{Update: I had just finished this post when I came across a response to Waugh from the Irish Expert Body on Fluorides and Health, pdf downloadable here. They reinforce some of the same points I have made here and address a number of other issues Waugh raises, concluding: “It is apparent that Mr Waugh’s report does not form a basis for a review of current dental health or fluoridation policies.”}
Fluoridation- a sensible and effective public health measure- or a commie (or Big Government) plot to steal your bodily fluids?
Fluoridation of public drinking water has been an environmental hot-topic for decades. I remember going to a talk about it nearly 20 years ago. More recently the odd phenomenon of the anti-fluoride movement has come to my attention through a report by Cork-based environmental scientist Declan Waugh.
In Waugh’s lengthy report Human Toxicity, Environmental Impact and Legal Implications of Water Fluoridation which does not appear to have been published in a peer-reviewed journal and does not have the status of a scientific paper- he makes the following claim:
While the practice of fluoridation of drinking water was intended to have a beneficial effect on caries prevention and to reduce social inequalities in dental health, there is now unequivocal evidence to show that the practice is now contributing to adverse public health risks and environmental impacts. The public have always been assured that there was absolutely no possibility of any harm or risk from fluoridation of water. There is now unequivocal evidence that demonstrates that this is not the case. This report presents the scientific and medical evidence from over twelve hundred peer-reviewed scientific articles that demonstrates beyond any reasonable doubt that fluoridation of drinking water is a significant contributory factor to the negative health burden of Ireland. This report presents a summary of the published peer-reviewed health and environment related literature on fluoride and its implications for human health and biodiversity.
The repetition of “unequivocal” and “beyond reasonable doubt” in a self-published report written by a single individual with no published papers in this field should raise more than a few eyebrows: there is no scientific committee that would put their name to Waugh’s conclusions.
Even before this, the report starts with a prominent page like a billboard for woo proclaiming the relevance of the Precautionary Principle- this should ring alarm bells enough to shame the curators of Notre Dame. Waugh is trying a trick used by environmental extremists and quacks the world over: you can’t disprove what we are saying, and we certainly know how to sow fear and doubt, so you had better err on the side of caution. Waugh then goes onto spend the next 300 pages doing his best to scare the pants off you so you agree to just that.
Apart from anything else, since fluoridation is a public health measure shown to have a beneficial effect on the populations dental health- something which used to be so bad before modern medicine and science that it was actually a major killer- the Precautionary Principle can of course be invoked to support either position: we should continue to fluoridate lest we risk a serious deterioration of dental hygiene.
But what Waugh does not make prominent anywhere that I can see is that the overwhelming consensus of scientific opinion has already signed off on the effectiveness and safety of water fluoridation. Here is a list (pdf) including all the major scientific academies around the world who attest to this. Waugh is a one-man Galileo trying to save the world from a global scientific plot to kill us all.
Waugh’s report tries to link practically every major health condition in Ireland- one of the few European countries that still fluoridates- to fluoride in tap water:
Cellular Oxidative Stress and Fluoride; Congenital Heart Defects, Down Syndrome, Neurological and Angiogenic Diseases; Lipid Peroxidation and Fluoride; Vitamin C Deficiency and Fluoride;
Periodontal Disease and Fluoride;
Calmodulin Activity Sudden Death Syndrome;
Neurological Disease;
Diabetes;
Calcification of Major Arteries;
Genetic Damage and Fluoride
Osteoporosis and Fluoride
Vitamin D, Bone Health and Inhibition of Fluoride Toxicity
Bone Cancer
Dental fluorosis
are all linked with fluoridation and drinking water. The only thing missing of significance is impotence and loss of the body’s vital essences.
Waugh claims:
All of the evidence is convergent and demonstrates that fluoride compounds should not be added to public water supplies, when examined collectively the evidence clearly demonstrates that fluoridation of drinking water supplies is both unsafe and having significant negative health implications for human health, society and the natural environment.
