:'x

ft
,{
'

.!
ai

'i

I
I

,l

FLUORIDATTON, 1g7g

.i
Dangers
t,

Scentifc Crticfsrds a.nd Fluoride

by

,l

Phillp R.N. Sutton,

D.D.Sc.(MeIb.), T,.D.s. F.R.A.c.D.s. caderelc ssociate, Ilniversity of Melbourne.
Formerly Senfor Lecturer

;
l
I

ln Dental

Science,

Senor Rosearch Fellow

A personal eubneson to the Committee of fnquiry Lnto the

Fluorlilatloa of Vlctorian Water Supplies Conprf.eingl Dr D.lul. Myers C,M.G., Charman,

Dr V.D. Plueckhahn, EtD: ancl Dr A.T,.G. Rees, O.B.E.

August,
With

1979

an, Appendf.x

January

1980

copyrJ.ght @ 19Bo by philip R.N. Sutton

rsBN o95949?6og

PRBITACE

Tliis subnrission was prepared opecificalJ.y to corlply with the

Terms

of Reference of the Committce of Inquiry into the

hJ.ter

Ftuoridation of Vlctorirn
vras preparecJ.

Supplies.

0f necessfty it

to meet the revised dead-l-ine specified by the

important information which has
come

Comnittee.
New and

to

hand

since this

document vas submitted

in August,

1979

has been

added as an Appendix.

For a serious consideration of fluordation it is

necessary to consider a nuch wider coverage of several aspects

of this subject.
more

It is suggested that at least three of the

recently published boohs, mentioned in the references,

are essential- readin6: The Fluoride Question (Gotzsche , 19?5), Environmental Fluoride . 1977 (Rose and. Marier, 19??) and, Fluoridation: The Great Dilemma (Walaott the Fluorj-dation of Drintcing
Vrlater

4' ,

19?B)

'
and

n addition, tre Report on the Quafitr of the Environment

written by a minsterial
Judging by the

comrnittee appointed by the Government of Quebec, Canada, has

just been printed and will be available soon. In

was
my submission

abstract of its contents, this is a very important publicatj-on. the discusoion of dental fluorosis in section XIX.
Thj.s has norv been moved to section XIII,

therefore the origina sections XIII to XVIII have become XIV io XIX, respectively.
January,
1980

P,R.N.S .

TAI]LE O}'

CON'.UJNTS.

I'age

Tal.j-e

of

contente;.

II. III.
IV.

Introduction.
Sumrnary.

6
9

PAIT

ONE

Iuiethods used

to prornote fluoridation.

12

(1) (z)

3)

(4)

(a) Discouragement of discussion on fluoridation. (b) Repression and, abuse of opponents of fluoridation. (c) The suppression of publisheu evidence against fLuoridaton. (A) Diffj-culties in publishing neb, naterial which questons fluoridation. The motives of those who prornote fluoridatlon. ( a) Altruistic motives. ( b) Financial advantages from promoting fluoridation. (c ) personal_ prestige. fluoridation.
between

A.F. C.0. Repressive actions.

1L Political- action to introduce fluoridation. 15 Pronoti.on by rend.orsements | . (a) The dominant role of the U.S.P.I{.S. in the promotion of arti_fcial 17 fluoridation. (U) Australian endorsements of 18 f luori.dation. (c) The basis for endorsements. 1g () Scientific decision by najority vote. 1g (e) Scientiots and scientfic organizalons 20 opposing fl-uoridation, (f) A comment on endorsements by the N.H.& M.R.C., A.1.4., A.D.A., and

21

27
21

26 29

11

34
Z

t4
37

v.

The nature of artificial

39 39 39 4o 40

(l ) The fund.amental difference

water supplies. (-6) Fluori<iation is-ompulsory medication. (?) Fluoridation may violate religious and personal convictions. () Fluoridation fthe favoured, pollutantr. 1

4r
47 45 46

lage

VI.

Fluoridatlon and dental

(r
)

manpower recluirements.

4Z 4Z
4B

Q)

0)
(4)

Studies by l)rofessor B.L. Douglas. The dentists in Ilasel- (Switzerland). The number of dent,ists in fl-uoridated and non- fluorfdrte d I r e pre sentative

Arnerican cities | . The number of dentists in U.S. fluoriclatfon

4B

() VII.
(r

trial

cities.

Comment.

5o 52 54 54 56 56
5B

The increasing rejection of fluoridation overseas.

Q)

3)
VIII.
IX.
X.

Vlestern Europe. The United Kingdom. the U.S.A.

