From ggvideo@northnet.org Tue Jan 23 10:21:33 2001 Date: Mon, 8 Jan 2001 17:22:22 -0400 From: Paul Connett To: ggvideo@northnet.org Subject: IFIN #224. 50 Reasons updated and referenced. INTERNATIONAL FLUORIDE INFORMATION NETWORK. IFIN BULLETIN IFIN #224: 50 Reasons updated and referenced. Jan 8, 2001. Dear All, Michael and I have updated our "50 Reasons to Oppose Fluoridation". We have also added in the references as well as the appendices. We hope that this will serve as a well documented opening package for someone getting into the issue. We have printed an open format copy below as well as putting a formatted copy on our homepage at http://www.fluoridealert.org If you haven't done so recently you might want to check out some of other features on the web page e.g. Citizen's Tool-kit in the top bar and campaign updates (by country and US state) abstracts, important statements and videos on the left hand bar. If you are not a founding member of FAN and would like to be on this "historic" list, please let us know. Thanks to all. Fluoride free by zero three but some want it done in zero one! Paul Connett. PS. As of 4 pm (EST) today there are 1465 signees on the online petition to WHO. The address: http://www.petitiononline.com/4001k/petition-sign.html 50 REASONS TO OPPOSE WATER FLUORIDATION. Dr. Paul Connett Professor of Chemistry St. Lawrence University, NY 13617 315-229-5853 ggvideo@northnet.org with assistance from: Michael Connett Webmaster Fluoride Action Network http://www.fluoridealert.org Introduction: Citizens and decision makers confronted with a proposal to fluoridate their water are frequently reassured by the number and the prestige of the US agencies and medical organizations that have endorsed this practice. Sadly, in the case of fluoridation, confidence in these agencies and organizations is misplaced. The US Public Health Service (PHS) endorsed fluoridation in 1950 before one single fluoridation trial had been completed and before long term health studies in either animals or humans had been undertaken. US agencies, along with the medical and dental community, have bottled themselves up with such a "pro-fluoridation" position that they have been unable/unwilling to revisit the issue scientifically even while many studies published since 1990 raise serious health concerns. The matter has been pursued almost like a "religious crusade". Some proponents deny that a scientific debate even exists (Easley, 1999) and the CDC has gone so far as to herald fluoridation as one of the "top ten public health achievements" of the Twentieth Century (CDC, 1999)! (See our point by point critique of the CDC's position at http://www.fluoridealert.org/cdc.htm). We believe that if the fluoridation "orthodoxy" is left unchallenged it will seriously undermine our government's ability to persuade the public that rational scientific argument informs public policy. If we lose the public's confidence in these matters the ramifications will go further than even the dangers of fluoridation. It is time to remove this poison from the water and from our political system. Here are 50 reasons for doing so. 50 Reasons. 1) Fluoride is not an essential nutrient. Humans can have perfectly good teeth without fluoride. There is no disease associated with fluoride deficiency. 2) Fluoridation is not necessary. Many Western European countries are not fluoridated and have experienced the same substantial decline in dental decay as the US. It is erroneous, therefore, to attribute the decline of tooth decay in the US simply to water fluoridation. There are many other factors which have been responsible for this improvement. (see table for declines in tooth decay which have been extracted from the World Health Organization's data base at http://www.whocollab.od.mah.se/euro.html at the end of this statement -appendix 1- as well as statements from European government officials- appendix 2). 3) Fluoridation's role in the decline tooth decay is in doubt. The largest survey (over 39,000 children from 84 communities) conducted in the US by the National Institute of Dental Research shows little difference in tooth decay of permanent teeth among children in fluoridated and non-fluoridated communities (Hileman, 1989 and Yiamouyiannis, 1990). At best there was an 18-25% difference in decayed missing and filled surfaces (DMFS) (Brunelle and Carlos, 1990). This difference is LESS THAN ONE tooth surface! There are 128 tooth surfaces in a child's mouth. 