FAN Newsletter

UK Government Pushing Mandatory Fluoridation
The British Conservative party is using primitive propaganda techniques to push mandatory fluoridation.

Even though in the UK, government after government - of both parties - have endorsed water fluoridation, the practice has been stalled having reached only 10% of the population after several decades of trying. Prime Minister Thatcher could not move the needle even after offering to indemnify water companies against financial liabilities. Efforts to fluoridate Northern Ireland failed miserably with 22 councils voting against the measure. Scotland too remains unfluoridated and instead sports a cost-effective ChildSmile program which has had greater success fighting dental decay in low income areas than fluoridated countries like New Zealand.  Efforts over the last two decades to fluoridate Southampton, Manchester, and Hull have all failed. Now comes Boris Johnson with an effort to introduce mandatory fluoridation for the whole of England. For the details, see the UK policy paper, Health and Care Bill: water fluoridation, from the Department of Health & Social Care.

However, their rationale for doing this lacks scientific substance, and their dismissal of the US and Canadian government-funded studies on IQ are shoddy. Our well-informed supporters will cringe when they read the commentary in this Policy Paper on two of the IQ studies funded by the US National Institute of Environmental Health Sciences (NIEHS) in the section on the “Evidence of potential harm” (see below) They will immediately realize that this is a crude piece of propaganda posing as scientific analysis.  Our supporters will realize this, but unfortunately, in Britain and other fluoridating countries, many citizens will not, because the media is not keeping them informed about the Mother-Offspring fluoride studies performed in Mexico and Canada. I will summarize those findings and then show how crudely the British government paper uses sleight of hand to dismiss them.

Fluoride’s neurotoxicity

To put the neurotoxicity issue into context, there has been an ever-growing body of peer-reviewed studies, beginning in the mid-1990s, that indicate that fluoride is neurotoxic. To date, 69 human studies, most from endemic fluorosis areas in China, have associated lowered IQ with fluoride exposure.  Promoters of water fluoridation have dismissed the relevance of these studies (a) because of methodological limitations and (b) because many (but not all) of these findings occurred at higher fluoride concentrations than those used in water fluoridation programs.  Nevertheless, there has been general agreement that the findings have been remarkably consistent (Choi et al., 2012). Moreover, some of these studies have been very good, e.g. Xiang et al., (2003a, and 2003b), and of course that fact “disappears” in the proponents’ broad brush dismissal of ALL the studies.

A very significant improvement in the quality of these studies occurred in 2017, when the first of four NIEHS-NIH (National Institutes of Health) funded prospective-cohort studies were published (Bashash 2017 and 2018; Green 2019; and an infant study by Till 2020). 

For the first time, the studies included measurements made in pregnant women and their offspring.  This was important because fluoride is known to cross the placenta.  Measurements of both exposure and outcome were made at the individual level (previously these were made at the community level, in so-called “ecological” studies).

The study by Till, 2020 showed that the infant brain is also very susceptible to damage from fluoride. This study found a large reduction in children’s IQ when as infants they were bottle-fed in communities which were fluoridated compared to children who when as infants were bottle-fed in non-fluoridated communities. 

Most importantly, the fluoride exposures in all these studies were at levels commonly experienced by pregnant women and children in fluoridated communities in Canada and USA, which adds fluoride at 0.7 ppm. The weight of evidence now strongly suggests that fluoride is capable of damaging both the fetal and the infant brain at very low levels.

Based upon Grandjean et al., Benchmark Dose Analysis (BMD) published in June 2021, offspring born to women exposed to fluoride doses commonly experienced in communities at 0.7 ppm, would experience a loss of 4 to 5 IQ points.  To put that into perspective, at the population level a shift downward of 5 IQ points halves the number of very bright children (IQ >130) and increases by 57% the number of children needing special care (IQ <70).  Both changes have enormous social and economic ramifications for a large population in a country like the UK.

Largely, because of the large number of children being deliberately exposed to fluoridated water, "fluoride is causing a greater overall loss of IQ points today than lead, arsenic or mercury" according to Grandjean et al. (2021) in their BMD paper.

Not mentioned in the UK government paper are other recent studies published on other organs, tissues and body systems, for example a major prospective cohort study from Sweden demonstrates a higher risk of hip fractures in post-menopausal women associated with long term exposure to natural fluoride at levels in water in the same range as the USA fluoridates its water [Helte et al., 2021]. This is a very serious finding because it is well known that hip fractures in the elderly are debilitating, costly to treat, lead to a loss of independence, institutional care and often shorten the life of those impacted. This finding also underlines the fact that fluoride can impact our health from womb to tomb, affecting the brains of the fetus and the bones of the elderly after lifetime exposure.

