Fluoride Paranoia, Part 2

By George Johnson | February 17, 2013 4:38 pm

Fluorine and chlorine. From the Periodic Table of Elements.

Element No. 17 is a deceptively simple-looking atom, crucial to life and yet capable of snuffing it out in an instant. Its name is chlorine. Added to municipal water supplies in traces of up to 4 parts per million, it is responsible for practically eliminating cholera, typhoid, and other scourges from much of the developed world. Chlorine gas, on the other hand, has been used as a weapon in chemical warfare. As Paracelsus put it: “All substances are poisons. . . . The right dose differentiates a poison and a remedy.”

Sitting directly above chlorine in the periodic table is an even simpler element:  No. 9, or fluorine. Like chlorine it is a member of the halogen family and occurs naturally in the water and minerals of the earth. In its ionic form, fluoride, it can be added to drinking water in traces of about 1 part per million to improve dental health, especially among children in poor families who are not getting consistent care.

There is a genuine debate over just how necessary water fluoridation is for the general population now that it is widely added to toothpaste and other products. But the only established downside is that during infancy and early childhood, too much fluoride might raise the chances of harmless, barely visible white spots called fluorosis. Uglier staining is only a problem with the extremely excessive amounts of fluoride that mostly occur naturally in some wells and community water systems. That is why public health and environmental officials recommend a maximum concentration as well as a minimum. I have found no reports of anti-fluoridation crusaders demanding public action to remove natural fluoride from their water. The enemy they most fear is not this particular halide but the government and the scientific establishment.

That would have to include the Australians — their National Health and Medical Research Council concluded in a review of the scientific literature that fluoridation is safe and effective — as well as the Europeans. The most recent and extensive review of the research was by the European Commission’s Scientific Committee on Health and Environmental Risks. It found no conclusive evidence linking fluoridation to osteoporosis, osteosarcoma, thyroid disease, or brain damage — the specter raised and mostly dismissed (with a twinge of uncertainty) by the recent piece in Slate.

Instead of fluoridating water, European countries more often choose different avenues. A Q&A on the website of the Pew Charitable Trusts gives a good summary:

. . . at least 70 million Europeans consume fluoridated salt, and this method of fluoridation reaches most of the population in Germany and Switzerland. These two countries have among the lowest rates of tooth decay in all of Europe. Fluoridated milk programs reach millions of additional Europeans. A number of areas in Italy have water supplies with natural fluoride levels that already reach the optimal level that prevents decay. This is a major reason why Italy does not have a national program for water fluoridation. Finally, some countries in Europe do elect to adjust fluoride levels in community water systems. Fluoridated water is provided to 12 million Europeans, mostly reaching residents of Great Britain, Ireland, and Spain.

There are probably historical and sociological reasons for the different national approaches. I would love to hear from anyone who can point me in that direction.

For all the good science out there, it is swamped by misinformation — globs of pernicious memes spread by the amplifying effects of the Internet and the populist bias of the Google search algorithms. A study published in an Australian and New Zealand  journal, When Public Action Undermines Public Health: a Critical Examination of Antifluoridationist Literature, came to this conclusion:

Extremist arguments find fertile ground among disenfranchised, psychologically disturbed, and alienated individuals. A subculture has now developed around and for such people who are believed to find psychological gratification in imagining themselves heroically in the possession of such secret and ‘subversive’ information. . . . The situation whereby a small group of determined individuals can manage to deny half a century of science pays testimony to the power of emotional arguments and the potential of misleading propaganda.

Depressing as it is, I’ll probably return to this subject. I’ve been fascinated by conspiracy theories ever since I wrote my first book, Architects of Fear. Meanwhile I will leave you with this cartoon from 1955. It shows that from the beginning, fear of fluoride was accompanied by vaccine paranoia and a certainty that mental (not just dental) health programs were part of a Communist brainwashing plot.

Flyer attributed to the Keep America Committee. Wikimedia Commons.


This is part 2 of what has become three posts:

Fluoride Paranoia and Betteridge’s Law

Fluoride Paranoia, Part 2

Truthiness with Numbers

  • http://www.facebook.com/people/Pamela-McCorduck/100000716423988 Pamela McCorduck

    Brilliant, George, and thanks.

  • spruce221

    After 50 years, Fairbanks, Alaska put an end to fluoridation in 2011. Prompted by citizens, a city-chartered task force of scientists and medical experts were engaged to answer the question: Is fluoridation safe and effective? The task force was composed of four PhDs in chemistry and biology plus a pediatrician and a dentist. They spent a year reviewing the most recent studies about the effects of fluoride. The panel concluded that water fluoridation is neither safe or effective and recommended that it be stopped. The city’s report is available here: fluoridefreefairbanks.org.

