineer , Oct., 1956)
indicate that this incrustation and sludge breaks away and,
fLows free ín the pipes, bloclcing filter eystems.
(InstÍtute of plunbers | 1g5G).
il See appendix 16, p. 276,
r
X6l
PLUMBING PROBLEMS RES ULTING FROI,I FLUORTDATION.
At the time that the Act was being considered' litt1et if
any, mention was mad,e Of the plrr.mbing problems wþich have
been reported to follow fluoriclation in some citÍes in
the U.S.A.
As early as 1951r aoon after the first use of
oodiun silícofluoride solutione in artificial fluoridation,
j-t was reported ín the Journal of the Arnerican V'fater Works
Association that: rsodium siticofluoride solutions have
been found to destroy steeL pipes very rapidly. | (Earper,
19j1). Mel_bor¡rne uses a rsodium sj-Iicofluoride slurryr.
( itirth, 197?) .
In 1956r one early case râIas mentioned in the
rQuarterly Newsletterr of the Institut-e of Pl-unbers of
Australia 9956). Under the heading rFluorides in
Industry, Effects on Water Pipesr, an article nentioned
tha'tr in a large steel tank, protectively paintedt
corrosion had taken ptace removing the baked enamel and
penetrating the steel-. In a cenent tank the cement had,
deteriorated causÍng the sand to sink to the bottom.
It reported:
tFLuoridec¡ are doing a real cleaiin6 iob on the insideof the underground water mains of the town of North
Andoverrs publíc water supply! Their corrosive actionwill soon requíre their replacement. Fluoridation issoftening the heavy rust formation that has collectedon the inside of the town water nains over the yearst
64
to a semi-soft consistency. As Ít frees itserf, itcarrieo a10n6 v¡ith the water. The watcr bringo thisseml-soft sludge to our filters.r
In llovc:nbcr, 19?t+, the Seattle Vrlater Dcpartment proposed
adding 2oo to Joo tons of riure to the supply to solve tb.e
rising tide of co*osion complaints. Ilovrcve r, nine nonthsl-ater the council revorced their decision as there vras no
information on the effect of l.íme on people. (ArticLe,1975). Are the effects nov¡ lcnovrn?
The rsoftnessr of Melbourners waters posed probJ_ems
when fluoridation vras introduced. D¡ II. llarris (1g?6b) |unj-versity of Aston, Birminghan, said that when artificialfluoridation is conmenced,, rlime water, Ca (OII)Z , wÍllar'so have to be adcred, especially to soft waters to stopiron from leachin6 0ut of pipes. r The victorian Ministerof vJater supply said that: rrhe most sui-tab'e na.teriar- forpH adjustrncnt is hydrated Ii¡,,re and t,his wirr be added to thewater as part of the fluoridation process.r (Granter rlg?6).The senÍor Bxecutive EngÍneer, opcrations and ,a.Íntenance,victorian state Rivers and water supplies comrnission, said:
rAt this time laboratory tests on the water (for bothl{el_bourne and, the pcninsula) fra¿ shov¡n that the addÍtionof fluoride, even in the form of soclium silicofluoride,could depress the pI{ from around abou t 7 to as 10v¡ asAcoe2¡ and this wour-d necessitate the additíon of about2 to j popor. of hydrated lime at each fr_uoridationplant, ín order to avoid severe corrosion
'nd rrred,
water in the reticulatj-on systen. , (Uj-rth , 19??). *He atated that a rsodium si1Ícofl.uoride slurryr üras to beenproyed in r'{erbourne, and that rit appeared that nowhere
* See appendix 1Od, p. Z?j.
65
eLse l-n the r¿orl-tl l'rns this heing rlone'I This rLocal1y
ma<lc slurry $tar produced from a phoophate rock lnportetl
fron Morocco. I lle said that for the Peninsula scheme
the suppllee of powder vÙere likely to conre fron BelSiun
or Denmark. (Both thooe countries have rejectecl
artl,flcLal fluoridatlon' )
66XI
FLUORIDAT ION AND TI{I]
In 19?6, Dr l'1. llarris
UnlverettY of 'l\eton'
SAITIITY OF TllE \'iATEIì SUPI'LY.
of the DePartment of PharmacYt
I3i-rmin6ham, raisecl a question which
does not appear to Ìrave been considered j-n Victoria'
He said:rostensibly, line water is added fto fluoridated watefl
to stop iron fron leaching out of pipes'
Another rea6on, seldom admittett or forgottent Ís
to provide enough calcium and alkal-inity to reduce
the cytotoxicity of acid solutions of fluoride'
What was once a near neutral water a little above
pll 7, becomes an alkaline water having the taste
spoíIed, and, incidentally nraking line-sensitive plants
less able to cope wÍth their environment' Since the
fluorid'ation of Birminghamrs water supply in the early
1 96os the
pI{ 8. 6.
cholerae
hydrogen ion concentratíon has often been at
At this PiI there is a danger of Vibrio
proliferating, especially in hot weather' and
so chlorination is, or should be ' maintained at
maximum level. | (Harris | 19?6b) '
DrsK.HelgeJ-andandJ.I,eirskarreported,LnlgT6,that
incellcufturesusinghunanepithelialcellsrwhenthe
pH of the incubation medium was lowered' in the range of
?,O to 6.4, an enhanced cytotoxic effect of fluoride was
found and also a twofold increase in the intra-cellular
concentration of fluoride 'T.¡ 19?6, the Victorian Minister of lrlater Supply'
explaíning why it was considered necessary when
fluoridating Melbourners water supplies to add line in
addition to fluoride, said:
6Z
t " ' the adcrition of fluoride chenical to the watersuppried to the r"letropolis causes the pII of the waterto be l0wered to levets which are unacceptable in watersuppl-ied for rlomestic consumption.
r{elbourners water is generally slightly acidic andthe reductr'on in pII occurs largely aG a result of the10w mineral content of the v¡ater. The rnagnitude ofthe reductÍon varies with the source of the water andis as h'6h as 0.6 in water drawn fro¡,n the M¿rroondahReservoirlr (Granter , 19?6).
The 1973 t4.lq.B.r/{. rTypical complete chemical analysis ofwater suppliecl to l,lelbourne and }tetropolitan Arear showedthe pH as 6.5_?,0. ff that pH range rvas red,uced by 0.6,as stated by the Minister, the level v¡ould be berov¡ thefigure of 6.4 , the bottom of the pH range used byHelgeland and Leirskar (lgzs) in theír study of cytotoxicity.
Since fluoridation was introduced in tfeJ_bourne,monitoring of a suburban d.omestic tap has revealed, manypII reacìings whfch exceeded B'6r solre of the¡n'ei.rrg as hiShas 10.O. It will be recalled that Dr llarris (1gl6b) statedthat at pH 8.6
proli.f erat j_ng.
there is a danger of VibrioA spokesman for the l,l.l"f.B.l^I. saj-d that
Melbourne water is not chl0rÍnaùed excopt for brief periods,such as after the ínstaLlation of nerv mains.(fn passing, it may be mentioned that recently inMelbourne cases of cholera were found in travellers whohad just returned from overseas.)
holeraec
6B
@[. If the above-mentioned' atatements are corrcct '
will wo be forced into the followin6 chain of events?
(a) As a result of introclucing fluoriitation in an
attempt to reduce tlental caries, nainly in childrenr nany
of whon, according to a study in Syclney by Enno' Craig and'
Knox g9?6), now rconsume more prepackaged fluids than
actual tap waterr, be forced to (U) aitd anô maintain
naximunchlorinationofourwatersuppliesto(c)protect
us fronr the potential1y dangeroue proliferation of bacteria
in alkaline water (Earris | 1g?6b). (¿) This alkaLinity havÍng
been produced by the Linre added to the water by the M'M'B'b¡'
(Granter | 19?ü to rreduce the cytotoxicity of acÍd
solutions of fluoridesr (llarris | 19?6b) and to counteract
their effect in producing rsevere corrosion of the water
pipes' (ttirth , 19?7) .
69XII.
THII ETTTCACY OF ARTIFTCIAL FLUORIDATION IS TIONA]]LE.
ÂtthetimeofthepassingoftheFluoridationAct'claims
thatfluoridationwouldreducetheprevalenceofdental
cariesbyapproxímatelysixtypercentwerewidelyaccepted.professor I\T. l"iartin 9964) said:
rThat means that two out of three decayed teeth are
actuallY Prevented. I
It is remarkable that, such claims for the marked efficacy'
ofartificia].fluoridationinreducingcarieshavebeen
accepted for so long, and so widely' As Dr A' Aslander said:
rFluoridationisanillusorypromiseramirage'thathasfead many peopler even scientists, astray'r (Aslander'
1966).
Durin6thepastfiveyearstlrerelrasbeenanincreasing
avrareness that the claim, that fluoridation is renarkably
efficacious, is false. *
(1) TÌre Determination of ChanAes in De ntal Caries Prevalenee.
The decision whether there has been a decrease in dental
caries in a community cannot validly be made on personal
opinions, however wel-l- qualified the observer may be.
If one doubts that, consid.er the following statement by a
very experienced clinician, before luielbourne v{as fluoridated:
| .. it is a delight for any dentist to inspect the mouths
of any of the 5,5 nllJ,ion Australians vrho enjoy the
benefits of fluoride.r (Doo1ey, 1977).
Lord Douglas of Barlocfr (f960) said:
rThe case for fluorÍdation of water supplies rests entirel-yupon statistical evidence. It does not rest uPoD
* see appendix 4b, pr 260,
7o
clinical- evidcnce from doctors who have admÍnisteredfruqridelr to . treir patiento for rong periods and haveobserved the reeults upon indj_vlduals.l
Therefore it is necossary to assess the efficacy offluoridation from the results of long-term experÍmental
triars' These are of two main types - tlongitudinarf
trials and rcontroLledr trials.
Q) Lonmitucìina I Trials of Fluoridat l-on.
Trials without controls, often carled rlon8itudinarr triarsbecause the finar data obtained in the test town are conpareclwith the original data, are not valid.
hofessor W.f .B. Beveridge, in his book The Art ofSc ie n ti. fi c Investisation said of such studies:
rA common falIacy, for instance, is to compare groupsseparated by time
- the data of one yoar being compareclto data obtained in previous ye¿rrs. Evidence in thisway Íe never'conclusive, thouSh it may be usefullyeuggestive. rrrf when the tide is falling you take otrtwater with a twopenny pail, you and the moon can doa great dea1.r r (Beveridge, 1961).
SÍr Austin Bradford HÍII, said:rrhe advent of the controlled triar has led to the rapidabandonnncnt of useLess nethods. | (Uiff , 1966),
Unfortunately the necessity to use a control citywhen setting up a fluori-dati.on triar is not often recognizedby those who have not bcen trained in scientific methods _and sometimos even by those who have been. fndeed theN.H.& M.R.C. , in 1965, sa5-d that in r1he assessment ofbenefits accruing from fluorÍdation! fthe fluoridated..community should be used as its ov¡n control. !
71
unfortunately every fluoridation trial in Australia ll¿ts
used this nethod - termed ruseleosr by Sir Austin llradford
rrirl (966).
3) The Nee for Controls in Ex erame ntal Tria1s.
The assessment of the cfficacy of artifj-cial fluoriclation
canbedecidedonlybycarefuland.accuratestudyofdata
obtained frorn properly desiSnecl and conducted controlled
experirnentaltrialshe]doveraperiodofat]easttenyears.
As Sír Rona1d Fj-sher (951) said:
rIf the desi8n of an experiment is faultyr any method of
interpretation which makes it out to be decisive must
be faulty too. I
The necessity for these trials to be controlledt by the u'se
of an untreated city for comparison rvith the test one, is
obvious to any trained experirnenter, and v¡as realized before
the first f luorj-dation trialg were set up in Americ¿t ín 1)l¡5.
For instance, when the E'¡anston trial was being organizedt
Blayney and Tucker (tg48) said:
rA study of this nature must have an adequate control. I
À statement by the Anerican l,later iJorks Àssocj-ation 3g+g)
said that the experirnental verification of the fluorine-
dental carÍes hypothesj-s robviously necessitates the use of
a nearby rtcontrolrt city with a water supply comparable in
aII respects to that to which fluoride is being added. I
Sir Derrick Dunlop aÌsot in the Medical Journal of Australia
ia 196?, enphasized the neceesity for controls when
conducting clinÍcal trials.
72
rn 1953 a llation¿rl tlearth anct l"iedical Research councilresorution specified the use of a control city in the proposedAustrarlan fluoridation trial
- which was not eotabr-ished.Unfortun¿rtel-y, as has bccn mcnr:ionc., t'is robviously r
necessary requirement has been dÍsregarded in a1t Australianprojects, and in nany others elsewhere. Ilone of themempl0yed a controÌ, and in some there wa.s a narked increasein the dentar care of chircrren soon after the com¡rencementof flrroridation. The same thing has occurred in r,íer-bournewith the establishment of a course for training dental nurseswho wirr provide dental treatment for chir_dren. There urere100 6raduates in the first two years and it is expected thatthe annual 0utput will be 40 nurse. per year, all very welltrained and hi6hly motivated in preventive net,ho<rs andinstruction. Thio output, all restricted to the treatmentof children, is ap¡:roximately the same as the total ouùputof dental gracluates to serve the whol_e community. Obvj-ous1y,the results of a survey of Melbourne chirdren macre beforefluoridation cannot valict-y be corn'ared with conditionsfound in several years , tÍrne
"
Sinilar changes have occurred in other areas.rsupplementary measures such as inproved diet, partÍcularlyfresh fruits in season i-nstead of sweets and softdrinks, topical application and Íncreased dental carehave been acknowred6ed to have been instituted in severalU.S. communities. r (ZiegeJ.becker and Thornson , 19?j).
Fr-uorídation was comrnenced in America in 1g45 by ttreTJ's ' Pr:b1ic tealth service r+hi-ch estabri.shecl the firstexperi-n:enta1 t¡ial_ at Grand iìapids, and the U.S.p.H.S. has
?t
been promotÍng fJ-uoridation ever since that tine"
(4) The Prernature Establ-ishment of Fluor idation Trials.
Thefirstfluori<lationtrialsv¡erecornmencedatatirnewhen
very little was known of the effects of fluoride ' except
those relatin6 to teeth.
An Editori.al in the Journal of the Ameríc Dental
Assoc ti.on in 19114 (pr r,. Pierce Anthony' Editor) stated:
tVlhile these data are certainly speculatively attractive
as leadlrrg to possíble mass treatment of caries t our
knowledge of the subject certainly does not warrant the
introduction of fluorine in conmunity water supplies
generallY.Sodlumfluorideisahighlytoxicsubstance,and
while its appllcation in safe concentrations, and under
stríct control by competent personnel¡ maY prove to be
useful therapeutically, under other circurnstances it
may be defj-nj.telY harnful.To be effective, fluorine must be ingested into the
systen durin6 the years of tooth devel,opment, and. we do
not yet know enough about the chemistry involved to
anticipate what other conditions nay be prod.uced in the
structure of the bone and other tissues of the body
generally. I
lle concluded:
rBecause of our anxÍety to find so¡¡e therapeutic pro-
cedure thaü will promote maGs prevention of cariest the
seemlng potentiaLities of fluorine appear speculatíveIyattractive, but, in the l-ight of our present know}edge
or lack of knowledge of the chenistry of the subjecttthe potentialities for harn outweigh those for good. I
Three months later the U.S. Iì¡blic Health ServÍce commenced
the first trial of artificial fluoridation. (Dean 94. r
1950). No nention "". t"d" that the ínhabitants of the
74
ürial city, Grand Rapids, h/ere consulted, or even notified,
before they worê ueèd fn tirÍs exporinent.
(¡) The smatt Number of !'luo ridation Trial s vrith BxperimentaIControls.
-
Anyone who investígates this subject seriousr-y (instead ofrnerely pa*otÍng the opinions of others, based on hearsay)will soon realize that very fcw 6enuine fluoricia.tion trialshave ever been attempted. Therefore claims for the efficacyof fruoridation are based on ve¡y rinited e><perimentar data.
trt nuet be emphasizecr that the fluoridation hypothesisin lts entfreüy rests on a very narrolr base of selectedexperlmentar infornation. rt i.s this verir base whichis vulnerable to scíentÍfic criticism. Ancl, it isupon thi6 very narrow base that the very impressivearray of endorsement rests rike an inverted pyramid. I(Ne6in | 1956).
The firct four nain trials _ in Grand Rapids,Newburgh and Evaneton, in the u.s. r and at ì3randford, canada,are stfll the rnoet cited studies established to test theeffi-cacy of artiffcial fruorídaüion. IÌowever very fewinvestÍgatÍons of the numericar data pubrished by theirauthors have been publlshed. Those results have now beenrepeatedly criticized and the critÍcisms have not been shownto be íncorrect.
(6) F tÍon De monstra tions.sone proJecÈs, spoken of as fruoridatron triars, were Ínfact mere rd'e¡lonstrationsr i-n which rthe prestige of officialbodÍes has ar-ready been comnitted to one concr.usion in the
?5
mattcr.r (no¡Us | 1g5Ð" for instance the British llinistry
of lleaLth Sgrr) Ref crence llotc t rofcrrln8 to the areas chosen
fortheflrstf]uoridationprojectolnGreatBritain,oaid:tThese areas are to be the subject of controlLed
demonstrations, not experiments, for the results to be
expected are already full-y attested by Arnerican
experience. I
The author of .¡-he l.{ew zcaland project at Hastings said:
|Astudyhasbeeninstitutedinthiscitytodemonstratethe effectiveness of the programme in reducin6 the
prevalence of dental caries' r (Ludwig | 1958) '
Indeed, the Assistant Chief, Division of Dental Publj-c Health'
U.S. Public lleal-th Service, said:
rThe fact is that the projects at Brantford, Grand Rapidst
Nevrburgh and Evanston vtere designedr " ' rto denonstrate
the effectivenesG of the procecìure.r (Galaganr 1960).
Q) The Terms rContr olIed Stud and rControfled Fluoridationr .
The use of these terms in reports on fluoridation may nÍsIead
those who are trained j-n experj.mentaÌ procedures. The two
terns have entirely different meanin6s'
rcontrolied otudyr is uscd rarely and, in most cascs, denotes
the use of an untreated control city to compare with the test
onê ¡
rOontrolled fluoridationr, however, sinply neans that the
fluoride feecling apparatus !ìtas rcarefully controlledr that
the tap was turnecl on the desirecl amount. The r¡llio Chronicl-e
(WttO, 1969b) referred to rthe controlled application of
fluorides.r rControlled fluoridationr vras defined by the
U.S. Department of l{ea1ih Education and tr{elfare, Public }Iealth
Service ( Fluoridatj-on census. 1969) as rthe conscious
76
rnalntennnce of the optfm¿rr fruoride concentration l.n thewator eupply. I (U.S. Do¡:t.lloalth E.W. , 1r)?O) ,
Even the V/IIO Expert Lrommittee in r.Jater tr,luoridation(gsa) used the term in that misreadi-nß hray, stating that:
rllundreds of controlled fr-uoridation programrnes are no\¡r1n operation in many countries. some have beenoperating for the past 12 years, so that concrusÍons arebased on experience. r
No reply uraa received from the rvHo to an inquiry regardingthe names of those f contro-rled fr-uoridation programmesr. rnfact, only a very snarl number of studics vrith cont,rol cf tiesexisted
- the term rhundredsr vra6 pure myth. At that tine
there were only four studies of any irnportance. When some
of their numerous shortconings were reportecì (Sutton , 1g5g),Dr C.G. Dobbs SgeO) eaid that it was:
r.. disturbing that trre various cornrnittecs and professionalbodiee who have considered and published reportsfavourabre to fluoridation have either failerr to pepceÍve,or else have chosen to 6uppre6s any nention of thesequíte obvlous and elenentary grounds for critícism. r
Those five main trials whi-ch were studiccl (Sutton 1959, 1960) ,in Grand Rapids,.Newburgh, Evanston anci Brantford (two triaLsr¡rere conducted in tsrantford), renain the nain basis of dataavailable üo judge the results of fLuoridation.
Later, the commencement of other controlled trialsuras announced. One was the llastÍngo trial in lìer,¡ Zealand,but when the author found that the dental carles rates in theproposed oontrol city of Napier !Íere consi-dêrably l0wer thanthose in the test town, the control was abandoned. (Ludwig,1958),
Ànother trtal was at T1o1-Cul-enberg in lloLlan<l
The comparability of the teot and the control
crltÍclzoct (ZLeSolbecker and' Thomson' 19?')'
77
( Kwant , 19?7).
towns has been
Those critics
aaid:
rÀn analysls of the figures of the Tiel/culenburg survey
in the Netherlands and those of Grand Rapids' I'lichigant
U.S.A.r after 10 years of fLuoridation wTrich provides the
baeis of fluori-dation in llolland shows that the cLain of
benefitstoteethfronfluorÍdeaddedtodrinklngwateris not supported'by ühe data presented' I
Tluoridation is now banned in the Netherlands'
(8) R tÊr Repor of uÌts t and ons of FIuorídation
[email protected]íntheresultspublish-
ed fron the few fluoridatÍon trials' It is regrettable that
very few studies bave been nade of the published data' The
statisticíans who have done so are all crltical of the
method,s used in these trial's' Îv¡enty yoars ago ít was
pointecl out (Sutton, 1959) that enctorsenenüs of the efflcacy
ofartificia].fluorictationwerebasednrainlyonthestateclopinionsoftheauthorsofthosefluoridationtrÍa}s,and
of others. Thls continueç to be the case and endorse¡nents
are etilL founcled on this nebulous base'
In its First Report (ttre only one), the ISHO Expert
Conmittee on l¡Ùater Fluoridation (lg58) devoted only 16 lines
to the results of fluoridatíon. under the heading rResults
of FluoridatLonr, instead of resulte belng consídered' connent
wasconfinedto:lReportsoftheresultsafterl0years
?8
G) h
of oontrol_lorl fluorlrlatÍon f n thrco c j.l;ir_,u. r
Dxaminatrono of tho rrut¡¡ obtr.rlnoci in t,hesc trf¿rls, whÍchhave been pubJ-Íshed by oncrorcing bodies , ¿rre inadequate,al-most absent. rt ís a.n und.erstatement to tcrm trris fair_ureregrettable. ..
The re'markable fact of the r-ack of examination ofthese data continuos to be denonstrated repeatedly. Iurany whoactfvely support fluoridation are vory vague about the dataon which the whore process ie supposed to be based, andnay not know even the names of the test and contror citiesin the trfale which were established. *
rn the promotion of fluoridation it is sti.r-l the so_carledrexpert'opinionr of which notice Ís taken, not the accuracyand the reLÍabilÍty of d,ata.
ofA rtifGr ss Erro in the I'iain Âm
1cÍa1FI uor dationerica_ Canad l-an Tr ial-s
rn the very Ímportant ancl, cìespite statements to the contrary,di'oputed questíon of the efficacy of artíficlal fluoridation,rer'ance is etf.' based,rnainr-y on the orand RapÍds, Ì,rewburghand Bvanston studies in the U.S. and on one of the tv.¡o trialsheld in Brantford,
'anada. These l{ere oet up betvrecn 1!4Jand 194?' Twenty years aßo many gross errors were forurdln the reports fron thoee four üria1s and nunerousonlssÍons and nls-statements in them were pointed out.(sutton ¡ 1g5g). Not one of those Srounds for critÍcisnhas been" rofuted. It üras concluded that:
r'he eound basis on which the efficacy of a publicbealth ¡neasure nust be assessed is not provided bythese five crucial trials. r
appendix 1J, p. 2?4.* see
?9
(ro) Add L tlona 1 Errors in the Ilvanston 1'r ia1 Data.
In January, 196?t which was the twentieth ¡¡Lnniversary of
the commencement of the Evanston trial ' an entire specíal
issue of the Journal of the Ameraca n Dental As sociation
was devoterl to a report on that study' In this ' all the
original tables, complete with their gross numerical errors t
v¡ere reprodu.ced, desplte the fact that these bad been pointed
out some eigbt years earfier (Sutton '
1959) and sorne of them
had been acknowledged by the autbors (Sutton' 1960)' In
additionseveralfaultytableswerepublishedforthefirst
time, The tables then showed three different statements
regarding the number of children aged 6-8 years who were
examined in l,vanston during the 1946 examination:
(i) 1gg1 children - see Tables 10, 11' 30' 4o and' 4/'
(i:-) 1985 c:nlr<lren - see Tables 7, B, 16, 13' 21 and )2'
(iii) 1?r4 children - see Tabtes 24 and 25'
There were also no fewer than six different sta-tenents of
the nuntber of children a6ed 12-14 years examined' in lÌvanston
ín 19462
(i) 1?oi cl:rjj-clren - see Tables 1, and 72'
(ii) 1?oz chlrdren - see Table 47'
(iii) 1?o1 children - see Tables 11 ' 70 ' 41 ' 44 and 4J'
(iv) 169? cntrdren - see Tables f, 9, 12., 13, 17r 19' 2?, '1'(v) 1556 cltlldren - 6ee Table 26'
(vi) 1146 children - see Tab1e 46'
Between the sum of the two highest statements of the number
of children examined in livanston in 19461 and the sum of the
two lowest statements of children examined in the same year
in the same stu<ly in the same city, there is a difference of
294 children (991 + 1?ot -1?54 ' 1146 = ?94) '
8o
These errors vrere mentioned 12 years ago to theTasmanian Royal Commission on Fluoriclation.since that ti-ne r have not heard of any nention of them orof a criticisn having been nade of the numerical d.ata
Bublished in that report. rt appears that, in the manner
coru'.on in fluoridation trials, those erroneous tabres havebeen accepted at thei-r face varue, without investigation.
lwenty years ago it was pointed out (Sutton and Arnies,1958) that:
trhis uncritical attitude to these studies is rife.,rAlso, i.t has been assu¡ned, that associations andinclividuals that . .. accepted the respçnsi.bility ofpublicly advocating fluoridation, have undertakenÍndepencrent cxaminations of the data, and not mereÌyrepeated the opinions of others. r
ït is pertinent to point out that, in the Forer,¡ordto that article in the Journal of the Ane rl_can DentalAssocia tion , Dr F.A. Arnolcl, Jr., the Assistant SurgeonGeneral, chief Dental .fficer, u.s. rtublic l{ealth service,ín 196? said:
r'ere, in a sin61e report, are data on the effect ofwater fJ-uoriclatj-on on dental caries so completelydocunented that the article is virtuarr_y a text book foruse Ín further research. ft is an irnportant scientificcontribution toward betterment, of the dental health ofour nation. rt is a classic in this field.,
rt is indeed a classic - a first-c'ass example of the
e*ors r onissfone and nis-statenento whích abound in thereports of these fluoridatÍon trials.
8r
(rt ) T uestlo of de ed eru nof teeth. An
important factor which nay occur when fluoridation is
introduced ls that of a delay in the eruption of teeth'
Ín 199?, Dr Kaj Roholm said that: rThe teeth nray be tlelayed
in eruption.r However Dr C'D'14' Day (1940) coulô find no
evidenee of delayed eruption in his patients in rndia'
Dr E.M. Short (1944) said that concentrations of fluoride
of 2,6 p.p.n' appeared to be associated with delayed eruptiont
but founcl no sígnificant clifferences with Ìess than 2'O pop'lllr
Theevidenceforctelayecteruptionfol}owing
fLuôridatLon is stil-I conflictíng' Sone state that delay
in eruption occurs because the dcciduous teeth' being less
carious due to fluoridatíont are retained for a longer
period than they are in non-fluoridated com¡nunities'
IntheEvanstonfluoriclationtrialtheres'asa
suggestíon of a progressive decline in the number of erupted
fÍrst permanent molar teeth ín six-year-old children'
Unfortr¡natelyrnod'efiniteconclusioncou]"dbereachedbecause
the authors failed to publish the requisite clata in the
following reports. (sutton, 1959)'
Dr R. Feltman and G. Kose1 (11961) reported tlratt with
the use of fluoride tablets:
rThere being a delay in the'eruption of the teetht Ín
aone cases by as nruch as a year fronr the accepted eruption
datesrthismaybeafactorinthelesserincidenceofdecay. The teeth dteJ-ayedÌ Ln eruption have the
opportunity to mature more prior to becoming exposed
to the foroes that trígger the caries nechanism' r
Of course, if there is a delay in eruption as a resuÌt of
fluoridatíon,therewíl].beadel.ayintheonsetofdental
caries, for unerupted teeth cannot decay. (see appendfx 1?c)'
8z
(ta) Rerl t1 or et rdatlon of dcntal carle¡: . AE has becn
nentioned, the asseasment of the resul-ts of the chanBes indental caries prevarenco ln a popur-ation cannot be made by
clinical ínpressions. Sir Derrick Dunlop (196?) said:rrhus, thg crinical impression persisted for hundreds ofyears that blood Iottíngs, sweatÍngs, vomitings andpurgings r¡Jere good for people. r
However, even when data are obtained fronn a controlred trialthere arÍses the irnportant matter of the interpretation ofthe results.
The authors of the Evanston üriar (r:r.ayney and IIirI,'1967) spoke of tthÍs reduction and retardation of Iesions.,They said:
rlrle presume that a 1if etime exposure to fluorÍde, withthe increasin8 resist¿rnce of the ena.mer_ surface to carÍesatt¿rck, results in either the carious process beginningat a later time or the decar-cification progres.ing at aslorver rate, or both. t
Thore are two main ways of looking at data frornfluoridation trÍals, The first, used in promotingfluorÍdation, is to expreso the result as a percentagereduction in dental caries in various age Broups, usual.lyusing the D.M.F. (decayed, missing and fi1led) index.The difference between the fi¡st and the rast D.r"r.F. readingis divided by the first reading and the change expressed asa percentage. In the case of a controlled study, thedi'fference between the test and the contror is expressed, asa percentage of the contror figure. That r¡ethod has beencriticized, anongst nany others, by Dr C. Dillon (t956) wfrosaid that rthe calculations of the proponents of communal
1
2222
9
oo1
23
6
1
2145
6789o1
Bl
fluorlrlatlon can support no statÍstical convicüion' I
IIis argunrent ls too lengthy üo be reproduced here '
Ân engineer, K.l(' Faluev (tg5B) prepared the
following table to explain the rpercentage rcductionsl
obtaÍned by that nethod of cal'cu1atíon' It makes the
reasonable assumption that there is an increase of 1 D'M'F'
tooth per year in two childrenr or Sroups of children' and'
that the onset of carÍes comnences two years later in the
fluoridatedgroupühaninthenon-fluoriclatedone.
Tota1 number of decayed teeth at each age'
Age Non-fluoridatect Fluoridated Difference Fer centI Reduction I
1001C0
665o4o
lotal 19j/15 =o,60
| 6æ/0 aveîagel
some remarlcably inpressive results can be obtained
by this percentage reduction method of expressing data.
For instance the Commonwealth Department of liealtir journal
llealth ín 1961 claimed that in lùew z:ealand there had been
a rblorld Recordr success rvlth 'fluoridation. The clained
t?4% reduction¡ 1n dental decay in pernanent teeth on
exanination of the data proved to be a rdecreaset of 1.04
D.l"i.F. teeth in a small number of 6-year-old children, in
a study wÍthout any provísion for el-íninating possS-b1e bias
by an examiner r,¡ho had stated that the study was I to d.emonstrate
the effectiveness of the programne in reducing the prevalence
of dental caries.r (ludwigr 1958).
B4
Tho slogan that fluoriclation rdecreases decay by 60%r hasbeen remarliably Guccessfulr 1t has becone a trulen in eorne
circres, but ie now befng questioned by practitioners workingÍn artifícial1y fluoridated areas (Schofiel_d , 1966),
The other approach to the same data j.s to conside¡the di-fference as due to a retardation of cari_es.
Dr R' Weaver (lgt¡trt 1g4g) in tris study of caries j-n Northshields and in naùuralr-y fluoridated south shierds, said:
I r thj-nk that the nost inportant r-esson to be learnedfrorn tht" r'rorth and south shÍelds invest,igation is thatthe caries-inhibitory property of fluorine seems to beof rather short d.uration. r IIe also said:trhere is, therefore, some jusLifi-cation for saying thatfr-uori-ne inhibited caries in south shi-er_ds chir_dren tosuch an extent as to reduce the incj.clence of earies bynearly half _ a reaÌIy remarkable resuÌt. I suggest,however' that such a conparison can be most nisleading.The 12-year-olrr chilcrren i-n south shields averaged 2.4DMF perrnanent teeth, vrhilst the corresponding childrenÍn North Shielcls averaged 4., lir,,F permanent teet,h.The question which rearly need,s to be answerecl isItHow rnany years does it take for the figure of 2.4 inSouth Shields to reach 4.32,, The answer isapproxÍrnately three years. r
He concruded that '{:here is in fact no very strikingdifference rn the íncidence of caries in the two tovrns. r
This
development
observatíon that fluoriclation defers theof caries tvas menti-oned in an Editorial ín ühe
Journal of the Âme rica nDe ntaÌ A ssocÍatÍ on in 1944, rt said:" ' it has been found that the presence of fr-uorine inthe drÍnking vrater has a retard,ing infì_uence upon dentalcaries. I
B5
]N DENTAL CARTDS RATEs (D. M.F. ) IN PERI'l,fll[E]IT TEBT]II DELAY I
S OF ARTITIC IAL FLUOR ID/\T1ON IN TTTRTE CITIIISAFTER 10 YEAR
14
12
o1
t)){)I!,
qa
.1
Ioo)P(ú!ao.r{hrú()
8
6
4
o Grand Rapids Brantford Hastings
Fig. 7, The approxímate tdelayr in dental caries (O.I\i.F.)
raüee after 10 years artificial fluoridation in Grand Rapidst
U.S.A.¡ Brantford, Canada, and llastings, New Zealand'
2
16
15
14
1t
12
f{(¡t+tq-{
dÈáokh0
(,tto.:i
11
10
9
B
?6
t
2
2
,
2
u)t{dû)>.
É'rl
Þ,(ú
r{c)
î
t
1l+
1'J
76
ß{
15+-16
.r{+
.rlß{otrlq-.t
1211
10
9
I
(ú
rà)of{ho
0,bo
7
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7
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11
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B
o.rl+)dõ'r{f.{o5-{qr
c)f{o+{c,pÈ5ol.{bo
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t{o+)aHrd
Ê{âo¡{h0
16
15
14
17
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Êi
oh0 qr
11
10
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ô0
7
6
7
3
,
7
7
7
2
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hd(¡,hÉ.r{
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14
12
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7
6
Éo.rl+)dd.r{koá-lcH
c,f{o
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I
86
'rhat obocrvatÍon has been made in other naturalryfluoridated areas. In jg6t, f.A. Irvinß reported that:
| ,.. in the high fluorlne water oupJrÌy area6 Én Usse4]there is onLy a d,eferment of the olrset of decay, anddespite the fluoridated, water there are stilr decayingteeth. r
The same effect has been detected in the data fromartiflcial fluo¡idatíon trials. Fig. 3 depicts the rdelayrin the D.M.F. rates reported after ten yeare artificÍalfluorÍdation in the three trial cities: Grand Rapids,U.S.A.i Brantford, Canada; and lIastin6s, Nevr Zealand,.The contrors for both the Grand Rapids project and the oneat Ilastings, u¡ere a.bandoned early in those trial-s.The Nationar Ilealth and rrrer-fare study in r3rantford had manydeficiencj.es (Sutton ¡ 1959, 1960) . The rlata from theother two main trials, at r'Iewbur6h and Evanston, rtrer€pubrished in such a rnanner thaü sinirar cornparisons cannotbe rnade.
The rdelayr ín these three studios (tat<ing the publi_sheddata at face value) was, except in the youn6est a6e groups,between tr'ro and threc years, similar to trre three-yeardelay reported by Dr Ï,Ieaver (194g).
The BritÍsh experinental clata were conr:iclered byDr C.G. Dobbs (l9Z¿) vrho said that:
t"'âfter an initial postponernent, the rate of progressof the disease is unaffected" rt has now becone obviousthat, in B¡itaÍn at any rate, fluoridation does notprovide the rnajor sor-ution to the dental caries probremthat v¡as suggested by the earlier propaganda.,Those BrÍtish data v¡ere depicted by Þofessor A. schatz an.
8Z
Fig. 1. Curveo showi-ng Dl"iF values
uoridated,
2
7
6
C ontrol
I
oB910
for chÍlcJren of <lifffluoriclated and cont
e¡ent a¿¡cs i-nrol arcas.
5aqI¡
Êi3
1112131AG]1
Fig. 2, Curves from Fig. 1 clrawnwith the control noved to the rÍghtto shov¡ that caries develol:s at theoame rate j.n both the fluoridatedand control ¡çroups.
l,.lnorirlate d ---Control
B 9
?
(,
2
1
o
I'luoridated
5
r" ¿[
At
Control9 tO 11 12 13 1Lt
10 11
AGE
12111
FÍg. 4. Thie figure is redrawn from tvro fi6urespubliehed by Professor A. Schatz and. Dr J Martin (1 9?2')whfch depÍct D.M.F. values published Ín 1969 by theBritfsh Committee on Resear ch into Fluoridation v¡hichcLaimecl that rthe fluoridation of vrater supplies at thelevel of 1 p,p.n. F is a hiAhly effectÍve vray of 'reduc ingdental d.ecay. I (Table 5, I he uoridation StudÍes inUnite and the lìesu s Achieveear .M.S.O. , London. 1 a
after venthe
B8
Dr J. I4artin, see Flg. 4.
their Íllustratlon clearly shows that t after the initial delay
1n the onset of caríee, the D.M.Il. rat'c increases at almost
exactly the sane rate in both the control area and the
fluoridated one.
The question should be considered whether thÍs delay
phenomenon Ís who1ly or partly due to a delay in the erupt,ion
of teeth. Unfortunately, data v¡hich mi¡çht have thrown light
on this nattcr were not published. Âlso, there is a consid-
erabfe degree of uncertainty fn the caries data released from
the fluoridation trials due to the nany errors in their
experimental nethocta (Sutton , 1959, 1960) ,
3t ) Reports by statisticíans.