How is this even possible when hitherto Waugh’s ground-breaking if not revolutionary report, the overwhelming scientific consensus is the exact opposite?
The problem is, fluoride is indeed linked with all those conditions- but not at the dose of 0.7 ppm that water fluoridation regulates for. Indeed, water fluoridation involves the regulation of fluoride levels in municipal water, which can also mean that in some cases levels are reduced from naturally occurring levels which can be higher than is considered safe.
This is the first rule of toxicology, completely missing from Waugh’s report: it is in the dose. A low level of something can be beneficial even though at a higher level it could kill you. My three cups of morning coffee may not be entirely the most healthy way to stat the day what with all those known carcinogens in coffee, but I would have to take a much larger dose for it to to me any serious harm. (Mind you I maybe I should check the systematic reviews on this first…)
Yet Waugh often fails to distinguish between high- and low-doses, or between fluoridated water or natural water sources with high levels of fluoride. These are some of the tactics highlighted in a 2012 report by Institute for Science in Medicine (ISM) The Anti-Fluoridationist Threat to Public Health. For example, the 2006 National Research Council (NRC) report is reliably quoted by Waugh to support his scare-mongering case, without explaining that this was not a report about municipal water supplies, but about naturally occurring water sources with much higher levels of fluoride.
On page 171, Waugh states “In communities where fluoridation has been discontinued, as in Finland, former Eastern block countries, Canada, Cuba, Holland, and the U.S., tooth decay rates have not increased but continued to decrease.”- again, neglecting to point out that in the Cuba case at least, the water fluoridation program was replaced by a program of “a weekly, fluoride mouth-rinsing program in its schools.29 Effective mouth-rinsing programs generally cost significantly more per person than CWF.”
Reliably again in the tradition of all good anti-fluoridationists, Waugh cites flawed Chinese studies on the link between fluoridation and IQ:
This research finding would further support the results of a series of studies undertaken in China by Wang et al.646 examining the developmental effects of fluoride. Despite this latter research reported to have several shortcomings, it did reach the same conclusion as Rocha-Amador et al.647 and others648,649 indicating that fluoride negatively impacts intelligence.
Again, he references several times a study on skeletal fluorosis in India without explaining that this was a study of the effects from a) naturally occurring fluoride levels which are up to 15 times higher than those used in municipal supplies, and b)industrial pollution in India. The ISM notes “Skeletal fluorosis is a condition that is virtually unheard of in the United States.”
Water fluoridation was first introduced into Ireland in 1964 and in 2002 there was a comprehensive review of the health effects. The Forum on Fluoridation is referenced a few times in Waugh’s report, eg on p39 he states:
the Forum for Fluoridation, a body representing an expert panel of consultants in Ireland, came to the conclusion that “the effects of fluoride on the general environment and on the aquatic environment in particular are imperceptible”.
It is rather astonishing that in the absence of conducting or evaluating field surveys or environmental/ecological assessments for damage by fluoride to animals, plants, and vegetation and in the absence of bio-monitoring for fluoride contamination or determining the amounts of fluoride in air, soil, vegetation and water, that the Forum for Fluoridation could come to any such conclusion.
But anyone can see just by reading the document that it is a thorough and detailed review of numerous high-level scientific reports on water fluoridation; his objections about “lack of research” is a complete red herring, as he is talking about entirely different issues than those pertaining to the health risks and benefits of fluoride in drinking water.
On p143 he cites the Forum again:
According to the Forum for Fluoridation Report (2002), in the year 1990 there were 1,509 hip fractures in the over 60 year olds; in 1999 this increased to 3,504 and by 2000 this figure had risen to 3,821. This represents an alarming increase and it has not been investigated whether exposure to fluoride may be a contributory factor.