Support for, and opposition to fluoridation by Australian medical and dental- graduates.
The difficulty
Plumbj-ng problerns

j-n controlling fluoride concentration.5g

resultng from fluoridation.

6l
66

xI.

Fluoridation and the safety of the vrater supply.

PART

TWO

XTI.

The effica.cy of artificial questionable. (r

)

fluorj-dation is
69

(2) ( (4 )

()
(6)

experimental controls . 74 Fluori-dation demonstrations . tcontrolled stud.yr and rcontrolled 74 Q) The terms fluoridationr. (B) Resu1ts, reports of results, and. opinions of 75 fluoridation trials. 77 (e) The gro6s errors in the main Arnerican/ Canadian trials of artificial fl_uoridation. (ro ) Additional eruors in the Evanston trial data. ?B ?9 (tr) The question of delayed eruption of teeth. 8t (z) Red.uction or retardatuon of dental caries. 8z 0t) Reports from statisticians. BB
2

The determinaton of changes j_n d.ental carj_es prevalence. 6g Longitudinal trials of fluoridation. 7o The need for controls in experi_nental trials. 71 The premature estabLishment of fluoridation trial s. The snall- number of fLuoridation trials with 73

PART IIIRI:;E

XIII.

Dental fluorosis. (t ) Dental fl-uorosis indicates chronic fluoride polsoning. Q) The prevalence of dental fluorosis in a

Page

9t 9t
9t+

3)
(4)

Factors affecting the degree of dental

The classification of dental fluoross. The Index of Fluorosis. I Objectionable I fluorosis. Teeth with mottled enamel are imperfectly formed. The appearance of dental fluorosis
f

fluoridated area. fluorosis.

(6) (?)
(B)

94 96 97
9B
9B

(e)

The unknovrn prevaLence of dental fluorosis The important factor of clinrate temperatureE.

rnottled teethr.

99 100
101

(ro)

in Victoria.

daily
poisoning

(tr) Short periods of chronic fluoride

produce dental fluorosj_s. Uz) The concentration of fl-uoride at which fluorosis occurs.
PART FOUR

102 103

XIV.
XV.

The roptimumf fluorde concentration in dr inking water. Other sources of fluori_de.

106 112 112 115 115 116

117 118 123 127

(t ) Fluoride in food. (a) Fl-uoride 1n processed foods. () Fl-uoride in everages. (c) Fluoride in watere () FLuoride in sprayea vegetables. frij-t and vegetables. (z) Fluoride in toothpaste, mouthwashes and

3)

Atnospheric fluoride. (a) Absorption of fluori.de fron the

tablets.

ndustrfal pollution. (c) The spread of fluoride contamination. (a) Diverse types of daraage from fluoride. (e) Atmospherc fluoride is not nonitored
by the Environment protecton Authority. xv.
XVIT.

()

atmosphere.

124 126 128

129

The roptimurar total fluoride ingestion.

The factor of emperature.

13t
142

Page

XVIII.

The fluoride concentration epecified in the Act is an arbltrary one.

PART FIVE

1\6

xil.

The toxicity of fluorid.ation

(1

thc effect of of - t^ater. the other constituents

149 158 161 162 164

) The importance of other constituents of the water. The sof tness of Mel-bourne nater. Q) (r) lVater hardness cal-cium and rnagnesium. (4) Naturall-y fluordatett water is usualLy hard.

xx.
XXI.

Ske1eaL

fluorosis.

166

FLuorLdation: Psychological reactions to dental fluorosia and direct effects on the central
netvous system.
169 169
172

(r

Psychologica3. reactione to dental fluorosis. ) Q) Direct effects of fluoride on the central

nervous system. Possible psychological results from

fluoridation.

179
1?t+

XXII.

Fluoridatj-on and cancer morta-ity.

) Early papers which suggest that fluorcle nay affect cancer. ( ) Conments by Inof essor Al-bert Schatz. (t) Papers linlcing fluoridation nith cancer mortality. (4) Comments on the report by Drs Burli and, Yiamouyiannis re6arding a l-nk between artificl-al fluoridation and lncreased cancer mortalty. (a) stattstical aspects. (b) Association and, causation. (c) the response 1n Australia to these
(1

1?4 175 177

1?8 1 78 1 ?9 180
181

fluoridat ion/ cancer mortality results. (a) tne U.S. court hearin6s and decision. (e) The visit of Dr Yiamouyiannis to Australia. (f) 19?9 pvblicattons relatng to thio
subject.

187
184 18?

lo(rrr.