Tr.renty years ago Professor D.G. steyn (t95Ba) sug¡lested. that,
before proceeding vlith fluoridation, those concerned. should,
in the interests of many mÍl1-ions of people, rsubject the
Amerícan ¡rethod of statistical analysis to severe scrutiny
in the light of the critícisms levelled at it. In this way
a great future tragedy nay be averted. I
sone of the shortcomings of the four nain fluoridation trialswere pointed out thc fol-lowj-ng year (Sutton , 195Ð .
Anne-Lise Gotzsche (9?ib) said:I I have shown dental statistics to scientists workin6ín other and unrelated fielde
- in, for instance,biochemistry
- and, Irnr afraid, they simpLy 1augh atthe rrreshuf fllngrt, statl-etÍcal |tv¡elghtíngt!, the suddendisappearance of up to 1000 research subjects, &c.l
Judging iron the few publications rvhich consider the
efficacy of fluoridation, those vrho pronote and end,orse
Bg
thfe procese have noü taken hofescor steynrs advice.
Dr M. Ilarrle ?926a) sairl:
I r know of no fluoridatj.on investi-geition involving dent¡rrexaminatÍon which vra6 carríed out under the directionof an acadernio statistician. r
FortunateJ-y, statisticians are no$r beginning to look
at the data published in fluoridation t,ria1o.
One of the firet comments by statisticians v¡as rnade on the
first fluoridation triaÌ, run by the united states public
Hea1th Service, aü Grand Rapicls. Extracts fron their reportwere pubrished in a county dentar journal (De stefano, 1954,\
and have been ignored. They said:rrhe authors appear to have d.emonstrated an unfortunatedÍsdain for sone of the pre-reeuÍoites of vali<l research. r
And rin the first p1ace, the sampling desígn of theoxperlment fs enbarrassíngl-y conspicuou.s by its absence r .
They also eaid that:r... tho lack of eophisticatÍon shown in selecting thesanple leads to complete bewirdermenb as to the preciseeffecüs or the extent of the effect of fruoridation. r
rt ehourd be noted that it was upon the results reported fromthat study on which the united states publíc llealth servicebaeed 1ts, very prenature, end,orsenent of fruoridation.Thís was folrowed by encrorsenent by the American Denta1
AseociatÍon, leading to ùhe vast superstructure of end,orse-
ments by all manner of societies and assocÍations, v¡hich vrere
nentÍoned Ln eection IV.
rn 1974, hofessor R.s. scorer of the Departnent ofMathematice, rmperial college of scÍence and Technology,
9o
London, publlshed sone conrments. They concerned the annual
reporte of the Medical Officer of Health re6ardln6 the
Angleeey Dental Servloe. /\t that time Angleeey had been
fruoridated for nearly 19 years. Professor scorer said:rlt le qufte remarkable that one of the Annua1 Reportsehould bave referred to the Itdranaticn Ímprovementresulting fron fluoridatÍon when there are no figuresat all to support this. I rThere are no perceptibletrende of any kincl, ancl it ís quite impossible to detectany lnf1uênce of fluorídation at all. If anything,teetb have got wor6e.r (Scorer | 19?4).
,
The sane year, Dr R. Zfegelbecker og?4) of the rnstitutefor Envfronnentar Reeearch, eraz, Austria, studied the eame
reporte and aLso the data publis hed in the fl dations Íes Ín t Unl.tecl Kin dom and Results Âchieved afterELeven Year€lo (See Fig. 4, p. 8?,) He said:
rrhe lnescapabre concrusion fron the officiaÌ dataconcerning ühe developmenü of dental- heal-th inAnglesey fs tbat the fruoridation of drinkÍng waterintroduced fn 1)JJ inaa not been ouccessful. r
He also eaid¡rTbe fluoridatfon of drinkin8 water has not resurtect ina reduction in the average number of treatrnents requÍ_redor 1n the average nunber of fillin8s and extractions inthe deciduons and pernanent dentj.tlons. r
hofessor scorer ugzs) also publíehed comments on a paper
by hofessor D. Jackson et al. , (lg?i) which conpared,
chlldren in fLuorÍdated Anglesey wÍth those in Bangor and,
Caenarvon. He commented:
rrt 1s a v6ry badly designed investÍgation by even the
9t
most modest epidemiologlcal standards. !
rThe study does not come up to the standards worthyof a universfty, nor would ít morÍt publícation 1n a
reputable journal. I
Dr Zie6elbecker g9?5) also comrnented on that study (Jackson
9L4. t 1975) . He said:
rThe cause of this contradiction lies in the exceptional-Iyfaulty design and the faulty interpretation of the resultsof the GI¡JYÌ{EDD DENTAL IIBALTII STIIDY by its authors. I
rThe reoult of the study could have arisen sole1yfron the selections nade and ís a flagrant contradictionof other long-ter¡n and official data on Anglesey whichprovide an incontestable record of the fail-ure offluoridatlon.l
Unfortunately, even today, twenty years after a study
wa¡: made of the four main (an<l one rninor) American/Canadian
fluorÍdation trials (Sutton , 1959 | 1960) | very few publíshed
comments have been made on those key tr.ials. (tt is pertin-ent to mentlon that the findings ln that strrdy were checked,
in detail, by Professor l,laurice Bel_z and. three members of
his staff at the Department of Mathmati-car statistics,
Universit,y of I'Íelbourne. )
hofessor Per Ottesta<l, Department of MathenatÍcs,
Agricult,ural Collego of ltrorvray, exanined the data ofthose American/Canadian trials, and additionaf naterial fro¡lSweden, and said ín 1969t
rNo one who ls in close contact with 6ound research andwho has seríously considered the question of researchnethod, would accept the so-calred scientific basís that1s being advanced for promotÍon of fluoridation. r
92
Profesoor Ottestad oaid that a comparlson of the data
published in those trials indicates that:t.,, a hypothesis that assunes fluoridated water tohave the oarne effect as water with the same naturalfluoride content, cannot be accepted. The reason,of course, is that there are other facto¡s thanfluoride which Lnfluence the DIß rate ¡ probably otherelements in the clrinking vratcr.r *
He concluded:
rThe experiments which have been made on adding fluoridesto drÍnking water vrere oo unsatisfactorily planned andcarried out, that the results are inadequate as a basfsfor estimatfng the effect of fluorídation in, for exanple,llorth America, and most certainly in Norway iffluoridation is to be practised here. There is no
doubt, noreover, that oùher factors pÌay a part.¡Tvrenty years ago it vras concluded (Sutton , 19j9) that:
rrhe sound basÍs on whÍch the effi-cacy of a public healthmeasure nuet be assesaed is not provided by these fivecrucial trials. I
since that tlme, not even one of the many observations on
which that statement was based has been found to be incorrect.Farticurarly since the results of the British trials have
been examined by statisticians, it can now be stated confidentlythat the clalns for great dental benefits as a resurt ofartffLcfaL fruorfdatlon have beenn at roast, greatly ,
exaggeratecl .
* see appendíx 4c, p. 261,
XIII. 97
TOXICITY - DIINT¡\L FLIIOROSIS.
Dental fluorosis or rmottled tecthf has always been an
important factor in the fluorj-dation discussiont for cases
occur whenever artificial fluoridati-on is commenced.
Thcre ic much r,:risunderctanding regarding this condition.
Some knowled6e of it ís essential vrhen studying the toxicity
of fluoridation and of fluoride íngested from other sources.
Dental fluorosis i-s a condition of the tooth*
characterj,zecl by faulty forrnation of the enamel. (Faulty
enanel can al-so be produced by illness and frora malnuürition,
the position of the malformation indicatirrg the a.ge at
which the child rvas sicJc and the area of tooth affected
shor.r:lng the duration of the il-l-ne,.ss. )
(t ) Dental Fluoroois fndicates Chronic FluorÍde Pois oníng
Denta1 fluorosis vras described, in 19lt3t by Dr D. Ast (who
subsequently becane the main investi6ator in the t,Ielvburgh
fl-uoridation trlaL) as Ithe first objective ínrlication of
chronic fluorine poisoning. I }Iany sinirar statement,s have
been ¡¡ade by othero, including the Medicar Research councir
U94e).
this fact is generally admitted except by the most
dedicated fluoridatíon promoters. For instance, professor
Noel l,iartin of Sydney, in reply to'a question wheilrer
dental fluorosis is an indicator that people rnight be being,
poisoned, said: rllor Dor itts an incticator of fluoride Ínthe diet, itrs an indicator of fruoride afíecting the
formation of teeth.r (N.D. I"lartin , 19?9). 'F *
JF See appendix 1/d, p. Z?8, lIlF See appendÍx 2b, p. Z5B,
94
Dental fluorosic can develop only during the
fornatÍve perlod of the enamel of the teeth concerned, to
the age of approxÍrnately four to five ycars in thc case of
the incisors. Periods of chronic fluoride poisoning which
may occur after the enamel- development is cornplete and when
the teeth have eruptecl vrill not be indicated by rrnottlj-ngr.
Q) The Prevalence of Denta1 Fluorosio in a Fluoridated Area.
It is now admitted, even by those who are in favour of
fluoridation, that 1:en per cenü þt least] of children raised
on fluoridatecl water since birth will exhÍbj-t some degree of
dental fluorosis (N.D. [lartin, 19?9), but the c]-aim is made
that the lesions are so i-nconspicuous that it recluires an
expert to detect them. Á,s wilL be seen later in thissection, that claim is not correct.
comments that the degree of <Ìental fruorosis,occurring
in some children drinkÍng fluoridated, water, j-s of rno cosmetic
importance' ignore the essential point -
that any clcgree offluorosi-s is evidence th¿rt the chirct experienced. a period ofchronic fluoride poisoning. As Dr Vt. Gibbs (1958) said:
rThere is no evidence that this damage is directedselectivel.;r to the ameloblast [énameI formín6] cel1s on1y, r
3) I'actors Affect r-nà the Degree of Dental Fluorosis.The degree and the appearance of dental fruorosis depends
on the degree of poisoning whÍch, usuaIly, varies with the
totaL amount of fruo:ride 5-ngested by the individual, theirpersonal susceptibility and the level-s of protective
substances in the v¡ater and the criet, r.rhicrr have been
dlscussed already. The area of tooth affected depends on
the duration of the cxposure to toxÍc dose6.
9'
ì'lormal Ques tionab I e
Very l.li ld r-ii 1d
l\ioderate Severe
Fig. 8. Photo6raph of the illustration published by Dr
H.T. Dean ?942) to explain his descriptions of the
appearancesofthevariousclassesinhisclassífication
of dental fluorosis. (copyrighl 1942 by the American
Association for the Advancement of Scíence)'
96
Professor A. schatz and Dr J. Martin o964) reported:rUnder certafn conditlons, fluoride toxicity actuallyfncroaees as the concentration decreasest This iswhat ls known aB a paracloxlcal cffect. I fFor theocroaeonc¡, tho Loeue of fluorlde toxicity cannot boresolved by considering only the concentration offluoride in the water. I
(4) The Cl-assificatlon of Denta1 Fluorosis.
Dental- fruorosis cannot be considercd sensibly without a
knowledge of the various grades of danage. These grades
were established ¡noro than forty years ago by Dr H.T.
Dean g9t4) and, although some slight modificatj.ons
of this syeten have been used., his classification Ís stirlthe etandard for assesslng and describin6 clentar fluoroeis.
The following descrÍptions are abbreviated rnainly
from a later deocription by Dr Dean in the book Fluorineand Dental Health from which the accompanying irrustration(Tlg. B) wae taken. (Dean , 1942).
t@1. The enaneì- prcoents the usuar- translucent semi.-viüriforn type of structure. The surface is smooth,gloesy, and uoualÌy of a pale creamy rvhite color.SuestionabIe. The enamel discloses slight abemationsfron the translucency of normal enamer, ranging from afew wh{te flecks to occasional_ white spots. Thisclassificatíon fs utilized Ín those instances where adefinite díagnoois of the mirdest form of fluorosis isnot warranted and a crassification of ,normarrr notjustified,
Verv Mild . Sma1l, opaque, paper v¡hite areas scatteredirregularl-y over the tooth but not invorving as much asapproxfmately 2J per cent of the tooth surface.Frequentry included in this classifi.caüion are teeth
97
shor,ving no more than about 1-2 nm. of white opacity
at the tip of the summit of the cusps of the bicuspidsor second nolars.
IliE. The white opaque areas in the enanel of the
teeth are more extensive but do not involve as much as
!O per cent of the tooth. I (Dean | 1942). rpaÍnt bfown
stains are sometines apparent, generally on tbe upper
incisors. I (Dean, 1914).
rlrloderate. All enamel surfaces of the teeth are affectedand surfaces subject to attrition show marl<ed vlear.
Brown staln is frequently a disfiguring feature.
@. Includes teeth formerly cl-assified as
ilmoderately severerl and rf 6everett. AII enamel surfaces
are affected and hypoplaeia ís so nrarked that the generaL
form of the tooth may be affected. The na-jor diagnosticsi6n of this classificatíon is the discrete or confluentpitting. Brown stains are widespread and tceth oft'en
present a corroded-Iil<e a.ppearance.r (Dean, 19\2).
It should be noted that:tThe chÍId is classified on the basis of the severest
forn of dental fluorosis for two or more teeth. o (Dean,
1942).
Therefore, i-f only one tooth Ís classified as rmildr and
others as fvery niLdr r the clasoíf,ication is rvery nildl
although the presence of even one rmildf upper incisor
greatly affects the appearance.
$) The Index of Fluorosis.
This is a score used to indicate the degree of dental fluorosis
Ín a cornmunity" Each indivídual- is given -one of the
fol.lowing scores: Normal = Or cluestionable = 0.5r very mild =
1, rnild = 2r moderate = 3, severe = 4. The average score
of the community is the Index of Fl-uorosis.
98
(6) tObjectionabLe IrLuoroslsI.
Thls term, or tobjectionabLe mottlin6t, requires some
explanation. These terns are used by public health
officials. They dísguise the fluorosís damage to the
most-affected indivÍdual-s by conbining their degree of
fluorosis with less-affected or unaffected rnembers of the
comrnunity. If the degree of dental fluorosis in a town
iS said to be Inot objectionablel this does not nean that
no chi1d, or íts parents, vrill regard its mottled teeth as
Inot objectionabler. On the contrary, a proporüion of
the children can have unsightly nottlin6 which is very
objectionable to them, but j-f a sufficient number of
children have little or no visible mottl_íng, so that the
mean score, the index of nott1in6, is less than O.4, then
the nottring in that community is consiclered to be Inot
objectionable I
officials.
from the point of vj.ew of the public health
As Dr Colin p. Il,arrison (lg6l) of Mel_bourne expresoed iü:I rt may be heart-warning for the person with nottled.enanel to know that the condition of his tceth ís causingthe pubric heal-th authority no sleepless nÍghts; but byvrhat ri6ht does the authority decide that the mottled.enamel is of no significance to hirn?t
(?) Teeth with Þfot tled Enane1 are Inperfectlv For Ìne rì .
ït has been known for more than sixty years that fluorosedteeth are structurally wealc and rwhen the teeth do decay
the frail- condition of the enameÌ makes it extremerydlfficult to rnake good and effective fiIlings. r (Black and
IufcKay , 1916).
99
Dr Kaj Roholm, in hie cla$sic nonograph uorine Intoxication
wrote , Ln 1917 z
rThe enamel changes must be regarded as lrreparable;they are very disflguríng, especially when acconpanied.
by pigmentation. In the mild degrees the strength ofthe tooth does not oeem to be reduced and the caríesfrequency is not remarkably high. In the severe degrees
the cnamel is brittle and the tooth as a whole littleresistanto [to caries] .
Dr C.H. Boissevaín Ugll) said:
rOnce a nottLed tooth starts to decay, however, itdeteriorates rapidly, as they are ctÍfficult to repairbecause of the brittle enamel and hard dentin. I
Much of the deflnitive research on dental fluorosis v¡ae done
by Drs l,largaret Smíth and H.V. Smith (1940). They said:tThere 1s ample evidence that rnottled teeth, though theyare someurhat nore resistant to the onset of decayr arestructurally wealc, and that unfortunately when decay does
set in, the results are often disasterous.r
I have myself observed such rapid destruction in teeth of
PoJ-ynesian and Micronesian children who had rvery miJ.dt tormoderater fluorosis.
(8) The An¡earan ce of Dental Fluorosis rl,iottled. leethr.
In 1916, Drs G.V. Black and F.S. McKay described the
appearance of teeth having dental rnottlingr, saying:Itr'Jhen not stained with brown or yellovr they are a ghastlyopaque white that comes proninently into notice when thethe lips are opened, which nateriall.y injures theexpression of the countenance of the individual. e
rn the pro-fluoridation literature, teeth which were described
as tghastly opaque whiter are now cal-Ied rpearly white,. An
100
artlcle Ín the .Iournnl of the Âmerican Derrtnl Associat l.on by
Dr V.L. Dlefenback 9$!.(965) claimed that fluoridatl_on isa rcoemetic enhancementr making the teeth more beautiful_.
Tbe lesione of dental fluorosis are initialty vrhite but,
d.ependin6 on the degree of damage, and unknov¡n factors, the
area may later take up brown stain, rnost comnonly seen.on
the upper j-ncísors. Attenpts to remove this stain are
usually unsatísfactory, and the staÍn returno. As theirpreEence ruins the appearancc of the child, and nay induce
a narked psychological reaction, they must be renoved by
crowning the teeth or in some cases fÍlring the affected
areas. AbrasÍon of t,he stained areas vrith pumice (a
practice amongst Micronesians) rnay rcmove most of the staj-n
but, of course, eevercly damagee and weakene ühe tooth.(Sutton | 19?8),
(e) The Unknown Prevalence of Dental Fluorosis in Víctoria.
rt ís not suggeeted that a large proportion of children inMelbourne who have been cìri-nlcing fluoridated v¡ater since
birth wilI, when their teeth erupt, exhibit dental fluorosiswhich wJ-II 1n a few years time become stained. present
evidence is inadequate to aosess the risk but, because ofour exceptionally rsoftr water, it is very likely that theprevalence of fluorosis rvilL be unusually high. (Twelve
insurance conpaniea r¡rere ap¡roached to find out whether theywould Íssue a poJ-Ícy to cover the cost of repairing thedanage to teeth frorn dentar fruorosis. /rrr of thom
refused to write such a policy. )
The MÍcroneer.ans rnentioned above lived or, "o""tatolls until the age of at leasü sÍx years and,, during the
101
devel-opment of their tooth enamel¡ dranì.- rainwater ancl water
from ehallow welle containfng O.2 to 0.7 p.p.m. fluoride.
The atmosphere was f¡ee of fluoride from industrial
pollution, but they woulct obtain some from sea spray and
from their dÍet whi.ch contained seafoods.
( ro) The fmnortant Factor of Climate - DaiIy Temperatures.
Snith and. Smith (1940) said:
r.. to one who is familiar v¡ith the disfiguring defectknown ao nottled enamel which affects the teeth of everyperson who drinks water containing as little as 1 p.p.rn.of fluorine during the years of tooth formation, thisrecommenclation [to introctuce f luoricl¿rtion] seems, to putit mildly, unsafe. I
Their observations were made in Arizona, where Drs D.J.
Galagan and G.G. Lamson found.- in 1953, that:rln the water supplies of the Arizon¿r conmunities studied,concentrations of fluoride above O.B ppm resulted inobjectionable fluorosis; concentrationo of 0.6 to O.Bppm resulted in an occasional diagirosis of fluorosis;
, concentratlons belorv o.6 ppm did not cause objectÍonablef luorosi.s. I
In those commuhities thb mean €inh\ra1 temperature vlas
between, l9 and 22 de6rees C, which is sirnilar to that ofMelbourne rvhich ís 19.! degrees C. (Of course inland
country districts are higher. )
The eummer temperature, not the mean annual one, isthe temperature to be coneídered when discussing the question
of tlental fluorosis. Normally the consumption of water,
and therefore of the fluoride it contains, increases in
102
eiummer. unrees t,hat increaoe is offset by a decrease inthe intake of fl-uoride fron food and ot,her sourceg, the
probabillty of thc development of fruorosls, and of its more
severe grades, is increased. rn Metbourne, the mean maximun
temperature for January is 26.J degrees c - almost twi_ce
that for July, 17.! degrees C (Bureau of Meteorol-ogy).
The importance of ühe high summer tenperature
which has been disregarded here - ís weÌr recognized ÍnRussia. Drs R.D. Gabovich and G.D. Ovruüskiy (1g??) saiC:
I rt is advisable to send chÍl-dren living in centers ofendemic fluorosis to a resort for z-3 months i-n thesunmer where the v¿ater is low in fl-uorine. Examinationswhich we made in communitÍes whose drinking water contains1,5-2.5 ng/r fr-uorÍne showed that children v¡ho Ief t agiven locality for 2-3 months for a number of years inearry childhood either had no signs of fluorosis orwere affected with nild forms of the d.isease. Themajority of chÍrdren vuho dicr not leave the encìenÍc regíonreveal-ed fluorosis danage, including severe forms. r
vüilI those chirdren who develop fruorosis here show evidenceof a seasonal_ variation in intensity?
(l t ) Shorr Periods of Chronic Fluoride Poi.sonin g Produce
Dental FIuo rosi.s.
!'Ihen enamel- is deveLopÍ.ng, only short periods of chronicfruoride poisoning (or poisonÍng from some illnesses ) aresufficient to produce a band of nottred enamer. rt íssurpri-sing, but that basic fact ís not alv¡ays understood,.
Even the chairman of the Fluoridation conmittee of the N.s.vf.Branch of the Australian Dental Association in 196g assuredthe public that 116 yearsr constant exposure to 2 mg. per
10';
day ís necesßary to pr.ocluce vleibly objectionablc fluorosis.l
(Freemanr 1968).
The short periods required were demonstrated, as long
ago a6 19771 when Drs }fargaret Smith and Edith Lanl.,z fed
fluoride to albino rats or gave the animaLs subcutaneous 01.
intranuscular injections wíth sodium fluoride. By injecting
fluoride revery other dayt, they foundt in erupting incisors:tEight ringe of abnormally dul1 white and corroded areas
alternating wlth normal pi6mented. areas. I rAs in the
case of hurnan teeth, normally formed enamel did not become
motù1ed upon fluoride intake.r
(re) The Concentrations of Fluoride at which Dental
Fluorosis 0ccurs.
In Colorado, fluoride naturally present in the water supplies
produced clental fluorosis which was conmonly known as
fgolo¡ado brown stainr. fn 1933, Dr C.Il. tsoissevain
analyzed 169 water supplies in that area and compared the
results with the prevalence of fluorosis. I'Ie found rvery
litt1e mottled enameLr in two cities wiüh O.J p.p.m. and
O.2 p.p.m. fluorj-de, and said:
rWe have seen that wherever fluorine-containing water isdrunk, mottled enamel aPPears.r
lle concluded by saying:
tChildren less than five years old should drÍnk water
free from fluorine. I
104
Desplte such reports, supporters of fluoridationused to say that no dental fluorosls could occur with
fl-uoridation at 1.0 p,p.m. They now admit that ten per
cent of children who drink water containing that
concentration, from birth, r^rill develop some degree of
dental fLuorosis, (N.D. Martin, 19?9).
It is hi6hJ-y probable that that estimate is a
coneervatíve one, for there have been many reports of dental
fLuorosÍs occurring at much lower concentrations of fruoride.seve¡al of these, from di-fferent tÍmes and from differentlocations, will be nentioned to Íllustrate that point.Dr D.c. Badger (g+g) said that ldentar fruorosis was
observed in Jo per cent of the children who drank water
containÍng O.9 p.p.m. of fluorine. I
Ðro K.A. Rosenzweig and I" Âbkewitz (lg6l) studied an area
in rsrael which drew its drinking water from twenty werIs.Their fLuoride content ranged from O.t5 to O.95 p.p.m., rmost
of the 20 wells containing O.66 - O.lJ ppmt . They saidthat the rfruoride content of the locar. water supply . . i.s
definitely too high, and the anount of fluorosis observecl
is not justified by the sli6ht reduction of caries prevarence.rDr K. Ueda et al., (t964) for.r¡d that, in Japan:
rcontrary to the prediction, considerabr-e numbers ofvery nild and mild cases were stilr found in the do¡¡esticwater group consuming as littLe as O.þ to 0.6 ppn bffluoríne. r
Dre R.D. Gabovich and G.D. Ovrutskiy ('tgZÐ said that íncountries with a hot climate, such as rnd.ia and lr{orocco,
105severe dentar fluorosis damage io widespread whr.re
fLuorfne concentration in drÍnking water is only O.r_O.5mg/r, I
Dr S.S. Joll-y et aI. (,tg?lU) studied ende¡ric fl,uorosis lnthe Punjab, fndia, and eaíd:
fBecause the ninfnun threshold for the causatfon ofdental fluorosis is well bel0w 1 pp¡n
- possibly inthe range of 0.5 ppn
- the rever of 1 ppn fluoride inwater accepted as safe in the western wo¡rd is notapplÍcable in India. ft rnust be emphasized that nolinear relationship exísts betvreen the r-evels offluoride in water and the inciclence of dentalfLuorosis. r
The fluoride content of the water supply is onlyone factor, although a very Ímportant one, in cleterminin6whether fluorosfs rvil_I develop in an individual. Thereare nany other factors
- vrhich will be r¿entÍoned r_ater _in the water supply anrl in individuals v¡hích modÍfy theprevalence of dental fluorosis.
XIV. 106
TIIE ' O}']]TMIJM I ITLUORIDI ; C'ONO]JTITIIIITI Or{ Ill Ul(IlIf,IltC t'üÀTttR.
ïn the ftuoridati-on riterature the words roptimarr and.
toptimumr are used frequently in connection v¡ith the fluorideconcentration of the drinkÍng water and,, much less often,when speaking of the totat fruoride intake, includ.in6 thatprovided by the r+aüer supply.
l'ühen a naturarly or artificially fluorid.ated watersuppì-y is described as having an roptimal fr-uoride concen-trationr, the author considers that the concentration isthe nost favourable for the teeth. !,Ihether the ingestionof water containing fruoride at that rever is ad,vantageous
or detrinental to the other parts' of the body is veryrarely considered. l\s one consultant physician said to me:
rYou wour-d thinrr that the body was nothing more than aset of teeth. r
l¡Ihen the roptimalr concentration of fruoride isunder rìiscussion, not only are other organs of the bodyignored but also the period.ontar tissues v¡hich support theteeth and' attach them to the bone surrounding trreir roots.Few comparisons have been made betureen the condi-tion ofthe periodontar tissues of people rivÍng in naturalryfluorídated areas and the condition founrl in those who havelow-fluorj.de water supplies. ln any case, it should. not beassumed, as has been d.one, that the resurts of artificialfluori-datÍon wirr be the sane as those found. in naturallyfluoridated areas. professor per Ottestarl (1969) said that
107
a comparf6on of the clata publiohed 1n fLuoricl¿rtlon trials
Bhows that:t . . a hypothesis that assunes fluoriclated vrater to have
the same effect as water vrith thc sarne natural- fluoride
content r cannot be accePtecl. I
l4ost aclvanced perioclontal disease, J.cadi-ng to
extensj.ve logs of teeth, Ís seen in adulto aged io years or
more. As artifj-cÍal fluoridation comnenced in Anerica and,
canada just over thirty years ago, it is still too soon to
gain any real idea of its effects on thc prevalence of
advanced periodontal disease ín adults j-n llorth America.
Of course the effects in Victoria, rvhich has exceptionally
soft water supplies, could be considerably different frosl
those seen in Arnerica.
One inporLant factor in producing periodontal dísease
is the presence of abnormal trauma betv¡een contacti-ng teeth.
This is usually reduced by attrítion - the wearÍng away of a
lart of the teeth. It is etated that artificíaI fluoridatÍon
will harden the tooth enamel - with higher fluoride
concentrations in the water brittle enarnel is forrned. This
hardenín6 may reduce the rate of nornal attrj-tion bet,ween
teeth, and therefore increase the trauma on ühe¡r, leading
to an increase in periodontal disease and to tooth loss j-n
adults.
The idea of instituting artificial fluoridation
aroee fron observations made in the U.S.Â. that, although
dental fluorosio occurred Ín naturally fl.uori-dated areas
the caries rates were low. The leveL of 1.o p.p.m. fluoride
was selected for use in the Grand Rapids project because it
108
was considered to be the hJ-6hest concentratlon of fruoridewhlch could be added to a water suppry wr.thout the
associated indcx of dentar fruorosis being sufficientrybigh to be of public health significance.
În 1950, Dr II,C. Hodge publÍshed a graph (using a
logarithmic scare) v¡hich clepicted the avcrage index ofdental fluorosis, in children aged 12-14 years, ín 2j u.s.citíes. These varues were d.ravln as tv¡o straight Iines,one for towns v¡ith 1ess than 1.0 p.p.tÌ1¡ fl_uoride in theirwater and the other f or the reroaining tovrns, wÍth a thirdstraight line shorvin6 trr.e avcrage dental caries experiencefor those chirdren in each town. These three rinesintersected at a point indlcating approxinately 1 p.p.m.f ]uoride, IIe said:
rThis poi-nt is probabÌy thc best avail¿rbl-e guicle for theselection of the concentration of fluoricle to beestablisÌ:ed artificiarry in crcmonstration studies oftbe effectiveness and thc safety of fl-uorides in thecontrol of denl"al caríes. r
Later the fluorire concentration usecr in Americansche¡nes v¡as adjusted to take into considcration the crimate.The .¡Jtlo ch::onicle said that the f optimum level is not anabsolute va1ue, it may range frorn 0.6 pp, to,l.2 ppr.,(r,vtto, 1g6gb).
fn 1953 the N.ll.& ¡1.1¡.g. resolved (in part) that¡t..it is emphasized that concurrent research r-s essentialin order to assese the resur-ts of the treatment of thewater and to determÍne accurately the optiraumconcentration of fruoride unde¡ AustraÌian conditions. r
109
The N.H.& M.R.C. contínued:
fTho anount of fl-uorlno to bo adrlcd nuet bo carefully
detorminod and adJuotod to meet climatic and
environmental changes. I
IAproperlycontrolleclnationalstudyofwaterfluo¡idation under Ausüralian conditions should be
instituted irnmediatelY. I
Unfortunately, no stucly was commenced'
The Dírector-General- of the Wi.lO (969a) said:
rFluorÍdation of public water supplies requires an
accurate maintenance of the optimal- Ievel, which may
vary from 0,6 to 1.2 p.p.nt. for clifferent geographic
and climatic areas and. according to seasonal changes
in mean temperature and average d'rinking-v¡ater
consunption fi6urês o I
l.iowever , in 1)11 , the N.H.& I'i.R.C. recomnended that, in
Australian fluorídation projccts, ra uttiform concentration
shoulcl be maintained irrespcctive of seasonal variations
in the particular area concerned. I That advice has bcen
adopted by the victorian llealth Commission - confirmedt
as far as \^ras possibÌe, by noniùoring the erratic donestic
concentrations. The important factor of rseasonal changes
in mean temperature I rnentioned by the Director-General of
the VJHo. (1969a) has been ignored. Also' although the
raverage drinking-water consurnption fisurcE;r, if they were
known, would alnost certainly be considerably different in,
for instance, Mildura and l4elbourne r thê Act leaves it to
the discretion of the llealth Commission to specify the
maximum concentration of fluoride to be uoed. Another
factor is the increasing use by children of prepacka6ed
drinks. The fluoride content of those sold in Sydney
110
varies considerably (Enno , 19?5; Enno et al. , 19?6),
Those promoting fluoricration otrivc to give theinpression that water containing approxirnately 1 p.p.trr.fluorlde is the normaJ- situation, and that arr- waters whichhave a lower fluoride concentration are rfluoride deficienü,waters. The official fi6ures, j.n the book lriatural,FluotideConte¡ t of Comm unal Water S pplic s fn the Unj.ted S tates(u's' Depa'tment of Hear-th, Bducation and r¡Ielfare , 1g5g),show that, at that tÍne, only 1 r9O3 conmunities, with apopulatlon of írgjzrJoz lnað, one or more water sourceconüaínlng at 1east O.Z p.p.m. fLuoride. The authore ofthe fluoridation trial in Evanston (Uiff et al. , 1g49) saidthat tapproxinately 4,to? per cent of the entire populationof the unrted statesr had racces. to a corn¡lunar water eupplycontainLng fluorine in the anount of O.5 pprr or r¡ore. r
Therefore, Goon after artíficial fluoridation comrnenced, inthc u"s., more than g5 per cent of the populatfon lrere usinSwater supplÍes contaÍning less, in nany cases considerably 1ess,than half the leveI of approxinately 1.O prp.m¡ fluorideused Ín artÍficÍaI fluoridation. of couree the v¡orld averagefor the fluori-de content of domestic water supplies is notknown, but the WIIO (,tg6gA) stated in Íts Chronicle that:
rSurface waters are generally 1ow in fluoricles (lees than1 ppn) ' vrhíle underground. or subsoir- waters, which havea greater opportun'ty to contact fr-uorine-bearing rocks,usually contaín hig.her Ievels. r
Therefore, d'espite sta'bements by those pronrotingfluorÍdation, domestíc water eupplíes containir?g approxiroately1 p'p'nr. fluoride naturalry are not the usual conditíon in
111
untrcated watere. On the contrary, they are distÍnctIy
unusual, and comprise only a very 6maII minority of natural
water6.
tIt is consequently prima facie improbable that the
biological evolution of hunan beings has resulted ina constitutional need for fluorides. I (Doug1as of
Barloch | 1960),
In many area6 Ít is obvious that the level of 1 'O
pop.rh. fluoride in a water suppl-y is too high, even 0.6
p.prÍìr - the lower end of the range of concentrations
mentioned by ti-re 1rIHO Director-General (1969a) . This is
inclicated by the development of levels of dental fluorosis
which are t objectionable I even to the public health
offj-ciaIs. (senstbl-e people who know tha.t fluorosis is a
sign that chronic fluoride poisoninS has occurred., surely
must consider that any levef of fluorosis is unclesirable.)
As was seen in section XfIIr in certain areas
many cases of fluorosis r¡tere observed although the fluoride
concentration was as Iow as o.5 p.F.rn. (tcaa et aI ., 1964)
and even O,J to O.! p.p.m. (Gaboviclt and Ovrutskiy, 1977).
The resolution on fluoridation passed by the Twenty-second
Worlcl Eealth Assembly (WHO, 1969c) | said that fl-uoridation
should be introduced rwhere the fluoride intake from water
and other sources for the given population is below optinal
levels.r Therefore, in areas in whj-ch the amount of
fluoride ingested fron sourc€.)s other than water is
sufficient to produce dcnt¡r1 fluorosis, the optimum
concentra.tion of fluoride j.n the water supply is zero.
xv.112
OTITBR SO URCDS OII FL RIDE.
the WIIO rosolutfon on fluortdatfon ( 1969c) etatod that rothe¡sourcea0 0f fluoride nuet be taken into account when
deternining the fluorrde concentration considered desr,rablefor a donestic water supply.
sources of fluoride other than fron water suppliesincrude: (r ) Food , (z) Toothpaste and medicaments and(l) rne atnosphere.
3) Ftuoride t-n Food.
In the inportanü etudy Environme ntal Fluoride 19 ?? (Rose andMarier, 19??) it was stated:
r.ne of the major factors thought to be contrÍbuting tothe increase Ín human exposure to fluoride is theincreasing fruoríde content of foods. such an Íncreasecan ariee fron three main 6ources, namely, the use offluoridated water in food and beverage processing, theexposure of crops to airborne fluoride (and to water-borne fr-uoride in areas írrigated. v¡ith fluoridatedwater
- Auermann, jg?, ) and the use of fluoride_contaÍning fertilizers. r
Drs R.D. Gabovich and G.D.Ovrutskiy (lgZZ) said that theanrount of fluorine in the diet is affected not onl_y by theamount in indlviduar- foods, but also by a number of otherfactors. They {nclude the nature of the peoplesf fooclwhich is determined by ühe quantítative amounts of indivÍdualfood products in the diet, culinary technique, the anount offluorÍne in seasonÍngs and preeervativee and, ffna'ly, ühe
11'
possible tranefer of fluorine to food from the cooking
veseel. That posclbllity wae raioed by a study tn 1975
which found that when fl-uoridated water (t p'p'ln' ) was
boiled d,own by between a half and a third of its volume
the concentration of fluoride increased to nearfy , p.p.lll.
(futf and Parkins, 19?5),
Fluorideismuchlegstoxicj-nfoodthanitisÍn
water (Steyn | 1g58b) and the rate of absorption from solid
foods is slower and Less coutplete. (Weddle and ¡iuhler,
1954t N1arie r ' 1964) .
Dr G.L. Vialdbott (g6l) surveyed the fluorid'e
content of foods, and concluded:
rFluoride is present Ln nearly every food; the highest
concentraticns are found in tea, seafood.¡ bOne neaI,
spinach and ¡3elatj-n, the least in citrous fruitetvegetables, eggs and milk. The amount of fluorideion taken into the system in food is unpredictable;
it is dependent on numerous factors pertaining to the
food, its processing, and preparation, and on the food
habits of the individual- consurxer.l
At present there is a I gener.al l-ack of current information
on the fluoride content of foods and beverages. | (Farkae
and Parsons, 19?4). In view of the increasing consumption
of bottled and canned. drinks, a study in Syd'ney (Enno 9!-4. ,
19?O is of interest, for it found that a najority of those
drinks had rfluoríde concentrations well below that of
Sytlney waterr, which is fluoridated.