4) One of the early trials which helped to launch fluoridation took place in Newburgh, NY, with Kingston, NY as the control community. After 10 years of this trial it looked as if there was a large decrease in dental caries in the fluoridated community compared to the non-fluoridated community. However, when children were re-examined in these two cities in 1995 (50 years after the trial began) there was practically no difference in the dental decay in the two communities. If anything, the teeth in unfluoridated Kingston were slightly better (Kumar and Green 1998). 5) Modern research (e.g. Diesendorf, 1986; Colquhoun, 1997, De Liefde, 1998) shows that decay rates were coming down before fluoridation was introduced and have continued to decline even after its benefits would have been maximized. Many other factors influence tooth decay. Studies in India (Teotia and Teotia, 1994) and Tuczon, Arizona (Steelink, 1982) have shown that tooth decay actually increases as the fluoride concentration in the water increases. 6) In communities in former East Germany, Cuba and Finland, where fluoridation has been discontinued, dental decay has not increased but has actually continued to decrease (Kunzel and Fischer,1997,2000; Kunzel et al, 2000 and Seppa et al, 2000). 7) Leading dental researchers (Levine, 1976; Fejerskov, Thylstrup and Larsen, 1981; Carlos, 1983; Featherstone, 1987, 1999, 2000; Margolis and Moreno, 1990; Clark, 1993; Burt, 1994; Shellis and Duckworth, 1994 and Limeback, 1999, 2000), and the Centers for Disease Control and Prevention (CDC, 1999) are now acknowledging that the mechanism of fluoride's benefits is topical not systemic. Thus, children don't have to swallow fluoride to protect teeth. As the benefits of fluoride (if they exist) are topical, and the risks are all systemic, it makes more sense, for those who want to take the risks, to deliver the fluoride directly to the tooth in the form of fluoride toothpastes or gels. Swallowing fluoride is inevitable once it is put into the water. (All the references for "topical versus systemic benefits" are listed as a group in the reference section.) 8) The US fluoridation program has massively failed to achieve one of its key objectives, i.e. to lower dental decay rates while MINIMIZING DENTAL FLUOROSIS. The goal of the early promoters of fluoridation was to limit dental fluorosis (in its mildest form) to 10% of children (NRC, 1993, pp. 6-7). The percentage of children with dental fluorosis in optimally fluoridated areas are up to EIGHT TIMES this goal (Williams, 1990; Lalumandier, 1995; Heller, 1997 and Morgan, 1998). The York Review (2000) estimates that up to 48% of children in optimally fluoridated areas have dental fluorosis in all forms and up to 12.5% in the mild to severe forms. 9) Dental fluorosis means that a child has been overdosed on fluoride. While the mechanism by which fluorosis is formed is not definitively known, it appears fluorosis may be a result of either inhibited enzymes in the growing teeth (Dan Besten 1999), or through fluoride's interference with the thyroid gland. 10) The level of fluoride put into water (1 ppm) is 100 times higher than normally found in mothers' milk (0.01 ppm) (Institute of Medicine, 1997). There is no benefit, only risks, for infants by ingesting this high level of fluoride at such an early age - this is an age where susceptibility to environmental toxins is particularly high. 11) Fluoride is a cumulative poison. Approximately 50% of the fluoride ingested each day accumulates in our bones, pineal gland, and other tissues. If the kidney is damaged fluoride accumulation will increase. 12) The early symptoms of skeletal fluorosis, a bone disorder which impacts millions of people in India, China, and Africa, mimic the symptoms of osteoarthritis. Osteoarthritis, which is the most common form of arthritis, affects over 40 million Americans. Few if any studies have been done to determine whether these cases of osteoarthritis in America are early symptoms of skeletal fluorosis, which they very well could be. The cause of osteoarthritis is currently unknown. 13) One animal study (National Toxicology Program, 1990) shows a dose-related increase in osteosarcoma (bone cancer) in male rats. The initial finding of this study was of "clear evidence of carcinogenicity" a finding which was soon conspicuously downgraded to "equivocal evidence" (Marcus, 1990) EPA Professional Headquarters Union has requested that Congress establish an independent review of this study's results (Hirzy, 2000). See http://www.fluoridealert.org/testimony.htm 14) Two epidemiological studies show a possible association (which some have discounted: Hoover, 1990 and 1991) between osteosarcoma in young men and living in fluoridated areas (National Cancer Institute, 1989 and Cohn, 1992). Other studies have not find this association. 15) When high doses of fluoride were used in trials to treat patients with osteoporosis in an effort to harden their bones and reduce fracture rates, it actually led to a HIGHER number of hip fractures (Hedlund and Gallagher, 1989; Riggs et al, 1990). 