So with that backdrop, here is how the UK government paper dismissed the health concerns of water fluoridation.

“Evidence of potential harm”

“… there have also been some more recent studies reporting associations between exposure to fluoride and adverse developmental neurological effects [Bashash et al., 2017; and Green et al., 2019]. However, the evidence does not support this and various authoritative expert evaluations from different international organisations all agree that there is no convincing evidence that fluoride in drinking water at levels used in fluoridation schemes or at concentrations below the regulatory drinking water limit is harmful to general health [Canada, 2019; Australia, 2016; New Zealand, 2021; European, 2011; Ireland, 2015]. 

What’s wrong with the UK analysis?

1. The UK authors have not put this discussion into the larger context of a very large body of evidence of both human and animal studies that fluoride is neurotoxic. 
    
2. In their discussion (or rather dismissal) of recent IQ studies the UK authors failed to mention the very important study of Till et al, 2020 discussed above. This was released in November 2019, approximately 20 months prior to this UK analysis. That is quite an omission. Scientists call this “selective use of the literature” and in this instance it has been used to serve a political agenda.
    
3. Referring to the Bashash, 2017 and Green, 2019 findings, the UK authors use the vague sentence that the “evidence does not support this” without citing a single specific study, of comparable rigor, which refutes these findings.
    
4. When the authors switch to the claim that, “expert evaluations from different international organisations” to dismiss the importance of these two IQ studies, they do a very poor job.

The UK Policy Paper provides citations to 5 reviews from what they call "international organizations" to support their cavalier dismissal of the NIEHS funded Bashash, 2017 and Green, 2019 studies. Only one of these reviews comes from an international organization (EU’s SCHER) the other four come from government agencies within countries with a large percentage of their population drinking fluoridated water. Their reviews usually support government policies.

EUROPEAN - 2011. EU. Scientific Committee on Health and Environmental Risks - SCHER (2011). Critical review of any new evidence on the hazard profile, health effects, and human exposure to fluoride and the fluoridating agents of drinking water.

Note: The EU SCHER committee published their review in 2011 when only a small sample of the 69 IQ studies were available. As far as the UK commentary is concerned this review has no bearing on the quality of the Bashash, 2017 and Green, 2019 studies, since this review was published 6 and 8 years before Bashash, 2017 and Green, 2019, respectively.

IRELAND - 2015.  Health Research Board. Health effects of water fluoridation. An evidence review. Health effects of water fluoridation.

Note: This board was appointed by the Irish government that has enforced mandatory fluoridation in the country since the 1960’s. Their review is irrelevant in terms of the UK commentary since it was published two and four years before Bashash, 2017 and Green, 2019, respectively.

AUSTRALIA - 2016. NHMRC. Jack B, Ayson M, Lewis S, et al. Health Effects of Water Fluoridation. Evidence Evaluation Report. National Health and Medical Research Council; 2016.

Note: The National Health and Medical Research Council (NHMRC) is part of the Australian government and it is generally felt that its role is to defend government policy on scientific matters. In this case, Australia is extremely pro-fluoridation with the largest percentage of their citizens drinking fluoridated water than any other large country, even the USA. In this review, which is essentially a repeat of their review in 2007, which largely consisted of sections copied and pasted from the York Review (McDonagh et al, 2000), their reviews of IQ studies are poorly done. One example, in 2007 they excluded the Xiang et al., 2003 study because they claimed it did not have a control population, which it certainly did. Again, this Is all irrelevant because this review was published one and three years before Bashash, 2017 and Green, 2019, respectively.

CANADA - 2019.  CADTH. Community Water Fluoridation Programs: A Health Technology Assessment-Review of Dental Caries and Other Health Outcomes. Ottawa; 2019.

Note: This is the first of the cited reviews in the UK paper that was published AFTER the Bashash, 2017 study was published. However, it was a very poor and biased review and it didn’t review the Bashash 2017 study. I was a member of an expert team invited to critique this review on behalf of Safe Water Calgary (see July 2019 critique). Safe Water Calgary suspected, and probably correctly, that this review was rushed into press in order to influence a Council decision to re-fluoridate Calgary (it stopped the practice in 2011). But again, that is irrelevant to the UK’s argument because this report does not examine either the Bashash 2017 or Green 2019 IQ studies.

NEW ZEALAND - 2021. Office of Prime Minister’s Chief Science Advisor.  Update on evidence The Royal Society of New Zealand, 2021. Fluoridation: an evidence update.