Another factor wílL arise if we foÌlow the present
American ctaze for drinking bottled Imineralr vrater.
rAmericans are expected to spend $ tff million on the stuff
this year.r (tAget, Aug. 2?t 19?9). In America, Iow-fluoride
114vrater is sold for children, to prevent dentar_ fluorosÍs..Dr E. Auermann (19?3) pohted out that:
tDuring thc course of ycars, the totar- fluoride uptakeincreases because of trre rise in fruoride revel in foodproducts. r rKnowr-edge concernin¡1 the dietary totalfl-uoridc uptake in humans is stirl lirnited in spite oftre worldvride propagation of fluoridation of drinkingwater. I
A review of the toüaI fruoricre intake and fruorlde contentof cornrnon foods (Caro1 S. Farkas, 19?Ð e uggeeted thaüthe data on the fruoride content of foods ehourd be updated,and said:
trn current publicatione and textbooks most data regardlngthe fluoride contcnt of cornmon foods as well as tablessho'ing the average <laily intake of fluoride in varfouscount'riesr are based upon víorrt carried out up to thirty_seven ycar€j ago. Such work does not al_Iow for theeffect of fruorictated clrinkin¡5 water on fluoride levelsof processed ancÌ cool<ecl foocls. r
rData in tabl_es published in ilre 1ÇlOts, cj,ting averagefr-uori.e in6estion, were found to be based upon a smal'sarnpJ-Íng. some figures presented were found to includemisquoted data. r
The author mentioned cases of:... the biased choice of data whi_ch constitute thefor the conclusion that [diets are usually low Ínfluoride and remarkably uniforn world widen. r
basis
(she cites Drs H.c. Ilodge and F.A. smit'as the authors ofthat claim, both of whom have been prominent promoters offLuoriclation for more than twenty years. )The review conti.nues:
rrn view of these factsr one cannot but question thereliability of or-der data in tabros utilized ín 1g?o
115
and later to indicate that little fl-uoride is consumed
in the diet. I
(a) tr.luoricle in processed f oods. Dr E. Auerrnann (19?7)
said that the ftuoride l-evels in processed food:
| . . . dif fer f rom those of rar'r products t dependin8 upon
the method used in processing and the naterial with v¡hich
the food. comes in contact during processin¿¡. On the
other hancl, in food which was prepared v¡ith fluoridatedwater, 2 to I times higher fluoride Levels were found
than in food in a nonfluoridated area. I
It was estimated that the:
r... widespread use of fLuoridaterl vrater (1.O ppm) infood processin6 and preparation wil-l- probably nean afoodborne fluoride intake of cq 1.O-1 .2 mg per day. I
(Mari.er and Rosc | 1966).
rAlthough the Marier ancl Rose data vlere avai-l-ab1c in the
literature, the 1970 'I'IHO report on Fluorides and ilurnan Health
rcliccl upon the 1949 figures by l"lcO1ure instead of the more
recent data.' (Farkas, 1975). ('f nis section of the VrlHq
book v¡as rvritten by Dr J.C. lttuhler, another prorninent
f luoridation ad,vocate. )
(¡) Fluoride in beveraí4es. rTea, dependin6 on its source
and grades, contains large concentrations of fLuorides.l
(McCIendon and Oerston-Cohen, 1957). the many publj.cations
on this subject cite considerabl¡r different, values. The
range is a Least from BO to 6OO p.p.nl. fluoride. (Schatz
and Schatz, 1972). A Russian report (Gabovich and
Ovrutskiy, 197?) said that if it is taken into consideration
that the average amount of fruorine in domestic varÍeties
116
of tea is lO ng/l<g,, then with the prcsence of ?Oilt, water_soluble fLuorine, 1 g of tea is the r;ource of O.O! nrg offLuorine. In Britain, otrong tea c¿rn cont,¿rin up to 0.6-1'4 ng/r of fÌuoride ancì a cup of tea as nuch as 0.5 rng off luoride (t'Íartin , 196j) .
rn a tea-dri'nking community, such as victoria, tea must be
an important source of fluoride.
In beer, the aynount of fl-uoride depends on thefluoride concent¡ation in tÌre water, and is cr_ose to it,.(GabovÍch and Ovrutskiy , 19??).
caror Farl<as u9?5) poÍnted out that thc reliability ofolder data shourd be questioned even thou8h it has been
used in tables published recently. She saicl:tAn j_nteresting case in poj_nt is the figurc given forthe fluoride content of beer in the r,rJlio tabre, namelyO.2O pprn, a value dcrived from a paper by p. Cliffordín 1945, as recorded in l,tcClure rs 191¡9 table. Forbeer processed with fluoricraterr v,,ater l4arier and Roseobtai ned .68 pprn fl_uoride.presented the 1ower 1945 da-ta
Yet
oc off A m JJ. PubI Hlth. Rep . | 64: 1061,
uor ide in watere dve
the hltlO report in 19?O
McClure. r (C1ifford,z 277 , 1945; trcC]ure,1949),
tables. Professor A. Schatz
by
28P
.tl
(c)
and
F1
Dr Vi-vian Schatz in 19?Z pointed out that:rvlhat happens v¡hen fluorine is adcled to the soil dependson such factors as the forn i-n rvhich it is applied, theamount of fl_uorine, how rnuch lime ancl phosphate arepresent, the species of plants Brown, and the soil typeand its geol_o¡;y. r
They cited severar papers whicrr indicate that there can bea considerable íncrease in the fluorÍne content of common
11.7
foods, nainly due to the use of fertilizers. In one
distrlct in Japan, durin¡ç a poriocl of ceven years the
fruorido content of wheat rose by 64!1, of pumpkln by 4zgl¿
and in waternelons it increased Uy B3l%.
The 12th rnternatíonaI convention on vital substances,
I"trutrition, and CivilÍzation Diseases, at hague, said that:rrhe fluoridation of drinkin6 water rercases a fluorinecircuÍt which incLudes ve6e bables, fruit ancl otherhorticul-ttrral products as wel1 as nilk, and has anuncontrol-1abIe effect on the human organisn. r
(International Society, 196?) .
Recently Dr B.s. l{a.lker Ogzg) of canberrar ¡.;ointed out thatfar more water is used to irri¡4ate vegetabre gardens than
reaches the nouths of schoô1-age children, and. that vegetatÍon
absorbs fluorine fron the soíl. IJe then askecl:
I rn the light of the above, can anyone rf exper¿rr or not,give me an absor.ute assurance that the r-ettuce grown inmy backyard v¡irI never become toxic throu6h excess fLuorine. r
That problem d.oes not appear to have been inveotigated.
(¿) Fluoride S a d fruits andve tables. Fluorideresidues on and in fruits and vegetabJ-es, from the use ofa6ricuÌtural sprays, can be considerabre. rn 196g ttreÌ{.il.& }',I.R.C. listed :
rsubstances vrhÍch, rvhen used as directed, usuarly resultin detectable residues in or upon foods and for whichthe followíng tolerances app1y. r
This List inclucles soclium silicofluoride (as F), ? ppm.
(l'1e1bor-¡rners water is fluoridated by aclding a sodium
118
ofllcofluorÍde slurry _ Hirth , j9??).
Slnilar]-y, ín 19?6, the U.S. ItnvironmentalProtection Agency stated:
rA toreranco of ? parts per milr-ion of cornbined fruorineio estabr-Íehed for resÍdues of the insecticidal fluorinecompoundo cryolite and synthetic cryoÌite (sodiunaLuminium fr-uoride) Ín or on each of the forlov¡ing rav,agrfcultural commodities. t
The r-ist mentioned 4g varieties of vegetabres and fruits.According to Dr D.C. Badger (1949), that level of Z p.p.n.was established by the U.s. Food and Drug Administration onthe testimony of Dr H.V. Smith ancl co_v¡orkers.
fEach [ree g""mJ apple thcn contains 1.16 mg of fluoríneor the equivalent of 1.16 ppra of fluorine in 1 liter ofwater' This wourd cause mÍ'd mottling of the enamelif apples are eaten consistently, even though ühcre isno fluorine in the drinking rvater. r (Smith , 1949),
The use of agrlcur-tural oprays has increased greatry. IIov¡often nowadays doos one find a 6rub in an appJ-e, or evenbetween the 1eaves of a green vegetable?
(¿) Fluoride Ín tooth Paste. mouthwas he s and t,ablets.The J.mportance of toothpaote ar a source of fluoride intakehae been dlorogarcled. The danger of repeatcdly srvalrowingfluoride tn toothpaste, two or three tines a <ìay, in acomrnunity with fruoridated water has not been brou6ht tothe attention of the publi-c, and children are pernitted touse fluoridated toothpaste without supervision. Dr J.L.'HardwÍck (lgzs) found that 'chir-dren aged 4 and under areprone to swa110w nuch or alr- of the d.entifrice they use. r
119
The Departnent of Hea1th, German Federal Republic
g9?6) said that vrhen fluoridation is present it is of the
utmoet importance that a simultaneous additive intalçe of
fluoride from toothpaste, tablets or oalt does not take
place.
IIost toothpastes sold in Victoria contain fluoride.
American trial-s used concentrations of frorn fOO to 2O0O
p.p.n. F (Stookey | 19?O), The amount of fluoride ingested
fron toothpaste varies in d.ifferent studies t but it can be
considerable. In teenage children a single brushing with
a dentifrice containing O,15% sodiu¡n fluoride resulted in
a fluoridc retention, for each time of brushin6t of about
6O% ot the solutrle fluoride and io% of the total fluoride
content of the clentj-frice (v¡ink.ler et aI. , 1953). l/üith
the recent introduction of fluoriclated toothpaste with
various attractive tastcs, thc quantities svrallovred may be
expected to fncrease, particularly in the case of young
chiLdren who, with their 1ÍB'ht body weight! are extremely
susceptible to an overdose. 'l
Dr Ingricl TIellstrom ?960) found that rfol-1owin6 the
use of a 0.1% NaF mouthwash, an average of 2.0 rng of fluoridein adults and of O.85 nS in children was retaineclr. That
is nore than three ti.lnes the dose recently su,ggested for
young children consuming fS.uoride tablets. (Council on
Dental Therapeutics, 1977). Of course, if the rnouthwash
was used more ùhan once a day the overdose would be even
greater.
* See appendix 1!, p. 2?6.
120
For many years the use of sodiurn fluorr.de tablets,containÍng 1 mg fluoride, has been advocated by somo clinf_ciano for children living in areas Ín which the water suppryís not fluorirlalied. rnÍtially the dose reconnended wae onetablet (1 m6 F) per day, but because of the development ofdental fluoro,sie in many chlldren usÍng that dose, ín 1g67tbe American Medical Association suggested that, for cbildrenless than three years old, the daily doee must not exceedo'l mg. rn 19?? the counci.l on Dentar Tberapeutfcs agai.nhalved that dose, for chÍrdren less than two years o'd, toO.ZJ mg per day quarter of the dose origlnallyrêco¡nmended for those chir-dren. Tabrets containingO.J mg fluoride are now available and O.25 mg, ones will beon sale soon. This matter is discussed in section xxvr whlchdernonstrates that there Ís no safcty rnargin with fruorÍdation.
Ân important problcm whrch occurs in victorla, issome parents continuin6 to administerto children drinkÍng fluoridated r¿ater.
Fluorídation was introduced ínto lufelbourne wlth very lfttlepublicity, ancl nany people stilr clo not know that they aredrinking fluoridated water. *
rn 1962, the u.s. public llealth service Íssued awarning, throu¡gh professor p. Jay, that in areas withfluoridated water the use of flúoride tablets and othersupplernents was not only unnecessary but was defÍniterycontraindicated. (llalabott et al-., 1g?g),
However, in Australia pro-fr'oridatfon spokesnenhave taken the opposite view. professor N. vrartin (lg?r),
* Se" appendix ,tb, Þ. 255.
ühe practice offl-uorirte table bs
121
ín a statelnent endoroed by the Fluoridation of Public l{ater
suppllcs Advioory council of the N.s.l1l. Dcpartment of lleal-tltt
said:
tÂfter the age of six when the artterior teeth are fully
formed, and there is no possibility of any unaesthetlc
fluorosisr a parent..... could be advisecl with safety
to continue the oupplement which was being usetl prior
to fluoridation. This woulrl then at the maximum levelof intake represent no more than the consumption of a
drinkingvlatercontainingtwopartspermillion.I
The chairman of the Fluorirlation sub-co¡'nmittee of the
victorian Branch of the Australian Dental Association
(Levant | 19??) said:
rThere is an extremely wide tolerance, ancl the talcin8 0f
tablets after the introduction of fl-uoricle into the
water supplies is not clangerous. r t
The chairman of the FLuoridatj-on committee of the N.s.l¡J.
Branch of the Australían Dental Associatíon (Ireenanf 1968),
at the time when sydney water was being fluoridated, oaÍ.d
that rthe approprÍate authoritiesr recommend that children
ingesting fluoride eupplements continue to use those
supplernents for approximately six ¡nonths. Iie said:
t It is obvously possible that r at times up to this cut-off date ¡ so¡tê chil-dren will be ingestin6 the equivalentof 2 n6. of fluoride per day. It should be clearlyunderstood that no harm whatsoever occurs at thÍs leveÌ. I
rOver a period of ¡rontbs onlyr ít is reasonable to expect
no discernible effecto. I He consiclered that r16 yearsr
constant exposure lo 2 m6,. per day is necessary toproduce visibly objecti-onable fluorosis. I
That is an extraordinary statement for it is widely known
* See appendix 2a, P. 255.
122
that, far frorn requiring r16 yearsr constant exposure to
2 nlo pêI. dayt, ciental ftuorosiG can develop within a short
period (even a few weeks) of exposure to a toxlc intake
of fluoride. Indeed, all fluorosis in the incisors,
incluclíng t vlsibly objectionable fluorosisr , must have
developed when the enamel of those teeth was forming
during the first five years of life. (See section XIII).
The dose of 2 mg fl_uoride from water and tablets, every
day, stated here by tr'reernan, and by }4artin (9?t) t to be
safe for children, is a toxic d.ose. For that reason the
Ger¡nan Federal Republic Department of lleal-th said that it
is of the rutmost importancer that fluoride supplements
are not talcen sirnultaneously with fluoridated water.
(Departrnent of I'Iea1th, 19?6). *
The u6e of tablets without the fluoridation of the
water supply Ís widely advocatedt provided that the parents
are ful1y informed of the hazards. This would elininate
religíous and ethical objections to fluoridation, it would
be nuch cheaper, and would adhere to the medical princÍp1e
of giving a measured dose to the patient (and not to
others). Dr R. Feltman and G. Kosel (961) adninistered
fluoride tablets to children and to gravid women, and said:
rOne per cent of our cases presented evidence ofundesirable side effects from fluoride therapy. Itis poi-nted out that if a patient is affected by
fluorid.e, by this method, the allergen or intoxicantcan be removed readily from the diet by discontinuanceof the dietary supplement. I
t See appendi-x 1c, p. 255.
12t
(t) A'trnospherfo FLuoride.
There 1s st111 Littl-e awarenens of the importanü problem
posed by the fncreasLng polrutfon of the atmosphere by
fLuoride. rt Le a true pollutant for, except in mÍnute
amounter it is not normalry found in the atrnosphere. Except
under exceptional circumstances, such as vorcanic actÍvity,all soluble fLuoride found ín the air in excess of o.oJ¡g/ntcan be assumed to havo orÍgínated fron o,an-made sources.(Rose and Marfer, 1g?Z).
(a) Absorption of fluoride from the atmosphere Airbornefluoride nay be absorbed either directly througrr the lungs orÍndirectly. from food.
Dr A.L. KnÍght (gzs) pointed out that: rAirborne
fluorldes are readlly absorbed in the trr.gu., There isevidence of refficÍent and probably essentially-compreteabsorptlon of lnhaled ftuoride into the bocly. | (Rose andMarier, 19??),
so¡ne airborne fruori<le is self-administered as a
result of usfng those aerosor products in vrhich the
properlant contains fLuori-cÌe, and some is absorbed fronbreathing air which is contaninateil, mainry by industrialemLssfone. The fluori.de content of some anaesthetics isof importance to operating roon staff.
Inhalation fron cigarettos rrnay be another
sÍgníficant source of fl-uoride intake by hurnans.r (Rose
and }farJ.er, 19??). Those autho¡s saicl that Okanrura and,
MatsuhÍsa (965ù found a range of from 35 to 640 ppm F in
124
cigaretteo, with an average of 16' ppm for Japanese
cigarettesand2g6forAmericanonesyielding,respectívely'
157 and 244/^8 F Per cigarette'
In view of the present evidence that fluoride is a
carcinogen, it could weII prove to be a major factor in
the association between cigarette smoking and lung cancer'
ch into Environmental PoIl"utíon l/ùIlO rePortt 'Resear
includes fluori<le, with arsenic and beryllium' in the loca1
air potlutants rbecause serious 1on6-term effects have
occurred in man and animals living in communíties adjacent
to industries emitting these substances'r In a table list-
ing tAir pollutants with reco6nized or potential long-term
effects on health at usual air-pollution levels I the report
said that fl-uoride causes fluorosis and rpromotes orI
accelerates lung disease ' | (tnlito
' 1968 ) '
(r) Indus trial- l-ut ion . Both Melbourne ¡rnd Geelong haveI
a nur¡bcr of índustries of the types Ìisted as major emitters
{.i}of fluorj-de Pollutants '
The situation in Ì4elbourne may improve vlhen the new gas-
povrered po'¡Ier station replaces the present briquette (brown
coal)- povrered one which is situated' only four miles' and
usually to windvr'tr<l, of the centre of the city' Tn 19?4r
the journar Fluoride abstractecr a study by staff of the
university of Dresden (Däss1er gg-4. r 19?3) on fLuoride
enissions from brorvn coal- electrical power plants' This
r.lasinstitutedwhenitwasfoundthattt¡erel,'asaníncreasing
mortality amongst bees near those install-ations' Fluorides
are considered to be a major cause of cleaüh of bees in
rþ see appendix 12a¡ p. 271' {# see appenclix 19ar Þ' 282'
125
Drs R.D. Gabovich and G.D.around fluorine plants rman
fl_uo¡ine r¡ith air per day. I
rial region of Lincolnshiret with hyclrogen fLuoride that* See appendix .19b, p. ZBZ, ilt
*l* 5"u appendix ,t/a, p. 2T6.
industrial areas. They found that when the coal was burnedat IOOO degroes C, between ZB and 1OO per cent of thefluorlcle contcnt eetcapos as a gaoeouo eompound. Theauthors estinated that emitted fluoride gas traveJ.s betweenone and two kilometers, in contrast to dust contalnÍngparticulate fÌuorÍde which has a wider expansion radiusaepeúaing on the topography of the area, ,re height of ,rechimneys, partj.cle sj-ze and, rnany other f ctors. They saidthat enissÍon of fluoride from power plants has receivedlittle attention and damage to the environment near suchpJ'ants is usuarJ.y aÈtributed main.r1, +^ c^ *mainly to SOr.
The atmospheric fluoride emitted fron the poÍntI-Ienry alumÍniurn plant has been monitored, vrhen atmosphericconditions are favourable, as far east as Mount ElÍza, adistance of approxirnately J5 miles. However most of thefl-uoride emitted rfalls outr v¡ithin a two_mile ¡adius ofthe p1ant. (Hayes, 19?g). **
This problenr is a najor one for :trndustriar- fluoride e¡nissions into the atmosphere inthe United States total r¿oyear and BB?/o cones fron ,;"u
than loorooo tons per
tÍ1e' srass, porcelain, "t;"ffï, ";:ïJi,"j"jl;
ro;"'"-';#;:tion
or coal.' (l.Iationar Academy or sciences,
ovrutstriy (.tgZZ) estimated thatinhal_es from 1 .5 to 12 ng
They said that rfn one Índust_(Eng.J-and) ttre aÍr is so pollutedthe grass contained up to 22OOSee appendix 19c, p. ZB3.
126
ng/kg fÌuorlne. cowe pastured in this regi.on suffcrerr fromooteomar-acia, tho fl-uorino content of thcir uri.ne reached69 n6,/r and 15rooo ms/ks in bones. Âniong chiLdren livÍngncar the plant crentar fruorosi. r¡ras vrid,espread and thefluorÍne content of thelr urine was 4.2 m6/I.t
Drs R.A. papetti and, F.R. Gil_more reported , ín 1)11 ,
that:rAir pollutants that have caused widespreacr injury tolivestock in the united states are confined chiefry totwo substance6, fluorine (fluorides) and. arsenic (maín]yas Asr.r).r rThese compounds settl_e on or react withanimar fodder, and accunur-ate to concentrations much6reater than occur in anbient air. r,ivestock eatingthis fodrrer suffer acute or chronic poisoning, resultingi-n Ìoss of strength and vreight, and frequently i-n de¡-rth. I
llowever the main sourcc of fluoricte Ín dairy cattle can bethe rnineral suppr-ements in purchased cake or grain balancers.(Crirtitrrs-Jones, 19??) .
(c ) The spreact off luoride contamination . Fluoride contam_ination of the atmosphere affects people, animals and plantsnot only in the immediate vicinity of fluorÍ-de-emittingindustries but also for a consicrerable dist,ance fros¡ thep1ant. For instance cattle ln the Columbia River valleydeveloped advanced
lameness ancl poor
chronic fluorosis, rvÍt,h bony svrellings,conditÍon althou.gh sorne of the herds vJe¡e
8 ¡oiLes fron the source of the fluorÍde pollution, analuninÍum plant. (Udall and Ke1ler, 1952).* fJñ
In her very accurate booko The Fluoride Q.ue st ion Anne-Lise*See appendix 14, p. Z?5, ** See appencìix 1/b, p. 27?.
12?
Gotzsche (9?5) said:
tAt the first Buropean Congrese on rrThe Infl-uence of AirPol-Iution on P1ante and Animalsrr at i'lageningen in ApriJ-
1968t itwao stated that aírborne fluorides had destroyed40Or0o0 hectares of European forests. It was alsoclaimed that in I'Iorway, fluoride injurS-es to coniferousforests coul-d occur at a distance of 72 kil-ometres fromthe emÍtting source. ït was stateil at a symposj-un inBarcelona 1n 1969 tnat a German survey of areas withcoaf-burning industries revealed that rainwater couldcontain up to 14 ppn f J-uoricle, or 88 times the l-eve1 inthe control areas. These leveLs correlated directlywith those found in vegetationo l"loreover, grazÍng neara fluoride-esritting factory could result Ín a lO-1OOj-ncrease in intake. fn one German survey, forage was
shown to supply nore than 90 percent of the fluoridein6ested by cattle. I
Dven when a serious attenpt is nade to elÍminate this problem
a grave situation may persist. In 1973 ít was reported
that, as a result of fluoride pollution in l.fontana:
rForest insects were found to accumurate fluorides. r rEven
though the company reduced fluori-de emissions by 6?percent between 19?O and 1971, data collected in 19?1
indicated that ve6etation in Glacier l,iational Fârk, ?
air rníLes distant from the source, was stirl accunuratingabnormal a¡nounts of fluoricle. r (Carlson , 19?3) .
rn the discussion regarding the proposed estabrÍshnent of a
very large aÌuminiun smelter at porttand saj_d to be thelargeet fn the worLd when ft tE fulry devéLoped = ¡e menüíon
seems to have been made of the effect whích atmospheri_c
pollution with fluoride nay have on the surrounding pasturelands nor
- much more lmportantly - on the heal_th of the
population (see pa6es '16?-,168),
128
(¿) Dlverse vnes of dama pe from fluoridc. The veryt
diverse typea of damage which fLuoride emisslons Lnto the
atmOsphere may produce in man, anlmals and pLants, are well
lllustrated by lnformation from Czechoslovakia. A report
ín the Journal Science of the first meeting of the
International Society for I'luoride Research (Ìfariert 1968),
mentfoned a series of papers from Bratisl-avafs Research
InstÍtute of ilygiene (Balazovar Lezovic and Ì'Ïacuch). The
report eaid that ln industrial regions:
rAir concentrations as hi¡Sh as 1.11 mill"igrams of fluorideper cubic meter were recorded; close to the factory tbe
flurlc distribution was 61 per cent solid and 79 percent
gat¡eoua. Farther avray, the distribution was 1þ percent
eolld and 85 percent Baseous. In afflj.cted. areas,fallout from fluoride-bearing particles was 711? kfLo-grams of fLuoride per square kilometer¡ that isr a 90-fold l-ncrease ovcr the 8e ftfograms per square kiLometer
found ln a control area. Surface waters, at a 10-
kÍlometer dLstance from the factory, contained 10.9
millJ.grans of fluoride per Iiter. hliùhin a J-kilometerdistance tree l-eaves vlere necrosedt had a decreased
chlorophyl content, and the amount of fluoride was 7 to72 tÍmes more than that normally found. Vegetables and
frul¡t were diofigured j.n shape and. colort and cont,ainedfrom J to 21 times more fluoridc than did control samples.
Al1 bee colonies had died, and 95 percent of the cattlet¡rere affl-lcted with fluorosis; this condition was
conffrned by fluoride analysis Ín several tissues. I
Marferre report on these Czechoslovakian papers continued:
rIn conparison wíth a control group, 1ocaI children had adecreaoed hemoglobin and increaeed erythrocyte level,wlth two to three tj-mes more fluoride in their teeth,fingernails, hair, and urine. The childrenrs dalty
129
intake of fruorÍde was estinated to be 2.15 mirligrarnsper dayr of which 1.40 milligrams bra6 0btained from food,0.55 milllgrarno from air, and o.20 rnirrigrams fromdrinking water (deep well: rou¡ ftuoride content). rnthe contror area totar daily intake of fruori-cle was 1.omilligram of which o.8 milligram was ingeoted with food.The fruoric intake in the inclustrial area was thereforemoro than twÍce that found Ín the control region. r
rft as these authors rcported, children can in6estfron atnoepheric pollution o-55 mpç of fruoridc per day -nore than half the suggested roptJ-nwnr intarre from drinkingwater, and nore than the total dose now suggested for youngchirdren
- sls¿¡ly this source of fÌuori¿u shourd have beentaken into account when the revel of fruoride to be adcred
to vlctorian waters bras decided. No evidence has beenfound that that was done.
(e) tmos rt-c uori is not monito red b the Vic torianEnvironment Prote c tion Au thority. tIn 196? | the AmericanAssociatlon for the Advancement of science risted fluorideas the third most serious aÍr pollutant i-n a group headedby eulphur dioxlde and ozone. In 1966 tne lIationa1conference on rporr-ution ancr our Environment,r in l"rontrealdecided that 'rprolonged exposure to ambLent airconcentratlons of lese than 1 part pen thousand nillionparts of air volume of fluoride nay create a hazard ...ín thfs respect fluorides are 100 times more toxic thansulphur dioxlden. r (Gotzsctre, 19?j),
t
Deepite thie, the most recont report of theEnvironnent protectfon AuthorÍty (19?g) of Victoría does
1ro
not mention fluoride. Recently a member of the staff of
the E.P.A. staLed that they do not monitor fluoride and do
not know of any Sovernmcnt departmcnt v¡hich does' IIe said:*
rlrle bave not been asked to do so'l
It is renarl"able that the llealth Departnent ' which has
supported fLuoridation for many years, has not asked' for
the testÍng of atmospheric fluoride, at least sínce it
becarne widely known, throu6h the 1968 V¡llO Technical Report
Researeh inüo Bnvironnental Pollution , that rserious long-
termlrealtheffects}raveoccurred'inmanIincotnmunities
which have industrÍes which emit fluoride. Both I'felbourne
and GeeLong have many such industrj"es' * t
As Anne-Lise Gotzsche wrote in 19752
tAgain, as Ín so rûany other fields of fluoride sciencet
the pubJ-ic hasnrt been told, the work hasnrt been donet
and the public hasnrt been told that the v¡ork hasnrt
been d,one. Fluoride Bollutj.on is not supposed to exist.r
TrutY as Dr C.G. Dobbs said ín 19722
FluorÍne is rThe Îavoured Pol-Iutanür.
ü see appendix 4h, P. 262.
It See appendix 12b, Pr 2?4,
XVÏ. 1rt
TI{E IOIXIIMUM' TOTAL }'LUORIDIj INGIT|STIOI'1.
The Twenty-second lrlorld l{eal-th Assenbly of the üIHO (1969c)
passed a resolution on Fluoridation and Denta1 Health.
This said (in part) tfrat the Assenrbly:
rRecomrnends l{ember States to examine the possibflity ofintroducing and where practicable to introducefluoridation of those conmunity water supplíes where
the fluorlde Íntake from water and other sources forthe gÍven population j-s below optinal levels. t
That resolutlon can be expressed as: o - i = f, where
ror is the roptimal levelr for total fluoride intake per
day; rir is the total- daily intake of fluoride rfrom water
and other sourcesr for the given population; rfr is the
addftional daily amount of fluoricte which shouLd be
provlded by ühe fluoridation of the water supply.
It is obvious that tbe value rft will be a strong
influence in determining the fluoride concentration
required in the water, and. that until rfr is known no
rational approach can be nade to the fluoridation of a
comnunity water supply. Furthermore, the value of rfl
cannot be known unress both ror and, rir are known. (¡.or
consideration of rir see sections XV and XVIII. )
Therefore, before commencÍng the fluoridation of a water
suppry it i-s essentiar to know the toptimalr total dairyconsumption of fluoride by the population concerned.
One would expect that this fundanentar varue wourd
be readily avairabre, but a search of nuch of the literaùure
1tz
will 6oon ehow that it ie very elusive - the hIHO Resolution
dld not otate the ¡optimal Ievelr, nor dld its Director-
General (WIIO, 1969a) , nor has anyone e16e.
Those who mentlon the matter of total fluoride
intahe stÍII place much reliance on tables published in the
early 1)lOs, such as fn the l{HO book I'Iuorides and Euman
Health (wEo, 19?ob). However, Roee and Marier (gZZ) saÍdl:
t[arkas l'tgZSJconcludes that composite tables on fluorÍdeintakes published prior to and during the early 1)lOtswere based on ÍnsuffÍcient data and Íncruded nisquotecldata" Having examined the original sources, vre
conclude that these TabÌes require major revision. r
(See aleo section XV. )
Areas of endemÍc dentar fruorosis (see èection xrrr)are due to nany of the population having an excessive ùota1
intake of fluorÍde, but generarly other factors are ignored
and the effect is attrÍbuted solery to the fruoride content
of the water suppì-y being too high. Àrso, in a cornmunity,
the rndex of Fluorosis (see section xrrr) is used to denote
whether the total fluoride intake is too high, other
examinations are undertaken only rarely. Ilor"¡ever, dentaÌ
fl-uorosis is an unoatisfactory indication of current fruorideingestíon becåuse it is alr,rays out of date. For instance
the prevalence and the degree of fluorosis in the anteriorteeth of 14-year-o]-d chitdren provides no informationregardÍn6 the current ingestion of fluoride, but it gives
sone idea of their lever of fluorÍde intalce when the toothenareel vras formÍng 9 to 14 years previously. Therefore, even
íf the fruoride content of the drinking water remains the
17'
sane r it is almost uscless as an Índfcator of the present
level of fluoride ln6estion, for thcre 1s little rioubt that
thc amount of fluoride obtalned from sources othcr than v¡ater
is increasing. Professor A. C¿rrlspon (1978) eaid:rfnformation frorn the U.S.A. and Canada shovrs that a
considerable increase in total fLuoride intake hasoccurred during the Last decades. I
He said that estimates indÍcate that the present fruoride
intake in localities without fluoridation is as great as the
initially calculatcd intake Ín fluoriclated areas.
Any consÍ<ieration of the roptimunnr or of the maximum
perniesible totar daily ingestion of fluoride must tal<e intoaccount the a6e and the body weight of the individual.Tberefore the question of total fluori<le intalte will be
considered under three headings: (i) ttre foetus, (ii)
children, and (iii) adults.(i) The foetus . Drs R. Feltman and G. Iiose1 (1961),
in their study of the administration of ftuoricie tablets
containing 1.0 ng, 1,2 mg and O.BZ5 n6 t, to t61 pregnant
vromen (witb 240 controls) ane 6?2 children tthrough thcireighth year of rife' (wítir 46r contrors), found that:
r.. fluoride ingested by gravid. women enters the maternarcircuration, is stored in tr:e placenta and passes throuۍhthe placental barrier to enter the foetar brood supply.l
Dr r. GedaÌia and hÍs three associates (964) conpared
sanples of maternar brood, cord brood and rvhore pracental
tissues, in three groups of wornen who v¡ere consuming water
with low (0.06-0.15 ppn F), medium (0.5-O.6 ppnr f.) and high(0.6-0.9 ppm F) fluoride contente. They reported that:
ß4r.. when tho fluorids íntake is Iow, fluoride freelypaoc¡es through the placenta, but when the fluorideÍntahe 1s high, the placenüa plays a regulatory roleancl protects the foetus fron excess.r
Drs R.D. Gabovich and G.D. Ovrutslciy 997?) said:I It can be assl¡red that the comparativeLy rare inc j_dence
of fluorosis in deciduous tecth is connected with theability of the placenta to inhibit considerably theintake of fluorine by the foetus. I if
Therefore the custor¿ of prescribing fluoride tablets to
pregnant vlomen, which still occurs, Ís contrary to the
physiological requirenents of the foetus, and the snallamount of fluoride which passes throu6h the placenta wourd
be obtainable from the nor¡ral naternal diet.(ii) Children. Drs Gabovich and Ovrutsk-iy (1g??) said that:
r.. motherrs mlllc contains very smaLl- amounts of fruorÍne,even when water containing hi6h concentrations isconsuned. I
They anaryzed breast milk in two cities. l¡,rith water
contaÍnÍng o.3 p.p.m. fÌuoride the average milk content v¡as
o.163 nB/\, and with a water concentration of 4.1 p.p.n. theniLk contained O,2?5 ng/I fLuorid.e. They cornmented:
rrherefore, it can be concrucled that increased consurnptionof fluorine increases its content ín breast milk but onlyslightly (approximately the sane as Ín the blood). I
Tn 1973, the l,fectical Journal o f Australia publishedan articre on roptimun Fluoríde rntaker by professor N.D.
Martin, which was enrr.orsed by the FruorÍcration of pubric
Ïrlater supplies Ad,visory comnittee of the N.s.hr. Departnent ofHearth and radopted as a statenent of policy on this natter. r
* See appendix 1fg, p. 28O.
135
1)rofessor Martin s¿rld:
r.. a6 the amount [of fruoricte] cxcrotod, in b:reast mirkfo extromely Ìowr .. rthe breact-fccl chircl should begiven a fruoride supplement evcn ilrorrgh the mother isconsumln6 flUOridated water. r IIis recc¡mmendation vrasrhalf a rnirligram of fr-uoricre per day for children tothe age of one year. I
commentinB on that recommendation a pharmaceutical chcmist(1.,¡. Kausman , 1g?3) said¡
frhe breast-fed baby creates rear problerns for thefluoridation theory. professor luÍartin acknowredges thatthe breast-fed baby receives rittle or no fluoride frombreast milk. A lo8icaL anrl accepted ar6ument runs thatbreast mirrr contains optimum amounts of nutrienüs forproper development of the child, and the absence of aparticular substance is evidence that the substance isnot required for any normar crevelopment of the chi1c1.Even when the feedin' mother is on a Ìrigh fluoride d.ieü,lor^r fl-uoride breast mirk 1:rcvails, This stubbornnessmight lcad the reader to question assertions that fluor_ide is usefur and rrarr¿Iesc to the breast-fed child. r
IIe concluded by saying that:f" the concept of fluoride-deficient motherrs nilk istoo difffcult to accept. I
Professor A. Carlsson (lgZg) pointed out that animalexperinent's have ehown that drugs can rproduee speciffcpernanent dísorders Ín the learnin' abirity and othersubùIe behaviou¡al componentsr, and said:
rone wonders what a lo-fold increase in the exposure tofluori-de, sueh as occurs in infants bottre-fed wÍthþluoridated] water-diluted preparations, may nean forthe developnent of the brain and other organs. r
116
Professor Carlsson continued:
tAgain, problems associated with thls can be solved onlyby precise and, comprehensive epideniological studies inwhich, for example, breast-fed and bot,tle-fed babies
are compared in localities with a varying vrater fl-uoridecontent. No atudies of this kincl have yet been made.r
It should be noted that the CouncíI on Dental
Therapeutícs of the Àmerican Dental Association sug6ested.,
in 19?7, that for children less than two years of age the
dose of fluoride in tablet forn shoulcl be 0.25 mg daily.
In a Report, it said that if the water supply contains more
than O.2 p.p.m. fluoride that d,ose must be red.uced.
(Driscoll and Horowltz | 19?B). This is only haLf the dose,
previously sug6ested. Therefore, those who still adhere
to the advise 6iven by the N.S.W. Department of Health at
the tine when the Victorían FluoridatÍon Act was passed,
are administering twice the cr:¡rently-reconmended dose to
the young children under their care. As a result, at Least
some of these children are developín6 fluorosis in their
f¡ont teeth - how severe the fluoroeis is only time willreveal.
The councir on Dentar rherapeutics recomnendecl thatchildren aged 2 to J years should receive 0.5 mg fruorideper day and those a6ed three year6 or nore 1.0 ng daily.rn bcth cases they specified that the dose nust be reduced
if the domestic water supply contained 0.2 p.ponro or more
fluoride. The council also specified that if the fluorid,e
level exceeded 60% of rthe concentration reconmended forcommunity water fluoridation in a geographic regionr fluoride
13?
suppler[ents nuet not be prescribed. (DriscoII and Horowitz,
1g?8). *
Unfortunately the Victorian publf.c has not been inforned of
that prohibitJ.on andn judging from the large number of
fluoride tablete which are stlll soldlr many chiÌdren nust
be ingesting far too much fluoride r particularly íf the
anount absorbed fron fluorídated toothpaste is taken into
account. (See also sectione XV and XXVI.)
The Councj.L on DentaL TherapeutÍcs said:
rThere is no evidence that the d.oses reconnended by
the Council produce esthetically unacceptable clentalfluorosis. I (Driscoll and llorowitz, 19?8).
(In section XIII some conments were made on the ternfobjectionable fluorosis I whlch is used Ín tlre jargon of
public health officialc, now called raesthetically
unacceptable I fluorosis. ) The above-¡nentioned etatement
by t,be Council on Dental Therapeutícs is a tacit admission
that some degree of dental fluorosis occurs j.n chiLdren
ingesting the doses of fluoride which it suggests.
Therefore, even in the U.S. v¡ith its hard waters,
there ls little doubt that the doses recommended by the
Council on Dental Therapeutics - O,2J mg to age two years,
0.5 mg between tv¡o and three years old and 1.O ng for
chil-dren aged three years or nore r per day - are above
the roptinumr level of fluoride ingestion.
(rii) Adutts. Dr c.G. Dobbs (gZz) said:rSo far, after 26 years of fluoridation, neither theactual nor the rroptimarrr fruoride intake has ever beendetermined for any tr6iven populationfr served by a
* See appendix !b, p. 268.
1t8
community water suppl-y. Hitherto rel-iance has been
placed upon wild extrapolatíonß on a national basis froma few dietary stud.les, some of them as oÌd as I'{cClurersin 1941.t
In 1971, Ralph Nader related that Professor Bamy Commone¡,
harl asked the U.S. Fubllc l{ea1th Service to provide
informatlon on total fluoride intake. They did not reply.
