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Saturday, Jan 25, 2025 - 01:24 SGT
Posted By: Gilbert

The Other Side Of Fluoride

This blog's approval of Robert F. Kennedy Jr. has raised some questions by acquaintances, a sentiment that was shared by a dean of public health at our national university in the local broadsheet. Some commentary may thus be called for, in like vein to Communications Of The Social Media Gang on coronavirus mitigations back in June 2021. Before we begin, it should be emphasized that all opinions expressed therein are solely my own, and do not necessarily represent the views or opinions of my employers - past, present or future - or indeed, any other entity or individual.

The boilerplate disclaimer done with, a quick summary of the published opinion: prospective U.S. Health and Human Services secretary (i.e. Minister of Health equivalent, in the U.S. Cabinet) RFK Jr. has (consistently) advocated for the removal of fluoride to public water supplies across the United States due to being "an industrial waste" linked to I.Q. loss, cancer and other disorders. This characterization of fluoride is stated to have been debunked in the Staying healthy in an era of health fallacies and fake news article, which then admits that recent work published in the reputable JAMA Pediatrics journal indeed suggests a link between fluoride exposure and childhood I.Q. loss... but that the study's methodology was flawed and actually inconclusive, and therefore "the damage was done as misinformation spread".

So, what are we to make of this? Believe The Science, but not the latest science that one disagrees with?

A little more background then. The fluoride study in question is a systematic review conducted by the National Toxicology Program of the U.S. Department of Health and Human Services (i.e. the very department that RFK Jr. has been nominated to be the boss of), and originally released as a monograph in August 2024 - thus, not some fly-by-night outfit. From a total of 74 primary research studies (mostly from China), the review found an inverse association between fluoride exposure and childrens' I.Q., which held over various dose-response thresholds from less than 4mg/L, to 1.5mg/L (with the current recommended concentration by the U.S. Public Health Service being 0.7mg/L, lowered from an upper range of 1.2mg/L in 2015). In particular, regression analysis yielded a 1.63 I.Q. point decrease, per 1mg/L increase in urinary fluoride.

Given the implications, it was perhaps inevitable that the systematic review encountered stiff opposition from sections of the scientific establishment, and got bounced between inside and outside committees for review before getting published; a spokesperson for the American Dental Association was reported as being amenable to the current version of the review, while reiterating that it was not conclusive evidence. Since the local opinion piece is adamant that being against fluoridating in water is misinformation, let us play Kennedy's advocate, and present the case for the plaintiff here:


Not So Obvious After All?

(Source: wikipedia.org)


Proponents of tap water fluoridation have routinely claimed that "fluoride has been a cornerstone of public health strategies to combat tooth decay since the mid-20th century, with countless studies validating its safety and efficacy" (from the State's Times opinion), and it has been named as one of the ten great public health achievements of the 20th century, by the U.S. Centers for Disease Control and Prevention (CDC). Given that fluoridation has been the official policy of the U.S. Public Health Service from 1951, however, it would seem obvious that the practice would have been adopted worldwide, in the 75 years since. However, it turns out that takeup has been very low, with only some 5% of the global population receiving artificially-fluoridated water, in about 24 countries.

An immediate reaction might be that the rest of the world had been unfortunately denied the wonders of fluoride, due to cost or infrastructural limitations. However, it is quickly noted that by far the majority of developed countries - including essentially all of Europe, Japan and South Korea - do not practice water fluoridation either, while maintaining comparable dental health levels. How, then, is this fact reconciled with the "unmistakeable benefits" of adding fluoride to drinking water? Are the bulk of the dentists and medical doctors in all these countries misinformed conspiracy theorists, or just plain evil?

This glaring discrepancy has been much-discussed online, and the explanation has generally been that those other countries administer fluoride via other means (salt, milk and of course toothpaste; though some nations such as Japan seem to prefer hydroxypatite), and/or have more widespread access to dental care. Moreover, a recent Cochrane review has found that the dental health benefits of adding fluoride to drinking water has declined since the 1970s, once fluoride toothpaste became more commonly available. Indeed, an August 2001 recommendation by the CDC asserts that "fluoride's predominant effect is posteruptive and topical" (rather than systemic), from which one might figure that it makes more sense to directly apply fluoride onto teeth (as with toothpaste), rather than drink it.

Anyway, before continuing further, it appears reasonable to state that while RFK Jr. is a "conspiracy theorist" on fluoridating water in America (and Singapore, so it seems), he would very much be part of the mainstream in Europe, and most of the world.


But What Of The Children?

I guess this is good news overall
[N.B. An obvious critique is whether these examples were cherry-picked.]
(Source: fluoridealert.org)


With the initial observations on the (low) prevalence of fluoridation done with, it might be mentioned that the practice seems to have a strong Anglo influence, after initial research began in Colorado at the beginning of the 20th century. Among the top fifteen countries and territories with the highest prevalence of flouridation, most of them are or were intimately connected with the British (i.e. Hong Kong, Singapore, Brunei, Australia, Malaysia, the newly-great United States, Ireland, New Zealand and Canada), of which Singapore holds the unique distinction of being the only country with a 100% fluoridation rate*. Perhaps expectedly, our Ministry of Health has maintained unequivocal support for fluoridation (ref. press releases in 2010, 2012 and 2015), and may thus be feeling especially threatened about the New Science - and thus the opinion piece.