Th infl-uence

of fruorrde in8eston on genetic changes mongolsm. 4

Page

XXIV.

Other nedical aspects of fluoridation.

191 191 193 194 196

198

(t ) Fluoridation and the thYroid. (z) The aorta. 3) The kidneys. (4) Other conditions.
XXV.

Intolerance to fluoridated water.

(r

AIlergy, Q) Fre-fluoridation evidence of intolerance to fluoride. 3) Intolerance to artificially fluoridated, wate!. (4) Confrmation of intolerance by doubleb1lnd tests. () Recent conplaints in Victora of intolerance to fluoridated water. (6) The difficuJ-ty in d.agnosing intoleance to fluoride. (7) Intolerance o fluoridated toothpaste. (B) The problen of l-ntolerance to fluoride will grow. (e) The great difficulty in obtaining compensation for il-lness caused, by fluoridation.
XXVT.

The denial by the Aurerican Acadeny of

198

198 199 200

201

202

20t
204 205 207

There s no margin of safety vith artificial

fluordation.

(r

The need for a large rnargin of safety for substances added to the water

Q)

3)
(4)

$)
XXVII.

recent marked decreases in the recommended dose of fluoride. Fa1ee claime that there is a 1ar6e nargin of safety wth fluoridatj-on. Msplaced confdence in claims regarding a safety margin with fluoridation. C1ans that there 1s a safety nargin with fluordation are I patently naive I .
The

supplies.

207
208

210
212 217

The influence of fl-uoridation on manrs environment.

214 214 214 218 220

222

(1) The ffluoride circuitr arising from fluordation. (Z) Fluoride d.amage to trees, plants and cut \7) (4)
The synthesis of organic fluoride compounds. Vil1 fluoridation affect rnarine life in

flowers.

Port Philtip

Bay?

XXVIII.

Conclueion.
Re

ferences

225
253
E

Appendx

II.

6.

of thfs rnquiry instruct the comnttee to receive tnew evidence concernng the effects on hurnans of fluoridation of water suppliest which rwould warrant a review of the Health (Fluoridation) Act. r (victorian
The Terms Reference

of

Governnent, 1977).

is vague, but is taken to refer, primarily, to naterial which was unrikery to have been brought to the attention of the embers of the vctorian Parlianent before the passing of the Hearth (Fluori.clation) Act in 1g?3, or whlch has been published or become known since that tine. of course t wirr be necessary to nention earlier pubrications, in order to rnake the Inevt naeriaI intertigabre or to pl-ace it i.n its proper context. unless earrier work is considered, practcalIy all the evidence which is stilI cited in favou of fluoridation, incruding the key experimental trials, cannot be taken nto account.
common sense

The expresson rnew evidencer

dictates that those who advocate the

compuloory nedication

of

whol-e popurations, such

as the

victorian Health Departnent, shourd be required to prove, beyond reasonabre doubt, that the process is efficacious and is safe for every nenber of the conmunlty. However, it appears that the Terns of Reference absorve the Health Departnent, and others, from that sensble requireraent.
nstead, the onus is placed on those who oppose artificial fruoridati-on to produce Inewr evidence.

Ae the Deputy Speaker of the llouee of Lords, Lord Douglas

of Barloch, oald ln

1960:

rThe fact remalns that the onuti of proving that

fluoridaton ie beneflcial to the teeth rests upon those who assert it, and so does the onus of proving that the continuous ingestion of fluorides involves no risk of cumulatve toxicity. This onus of proof has not been satisfactorily discharged. I
The dfficulty

in obtaning

ans'bers

from official

bodles to queetions relating to fluoridation, is

illustrated by the fact that the Premier of Western Australia wrote to the Nationar Health and Medical
Research

council requesting infornation about raccepted safety lnits for fruoride absorpt,ion, fluoridated water in hernodyalysie,
and

/[ustralian research or soientific discussion on fluorides. t Four and a half months later he had not
(Cant

| 19?Z), Even more remarkable is the statement of the Dr D. Everinghan (19??) ttat, when he was Australian Mnister for Health, 19?2 to 19?5, he requested his scentific justification for water fluordati-on.
He

received a reply.

Hon.

Departmental advisers to produce for hin a statement of the

After

reminders, two years later he finarly received, a short and

unsatisfactory reply.
I

said:

r indicated that r did not regard this as scientific evidence and requested the same; in partcurar claims of !aldbott and Rapaport that fluoride allergy or Downrs syndrome (nongolisn) are found to be associated with water fruordatfon should, r suggested, be refuted n scientific fashon, not by rhetoric or appeal to established authority. r an stiIl wai-ting to see such refutation. I

Edftorlal Ln the rGeelong Advertlserr of l4ay 14, 19?9() said that the Terms of Reference rseem to
The

be loaded n favour of the status quo.