After fconstqnt hammeríngr, about eighteen lnonths 1ater
they gave a figure for the average Íntake for adults inp.pome, but did not give data for children.
In 1972, Carol Farlcas made a survey of rover 2OO
rrexpertsrr in thc fíelds of nutrition, crentistry and medicinel
regarding the maxinum safe daily íntalie of fluoride fror¡ allsources. Professor II. Jenkins repliecì.:
I r do not thÍnk there is yet a consonsus on the ¡;raxímumsafe dose of fluoride ingestÍon. r
other repl-ies v¡hich she receiverl bear that out, for the
estimates for the safe dail¡' ingestion by adults of fluori<lefrom all sources ranged from 2-3 m6 to 6-l rit6. Ân even
higher value was stated by Dr J.L. Ilardwick (1g?5) v¡ho saÍd:r..the consistent in8estion of fruoride at the 1evel ofabout 8 mg dairy in adurts appears to be safe fromcumulative hazards. I
These rrexpertsr did not state the figure which theyconsidered to be the roptinumr one. Irowever, as that valuecannot exceed the maxintrn permiseibl-e one, unress there was
generar agreement that the roptÍmumr $ras 2 ng or ress, theiropinions regarding bhe roptímumr value wourd criffer.
1t9
The 15th Internatlonal Convention on Civil.ization
Diseasos, Vita1 Substanceo and Nutrition, hcld from Bth to
14th Septenber | 1969, passed a Resolution No. VIII whích
was published in its Bulletin J9a. (rnternationar socÍety
for Research, 1969). Thio considered the Resolution on
nluoriclation and Denùar llearth whl-ch harr been passed two
nonths prevÍousIy by the I^IIIO (969c) ,
The Convention conrnonted:
rrhe Resolution passed by the w.H.o" is an aclmission thatfluoridation Ìras not yet been investigated carefullyenough from the nodical and scientífic point of view.This l-s borne out by the second part of the Resolutlonwhich requests the Director-General to continue toencourage research into the etiology of dental_ caries,the fluorÍde content of rliets, thc mechanism of actionof fruoride at oiitÍmal concentrations in drinking vraterand into the effects of greatly excessive intarce offluoride from natural sources. r
The Convention sa:Ld that:rl-rom this the conclusi_on can be cìrawn t)rat
1. the etiolo6ical circumsta'ces of dental carieshave not yet been eatisfactorily elucidated,
2. not enough is knov¡n about the nechanisn of actíonof fluoride,
7. not enough is known about fr-uoride Íntake fromvarious foods.'
Bulletin J9a continued:r.. these matters were discussed and evidence from anumber of researches was assenbled. v¡hich red to theconcrusion not to recommend fruoridation of drinkÍngwater supplies but to chose trre arternatíve of dentalcare combÍned with otber v¡el_l-tried method.s instead,. r
140
The ondorsement of fluoriclation by the IrIHO (t969c)
has received nuch publíclty and many people vrouLcl expect
it to be scientÍficaIly reliabLe ancl based on a careful
study of the availabl-e evidence both for and against
fluoridatÍon. It followed a report prepared by the WIIO
Direc tor-General (wtto, 1969a) .
The Int,ernationaL Conventi-on said:
rMention shall be nade of the fact that unfortunately thedocumentation of the report of the Director-General ofthe tforld Health Organization is very incomplete, becauseno mention is made, and no reference gi_ven to, the principalresearches on fruoride toxicity¡ êrgr Rohohnrs rrFruoride
Intoxicationrr, the researches of CoI. Shortt and hissuccessors in rndia fron 1 917 to thc present time, Theorerron enzyme inhibition, Rapaport on niongolism, Rodriguez inspaín and steyn in south AfrÍca on sÌ-,eretar fLuorosís,Fel-tnan and Koser on sÍde ef fects of f luoricle, uaÌdbotton fl-uoricle alrergy and many others. Thcre are no reportsand otatements of experts I cornr:rittees ¿rncl study groups andreeolutlons of organfzatíons against fruoridatíon ofdrinking vrater supprÍee. The often discussed pubJ-ícationsand resol-utÍons of our society, the opÍnions of eminent
, scientists, and, the decisÍons of Governments not topermlt fruoridation of pubtic wator suppLÍes are notrnentioned. I ( rnternationaL socieüy for Research , 1969) .
The statenent in favour of fluoridation is contained inparagraph 2 of the Resolution of the UHO (gf>9"), nost of whichwas cited at the co¡r¡¡encement of this section. rl_uori-dationvras suggested :
r.. where the fluoride intake fron water and other sourcesfor the givcn population is below optimal level_s r.
141
Thc International socloty for Research on civilizatlon
Diseases and Vital Substances (969), comtnenting on that
statemcnt in the WIIO Resolutiont oaicl:
rVJithout going into tho details of the argument attentionrnust be drawn to the fact that it will be impossible üo
give effect to this resolution, because it does not state(neither does the report of the Dircctor-Genera1 on r,¡hÍchj.t was based) v¡hat is thcrroptimal levelrr of intalçe offluoride.
There cannot be any optimal levcI of intake for a
given population. It is thc intake of each individualwhich natters. This is certainÌy not the same for each
individual. It r'¡ill vary with age, sex and indÍviduaLbodily reactíon. Some individuals are more sensitive tofluoride than others, for exaurpÌe persons suffering fromkidney trouble are less able to excrete fluoride and more
liabIe to injuries from it.In any case even if the rroptimal level-tt of fluoride
intake were l..nor^rn, it is impossi-ble to achieve it by
adding fluoríde to the public water supply, because ofthe very 6reat differences in consunptíon of water by
different individu¿'.Is (one Lo 12 litres per Oay). Talcinginto account these differences, the daily intahe offluoridated drinkin6 water can introduce into theorganisn quantlties of fluoride which toxicologists,pharnacoJ-ogists and hygienÍsts consider toxic. I
r,{e end this section almost where we began, for we do not
know the f optirnum intaker of fluoride. However, r^re now
lçnow that there is no such varue and that the I'IHO resolutíon
endorsing fluorídation cannot be carried out for it specifiesa method for deternrining the fntake of fl-uoride fron water
supplÍes which is irnpossible to execute.
XVII. 142
rIT]T FACTO R OF TEIVIPERATURIJ AI{D S]iÀS ONAI, VAIìIATIONS.
The concentration of fluoride to be used in victorian v¡ater
supplies, which 1s laid down in the Act, is close to, but
noü exceeding, 1 p.p.nro fluoride. provided that each
indivÍduaÌ consumes one Ij-tre of water per day, by drinkíngit or ín prepared food, the dose of fluoride ingested wj.llbe one mÍIligran. That is the dose specified when
admÍnístering fluorfde to chíl-dren who are nore than threeyears of age.
A fal_lacy of the fLuoridatíon case is the cJaim thatall people drfnk about the same amount of vrater. of course
they do not. Apart from personal preference, there are
many other factore, one of v¡hich is the daíly temperature.
ThÍs has an effect, sonretimes a marked effect, on the amount
of wate:r coneumed and, therefore, on the d.ose of fluoridcirlgested from water. Recently, professor T. Dav¡son (19?9)
said that workers at Broken Hilr drink u¡r to 1 1 litres per day.rf thle bad been fluoriclated water
- or beer made ruithfluoridated water
- they woul-d have been j-ngesting fronbeveragee aloner approxímatery 11 mg of fruorÍde daily, whichis far in excess of even the highest estínates nade for the
safe total daiJ-y ingestÍon of trtuori¿e f¡om arr sources.
Both the u.s. and the victorian cIÍmates can be carredttenperatgt ones, but the mean annuar temperatures are verydÍfferent. ThÍe ís shown in Fig. 5, which compares themean annuar temperaturee of ùhe Austrarian capitar citÍes withthose of the four major fruoridation test ci-ties in the u.s.
14tM]IAI.I A}.I¡IUAI, TB}iIIIRATUREI]
B
AÞ
M
Australian Capital Cj.ties:HobartCanberraMelbourneAdelaideSydneyPerthBri.sbaneDarwfn
D
25
20
1'
10
P
c1-Io,
.r'ln
r'{(¡)()u¡c)c)hê0í)A
5
EB r'r GR
ArtificiallyFluoridatedTria1 Cities:
BrantfordNewburghGrand Rapid.sEvanston
o
F19.5.
The ¡nean annual tenperatures of the AustralianCapital Cities compared, with those of the fourmain American and Canadian fluorídation trialcftiee.
144.
It can be seen that, by our standardo t the weather in those
four cities ís cold - nuch colder than 1n Hobart - and
their mean annual tenperatures are only half that of
l'leIbourne. Despite this narlced difference between our
cIínate and those of the teot cities in America, the
concentration of fluoride specified in the l\ct is the same
as the 1 p.pomr üsed 1n Grand Rapids, Evanston and. Brantford,
and only slightly less than the 1,2 prp.m¡ used Ín Î'.Iewburgh.
In addition, no evídence has been found that there
is a variation in the fluoride concentration in the MeLbourne
water between the sunmer and the winter periode. This is
d,espi-te the fact that the mean maximum temperatu¡e here Ln
January (26.5 <legreee C) is alnoct exactl-y twice that (13.5
de8rees C) found in July.
As tr,e.s pofnüed out fn eectfon XIII, only short perlods
of hi-gher fntake of ftuorÍde are necessary to produce cirronic
fruoride poisoning and, thereforer areas of dentar fLuorosie
Ín developing teeth (apart from offects on other organs).
T.n 1954, the N.H.& M.R.C. said that the concentratíons
considercd appropriate for sunmer and for winter should be
averaged and the resulting value Inaintained wíthout
variation throughout the year. I However it Ís the maxinum
tenperature which natters when consid.ering dentaÌ fluorosis.Therefore that recommendation of the N.H.& M.R.C. isunsound and it is not in accord.ance with the practice in many
AnorÍcan communities.
As the dairy temperature is an important factor indeternining the fluoride content of water v¡hich is consid.ered
145
to be deelnabre, the comparÍcons ehown above Lndicate that(a¡r,art from othor congLderations) the concentratLon offluorfde reconmencled, for vlctorian waters, 5-n tho Act, istoo high - particu1arly in the summer months.
XVTIÏ. 146
TIIE FLUORTDD CONCNNTRATION SPBCIFIED IN TTIB ACT IS AN
ARBITÍIARY O}IE.
Paragraph !. ß) of the Health (Fluoridation Act 1g?t
statee:fNothing ín this Act shall authoríze a water supplyauthority to add fluoride to an extent that resultsin an aver.¡ge optJ.mum concentration in excess of one
part fluoride per millÍon parts of waùer. I
À1so, paragraph 6. 3) states:
rThe water suppfy authority adding fluoríde to a publicwater supply -(a) ehall eo regulate the concentration of fLuoride
that such concentration sha1l not exceed themaxinum concentration deterníned by the
.auommrssLon.
lleither of those paragraphs specifies the acceptable range of
the concentratíon or the period over which the ravera6e
optinwn concontrabiont -, u/þ4tever that rreans - is to be
calculated. It is assumed that the obJective is to
naintaln a coucentratj,on clooe to, but not exceedingt
1 p.p.n. fLuo¡Íde.
The VJHO resolution (1969c) su6gested introducing
fluoridation:| 0.. where the fruoríde intake from water and other sourcesfor the given population is below optiural Ievelo. r
That etatenent was reinforced by an article in the WHO
Chronicl-e ('l 969b) v¡hich saÍd:
r0n1y when the natural fluoride íntake fron al1 sources
147
(includln¡ç wator) hae bcen asuesscd ls it pooeible tocalculats the level to whlch the fluoride content ofwater supplies needs to be adjustcd. In tropical areac¡
the level rnay be about 0.6 pprn, irt tenperate area6 1.O-1.2 ppn.'
Therefore, if it is decitÌecl to add fluoride to the domestic
water eupplieo, before determÍning the concentratÍon to be
added, it Ís necessary to know, for each area supplied:
(i) The fluoride intake from rother Bourcesr, and
(ii ) rne t optJ-nal leve1 r .
Those rother sourcesr include fluorid.e in food,
toothpaste, tablets and medicaments, and in the atmosphere.
l\s has been seen, the fluoride content of foods is
considerably differentr even in the same type of foodt the
concentration varying with the soil in which it is gro$tnt
the use of agrfcultural sprays, method of cookingt and
other factors. fn a place like Melbourne, where there are
large ethnic groups with considerabry crifferent food habits
and methods of cooklng, there are more than usual variationsin indivitlual food Breferences, quantities eaten and drinki_ng
habits. The factors to be considered in attempting toassess the fluoride content of the food of a community are
almost endless.
Sinilarly, tbe fluoride intake from toothpaste,
tablets and medica¡nents d.epends on the personal habits ofthe individual" Ng evidence has been found of a survey
havíng been nade Ín victoria to deterrnine the fl_uorLde
intake from food,, toothpaste and med,icaments.
149
One thlng Lo certain, the lmportant factor of lnhalatj.on
of atmosphoric fluorlde haa not boon investigated by the
Environment lrrobection Authority (19?8), The conclueLon Ls
inescapable - the fluoride intake from rother sourcesl
in Victoria is not known.
Resolution ltlo. VIII of the 15th InternationaL
Convention on Civj.Iization Dieeases, Vita1 Substances and
Uutrition (International Socj-ety, 1969) saicl (in part):rThere cannot be any optinal leve1 of [ffuoriae] intake.for a given population. It is the intake of eachindivicluaL which matters. This is certainty not thesane for each lndfvidual. It wÍL1 vary vrith a6e, sexand indivídual bodily reaction. I
In Victoria, values are not k¡own for both of the
factors which the blHO stated must be consídered when
deterniníng the fLuoride concentr¿rtion of a water supply.
Therefore it is obvious:
The fluoride concentration speci-fieci, in the Act is an
arbitrary one.
xIx 149
THE TOXICITY OF F],UORIDÂTION AND THE DFTECT OF OTITBR
CONSTITUENTS OT TIIE VtrATER.
Toxicity from ingesting fluoride may be acute or chronic.
A thÍrd category - long-tern - has been sug6ested, in
which the toxíc effocts d.o not appear until after the
ingestion of fluoríde has conüinued for many years.
!ùhen speaking of the toxiciüy of fluoridated rvater
(approximately 1.0 p.p.m. I.) the discusoion is of chronic
toxicity from the ingestion of many small doscs of fluoride
and, possibly, of 1on6-tern results. It ie irreaponsible
to suggest that, in the ordinary course of events, people
will develop acute poj,sonfng from drinking fluoridatecl
water. (0f cource, as mentioned in section XXV, 6ome
indj-viduals are sensitÍve to, and. become irl from, very snalldoses of fluoride. ) severar rare cases of acute poisoning
from drinking fluoridated water haven however, been reported.
They vrere due to the nrarfunction of the fluorÍdationapparatus. For instance, on Apri1 16, j9?4, at a ruralschool in North carolina, twelve adurts and 201 students
experlenced nausea and vorritÍng two to five ninutes afterdrinking orange juice prepared with water. ÌIone of the
otber 126 students becane ilr. rt was found that the
fluoride feeder had. continued to operate arthough the
water punp had faÍIed. Laboratory anarysfe of the orange
juice ehowed a fruoride coutent of zlo ng/ritre Ínstead
of 1 ngrlIitre. (Clark et aÌ. , 1g?4). *
* See appendix 'loa, pr 27o,
150
Fluorldatfon pronoters frequently nake the deceptÍve
clafn that lt 1s neceosary to drfnk more than fiftybathtubs furr of fruoridated water before being poísoned.
That claim is based on tbe likl-ihood tbat acute fl_uoridepoisonlng wourd en'ue Íf the fruoride content of thatrarge anount of water was concentrated and drunk as as1ngIe doso. spokesrnen makin6 that statement are eitherfgnorant or are out to deceivc. The usuar problem fronfluoride fngestion is ilre cumulative effect of the many
snall doses taken each day over a long perj.od.
The possible long-term hazarcrs of fruoridation,and the necessity to maintain studies to test for ilrem,
have been mentÍoned by a number of scientists.r.n 1965, Professor D.G. steyn, the chicf Research officer,Life science.¡ Divisi.on, Âtomic rl'ncrgy Boarcr, pretoria, saicÌ:
rAs har¡nful effects of the ingestion of mimimar amountsof fluorides may be i-n evicrence only after some .eca*es,ft fs obvious that the above observations, tests, etc.ehould be conclucted over periods of at r-east twenty toforty years. I
The rnternationar society for Research on Nutrition and.
Vital- Substances Og6Z) agreed, saying:r..' long-range crinical investigations and bioro6icaltests shourd be conducted over several crecades, sinceit is inposcible to corne to rer-Íable concrusions asto the danger or rrarmle'cnc.s of fluoricrati_on of cìrinkingwater before that time. since numerous factors have tobe conslderect in thi-s fiercr of research, Ít vroulcr benecessary to incrude as many test persons as possible,thereby covering the entire te¡rain, which includ.es age,
151
pregnancy, feeding of mothers, statc of health, drugs,water, nutrition and bevera6cs. I
No eviclence has beon found that tIon6-range clinical
investigations and biological teotsr are being conducted
here.
An important dlscovery which affects consideration
of the toxicity of fluoride was that I there are two forr¿s of
fluorÍde in serurn, exchangeable and non-exchangeable. g
(Taves | 1968). That finding was confirned by Drs Ii.,J.D.
Arnstrcng ancl f,. Singer (gZO) who said that blood
r..pIasma contains two forms of fluoride. One form isfree and ionic, the other bound ¿rnd non-ionic. It isthe former kind of plasma fruoride that can be expectedto participate in physiological reactions.r
rn a paper given to the rnternational society for Fluoride
Research, H.A. Cook QSZS) saicl:rThe fluoride ion, r.rhi-ch is what we nean by rrfluoridett,ís intenscly toxic to arl life. rt inhibÍts essentialenzymes and kills IivÍng cells, but onl¡r i¡ it is freeand thus able to exert its toxic effects. llowever ithas a very great propensity to be combined, or bound,and this fortunately reduces its toxiclty. vriere thisnot so, then the ubic¿uity of its distribution v¡ouIdensure that there v¡ould be no riving organisn on theearth. I
rrhe toxicity of the fluoricle ion is thus shown to bee:<erted when it is free, and it can be sa-id to beproportional to the degree of freedon of the ion,v¡hfl-e the conpretery bound fLuoride ion Ís non-toxic. r
Professor N.po Buu-Hoi (1962) said:r.. ühe most spectacular manifestations of fruorido-toxicosis are connected with irnpaj_rments in the nnaniford
112
functious of calclum 1n the body. I
In 1946r J.T. Irving founrl, ln the tceth of rats, that:t.. urhen the blood calcium is raised thc action offluorine on the predentÍn is greatly lessened orprevented, while when the blood calcium is J-owered,
this effect of fluoríne is caused in rats prevÍouslyfound not to show it. These observations strengthenthe theory previously put forward that the action offluorine on tecth is reLated to the ]-evel of the bloodcaLcium. r
It should be realized that sensitívity to fluoride varies
considerabry and is different ín different classes of anímar.
It ís important to knovl, when considering the results of
animal experiments, th¿rt rman is nuch more sensitive to
fluoríne than the ratf (Roholm, 1932) - between six and ten
timee more sensitive.
Arthough the concentration of fruoride in clrinking
v¡ater is an important f¿rctor in determÍning the amount
ingested anrl the prevarcnce of fluoride toxicity, i-t isnot the only factor.
Profeseor A. Schatz and Dr J.J. I,tartin hg64) said:r.. the issue of fluoride toxícity cannot be resolved byconsiderlng only the concentration of fLuoricle in thewater aLone. I
Drs R.D. Gabovich and G.D. ovrutskiy (19??) concurred, saying:r.. ths incidence of fluorosis and its frequency are notdue on]-y to a certain concentration of fruorinc in thewater. Naturar and social conditions, affecting thereact'ivity of the body and the physioJ_ogical conditionof the centrar nervous systen, can intensify or weakenthe effect of fluorine.r
157
They founrì that increasing the calcium in food decreascs
fluorldc retentlon ln the ekolotons of animal-o, an<l s;aid:
rThe excretion and rleposition of fluorine in the bodycan be affected by the acid-base equilibrium as well asby the amount of proteins and vitanins in food. Forexample, lack of vitamin C in the diet increases thedeposition of fl-uorine Ín thc body and enrichment ofdiets with ascorbic aci-d and severaf other vitaminswhich stimulate metabolic processes reduces thedeposítion of fluorine. I
They s¿rid that no specific anti-fl.uorosis agents are knovrn,
but for protection against fluorosis rthe goal is a fu11y
adequate diet from the physiological_ point of view. r
There are considerabl,e difficulties in recognízing
the effects of fluoride toxicity in its early stages.
Bven when marked, symptoms occur they are not obviously due
to fluoride toxicity for they mimic other diseases.
Dr P.li. Springefl g9?5) pointed out that, with a pollutant:r.. it is extrernery di-fficult to dia6nose subclinicaleffects, and thus to decicle whether there is a threshord,below which there are no uncìesirable symptoms.r
Dr Stephen Boyden (lg?Z_), Urban l]iology Group, A.I,tr.U., said:runfortunately, the tests to which chemical compound.s areusuarry subjected in efforts to cletermine their so-cal_ledrrmaxi-mum perrnissible doses or concentrationsrr d.o not takeinto aceount possibr-e changes in mental function, moocrand so on, and also would often fail to pj_ch up Ìong_term or chronic effects on the organism. Furthermore,the tests are seldom, if ever, designed to pick uppossible synergysti-c or adctitive effects of dÍfferentenvironmental poJ-lutants of this kind. The danger isthus a very rear one that, because of pseudoadaptation... an insidious deteri-oration of health rnay occur i_n a
154
human populatlon aB a consequence of fncreasing envlron-nental chemÍoalfzatLon, without producínB any appreciabJ.e
effect on mortalJ.ty and fcrtllLty rates r and, withouteociety even reco6nizíng that a state of iIl healüh
exlsts. I
llowever, in some people, obvious illness does occu¡ from
ingesting snal1 doses of fluoride. Drs R. Feltrnan and G.
Kosel ?961) reported that side effects occurred. in one per
cent of pregnant vronen and chll-dren given fluoride tablets
under supervision. They said:tBy ühe use of placebos, ít was definitely cstablishedthat the fluoride and not the binder rtlas the causÍtiveagent. These reactions, occurring in gravid vromen and,
in chíIdren of all ages in thc study group affectecl thedermatologlc, gastro-intestinal and neurological systems.Eczema, atopic dernatiti-e, urtlcaria, epigastricdistress, emesisr and headache have all occurred. withthe use of fluoride and disappeared upon the use ofplacebo tabl-ets, only to recur r.lhen the fluoride tabletvras, unknowingl-y to the patíen'b, given again. I
The daily intake of fluoricle from a fluoriclated. water supply
is supposed to be sirnila.r to that from taking a tabtet
contaíning approxirrnately 1 rn6 fluoride, such as vrere
ad¡rLnistered by Drs Felturan and KoseL. fn a large city, ifthe proportion of people (or of children and, pregnant wonen)
affected even approaches the one per cent which they observed,
the nr¡nber of peopre with recognízed, or unrecognized, side
effects from Íngesting fluoride wíII be very large.
Professor Arvid Carlsson ?gZB) of the pharnacol_
ogical rnstitute, university of Gðteborg, pointed out that:|ïf we assune for a monent that l¡ater fluoridatíon brín6s
115
about an increase of 5 - 1ú/" in any comnon dioease¡ êrgrcancerrl "..lthe pc rc e ntane increaoo is so small thatonly precloe epidemlolo6ical studie6 on a vcry Ìar6caruount of material can be oxpected to revcal i.t.r
He said also:rOur hearth authorities wirl in future be involved to aneven greater extent wíth the problerns which thispollution brings in its train, problems of a very highde6ree of conplexity as regards difficultÍes in quantitivesurveying, interactions with othcr substances, etc. OurcommunÍty will require .even greater resources to be putto use to hold chemical exposure down to an aeceptabrelever. The fact that in this situation a poison shourddeliberately be distributed throughout our environmentin enormous quantities represents an i1r-considered.action. I
When claims are being made for the safety of the
long-term inBestíon of fruoricle, despite its toxicity, itís h16h1y l1kely that ilre Bartlett-cameron study wit-l- be
cited. The reeults of this study were pubrished ln the
u.s.P.H.S. journal Public Ileal-th Reports (Leone g[_3!. r
1954). Thie otudy has been cited on a very large number
of occasions. Dr A.Â. Lond,on ?geZ) said:rBríef'y, a group of 116 people in Dartl-ett, Texas, witha natural fluorÍde content of B ppm in its rvater eupply,vras compared with a eo-carled rrcontrolr group of 121people in Caneron, Texas, with about O.5 ppm fluorid.efn its water supply. Canreron cannot be considered anon-fluoride city. I
The ffrst examination was macle in 1943. Fourteen of theSartlett eubJects and four of the cameron ones dÍed beforethe seconci examination, ten ycars 1ater I ín 1)JJ; rwhil_e
about 6o to 90 in Bartlett, Bo to 90 in cameron remained at
156
risk in the stucly areao and were re-examined, for various
abnormalities, by an entirely different team in 1)JJ.r
His paper considered that paper Ín eome detail and he
referred to I the ludícrous inadequacy of the Bartlett-Caneron study a6 a basis for assurances of rreafetyrr.t
Professor D.G. Steyn (1964b), referring to that study, saÍdlrGrave d.oubts as to the validity of thfs, so very oftenrepeated, statenen'b exist. I
He'cited his earlier paper (t964a) which harl consídered
several aspects of the etudy, one findin6 beíng that, of
the people who had been dentally examined in Bartlett in1951, only 11 had lived there all their lives anð, 60% came
to live thore aftor the age of 1lr years. Also, there was
considerable doubt regarding the hÍstory of the rvater
supply in Bartlett. Professor Steyn safd thatn prior to
the few years which preceded the study, the fluoride content
of the wells used vras Brobably substantialry less than I p.p.rn.
Drs R"D. Gabovich and G.D. Ovrutekiy (gZZ) sairl:rThe varied character of the groups (by age, kÍnd ofvrork) and theír srnall nu¡lber deprive this work ofconviction. I
The fact that this study continues to be cited,, over and,
over again, indicates that there is stilr no better evidence
to suggest that the long-tern Íngestion of fluorides, atthe concentration of 8 poprn., Í-s safe. (Apart from, ofcourser the development of very robjectionabler dentar
fruorosis.) rt ís re¡narkabr-e that this obviously deficientstudy should continue to be cfted as strong evidence for thesafety of fl-uorlde ingestion for atr people, ever¡rwhere.
15?
In 1958 hofessor Steyn 119J8a) diccussed the
toxiclty of fluoride at eome length J.n hÍs book The Problem
of Dental s and the Fluoridation of Water Supplies
which has 558 references. I¡ater tbat year (1958b) he saÍd:rIt is the authorrs consídered opinion as a toxicologistand pharmacologÍst of rnore ühan lO years experÍencethat under certain conclitions, especially with certaíntypes of water, artificial fluoridation of public watersupplies may, and does, constitute a gral¡e danger tohu¡nan healtb. r- ]l
The recent book: Fluoridation: The Great Dilemma (Waldbott
9!-4. | 1978) | considero nany nore aspects of the toxicityof fluoride than it has been practicable to mention here.
To concl-ude thcoe general comments on the toxicityof fluoride, the opinion of Professors T. Gordonoff and l¡I.
Minder 3960) wilr be citcd. rn the Su¡rrnary of theirrevíew of fruorine in the book lrforld Review of lfutrition and
DietetÍcs thcy said:rBecause of its varied activitÍes, there can be noquestion of anything but an accuratel.y measured,
suppl.enent, and in no circumstances an aclditÍon todrinking water, lvhÍch makes impossible a'y kind ofexact dosage and control, I
Final"ly, in thÍs discussÍon on the toxicity offluoridation, the effect of the other constituents of
the water will be nentioned, because this aspect is ofparticular interesü in victoria for our water supplies
are exceptionally soft.
* See appendix /b, pr 265,
158
since the fluoride content of Merbourners water supplles has
been raieed fron Leee than 0.1 p.p.n. to approxÍrnately 1.oprp.nr t there also have been changes Ln the concentrationsof some of the other constituents of the water. one ofthese, as has al-ready been mentroned, has been intentfonal1n ordor to protect the water pipes fron corrosion due to
the lncrease Ín the fluoride concentration. (Itirtn, 19??).
(r ) The Imnort ance of other Constituents of the Water
trlhen considering artificiat fluorid.ationr many people speak
only of the fluoride content of the water, ignoring the
infÌuence of the other constituents. However, the5-r Ímportance
has been reco6nized for many years. In 1949, the American
I¡tJater Works Associatfon sald that the experimentaJ-
verification of the fl,uoride-dentar cariee hypothesis:r... obvÍously necessitates the use of a nearby ttcontrolrlcity with a water suppry comparable in aIr respects tothat to which fluorj-de is being added. r
Professor D.G. Steyn ?lg58U) said:I rt ís obvious that the resurts (in regard to dentaldecay and, toxicity) observed in a'particular prace withfluorine-containing water can, and. shourd, not be appliedto a different, v¡ater suppry, 1et aLone to water suppríesin different countries.r
In 19?2, Dr Margaret Crawford referred to:f. o. a problem concerning fluoridation of water suppliesin thís country which has not received eufficientattention - that Ís, the relati-onship between fruorídeand other ions present in drinking-vrater, in particurariod.ine. I
119
aEt¡tr{a
P{
r^oC)qt()o.ú
Q.D(,Édf{.útri
4oo
,oo
200
100
HARDNESS OF WATER SUPPTIES
GR ES
B
N(,Hf{áoIr{0)à
tÍ
0
Teet Cities Fluoridated Cities
Fi¿ç.6.
:ï,::::ï ;,' ï": :' 13',, :'"T; i::ïï,;" l, î "i î;ï; l;'",, :::"visited by the United Kingdom Mission (,tg5Z),
Test citiee: Marshall, Newburgh, Grand Rapids, Evanston,Sheboygan (U.S.A.) and Brantford (Canada).
160
CAIÆTUM IN TER SUFPLIES
Calciunprpr!1r
Melbourne Test citi.esNEGRB
Ffg. 7.
The Calclun content of Melbourne water (M.l.f.B.rd., 19?3)
compared with the four main fluoridation trial citÍes.llelbou¡ne 1 .6 p. p.Ítç
Newburgh 75.O p.prtreEvanston tB.O p.prnlrGrand Rapfds JJ.O p.p.m,Brantford 60.0 p.p,nr.
6o
5o
4o
to
20
10
0
161
Q) The rsoftne6st of l,lelbourne Water.
vrlhen consfdering other characteriatlce of the water, a factorof particular intercst fs the rhardne¡¡sf of the water, due
nainry to ito caLcium and nagnesiu¡n eontent. l{erbournef E
water suppJ.Íes are partÍcular1y rsoftr.
Merbourne and Metroporitan Board of hrorks rtypical
analyseer of our water in 1)lJ showed a hardness of 1o.o( as cacor) with calcium 1.6 and magnesiu-m 1.1 ng/L, The
same varues were gíven for the sylvan dam in the 1plg reporü,but, the cardinia dan had a hardness of z? ng//!, vrith carcíuu6.0 and nagnesiu^n Z.O mg/I,
Figs. 6 ancl ? shor^r the lrlelbourne (Sylvan dan)
calciun and hardness revels and, for comparison, the varuesfor the American test ôities and, for other cÍtÍes visiüedby the u.K. I'fission 3g5z) to inspect AmerÍcan fruoridationprojects. soon after their vÍsit, two of the ftuoridationtest cÍties, l{arsharr anct sheboygan, ceased to pubrish data.Those díagrans show the exceptionar softness of r,rerbo'rne
water (SyÌvan) and its vêry low calcium content.Many references are nade to the rnaturarry fruoridatedf
town of l¡Iest }lartrepool, in England, rts water supply
has a hardness of 5OO, with 1OO p.p.m. calciun and 15O prpono
magnesÍum. (Fremlin and Mathieson, 196?). These figur;es are,respectfvely, 50, 62 and, 136 ll,nes those for the sylvan dan.(M.M. B.t/ù. r 19?B) ,
162
TIie llirmin6ham, Errgland, water fo consLdercd to bo
a soft water by world standarde for i.t contains ronly about
12ppm of calciumr and 1 ppm of magnoeium. That calclun
concentration is 7.5 times the figure for Sylvan and twice
that of Cardinia. It was found that, when concentrated
by boíJ.ing, rnaturalfy or artificially fluoridated waters
behave in nuch the same way but 1n a way entÍreIy diff,erent
from ùhe solubility-product theory. I (Frenlin and Mathieson,
1967),
3) V'Iater Ilardness - Calcium and Magnesiurn.
In considering the toxicity of fluorid.e in water, ite
hardness ls of 6reat fnportance. Calcium is the accepted
antidote for fluoride poisoning, J.ime water or calcium
chloride being used to wash out the stonach and, calcium
gluconate is injectecl intravenously. (Jacobziner ancl Raybin,
1964i Martindale, 19?2). The very great differences,
shown in Figs 6 and 7, between the hardness and the calcl_um
content of l,lelbourne water and those of Anerican test cities,indÍcate that considerable caution should be shown when
basing the expectation of the toxicity of fluoridated
water Ln Merbonrne, or in victorian country area6,-on resultsobtained in American citíes wÍth ¡nuch harder water supplies.
The rnternationaL society for Research on NutritÍonand vital substances eaid that: fFluorine actÍon involves
prinarily the antagonism between fruorine and other elenents,
especially calcium. I (International Society , 196?).
161
In an rOccasfonal Surveyr in 196O, the ,ancet eaÍd:fFruorides usual-ry occur natural-ly in water wiüh a highcalclum content, and the effects of fluoride may werlbe nodifLod in soft water. r
rNo conpounds are known that vrill compretely preventthe toxic effects of ingested ftuoride, but conrpoundsof calcium and phosphorus have been found to red,uce thetoxÍcity in snal_l 1aboratory aninrals.
Dr H. spencer gg.g!. , (lg?8) said that r lower incidence
of endemic fluorosis is reported ín areas rvith water'highf-n nagnesfuru and calcíun. r
Professor S.S. Jolly 9L-*., Qg?la) also nentioned,the
protectlve effect of calcium and magnesiun, saying:r... other chenical constituents of drínking water whichare protective agaÍnst the development of fruorosís suchas magnesium, calcium and total hardness, r rmagnesium
6eens particularly Ímportantr .
rn experiments with rats Ít was found that increaeingleveIs of lonÍzabre oalts of ma6nesium, aluminium, or calcium(in increasing order of effÍciency) progressively reduced
depos{tion of minerar fr-uoride by a factor of fron one-
third to three-fourthsn respectively (Wea¿te and. Muhler,1954),
rn 1926, before fruorÍde was kncwn to be the cause
of srottled enarnel, Dr C.A" pierle reported that:I rt is possible to produce mottlíng and brown stain r.nthe teeth of animals by J-owerfng the calcium intakebel-ow that needed for the growing aninal.r ,It is alsopossibre to prevent nottrin6 by supplyÍng the carciu.nrequÍrenent of the animal. r
The inportance of the carclnn content of tbe hunan diet ín
164
realucing the prevalcnce of dental fluorosis was obeerved
by Drs M. I'{assl-er and I. Schour ln 1952. They found that:
rThe nutritional status of the populatÍont eopeciallythe calciun fntake, affects the prevalence and the
degree of mottling caused by the fluorine concentrationÍn the water supply. The poorer tbe nutritionalstatus and the lower the calcium intake t the more
prevaLent and the rnore severe the ¡noùtling. I
They found that fn one undernourished Italian town with
1.1 p.p.n. fLuoride in Íts water supply, 6U/o of the people
had nrottled teeth and the index of fluorosis v¡as 1.2.
However, in Joliet, Illinois, with the eame fl-uorid,e
content of the water, 25.1% }r.aa mottled teeth and the índex
of fluorosis was O.46.
(4) Naturallv Fluoridated hlat ers are usual Iy Harcï.
Deopite the evidence to the contrary I some stllt say that
the other constituents of the water can be disregarded, for
at the Low levels used Ín fluoridatíon there is almost
conplete ionization 1n the water suppty. However, the
queotíon is not what happens in the water supply but what
happens when an indivíduaI svral-Iows fluoridated water.
In tnatural-ly fluoridatedr areas the fluoride is alnost
always present in hard waters with a considerable calcir¡n
c ontent .
rParticuLar ernphasis should be placed on the Ca and Mg
of hard waters which may constitute a protectÍvenechanism not avaiLable in extrenely soft $raters. t
(Marier g!4. , 1963) .
As bas been 6een, Melbourners water ie extrenely soft.
165
In RuseLa it has been found that calcium definitel-y has a
protcctive effect wÍth high concentrations of fruoride intho wator (of the orclcr of 1.o-1,j n6,/Ð. (Gabovlch an<l
Ovrutskiy ¡ 1977). (It is of interest ilrat these workers
regard 1,o mg/L - the concentration to whÍch our waters
have been mechanically raieed - as a thÍgh concentrationfof fluorÍde. )
Therefo¡e r when an individuar swallows naturarryfluoridated hard water, both the fluoride and Íts antidote,calcium, are swallowed in the same mouthful.
rNatural fluoride ion co¡centrations much greater thano.1 ppm in the fresh rvater systems of the v¡orr-d are rare.,(Harris | 1g?6b). Generally speaking, normaL surfacewater supplÍes, derived frorn rainwater feeding streams,have a very row fluorlcre content. Þlerbournc had such awater before fruoricration com¡nenced.. on the other hand,water fron runnaturalr supplies, such as deep weIIs, is much
more 1Íkely to have a high fruoride contcnt, and is usuallya hard ürater.
It has been knorvn for nany years that vlhen softwater contains approximatoly 1 p.p.m. fluoride, thatdentar fluorosis is likeIy to occur in some chirdren. rn1942 Dr C.F. Deatherage said:
I rt is these soft, waters which causc the most severemottled enamel. r
As Melbourne has a particularly soft water, it is tÍIcelythat our chirdren v¡i1I creverop more d,entar fruorosis thanthe proponents of fluoriclation expect.
xx166
skeretal fruorosis is ran unnaturar thr.ckenin6 of bones _vertebrae, pervis and long bonee, sornetÍmes wlth severepaf-nr which can eventuarly arise from drinking watercontalning 4-8 ppn fluoricte. (I.Iarris | 1g?6b).