    The task force process was an educational asset to the community. Among the things learned:

    When fluoridated water is boiled, it becomes concentrated. Soup, coffee and tea drinkers beware.

    Exposure to fluoridated water occurs through drinking, in baths and showers, vegetable spritzers in grocery stores, foods grown with fluoridated water, restaurants and public swimming pools.

    When passed through municipal water treatment plants, fluoride (fluorosilicic acid or a variant) is transferred to the environment, be it lake, river or ocean.

    African-Americans are more vulnerable to the harms connected to fluoride exposure because they have higher rates of CKD (chronic kidney disease). Their kidneys are not able to clear fluoride as effectively as other ethnicities. The Martin Luther King family has publicly called on the Georgia Legislature to stop mandatory fluoridation in that state. Further, the largest Latino organization in the US, the League of United Latin American Citizens, says fluoridation is a civil rights violation. LULAC says fluoridation is forced medication and has passed a resolution opposing it.

    Two of Alaska’s three largest cities have axed fluoridation, Juneau and Fairbanks. Palmer, a small town north of Anchorage, also pulled the plug on the medication. There’s an effort underway in Anchorage to the same outcome. At some point soon, a federal or state biologist will make public a connection between fluoride exposure and Cook Inlet’s beluga whales’ failure to thrive. And no wonder, the endangered mammal’s habitat is awash with the potent neurotoxin.

    The shorthand on water fluoridation: it turns soft tissues to bone. Study the science. The conclusion is inescapable.


    • RogerSweeny

      “When fluoridated water is boiled, it becomes concentrated. Soup, coffee and tea drinkers beware.”

      When any water solution is boiled, it becomes more concentrated. Some water goes off into the air as steam. The same amount of “solute” remains for a smaller amount of “solvent.” However, the change is extremely small when you boil water for coffee or tea. Very little of the water actually boils off.

      Try a little experiment. Put a pan of water on a stove and notice how high the water is. Bring it to a boil and check the level again. I’ll bet you won’t even be able to see any lowering. Set it to boil again and keep it boiling for 10 minutes. See how much lower the water level is. It won’t be much. Or make a pan of soup and let it simmer for an hour. Not a rolling boil but a slow soup simmer. The level won’t go down much at all.

    • bitrat

      Interestingly, fluoride is volatile in steam – it can’t be removed by distilling water…..that should mean you’d actually lose fluoride when water is boiled….

  • http://twitter.com/marcalberts Marc Alberts

    Actually, if you read the accounts of the Fairbanks decision they voted to remove fluoridation because there was already a significantly high natural occurance of fluoride in the drinking water. It is also worth noting that this recommendation was opposed by the ADA, the CDC, and the WHO positions on the subject. From what I’ve read, it seems more that fear drove the decision rather than good science.

  • http://www.facebook.com/paul.knowles2 Paul Knowles

    I may be mistaken here, as not all facts can be verified, but isn’t it the case that the fluoride being used is a by-product from the aluminium manufacturing and highly toxic?

    • TYactive

      Fluoride is a mineral that is extracted at the same time as products used to fertilize food crops. It improves healths by protecting teeth in the amounts you are talking about for fluoridated water or salt as in Europe.

  • http://www.facebook.com/shaynamwilliams Shayna Williams-Burris

    I’d also be interested to see an article on iodized salt since the naturopathy crowd is going after that one, too. I honestly think it’s all crazy as these are vital substances to human health, which would not be consumed in adequate quantities without public health initiatives.

  • http://twitter.com/VFarakon Vincent von Farakon

    Here’s a recent article from fox news(I’ll continue my comment below):

    Does fluoride in drinking water hurt your brain?

    By Dr. Keith Ablow

    Published August 22, 2012



    Back in 2011, the EPA reversed course and lowered the recommended maximum amount of fluoride in drinking water due to data that the levels then being allowed put kids at risk of dental fluorosis–streaking and pitting of teeth due to excessive fluoride, which also puts tooth enamel at risk.

    This conclusion was a discordant note amidst all the accolades fluoride had won, starting with the discovery during the 1940s that people who lived near water supplies containing naturally occurring fluoride had fewer cavities in their teeth. A massive push ensued, with government and industry encouraging cities and towns to add fluoride to water supplies.

    Related: Dental health linked to dementia risk

    Now, questions about the impact of fluoride on mental health are growing and can no longer be ignored.

    A recently published Harvard study showed that children living in areas with highly fluoridated water have “significantly lower” IQ scores than those living in areas where the water has low fluoride levels. In fact, the study analyzed the results of 27 prior investigations and found the following, among other conclusions:

    * Fluoride may be a developmental neurotoxicant that affects brain development (in children) at exposures much below those that cause toxicity in adults.