16) Eighteen studies (four unpublished, including one abstract) since 1990 have examined the possible relationship of fluoridation and an increase in hip fracture among the elderly. Ten of these studies found an association, eight did not. One study found a dose-related increase in hip fracture as the concentration of fluoride rose from 1 ppm to 8 ppm (Li et al, 1999, unpublished). Hip fracture is a very serious issue for the elderly, as upwards of a third of the people who have a hip fracture, die shortly after the operation (All 18 of these studies are referenced as a group in the reference section). 17) Animal experiments show that fluoride exposure alters mental behavior (Mullenix et al, 1995). Rats dosed prenatally demonstrated hyperactive behavior. Those dosed postnatally demonstrated hypoactivity (i.e. under activity or "couch potato" syndrome). 18) Rats fed for one year with 1 ppm fluoride in doubly distilled and de-ionized water, using either sodium fluoride or aluminum fluoride, resulted in damage to the kidney and the brain and led to a greater uptake of aluminum into the brain (Varner et al, 1998). Aluminum in the brain is associated with Alzheimers disease. 19) Fluoride and aluminum fluoride complexes interact with G-proteins and thus have the potential to interfere with many hormonal and some neurochemical signals (Struneka and Patocka, 1999). 20) Aluminum fluoride was recently nominated by the Environmental Protection Agency and National Institute of Environmental Health Sciences for testing by the National Toxicity Program. According to the EPA and NIEHS, aluminum fluoride is a "drinking water contaminant" with "high health research priority" and "known neurotoxicity." If water which is fluoridated contains aluminum, as it often does, than aluminum fluoride complexes will form automatically. 21) Three studies from China show a lowering of IQ in children associated with fluoride exposure (Li, 1995 and Zhao et al, 1996, Lu et al, 2000). Another study (Lin, 1991) indicates that even moderate levels of fluoride exposure (e.g. 0.9 ppm in the water) is particularly detrimental to the mental development of those with iodine deficiency -- both by lowering IQ and by increasing the incidence of mental retardation in the newborn. 22) Studies by Jennifer Luke (1998) showed that fluoride accumulates in the human pineal gland to very high levels. In her Ph.D thesis Luke has also shown in animal studies that fluoride reduces melatonin production and leads to an earlier onset of puberty. 23) In the 1930's fluoride was prescribed to reduce the activity of the thyroid gland of those suffering from hyperthyroidism (over active thyroid). However, excess fluoride exposure could be dangerous for those who have borderline thyroid activity or those who suffer from hypothyroidism (under active thyroid) (Schuld (review), 1999). In the US, more than 20 million people currently receive treatment for thyroid problems. Two symptoms of an underactive thyroid are lethargy and obesity. Pregnant women with hypothyroidism are more likely to give birth to mentally handicapped children. 24) Millions of people in India and China suffer from crippling skeletal fluorosis and other diseases as a result of high endemic exposure to naturally occurring fluoride (Jolly, 1971; Teotia and Teotia, 1988; Susheela, 1993, 1998). 25) Chinoy (1994, 2000) has shown that fluoride's toxic effects are made worse by poor nutrition. Children from poor families are more likely to suffer from malnutrition. Moreover, poor families are less able to afford avoidance measures (e.g. bottled water or removal equipment.) 26) Some people appear to be highly sensitive to fluoride as shown by case studies and double blind studies (Waldbott, 1978 and Moolenburg, 1987). This may relate to fluoride interfering with their hormone levels including those produced by their thyroid gland. It is not ethical to ignore these people's interests. 27) According to the Agency for Toxic Substances and Disease Registry (ATSDR, 1993) some people appear to be particularly vulnerable to fluoride's toxic effects, these include: the elderly, diabetics and people with poor kidney function. Again, it is not ethical to ignore these people's interests. 28) Also vulnerable are those who suffer from malnutrition (e.g. calcium, magnesium, vitamin C, vitamin D and iodide deficiencies and protein poor diets). Of particular concern here are children from poor communities, and these are precisely the people being targeted by new fluoridation proposals (Oral Health in America, May 2000, httm:// www.nidcr.nih.gov/sgr/execsumm.htm). 