Waugh neglects to tell us that the Forum cites other risk factors than fluoridation for such conditions:
The risk factors for the development of primary osteoporosis include genetic predisposition, hypogonadism, low body weight, cigarette smoking, excess alcohol, low dietary calcium, vitamin D deficiency, late menarche, irregular menstruation, early menopause, physical inactivity and high caffeine intake.
Nor does he cite the 2000 Hillier review, cited in the Forum, which concluded:
It was demonstrated that the frequency of hip fractures correlated with low body-mass index and physical inactivity. After adjustment for these and other confounders, the investigators could not find an increased risk of hip fracture among individuals with lifetime exposure to water containing fluoride at concentrations greater than 0.9 mg/litre.
Waugh cites the 2000 York review:
In 2000, the NHS YORK Review, following a critical and detailed examination of water fluoridation, concluded remarkably that it was unable to identify one high-quality study to show that the practice is effective or safe.
But as the Forum explains, the standard of evidence for positive effects has to be of a higher quality than that indicating negative effects; studies were ranked A-D with A being of the highest quality; studies showing benefits were in category “B”, the second-highest, while evidence showing negative health effects- of the kind cited constantly through Waugh’s report- were only found to be of category “D”- the lowest standard.
{Update: Irish Expert Body on Fluorides and Health’s response to Waugh points out that the highest quality of evidence requires randomized control studies, which are not really practical for studying the effects of fluoridation.}
Nor does Waugh tell us the York review’s conclusions. Although the authors were unable to find high-quality studies on water fluoridation, and were unable to come to conclusions on a number of issues due to lack of evidence, their overall conclusions paint a completely different picture to the one Waugh would have us believe:
The best available evidence (level B) from studies on the initiation and discontinuation of water fluoridation suggests that fluoridation does reduce caries prevalence, both as measured by the proportion of children who are caries-free and by the mean dmft/DMFT score….
An {beneficial} effect of water fluoridation was still evident in studies completed after 1974 in spite of the assumed exposure to fluoride from other sources by the populations studied….The best available evidence on the association of water fluoridation and bone fractures (27 of 29 studies evidence level C) show no association. Similarly, the best available evidence on the association of water fluoridation and cancers (21 of 26 studies evidence level C) show no association…
I could go on but that should probably suffice for now. Waugh seems to have produced a 300+ -page report trawling exhaustively through hundreds of studies painstakingly cherry-picking anything he can find that might make it look like water fluoridation is a really bad idea, ignoring any evidence to the contrary, including the vast bulk of the world’s scientific opinion which, he claims, is just wrong, because Declan Waugh says so. In fact he appears to have deliberately misrepresented most of the reports and studies he cites, claiming them to support his own contrary views when they clearly do not! There’s chutzpah for you….
Why? In a recent article in HotPress, which seems to have taken upon itself to run an anti-fluoridation campaign, Waugh says
I’ve read over 2,000 fluoridation studies at this stage. I’m not getting paid for this – I have no conflict of interest, and I’m not representing anyone in doing it. It has cost me a fortune; all of my savings have gone into it. And I’ve done it purely on the basis that I have a sixteen-month-old baby; I’ve had incidences of cancer within my own family; and I have friends with neurological problems.
He seems to be genuine, but really someone needs to tell him that correlation does not prove causation. The article claims Ireland has the “sickest population in Europe” and apparently Waugh is convinced, beyond any doubt whatsoever, that fluoride is to blame:
In the street where I live, there are four men who have died from cancer, and there are only eleven houses. There’s absolutely no doubt in my mind that it’s related to the water.
Maybe he should go and talk to the anti-GMO folks who have no doubt that all disease is caused by GMOs, or the organic folk who think all disease is caused by “chemicals” in food and industrial agriculture, or the chemtrail folk who are convinced…. Wait a minute- maybe he is talking to those quacks and cooks, maybe that is indeed where he has learned his quackery from.
Perhaps it is individuals such as Waugh, driven by complete certainty and missionary zeal that they are right and the Experts are Wrong, who should really give us cause to worry.