    * Rats exposed to (relatively low) fluoride concentrations in water showed cellular changes in the brain and increased levels of aluminum in brain tissue.

    Other research studies in animals link fluoride intake to the development of beta-amyloid plaques (the classic finding in the brains of patients with Alzheimer’s dementia).

    And research on fluoride also has implicated it in changing the structure of the brains of fetuses, negatively impacting the behavioral/neurological assessment scores of newborns and, in animal studies, impairing memory.

    This information is very important, from a psychiatric standpoint, because we have witnessed rising rates of attention deficit disorder, major depression, dementia and many other psychiatric illnesses since the 1940s, and because the United States (which fluoridates a much higher percentage of its drinking water than most countries, including European nations) has some of the highest rates of mental disorders in the world–by a wide margin.

    It is not clear, of course, that fluoride is responsible wholly, or even in small measure, for these facts, but the connection is an intriguing one, especially in light of the new Harvard study.

    Given the available data, I would recommend that children with learning disorders, attention deficit disorder, depression, attention-deficit disorder or other psychiatric illnesses refrain from drinking fluoridated water, and consult a dentist about the most effective way of delivering sufficient fluoride to the teeth directly, while minimizing absorption by the body as a whole–and the brain, specifically.

    Dr. Keith Ablow is a psychiatrist and member of the Fox News Medical A-Team. Dr. Ablow can be reached at info@keithablow.com.

    Read more: http://www.foxnews.com/health/2012/08/22/does-fluoride-in-drinking-water-hurt-your-brain/#ixzz2LNX0yLmA

    Continued comment: The article cites a Harvard study, and Harvard is generally considered a reliable source of scientific data(sorry I didn’t put enough energy to find this study). Perhaps this is part of the cause of the recent backtracking on Fluoride rather than a conspiracy theory? I’d be interested in others views/ideas about this.

    • facefault

      You mean this meta-analysis?
      1. Reduced IQ was only found with fluoride concentrations much higher than those in US drinking water. (Indeed, in many of the studies they used, the reference group drank water containing fluoride at US levels).
      2. Most of the effect appears to have come from fluoride from inhaling coal smoke, rather than fluoride in the water; the results were no longer statistically significant (p = 0.062) when they excluded the studies in which children were co-exposed to coal smoke, arsenic, or iodine.
      3. None of the studies they looked at controlled for lead, which is a damn big oversight.

      Also, you should generally take Keith Ablow with a serious grain of salt – even about psychology. He’s not above twisting the evidence to get viewer attention (most infamously on transgenderism, though his Newt Gingrich comments were seriously ridiculous), and he seems to have resigned from the APA purely to avoid any consequences for his routine violations of their ethics code.

  • Tom Tito

    You completely miss the recent science on harm to the developing brain. And you miss the fact that most of Europe has not put fluoride in water or has stopped.

    The “only real downside is …harmless, barely visible white spots called fluorosis”?
    Please review the Harvard School of Public Health study.

    • byGeorgeJohnson

      I suggest you read the study rather than the press release: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3491930/. It is talking specifically about high levels of fluoride in China. The dose makes the poison. And, as I wrote, Europeans fluoridate salt and milk instead of water.

      • Tom Tito

        I suggest you read this update on the Harvard study, which by the way also specifically talks about “slightly increased fluoride exposure”. http://braindrain.dk/2013/02/fluoridated-water-and-brains/

        • facefault

          Doesn’t contradict what byGeorgeJohnson said. The author of that post seems to see more in the meta-analysis than is actually there.

          Also, what makes you think fluoridated water is more dangerous than fluoridated salt and milk? Can you point me to a study comparing them?

          • Tom Tito

            It contradicts the assumption that concern over serious health risks is evidence of paranoia. Fluoridated salt and milk is not dangerous to me since I choose not to consume it.

          • facefault

            And yet you said “Europe has a better way to get the possible benefits of fluoride with out the risk.” So either you think fluoride in salt and milk is less dangerous than fluoride in water, or you’re bloviating.

      • Tom Tito

        Europe has a better way to get the possible benefits of fluoride with out the risk.

  • Tom Tito

    There may be some opponents who are paranoid, the fictional general from
    Dr. Strangelove comes to mind, but a large majority of government leaders around the world do not fluoridate water. Surely they can’t all be acting or not acting out of paranoia. I think the modern environmental and consumer rights movements are responsible for this growing trend of cities stopping fluoridation of drinking water. People are more concerned about chemicals in their food and water and are more aware since requirements to list these on food labels. Bottled and filtered water is now a major industry, thanks in part to doubts about the supply of public drinking water.