29) The margin of safety (i.e. the ratio of the toxic dose to the therapeutic dose) is very small. Pharmacologists like to have a safety margin of at least 100 for new drugs. For long term bone damage fluoride's safety margin could be as low as FOUR (Connett and Connett, 2000, see response 30). For dental fluorosis there is NO MARGIN OF SAFETY. 30) Fluoridation is unethical because individuals are not being asked for their informed consent prior to medication. This is standard practice for all medication -- the only people in society who can be required to take medication against their will are the imprisoned and the mentally infirm. 31) While referenda are preferential to imposed policies from central government, it still leaves the problem of individual rights versus majority rule. Put another way -- does a voter have the right to require that their neighbor ingest a certain medication (even if it's against that neighbor's will)? 32) The early studies conducted in 1945 -1955 in the US have been heavily criticized for their poor methodology and poor choice of control communities (De Stefano, 1954, Nesin, 1956, Sutton, 1996). According to Dr. Hubert Arnold, a statisician from the University of California at Davis, the early fluoridation trials "are especially rich in fallacies, improper design, invalid use of statistical methods, omissions of contrary data, and just plain muddleheadedness and hebetude." (see http://www.fluoridealert.org/uc-davis.htm) 33) Once fluoride is in the water it is impossible to control the dose to individuals precisely. A) Some people drink more water than others. B) There are many other sources of fluoride, including: food and beverages processed with fluoridated water; pesticide residues and dental products. Exposure to fluoride has in fact steadily increased since the 1940s, to the point where even fluoridation proponents admit that we need to reduce total fluoride consumption. 34) Despite the fact that it is recognized that we are ingesting too much fluoride, and despite the fact that we are exposed to far more fluoride in 2001 than we were in 1945 (when fluoridation began), the "optimal" fluoridation level is still 1 part per million, the same level deemed optimal in 1945! 35) The US Public Health Service first endorsed fluoridation in 1950, before one single trial had been completed (McClure, 1970)! It may not be coincidental that in the same year of the US PHS endorsement, the Sugar Research Foundation, Inc. (supported by 130 corporations) expressed its aim in dental research as, "To discover effective means of controlling tooth decay by methods other than restricting carbohydrate (sugar) intake" (Waldbott, 1965, p.131). 36) The fluoridation program has been very poorly monitored. There has never been a comprehensive analysis of the fluoride levels in the bones of the American people. US Health authorities have no idea how close we are getting to levels which will cause subtle or even serious bone and joint damage! 37) The Food and Drug Administration (FDA) has never approved the fluoride supplements given to children, which are designed to deliver the same amount of fluoride as fluoridated water (Kelly, 2000). 38) The chemicals used to fluoridate 90% of water fluoridated in the US are not pharmaceutical grade. Instead, they come from the wet scrubbing systems of the superphosphate fertilizer industry. These chemicals are either hexafluorosilicic acid or its sodium salt. They are contaminated with toxic metals and trace amounts of radioactive isotopes. This hexafluorosilicic acid is a classified hazardous waste, with the public water supply being used as the vehicle for its disposal (Glasser, 1999) As Dr. William Hirzy, of the EPA Headquarters Union, recently stated, "if this [hexafluorosilicic acid] gets out into the air, it's a pollutant; if it gets into the river, it's a pollutant; if it gets into the lake, it's a pollutant; but if it goes right straight into your drinking water system, it's not a pollutant" (Hirzy, 2001). 39) These hazardous wastes have not been tested comprehensively. The chemical usually tested in animal studies is pharmaceutical grade sodium fluoride. The assumption being made is that by the time the waste product used has been diluted down, all the hexafluorosilicic acid will have been converted into free fluoride ion, and the other toxics and radioactive isotopes will be so dilute that they will not cause any harm, even with lifetime exposure. These assumptions have not been examined carefully by scientists, independent of the fluoridation program. Recent testing by the National Sanitation Foundation suggest that the levels of arsenic in these chemicals are high and of significant concern (Connett, M., 2000). See http://www.fluoridealert.org/f-arsenic.htm). 