Further reading:
Community Water Fluoridation- Centers for Disease Control and Prevention
Why Portland is Wrong about Water Fluoridation
Swastikas and “witch-hunts”: on the front lines of the fluoride wars
Skepteco 
Hi Graham, one thing is pretty certain from reading this blog is that you havent a clue what you are talking about. You are right about one thing only it is the level of exposure that is important but that must be examined on the basis of the nutritional and health status of the individual consumer. The European Food Safety Authority have stated that consumers how live in a fluoridated areas will consume up to 4mg more of fluoride a day than those living in a non fluoridated area. They also said that much greater variations are likely. What you fail to grasp is that we already have a population that is chronically exposed to fluoride in their diet, we are the largest consumers of tea in the EU, which contains high levels of fluoride. The UK is next to Ireland in tea consumption. The cancer incidence in Ireland is 40% above the UK. It is 85% above the European region average. Some cancers in the south such as blood and bone cancers have been increasing at almost 3% per year in the south while the incidence rates for the same cancers are static or declining in Northern Ireland. I have just finished reviewing the raw data provided to me by the food safety authority on ireland onf fluoride levels in foods and beverages and can confirm to you that the analytical data is erroneous and unsound. Their measurements are more than an order of magnitude out. This has been further checked by other scientists i have forwarded the data to and it has also been compared to published data from the EU, UK and USA as well as independent testing undertaken in Ireland. Finally to clarify three senior members of the US national Academy of Sciences ( Two Professors (1-neurosciencist and 1 dentistry and chemistry) and one leading international toxicologist) who were authors of the US report on fluoride in 2006 have written in support of my report.
Hi Declan thanks for your comment. Unfortunately you appear to have failed to respond to any of the substantive points concerning misrepresentation of evidence in your report that I have highlighted. Finding numerous examples of same was child’s’ play. Your report is so full of them it is like shooting fish in a barrel. The effect of this is that you have zero credibility, so even if the issues you mention here concerning Ireland as being a special case due to its tea-drinking habit were valid, you are clearly not the person to advance them.
Please show where in your report you have controlled for other risk factors with regard to cancer that might apply in Ireland, other than fluoridation.
I am confident that if any of what you say is true, then science will eventually catch up and confirm them. Until then, it is pretty pointless engaging in vague unsubstantiated claims and general hand-flapping because the likelihood is that you have misrepresented those as well. I suggest you re-write your report with correct and accurate representations of your references, and stop treating your readers like idiots who can’t use Google.
Irish cancer rate second highest in world
Also,
Also, blood and bone cancers do not appear to be in the top 5 most prevalent cancers in Ireland, so citing the high incidence of cancer in Ireland in general alongside the rise in these particular cancers is misleading.
Wrong. The national cancer registry has reported that the incidence of chronic lymphoblastic leukaemia in RoI increased by 2.8per year between 1994 and 2004 while remaining static in NI. In 2004 it was 53per cent higher for both men and women in RoI compared to NI. This is a blood and bone cancer. You might explain the differences?
Ah, the 300 page report by the lone maverick or activist group. This is really becoming a pattern lately. Extended Gish Gallops. I think that must be one of the side effects of word processing technology. It used to just be to hard to do that on a mimeograph and stand outside the grocery store with your sandwich board.
Hi graham and Declan. I have no intention to engage with any debate with regard to Declan’s competence or indeed the efficacy of fluoride. I have not read his report and i have recently started to once again to use fluoride toothpaste in the hope of addressing dental issues
It does seem strange to me that here is a form of medication that is dependant on how much water I drink and that needlessly treats the water that I flush the toilet with. Surely giving advice about toothpaste dosage and even subsidising toothpaste would be more effective in medical and financial terms and would allow people to ‘opt out’ as they can with other government health initiatives?
I have to say that the reason for some European countries to cease fluoridation and then not re instate is interesting. Why is Germany not convinced by all credible sources that Graham quotes?
