Fluoride in the Water - A Dissenting View

Well, perhaps not a dissent as I was opposed - but my opposition was not on the public health merits of fluoridation which I conceded, but more on the libertarian grounds of government intrusion where it is not welcome.

But as I mentioned very smart people can disagree and here is one that does.  Coert Olmsted e-mailed me and was thoughtful and polite and as his comment is too long for the normal comment process I told him I'd post it here:

I am a retired university scientist with a PhD in Applied Math, a 30 year professional career in scientific data analysis and decades of community involvement experience. I’ve actively worked the fluoridation issue for many years and consider myself to be a smart person. Some might even call me very smart. I am not, however, very, very smart – only very, very careful about information and very, very much into common sense, responsible medicine and the precaution principle.

To think that fluoridation is an innocuous topic and the policy decision to implement it a slam dunk is, to me, not very smart at all. About 2.5 years ago I studied the paper by Griffin, Jones & Tomar claiming that for every dollar spent on community water supply fluoridation (CWSF) there are $38 saved on avoided dental treatment costs. As a service to the Fairbanks Fluoridation Task Force appointed by Fairbanks (Alaska) Mayor Jerry Cleworth in 2010, I wrote and provided a review and critique of this peer reviewed study, reporting that their “secondary research is a tightly narrow examination of the strictly microeconomic effects of CWSF over selected sample communities. Like most industry oriented economic analysis, it examines as little data as possible which will still provide a computable cost-benefit number.”

 Furthermore they neglect any externalities associated with harmful side effects of fluoridation. In fact the authors justify ignoring these external costs because, in their words, “adverse effects resulting from water fluoridation exposure are negligible.” This is all the further they investigate possible negative side effects. A quantitative measure of how small is "negligible" is not given, nor is any reference to scholarly research on the subject provided. The only citation (#14) is to an unpublished internal US Public Health Service report: "US Department of Health and Human Services. Review of fluoride benefits and risks. Report of the ad hoc subcommitee on fluoride of the Committee to Coordinate Environmental Health and Related Programs. Washington, DC. US Public Health Service, 1991." 

There is no consideration whatsoever given to external costs associated with control and cleanup of accidental spills of silicofluorides nor health and administrative costs of responding to accidental overfeeds of fluoride into community water systems. These kinds of events are very costly, can be deadly, and are not at all infrequent.

Also unmentioned are the very significant costs of cosmetic and dental treatment for tooth damage due to dental fluorosis. It is officially acknowledged that CWSF significantly increases the incidence of dental fluorosis, but it remains an axiom of the pro-fluoridation community that dental fluorosis is primarily a "merely cosmetic" effect. No dental research is cited to justify this assumption, nor is any scientific source or argument advanced in its favor. It is, in fact, a policy axiom settled upon long ago by unidentified authorities within the public health professional sector. In my experience, this kind of information is called "folklore" by scholars and occurs at many levels, even in advanced applied mathematics. In the context of CWSF, however, it covers up major consequences.

To continue citing a narrowly derived and unqualified cost-benefit number as widely as possible, promoting it as a definitive result justifying the benefit of a major public health intervention policy, dismisses 20 years of very important research conducted at the highest level all over the world which shows incontestably that adverse effects of CWSF are far from “negligible”. But it is what can be expected from a CDC team working to back up their directors claim at the millennium that “CWSF is one of the 10 greatest accomplishments of 20th century public health in the USA.” When I hear top bureaucrats promulgating this kind of self-adulatory congratulation, I reach for the ‘mute’ button on the remote control.

So fluoridation does not “make policy sense”, and it amounts to willful ignorance to say, “sure, everybody else does it.” In fact fluoridated communities make up a small fraction of the world population. In India and China it is regarded as a high crime to fluoridate public drinking water. In Europe less than 2% of the population is served by CWSF. In Sweden the practice was prohibited decades ago and a very, very smart man there, Arvid Carlsson, 2000 Noble winner for Medicine, explains very clearly and persuasively why he strongly advised his government against CWSF.

I also find it incongruous that a provider of “Beeronomic” analysis would have no objection to CWSF. After all, Portland is one of the major centers of successful American craft brewing. At least two national breweries, Olympia and Coors, have made the core of their advertising campaigns a focus on the purity of their water supplies. Surely there is a lesson there. Martinellis went to considerable expense digging a well recently when their home town, Watsonville, CA, became fluoridated. They knew it would hurt their national market share in new water based beverage products.

To anyone interested, I can provide many documents and references for all the above assertions. 

Sincerely,
Coert Olmsted, PhD

Professional Data Analyst

Scientific Advisor, Fluoride Free Fairbanks
C.Olmsted@post.harvard.edu

As a note, is incorrect to say I have no objection, in fact the point of my post was to object and mostly along the libertarian cry of 'leave our wonderful water alone.'I will say, however, that I remain convinced by the scientific evidence that there are net positive effects of fluoridation.