40) Studies by Masters and Coplan (1999) show an association between the use of hexafluorosilicic acid (and its sodium salt) to fluoridate water and an increased uptake of lead into children's blood. 41) Sodium fluoride is an extremely toxic substance -- just 3 to 5 grams, or about one teaspoon, is enough to kill a human being. Both children (swallowing gels) and adults (accidents involving malfunctioning of fluoride delivery equipment and filters on dialysis machines) have died >from excess exposure (see http://www.fluoridealert.org/accidents.htm). 42) Fluoride is very biologically active even at low concentrations. It interferes with hydrogen bonding which is central to the normal function of all living things (Emsley, 1981). 43) Fluoride inhibits enzymes in test tubes (Waldbott, 1978), in bacteria in the oral cavity (Featherstone, 2000), in the growing tooth (DenBesten, 1999), in bone (Krook and Minor, 1998) and in other tissues (Luke, 1998). 44) Fluoride has been shown to be mutagenic, cause chromosome damage and interfere with the enzymes involved with DNA repair in a variety of insect, tissue culture and animal studies (DHSS, 1991, Mihashi and Tsutsui, 1996). 45) Fluoride forms complexes with a large number of metals, which include metals which are needed in the body (like calcium and magnesium) and metals (like lead and aluminum) which are toxic to the body. 46) Some of the earliest opponents of fluoridation were biochemists and at least 14 Nobel Prize winners are among numerous scientists who have expressed their reservations about the practice of fluoridation (SEE APPENDIX 4 FOR LIST). Dr. James Sumner, who won the Nobel Prize for his work on enzyme chemistry, had this to say about fluoridation: "We ought to go slowly. Everybody knows fluorine and fluoride are very poisonous substances^ÊWe use them in enzyme chemistry to poison enzymes, those vital agents in the body. That is the reason things are poisoned; because the enzymes are poisoned and that is why animals and plants die" (Connett, 2000). 47) The Union representing the scientists at the US EPA headquarters in DC is on record as opposing water fluoridation (Hirzy, 1999) and rejects the US EPA's approval of the use of hazardous industrial waste products to fluoridate the public water supply (Hanmer, 1983). 48) Many scientists, doctors and dentists who have spoken out publicly on this issue have been subjected to censorship and intimidation. Tactics like this would not be necessary if those promoting fluoridation were on secure scientific ground. 49) Promoters of fluoridation refuse to recognize that there is any scientific debate on this issue, despite the concerns listed above and objective reviews of the controversy (Hileman, 1988). Dr. Michael Easley, one of the most vocal proponents, goes so far as to say that there is no legitimate debate, whatsoever, concerning fluoridation. According to Easley, who works closely with the CDC and ADA, "Debates give the illusion that a scientific controversy exists when no credible people support the fluorophobics' view." Easley adds that "a most flagrant abuse of the public trust occasionally occurs when a physician or a dentist, for whatever personal reason, uses their professional standing in the community to argue against fluoridation, a clear violation of professional ethics, the principles of science and community standards of practice" (Easley, 1999). Comments like these led the associate technical director for Consumers Union, Dr. Edward Groth, to conclude that "the political profluoridation stance has evolved into a dogmatic, authoritarian, essentially antiscientific posture, one that discourages open debate of scientific issues" (Martin, 1991). 50) We should not wait until human studies prove indisputable harm has been caused before we act; because if we do, then it will be too late for millions of people. Because of intense political pressures from industry, regulatory agencies dragged their feet on regulating hazards like asbestos, DDT,PCBs, tetraethyl lead, tobacco and dioxins. We need to use the Precautionary Principle. Decision makers should address four questions: 1) Based upon the weight of evidence drawn from both animal and human studies, how likely is it that fluoride will do harm *** WITH lifetime doses? 2) How serious is this harm should it occur? 3) How significant is the benefit being achieved? 