Mike
according the the Fluoridation Forum
(Well worth reading the full report, as you do so I think you will see just how misleading Waugh’s blithe dismissal of its conclusions is.)
Water fluoridation has proved far more cost-effective than other approaches, but yes you are right that a lot of the opposition to it is a kind of indignant sense of lack of choice, which easily morphs into conspiracy theories.
As to why Germany and other countries have ceased fluoridation- because of public pressure due to well-funded misinformation campaigns. Anti-fluoridation campaigns are part of the anti-vaccine/quack medicine nexus. The scientific consensus is also just as clear on the safety and beneficial nature of GMOs, yet they have been largely banned in Europe despite Monsanto et al being supposedly of such enormous power. The same could be said of nuclear as well to a large extent- the German move away from nuclear after Fukishima is not a result of strong scientific advice, but of a powerful German Green party and the apparent ease with which well-run campaigns can scare people. It should come as no surprise that Governments are frequently much more influenced by activists than by good evidence. This becomes a self-fulfilling prophecy- the success of activists’ scare-mongering then is used as evidence they must be right- just as you ask here, why has Germany stopped fluoridation? There must be a good reason! You can see this in the anti-GMO movement as well- look GMOs have made slow progress and are banned in lots of places, must be bad!
– cancer issue : remember you can’t compare cancer rates in different countries very well , cos since most cancer doesn’t show up until old age then in developing countries people often get killed by something else ..before they get cancer.
– “Waugh seems to have produced a 300+ -page report trawling exhaustively through hundreds of studies painstakingly cherry-picking an…. appears to have deliberately misrepresented most of the reports and studies he cites, claiming them to support his own views when they clearly do not!” now that couldn’t happen in Climate “Science” could it ?..Mr Lewandowsky ?
Excellent post, thank you for taking the time. I wrote a little about Girl Against Fluoride here, if you’re interested: http://geoffsshorts.blogspot.ie/2013/11/girl-against-fluoride-f-minus-for-effort.html.
Even the number of reports cited in the waugh reportis exaggerated. If something as simple as that is wrong what can be trusted in the contents. Also one of his key findings on enzyme inhibition is based on a deliberate misreading of an in vitro study that doesn’t involve fluoride.
You wrote: “As to why Germany and other countries have ceased fluoridation- because of public pressure due to well-funded misinformation campaigns”
Let’s see if you actually know what you are talking about. Can you give me any evidence of public pressure or a well-funded campaign to end water fluoridation in West Germany? I bet you can’t find anything like that. I say there have been a lot of made up excuses for why nations do not practice water fluoridation published as supposed “facts” by a dental trade organization. They never back up these excuses with any evidence.
West Germany ceased fluoridation in 1970, so you are right, there was no campaign there; but they do of course fluoridate table salt. Do you doubt there would be strong opposition if it were proposed to be re-introduced? The point is, activists always claim that the fact it is not practiced in some other countries means it must be bad, a non-sequitor. Governments do not always follow best scientific advice, and other anti-science positions on GMOs and nuclear power are widely held in Europe and are most certainly because of successful scare-mongering and misinformation campaigns. Anti-fluoridation is closely aligned with other right-wing attacks on public science such as anti-vaccination and is promoted (and funded by if only indirectly) the general quack industry, also Big Organic. Would you argue then that if say Germany proposed to re-introduce fluoridation there would be public support? You dont think quacks and organickers would oppose fluoridation in Germany and elsewhere in Europe? Should we start a Fluoridate Now! campaign across Europe perhaps?
So in West Germany government officials, without any public pressure or any well-funded misinformation campaign decided, on their own, that they would not have water fluoridation in their country. This was despite a very large, well-funded campaign by the U.S. Public Health Service to have the nations of the world adopt water fluoridation. West Germany had some water fluoridation and then stopped doing it. Why?
