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Water fluoridation opposition refers to activism against the fluoridation of public water supplies. Concerns include the lack of quality research data available, evidence that it may cause serious health problems, and ethical issues.

Ethics

Many people who oppose water fluoridation consider it to be a form of compulsory mass medication. They argue that consent of all water consumers cannot be achieved, nor can water suppliers accurately control the exact levels of fluoride that individuals receive, nor monitor their response. It is also argued that, because of the negative health effects of fluoride exposure, mandatory fluoridation of public water supplies is a breach of ethics and a human rights violation.

In the United Kingdom the Green Party refers to fluoride as a poison, claim that water fluoridation violates Article 35 of the European Charter of Fundamental Rights, is banned by the UK poisons act of 1972, violates Articles 3 and 8 of the Human Rights Act and raises issues under the United Nations Convention on the Rights of the Child.

Water fluoridation has also been criticized by Cross and Carton for violating the Nuremberg Code and the Council of Europe's Biomedical Convention of 1999.

Health risks

While the available data is sometimes contradictory, water fluoridation has been linked to:

• A weakening of bones, leading to an increase in hip and wrist fracture.

• Liver damage, impaired kidney function, and fluorosis in children.

• Cancer. The evidence is mixed and tentative, although a 2006 study found a relationship with male children.

• A 2000 epidemiological study found that in areas with high intake of silicofluorides, children had increased lead blood levels. A 2007 update on this study confirmed the result and noted that silicofluorides, fluosilicic acid and sodium fluosilicate are used to fluoridate over 90% of US fluoridated municipal water supplies.

• Chromosomal damage and interference with DNA repair.

• A lowering of IQ.

• Inhibition of melatonin production and promotion of precocious puberty in animal studies. Fluoride may have an analogous inhibitory effect on human melatonin production, as fluoride accumulates readily in the human pineal gland, the brain organ responsible for melatonin synthesis.

• A weakened immune system, leaving people vulnerable to the development of cancer and AIDS.

• Damage to the male reproductive system in various species.

• A disruption in endocrine function, especially in the thyroid.

Fluorosis

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Dental Fluorosis

Two academic dental officials formerly in favor of fluoridation, Dr. John Colquhoun and Dr. Hardy Limeback, cite dental fluorosis as a major reason in their opposition to fluoridation. Dental fluorosis occurs because of the excessive intake of fluoride either through fluoride in the water supply, naturally occurring or added to it; or through other sources. The damage in tooth development occurs between the ages of 6 months to 5 years, from the overexposure to fluoride. In its severe form it is characterized by black and brown stains, as well as cracking and pitting of the teeth.

The World Health Organization cautions that fluoride levels above 1.5 milligrams per liter leaves the risk for fluorosis. To protect against this health organizations in some high fluoride areas endorse providing alternative water sources, or removing fluoride from the water. 0.07 – 1.2 milligrams per liter of fluoride is considered to be the optimal level. A CDC evaluation concluded that prevalence of some level of fluorosis among children and adolescents in the United States had increased by from 22.8% in 1986 – 1987 to 32% in 1999 – 2002.

Skeletal Fluorosis

Skeletal fluorosis is a bone disease exclusively caused by excessive consumption of fluoride. In advanced cases, skeletal fluorosis causes pain and damage to bones and joints. Advanced cases usually involve about ten times the normal amount of fluoride. Development of skeletal fluorosis is directly related to the level and exposure of fluoride exposure, for example, water fluoridated at five parts per million (ppm) for ten years or more is needed to produce signs of osteosclerosis.

Concentration of fluoride

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In 1986 the United States Environmental Protection Agency (EPA) established a maximum contaminant level (MCL) for fluoride at a concentration of 4 milligrams per litre (mg/L). In 2006 the National Research Council (NRC) concluded that the current MCL of 4 mg/L should be lowered. The EPA has yet to act on the NRC's recommendation.

Critical evaluations and studies

The largest study of water fluoridation's efficacy, conducted by the National Institute of Dental Research, showed no statistically significant difference in tooth decay rates among children in fluoridated and non-fluoridated communities. A review of the evidence from the University of York, published in 2000, examined 30 studies. The researchers concluded that the quality of evidence in most studies was poor, also expressing concern over the "continuing misinterpretations of the evidence." Many medical authorities argue that the effects of fluoridation on teeth are topical (brushed on) rather than systemic (swallowed).