A decade ago it would have been consÍdered absurdeven to oonsÍder ühe possibÍríty that skeletar fruorosÍscould occur here, even after fngestin8 fruoridated water fornany yearg. At that time ühe cases reported in thellterature were in adurts who had drunlc v¡ater containingfluorfde at 6 p.pon. or more for long periods.
However, a brief nention of thÍs subject is nowrequlred becauee of several papers published conparativelyrecently. #
rn 19?i, Dre K.A.v.R. Krishnamacharí and Kamara Ibishnasvranyreported on twenty-four male patients with genu-valgum
deformfty, Ín rncria. rAlr had eviclence of spinar osteo_sclerosfe al0ng wÍth extensive osteoporotic changes in thebones of the extrenities. r They r¡ere all severe cases and,renarkably, incruded some subjects who vrere r_ess than tenyears of age and theÍr water supplies contained from j,j to6 p'p'm. fluoiide. rscr-erosis was observed in the spineeven anong childreü under jO yearci of age. I
rllhe fact that they beloriged to different vÍrlages situatedmiles apart, but that all the villages l"fere enrre¡oÍc forfruoroefs, and the similarÍty of the crinical picture,otrongly suggeets that the syndrome of genu valgum andosteoporosís is an expression of envr.ronmental fluoridetoxíclty. t
appendix 1/f, p. ZgO.* see
167
That skelotal fluorosis is due to onvironmental
toxÍcity, and not only to fluoride ín the drinking water,
is establ-ished by data cited ín an editorial articLe in
Fluori-de in 19?? (¡). The article states:
rsubsequently in a systematic survey c¡f 2B4Z residentsof the city of Dohna, DDRt Schnidt establíshetl that29 persons (24 nen, ! women) were afflicted with skeleta]-fluorosis. None of these persons vrere employecl at thenearby hydrogen fluoríde pIant. They l{ere residingJJO lo 2100 m ctistant from the pÌant. Near the smeJ.ter,
the air contained from o.JZ to o,?5 ng,/m1 (Maximun
Allowable Concentration O.oJ mg,/m1) .'
A nore recent (19?9c) editorial article, a].so 1n Fluoride
cites the case of a 2l-year-o1d nur6e v¡ho iÌlicit1y had been
inhaling the fluorinated anaesthetíc methoxyflurane
(Penthrane) for about p years. The article states:r...thi6 patientrs skeletal changes were preceded for 4
years by a variety of s¡rnrptoms which had baffled theattendin6 physicians; they had been unable to rnake a
diagnosis. These symptoms vlere vague paín, trexceedingly
painful bonerr, headache, polydypsia, po3-yuria, and epÍ-gastric distress. In addítionr she had narked byper-tension. (ttooa preosure 2?O/1 JO) which gradually subsÍdedas she irnproved. The presence of a gastric ulcer Ísnotable in view of recent reports by Czerwinski and byFranke which lÍnk fluoride with gastric uIcer. The
patient al-so exhibited rrmul.tiple, fixed, exquieitelypainful nodules on her extrenítiesrr probably a chemLcallyinduced l-ymphadenitis. She also had severe mentaldepression, another synptom often encountered inpre-okeletal fluorosis, which required extendedhospitalization on the psychlatry service. t
168
(tt ir¡ unfortunrrtc that thc journar Fl-uoridc, withits wearth of medicar informat,ion on thi-s subject, is not
l.lsted as held in any medical library in Australj-a.Therefore the artlcres and abstract,s which it pubrishes arenot readily available to physicians. rndeed., the sole hord-ing listed ís at the Australian Nationar ribrary, canberra. )
The question .shour-d be raised.: lrlilr cases of skeLetar_
fluorosis in time deverop in vÍctori-a? consider the facts:(a) chronic fluoride poisonlng can occur in chirdren drinkingfruoridated water, indicating a degree of chronic fluoridepoisoning in early childhood. (U) IjnfortunateJ-y¡ undêr_nouríshed children exÍst in Victoria. (c) Sone ind.ividuaLsare intolerant to fluoride and develop marked, side effects afteronly sma1l doses. (d) Mer-bourne water is extremely soft. (e)the summer tenperature is high. (f) We are increasingly subjectto ingest fluoride from sources other than water, such as fronfood and t,oothpaste, and to i.nhale fr-uoride in the atnrosphere.
Ar-1 these factors were menti-oned by sir Edward Dunlop(9?5) of Merboì.'ne, in expressÍng his strong opposition tofluoridation. Much of his criticism was based on hisobservati'on of hofessor Arnarjit singhre patiento wÍthcrippling fluorosis. These rndi.an vilrages had water supprieswith a fluorid.e. content rangJ.ng fron j.j to 5.2 p.p.m.
As cases of skeletal fluorosis have been reported fromEngrand, Germany and A¡neri-ca in people livì-ng near fruoride_emj-tting factories (Editoriat_, 1g??b), it is most irnpo¡tant toconsider the possibir-ity ühat skeletal fluorosis may devel0pin Victoria.
XXI. 169
FLUORIDATION3 PSYC HOLOGICAL REACÎTONS TO DBNTAL FLUOROSIS
AND DIRECT EFFECTS ON T ITE CENTRAL }IERVO US SYSTEM
the discuseion and the pronotíon of fluoridation has been
almoet compÌetely concerned with Íts effect on the teeth.
The known changec¡ produced by fluoride on bones and soft
tfeeuee have received vory l-ittLe mentiont d'espite the
fact that the nraJority of papers in the medical, veterinary.
ancl agrfcultural literature are concernecl with ito toxicity.
One ínportant aspect which appears to have been
forgotüen, Ín Englioh-speaking countries, 1s the effectwhich
fLuorlde ln drfnklng r.rater may have on the central nervous
systen and the psycholo6ical effects of unsightly denüal
fluorosle.
(r ) Peycholonical Reactíons to Dental Fluorosis.
Little concern has been shown for, or study nade of, the
reactíons of chÍldren who have developed. visible d.ental
fluoroeLÉ aa a reeult of íngesting the fornrerly-recommended
dose of fluoride in tablets or through consunring fluoride
ln their drlnking water. The nental stress, to both the
obÍId and lts parents can be considerable, and stress can
be a factor fn the ilevelopnent of acute dental caries.
(suttont 1962t 196jt 1966).
The inportant eubject of, the psychologÍcal reactions
to dental fluorosis was mentioned. over sixty years ago
by Drs G.V. Black and F.S. I"lclhy (916), They said:
rA natter which should not be overlooked in this, Ís thenental attLtude of these per6ons. I have found it very
17o
dlfflcult to obtain a good opportunity to examine theseteeth fn the nouth becauee thê persone have been soeensltLvo to such ob,servation. one of them told neth¿rt hs had armoot cornpretely rotirerl fro¡n oociotybecause people stared at hin as though there vùâ6 soüê-thing about his countenance that was uncanny. r
Such unei6htly degrees of dental fluorosis may
occur as a result of consurning fluorfde tablets, but itrnay be said that they cannot arise when the fluorid.e contentof the water {s only 1 p.p.n.. That io noü so. Even Íf one
ignores ühe certainty that fluoride is ingested from otherEOUrce.r sucb ae toothpaete, numerous reports have beenpublÍehed that the lever of fluorosi-s in a cornmuniüy wasfobjectionabler aÌthough the water supply contained less than1 p.p.n. fluoride. (Galagan and Lamson, 1g5t; Rosenzweig
and Abkowftz, 1963i Ueda et al., 1964).
My personar et,ucries of Micronesians and. polynesians
who drank both rainwater and water from ¡verls contaí'inga naxfnum of O,7 p.p,m. fluoride, have included many
subjects wÍth rnildr and rmocrerater fluorosis v¡ith brownstaining. Thei-r appearance was so objecüio'abre to themthat they endured the process of having their incisgrsabraLded, generalLy with a pumlce rstoner, {n order to redueethe etained appearance. (Sutton, 1g?B),
fn the Med lcal Jo naL of Aus tralia Dr N Long asked:rwhy should pre-war teenagers of outback Nhir-l requi-re arlthelr mouldy-looking fluoride teeth renoved beforeenterÍng tho ¡na*iage narket, when theír bore drínking_water only contained O.B ppn of fluoride?r (I,ong, 1g?O).
171
rt i-s saÍd that the daily consumption of a fruorid.etabret (t m6 F) wrrl produce a similar reeurt to drinkingwator containing approxímately 1 ppm fluoride. fn 19?6,
Dr K. Johnson reported mottling of the teeth of sono ofhis patients in Melbourne, sayíng:
I It was found that the datly consunption of therecomnended dose of one fruoride tablet has resurtedin a eÍniIar Íncidence of enanel mottling Ín thepatÍents in this practice as ln the U.l(., but thepercentage of teeth invol_ved is greater, 11.4 percent as coropared with ?.9 Bet cent. r
of the f8 children of average age 12 years given tabrets,15 G9%) hact fluorosed teeth, but there were no enamel
opacities in 10 other children. He said. that:1.. several parents have expressed. clismay at theirchildrens I appearance ancl even goíng so far as to statethat rrÎhey wish they had never given them fl_uoridetabletsll. I
r know three physicians whose chirdren have been damaged inthÍs way.
rn the present obsession with the question of thereduction of dentar- carles rates Ín populatíons, above arlothe¡ considerations, concern for the Índividuar child haslargely been r-ost" For instance, professor Linus paulingsaid that:
rln general, only nÍId or very nild nottling of theenanel is caused by the concenüration of fluoride,recotnmencred Ín the ftuoricration of drinking water" r
Ee expressed his opinion that:rrhe dÍsadvantage of occasionar nild nottling of the enanel
172
1s far outweighed by the advantage of groat decrease
in dontal carieo. I (Pauling, 196?).
As hae bsen scen, the appearance of every child. afflicüed
with rmildr dental fluorosis is ruined.
(e) Direct Effects of Fluoride on the Central Nervous
System.
hofeesor D.G. Steyn (1958b) said: rFluorÍde is a reüro-
toxin, and the central nervous system tissue contains
neuro-kreatin. r AIso rit is knov¡n that some fl-uoride
accur¿ulatee in those parts of the body where kreatin is
located. I
In the En6lish translation of thc Ruseian book Fluorine
in Stomatoloqy and Hyniene (Gabovich and Ovrut skiy, 1977)
the authors state:rFrom the above it becomes evident that fluorine,affecting metabolisro in nerve celIs and disturbingreceptor functíon and the tranomission of nerve inpulses,can influence the function of hÍgher sections of thecentral nervous oysten, which should be reflected Ínthe cortical regulation of vegetative procer¡oes and
conditioned reflex actj.vity. I
They nentÍon that Gabovich, when studyfng the'ability of
spinal centers to eummarize sublimnal lmpulseer found
cleviatfons in rato consuming water with a fluorine
concentration of 6 ng/L, (nats are between six and ten
tines more resÍstanü to fluoride toxicity than is nan. )
the Executive Director of the Feingold Association of New
York for Hyperactive Cbildren said, in 19?62
tFl-uoride is one additive that cannot be toLerated by
children in this group. It has a severe adverEereactlon upon theír nervous system. I (GelardJ., 19?6),
17t
ß) Possl- b t_e Psvcholoqical Results from Fluoridation.
In 19?2, the Auetralian Metllcal ¡Iournal contalned an
artlcle by Dr Stephen lJoyden, of the Urban Btology Group,
Australian National university. Dr Boyden pointed out thatone of the nost ma¡ked envfronnentar changes which is takingplace is the increasing rchenicalízationt of the environment.
Ee said that:r.. it is inportant to appreciate that the firstsynptoms of exposure to nany toxíc chemicals a¡e notphysiological, but psychologÍcal-, and ínclude suchsymptons as confusion, personalÍty changes, fatigue,loss of menory and nental dulIness. Or, to put itanother way, behavÍour is exquisitely sensitive totoxic substances rn the environment. r (Brown, 1966;Boyden, i97Z).
rf such symptons occur fron exposure to íncreased doees
of toxlc fruoride, as a result of the fruorictation of the
donesti-c water, is it likery that more than a few peopr-e
will suspèct that the cause of those symptons io to be
found in the water supply?
¡þ
XXII. 1?+
FLUORTDATION AND CANCER MORTALITY.
A very f-mportant developnent since the passing of the Act
has been the publication of a paper by Drs J. yiamouyianni-s
and D. Burk ín 1977, in the specialist journal Fluoride.This paper revealed a rink between artÍficial fruoridationand increase in cancer nortaLÍty in the ten largestfruoridated cities (t96o census) ín the united. states. f,
rt is understoocl that Dr yiamouyiannis addressed tbe
commj.ttee durin6 his recent vlsit to Austraria, t,herefore
the data presented in that study will not be discussed here.
(t ) Earl Papere whic h st that Fluoride may affectQancer.
For nany years data have been avairable which suggest thatthe ingestion of fruoride raay affect cancer, but r-ittreinvestigation has been und.ortaken. ror Ínstance, the ü.s.National cancer rnstitute has promoted fluoridation for many
yealsr but at the congressional investigation into Íüs work(U.S. Congrees, 19?Ð it was reveal_ed that it had not
conducted even one study to deternine whether fruorid,e
affects cârc€r¡ The rnstítute then announced that it was
about to conmence a thrss-year study on animals.Dr R"A. Holnan said, ín 19612
tMany observations have 'uggestecl
that agents which d.ecreasethe catarase of cerls nay predispose to tu.uror fornation.r¡since fr-uoride can inhibit catarase and. since it is acunulative poÍson, the danger of i.ncreasing the câDC€r_inducÍng potentiar in humans must be consídered. I Ee added:t /rlthough there Ís not to my knowledge any good posftive
See appendix 4f, po 262.
175
evLdence llnking fluorlde wíth known cancer caseG, thewhole questlon of fluorido intake from foodr.vrater,insecticidos, and lndustriaL processes should be much
more thoroughly Ínvestigated. I
Professor Douw Steyn (Ctriet Research Officer, Divisíon of
Ilfe Sciencea, Atomic Energy Board, Pretoria, South Africa)
ln 1964(q) ¡ oaid:
rThe fLuorf.de J.on, beln6 an active general enzyme poison,may be a factor in triggerín6 cancer.r rIn this respect,we must 6ive special consideration to catalase.lfCatalase tnhtbltion Ís known to be associated withmutagenlc proceesee and the dovel-opnent of viruses,and 1t ls known that nany of the proven carcinogenica6ente can inhíbit this ênz¡rírso I
Profeesor Steyn (1964a) said that he agreed with the
statenent of Dr Eolnan (962) tfrat:rSodium fluoride ie a potent catalase poison and 5.s
cumulatíve. The use of sodlum fruoride is frau8ht v¡ithgreat danger, and ln any case 1t does not deal with theprime cauae of dental caries, which is generallyrecognized as being a sophisticated and chernicallyadulterated food supply. t
Q) Comments bv hofeeoor ALbert Scha tz.T.n 19?6, Professor Albent schatz v¡as avrarded, the Grand prix
HurnanitaLre de France r the highest distinction in tr'rance forneritoríous eervice to hunanity, in recognition of his
outstanding scfentlfic achievenents.
rn 19?2 Professor schatz and Dr vivian schatz statecl:tFluorine is, among other things, a carcinogen. It istherefore fuoportant to ninÍnrize our total daily fluorineintake. I
176
They nade the followín6 conmente:
rOkanura and lulatsuhLea became interosted 1n fruorine as aresult of their reeearch on the geographicaL distrLbutionof nortallty due to gastric cancer. r (Okamura andIulatsuhisa, jg6?). rThey found a correlatÍon betweenfruorÍne content of rice and, death rates for gastriccance¡. There !üere also geographical and annualcorrelatlons between Lhese death rates and the anountsof phosphatic fertirLzers applied to rice paddÍes. Thefertilizers used contained O.01 to 9.BB% ffuorine.
okanura and Matsuhlsa (lg65u) also found. that the 1960tleath rates fron gastrl-c cancer correrated v¡ith thefLuorine content of ItMisot in 28 prefectures of Japan.rrMisorr is a fermented product nade from rice and soy_beans. t
They continued¡
rour analysis of officiar health statistics from Birnínghan,England, show that the death rates fron Ler¡kenia and fromall typee of cancer vrere significantly greater fron 1965to 1969 þrter the fluorídation of Birmin6ham Ín 1964]than from 1908 ro 1964, (Blrmingham, l96}i Mj.IIer,1970) ,
fAs recently as 1970, Soviet investigators expressedconcern about the possibrlity that fluorine in drinkin6water might cause cancer. r (Gabovich and TsiprÍan , 19?O).,In 1)6J, Taylor and Taylor found that fluorine andother halogens accer-erated the growth of tumor transprantsfn mLce and enbryonated eggs. As lÍttle as 1.O ppn ofsodiun fluori-de in the drinking water stimurated growthof tumor transplants in mice.
Fluorine also produced defornities in toad enbryos(Kawakara and Kawaharao 1954) and melanotic tumors ínDrosophila (Rapaport , 1963). Fina]ly, fluorÍne eausedIta consistent antt híghly sfgnificant increaserr Ln
177
rrthe production of recessive letha1 nutationo by X-raysl.n Droeorhila spern.'r (l{ul<kerJee and SobeIs , 1968 ) .
Theee ancl other roporte validate Alexander Levittrswarnlng, in 1948, that fluorine ancl other halogens rfnay
be responsÍb1e for geographlc or regional occurrences
ofil several rldiseases, Íncl-uding cancer.rrl
(t) Paners linkinn F]-uorídation with Cancer l4ortality.
Tno papers baeed on officíal figures may be nentÍoned briefly.(a) In 197?, Margaret Rrady reported on data fron the
BirnÍngham, U.K., Health Report'- 1973. Sbe said that:fBirmingham began fluorÍclatíon towards the end of 1964,and in the preceedJ,ng ten years from 1954 th'ere v¡as
litt1e or no over-a1l riso in the cancer deathrates, but after the introduction of fluoridatÍon in1964 tyrere was a marked riee as is shorvn in theacconpanying graph, just as in the report for raany
American cities by Drs. Tiamouyiannis and Burk. lrlhilethis graph does not proye that fluoridation was
responsÍbIe for al-L of the higher cancet death rates,it gives cause for great concern. I
(¡) In 19?? Dr V"A, CecÍIioni reported that he had obtaÍned
cancer death data for the years 1966 to 19?4 from the Vital.Statistics for the ProvÍnce of Ontario, Canad.a. This
covered 26 fruorídated and, 2J non-fruoridated cíüies v¡ith
populations of 1or0oo or more (971 ontario census). The
totar number of cancer deaths for the 9-yea¡ period was
16,6% bigher ln the fluoridated cities. When 12 of those
cíties were. compared with 12 non-fluoridated ones of
similar sizerthe crude cancer death rate per IOO'OOO
population vras 27% híeher in the fluoridated cLtfes"
1?8
Three years earrler, Dr cecrriont (lgz4) tra¿ studiedthe incÍdence of cancer in the steel cÍty of Hamirton,
OntarÍo. He said:rA revfew of the ¡rortaLfty ratee for cancer for theyears 1966 to 1g?o in Hamilton revear-s a considerablyhlgher death rate fron cancer Ín l.IamÍrton than r.n thelees industrialized cÍty of Ottawa. The higheot rate(65 per loorooo) occurred in the proximity of the steernil-lsr compared wfth the cleath rates (2J an¿ 12 per100r00o) farther distant. Adrnission records at twolarge Hanirton Hospitals showed a close correlationbetween reepi-ratory disease and the daily polrutÍonindex. r
Dr cecilioni had previousry found that airborne fruorider¡ras a maJor conta¡¡inant derived fron the rnanufacture ofsteel.
(4) Conments on the Report by Drs Burk and YiamouyiannÍsRe dinr¡ a Link betwee Artificn ial Fluori-dat íon and Increase d
Cancer Mo rtali ty.
(a) Statistical aspects. Und.er exanination, both ofthese authors estabriohect ühat they had considerabreexpertise on statistical matters. I{ovrever, they also hadto advise thenn the eminent statÍstÍcÍan, Dr rÂr. Edwa¡d.s
Dening (See lrlho's I,üho in America 38tn I¡d. ) " The Chairnanof the 197? congressional Enquiry ínto the activities of theIIatÍonal Cancer Institute asked Dr Hubert Arno1cl,, Departnentof Mathernatics, University of California, Davis, for anas.essment of the Burk-yiamouyiannÍs etudy. Ee reeponded:
fr have exanined that study and find that they have nadea very thorough exa¡oinatÍon of the extensive avaiÌabr_e
179
dataandthatthoyhavecorrectlyapplletlvalidstaüistical methods. their conclusions that there lsa definite link between cancer and fluori.des in the
drínkin6 water of a nunber of large citÍes Ís valid
statistically.' (Arnold, 19?7).
(u) Âssoc :Le ri on and causati The point hae been madeon a
by several commentators that the Br¡¡k-Yiarnouyiannls study
reveaLs merely an assocíation, and that association does
not prove causation.
That is eo, but it shoul-d be renenbered that it was the
demonstration of a like assocÍation, only an associatiOnt
between cigarette smokÍng and the prevalence of 1ung
cancer, which caused the tremendous ouücry against
smoking, and which motivated government efforts to reduce
this habit. As Sir Austin Bradford IIilI 9966) poÍnted
out, action on the basis of probabitity is rhow we usually
conduct the affairs of medlcÍne as weLl aÊ our Iives. I
In a eituation such as the present one, in whÍch
a chernical is beíng administered to the whole population.
which may shorten the lives of a large number of people t
great care mu6t be taken. v'lhen it is found thaü a strong
association such as the present one exists, based on a
very large sample, and when the obvious variables of age,
race and sex have been considered and determined not to be
the naj.n cause of the association; until another factor or
factors is establíshed as the cau6e of the association,
prudence dictates that the adninÍstration of the chenicaL
be discontinued.
180
(c) Res nse Auet atot se FluorÍdatio
Cancer Mo 1it 6 te.
The ffndlngs of Drs Burk and Yfanouyiannis have been attacked
Ín AuetraLia in newspaperar particularly eÍnce thl-e
fluoridatlon/cancer link was nentioned in the A.B.C.rs
fFour cornersr televisJ-on programmê on April 21t 1979,
Thecritics,asusua},cíteclauthorities,inthiscasethe
U.S. National Cancer Institute (Iloover 9þ!t 19?6), the
Roya1 CoJ.tege of Physicians g9?6)¡ Do1l and Kinlen ?9??)
and the Royal Statistj-cal Society (Ot¿han and NerveIIt
1g??). They did not mention the replies, such as by Dr
Yiamouyiannía (glZ) nor the proceedings in the U.S. courü
case in 19?B t mentioned below.
fn Hol1and, the disclo6ure of this fluoridaüion/cancer
nrortality línk was an Ímportant factor leading to the abandon-
ment of fluoridation after many years¡ experÍence.
However, in Auetralia the reacti<¡n to this same infornation
by bodies, such as the N.H.& M.R.C.r the A.M.À.t the A.D.Â.
and Public HeaLth groups has been most ocld. .â'fter al.lt
the nain responoi.bility of these bodies shouLd. be the health
of the popuì-ation, and they therefore shoul-d be expected to
study this new development. Instead the response by the
epokesnen for their Executives has been (as pofnted out
DÍesendorf , l9?9i !,lal-ker, 1979) enotional, unscientific and
nisinforrned. Indeetl, many attempts have been nade through
the medLa to aosure the public that such a link does not
exÍst, by citing out-of-d.ate articles which have been proved
to be based on inconplete and faulty data.
181
For lnetance I in the Houee of Representatrves the
ActÍng Minlster for Health (Hon. hl.C. Fife, 19?Ð saíd¡rrhe cl-aín of recent evLdonce 6u6geotlng a r-ink betweenfluoridatfon and cancer hae been rejected categoricalryby the united states cancer rnstitute and other inter-national authorities. I
(a) . Court Hearinqs and Decision . In 19?8, seniorThe U.S
lepresentatlves of the u.s. Nationar cancer rnstitute and
of the rother internationar authori-tiesr rnentioned by the
Acting Minister for Eealth, gave evid.ence, under oath, ina U.S. court. They includ.ed Dr L. Kinlen (lgZÐ of the
RoyaJ- College of Phyeicians and Dr D.J. NeweII (192g) ofthe Royar statistical society. Both of those witnesses
were forced to adnit that the data in their papers
rrefutingr the fÍndings of Drs Burk and yi.amouyiannis
were incomprete and faulty, and were noü obtained from
original sources but from the u.s. National cancerInstitute. fndeed, Dr R. Hoover the Director of thatInstitute wrote to Dr Kinlen on Sept. Z6t 19??, saying(in part):
rr am 6orry for thís error, particurarty since it seensto have been perpetuated by yourselves and, the RoyalstatlstÍeaI society. r am a bit distressed atso thatneither you nof the Socfety checked some of theorÍgÍnal numbe¡s. | (Unitea States Con6ress t 19??).
sone of these original figures are readily available.(severar years ago r personarly checked the originar Br¡¡k-YÍamouyíannie clains by obtaining the d,ata from theMelbourne pubLic Library. )
1Bz
DurÍng that court case the Burk-Yiamouyiannfs data
were open to examfnation by critlcs who were excoptionally
well qualifled to locate and point out any errorc. Inlr tI.R.
Graham, counsel for the plaintiffs (who opposed fluoridation),
gave hio final sunmation on September 25¡ 1g?8. He said:rlrJe cornmend the defcndants and their counsel ín thisrespect: their presentation has been the best possible.They have called witnesses from hi6h places in thescientific worrd both here and abroad. They have cross-examined vigorously, and offered every objection knov¡nin biology, medicine, and. epidemiology to the thesisadvanced by the di-stinguished doctors who have testifiedon behalf of the pIaÍntiffs. ¡
Despite this, the clain that there Ís a linl< betv",cen
fluoridatÍon and cancer nortality ïrac not refuted.
In his sumrning up the Hon. Judge J. Flaherty (who
has recently been appoÍntecl to the Supreme Court) saÍd(in part):
rPoÍnt by point, every criticism defendants mad,e of theB-Y study was met and explained by the praÍntiffs ["toopposed fluoridationf " often, the point was turned,round against the defendanto. rn short, this courtviras conpellingly convinced of the evidence in favour ofplaintif,fe. t Judge Flaherty then said that Dr D. Taves
ra v¡itness cîlled on beharf of def,endants, acknowJ_ecigectcertain unresol-ved doubts concerning the safetl offÌuoridation, and was then asked.
Itshffting your rores from scientist to doctor ofmedicíne following the Hippocratic Oath ... woüld.you as a doctor of nedicine recommend, that fluoriclebe dumped ínto the public water supply?"r A
colÌoquy followed,tThe climax was
18'
,rQ. Is your testirnony that you recommend fluoridation
in public ràtater suppl.ies?
A. I donrt want to otate on thaü"rr I
The Judge thên said:
rV'lhenever the public health nay be threatened, a courtof equity bas a duty to act. Therefore, a prelimÍnarylnjunction prohibitin6 the additlon of fluorícle tothe waüer suppIy... shall issue.r (Flahertyr 19?8)
Dateil November , 16, 19?8. ìÍ
(e) The Visit of Dr Yiamouyiannis to AustralÍa. In June
1979, Dr Yiamouyiannis visited Austral.ia. This provided,
an opportunity for his data and fi.nclings to be discussed
and, if faulty, díscredited" Despite the fact that his
visit was well publicizetl, and that many personal invitationswere issued in an attempt to engender discussion, none of
those who had criticizecl his findings in the nevrspapers
''¡ra6 prepared to discuss then v¡ith him. At a meeting inNowra, Dr Joyce Ford, the Dírector of the centrar cancer
Registry, N.S.W.; ñêtrtÍonecl unpublished data being collectect
in sone towns ín N.S.tf . , but dlit not conment on the data
of Dr Yíanouyiannls. During the whole of his visit,nedj-cal conment on his d.ata was notably 1acking.
I v¡as present aü a neeüing at the Australian NationalUnÍversLty which was arranged so that Dr Tiamouyiannis couldpresent his case" surprisingly, half of the one-hour
Ìecture tine was, with littIe notice to Dr yianouyiannis,
arlotted Lo a retired professor of pharmacy who admÍtted
that'he knew little about cancer and. spent most of hie¡F see appendix /a, p. 265.
184
lecture tLme discueeJ-n6 dontal aBpects of fluorldationand doser/regponse rates.
Durlng queation time Dr YianrouylannÍs wae agaln
attacked - that Ís the appropriate word - because of
his assocfatlon with the National Hearth Federation which
Ís a non-profit consumer-oriented organization devoted
exclusively to health matters. According to the U.S.
fConsuner Reportr of July . 19?8 (Anonynous, 19?B), several
of the officiars of the Natfonar llearth Federation rwere
convicted of misbranding dietary products with false
nedical claims.r the last tine that these events lûere
sai-d to have occur¡ed was Ín 19Ø, that is gLeven yeare
before Dr YÍamouyiannis became scientific Director
his first associ-ation wi-th the Federation.
In the U,S. court case in 19?8, when the defense
attorney attempteil to attack Dr yianouyiannis because ofhis aesociation with that Federation, the Judge aeked
counsel whether he courd show any evidence that Dr
Yianouyiannis v¡a6 connected wÍth rthese al-reged fraudsr.Defense' counsel: fNo, r canrt. I The Judge then said:
rThen, ny goodnessr why wouJ.d you be here fnpugningthe reputati.on of this fndividual due to some otherindividuals t arreged. fra'dulent activíties? Thatflouts in the face of due process of Iaw and every_thÍng we stand for in this Co.¿rt. r (F]aherty, 19?g),
(r) PubI tions Re lat to this S b ect . Inapaper publíshed in January, 19?9, Drs Ìf.A. Strassburg and
s. GreenLand criticized earry naterial'obtãined by Dr J.A.
185
TiamouyiannLa, which they sald wae Inot published in a
ecientl-fic Journalr but was rpopularly circul'atedr. It
would appear that the nanuscript of their paper waE rlostt
for upwards of two years. Tþe latest reference which they
cite was datecl 1975. They do noü mention the correct
reference for the work of Dr Tiamouyiannis t which ís the
paper wbich he and Dr Dean Burk published l-n 1977 in the
journal F1uori9e, eighteen months before Drs Sürassburg and
Greenland published their critÍque" That paper Ín J'lugride
íncludes data fron the cities of Bostonr Cincinnatí and New
0rleans which the critique saÍd fwere excluded fron Dr
Yiamouyiannis r study. I One wond,ers why this out-of-date
criticism nas published.
In ,January, 1979, Dr Dean Burk considered the d,ata
obtalned by Dr L.J. KÍnlen regarding the incidence of cancer,
in six parts of the bod.y, in Angl-esey, Watford and BirmÍngham
(f1uorÍdated in 1955¡ 1956 anð,1964 respectively). Dr
Kinlen (9?5) tra¿ concluded that there r^ras no increase over
the cancer incidence up to 1969r as compared wÍth rr¡atchedl
control aréas with 1ow fruorid,e level-s in their water oupplies.
Dr Burk stated:
rAs evident in Table 1, KinÌenrs conclusion appears to be
untenabre, and England is now faced v¡ith a denonstrationof the exlstance wLthfn its own borders of a fluoridation-cancer incidence link that is readily derivable fronKinlents ovrn data. l¡fhether the data are adjustect forage and sex, in the nanner carried out by Kinlenr.orlefü unadjusted, the fluoridated populations shov¡ cancerincÍdence increases for the six organs of respectivelyI and 13%. These are very large increases for the time
186
perlods lnvolved, and ars even greater than correspondingfncreages ln cancer r¡ortality ouch aa reported Ln theUnlted Statoe, for even longer poriode of observatlon,and for approximately ten-fo1d greater populations.Cancer inoLdence fs, of course, greater than cancermortallty 1n a given populati-on, and this appears to betrue for cancer increases associated with fluorÍdation. I JF
As Dr M. Diesendorf Ogzg), who was present at the meeting
at the Austral-ian National_ UniversÍty in June, 19?9, said:r... a correLation between fluorÍdation and cancer deathrate . o. has not been convincingry refuted in the twoyears since its publicaüion. ¡ (Diesendorf, 19?g),
rn a reply to the chairnan of a u.s. congressional
Inquiry in 1977, Dr H.A. Arnold. of ühe Departnent ofI'tathenatics, University of California, saÍd:
rrhere are 6ome who argue that causar relationships arenot provable by statistÍcar studies in the Iarge, butonly by controrr.ed laboratory or crinical experinentsin whích cau6e and effect can be obaerved j-nÍndlvidua].s and groups of inclividuals. on the basisof published researcb and the Burk-yiamouyiannisetudyr Ít is no$r unquestlonabry tine to perform theseexperinents and to suopend arL nechanical fluoridatlonof public waters untfr defÍnitÍve resurts have beenobtained. The experiments should, be funded andperformed by, and under the supervision of agenclesin no sray connected with any agencies th-at may havecommi-tted thenselves to previous opinions or stances,negative or positive. I
That is so. vühile ühís ftuoridation/ cancer link remainsunrefuted it is foJ-ly to continue fluoridation.
JF See appendíx 18, p. 28O.
XXIII.
TIIE INFLUENCE OF TLUORIDB INGESÎION ON GBNETIC CIIANGES
MONGOLISM
18?
Recent fÍndings, that even row concentraùfons of fruorid.e inthe drinklng water can produce genetic changes, supporü the
obeervations of Dr r. Rapaport u956, 1959t 1961) ttrat:r.".ê paralleJ-ism has been observed betwecn the íncidenceof this disease fnongolisml and the fluorine content ofdrÍnkÍng vrater. I
In 1976, Professor A.H. Mohanmed reported that:fAs littre as 1 p.porlr of sodiunr fruorÍde in drinkingwater can produce pernanent genetic damage in nice.The chromosomar damage and breakdown observed in thestudy ls believed to be the direct result of fluoricleacting on the D.N.A. etructure. r ¡ß
The nutagenic activity of inorganic fruorÍde compouncls rìra6
studíed by Dr E.A" Guleva et 4. (gzz). who concluded thatfluorÍrle stlnulates the fornatÍon of mutagenic netabolitesin the organisnr of rats. In 19?3, Drs B. Mitchell and
R.A. Gerdes said: rrheso data denonstrate that under the
test condltions sodium and stannus fluorides are nutagenic
to Drosophila rnelanogaster. r
Dr Aran stoller of l"lelbourne has d.one considerable
worl< on the etiology of mongolisn. In 1963 he said thatthere are:
r.. two separate aetiotogical processes - one affectfn8younger mothere and independent of máternal age ancl theotherr a xnore frequent phencmenono affecti.ng old.ernothers. e
Ü See appendix 4e, p. Z6j,
1BB
D¡ StoLler mentloned that Myers (19t8) founcl that where
there was a high incÍdence of maternal thyroid disease
there was a hlgb lncidence of mon8ol-ism. (Moderate
concentrations of fluoride in drinking v¡ater can block
iodj.ne absorption, Crawford, 1972.)
Dr Stoller said in 1963t
rThe ageing oocyte is the most constant factor in theprimary producüion of mongolism. Such an oocyte would,,in some way, appear to be vulnerable to attack by vÍrus,with a resultant, mutation leading to a nongoloid chi1d. r
Two years later, with Dr R.D. Col-lman, he said:1.. we are in no doubt that there is an environmental_
factor operative in a high proportion of thesecongenital abnormalities. r (Sto1ter and Colhnan, 1965).
Dr f . Rapaportts first study (956) reveal-ed a
relationshS-p between the incidence of mongoris¡r and the
anount of fruoride in the drinkin6 v¡ater" certaln aspects
of that study vrere crÍticíz,ed, therefore he conpleted asecond study which was designe<l to meet those criticisns,and he acknowled8ed. the advice of Dr Â.L. Russel¡ Chiefof the Department of EpidemioÌogy and Biouretry of ilre u.s,I'IationaL rnstitute of Dental Research" rn thÍs study he
found that, as the fluoride content of the dr,lnking waters
used by the mothers increased fron O.O-O.A, to O.3_O.? to1.0-2.6t the nunber of ca6es of mon6olism per IOO,OOO
recorded 1n the official records, lncreased from Jtv,1J Eo
4?,o? to ?1 .59 (p <o.oo1 ). rre saÍd:frhe ¡ole of the advanced age of the nother, in ilreetíol-o6y of nongol_ism, woul_d 6eem to reflect, a slow andprogressive accumulatÍon of fl-uorine in the notherfsbody. i (Rapaport, 1959).
189
Two years later (961) Dr Rapaport oaid:rÎheee facts have 1ed up to put forward the hypothesiothat fluorine plays a part f.n the pathogenesis of thisdisoaee by brlnging about a rnetaboric change simrtar tothe innate faurt tn the metaboriem which recent researchís now revealing. I
He was referrlng to his fincling that:rSodÍun fLuoricle, incorporated in the diet, produces Índrosophllae ¡nelanic tumors. This shovrs a change in ühemetaboLism of tryptophane. Thie change ín metabolisnfs oimilar to that shown Ín chirdren suffering fronrmongolisn. ¡ (Rapaport | 1961).
FolJ-owing Dr Rapaportrs fÍrst publication, a study
waE conpleted in England by Dr lf.T.c. Berry (lgsï) which
showed only slight difference6 Ín the prevalence of mongorÍen
Ín the fluoridated and non-fluoridated âr€âs¡
Professor IIu6h sinclaír, tn 1)lJ, said that he had had two
dÍscussions in the U.S. with Dr Rapaport about his v¡orlç on
fluoride and, Downrs syndrome and that he had rread the ressextensive work ín this country of rny friend Dr Berry. r r rbel-ieve further studies are requíred before Rapaportrs work
and conclUsions are. disniosed. r
Dr Berryrs work was also criticized, on severalgrounds, by Dr H.L. Needleman (lgZÐ and his co_workers.
Their main objection being rthe sparcity of d,atar " They
also criticized Dr Rapaportrs work, nainly on ilre ground thatthe number of mongoÌoÍd births was too sma'I. However, hÍsstudy was essentially a nrathenatical one, using officialdata. He dÍd not deternine either trre total number ofbirths nor the nunber of non6ols" No suggestion has been
nade that the official records were biassed.