One supposes that the ministry would not agree with many of the arguments against fluoridation, then, but some of the main ones will be covered here. Firstly, fluoridation of public drinking water sources can be considered as unethical by the principle of informed consent, which is a major reason as to why Western Europe has largely declined to do so. The counter has generally been that fluoridation mostly benefits the less-privileged, who have less access to dental care and, one figures, toothpaste. Parallels to vaccination as a public good have been raised, if with the caveat that the consequences of non-adherence are personal (i.e. one doesn't spread dental caries to others)

The counter-argument is then that although the topical benefit of fluoride is acknowledged, putting it in drinking water means that the dosage of fluoride cannot be controlled, and as explained here about HCQ back in 2020, the dose makes the poison. There is little dispute that fluoride is a neurotoxin at higher doses (especially critical with prenatal exposure for fetuses in the womb), and while the usual objection is that the concentration used for fluoridation is safe, and that "of course anything at twice the normal limit will have negative health consequences", this again goes back to the concern about uncontrolled dosages - especially relevant due to the narrow margin of safety (2x) before measured harm.

One easily imagines different people having significantly different fluoride intakes (e.g. a small-sized athlete or labourer drinking close to five liters of water daily, against a sedentary gamer subsisting on Coke Zero), and thus long-term accumulation rates - with detrimental effects. This is before individual responses to fluoride are considered, from which it should be fair to say that while water fluoridation may well be broadly beneficial to the population, it can still be harmful to some people - and if so, should they have the right to opt out?

[*N.B. with other special characteristics too!]


There Should Only Be One Side

Why is it *always* Red vs. Blue?
(Source: dysmocracy.com)


In fact, the fluoridation of water has been bitterly contested throughout the United States with some 63% to 73% having access to it currently, but with various communities increasingly against the practice, encouraged by a recent court order (by an Obama-appointed judge, since that appears important to affirm nowadays) ordering the U.S. Environmental Protection Agency (EPA) to begin the process of strengthening fluoride regulation.

At this point, it should be stated that most everybody should actually be on the same side here - we all want everyone to have good teeth, and we all want everybody to be (as) smart (as possible); it may be that fluoride is important to dental health at the right doses, and also that fluoride negatively impacts brain development at the wrong doses (which may not be that far from the right doses). Such trade-offs aren't at all rare in medicine, after all. Indeed, my personal expectation is that if one practices proper dental hygiene by brushing and flossing their teeth two to three times a day, it probably makes little difference whether there is 0.7mg/L or 0.0mg/L of fluoride added to their drinking water.

Seen in another way, the entire affair probably doesn't matter that much - water fluoridation has generally been claimed by proponents to reduce risk of cavities by about 25%, which while helpful, doesn't seem like a replacement for proper dental care, or directly life-threatening. On the other hand, a loss of 1.63 I.Q. points per 1mg/L increase in urinary fluoride doesn't seem overly catastrophic either, all the more with groundwater and wells often containing elevated levels of natural fluoride anyway.

Finally, the financial incentives. By all indications, the water fluoridation market (with fluorosilicic acid) is minor by pharmaceutical standards, being worth only about US$160 million annually as of now. That remains over a hundred million dollars more than its opponents have to draw upon, though, and it seems that RFK Jr. was entirely justified in pointing out that the fluoride added to drinking water is indeed commonly an untreated industrial waste product (which to be fair does not make it inherently toxic), oft from fertilizer factories... which may contain trace elements of arsenic and lead.

Given all this, one hopes it evident that RFK Jr. is hardly as much of a nutcase as the bought and paid for mainstream media is suggesting, with at least some of the FAKE NEWS enmity likely deriving from his threat to hit them hard in the pocketbook with a ban on direct-to-consumer pharmaceutical advertisements - which one feels is another entirely rational policy, considering that New Zealand is the only other country that allows such. Ditto his campaign against artificial food dyes, which has seen the FDA coincidentally ban the Red No. 3 dye - long known to be carcinogenic - in food and drinks, decades after they banned it in cosmetics.

The artificial dye issue is by the way part of his Make America Healthy Again (MAHA) platform centered around fixing citizens' diet, the removal of environmental toxins, regenerative agriculture and combatting corporate corruption (e.g. the ubiquitous food pyramid being designed to use up the grain surplus, instead of being based on health science), which again sounds entirely correct (but don't take my word on it, take Bernie's). And, while RFK Jr. might indeed be wrong in (mis)stating that "there is no vaccine that is safe and effective" (later denied), he has been changing his tune on immunization. If that is indeed true, I congratulate Americans on their first Health secretary willing to take on Big Pharma (many employees of whom are decent folks, I'm sure) in a long, long time.


He won't be using most of them anyway, after TikTok
(Sources: knowyourmeme.com, freepik.com)




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