In 2005, eleven environmental protection agency EPA employee unions, representing over 7000 environmental and public health professionals of the Civil Service, called for a halt on drinking water fluoridation programs across the USA and asked EPA management to recognize fluoride as posing a serious risk of causing cancer in people. The unions acted on an apparent cover-up of evidence from Harvard School of Dental Medicine linking fluoridation with an elevated risk of osteosarcoma in boys, a rare but fatal bone cancer.

In addition, over 1,730 health industry professionals, including doctors, dentists, scientists and researchers from a variety of disciplines are calling for an end to water fluoridation in an online petition to Congress.

Their petition highlights eight recent events that they say mandates a moratorium on water fluoridation, including a 500-page review of fluoride’s toxicology that was published in 2006 by a distinguished panel appointed by the National Research Council of the National Academies. While the NRC report did not specifically examine artificially fluoridated water, it concluded that the U.S. Environmental Protection Agency's safe drinking water standard of 4 parts per million (ppm) for fluoride is unsafe and should be lowered. Despite over 60 years of water fluoridation in the U.S, there are no double-blind studies which prove fluoride's effectiveness in tooth decay. The panel reviewed a large body of literature in which fluoride has a statistically significant association with a wide range of adverse effects.

The petition signers express concern for vulnerable groups like "small children, above average water drinkers, diabetics, and people with poor kidney function," considering that many members of these sub-populations may already be overdosing on fluoride.

Another concern that the petition signers share is, "The admission by federal agencies, in response to questions from a Congressional subcommittee in 1999-2000, that the industrial grade waste products used to fluoridate over 90% of America's drinking water supplies (fluorosilicate compounds) have never been subjected to toxicological testing nor received FDA approval for human ingestion."

A separate petition that calls on the United States congress to halt the practice of fluoridation has received over 12,300 signatures.

In the book, "The Fluoride Deception," author Christopher Bryson claims that "industrial interests, concerned about liabilities from fluoride pollution and health effects on workers, played a significant role in the early promotion of fluoridation."

Several prominent dental researchers and government advisors who were leaders of the pro-fluoridation movement have announced reversals of their former positions after they concluded that water fluoridation is not an effective means of reducing dental caries and that it poses serious risks to human health. The late Dr. John Colquhoun was Principal Dental Officer of Auckland, New Zealand

Dr. Hardy Limeback, BSc, PhD, DDS was one of the 12 scientists who served on the National Academy of Sciences panel that issued the aforementioned report, Fluoride in Drinking Water: A Scientific Review of the EPA's Standards. Dr. Limeback is an associate professor of dentistry and head of the preventive dentistry program at the University of Toronto. He detailed his concerns in an April 2000 letter titled, "Why I am now officially opposed to adding fluoride to drinking water".

In a presentation to the California Assembly Committee of Environmental Safety and Toxic Materials, Dr. Richard Foulkes, B.A., M.D., former special consultant to the Minister of Health of British Columbia, revealed:

The studies that were presented to me were selected and showed only positive results. Studies that were in existence at that time that did not fit the concept that they were "selling," were either omitted or declared to be "bad science." The endorsements had been won by coercion and the self-interest of professional elites. Some of the basic "facts" presented to me were, I found out later, of dubious validity. We are brought up to respect these persons in whom we have placed our trust to safeguard the public interest. It is difficult for each of us to accept that these may be misplaced.

On April 15, 2008, the United States National Kidney Foundation (NKF) updated their position on fluoridation for the first time since 1981. Formerly a supporter of water fluoridation, the NKF now takes a neutral position on the practice.

The precautionary principle

In an analysis published in the March 2006 issue of the Journal of Evidence Based Dental Practice, the authors examine the water fluoridation controversy in the context of the precautionary principle. The authors note that:

• There are other ways of delivering fluoride besides the water supply;

• Fluoride does not need to be swallowed to prevent tooth decay;

• Tooth decay has dropped at the same rate in countries with, and without, water fluoridation;

• People are now receiving fluoride from many other sources besides the water supply;

• Studies indicate fluoride’s potential to cause a wide range of adverse, systemic effects;

• Since fluoridation affects so many people, “one might accept a lower level of proof before taking preventive actions.”