19o
Needleman gj_4. (gZ4) studied the prevalence
of Downre syndrome fn Maesachusetts between 195O and 1966.
They concluded that:r.. the data provide strong evidence that fluoriciationdoes not cause any inportant elevation in risk forDownre syndrome, at least not for several years afterits introduction. r
Connrenting on that paper, Dr J.R. Lee said:rI found most interesting the authorsr attempts todisparage their ourn results with assunptions aboutad¡nÍttedly rfunknoürn compounding factorsfr. I rI believethat, the authors I data provide eug8estive evidence thatfluoride nay cause an el-evation in the risk of Downrssyndrome and that they reach an unwarranted oonclusÍonwhen they etaùe , in the abstract, that their data providerrstron6 evidencett against thÍs relation.r (T,ee, 1g?5).
The IIon. Dr D. Everingharn, when he was Austrarian I'[inisterfor Health between 19?2 and 1JlJ, asked his Departmental
advisors to provido him with the scientific evidence which
would refute the suggesbíon that there was an increase inDownrs syndrome (mongolì-srn) with increase j-n the fluoridecontent of. drÍnking water" severar years later, ín 1)ll,he safd: ¡r am still waiting to see such refutat,ion.r
As Dr lee said in 19?5: f Thu,s, the questlon ofDownro syndrome re¡nains a question.r
XXIV. 19t
oTHER I-IEDICAL ASPECTS OF FLUORIDATION.
-
tilhen artificfal fLuoridation wae first commenced in 194J Uy
the U.S. Public Hoalth Servfce, aÌmost the whole concern
was for its effect on the teeth - the retardation of,
dental caries and the flr effect of the production of dentar
fLuorosfs, known to be due to chronic fLuoride poisoning.
There was little concern forr even speculation about, the
poesible effects on the rest of the body. Aninal
experfnents to teet its effects on the other organs vrere
almost total-ly lacking.
It is now known that fLuoride, even in low
concentratfons, has a wiclespread effect on the bocly, a few
aspects of which wiÌI be mentfoned briefJ-y.
(t ) Fluoridation and the thyroid.
The anonymous author of a paper in the VIHO Chro-nie1e (19?Oa)
sald that fluoricle has no specíff-c toxic effects on the
thyroid glanil. rFluorfne neither accumurates in the
thyroid no.r fnterferes v¡ith the uptake of iod,ine from nornal
d,ietary solltlcos¡ |
Eowever nany others boLd opposing vÍews:
Professors T. Gord.onoff and w. tvrlnder stated, in 1960:rrhere is a true antagonisn between fluorine and thearnounts of ÍodÍne taken up by the thyroid. This nayresurt ln an approximateJ-y zo to Jo per cent reductÍonin function. r
Professor N.p. Buu-Hoi (96Z) etated tbat f fluoride ionsare known to interfere in the production of thyroid bormones",
192
Ibofessor Douw Steyn
experfment lndicates
antagonfenr. r
(t964a) said: 'The result of thisthat there 1s a fluorine-iodine
In 1972, an articlc in the I,ancet (T.K. Day and
P.R. Powell-Jackeon) reported the results of a study ofthe preval,ence of goitre ín 1? Himalayan villagesr The
wíde variatLone $rere not due to differences in iodine intakebut rvariations ln goitre prevalence v'ere found to correlatecloeely wfth the fluoride content (¡= O,74; p<0.01) and
wlth hardness (p= O.??; p<0.01) of the water in each
vfllage. I The pnovaronce of goitre vras hígher in the harderwatere and 1n those with more fluorides. The fluoridecontente of the wate:rs ranged from 0.1 p.p.m. to o.J4 poprtrrr
rn vLew of the exceptional softness of Melbournerswater euppliee (sylvan has a totar- hardness of only 10;M'M.B.vt. t 19?B) tt¡e comments of Dr Mar6aret cravrford, anauthority on blologlcal effects of eoft vrater, are ofparticular fnüereet. She said, ín 1jl2z
rì4r Day and r'rr powerl-Jacrcson denonstrate a cr-oseaseociatfon between rrardness and fluoride concentrationsin drlnking water.and the prevalence of goÍtre in hírlvillages in Nepal. These results raise a probJ_enconcernfng fÌuoridation of water supplies in thiscountry [U.fJ which has not ¡eceived suffieientattentr-on
- that fs, the reratíonship between fruorÍdeand other ione preeent in drinking-water, in particularlodine. I
fNaturaLly eoft waüers, however, have little or nofluoride and the fodine is therefore ar' availabre forabsorption. rf fluoride ís added to soft waters thiswfll not be so and a proportion of the populaÈion naycone to have euboptimum iodine uptake. The effects
19'
nÍght be eubtle and slow to develop and wouLd certaJ-nlynot be picked up by the crude ecreening used at preeent.r
It ie not known whether thie posslbilfty le being examined
here.
Dr J.R. McLaren ?gZe) has ¡rade rA review of the
voluninous l-iterature on the relationship of fluorides and
tbe thyroid glandr. A photocopy ie appended because thisis not avaflable 1n Melbourne,
(e) the Aorta.
ln 1967, Dr F.B. Exner cited an investigation by Drs Cal-l,
Greenwood É4. U965, Pub. HIth. Rep . 80: 529) saying:
rThey found that fluorine accuruulates in alJ. soft tisoues;and that the levele Ín different tis¡¡ues are notconsistently high or low in different individuals. Forexample, the peroon with the hi6hest leve1 in one tissueni6ht have one of the lowest fn another. Consequently,tissue retentlon cannot be governed so1ely anil directlyby fluorine intake, rnuch less by the concentratÍon 1n
the water supply.. But by far the highest leveLs in any sofü tissue (rpto 258 ppm) were found ín the walIs of the aorta, themain artery leading fro¡r the heart" I
That hi6h level of fluorÍde in the aorta vras ecÌipsed in a
more recent report. Dr G.L. Waldbott (19?4a) saÍil:rRecent data concerned rvith fluoride in water portendserÍous damage to hunan health: A pIIS fU.S. publÍcHeal-th serviceJ report (Geever gL4. , 19?1) dÍscrosedaü autopsy 8r4oo ppn of fluoride in the aorta (the largeartery of ühe heart) of two persons who had been residingfn Grand Rapids, Michigan (fluoridated since 194Ð, forless than twenty years and 2rJ4O ppm in another 1ess
194
than twenty yearo oLd from a New York State non-
fluorj.dated communlty, I
rTheee lovoIs are hÍ6her than thosc j-n bones of cages
of advanoed orippllng r¡koleta1 fl-u.orosis. No clinicaLdata on thoee cae¡e6 vrere reported to establieh whetherand to what extent such extraordinarily high leve1s offluoride had danaged the vascular system. I
Dr lüaldbott had reported other cases in 1962, saying:
rThese obeervatlons raise the question whether or not F-night contribute naterfally to sclerosis of arteries. I
(t ) Ttre KÍdneyo.
It hae been eaid that Auotralíans have the highest prevalence
of kidney dfseaee to be found anyvrhere.
rrn the human body, the kidneys are probably the mostcrucial organ durlng the course of row-doee long-termexpos¡ure to fluorida. | (Roso and Marier, 1g??) ,
The eane authors had previously roportecl that: rllcarthy
kÍdneys excrete 50 to 6A% of the ingested dose., (llarierand Rose ¡ 1971),
The International Society for Research on
Civilization Diseases and Vita1 Substances (1969) said:| .. persone suffering from kictney troubre are l_ess ableto excrete fluoride and more lÍab]e to injuries from it. r
0f partfcur-ar interest, ie the question of poisoningfron fluoride durfng dÍalysis of ki<rney pabients, due to thevery large volumes of water used duri-n6 this proce.ss. Drïü.J. Johnson ?gZÐ of the Artificial Kidney center, l,tayo
clinic, MÍnneeota, rn 1g73 .aid: rwe are currently usingnon-fluoridated water for arr- patients under our care. r
195
lle nentioned that 11 out oî 12 patÍents exposed to fluoríde
for two years or more had developed I symptornatic bone
disease, rib fractures and severe bone painr ' I In
addÍtion, two patients experienced extreme wastingt
sug6estin6 other toxic effects of fluoride'l
Dr D.R. Taves, ancl his co-workers ?965) were among the first
to investigate this problem and, after finding an increased
concentration of fluorirle in the blood serum during dialysis t
said that 'it would ""ur nrtdent to use nonfluoridated
di-aÌysate baths for }ong-term hemodialysis'r In 1974,
Dr J. Jankauskas said:
tAlthough no definite conclusions can be drawn at thistime, severaf inveetigators have advised the use of non-
fluorÍdated diaJ-ysate' baths for long-term hemodialysíÊ. I
The Australian Kidney Foundation, in 1974r said that
the question whether fluoride shoul-d be renoved from the
water used for dialysis tis a matter for the indivÍdual
doctor and we would not contenplate getting involved in a
question such as this which has generated so much controversy. I
Two years later thc Foundation said they had I no specific
statement to nake repçarding the fluorid¿rtion of water in
relation to patients wiùh kidney disease.r (Kincaid-Snith,
19?6) ,
From recent inquiries from the dialysis centre at
the Prince Henryrs Hospítalt it appears that in the dialysis
treatments carried out in most, if not a1J- t hospitals,
fluoride-free water is used, but that almost all of the
196
home di¡¡ryr:is machines obtain thoir water directl-y from
the domestic tap. rn Merbourne this water is fruoridatea.tApnrt from avoi-din¡1 poooltrJ-o darma¡1c from thc ron6-
term use ol' 1irr6e vol-umes of fl-uorÍd¡¡.ted water, it would
appear that the use of deionized water has other advantages.
rn an editorial articre which appeared l-ast year in the
Journal of the American l4edical Association (4), lrS. Vaisrub ('tgZB) said:
I rmpressive evidence has accumulated to Íncrininateal-uminium in the causation of dialysis encephalopathywith dementia (aiarlysis dementia, dementia dialytica)as the striking manifestatÍon. r rNo further cases ofencephalopathy were noted amon6ç 29 patients after thesubsequent reduction of the aluminium content of thedialysis water with the use of a deionizer. r Thisrerated to fan outbreak of encephalopathy that affectedei6ht of 14 patients in a sma1l dialysio unit.r
Dr Vaisrub concluded:
rlrfi-th the burk of evid.ence incriminating aluminÍum, thedoor is left open to effectÍve prevention of the dreadeddernentia dialytica. r
(4) or r cond tions.rngested fr-uoride reaches all the organs of the body throughthe br-ood. Many effects have been reported but they wilrnot be considered here.
.ne subject which has engendered conflicting reportsis that of the use of fl_uorÍde to treat osteoporosis. Thisuse of fluoride i-s not approved by the u.s. Food and DrugAd¡rinistration. rn an editorÍa' articr-e in JAMA ín 19?8,Dr s.J. Iifarx said that, outside of an investig,.ationar setting
See appencìix 1Ob , p o Z?O .*
19?
r...f1uorides should not bo prescríbed for generalized or
localizcd osteopenLa untíl f-nvestigations have documented
the efffcacy of high tloses without unacceptable toxicity. I
Sone iclea of the ranße of organs vJhich nay be
affected by fluoridc in6estion can be galnecl from recent
issues of Fl-uoride. They include : lleart (Jansen and
Thomson t 19?Ði Kidney, (Jankauskas, 19?4); Hair (ltuechniak,
19?il; Thyroíd , (l'lcLaren, 19?6); Bloød, (Mürer' , 19?6) i
skin, (Editorial, 19??ù; Bones, (Eriitorial, 19?7b); stomach,
(Iûditorial , '19??ù ; anrl Periodontal disease (Domzalska, 19?B) .
t¡lith the emphasis of the effect of fluoridation on
dental caries in children - a promised study on aduLts vrho
drínk artÍficially fluoridated water has noü been published
(nst, t944; Lonrl,on, 1967) - littre attention has been paÍd
to the influence of fluoridatíon on periodontaL disease in*
adults.
* see appendix 1le, P. 279.
xxv. 198
INTOLER/\ NCE TO TLUORI DA TED ll,JÀTER.
There are many reporto of intoterance to fluoride at a
level produced when the arnount ingested is inoreased by
the fluoridation of drinking vuater'
(t ) The Denia1 by the American Ac ademY of A11erqy.
Those promotíng fluoridation deny that cases of allergy
and sensitivlty to fluoridated water occur and cite
thestatementonthissubjectbytheÀmericanAcademyof
Allergy . Ilowever , Dr G . L. Vlaldbott stated that :
rThe widely circulated statement by the eleven-member
Executive Board of the American Academy of AJ-Iergy
asserted that rrthere 1s no evidence of allergy or
intolerance üo fluorides as used in the fluoridation
ofcomnunalwatersuppliesl|doesnotconstitutescienüific evidence.r tIe said that tthis statement was
requested by the u.s. Public llealth servicer the same
organization which is not only promoting fluoridationbut has also been financing the research of the eleven
scientists. I (wat¿uott , 1)J4a) '
He raüer wrote that two sentences had been onitiea when
tbaü letter of his was published. one of them said:
t[.n TQl1, for instance, four of the eleven received
$ 78Of621 dollars in research grants from the P.H.S.l
Q) Pre-fluoridation evldence of intolerance to fluoride.
Even before artificial fluoridation wa6 commenced, cases of
lntolerance to fLuoride were pointed out by Dr H. Trendley
Dean (often called, the 'father of fluoridation') and Dr
F.A. ArnoLd tlr. Both these nen urere members of the team
199
whlch oet up tho ffrot fruoríclatfon trral ln crancr Rapicrc.
spoal<lng of obsorvatLono in naturarJ-y frrrori<ìatcd areas,
tn 1942 Dr Dean eaicì:
rAmong lndivÍduals of even an apparentJ-y homogeneousgroup there are natural- clifferences in sensitiviüy(or reeistanco)r [to ttuoride in waterJ. He also saidthat there are rmarked variations within the group. I
The following year, with Dr Arno1d (lgt+3), Ue stated:rAnother important factor in this rerationship ofconcentration and effect is the tolerance of thelndlvidual. The oame amount of fruorine that causesa n1ld toxic ¡eaction in one individuar may cause asevere reaction Ín a'other. rn other words, vüe aredeallng with a 1ow-gracle chronic poisonl_ng of thefornatíve dental .rgan, in vrhich case some ind,ividualsnay ehow a more .evere reaction than others having acomparable fluorirle intake r ¡.. rpro6nosis v¡ith respectto one indivldual is obviously unwamanted. r
This intor-erance nay be due to a reduced ability to excretefluorÍde. Resorution lIo. vrrÌ of the 1!th rnternatÍonalconventlon on crvílization Diseases, vitar subctancer: and.
Nutrltion eaid (in part):rsome lndivlduals are more sensitive to fr-uoride thanothers, for example persons suffering from rrj-dneytrouble are less abl-e to excrete fluo¡ide an. moreliab1e to injuries from it. r
fo¡ Research, 1969).( rnternaùional- soc j_eiy
(r) rnrol-e ranco to Ârti f icially Fluoridated I¡Iat er .Dr G.r,. trlaldbott (19?4ù stated that he knew nore thantwenty hi'hry competent physicians who had eitrrer diagnosedor oonfÍr¡ned the diagnosls of serious il_lness fromfluorrdated water, ,but did not wish to become invórved in
200
the fluorldatlon controversY' Dr Vlaldbottro observatlons
have been attacked for many year6 ' altLrou6h he is a very
well qualifiecl specialist allergist' IIe said:
rBy far the maJority of nÌy cases had no bearing on
allergy (hives, asthma, all-ergic nasal and sinus
disease, and so on) ' They pertained to intolerance to
fluoride, that is, true poisonin8'r (v¡alauott ' 1974a)'
The medical publishing company C'V' Mosby' Ln 1iJ)'
published his book on I'lealth Effec ts of Environnental
Pol lrrtantswhichreferstothepublicationsofsornel'O0O
authors. Fr,uoride Ls one of the.pollutants mentioned
anclthebookcontainsnumerousreferencestodamageand+
illnesses from its ingestion'
ItÍsofsignifícancethatinthelgTScaseinthe
Court of Comnon Pl,eas of Allegheny County, Pennsylvania'
Dr V,Ialdbottrs evidence of allergy ancf intolerance to water
fluoridated to 1 p.p.m. 'b¡as runcontested and unrefutedr t
no r^ritness being called to attempt to rebut his statements'
(winner g!3!. | 19?8).
(4) Confirnation o f Intolerance by Double-Bl-ind Tests.
Í'hechargehasbeennadethatDrtrrfa].dbottistheonJ.y
persontoobservethesymptomswhichhedescribes.Ilowever'
in 1974(b) he said that he had received personal communÍ-
catíons fron sixteen clinicians each of whom had diagnosed
poisonin6 fron fluoridated water, and that Dr H'P' of
Aítkin, Minnesota, hacl Just reported 2f cases. Dr P.E.
?,anfagna ?gZ6) has aLso observed cases and has rcviewed
the subject.
il See appendix pa, p. 267.
201
A very carefuÌly conducted etudy râras completed inIloll-and by Dr lr.c. Moorenburgh and his co-workers, usinga double-brind technique with tho key data deposited with anotary. (Moolenbur6h , 1g?4, 19??; Grimbergen, 1g?4). Theyfound that, contrary to their expectation, the side effectefron drinkÍ-ng fruoridatecr water vrere not due to arlergy butto low grade poisonin6. Dr Moolenburgh (lgZZ) said:
I rt appeared that some ind.ividuars showed ùhe effects oftbis poisoning earlier than the rest of the popuration,but as more and more fruorÍde was put in the wateror in6ested from other 60urces , more and nore people
wouLd show side effects until at rast all of themmight have had compJ-aints. The first 1?/. of peoplewith eide effects rvere just the forerunners in the socaLled curve of Gauss. r
rrt arso appeared trrat the side effects in ourpatiente flickerecl on ancr off . I rApparentryfluoridation as a form of 10v¡ 6racre poisoning l0vrersthe generaÌ adaptation to attacks from noxiousinfluences in the environnent. r
G) Recen + Compl-ain ts in Vict orLa from FIuoridated Wa ter.It is understood that a 1ar6e number of StatutoryDeclarations i-s to be presented to the committee whichdescribe i.l-effects experienccrl after drinking, and, cookingfood in, fluoridated water, i.I-effects which disappearedwhen distilr'ed vrater was oubstituted for tap water.unfortunately an even greater number of individuals nay besuffering ih this way, but the associatÍon with fluoridated.water has not yet been realized. A typical case is that
202
of Diana l4artin, who recentJ-y ?gZg) stated:
r.. after tbe water was fluoridated I startetl having
healtb probLens.r rIt took ne two years and flve
specialistsbeforeleventuallyfoundoutthatltwaethe fluorlde that caused ny probÌens" I now havo to
$ï, ny water at $ ? fot a 2O-litre container to remain
healthy. Why do I, and others like me, have to go to
all thÍs trouble, when the chil-dren could be given a
tablet at school like they used to be given nilk? | *
It is not to be expected that more than a sma1l number of
such people will attencl an indívidual general practitior€!¡
Dr Nornan Long, in the Medical Journal of Australia' said:
rI know of only one case of total body rash and voniting1n an infant following - and due to - drinking
fluoridlated water; .but then, I am a radÍologist¡ and
this ís not my sphere. t (Long | 1970) '
(6) the Diffic ultv in D íne Intolerance to Fluoride.
Dr H.C. Moolenburgh (gZZ) said:
rone of the nost difficult thín6s Ín diagnosis of low
gracìe fluoride poisoning is the generaÌ character of
the conplaÍnts" Low grade poisoning is seldom detected
when you are not looking for it. I .
SÍr Arthur Amies said, in 19752
rlt is vain to state that doctors in Australia and other
countrÍes have often failed to observe fluoride toxicityj.n thei¡ area6. The directives which they have receÍved
from public healtli authorities have all too oftenindlcated that no untov¡ard side effects can occur. .
Medlcal practltioners can hardly be blanedr thereforetif they fai1- to link certaín s¡rnptons and signs withfluoridation. I
* see appendix 8, po 266,
20,
lord Douglao of Barlooh said, ín 19?2, that health
author{tlee rely on the aseertion that:r.. doctore fn fluoridated areas have not reported any111 effecte of fluoride. Thie statement does notcarry conviction, for these sane authorities advisedoctore ft*no generally do not know the synptons ofch¡onlc fluoride poieonÍng! that there cannot possiblybe any fLl-cffeote. r
Ee recalled the Long tine Ít took after cigarette smoking
became conmon to eetabLlsh that, it vras a principal- cause
of lung cancer. *
The aide effocte reported by Dr Moolenburgh (lg??):rBabíes screanÍng wfth inflated tumr¡ies, lots of peoprewlth paÍnful aores Ín their r¡ouths, people with Loosestools, urinary troubles, head,aches, dizziness, andqulte a lot of people with recurrence of allergictroublee lfke asthna ancl skin rash that had not troubledthem for years.r
(z) rn eto ridated Tooth ste .
Mention of rgores ln the nouthsr ¡e.caIls the fact thatthere have been nany reports of reactÍono to fruoridatedtootbpaete whicb cloared up when it was no ronger used.
More than tweqty years ago Dr T.E. Dou6J_as (lg16)
reported ca'ee of etonatitis, rerated to the use offLuorÍdated tootbBasüe or tooth powder. These occurredln 173 patÍente of arr. ages from th¡ee years to more thannfuety yearê of age. Thirty-two patients cooperated by
úndergolng rêpeated cou¡ees. After the symptoms had.
cleared up oonpretely, eaoh courge iconsisted of uee forthree weeke of the dentifrice contaJ.ning fluorides followed
appendfx lb, p. ZG4.* See
204
by use of non-fluoride dentifrfce until normalcy hacl been
nafntained three week6. I Two patients endured six coursea
and flve saw the effects of five courcies. It was noticed
that, Ín several patients, tsymptomatology was increased,
by as much as for¡r fold after two or three cour6eE - both
1n severlty and tfme required for completely clearing of
the lesiorrg. I
Two recent reports: rFluoridated toothpaste: A
caue¡e of perf.oral dermatitisr by Dr J.R. Mellette g!-3!.g9?6) and a paper by Dr M.A. Saunders 9976) who said
thaü Dr Emery Kocsard of Sydney had told bin that he had
treated !O patients with fluoride-related perioral
dermatitfs all of which responded favourably after the
cessatÍon of fluoríde toothpaste.
(8) The hoblen of IntoLerance to Fluori-de will Grow.
There can be no doubt that sone individuals are intolerant
to fluorÍde at the lncreased Level produced by the use of
fluoridated water. Tbeir problens wil.l grow. Although
they nay, at considerable expenne and inconveniencer obtaj.n
distilled water or fnstall. an íon exchange fluoride
rfilterr, the evidence already available indicates tbatt
a6 a result of fl-uoridation, the fluoride content wiJ.l
increase in the vegetables and canned. foods which they
purchase.
Dr Moolenburgh (lgZZ) suggeeted that those who are
at present intolerant to fluorídated water represent one
ttaÍIr of a GaussÍan curve, If, that j.s sor the aunhef of
people ehowing side effects nay be expected to increase
20,
rapldly aB the totaL intake of fluoride from all sources,
lncluding water, food and air, lncreases.
The Internatlonal Soclety for Research on Nutritl_on
and Vital Substances (g6Z ) polnted out t,bat:
rThe fluoridatl-on of drinlcS-ng water releases a fluorinecircuit which incl-udes vegetables, fruÍt and otherhortj-cultural products as well as nilk, and has an
uncontroLlable effect on the human organism. I
(g) The Great Difficu!-ty in Obtainin g Compensation forI1 lnee s Caused bv Fluoridation
In VictorÍa, those unfortunate people who are obviously
affected by ingesting fluorLdated v¡ater, if they wish to
obtaj-n conpengation for their disabil-lties are faced with
a great, and unusual, difflculty. This is due to tbe
repressive paragraph 4 of the HeaLth (Fluoridation) Act
which states:rNo person shall have any right of action against anywater supply authori.ty or any member of such authorityín respect of anything done in re6ard to the fluori-clation of a publíc water suppry in accordance with theprovÍeÍons of this Act.r (Victorian Government, 1g?3).
A barrlster has stated. that, because of thatparagraph of the Act, even a person who has been proved,
by the noot rÍgorous medicar tests, to have becone ir-Idue to drinking f-luoridated water supplied through theirdomestic taps, wourd have no practicar way of seeking
conpensatÍon. Their only course would be to sue the
victorian Governnent, a course, whÍch would prove to be so
expensive as to be prohibitíve for the average citízen.
The eltuatlon is dif ferent in Unglancl. L 19?7
memorandum by I'au1 M. ì4c0ormick, Research Fellowt
Nufffeltt College, Oxford, atated:
rlrlhen one arm of the Executive offers (as Ìras been
done) an inde¡nnity to the water authorities to cover
succeÊsfuL legal clairnE agalnet then arLElng out offluoridation, the Law ls rnocked. The water
authoríties are freed fron the le6al consequences oftheir actfone and thereby encouraged to break the Law.
Law is one of the fíret casualties in the battle forfluoridation. I
XXVT. 207
TIIERE IS NO MARG IN Otr' SAFETY !'JITH ARTIFICIAL FLUORIDATION.
The fmportant question of the nargin of safety of artiffcíaI
fluori<tation has received IiütLe consideration. This
nay be due to the wí<lely held inpression that there Ís a
wide margÍn of safety when water is fluoridated at 1 prp.Ill¡
(t) The Neetl for a Vlid,e Margin of Safety for Substances
Adde<i to the lrlater Supplies.I
Speaking on the general subject of the management of water
quality, the Dl-rector of the Division of SanÍtary EngiûÞerÍng,
Pennsylvania Department of Ilealth, said that the rlack of
precision and reliability nakes it essential that adequate
factors of safety be employed.r (Lyon, 1968).* **
Dr C.G. Dobbs ?957) pointed out that:rThere ie no leve1 of intake at which fÌuoride changes
from a toxic to a purely rrbeneficialrr substance; and
oince it is the total lntake which ¡¿atters, thequestíon at lssue is not the safety of fluorides at1 p.p.m. but the safety of any pernranent addition tothe general intake of fluoride, especially by tbosewhose fntake 1s already high. t
In regard to fluoridatlon, in 1950 Drs G.J. Cox and I-I.C.
Hod6e (two of the main early proponents of fluoridatLon)
saicl that, with the lncreased use of fluoride in vrater,
toothpastee, topical appllcations and, nouthwashes, vitanin
tablets and chev¡ing gum:
!.. it is proper to ínsist that d.ue attention be paid.to the possible hazards and to ÍnsÍst that there be alarge factor of .safety. Fluorine and its compounds
have 1on6 been known as poísons. I
jl see appendix l, p. 258. *t see appendix 10c, p. 2?1.
208
Profeesors 1. Gordonoff and W. Minder (tg6O) said:rAl,I authorities agree that fluorine is in no v¡ay an
innocuous substance; moreover, since its therapeuticrange is so very small, ít easiLy lends itself tooverdosage. I
ThÍs was well known even in 1940, for Drs Margaret
C. Smith and II.V. Smith said:fThe range between toxic and non-toxíc l-evels of fluorineingestion is very sma1l. Arry procedure for increaslngfluorÍne consumptiop to the so-called upper limÍt ofnon-toxicity would be hazardou6. This rvould be
especialÌy true in thc case of the addition of fruorineto public food or water suppries where uncontrollableindividual fLuctuations in intake wourd be encountered. r
(Z) The Recent Marked Decreases in the Recommended D ose
of F1uoride.
This narrow therapeutic range is welL ilrustrated by the
marked decreases in the recomrnended levels of fruorideingestion from tablets, which have been forced by the
increasing evidence of dentar fruorosis in chÍrdren gÍven
the previously reco¡nmended dose. rn a study usÍng the
old l-evel-s of 0.5 rng F up to the age of three years and,
thence 1.O mg F daiIy, it was found that 6??6 ot the childrenincluded in the study since birth had dental fluorosis.the group fruoroois index was o.88, which is well above
the level of o.6 which constitutes a pubJ_ic health problen:.(Aasenclen ancl peebles, 1g?4).
originally one tablet of coiÍun fruorÍde per day
( t ng F) was reconmended f or alr ages. rn ß67 thl,.õ was
changed, the American Medical Association then saying that
?.o9
the usual fluoríde eupplement 1e O.5 ng per day for children
up to the age of three years r and 1.O m6 per day from 3-14
years. suppl.ements should not exceed thoee amounte rin
order to insure that mottling of the teeth does not occur.l
Recently the recommended daily dose for children
Iess than two years of a6e has a6aÍn been halved, to 0.2J mg,
(Council on Dental Therapeutics, 19??¡ Eilitorial, 19?8i
Drj-sco11 and ÍIorowilz, 19?8). therefore the newly
recorimended dose is onÌi one quarùer of the dose orlginally
prescríbed. That statement nrust be qualifi-ed. by the recent
warning of the American Dental Associationrs Council- on
Dental Therapcutics:
rBefore a fLuoride supplement is prescribed' the fluorideconcentration of a childrs drinking water nust be deter-nined to avoid the possibilÍty of the chilil deveioping
dental- fluoroais from excessive intake of fluoride duringthe crucial periods of tooth calcification. For areas
that have natura.l fluorides at a concentration of O.2 ppn
or greater in the supply of drinking watert appropriateclownward, adjustnents must be nade in the dosage sched,ule.
The Council on Dental TherapeutÍcs of the A.nerÍcan DentalAssociation bas suggested that fluorÍde supplements shoulct
not be prescribed when the concentratÍon of naturalfLuorÍde exceede 60% of the concenüration .recommended forconnunLty water fluoridation in a geographÍc region. r
(Driscoll and llorowj-tz , 19?B).
Therefore, the present common practíce, ín fluorÍdated
Melbourne, of provlding young children wÍth fLuoride tablets
is a dangerous one, partÍcuì.arly in regard to the l-iklihood
of the developnent of d.ental- fluorosis. It ís clear3-y
contrary to that recent recomnendation by the Council on
Dental Therapeutics of the American Dental Association.
210
The subject of the fl-uoride ingestion by young
chÍIdren obvÍousl-y is in a state of confusion. The CounciL
on Dental Therapeutics pointed out that:rïn addÌti-on to the crosage schedure recommended by thecouncil, various fei-grrtJ other schedul-es have been usedor proposed. rn sorne ínstances, these schedules aremore conservat,ive than that of the councir for the earlyyears of a chil_dts life; in others, a higher dosage isused or suggested.r (Driscoll- and Horowitzr jg?g).
3) False Cl-ains that there is a Wide l4arein of Safet v
with Fluoridat Lon.
The claim is often mad.e that with fluoridated. water (at
approxinatery 1 p.p.m. fr-uoride) tbere is a rarge margin ofsafety. TvJo papers are typical of the cl_aims mad.e:
A paper which is repeatedly cited is one in the Journal ofthe American Den tal Associ-ation by Dr A.p. Black (1955).
He said:rA wide mar6j-n of safety is thus provided, inasmuch asi-ntakes of fr-uorine about fifty per cent above the ideardose produce very mild evídences in the appearance ofthe teeth of such excess. r
An article, by an anonymous author, in the vrIHo chronicl_esaid that rthere is a very wide safety margin between theoptimum leveI and the lowest leveI at which harmful effectshave been detected. r The article adnritted that mottlingcan occurr rbut only when the r-ever_ of fluoride is at least4-6 times greater than the optimun leveI. I The roptimum
levelr vras sald to range from 0.6 to 1.2 p.p.m. ¡ depending
on the climate. (wHo t 1969b),
211
However, the followi.ng year, Professor A"II' Slddiquit ln
another WIIO Publication, the book Fluorides and ÏIuman
&Bl!!, stated that: lAt 6 ppn the incidence of mottllng
Ls 1OO%.r (Siddiqui, 19?O). Thie has been known for
nany years. Drs If.C' Ilod6e and F.A. SmÍth (t954) in
FIuorí t n as a Public lleal h l,feasure , stated that at
4 p.p.n. l-ees tlian 5% of the teeth are nornal, almost half
have rnoderate or -evere fluorosls, and at 6 p.p.n. no
teeth are nornal.
Notwithstanding those well-known facts (to those
who read the literature) incorrect statements are stil].
being made here. In 19?? ühe Chairnan oi trto Fluoridation
sub-committee of the victorian Branch of the Australian
Dental Association said:
rThere is an extremely wicle tolerance, and the takÍngof tabLets after the introductl0n of fluo::ide into the
water supplles is not dangerous.¡ (Levant, 19??). lÞ
In contrast, the Gernan Federal Republic Department of
Health said, in 19762
rIt is of the ut¡rost importance to make sure that a
simultaneous additive intake of fluoride from fluoridetablets, fluoridated tooth-paste and fluoridated saltdoes not take place"¡ (Dcpartment of Health, 1976).
Regrettably, fluoricl.e tabLets are still readily
avallable in Melbourne -and are used - despite the
fluoridation of our water supplies, and nearly aII toothpaste
ou sale eontains considerable concentrations of fluoride.
It is now known (as has already been nentÍoned) that
children, ía particular¡ may swallow significant doses of
fluoride fron toothPaotes.
fi See appendJ-x 2a, p. 255.
212
(4) edc dence 1n Clalms Re a SafetMarqLn uJ lth Fluori dation.
confidence Ls stiLl. bein6 ehown in thc clalns that thore fea wLde safety margin with fruoridation, even by government,
advLsors. For instance Mr K.D. Green, secretary to the
PremÍer of victorÍa, in a letter r.¡ritten in 19?4 to reaosure
a vfornan who was worried by the prospect of havÍng to be
forced to drink fluoridaterl water, said:rrhe concentratÍon of fruorlde proposed for fluorid.atÍonis but 1 part per nilIion. At that lever, no matterhovr much wate¡ you drinkn no barm from fluorid.e shourdoccur. r
clearly, whoever briefed lrlr Green r{as unaware of the'situation.In a Letter to ne on Novcmber J, 1g?t$) _ and an identicallyworded one to Sir Arthur Anies , Jan l, 19?4 _ Mr Green
said that the ¡ decision to proceed v¡ith fÌuoridation was
onry reached after rong and exhaustive investigation ofaLl available material_" I
that term rexhaustive r recalrs the statement by theHon. D.J. Kir-r-en in ilre llouse of Representatives in 1964.He said that the fountain-head readíng to the fruoridationof canberraf s water supply uras a report of r u,ru-conmitteeof the Territory Advisory Council. IIe commented;
¡That report has been described varÍously as befngcritical, exhaustíve, and extenslve and, as appraÍsingevery known facet of fluori.dation. r rBut this sub_co¡nmittee cf the Advisory councir dealt with this greatissue in five paragraphs, ot 124 words. Each of theparagraphs represented a proposition not supported byone gkemick of evidenee. r
213
(¡) CIaims for a Safety MarRin with Fluoridation are
rPatentlv Naive r.
!'or more than thirty yearo the cl-aim that there is a wíde
margin of safety with artificially fluoridated water has
been known to be false.
The Director of Labor¿¡.tories, Department of t¡later supplyt
Gas and Electricity, City of New York (B'C' Nesin ' 1956)
said:rrhe proponents of fluoridatíon have tried to demonstrate
various factors of safety which are patently naive 'They speak of factors of safety of 2t or B etc' with
litt1e comprehension of the meaning of this term as
used in water supply practice' A factor of safety of
2 or 8 on theLr terms is no factor of safety at all'
It has been customary to consid'er a minimal factor of
safety of not l-ess than 'lO for substances which nay
be admitted to water supplfes' This would nean that
ten times the amount of the proposed substance when
presentinthewatersupplywouldbedefinitelywíthoutharm to human or beast. It is obvious from the
knowledge of fluoride toxicity that such a factor of
safety cannot be established when fluoride is added
to the water suppÌy at ttre J-evel recommend'ed by the
proponentsoffluoridation.Inviewofthefactthattheran6eofwaterconsumptionrnayvaryoveraratioof20toltheinsistenceuponafactorofsafetyofloÍsexceedinglY moderate. I
He then said:
I It must be conclude<l that the fluoridation of public
water supplies ís a hazardous procedure, people are
bound to get hurt, it remaíns to find out how many and
when. I
XXVII. 21t¡
TgE TNFLUNNCE OF FLUORIDATIO}T ON MANIS ENVIRONMENT.
Diecussiona on the effocte of fluoridation have, until
recently¡ been concerned with the effects on the teeth andt
to a much lesser extent, on the rest of the body. The
effect on mants environment has been overLooked or ignored.
The International Society for Research on Nutrition and
Vital Substances (96?) said that:
rThe fluoridation of drinkin6 water releases a fluoridecircuit which includes vegetables, fruiür and, otherhorticuLtural products and consumabÌes, and has an
uncontroÌIable effect on the human organism. I
Man ls unquestionably influetrced by hie environ-
ment. Therefore, although the Terms of Reference for the
Committee refer to rthe effects on hunans of fluoridation
of water supplies', 6ome consideration shoul-d be given to
the question of the effects of fluoridation on manrs
environment.
(r ) The rF1uorÍde Circuitr Arising from Fluoridation.
The fact that only a cmall proportion of the water fluori-
datect is consumed by the popul-ation has bcen recognized and
criticized by many people on economic grounds. Little
consideration has been given to the effects on manrs
environment of the fwastedr water. Part of this is used,
for washing and other donestic purposes and, with nuch of
the portion consuned by the population, is gathered up in
the sewerage systenr. The remainder is spread on the grcund
partly by the watering of plants and vegetables" It has
215
been found, for instance in Japan (Okamura and Mateuhiea,
1965b, 1967) that Ln eomo districts there ha,s been a marked
increase in the fluoride content of cro¡s. Much of thisis a result of uoing superphosphate fertilizers which
contain f luorlde " rlrlhat happens when fluorine is added to
the soil depends on such factors as the forn in which it isappl-ied, the amount of fluorine, how nuch lime and phosphate
are present, the species of plants grovrn, and the soil type
and geology. ¡ (Schatz and Schatz, 19?Ð. V,latering with
fl-uoriilated water wÍ11- also have an effect.