Communist China experimented with fluoridation and then decided not to adopt it. There was no anti-fluoridaiton movement there either. Once again, government officials made this decision on their own.
So are we are supposed to believe that most of the nations of the world are simply wrong for not adopting water fluoridation? Are we are supposed to believe that the scientific experts in most of the world don’t know what they are doing? In other words a minority has a very strong belief in fluoridation and they are right and the majority who don’t believe them are wrong. So in those countries that either rejected water fluoridation or stopped doing it “anti-science” has supposedly taken over.
Yes, fluoridationists have gotten major health organizations to say fluoridation is good. But this is a case where U.S. influence and money has paid off. The U.S. is usually the major funder of these institutions. Non-fluoridating nations are merely paying lip service to the U.S. It’s not worth fighting over it as they have nothing to gain. So they merely go along with fluoridation pronouncements from these organizations without objections. In a non-verbal way they say to the fluoridating nations: “you do that to your people – we are not going to have that in our country.”
West Germany has salt fluoridation. That’s not the same thing as water fluoridation and does allow for freedom of choice. It’s not mandatory. In France the market share of fluoridated salt has dropped dramatically. In the U.S. fluoridated salt is illegal. If we had non-mandatory fluoridated salt in the U.S. with no water fluoridation there would not be anywhere near as much controversy as there is now. Making fluoridated salt illegal in the U.S. tells us something about the toxicity of fluoride.
Fluoridation is not popular in general which is why we have mandatory state laws in the U.S. to prevent voting on the issue. Mandatory laws are thought necessary despite the many millions spent over the years to convince people that fluoridation is wonderful.
So I can take your argument and turn it around. Just because some nations have adopted water fluoridation doesn’t mean it’s good, just like nations rejecting it it doesn’t automatically make it bad. So when virtually all the medical and dental organizations opposed fluoridation when it was first proposed that doesn’t make it bad, in a similar manner when those organizations reversed their positions later that doesn’t make fluoridation good.
I think you are a little confused. The two statements above are contradictory: it is you and the anti-fluoride activists who are claiming the scientists are wrong! The science is clear: fluoridation is safe and effective. There are doubtless a variety of reasons why governments do or do not choose to fluoridate their water. Your “most countries” is deceptive- many countries have little in the way of central public water supplies in any case. For other countries, they may be rich enough to have other methods to effectively prevent poor dental health. It is not for me to say whether they are “right” or “wrong”; the point you still dont seem to get is that the fact that one or many countries choose not to fluoridate or not tells us nothing about the scientific evidence. You seem to think that science is just a majority vote of, not scientists even, but governments! LOL, if only! It’s like saying “50million Elvis fans can’t be wrong!” Clearly, there is no connection directly between the science and what governments choose to do. If Ireland stops fluoridation, this will certainly be because of anti-science scare-mongering from whacko quacks, well funded from the alternative health and Health Foods industry. The science has not changed, and does not change just because people turn against it. The anti-fluoridation movement is closely aligned with anti-vaccination, anti-GMOs, anti-nuclear, chemtrailz, UFOs…. it’s a paranoid anti-science conspiracy theory. Dont tell me, GMOs are bad ‘cos most of Europe have banned ’em! Governments can’t be wrong! Alas, governments respond to the herd-mentality and conspiracy fads of the constituents who shout the loudest, just as much as they do to scientific evidence: scientific credentials, or even acceptance of science as useful, are not in any way conditions for serving in public office. So now you are going to tell me weed is bad because most gvts ban it aren’t you? LOL. And you do have a choice btw: if you dont like the municipal water provided for you by your wonderful liberal democracy, just buy bottled water and STFU. Or collect rainwater- that is what I do. Seriously, I have no dog in this fight- I have my own rainwater supply and am nowhere near municipal supplies. I wrote this post because I am pro-science and I hate self-serving activists like Waugh lying through their teeth (pun intended). and I care deeply about public health measures and socialised health care, which is being undermined by quacks.