Use throughout the world

Water fluoridation is used in the United States, United Kingdom, Canada, and Australia, among other countries. The following developed nations previously fluoridated their water, but stopped the practice, with the years when water fluoridation started and stopped in parentheses:

• German Federal Republic (1952-1971)
• Sweden (1952-1971)
• Netherlands (1953-1976)
• Czechoslovakia (1955-1990)
• German Democratic Republic (1959-1990)
• Soviet Union (1960-1990)
• Finland (1959-1993)
• Japan (1952-1972)

In 1986 the journal Nature reported, "Large temporal reductions in tooth decay, which cannot be attributed to fluoridation, have been observed in both unfluoridated and fluoridated areas of at least eight developed countries."

In areas with complex water sources, water fluoridation is more difficult and more costly. Alternative fluoridation methods have been proposed, and implemented in some parts of the world. The World Health Organization is currently assessing the effects of fluoridated toothpaste, milk fluoridation and salt fluoridation in Africa, Asia, and Europe. The WHO supports fluoridation of water in some areas, and encourages removal of fluoride where fluoride content in water is too high.

Court cases

United States

Fluoridation has been the subject of many court cases. Activists have sued municipalities, asserting that their rights to consent to medical treatment, privacy, and due process are infringed by mandatory water fluoridation. Individuals have sued municipalities for a number of illnesses that they believe were caused by fluoridation of the city's water supply. So far, the majority of courts have held in favor of cities in such cases, finding no or only a tenuous connection between health problems and widespread water fluoridation. To date, no federal appellate court or state court of last resort (i.e., state supreme court) has found water fluoridation to be unlawful.

Early cases

A flurry of cases were heard in numerous state courts across the U.S. in the 1950s during the early years of water fluoridation. State courts consistently held in favor of allowing fluoridation to continue, analogizing fluoridation to mandatory vaccination and the use of other chemicals to clean the public water supply, both of which had a long-standing history of acceptance by courts.

In 1952, a Federal Regulation was adopted that stated in part, "The Federal Security Agency will regard water supplies containing fluorine, within the limitations recommended by the Public Health Service, as not actionable under the Federal Food, Drug, and Cosmetic Act."

The Supreme Court of Oklahoma analogized water fluoridation to mandatory vaccination in a 1954 case. The court noted, "we think the weight of well-reasoned modern precedent sustains the right of municipalities to adopt such reasonable and undiscriminating measures to improve their water supplies as are necessary to protect and improve the public health, even though no epidemic is imminent and no contagious disease or virus is directly involved . . . . To us it seems ridiculous and of no consequence in considering the public health phase of the case that the substance to be added to the water may be classed as a mineral rather than a drug, antiseptic or germ killer; just as it is of little, if any, consequence whether fluoridation accomplishes its beneficial result to the public health by killing germs in the water, or by hardening the teeth or building up immunity in them to the bacteria that causes caries or tooth decay. If the latter, there can be no distinction on principle between it and compulsory vaccination or inoculation, which, for many years, has been well-established as a valid exercise of police power."

In the 1955 case Froncek v. City of Milwaukee, the Wisconsin Supreme Court affirmed the ruling of a circuit court which held that "the fluoridation is not the practice of medicine, dentistry, or pharmacy, by the City" and that "the legislation is a public health measure, bearing a real, substantial, and reasonable relation to the health of the city."

The Supreme Court of Ohio, in 1955's Kraus v. City of Cleveland, said, "Plaintiff's argument that fluoridation constitutes mass medication, the unlawful practice of medicine and adulteration may be answered as a whole. Clearly, the addition of fluorides to the water supply does not violate such principles any more than the chlorination of water, which has been held valid many times."

Fluoridation consensus

In 1973, as cases continued to be brought in state courts, a consensus developed that fluoridation, at least from a legal standpoint, was acceptable. In 1973's Beck v. City Council of Beverly Hills, the California Court of Appeal, Second District, said, "Courts through the United States have uniformly held that fluoridation of water is a reasonable and proper exercise of the police power in the interest of public health. The matter is no longer an open question."

Contemporary challenges

Advocates continue to make contemporary challenges to the spread of fluoridation. For instance, in 2002, the city of Watsonville, California chose to disregard a California law mandating fluoridation of water systems with 10,000 or more hookups, and the dispute between the city and the state ended up in court. The trial court and the intermediate appellate court ruled in favor of the state and its fluoridation mandate, however, and the Supreme Court of California declined to hear the case in February of 2006. Since 2000, courts in Washington, Maryland, and Texas have reached similar conclusions. Citizens for Safe Drinking Water is raising money to support a lawsuit in federal court seeking an injunction against public water districts' use of unapproved drugs in the drinking water supply in the United States.