Recentry Dr B.s. vrralker (gzg) said that nuch more water isuseci to irrigate home vegetabre gardens than reaches the
mouths of chÍIdren. ife saidrFruorine is one of tho nost chemicalry-active of alL theel-ements, reacting readiry with organic matter to formfluorocarbons, already strongly suspect for theirpossible effect on the environment;
Soluble fluorides are admittedly poisonous;chenicals applied to the soil in even very smalr
concentrations may bufld up, over time, to quitesurprloin6 anounts;
Vegetation absorbs fLuorine fron the soi1" ¡
He added:
I In the J-ight of the above, can anyone, ,expertr! or not,give me an absoltrte assu¡ance thaü the lettuce grown ùnny backyaril wir] never become toxÍc through e]:cessfÌuorine" As an ex-agronomist, and keen gardener, Ishould like to hear argument on that poÍnt. I
At present there does not appear to be an ans$rer to thatq'uery.
216
(2) Fluorlde Dnmane to Tree s r Plant s and Cut Flowere.
Àpart fron the effect on man and anlnals, fluoride in the
atmosphere and ln water has becn ehown, in numeroue etudlest
to affect trees and plants and also some cut flowers'
Thesearticlesusuallyappearinagriculturaland
bortLcultural Journals and were little known in 1977 wben
the Act was Passed.
Drs R.D. Gabovich and G.D. Ovrutskiy ?gZZ) found
that the accumulation of fluorine in plants fs affected by
factors other than the anount of fluorine in the soil, for
exarnple, by the plant nourishment. They found dissÍmilar
accumulation of fluorine j-n different plants. There are
ptants which are rfluorine accumulatorsr such as spinach
(28,7 ppm) and, to a lesser extent, lettuce and parsl-ey '
(tottr 11.3 ppn) " (schatz and Schatz | 1972).
Dxposing Valencia orange trees to hydrogen fluoride
gasr with a fluoride concentration of I p.p.b.¡ that is
1l I TOOOTO0O'OOO¡ ÏIâs found- to produce rfluoride damage
ín the form of reduccd leaf size n reduced total leaf area
and reduced top vreight [wblch] remained proportional to
total fluoride accumulatÍon. I (Brewer É-4. t 1969).
An Ínportanü questlon is (even without consíderlng the
effecL of atmospheric pollutÍon wíth fluoride) whether
vratering trees with water containÍng 1 p.p.rl. fluorider which
i-s a thousand tines the above-nentioned concentrationr will
produce a similar type of damage.
Not only the trees are affected by atmospheric
fluorides but aLso the insects associated with then. An
important observatlon reported by Gabovich and Ovrutskiy
217
(lgZZ) wae that of G. Bredemann (Âlcaclemie-VerJ-ag, 1956,
Berrin) who found that the accumulatfon of fr-uorine inflowering plants, polluted with fluorÍne-contai.ningemfssione, causes nassive death of bees. rn the bod,iee
of clead bees there were frorn Jo to 11rfoo mg of fluorineper kg dry wei6ht, as against O.5 ng/kg in the control.courd a sinilar effect resurt fron vraterln8 flowerf.ngplants with fluoridated water? No etudÍes to determine
this point have been found.
The subject of the effects of airborne fruorideand íts effects on vegetation has already been mentioned
brÍefly and fs also mentioned in the book Health Effectsof Envùronmental Pollutants (watd¡ott , 19?3). one
unusual fact is that vegetation tends to inpede or interceptfluorfde ln air that is noving through the foriage, thus
creatlng an adjacent down-wind area of r-ower airbornefluoride concentration. (Rose and Marier, 1g??).
rt ís now welr d.ocumented that fluoricrated water(t prp.!r. fruoride) hae a detrinentar effect on the keeping
quality of some cut frowers. ilígher concentrations
produce more marked effects.Dr tù.8. Í'Iaters (r968a) reported that rthe keeping quat-ityof rose cut-flowersr rdecreased greatly as the dÍssorvedl- level. increased in the holding eolutions. r The decrease
1n the flower quality index after four clays vras g% at 0,6?ppm tro 21% at 1"20 ppn F and 45% witn t.tj pln Fr compared
with the coutrole. That ie: fone ppn F rnduced moderate
toxlcity synptons and 3 ppm F Índuced .evere toxicity synptons. r
?-18
Dr F. Spierin6 s 9969) observed dama8e to Sladiolus f l-orets
in fluoriclated v¡ater. Fluoride was shovrn to be the main
factor in producíng deterioration and v¡as the only specific
ionthatwastoxicatveryÌotlconcentrations.'Peta}
deterioration lncreased Ín a highly linear or quadratic
rnanner as the fluoride content íncreased"r (tlatersr 1968b).
The cluality rating decreased by 26% r'rith 1'1f ppn F' Dr
vüaters salci that rv'Joltz demonstrated that g3-adiolus fol-iage
is extremely suscepttblé to fluorides acquirecl through the
ll-eaves or roots. | (Woltz et al. , 1951i l¡lo1tz | 1964)'
At 1.1/ ppm F the number of days tbat chrysanthemum foliage
Iasted was decreased. by 1J/r, but this regression was not
sufficiently high to be significant. (Vrraters, 1968b).
Ln 19?6 it was fcund that the use of superphosphate containing
1.O% F produced leaf scorch in ]ilj-es anrl gJ-adiolus. (V¡oltz
and Þlarousky, 19?6) .
3) The Svnthesis of Ornanic Fluoride Comnounds
A possible hazard of fluoridation, whj-ch docs not appear to
have been taken into consideratior\ vtas mentioned by hofessor
IIu6h Sinclair (gel) , nour Director of the International
Institutc of lluman NutrJ-tion, Oxford. IIe sairl that probably
ùhe greatest aut,hority on organic fluoride compounds is Dr
B.C. Sauriders of Cambridget who stated:
tI, too, aB'very wo¡ried about the fluori-dation of publÍcwater supplies.r rI am parti-cuIarly worried, about thepossibÍlity of a buiful-up of I- Ínto organic conpounds
containing the C-r' link when aII said anrl done the plantrrgifblaarrr is able to do preciaely this. Are r^re sure
219
that there are no other plants or bacteria which canbring about this lcthaJ- synthesis?l
rlofeosor Sincl.¿rir explalned that by !lcthal synthesisr Dr
Saunders vras referrin6 to the fact that rgífblaart malces
fluoroacetic acid which is synthesized in the body into
fluorocitric acid, and this poisons rcspiration in ceIÌs"
sir Rudolph Peters (t964) pointed out that fluorocitric acid
is a very potent poir.;onn because minute amounts of it block
the nornal metabolisrn of citric acid, 0"1 mg per kg body-
weight can ki1I a dog. Thcre are variations in the toxicdoses. Thc rnonkey is less sensitive than many other
aninals, and this ap¡rears to be truc for man. Sir Rud.olph
Peters said that at comparatively low concentratione, broad.
beans and cabba.ges become very poisonous to aphids, and that
those who worked on thls proble¡n fwere worried by the clanger
implicit ln the persistence of the conpound.s in the soiL. I
In Queensland and the Northern Territory rGeorgina
poisoningr has seriously affected cattl-en sheep and goat
production since late last century due to eatin6 Acacia
Aeorfij-nae,' (Barnes, 195Ð. The plants in different areas
exhiblt a wide ran8e of toxicity to cattle, and there may
also be a seasonal variation of toxicity in individual trees.(Murray et ar," | 1961). rt has been found that this prantcan synthesize fluoroacetic acid as d,oes the south Africanr6ifblaarr rnentionecr. above. (oelrichs and McEwan | 1961)
"
rn 1)lJ Dr A.L" Knight said that fluoroacetate isfound in certain prants in ÂustralÍa, Brazir and south
AfrÍca" He said: lThere is no antidote. A couple of drops
220
by any routc ís l-lke]y to be fatal. I In IsraeLt rÀpproximately
)6 epectes of plante v¡hLch belong to varlous botanical
farniltes are known to contain fl-uoroacetate.r (Egyear 1973)'
Is it possible that such a tlethal synthesisr could
be nade by a Victorian plant when watered with fluoridated
water (which j-t has not encountered in its evoÌution) ínsteacl
of with rainwater or water having its normal t pre-'
fluoridation, very lov¡ level of fluoride?
(4) I,/'ül1I Fluoridation Affect Mar ine Lífe in Port Phillip Bay?
Another uninvestigabed, or at least unreported, aspect of
fluoridation of }Íelbourners water, is the question of the
effect of the discharge of fluoridated watcr into Port Phillip
Bay. Owíng to its shape, there is comparatively. littl-e
interchange between its water and the ocean, and nost of
this will affect, prinarily, the bay water near the Heads.
Evaporation wiÌI increase the salinity of the water, lncluding
the fluoride concentration, and rainfall will d.ecreasc j-t.
A former Minister of Hearth (scanlan, 1973) stated that the
fluoride level was 1.4 ppmr a concentration which cJ.osely
approaches 1.JppmF, which is the U.S. maximum tolerance lirnit
for narine life in oceans and estuaries. (U.S. Environmental
ProtectÍon /tgency , 1976).
In 19?4, the German Association of Gas and lrlater
Experts expressed rits decisLve reJection of fluoridatÍonl
becauae ì-t produces:
0.. o an unjustifi-ab1e encroachrnent on the environnent
of a toxic substance which would find its vray back
into our food through waste waters and water coursee
in an uncontrollable fashion. I
*
it tþ
ltt
?_?_1
In Melbournc, much of thnt ura,ste r,vatcr will ultimately
rr.:ach the llay. t
The Deperrtmr:trt, oI IIe¡.rIthr of l, l'e' Cerman 1,'edcral
Republic said, in 1976, that:rl{here fluorldation of drinhing water has been introduced,it will be necessary to also superviße and study thepossible ecolopçical side-effects and possible hydro-¡leochemical impi-r ct on the areas into which tlrefluoridated water io discharged. This w111 be
necessary to detect such Lnfluences and take counter-measures before irre parable damane can occur. I
Bishop ilarbour in Tampa Bay, Florida, has becorne a marine
graveyard due to fluoride waste frorn a che¡aical company
(St.I'etersburg TÍmes, Llar. 14, 19?O). It has since been
reported that in t'fay, 1976, Captain Jaques Cousteau
confirrned that finding. **
The question is: t¿r/i1l- the adclitional fluoridecontent of thc river,.-i and drains frorn fl-uoridation of our
v¡ater sup¡.rl:les, adderl to the direct dj-scharge into the 13ay
of fluoride wastes from industry, be sufficient in the future
to enable the 1977 Level of 1.4 p.p.n. fluoride to approach
a level which is critical for marine life? **¡r
The possibility should be studied carefulJ-y.
See appendix Ja, p. 263.
See appendix 20, p. 284.
See appendi-:c 4a, p. ?-j9.
XXVÏII. 222
CONCLUS ION.
Just before the llealth (Fluoridatlon) Âct was pasoed ln 19?7,
the hesiclcnt of the victorfan Branch of the Australian
Dental Associatlon sald that fluoridatÍon ris absolutely
eafe fron the ¡redlcal viewpointr ancl that the dentaL
advantages are v¡el-I proven. (Dooley , 1977) . Sinilar
clains were nade on beh.alf of other endo¡sing botlies. It
is clear that those assurancea vrere accepted by the nenbers
of Partiament, otherwise the Act would not have been'passed.
Those clains are nov, untenabie.
The German Association of Gas and lrlater Experts (9?S) said:
I ff there Íe a poten tia]- d.aneer that a certain substance
may cause chronic clisease ín nan, then its use for human
consuraption should be banned even if there ls no patent
evidence tbat it w111 do 60. I
Sinilarly, Sir /trthur /\mies (9?5) eaid:
rThe ease against fluorldation medically requires only
ouch evidence as ls necessary to support a reaeonable
doubt. V'Ihere the publicrs health is concerned no
reasonable doubt can be ignored. I
He considerecl that the doubt about fLuoridation r.¡as rmore
tban reasonable, it is considerabLe. I
A recent editoiial artíc1e (9?9U) in ttre rGeelong
Advertioerr denanded a more stringent standard:
¡In health terms, the question we have to ask ourselves
is whether it has been proved beyond a.l-L doubt - not
beyond reasonable doubt - that the fluorÍclation ofwater supplies is safe. If there is doubtr thencompul-sory fluoridation of our water supply systensshouÌd not procced. I |r
ik see appendix 49, p. 262,
227
In the four years since SÍr Ârthur Anies said. thatthe doubt about the eafety of fluoridation v¡as rconsid.erabler,
the evidence against its safety has greatly íncreased. There
j.s now no doubt that eone people are intol-erant to fl-uoríclaüed
v¡ater and become obviously ilt when they drink their domestic
water. Almost certainly far more people are less affected,the side effects being attrÍbuted to the stress of Life or
to other causes, the last factor to be suspected beÍng the
water in their home taps.
Of particul-ar inportance is the fÍ-nding of Drs
TiamouyÍannis and Burk (lgZZ) that there is a correlationbetween the use of artificial fluoridation and an increase
in cancer nortality" rntensive and expert criticisns ofthat finding (mentioned'in section )o(II) failed to faulteÍther the data or the statÍstical methods used. Therefore
this correlation thas not been convÍncingfy refuted Ín the
two yeare since its publication. r (Diesenctorf , 19?9)j nt
During the past year the pubJ_ic has becone avrate
of the disasterous effects of some of the drugs v¡hÍch have
been prescrÍbed, and Ín some ca6es obtained readÍÌy withoutprescription, for up to thirty years before being banneil.
Many papers have been published recentry which dear_ withthe í11-effects of fluoride on the total- environment.
rt would nor{ ,'een prudent to investigate vrays of decreasing,not increasin6, the totar amount of fruoride to which people
iXìll'.are exposed. one consÍderation is the cost of healthservices to the affectett people and the ross of productÍondue to undi.agnosed illness from fluoride intorerance.
-*I !"" appendix 11, p. Z?t, l+ See appendix 18, p- ãaO.lrl See appendix 4d, p. 261,
225
IlllF.lIlìllllC I:ìfl
/\ number. of the following rcfercnces rcfer to newspaper
reports, for the great majority of l-etters re6arding
fluorldation were not sent to scientific journals.
Aasenden, R. , and PeebJ-es t T.C
ry' t 192 321'
(1974) Ârch. OraI
.h¡aerican Dental Aesociation (1961 ) Comments on the
@ion. Bureau of Pub1ic
Inforrnatfon, A.D.A., Chica6o.
Arnerican t"ledica1 l\ssociatj.on (19Ø) Â.¡f .^. llev¡s Àug. 19.
Âmerican Vrlater Works AssocÍatíon 9949) ,¡. Amer. ttrater
ÍJorks Ass. , 41t 5?5.
Amies, A.B.Ir. (1959) 43g!-Dcn.!.-¡|., 4.: ?6.
Amies, A. B. P. (19?5) Actdress, I'lelbourne Tor+n IIaII,
June 4,
Ânonymo us (gZB) consumer Reports , Ju1y, p. 392;
August, p. 48O.
Arnstrong, W.D., and Singer, L. (19?o) oistribution j-n
body-flufds and soft tisgues. In Fluorides and
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Bditoria]-
Edltorial
Edi-torial
EditorÍa1
(t9?9^)
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(t9z9c)
(rgzga)
rThe Geelong Advertiserr, l'{ay 14.
rThe Geefong Advertiserr, JuIy 1/.
Fl-uoride , 122 i,
I'4elbourne tAger, JuÌy 16.
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EnvÍronnent Protoction Authority of Victoria (lgZB)
Reeult Þ of Air Po llution Iufonitorinn in Victoria
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113
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122.154
181
71
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102-3t 121
161-2
113
233
GabovJ-ch, R.D. I and Tsfpriant V'I ' $9ZO) Giß . Sanit.
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V. Schatz | 19?2).
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t'Ialdbott | 19?4),
Gelardi, VJ-ckie I,. 3gZ6) open Letter' Feingord
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APril 2/, 19?6,
German Associatfon of Gas and lrlater Experts gg?4)
Statement on the FIuorIclati-on of Dr ter.
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German AosocLation of Gas and Water Experts g9?5)
tation cler Trinltwasser-
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German Consu1 (gZÐ Letter, Conoulate General of
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Ge¡rier N.tr'.¡ âDd Keh¡, Florence 9957) $[!!!þ'
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Veter Record
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Brit. Dent. J., 1j8t ZB9,
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64, 66-8
1'
212
212
126
201
18?
,o
118, 1t8
16, 6Z
275
Ilarrle, M. (916a)
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EÍckE, c.s. (1961)
EiLl, A.B. $966)
Med.. J. Aust. , 2z 116. July 28.
Med. J. Ausù. , 2z 8o9. Nov. 11.
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Bogartb, J.t'I. (f96Ð Ug5!¡|¡!gg[., 1z 496. March J1.
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Eortòu, A. $gZo) &.g-, J =-]lltgL.
, 1 z ??5. Àpril . 11 .
41,,110
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Hu¡¡no, V.0 . (1952) U.S. Conqreso Heari beforethe Houee Se1ect Committoe to Investinate the Use
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Enßineer, October, 1956.
Interuatlonal Socl-ety for Research on Nutrition and
Vita1 Substancea 3962) Vital.stoffe Zi.v. , 12t 79
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InternatÍonal Society for Research on CivilfzationDiseaeee and vltal substances ug6g) Resorution No
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6z-4
139-411g4t 1
148 |
2O-1 | 43,117 | 150-1 ,162t 2O5,214
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197
171
194-5
237
Jolly, S.S.r Praoad, S.,
(19?1a) FIuo¡ide
Sharna, R.,
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Sharna, R.,
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A.ust . Dent.
and Chandcrt R.
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I
Jol1y, S.S. , Prasad, S. ,
(tgZ*) Fluoride,
Jones, Pamela B. (g4g)
Kausmant
Kawaharat
Exp.
8,, aud Kawaharar K.
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l(err, R. g96?) Brit. Med. J.r 2z 1?6. oct.21'
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s (Hanoard). Ilouse of Re ¡resentati.ves.
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KiLlonr D.J.
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105
42
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72-7
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Unfted States Departnont of IIeaIth, Educatlon, and
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Communal Water SupDlLee. P.H.S. Publlcation
No. 655. U.S. Govt. Printing Of f . , l,Iashington.
United Statee Departnent of Health, Education, and
r¡Ielfare (lgZO) Fluoridation Census. 1969.
Divísion of Dental Health, Bethesda.
Unlted Statee Envlronnental Protectfon Agency (9?6)
letter fron Dept. Health, Educatíon, and hlelfare
citing Paragraph 180.145 of EnvÍronnental data.
Uaited Statee Food and Drug Adninistration (19Ø)
lettere of Auguet 15 and Sepbenbeî 17, 196j.
(Cite¿ by A.Â. L,ondon , 196?).
Valsrub, S. ('tgZg) !ASA, 24oz 16to,
Victorfan Governrnont gg?r) .O,n Act to Reeulate the
atÍ of Pub1ic Water S 1Íes and forOther Purposeq. No. 8506. Dece¡nber 11, 19?7.
Waldbott, G.L. (1962) uoride j.n C aI Medicine.F1
S. Karger, Baee1. A Supplement to VoI. ZO (1962)
Int. Arcb , ÀIlerev and Appl . Inmunol.
l{aldbott, G.I, , (1967) Amer J. CIin Nut ., 122 455,a
VüaLd.bott, c.I, . (19?t) th Effecte of EnvÍronrnental
Pollutante C.V. Moeby Co. ¡ St.Louis.a
lrlaldbott, G.L. (lgZ4a) EnvÍronment , Vol 16, no ¡ 6 ,
JuIi/ Ausuet 19?4.
1
50, ?5-6
118,22O
,gt 4l
196
6, 13t 59,146t 2O5t 222
194
117
2OO, 217
2?t 193-4,1 gB-200
250
l{aldbott, G.L. (924A) FactE Àbout Fluorfdation.
Senfnar, ntce llnfversfty, Houeton. October 16.
hlaldbott, G.L., Burgetahler, A.l/t., and McKinneyr H.L.
OSZS) tr'luorldatLon:. The Great Dilenna.
Coronado Prees, Iawreaco, Kansas.
Walker, B.S. (19?9) rThe Canberra Tfnesr, July 11 t
P'25'!'Iaterer V{.E. (1968a) .t
8lz tj5.hlaterer VI.E. (1968b) êner. Soc. Eort. S,cl . | 92r 6rt.
weaver, R. (1944) .ElL!:-@., ??¿ 185.
v,Ieaver, R. (1948) @., 4t: 284.
Wed,dle¡ D.A. ¡ and Muhler, qJ.C. 9954)
542 4t?,
ÏJinkler, K.C., Dlrke¡ 0.8., van Amerongenr J. (lgSl)BrÍt. De D.t . J. t 952 119.
Winnerr F.V., Walther, F.O., and Grahan, J.R. (19?B)
Plaintiffrs Menorandum of Law and Srunnation of
Evidenco in Favour of a PreJ-ininary Injunction.
Aftkonhead et,al, v, Borough of l¡rlest Viev¡ et al.Court of Con¡ron Pleae of Allegheny County,
Pennsylvanfa, CÍvi1 DÍvision.
woltzr s,s . 3964) hoc. FLa. State Eort.. Soc .t
77 z 511,
Inlo1tz, S.S. ¡ Magie¡ R.O. ¡ and Geraldoon, C.M. (lg>l)Prg¡. FJ-a. Süate Hprt, Soc., 662 306. (Citea Uy
lrl.E. lrlate16, 1968b).
J. Nutrit. t
12Ot 15?
1?t 1Bo,215
21?
218
B4
84, g6
113¡ 16'
119
200
218
218
!,Jater FluoridatLon. First Re¡ort. Tech. Rep.
Serles No. 146, ülHO, Geneva. 1
Wor1d Eealth Organizatloa (968) Reeearch into
Envlronnen l,utlon üIIIO Tech. Rep. Serieo
No. 406. 'llrlllO, Geneva. pp. j?-78¡ 59.
World Health OrganJ.zation ?g69ù Report by the
Dfrector-GeneraI. rl-uoridatlon and Dental Hea1th.
Annex 9. ltlflOr Goneva.
l{orld Eearth organizatioa (gega) FruorLdation and
Dental Eealth. WHO Chronicle , 272 5O5.
Wor1d Eea1th Organization (969c) aZn¿ lVortd
AsÉenb1y, rTuly 2J. V'IHO Chronicle , 2Jz J12,
Ïtoltzr S.S.¡ âtrd. Marouekyr ¡'.,J.
f,tate llort. Soc. , 88: 609,
World Heatth organlzation (1958)
Vlorld Hea1th Organizatlon (Jg?Oa)
24¿ A?1,
Wo¡ld Health OrganizatÍon (l9ZO¡)
&gJII. V'IHO, Geneva.
(19?5) Èoc. Fla.
Expert Commít
251Panes
218
tee on 40, ?6-8
46, 1z4t ltol
trtlHO Chronicle t
1O9 r132t
79, 42,-191
1Bo
42
111 |140
?5¡ lOBr 110,146-7 | 21O
111-2, 131,E9-4o | 146
Fluorides and Human 115t 132
Yianouyiannísr.f. (lgZZ) lgryg, Z, 296, Auguet 6.
llanouyiannis, .I, (lgZB) Co¡nments on the Ef fectiveness
of Fluoridation (1 ppn). (Mineo.)
ïiamouyfannis, J., and Br:rk, D. (lgZZ) Fluoride,
10:1O2.21741
, 28-tor, 227
252
TlanouyfannLe, J., and Burk, D. (19?B) CertlfLed
copy of tranecrfpt. Aitkenhead et al. v. Borough
of ttest VLew 9!_È. Court of Connon Pleas of
Allegheny County, PennsylvanÍa, Civil DivÍe1on.
Zanfagna, P.E. 9976) tr'luoride , 9z 36.
ZÍegelbecker, R. ?9?4) Conment on the tr'luoridation
of Drinkinn V'Iater. AnÆlesea , from the Institute of
Bnviron¡nental- Research , Gtaz, llustria. Jan. I . (Mimeo. )
Zj-egelbecker, R. (19?5) The Fluoridation of _ItrÍnkÍngWater ín Anelesea (II). A Critique . Gtaz, Austria.
January 8, 1g?5, (Mimeo.)
Ziegelbecker, R., and Thonson, H.l{. (lgZl) Conunents on
the paper by G.Vt. Kwant - Sixteen years of r¡ater
fLuoritlation in the Netherlands and its influence
on dental decay. Fluoride, 6: 49t 19?3,
Paces
29
200
9o
9',!
72¡ 77
?_5t
APPENDIX
1a.
Since this submission vras completed j-n /\ugust , 19?9, many
important reports have come t,o hand which support or
supplenent the points mentioned in the subrnission. ThÍs
recent mat,erial appears below:
(See p. 28). The Melbourne rTruthr of October 20, 1g?9,
rnentioned the case of Dr Geoffrey smith, formerly the dentistat the hospital in Proserpine, Queensland, where the water
supply is artj.ficatì-y fluorídated to O.Z p.p.m. The
artÍcl-e stated that Dr smith had said that the Queensrand
hearth authorities had forced him to reaign because he had
conducted a hl6hly controversial_ investigatíon.
This found that j2 of the 1JO children (21%)
attendlng the Proserpine primary schoot had dentar fruorosis.Dr smith sai-d that the details of his examination and hisconcluslons $rere sent to the Queensland heatth authoritíes,and later stated (rTruthr, November 24, 197Ð that no moves
to check his findings had been i-nstituted 'untir Truth put
the pressure onr. Two days later an investigation was
commenced by two Health Depart,ment dentists, and the resurtswere published on october Jo - videroni, !t.T., and McEniery,T.M. (tg?g) , An Inves t tion of Children uncler Trea tnent atthe Prose ne State Schoo1 Dental Clinic with ParticularReference to Fluoros aS.
Those examiners confirrned Dr smithrs fincring that therewas a high prevalence of dentar fluorosis in proserpine
children. They exanined t]ne 779 children at the State
254
School- Dental Cl.inic, and reported:
1... excluding lrqucstfonablerr flrrorosis, therc were a
total of 55 cases in therrvery mildrrcategory or above.This 6ives a general prevalence rate of 16,2%..
It is apparent that the authors incl-uded all the rtquestionablerl
caÉe6 with the rrnornalrt ones r thus minirnizÍng the prevalence
of fluo¡osis.
Their report does not state the sex or ages of the
childrcnr nor how many of them were in each of the three
groups of children: (i) fExclusively Proserpine Town Waterr,
(ii) rFluoride Tablets durj-ng the first four yearsr and
(iii) children who had not, lived in Proserpine for the rvhore
of their first four years nor taken fluoride tablets at any
time during that period. In the absence of those data,
calculation, using the published fluorosis indices, suggests
that those groups contained J6, 84 and 1!p subjects,
respectively, and that there were approximatel.y 3Z
rrquestionablerr cases in the third group of (lg9Z) children.
The authors did not rnention that group v¡hen they stated thatthere were J4 cases of rrquestionableil in the (84 + 562)
chil-dren in the first two groups. (ttre figure of 84 was
cited by the Queensland MÍnister for Health. ) If, as isusual, these approximaùe1y 66 34 + j2) cases of frquestionablerl
had been lncluded in the fruorosis group, the prevalence inthe 779 chlrdren attending the whore state school would have
been i-n the re8ion of 16%, instead of the j6,Z% given in thisHealth Departnent report.
Dr Smithrs finding was the presence of dental
fluorosis in 21% of the 15o children in the prinary school.
.)c:E
1b. (See p. 12O), This Quecn¡¡I¿rntl Health Department re1:ort by
Videroni and McEniery indicated the danger of ingesting fluoride
tablets in fluoridated areas. They found that Ín the 84
children rwho had taken fluoride tablets during any of their
FÍrst Four Yearsr, the inclex of dental- fluorosis vras O.53¡
obtained from 12 rrniì-drr cases, 9 rrvery mildrt and 2ttrquestionabletr ones. The prevalence of fluorosis was stated
to be 24% - rrquestionablerr cases obviously v¡ere considered to
be rrnornalrr for this cafculation of prevaÌence.
1c. (See p. 122), The Queensland Health Minister, Sir V,Iil-liam
Knoxt utas reported in the Brisbane rCourier Mailr of l{ovember
2, 1979, as sayÍng:
r... among 84 children who had becn given fluorirle tabletsor drops durin,g any of their first f our years, thefluorosis index was .5j. This was only slightly belowthe index of .6 at which fluorosis could be describeda publlc health problen. I rI believe it warrants astrong health education programme airned at ensuring thatparents do not over-fluorídate their chifdren. r
The main lesson to be learned from these Proserpíne
data is that the much publicized wide margin of safety, when
drÍ-nking fluoridated water, exists only in the minds of
fluoridation promoters.
2a (See pp. 121 | 211), An exactly opposite statement, ùo thatnade in 1977 by Dr Levant, was mad.e two years Ìater by Dr
Gavan oakley the chaírman of the A.D.A. rs Fluoridation
conrnittee. The Medical Reporter of the Melbourne rAger of
?56
December l, 19'79¡ said that Dr Oak1ey ha(l statcd that fluoricle
suppLements should not be taken wlthout a prescription where
the water ls fluoridatcd ancl tlxrt, in additfon to increaslng
the chances of rnottling, fluoride tablets present a health
risk fron overdosing, especially when the tablets are
flavoured.
The Fl-uoridation Committee vras forced to make thistardy warning by rlisclosures in the Melbourne tTruthr,
commencing on October 20, 19?9, that a boy aged two years had
died after swallowing four fLavoured fluoride tablets, thatthere uras a high prevalence of dental- fluorosis in childrenvrho had ingested fluoride tablets in proserpine, Queensland,,
and' also in a private dental practice in Mel-bourne. This
warning, that fluorÍde tablets should not be used influoridated areae, v¡as issued 1/ years after a simÍlar one
was given by the U.S. PublÍc Health Service (see p. 120). Itappears that the FluoridatÍon comnrittee has tried to hide
from ùhe public the fact that it is not difficurt forchildren, in particul-ar, to ingest toxic d.oses of fl-uoride.
The 'Truthr report of December 8 said that when Dr
oakley was asked why tl're Australian Dentar Association had
not previously warned strongly about fluorid.e tabÌets, he
sal.d:
rltm pretty sure that it got covered. (in tne rnedia) ¡ut itmay not have got wide cover. Irte tended to bow out of theevent after the towns became fluoridated. because it vras a
. pretty controversial issue and we had won the fight.Irm not saying we acted irresponsibly. r
others consider it v¡as rrresponsible for the members of the
?_57
tr'-l-uorfrlation Commit, 1;o<l , who ¡rrcr,iumabl,v lrncw the da.n¡4er, not
to make ¡-¡urc that the public, ¡¡nct pharmacists in part.Lcular,
were sufficient.ly warncd. Dr Oalclcy attent¡rt:crl to place the
blame on drug manufacturers and pharrnacists ( rTruthr ,
December 8) by sa¡'ing:
rAll, chemists shoul-d know that particular l"incì of drugshouldnrt be sold to people. Drug manufacturers should
-if theyrre going to put fluoride tablets on the shelves -
have a big notice saying: 'rNot to be taken in fluorideareas. I
This failure by all the health authoritj-es to
publicize adequately the dan6er of consuming fluoride tablets
in areas with fluoridated water, has nade rnany Australian
children unwítting experiment¿rl subjects for a study of effects
of fLuoride overdosage. The Merbourne rrruthr of December B,
1979t reported that Dr Herschel Horowitz, of the u.s. National
Institute of Dental Research, said that Austraria was the only
country which has double fluoridatlon. He s¿tid:
rltlerre avrare of the recommended regimen in some areas inAustralia. From the epide¡ni_c .standpoint itrs veryinteresting because rìre know of no other country in whichthis practice io being done.r Austrarian chiLri,ren arebeing given taddÍtlona-l- a.mounts of fl-uoride beyond whatis considered optlnal Ín most countries of the world. r
trt is of interest to see what these kids loolc Ii.ke. r
the report said that Dr Eorowftz wirr be one of a four-flânTrIEO team whlch Ís to visit Australi-a next June to examine
hundreds of children.
rt is an indícation of the rigid pro-fluoridation
stance of Australian health authoritj-es that they have done
nothing to investigate this problem, obvious to anyone who
2b
?,8
ìinows ùhc rlarr¡;crc ol' l'-l uoride 1.rtgc,';t-i.ort, which t.ltc WIIO b,:-.¡rm
cxpecta to completr-' ln a portod of only bhrec' weolrir.
(See p. 9t). Dr Oakley uras reported in tÌre Melbourne rAgel
of December 5, 1979t to have made tl:e ru-marlca.Lrle claim that:rVery milcl mottling of teeth in fluoridated areas Ís a sj.gnof sound teeth. I
(See p. 2O?). Mention of precision and reliability recalls
the deecription of the fluoridation pla.nt at Proserpine,
given by thc speci:rl investígator of the rTruthr newspaper,
October 20, 1979. He .said:
r... fluoride r,¡as added to the cityts water supply ín a
crudely constructecl shed on the banks of a dry rj.ver bed.Stacl<ed in one corner Ìâras a pallet of f luoride bags, eachlabe11ecl with the word rrPoisontr. opposÍte this were two1ar6e meüal- vats in whlch the councir workmen s¿rid. thefluorfde was mixed. A few fcet away vres a simple putrlp
u¡;od Lo inJecl; t:hr: flì_rro.nirle into the wate:r supply. r
ThJ-s appears to be a very prinÍtive syctem, judgecl by the
very stringent regulations for comprex machinery 1aícl down by
Gabovich and Ovrutsl,_íy ?9??) ,
One wonders what happened when, soon afterwards,
severe flooding lnundated thls area of Queensrand, hoserpinebeing particularly seriously affected.
t
4. On Augusb 70, 1979, Dr J. -Benolt Bundock,
Adviser to the Minister of Environment for euebec,
referring to bill rt88tt which requested fruoridatÍonthe province, said:
f On the basls of preliminary scientifÍc evi-clencegovernnent, which took office in Novenber 19?6
Senior
Canada,
throughout
the actuaL
decided to
2r9
Íral<t: ¿t l;horou6h review of the whoLe problem beforefmplementing that measure. r
This governmcnt decioion resulted ln an important study, which
included several rittle-investi-gated irsper:ts; of fluoridation,by a conmittee of ten (Lamontagne et aI. ). Their full reportis not yet availabl-e to the public. The folrowing rnaterialis taken from the Abstract of the Denartmental ConnitteeR ort on the t of the Environment and the Fluorida tionof Drinkin o Waters. Environment Protection Services forQuebec (mÍmeo., undated).
4a' (see p. ?-21). That abstract maÌ.,-es some irnportant observationsregilrding the ef f ects of f luoricle on ac¡uatic life. It stated:
tRecent studies have shown that the exposure of rivÍngorganisms to concentration of flr,:orides above cert¿tinlimits in the water environment produces currul-ative effectsof fluorides. Biochemical and morphologicar chanpçes mayoccur in these or8anisms. Directly or indirectry thesechanges may restrict the capacity of these organisms to¡naintain their ecorogical posÍtion within the overar_Inatural ecosystem.
The accumulation of fluorides in aq,atic prants andfauna is a very irnport,ant phenornenon because of iüspotential impact on arr- animals consuming these organisms.Recent studÍes sug6est that the concentra-tion of fl-u,oridesalong the food chain is certainly not ress th¿in 10 to one. I
rrt is ¿¡lso known that severar- aquatic plants can easilyaccumurate fluorides at lever-s which exceed by far thel-evel- reached by their environrnent. r
Lamonta6ne et al. contj-nu_ed:
tFishes and ot'her aquatic species tend to accnnurate fl-uoridesin their body maÍnly within the skel-eton a-nrì the exoskeleton.
ít60
These aecuûru]-:tt,ions nry be vcry 5-mportant according todifferent ripecies. Furthermore, in thc case of certainorganisrns (for ex¡tmple the crab) this accurnulation may
be responsible fo¡ louerin6 the rate of growth with a
corresponding loss of weight and reduction of size ofthc inc'lividu,,. l.
In other cases, such as the fro6, tLre ernbryonic
clevelopment of their eggs is delayed when they aresubmitted to a concentr¿rtion of 1 p.p.r,n. of fluorides.Si¡nilar effects are observcd whcn tac'Lpoler; (larva of thcfrog) are exposed. I
rMore specifically, the e6gs of trout do not hatch r+hen
tJrey are expoíìr:d to concen'urations [ofJ 1.1 p.p. nil].ionof fluorides. I
The conclusion of the comnittec was:
I . . . there is enough evidence to conclude that the ¡¿c bualpresence of fluorides above cert,ain levels in the aquaticenvíronment is causin¿ irnportant biological damage toboth plarrt and anj-maì- systems. r
4b. (See p. 69). This committee appointed by the Government of
Quebec referred to:r... the medi-ocrity of the l-iterat're demonstrating itsefficiency in the prevention of dental caries. I
After mentioning laboratory experiments which showed thatexcess fluoride can produce intoxication of celLs formÍng the
teeth, the committee said.:
ton the other hand, it is nuch more difficurt to acceptarguments to the effect that v¡ater fluoridation at theproposed 1,2 ppm level- is highly efficient in the preventj-onof dental decay. This level- of admini-stration appears tobe a cornprornise between tan acceptable level_ of dentalfluorosisrr and some poseil¡l-e reduction in dental d.ecay.r
4c.
4d. (see p. 22Ð.
comment:
fft wouldpresent shoul_d
4e.
261
(see p. gz). Lamont,a¡,;ne et al-., referring to the experimentar
study of tÌre-. r:fficacy of f-Luoridation, said:rrt rnust be realizerS, however, tha,t what ap¡rears a sir,rpleroutine experiment is rcarJ-y a char-ten6ing problem t¡hichto thi-s day has not been sorved satisfactorì-ry. rt mustbe realized that the processes impticated in dentar cariesare estirnated to be undcr the influenco of a large nunberof variables. r
They listed more than fifteen of theoe, ancl sai-d:rMultivari-ate analyscs cannot cope with more th¿¿n three orfour variables and stilr- retain some credibility. on theother hand longitudinaf studi-es r-astin6 for some twenty-five years are ímpossible to carry out. one rnust thenturn to animal experi-mentation under controlled conditÍons. I
After nentioning the rmajor difficurtiesr of such experimentsthey said, regarcling t:re effÍcacy of fluoridation:
runder those conditions, it is not surprising to find thatthere is no consensus within the scientific comrnunity. r
seem
This Quebec Government cornmittee made a simílar
therefore that our preoccupations for thecenter on fluori_de i-ntoxication rather
than deficlency. r
(sec p. 1B?) . Referring to Dr Rapaportrs work, whÍch foundan associati-on between increasing fluoride concentrations ofl'¡ater supplies and an increasing prevalence of nongol births,Larnontagne et aL. said.:
rBecause of the inherent r-irnitations of such a study itwour-d not have receive<l a great deal 0f irnportance in thecontext of fluoride toxici-ty had it not been confirmedindirectry by studies carried, out on other riving systems.