4) Are there safer alternatives? Local and national officials should further ask if the answers to these questions leave them with enough confidence to override the individual's refusal to give their consent on the matter. It is a copout to call for further studies. We know enough to take preventive action now. If further studies are to be performed they should be performed after the fluoride has been taken out of the water. APPENDIX 1. World Health Organization Data Table: Declines in tooth decay in different countries. Based upon Decayed, Missing & Filled teeth (DMFTs) for 12 year olds (WHO data). DMFTs Year DMFTs Date % Difference Austria 3.5 1973 1.7 1997 -51% Belgium 3.1 1972 2.7 1991 -13% Denmark 6.4 1978 1.2 1995 -81% Finland 7.5 1975 1.2 1994 -84% France 3.5 1975 1.9 1998 -46% Germany 6.0 1973 1.7 1997 -72% Greece 3.8 1959 1.6 1993 -58% Iceland 8.7 1980 1.5 1996 -83% Italy 4.0-6.9 '78-79 2.1 1996 -48%, -70% Japan 5.9 1975 2.4 1999 -59% Nether 6.5-8.2 1974 0.9 1992-93 -86%, -89% Norway 8.4 1973 2.1 1993 -75% Sweden 6.3 1977 1.0 1997 -84% Switz 2.3-9.9 '63-75 2.0 1987-89 -13%, -80% US 4.0 '65-67 1.4 1991 -65% Current DMFT rankings: Netherlands 0.9 (1992-93) unfluoridated Australia 0.9 (1996) fluoridated Sweden 1.0 (1997) unfluoridated UK 1.1 (1996-97) 10% fluoridated Denmark 1.2 (1995) unfluoridated Finland 1.2 (1994) unfluoridated US 1.4 (1991) fluoridated Ireland 1.4 (1993) fluoridated Iceland 1.5 (1996) unfluoridated New Zealand 1.5 (1993) fluoridated Greece 1.6 (1993) unfluoridated Germany 1.7 (1997) unfluoridated Austria 1.7 (1997) unfluoridated France 1.9 (1998) unfluoridated Switzerland 2.0 (1987-89) 1% fluoridateed Data from: WHO Oral Health Country/Area Profile Programme Department of Noncommunicable Diseases Surveillance/Oral Health WHO Collaborating Centre, Malmö University, Sweden http://www.whocollab.od.mah.se/euro.html APPENDIX 2. Statements on fluoridation by governmental officials from several countries: France: "Fluoride chemcials are not included in the list [of 'chemicals for drinking water treatment']. This is due to ethical as well as medical considerations." (Louis Sanchez, Directeur de la Protection de l'Environment, August 25, 2000). Luxembourg: "Fluoride has never been added to the public water supplies in Luxembourg. In our views, the drinking water isn't the suitable way for medicinal treatment and that people needing an addition of fluoride can decide by their own to use the most appropriate way, like the intake of fluoride tablets, to cover their dairy needs." (Jean-Marie Ries, Head, Water Department, Administration De L'Environment, May 3, 2000). Denmark:"We are pleased to inform you that according to the Danish Ministry of Environment and Energy, toxic fluorides have never been added to the public water supplies." (Klaus Werner, Royal Danish Embassy, Washington DC, December 22, 1999). Norway: "In Norway we had a rather intense discussion on this subject some 20 years ago, and the conclusion was that drinking water should not be fluoridated." (Truls Krogh & Toril Hofshagen, Folkehelsa Statens institutt for folkeheise (National Institute of Public Health) Oslo, Norway, March 1, 2000). Sweden:"Drinking water fluoridation is not allowed in Sweden...New scientific documentation or changes in dental health situation that could alter the conclusions of the Commission have not been shown." (Gunnar Guzikowski, Chief Government Inspector, Livsmedels Verket -- National Food Administration Drinking Water Division, Sweden, February 28, 2000). Germany:"In the former Democratic Republic of Germany (DDR) in several districts the drinking water was fluoridated but after the unification of both German states in 1990 fluoridation was stopped. In the Federal Republic of Germany there was in about 1952 a drinking water fluoridation experiment. But it was stopped after one or two years." (Dr. K. Ewing (sp?), Geschaftszeichen (Bei allen Antworten bitte angeben), Bonn, Germany, February 11, 2000). Finland: "We do not favor or recommend fluoridation of drinking water. There are better ways of providing the fluoride our teeth need." (Paavo Poteri, Acting Managing Director, Helsinki Water, Finland, February 7, 2000). Austria: "Toxic fluorides have never been added to the public water supplies in Austria." (M. Eisenhut, Head of Water Department, Osterreichische Yereinigung fur das Gas-und Wasserfach Schubertring 14, A-1015 Wien, Austria, February 17, 2000). Japan: "Japanese government and local water suppliers have considered there is no need to supply fluoridated water to ALL users because 1) impacts of fluoridated water on human health depends on each human being so that inappropriate application may cause health problems of vulnerable people, and 2) there is other ways for the purpose of dental health care, such as direct F-coating on teeth and using fluoridated dental paste and these ways should be applied at one's free will." (Toru Nagayama, Environment Agency, Government of Japan, Tokyo, March 8, 2000). Belgium: "This water treatment has never been of use in Belgium and will never be (we hope so) into the