Republic of Ireland

In Ryan v. Attorney General (1965), the Supreme Court of Ireland held that water fluoridation did not infringe the plaintiff's right to bodily integrity. However, the court found that such a right to bodily integrity did exist, despite the fact that it was not explicitly mentioned in the Constitution of Ireland, thus establishing the doctrine of unenumerated rights in Irish constitutional law.

References

Footnotes

1. ^ Limeback, Hardy. (2000). Why I am now officially opposed to adding fluoride to drinking water. Fluoride Alert.
2. ^ "Second Thoughts on Fluoride". Scientific American.Reuters summary.
3. ^ John Colquhoun (1998). "Why I changed my mind about water fluoridation" (reprinted from Perspectives in Biology and Medicine). Fluoride. 31 (2): 103–118.
4. Second Look. A Bibliography of Scientific Literature on Fluoride
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6. Fluoride Primer: Fluoridation is a serious breach of ethics, International Institute of Concern for Public Health website, accessed 22 February, 2006.
7. Water fluoridation contravenes UK law, EU directives and the European Convention on Human Rights and Biomedicine. A Green Party press office briefing. 8 July, 2003. Paragraphs 56, 57 and 59 of the Home Office Guidance Notes on the application of the Human Rights Act establish that fluoridation violates Articles 3 and 8 of the Human Rights Act, and also Articles 3 and 8 of the Convention. Since fluoridation is the illegal administration of a registered poison with no medicinal authorisation, it constitutes a State sanctioned criminal act against the public, and is incompatible with the Convention on Human Rights and the Convention on Human Rights and Biomedicine. Where children are involved - indeed, specifically targeted - such an act also raise issues under the United Nations Convention on the Rights of the Child.
8. Int J Occup Environ Health. 2003 Jan-Mar;9(1):24-9. Fluoridation: a violation of medical ethics and human rights. Cross DW, Carton RJ. "The ethical validity of fluoridation policy does not stand up to scrutiny relative to the Nuremberg Code and other codes of medical ethics, including the Council of Europe's Biomedical Convention of 1999."
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12. Adverse Health and Behavior from Silicoflourides
13. Masters, R. D.; Coplan, M. J.; Hone, B. T.; Dykes, J. E. (2000), Neurotoxicology, 21 (6): 1091–100 http://www.ncbi.nlm.nih.gov/pubmed/11233755 {{citation}}: Missing or empty |title= (help)CS1 maint: multiple names: authors list (link) Dartmouth press release
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78. ^ Beck v. City Council of Beverly Hills, 30 Cal. App. 3d 112, 115 (Cal. App. 2d Dist. 1973) ("Courts through the United States have uniformly held that fluoridation of water is a reasonable and proper exercise of the police power in the interest of public health. The matter is no longer an open question." (citations omitted)). Cite error: The named reference "beck" was defined multiple times with different content (see the help page).
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80. 17 Fed. Reg. 6743 (July 23, 1952).
81. ^ 273 P.2d 859, 862-63 (Okl. 1954) (available at FindLaw for Legal Professionals)
82. 69 N.W.2d 242, 252 (Wis. 1955)
83. 127 N.E.2d 609, 613 (Ohio 1955)
84. Jones, Donna "Supreme Court turns down Watsonville's appeal to keep fluoride out of its water." Santa Cruz Sentinel. February 10, 2006.
85. Parkland Light & Water Co. v. Tacoma-Pierce County Bd. of Health, 90 P.3d 37 (Wash. 2004)
86. Pure Water Committee of W. MD., Inc. v. Mayor and City Council of Pure Water Comm. of W. MD., Inc. v. Mayor and City Council of Cumberland, MD. Not Reported in F.Supp.2d, 2003 WL 22095654 (D.Md. 2003)
87. Espronceda v. City of San Antonio, Not Reported in S.W.3d, 2003 WL 21203878 (Tex. App.-San Antonio 2003)
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89. Ryan v. A.G. IESC 1; IR 294 (3 July, 1965) — text of the Irish Supreme Court's judgement

External links

• Fluoride Action Network
• Template:DMOZ

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