262
Therle othe¡' studie¡; h¡¡ve now shown cluite convincingly tintfLuoritìes, by some unknown mechanismr scem to pro<luce
chromosome breaks and/ot aberrations. These reports ofun$uspccted cel-Iular damage are Ìrighly disturbing and
merit all the attention of the scientific cornrnunity. r
4f. (See p.1?4). The corurittee continucd:
rThe second disturbing study is that of Yiamouyiannis and
Burk which showed a higher cancer death rate in fluoridatedcities than in comparable non-f luoridated ones. lrlhen
first published, thj-s stud.y r^ras ridiculed by Public Hea1thOfficials. More recently, however, it has been
reaccredited before a court of l-av¡ as a scientifiestudy done according to the state of the art. It israther amusing to find that courts of law are d.oing thework that Public Heal-th Official-s should have beenconcerned with. I
49. (See p. 222), A.s a result of the recommendations of the
committee:
rThe Quebec Govcrnment declarcd a moritoriurn on compulsorywater lluoridation starting August 192?. It is stillenforced today. r
4h. (see p. 1tü. rn adclition, this abstract states that, due tothe recommendations of the committee:
rFluoride is nonj-toreù by the Environmental Protectio¡Services of the Queìtec Governlnent. r
4i. (See p. 6o). Lar:onta6ne et aI. saicì:
rDistribr.rtion systems mad.e of cement ancl asbestos or thosernade of cast, iron coated with concrete linings tend toprecipitate fluorides wÍth a corresponding de crease inthe leve] of fluorides v¡hen the ¡¡ater reaches the tap.r
(A spokesman îor the Melbourne water authority, the M.M.B.lù. ¡
in January, 19(JoI nrrlti that, except for ilrc ¡;m¡¡lrest co1.rp .r'utnainst the Boardrs policy i¡; to l-Íne arl- nains with cement.
hacticalry al-l thls worl.- has becn compretecl, ancl the remaínin6pipes would be lined. arj Íjoon as money is available. The factthat we have pipes rined with cement may account partially forthe failure of the Board to deriver fluoridated water at thespecj-fied concentration ¿tt d.omestic taps, as mentioned on page
61 and in appendíx 16.
4¡. (see p. 61). Referrin8 to technicar- probrems regarding themaintenance of roptimumr lever-s of fluoride, this Quebec
conrníttee cited an American st,ud,y, based on 6zo 10ca1
fluori-dation systerns distributed throughout 12 southernstates. Thís showed that 29O of these systems (46.8%) rwere
distributing fluoridated watera whose concentr¿rtions v¡ere
outsj-de the prescribcrl limi_ts I of from O.f to 1.2 p.p.ln.
5a. (see p. 221). The fact that chemi-car revels can build up inthe Bay wa¡: mentioned. in the Melbourne rAge I of November 21 ,1979. rts science Reporter (p. Roberts) said that hofessorJohn waid and Bruce Ricrrard.son, of La Trobe llniversity, hadfound that the 1evel_ of hi6h1y toxic pCB chemi-cals(polychrori'ated biphenyrs) in port phillip Bay is as high asthat found in the indusLrial regions of the united states.l{r RÍchardson is quoted as saying:
rPCBrs are an j-ncredibly long_livcrl cliernical. Once theyget into the environment trey persist for a rong time,more than Jo years. At this stage we know very tfttleabout the l0ng-term effects on human bei-ngs of very 10vrdoseg. r
6a
264
5b. (See p. zot). This tÀget report furnishes another illustration
of the time it nay take before the toxicity of a substance is
reco6nize<1. It said that the safety of PCBs, which are
related chemically to DDT, was first questioned in 1966 aftel^
it had been 1n common use fot 37 years.
(See p. 30). The campaign for fluoridation by the U.K.
Department of Health has now boen questioned official-ly.
The london rDaily Expressr of October 12, 1979 ¡ reported that
the British Government had be6un to show doubt over the
questl-on: Is fluoridc in drinkj-ng water safe? The Eealth
Minister, Dr Gerard Vaughan, met Dr Dean Burk and said:rI regard Dr Burkers [Burkts] evidcnce as too importantto ignore and I have asked my official-s to go into itthoroughly and report to me. I
The article said that the Tory MP I,1r Ivan Lawrence, who
lntroduced Dr Burk to thc Minister, had said that:rVery serious questions are raised about the effect on
comrnunity health. t
6b. (See p. 56). This tDaily Expressr article provides an
up-to-date (October 12, 19?9) estj.nate of the number of
people in the U.K. who drink fluorj-dated water. It stated,:
tThere is an officiai fund to hclp introduce the chenical,and the Department of Health under eùccessive Governmentshas encouraged it.r Despite that encouragement: rso faronly a limj-ted number of health authoritj-es, likeBirmingharn and vùest Midl-ands, have gone in f or fruoride ,involving 4r5OOrOOO people. r
26's
7. 0n Jul'y 11 ¡ 1')?9' Ju¡;ticc John P' Fl'aherL;7 r'trote to
the Lorcl l4'ayor c¡f Auclcler'ncl' N'2" Sir Dovc-Myer Robinson' from
theSupremeCourtoftheCommonwealthofPennsylvanía¡U.S.A.
The following quotes are from that letter:
la. (see p . 1Br). (Earry in 19?9 a runour was circurated in
AustraliaandNewZealandthatt}reDecisionofJudgeFlaherty'
nentionedonpa6elSJ,h'a'r].'oeenoverrulecl.)JusticeFlaherty
wrote:
rYou arc correct that I entered an injunction againot the
fluoridation of the public water supply for a Ìarge portion
of Allegheny Count¡r, Pennsylvania' I did this after a
very lengthy series of hearings on the issue ' I
Contrary to your inforrnation' my decree has not been
set aside by a higher court' Presently' the issue is on
appeal to the Commonwealth Court of Pennsylvania' but the
appeal involves merely the ,jurisdiction of the court
itdoesnotinvolvethesustantivemeritsofthecase.I
(See p. 15?), Justice FlahertY saíd:
rThe trial brought into my court e-':perts on the subject of
fluoridaùion,andI¡neticulouslyconsideredtheobjectiveevidence. In my view, the evidence is quite cotlvincing
thatthcaclclitionofsodiurnfluoridetothepublicwatersupply at one part per million is extremely cleleterj-ouo to
thehurnanbody,anrlareviewoftþeevidencewilldisc}osethat ühere was no convÍncing evidence to the contrary. I
?b
?c. (see p. 20). In his lstter, Justice Flaherty revealed that:
rsince my decision [against fluoridation] , I have received
hundredsofletters,cluiteafewofwhichhavebeenscntbyphysiciansanddentists,allconcurringwithmydecision.l
7d,
266
(See p. 26). Justicc Flaherty s;ricì that during the A'leghenyCounty court case he had found that:
r..the proponentc of fr-uorirlation cro notrr.ing more than tryto irnpugn the objectivity of those who op'ose fluoridation. r
(see p' 19) ' comrnents by many proponents of fr-uoridationdemonstrate that they have not careful_r_y studied the originaldata' Justice Flahert¡, observed this during the courühearings, ancl wrote:
rr serÍously believe that few responsibr-e people haveobjectively reviewed the evidence. I
Ïn some cafles the evicrence is voluminous. rn his courtcase there vrere twenty-eight hundred pages of testimony andmany lengthy exhibits.
(see p. 2o2). The !,Iel_lington, N.2., ,Evening post, ofoctober 2/, 1g?gt published the for-l0rving remar.rçable story,written by its columnist David McGj_1.l:
fAt the age of 12, Helen Murray be¿¡an fainting. Doctorsdiagnosed epilepsy, then rheuma-toid arthritis, finally akilrer arthritis. For seven years Helen was bedridaen,her pain relj.evc¡d wi_th cortisone. r
The story 'says that Helen read a booiç on nutrition by Dr EvaHill, and then vÍsited her. The story continues:rDr Hill took one r-oorc at the huge rotten peach bruises onparts of IIelenrs bo<ly and diagnosecr fr-uo¡ide poisoning.Helen is now on the raw fruit diet and non-fr-uoridatedwater frorn a spring' she is up ancr about, shipping anddancing. t
7e
o(J
í?.(tl
9a. (Seo p. 2OO). The MelÌ¡ourno rTruthr of Novenbcr tt j<)?9¡
reported Lh¿rt a two-year-orrt boy, who harl bcon 6iven onc
fluoride tabret a day since his first birLhday, had died j.n
BrÍsbane fÍve days after becomj-ng irr due to tal<in6 for:r
additional flavottrecl fl-uoricle tablets. The death certificategave the cause of death as: rFl_uoride poisoningr.
ïmnediatery after swallov¡ing the tablets the boy was
taken to a physician who purnped out his stomach ancl recovered
four tablcts, but he bccarne unconscio's and. was taken tohospital. Unfortunately the hospital staff did not hnow thatfluoride is a severe poison. The senior registrar is quoted
as saying:
rltle wernrt even at¡Iare it had a possible lethal dose level.r dontt think it was even risted in the poisonc book.r
she said that the motherrs explanation that the chird had
taken fluorlcre tu-brets had been rured out because:r...there t^ras no reeord.ed case (of fluorj-de poisoning) inAustralia that we knew of. r
Dr Hans Moolenburgh of Amsterclan, IlollancÌ, (see pp.
2o1-2ol+) was reported in that article in frruthr to have saidrover the telephone, that:
r'luoride is a poison that accurnurates in thc bocry.obviously this crrild was very sensitive to fruoride butthe dÍagnosis of fluoride poisoning is clear becauseeverything happened so soon a:[te:r ingestion. | ,When thebody is saüurated. with fruoride, it takes only a snarladditional dose to push him over the lillj-t. Uj_th thishistory, I think the extra tablets ki1led him. I
í.6Í)()lr. (Sec p. 1t?). The lulc'l l¡Ourne rTruthr r.'l Dcct..ml,,.-'r' B, 19?9¡
pointed out l.hat, <iesplLe Llrt-' [¡tc. L that l'lclbournt-ì I s w¡rter is
fluoridated, ffuoritle tabÌet¡ are 6tiII on c;ale.
In Au¡¡ust, 19?8, the Chief Pir,erm¿rcist of the U.K.
Department of HeaIth and Social Security issued a directive
to alL fGeneral Practice Pharmacist Contractorsr .regarding
the supply of sodium fluoride tablets, saying that they would
be ret¡uired to comply wÍth certain cond.ít:Lons. That letter
followed the publication in Accepted Dental- Therapeutics
37 ed,, of the rccommendations of bhe Counci.l- for Dental
Therapeuti.cs SSZZ) of the American Dental Association.
(See pp. 120 and 2O9).
However, in Victoria, at least six manufacturers stíll(January, 198O) sell- fLuoride tablets the packages of which
do not conply with those U.K. regulations, nor do the labe1s
specify the doses and usage l-aid down by that council, in the
follovring ways: (t) In five cases the label did not 6iveradvice to consul-t a de¡rtar or nedical- practitioner or a
pharnacist before administering the preparations.r (Z) ffrenecessity to reduce the dosage in fluoridated areas rvas not
mentioned by threc manufacturers, one stated that the dose
should be halved and one said to take onl;' ¿" directed if the
water supply contained O.Z p.p.m. fluoride. (The Councll
on Dental Therapeutics reconmended downward. adjustment of the
dose íf the v¡ater contains 0.2 p.p.m. fruorÍde or nore, anrl
cessation of medication when the water contains 60 per cent
of the roptimumr for the geo¿lraphic area.)
?69
3) A1l six brands solcl pacl;:aßes with more Lhan 1OO tablets,
but only one cornplied with the U.K. directive by using a
child-proof container. (4) One brand cìid not specify any
dose for children aged l-ess than two years, but in the five
remainin6 ones the sug,qesteC. doses '¡s¡r-' twice that rcconnended
by the Council for children less than twelve months o1d, four
tir¿es the recommended dose for those aged 1 to 2 years r and
in aÌl six brands the suggested dose for children a6ed 2-J
years was tü¡Íce that recorrirnendecl by the Council . (5) Five
brand.s sug¡;ested that pregn¿¡.nt women shoul-d consut:re 1yt tablets
(1.5 mg fluoride) daily.
The r0anberra Timesr of December 6 t 1979, said. that
a spokesnan for the N.H.& M.R.C. had said that there is no
evidence to show that pre-natal fluoride supplements (to
women living in areas with fluoridated water) might benefit
the unborn child, and the Council did not reconmend the
prescription of srrch supplements.
Fluoride su¡r¡rÌemcnts to pregnant vromen, vrhether they
drink fluoridated water or not, r¡/ere banned in 1966 by the
U.S. Food and Drug Adrninistration. On December 19, 1978,
the Chanceflor of Fairleigh Dickinson University, New Jersey,
referred to that ban, and also pointed out that the U.S.
Department of .A,griculture advises farmers not to use
fluoridated water.
One wondere how long it will be before the dangers of
fluoríde overdosage are recognized by our health authorities and
before our regulatÍons fal-I into line with current practÍce overseas.
?-7O
1Oa. (See p. 149), A recent caee of failure to control the
addition of fruorldo at the water worlçe had tragic resul-ts
for the patj-ents on kidney machines in one clinic inAnnapolis, U.S.A. The various stages of the inveotigation,into this incident were reported between November 20 and 2!,1979t in at l-east five newspapers: (i) rrre rrrtashington postr,(ii) the tlrlashington starr , (iii) the Baltimore rsunr , (:-v)
the San Jose rMercuryt anrl (v) the Annapolis rEvening
CapitaIt. However, this very nevrsworthy item apparentl.y
was not rnenti.oned in any Australian newspaper.
The accident i-nvolved the discharge of looo exce'sgallons of fluoride eolution, due to a worker reaving thevarve of a chemical storage tank open during a period of i6-1B hours. Thls caused the fruoríde concentration to riseto 1J tines its normal level. (Íi).
1ob. (see p. 196), This recent incident in Annapolis is a
dra¡natic iLruetration of the danger of using fluoridatedwater for diarysis, not only for J-ong-tern treatnent butalso, if an accident occu.rs in the addition of fluoride,even for a very short treatment period. The physici-an incharge of the clinlc, Dr G. Mitchell, said (i):
r.. eight patients began to suffer nausea, vomiting,weaknee. and burninS sensations in the chest after anhour or so of treatment. A1r were taken off the machi,,ê6. I
Deepite thls, one patlent dled that evening. An assi.stantmedical examiner said:
rrhere is no question that the fluoride caused the death. r
rrhe man had a bad heart, but the fluoride overdose added
27t
an extra strer¡c hle; cyotem couldnrt handle,I (1j.). rThere
war; JO timee t,he norl¡rr .l ¡,rmount of .lluoride in (trio Uoay)
tiesues. I (fv).
Another patient suffered a heart attack, but recovered. State
tests confirmed that there r¡rere high lcvels of fl-uoride in the
seven surviving patients. (iii).
The rWashington Starr said that:rvübire the federar government strongly recommends extensivepurification for water used in dial-ysis, neither state norfederal l-aw requires such cleansing procedures.r
It stated that:rrhe BÍo-Medicar Applications diarysís center was using tapwater filtered through a water-softening rnachine which isincapable of removing fluoride. r (ii).
After the patients became i1l- the clinic $¡as cl-osed, but planned
to open soon after the rinstallation of nevr filtersr. (i).Presumabl-y the new filters I were capabJ-e of removing fluorid,e.
such incldents make nonsense of reassuri-ng statements
regarding the safety of fluoridation apparatus, such as thatof the fifteen-nan committee on the Fruoridation of vlater
supplÍes. of the Royal colrege of physicians. rn theír 1926
publication Flu Íde. Teeth and Health they stated:rRegular or continuous monitoring of the fluoride concentra-tion in water suppties together with fail-safe devicesen'ure the maintenance of the fluoride revet withÍn narrowIinÍts. I
rrechnical advances have ensured the efficiency offluoridation prants and any temporary i-ncrease in thefluoride level automatlcally resur-ts in the fruoride feederbeing turned off. r
1Oc .
u2(See p. 2O?). Thc truth o1' thc st¿rt<-'mcnt, that aclec¡uate
safety f¡rctors should be employed when treating water because
of thc lack of precision and reliability, 1s established by
the Annapolis accident. The report in the Annapolis I
rEvenlng Capitalr of November 29 | 1979 ¡ commented.:
rState authorities oaid, yesterday that the accidentalsp1I1 of 1,OOO galLons of fluoride Ínto the cityrs drinkingwater supply probably would have gone undetected if kidneypatients had not become 111. I rThe effects of thefluoride overdose ls unprecedented because spills have
never occurred in a city where a dialysis center isLocated. r (v).
It is clear that the plant operators did not realize the
danger. The spil1 occurred on November '11 and was d.iscovered
the next day, but the state authorÍties were not notified.
The Baltinore rSunr reported that:fUnder the federal Safe Drinking llater Act, the spi1lshould have been reported inmediatery after it occurred.,heal-th officlaLs said. city officials said water depart-nrent officlals arrrare of the leak did not know the federaLraw and dld not think the leak posed any health probren. r
(rne cleath, and the illness of these patients, should not have
occurred for they did not undergo dialysis untíI a day afterthe epill was diecovered. ) sanples taken three days afterthe spiIl showed a level of 27 p.pono (iii).
rt is uncertain whether any acti-on wourd have been
taken if the epíll had been reported, for the chief ofMaryrandrs Departnent of communj-cable Diseases said that:
r... he did not berieve the water posed a health hazardf(iv). Also r...â healthy person would have had toconEurne l0 to 100 gallons of the contaminated water to bein danger. r (ii).
10d .
2.7tNevertheleso, the Department of Health ¿rnd Menti¡.l Hygiene
ordered Pepsi to destroï 25¡ooo cases of soda and coe¿r-cora
I an undetermined ¡rmount ¡ of that prorìuct . (iii, v ) .
The &¡.1-timore rsunr of November 29, jg|g, mad,e the
remarkable statement that :
rstate officials said they sinply do not know the effectsof the hi6her concentrations, although they stressed thatwater v¡ith fluoride as hi6h:rs Bo parts pcr nrilrion isused re¡çurarly in other parts of Lhe worrd rvith no moreill effects than nottled. or brittle teeth.r (iii).
rf that statement correctry reports the remarlcs of the rstate
officials, it is obvious that they were dangerously mis_
informed, even if BO p.p.m. was intended to be B.O p.p.m.
(see p. 64). The adrrition of l-ime to fr-uoridated water, toreduce the aci-cìit',' producccl by the fr-uori-cre, is comnon practice.The Annapolis fEvening Capitalf of Noverjr,er 29, 19?9, reported:
tltlhen public works personnel first noticed an increase inacid l-evel of the 'water after the spilr, rime was dumpedinto the system to neutrarize the water as prescribed bynornaÌ proceclures. pubric v{orks Director tloseph Axer_rodsaid that r-ime was i-ntroducecr. to conbat the hig.h acidicÌeve1s caused by the high amounts of fluoride whire prantpersonnel were tracìring down the cause of the probrem. r
He wao unable to say how much rirne w¡.-r¡; put into trre r¡¡ater. (v).
11, (See p. 2?-3). On July p , 19?9, the Seryior Advisor to theEnvironment Minister for euebec, canada, Dr J. -Benoi.t Bundock,wrote to Judpçe Flaherty acknowledging receipt of his opinion(November, jgZB) in the Allegheny County court case. Referringto the fi-nding of the inquiry into fluoridation set up by the
224
Governrnent o1' Qucbcc, Dr Bundocl" uaid:
t.. in so far as the carcinogenic cffects of fl.uorides areconcerned our Review Committee reached the s¿ì.me concl-usions
as you dj-d in your Opinion. r
Judge Flahertyrs Opinion (see p. 182) statecl that he rn¡as
rcompellingl.y convincedr by the evidence presented in his court
regarding the validity of the study that was conducted by Drs
Yiamouyj-annis and Burk (19??), which found. that cancer
mortality ratee werc hi6her in fluoridated than in non-
fLuoridated. cities in thc U.S.A.
12a. (See p , 124). The Mel-bourne tAge, of Decernber 11 , 19?g,
reported that the European uranium organization urenco-centic
wants to build a $5ooro00roo0 uranium enrich¡nent prant in south
Australia. The technicaf director of Urenco-Centic, Mr J.
Parry, sa j-d:
rWe are cÌea1in51 v¿itl'i a safe, clean process which has noeffl-uent. rn Europe and the uK, our plants are situatedclose to centreo of very high popul_ation. This is thesafest industry vre know. r
Despite Mr Parryrs claim that there is Ino effruentr, he isreported to have said that the only ]nazard, from an enri_chment
plant was hexafluoride gas, but that very stringent precautions
were taken to prevent gas lealcages. He did not state how
effective these rstringent precautionsr were in preventing the
release of this highly toxic gas from estabrished pÌants.
12b, (see p. lto). The Merbourne rAge, of Januar! Zjr 198or saidfhat three new arurnÍnium groups have begun talks ai¡red atsettin¿1 up smeJ-ters i-n victoría. The state Electricity
275
Commleefonra chalrman sai-d that thc:re were s1* or ceven
potontl.al ap¡rlfcantn for ¡lmsltor¡. IIo rcvo¿r1od tlr¡rt thc naw
Alcoa Portl-and emelter would havc' a 1'5?.rOOO tonne capacity lnthe first stage r and this could be expanded to a 5ZBTOOO tonne
capacity. (tfrts would be more than five times the output of
the present large Alcoa smelter near Geelong. )
11, (See p. ?8). those who are not satisfied with secondhand,
opinions and wish to examine the orígina]- data from the Grand
Rapids, Newburgh, Evanston and the two Brantford trials, wÍr1
find the fu1t. references in Sutton ?959.- 1960), which comnent
on the control-s used in those t,riars. Bocause of the many
instances in which dÍfferent reports from the same trial are
not in agreement, it ls essential- to read, and conpare, arr the
reports from each triar rather than rerying on the data and
statenents made in the final report.
The details of those fluoridation triaÌs were published
in the following journalo:
Alqer. tl. Publ. H1th., 1g5o; Canad. J. Publ. EIth 1951, 1954¡.t
1956i J. Arner . Dent. Ass .t 1951 t 1954-1958; J. Canad. Dent.
J. Dent. Res. 1948, i95o-50, 195?; OraISurA. , 1951; Publ. Hl-th. Ren. (w , 1950, 1953, 1956.ash. )
14. (see p. 126). The spread of fluori-de contamination was
mentioned recently by hofessor God.frey Tanner of Newcastr_e
University, N.S.W. He was commenting on the proposal toestablieh alurninlum smelters at ronago and Farrey, nearNewcastle. The Sydney rDaily TeJ_egraphf of December 1!,1979, reported hin as sa¡,in6:
2?6rEnglneer6 are anticipatlng one kilogram of solld fluorldeproriueed for evcry tonne of refinetl a1r¡nÍnLum produced.
Wltbln a 5 kn radius of the Alcan smelter at Kurrl Kurrithere 1e evldence of plant damage. If they donrt Lmprove
the pollutlon control above the present level, there iecertainly going to be danage to peach trees and other plantewLthln a 5 to 10 km radiue of Tonago and Farley.
This damage is not, therefore t going to be in Just asnall area. It wí11- affect the western euburbe ofNewcastle. I
On the A.B.C. television progranme rWork that was: Futureel
on tlanuar! 24, 198O, Dr Keith Windechuttle pointed out that
fluoride frr¡res severely affect the development of grapes.
Therefore the establishment of these very large proposed
emelters in tbe Eunter ValJ-ey may menace this nost inportant
wine producing area and affect Íts large tourist industry.
1r, (See p. 119), It Ís of interest that, according to rThe
Australiant of Decenber 1O, 19?92
rThe biggest toothpaste maker fn Japan has stopped addingfluorlde to dentlfrice. t
rThe Lion Dentifrice Conpany, of Osaka, has quietlyswitched to non-fluoridated paste, though it says Ít doesnot bel-ieve that fluoride causes any j.lI effects on teeth.The ewitch was discovered after a town council in Hyogo
Prefecture êanp1e-tested all avalJ-ab1e brands of toothpaste. r
16, (see p. 62), Another Ínstance of the lack of control of the
fluoride concentratlon in the Merbourne supplies was clted inthe rSun Eaeterly Suppl-ementt of December 1J, 19?g. ft statedthat the llaverley Council had found that the fl-uoride levels attaps at seven infant welfare centres varied, between 0.41 and
1la.
?_77
1,O8 ng/L. The lowest and the hi8hest values were obtained
from eamplee talcon fron trrps at the lrtellÍngton contrc inAuguet and October.
Early j.n December the Council asked the Board of
Works for an explanatÍon for these variatÍons, but no reply
had been received. (on January 21, 1980, the Ohief Health
Surveyor sald that, 6even weeks after that request, the
waverley council stlll- had not received a reply fro¡r the
Board. )
(See p. 125). A recent paper reported ùhat the emission offluoride into the atmosphere fron one alr:mÍniun smel_ter was
139 Kg, per hour between 1909 anð. jg6ï, and about !1 Kg per
hour fron 1968 to 19?3. At that tirne the emission was
decreased to the 19?? tate of 74 Kg of fluoride per hour,
whfch is !0.816 metric ton per day. I
Those data were obtained fro¡n a special /o-page suppre-ment entitled
Poieoninq in
ial- F]. ide Pol- ution Chronic Fl,uoride
Cornwall Island Ca tle by L. Ihook and G.A.
Maylín, contained in the Apri1, 19?9, Íssue of rhe corner-IVeterinar l-an (Cornel-I Universlty, Ithaca, N.y. ). This
in fluorosis.inportant paper should be read by those
The authors stated. that:flhe object of the present study is to record yet anotherman-made pollution disaster and, to interpret the patho-genesis of the os.eous changes in view of recent advancesin the understandÍng of bone metabolísm. r
the sou¡ce of the fluoride polr-uti-on was an ar-uminium
snelter ereeted ín 1g5g by the Reynords Metals company on the
intere ste d
2?8
Bouth bank of the St.Law::ence Ríver, State of Nev¡ York, cloee
to Cornwall Is1and, Canada, the population of whLch is
c.xcluslvely l'lohawk Indian.
17b. (See p. 126). The CornwafÌ Isfancl farms surveyed were betr¡een
1.6 and 6.2 kn from the aluminium plant. The authors stated:rChronic fluorÍde poisoning in Cornwall Island cattle was
manifested clinicaì-Iy by stunted growth and dental- fluorosisto a degree of severe interference with drinking and
nastication. Cows died at or were slaughtered after thethird pregnancy. The deterioration of cows did not allowfurther pregnancies. I
1?c. (soe p. 81). An important observation ln this study is the
fact that there \^ra6 a marked deray j.n the eruption of teeth.
It. was found that:rDelay in eruption of I,,' exceeds 1.) years, of Ia J years,of lr 7 years and of 14 2.5 years. r rThe cause of delayi-n tooth eruption was shown in the present material_.Fluoride arrests resorption of d.eciduous teeth roqts andof the supporting bone. By inducing one disease, fluoridedelays the manifestations of another. r
That comment ie of the utmost Ínportance when considering
whether fluoridation is effi_cacious.
17d, (See p. 9t). Although the work was d.one on cattle, thÍspaper gives a coneiderable lnsight into the development ofrr¿ottledr teeth as a result of fÌuoride ingestion.Krook and Maylin reported that:
rMottling was not seen in deciduous teeth but theincidence was great in permanent teeth. The incidencedecreased with age, which, agai-nr'indicated that the moreseverely affected cattle had died. r
17e.
?'79
It is wel-I known that the aneloblasts (which form tooth enamel)
are readlly affectcd by small- overdoseo of fluoride, producing
faulty enamo.l., termod clcntal fluorosl-a, which hao long been
recognized as rthe flrst objective ind,ication of chronic
fluorine poisoning. I (Ast, 194r). It is often assuned that
the ameloblasts are the only cells affected. However, inthis study it was found that:
rrhe target cells for fluoride in chronic fruorosis wereshown to be the arnelobl-asts, the dentar pulp cells and theodontobrasts [which form dentine] , and, in bone, prinarilythe resorbing osteocytee and also the osteobl_asts.r
the original paper shourd be consulted to study the micro-
photog;rarphs and other evÍdence which support that statement.
As a result of the poor quality of the enamel and
dentine in fruorosed teeth, excessive attrition (wearin6 away
of the biting eurfaces) resur-ts. The authors reported:rrhe íncidence was great in permanent teeth. The attrítionwaB very often so severe that the pulp was exposed. Theedges of the teeth became very sharp. Attrition thereforeinterfered severely with mastication and this was, no d.oubt,a contributing factor to emaciation in aging cattle. I
(see p. 1g?). ThÍs paper reported the effects of fruoride on
ùhe periodontal- tissues of 116 cattr-e. The authors dividedthen into three groups, and said that bulging of the gingiva(gums) occurred in ?9.6% oî a group of 98 cattle with decid.uous
teeth only, in 88 -6% ot 44 cattle which hacl both decid.uous and.
permanent teeth and in 91.4% of j4 cattle with pernanent teeùhonIy. They found that:
17f.
178,
280
rBulglng of the gingivá occurred becauee of recession ofalveolar bone with or without gingivitis from excessivernobility of teeth. I
Four casea were subnittecl for necropsy: (1 ) a 4-month-o1d
ma1e, Q) a 1-year-old male, (1) a J-yeat-old fenale and
(4) a 4- to !-year-old. fcmale. In case (4) therc was a mild
degree of l-oss of the al-veolar bone surrounding the teeth and
in case 3) this l-oss v¡íj.s pronounced, the mandíble was much
enlarged in the nrol-ar region and the bone was brittl-e and,
shattered easlIy. The authors said that the cauí:ie of thisalveolar recession was necrosis of the bone.
(See p. 166). The data obt¿rined from cattle on Cornwall
rsland show that fluorosis can arise not onry fron ingesting
fluoride from waùer, but also that ühe fluoride content offood and industriar polrution of the atmosphere with fl_uoride
rnay both be important factors. In this study, stunted
growth was the most obvious clinical sign ancl laboratory
teste tprovided concLusive evidence that the stunted growth
was the resurt.of chronic fruorosis. r rt was found thatthe target cells in bonc for fr-uori.cre r.¡ere rprimarily the
resorbing osteocytes and also the ostcobl_asts. r
(see p. 134). The fact that fr-uoride is transmitted trans-placentally in cattl_e was demonstrated. by findlng therremarkable I l-ever of 45o p. p.¡n. f luoridc in a /-rnonth-oldfoetus.
Fina1ly, one very important observation by Krooir and.
It4aylin regarding fluorid¿rtion, already mentionecr in appendix
?_81
'18.
17c¡ should be repeated. They saicl:
rrhe delay in eruption of pcrrn¿ì.ncnt teeth has arso beenreported ln childrcn in fluoridated communities. r
rrhe cau6e of delay Ín tooth eruption rr,¡as shown in thepresent material. Fluoride arrests resorpti-on ofdeciduous teeth roots and. of the çupportÍng bone. Byinducing one disease flfluorosÍe] , fluoride derays themanifestatíons of another [dental cariesJ.
(See pp. 186 and z1t). Late ín Decemberr lg?9, Dr Dean Burk
issued a news release. rt was basecr on the summary of a
paper rvhich he 1s to presont to the 4th rnternationalsymposium on the Prevention and Detection of cancer, to be
held in London-!{emb1ey, July ?-6-31, 1980. rt stated that,according to studies made by the Dean Burk Foundation,
Birmingham has now been found to have one of the highest,documented, increasíng cancer death raües of any large cityin the worrd. The basic popurati-on-mortarity data for thisstudy were obtained from the office of population censuses
and Surveys (OpCS) in London, through the courtesy of SÍrEr¡manuel Kaye.
The graphical data issued by Dr Burk on December 1u ^
19791 show that Ín Birminghan, for ten years prior to theintroduction of artificial fluoridation in 1964 the cancerdeath rate per lootooo people fr-uctuated from year to year,as is usual , d.ue to various factors. The mean l_evel was
approximateLy 212, with a range of between 204.5 and zzz.jlbut it dÍd not show any upvlard trend. However there u¡as anarked rise in the cancer death rates, recorded i-n these
1)a.
28z
official figures, after the introduction of artificial
fluorldation in 1)61¡, By 1967, three years after fluoridation,
the rate was higher than at any time in the preceding twelve
years, and it continuecl to riee rapidly (with the normal
annual fluctuations) until by 1)16-1977 ít approximated 290
cancer deaths per IOO'OOO people (that is, approximately 2!OO
for Birmlngham) - far higher than the figure of 222.! which
was the highest rate recorded in any pre-fluoridation ¡reâro
The news release saj-d that:fFl-uoridated Bj-rmingharn has now been compared with non-fluoridated Manchester over the years 1971-197? | adequateOPCS data for which are available. After simu.ltaneousstandardizatlon of all data for different age and. sexpopulation distribuùions in these two ci_t,ies, with one ofa variety of appropriate standardizing populationsexamined, it was found that over 10OO standardizedexcess deaths per year are nour rinked with fluoridatecldrinkíng water in Birmlngham as compared to Don-fluoridated Manchester, and this otandardÍzed d.ifferen-tlal is increasing at a rate of over 1OO per f,êâr. I
The rerease stated that all supporting taburar and graphic
details of the foregoing analyses had been deposited. forreview with the Department of Hearth and. social security(ogss) in London, and with other org.'izations and partiesin Britain and elseb¡here.
(See p. 124). An inportant recent discovery regardfng
poll-ution in Melbourne and Geelong, is that a giant vortexof wind over Port Phillip Bay is ensr¡¡ing that Melbournergets íts own pollution backr. That statement was made by
the science Reporter of the Melbourne rAger on Decenber 1J,
1 9b.
19c.
2Bt
1979, when reportin6 recent dÍscoveries by researchers at the
csrRO dlvlslon of atmoopherfc physico. He eafcl that Dr
Kevln spilÌane had exptained that the vortex was the wake
eddy cauoed by winds hittÍng the Arps, and that the 1oo-
kilonetre wide eddy was present on two out of three ofMel-bournets high-pollutÍon days. This articre stated thatthe level of photochenical smog, especially ozone, is alreadyhigh in Melbourne, and that the ozone leveI exceed.s thelùorrd Eealth organization standard on one d.ay in fíve, and
reached 2l parts per million in 19?6.
(see p, 125), Most of victoríars electricity is generatedin the latrobe Vall_ey by burníng brown coa1. Dässl-er qt al_.(9?r) reported t.hat there is a massive escape of fluorídegas fron European brown coal erectrical power plants.Presumably our generators, a1so, produce fluoride polruti-on.A part of this may be reaching Melbourne and Geelong, for Drspil-lane 1s reported to have said that pollution from thenorthern Latrobe valrey courd reach this port phÍrlip eddy,which covers both those citÍes.The tAge t reporter eaid that this csrRo fÍnding could haveinplications for the sltlng of industry near Geelong and inthe Latrobe Valley.
(see p. iz5). Dr spirlane said that porrution fron Geelongwoul-d take about 4o hours of stable weather to reach Merbourne.(rnis rnay include atmospheric fluoride pollution frorn thelarge aluninium smelter near Gee1ong. )
284
20. (See p, 221). There is conslderable pollution of Port
Phltltp Bay by lnduotrlal waete. For lnstancet Alcoa of
Auotralfa Li"mltod has an a6roomont with the Envlronmcnt
hotectlon Authoríty of Victoria (Licence no. EA OOO198/6 of
June 1 , 19?7, amended December 20, 19?4). This permits
Alcoa to dfscharge rvertically upwardsr into the atmosphere
1J toxlc waste componente. rFLuorj-ne Compounds as Hydrogen
Fluoridet may be dLscharged at a maximum rate of 16.83 Kg per
hour. No mention is made of dust containing particulate
fluoride, but this nay be included in the 11O,5t Kg of rd,ustl
which nay be diecharged every hour. On page 12J of the
present submission it was mentioned that fluorj-de fron that
srnelter has been nonitored approxirnately Jl niles fron the
source, but that nost of the fluorÍde ffalls outr within a
two-níle radius of the plant. Much of tbis wil-l faLl into
nearby Corio Bay, a part of Port PhiJ-lip Bay.
In addlti.on, the E.P.A. (by an agreement amended. on
June 10, 19??) permits Alcoa to discharge fluoride waste
directly l-nto Corio Bay at the rate of 1)J cubic metres per
24 hours, ùhe maximun concentratlon beÍng 20 grams of fluorideper cubic meter. The responsibllity for the monitoring is
left to Alcoa but the E.P.A. monj-tors fluoride concentration
in the discharge on a random basis, usually every two ¡lonths.
Conclusion.
This appendix contains
conclusÍons - that to
to animals, as well- as
Irfhen the Health
reports which reinforce the previous
dangerousingest or inhale fluoride is
to nan.
(Fluoridation) Act was passed by the
285
vlctorlan Governmont l-n 1971¡ Ilttle mention wae made of what
fs now known to bo a very lmportant f¿rctor - the absorptlon
of fluorlde from Bource6 other than water, including atnos-
pherfc pollution. our parlÍamentarians were assured that
fluorldatlon was eafe. However, this new evidence makes iteven more obvioue that those aEsurances were not justified.
The Quebec Governrnent conmlttee (Lamontagne et aI.,see p. 259) said:
frt would Been therefore ùhat our preoccupatione for thepresent should center on fluoride Íntoxi-catlon ratherthan deficfency. I
The first step 1n preventing fruoride intoxicati-on tn the
population, and the po1IutÍon of our environment by fluoride,Ís to halt the íntentlonal spreading of this toxíc substance.
This has been done by countrÍes in ttestern Europe which, afternany years of experience, have banned fluoridation.
ItIe must foll-ow their read and discontinue forthwiththe practice of adding fluorlde to our water supplíes.