  • subpixel

    My understanding of the York Review (McDonagh M, Whiting P, Bradley M, et al. A systematic review of public water fluoridation. York: University of York National Health Service Centre for Reviews and Dissemination; 2000) is that it found, of the literature examined, there were zero high quality studies done on the efficacy and safety of water fluoridation. That is, up to that point there was NOT a good scientific case. On that basis, all further comments along the lines of “preponderance of evidence” and so on are rendered false (or indefensible), since all we actually know is that not enough is known, that particular information is unavailable (due to lack of required research).

    From the page linked from this article about the Australian National Health and Medical Research Council review (http://www.nature.com/ebd/journal/v9/n2/full/6400578a.html) is written:

    [begin quote]
    Two systematic reviews2, 8 and one additional, relevant, original study9 were identified in the literature search on water fluoridation and dental caries. The York review2
    was chosen to form the evidence base for the effect of water
    fluoridation on dental caries in the current review, as it provided more
    detailed and comprehensive results than those shown in the review by
    Truman et al.6 It should be noted that 12 of the 21 studies included in the latter were among the 26 studies included in the York review.2 The lack of overlap between the two reviews is largely because the Truman review8 assessed both “fluoridation vs no fluoridation” and “fluoridation vs fluoridation at a lower level” whereas the York review5 assessed only “fluoridation vs no fluoridation”. Only one additional original study9 was identified in the current review and this did not change the conclusion from that of the York one.2
    It should be noted that the benefits from fluoridated public water
    supply were weakened because beverages and food products processed in
    fluoridated communities were exported to surrounding non-fluoridated
    communities.10 This phenomenon is referred to as the halo effect: Griffin et al.11
    attempted to quantify it by analysing data from the 1986–1987 National
    Survey of Oral Health in US School Children. Studies measuring the
    effectiveness of water fluoridation that consider only its direct
    benefit may have underestimated the total contribution of water
    fluoridation to caries reduction.

    [end quote]

    I draw attention to the statement, “Only one additional original study was identified in the current review and this did not change the conclusion from that of the York one.”

    Since the York review’s conclusion was that the entire history of fluoridation science was inadequate, we might suppose this one additional original study does not change that fact.

    The absence of evidence has been reported time and again, with recommendations appearing in, for example. in an earlier NHMRC report, for more research to be done, for certain information not currently collected to be collected, and so on; what has happened from that is… essentially nothing. No push by governments to invest in the research required, and so essentially not enough information exists to make strong assertions either way about the safety and efficacy.

    Regarding the history of the introduction of fluoridation, however, we can find plenty of evidence to show that the introduction was political, and that coercion of many kinds was used. For example the top-down rule of the ADA and similar organisations disallowing the questioning of the use of fluoride (be it in the water or otherwise) by dentists, medical professionals and so on. We know that water fluoridation was introduced as, let’s say, an experiment on the population _without_ a successful trial being completed.

    To mention some recent examples of, for instance, finally finding some evidence to support a systemic protective effect, is in a way an admission that perhaps the previous 50 years or so was operating on a bluff. We know that throughout the developed world, the incidence of dental caries followed very similar trends of decrease between fluoridated and non-fluoridated countries, so we know that there are ways to prevent dental caries without “mass-medicating” via the water supply.

    There is a general agreement that “high” levels of fluoride intake cause serious problems (eg skeletal fluorosis, not just a few stains on one’s teeth); pretty much anything is harmful to life in the right dose/concentration (eg you can die from drinking too much water). It concerns me greatly that we know that 4ppm is definitely too much in water, and even the standards bodies admit that perhaps 2ppm should be the limit, but that 1ppm has been described as “safe” for a very long time. This in itself seems absurd to me, before even going into the vagaries of how each person can and does drink different amounts of water, eat different foods also containing fluoride and so on.

    The (or one of the) greatest (inverse) correlations with dental caries is affluence; those less well off have worse teeth. Maybe fewer (or no) dentist visits. Maybe less likely to brush (etc), or care about brushing. Maybe poor quality food. It isn’t weather they drink the tap water or not.


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About George Johnson

George Johnson writes about science for the New York Times, National Geographic Magazine, Slate, and other publications. His nine books include The Cancer Chronicles: Unlocking Medicine's Deepest Mystery (August 2013), The Ten Most Beautiful Experiments, A Shortcut Through Time, and Fire in the Mind. He is a winner of the AAAS Science Journalism Award and has twice been a finalist for the Royal Society science book prize. Co-founder and director of the Santa Fe Science Writing Workshop, he can be found on the Web at talaya.net. Twitter @byGeorgeJohnson.


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