Note: Finally, we come to the only cited review that actually had something to say about Bashash, 2017 and Green, 2019.  Before we say a few words about this commentary it is important to understand the political context of this review. It appeared in time to provide some kind of scientific cover for the second attempt by the government to introduce mandatory fluoridation into NZ. This quote will give you an idea of how poor their understanding is of the literature on fluoride’s neurotoxicity:

“Recent studies continue to show that at very high levels and with chronic exposure, fluoride could potentially have negative neurodevelopmental and cognitive impacts. However, this is not a concern at levels used in fluoridation of water supplies in Aotearoa, New Zealand.”

This is nonsense. All the NIEHS funded studies discussed above (including Bashash, 2017 ; Green, 2019; Till, 2020)  were done either in communities fluoridated at 0.7 ppm or where residents received equivalent doses from other sources (as measured in the fluoride levels in pregnant women’s urine). The average level of fluoride in NZ’s water is 0.85 ppm in fluoridated communities, making the potential for more IQ loss than in the US and Canada.  

The review provides no critique of Bashash (2017) but they have this to say about the Green (2019) study:

“The study undertaken in Canada (Green et al. 2019) found that the mother’s exposure to fluoride during pregnancy was associated with lower IQ scores⁹ in boys (but not girls), even at optimally fluoridated water levels (i.e. between 0.7-1.2 mg/L). If this finding were replicated in robust studies, it would potentially be concerning as Aotearoa New Zealand recommends fluoridation of water between 0.7 and 1.0 mg/L. There was significant and valid criticism of aspects of the study by many subject-matter experts when it was released (see for example, ‘expert reaction to study looking at maternal exposure to fluoride and IQ in children’ (Science Media Centre 2019)). The study used sub-group analysis to find an association that is not explained in the paper (i.e. why were only boys affected¹⁰ and why verbal IQ was not impacted), the effect appeared to be driven by the minority of participants that had much higher fluoride exposures (i.e. higher than those in Aotearoa New Zealand).”
 

Note: None of these “subject-matter experts” were specialists in neurotoxicology and were hastily gathered by the UK industry-friendly Media Center for the purpose of deflecting concerns on the Green paper. The authors have responded to every single criticism of their paper, which included simplistic and inaccurate comments like “This is only one paper, we need more research.”
 

Then the NZ authors did what most promoters of fluoridation do when tackling the IQ studies: they compared it with a study done by Broadbent et al. in NZ in 2015. Comparing the methodology of Broadbent to that of Green, is like comparing a mole to a mountain. One only has to read the opening sentences of the Broadbent study to see how politically motivated it is on this issue. Broadbent complains that the fluoridation program is being threatened by citizens who have grown alarmed about the IQ studies mainly from China, citing a recent council meeting in Hamilton. Clearly the purpose of the paper was to dismiss these concerns. The paper was seriously flawed, and a recent draft review by the National Toxicology Program (NTP) gave it a low quality ranking.

Here are some of its weaknesses:

1. There were no individual measurements of exposure to fluoride. The cohort and control were differentiated only in terms of community water level.
2. The sample sizes were hugely disproportionate: 99 in the “non-fluoridated” community and 891 in the ‘fluoridated.”
3. There were other differences between the two communities which were not accounted for including other elements in the water. There was no control for lead exposure even though the same cohorts have been used to investigate lead impacts.
4. Many of the children in the “non-fluoridated” community were likely to have used fluoride (a prescription drug designed to deliver the same amount of fluoride a child would get from drinking fluoridated water).
5. Moreover, NZ at the time was one of the largest tea drinkers in the world. Tea is another major source of fluoride.
6. Thus, there was little difference in the total dose of fluoride between the two cohorts and the power to determine any difference in IQ between the two cohorts was very limited.
7. Of the four factors Broadbent did adjust for, most were only crudely controlled. For example, SES was determined solely by the father’s occupation and classified into just 3 levels. Inadequate adjustment for SES could obscure a lowering of IQ caused by fluoride, because almost all of the non-water-fluoridated children came from one outlying town that had lower SES than the fluoridated areas.
8. Finally, one should compare the status of the two journals in which these two articles appeared. Broadbent published in a dental journal, not one specializing on neurotoxicity or infant development, on the other hand Green published in JAMA Pediatrics, which is one of the leading journals in the world of its kind. Green’s paper was subjected to as rigorous a peer review as a paper of its kind is ever likely to get. Listen to the JAMA editors discuss the paper in an online podcast.

So out of the 5 citations provided by the UK government paper to dismiss concerns about Bashash (2017) and Green (2019) only one citation provided relevant criticism on only one of the two papers, and that has been addressed by the authors!

UK citizens deserve a lot better from the UK government on this serious issue.

Thank you, 

Paul Connett, PhD
Director
Fluoride Action Network