future." (Chr. Legros, Directeur, Belgaqua, Brussels, Belgium, February 28, 2000). The full text of these statements can be accessed at http://www.fluoridation.com/c-country.htm APPENDIX 3. Statement of Douglas Carnall, Associate Editor of the British Medical Journal, published on the BMJ website ( http://www.bmj.com ) on the day that they published the York Review on Fluoridation. Carnall in BMJ 2000;321:904 (7 October) Reviews Website of the week Water fluoridation Fluoridation was a controversial topic even before Kubrick's Base Commander Ripper railed against "the international communist conspiracy to sap and impurify all of our precious bodily fluids" in the 1964 film Dr Strangelove (www.indelibleinc.com/kubrick/films/strangelove/). This week's BMJ shouldn't precipitate a global holocaust, but it does seem that Base Commander Ripper may have had a point. The systematic review published this week (p 855) shows that much of the evidence for fluoridation was derived >from low quality studies, that its benefits may have been overstated, and that the risk to benefit ratio for the development of the commonest side effect (dental fluorosis, or mottling of the teeth) is rather high. Supplementary materials are available on the BMJ 's website and on that of the review's authors (www.york.ac.uk/inst/crd/fluorid.htm), enhancing the validity of the conclusions through transparency of process. For example, the "frequently asked questions" page of the site explains who comprised the advisory panel and how they were chosen ("balanced to include those for and against, as well as those who are neutral"), and the site includes the minutes of their meetings. You can also pick up all 279 references in Word97 format, and tables of data in PDF. Such transparency is admirable and can only encourage rationality of debate. Professionals who propose compulsory preventive measures for a whole population have a different weight of responsibility on their shoulders than those who respond to the requests of individuals for help. Previously neutral on the issue, I am now persuaded by the arguments that those who wish to take fluoride (like me) had better get it from toothpaste rather than the water supply (see www.derweb.co.uk/bfs/index.html and www.npwa.freeserve.co.uk/index.html for the two viewpoints). Douglas Carnall APPENDIX 4. List of 14 Noble Prize winners who have opposed or expressed reservations about fluoridation. 1) Adolf Butenandt (Chemistry, 1939) 2) Arvid Carlsson (Chemistry, 2000) 3) Hans von Euler-Chelpin (Chemistry, 1929). 4) Walter Rudolf Hess (Medicine, 1949) 5) Corneille Jean-François Heymans (Medicine, 1938) 6) Sir Cyril Norman Hinshelwood (Chemistry, 1956) 7) Joshua Lederberg (Medicine, 1958) 8) William P. Murphy (Medicine, 1934) 8) Giulio Natta (1963 Nobel Prize in Chemistry) 10) Sir Robert Robinson (Chemistry, 1947) 11) Nikolai Semenov (Chemistry, 1956) 12) James B. Sumner (Chemistry, 1946) 13) Hugo Theorell (Medicine, 1955) 14) Artturi Virtanen (Chemistry, 1945) REFERENCES. Arnold, HA. (1980). Letter to Dr. Ernest Newbrun. May 28, 1980. http://www.fluoridealert.org/uc-davis.htm ATSDR (1993). Toxicological Profile for Fluorides, Hydrogen Fluoride, and Fluorine (F). U.S. Department of Health and Human Service. ATSDR/TP-91/17. Brunelle, J.A. and Carlos, J.P. (1990). J. Dent. Res 69, (Special edition), 723-727. Bureau of National Affairs (2000). NTP soilicits comments on test for drugs, dietary supplements, water contaminats. Dec. 4, 2000. CDC (1999). Achievements in Public Health, 1900-1999: Fluoridation of Drinking Water to Prevent Dental Caries. Mortality and Morbidity Weekly Review (MMWR), 48(41);933-940 October 22, 1999. 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Waste Not, 82 Judson Street, Canton, NY 13617 on web at http://www.fluoridealert.org/fluoride-statement.htm Connett,P and Connett, M. (2000). The Emperor Has No Clothes: A Critique of the CDC's Promotion of Fluoridation. Waste #468, September. Waste Not, 82 Judson Street, Canton, NY 13617 see also http://www.fluoridealert.org/cdc.htm. DHHS (1991). Review of Fluoride: Benefits and Risks, Report of the Ad Hoc Committee on Fluoride of the Committee to Coordinate Environmental Health and Related Programs. Department of Health and Human Services, USA. De Liefde, B. (1998). The Decline of Caries in New Zealand Over the past 40 Years. New Zealand Dental Journal, 94, 109-113 DenBesten, P (1999). Biological mechanism of dental fluorosis relevant to the use of fluoride supplements. Community Dent. Oral Epidemiol., 27, 41-7. De Stefano, T.M. (1954). The fluoridation research studies and the general practitioner. Bulletin of Hudson County Dental Society, February 1954. Diesendorf, M.(1986). 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