The case

for artlficial

fluoridation remains the

sane. It wae stated by Dr L.G. OrBrien, the President of he Auetralian Denta1 Association, Vj-ctorian Branch, on April 26, 19?9. He clained. that: rThe simple truth is that there .s no scientifc controversy over the safety or effectlvenees of
.

fluorclation.

subnt that the evldence which will be docrrented in the following pages clearly indicates that that statement is incorrect and,, therefore, that the Act must be, at least, revieweil - if not inmediately repealed.

II.
SUI'4MARY

1.

tr'luorl.datlon has been pronoted by:

(a) valueless

rendorsementsf by various organizations, based nain]-y on

hearsay, (b) ttre repression of opponents of fruoridation, and (c) the suppression of new eviclence against t. 2. Fluorldation conpursoriry medicates every
member

of the

cornnunity wj.th smaLr doses of a poisonous substance through

their domestic drnking water.

rt contravenes med.icar ethics rt

ntended.

and may vlolate religious and personal convictions.

slould not be confused wlth chrorination, which is to trea.t the wat,er, not the consumer. 1,
claims that artificial

fluoridaion will reduce the

number

of dentsts required by the comrnunity have not been proved. 4' There is an increasing rejection of fluoriclation overcreas. fn western rurope, plants which had been in operation for many
years were closed and there is now an alnost conplete reJection

of fluoridation. 5. Opposition to fluoridation i-s expressed in rnost of the letters on the subject sent to tbe luiedical Journal of Aus tra]-a

6, I'he concentraion of fluoride in the domestie tap is very itfficult to regurate and usually it is not at the specifed
1eve1.

7, rt has been necesaary to add lime to the r.relbourne water to eonbat the rsevere corrosionr whch fr.uoride produces n water pipee. B, Recent'pubIcations su3gest that i.ncreasing the
-

arkau-nty of water, by adding limer the water is also chlorinated.

may be hazardous unless

10

9,

Cl-aims

that fluoridation w1Il produce a marked decrease

(approximately 60 per cent ) in the prevalence of dental caries

have proved to be, at least, grossly exapgerated.

10. Dental fluorosis, due to chronic fluoride poisoning of tooth-forming cells, will occur in at least ten per cent of children who drink fluoridated water from the time of birth. 11 , The roptirnum I or I optimal I f luoricle concentration in drinking water (said to be approxmately 1 p.p.m.) i" tr" on"
which promoters of fl-uoridation consider is the most favourable
one for teeth

they rarely consider its effect on the rest

of the

body.

12. Fluoride is being ingested in increasing quantities from sources other than water f6 food, toothpaste and from fluoride pollution of the atmosphere. Little is known of the fluoride levels in the Melbourne air for the Environnent
Protection Authority does not monitor fluoride.

11. There cannot be an 'optimunr total fluoride leve1 for every rnember of a communj-ty for this value varies with each
individuaL.

14. The irnportant factor of temperature variations

between

seasons has been ignored rvhen fluoridating our water.

15, The fluorid.e concentration of drinking water which is specifed in the Act is an arbj-tTary one. 16, Despite the addition of lirne to Melbourne rs waters they are still exceptionally rsoft I , wi.th 1ow concentrations of
calcium which is the antidote for fluoride poisoning.

11

1?, Recent publicatlons suggest the possibility that cases of ekeletal fluorosis may <levelop in victoria, particularly in
those who I1ve near fluoride-enittln6 factories. 18. Little is known of the psychological reactions of individuals
af flicted r^rith d.ental

fluorosis, nor of the direct

system.

ef f ects

of

fluoride on the central nervous

19. Recent discoveries SiVe support to the finding that an increase in mongoloid births is associated with increasing IeveIs of fluoride in water supplies. 20. ,tuoriated water, apart from affecting the teethr I have severe effects on other organs of the body. It should not be used in kidney dalysie machinee. 21. It is now deflnitely established that
some people cannot

tolerate fl-uoridated drinking water. They becone illt but recover when distilled vrater is substituted for their domeetic
water for drinking and cookng. 22. Clairns that there s a large margin of safety with fluoridation are false and are rpatently nal'vel ' 23. Fluoridation introcluces a rfluoride circuitr which
an uncontrollable effect on man and his environment.

has

24. Despite clains to the contrary, the reported link artificial

been disproved.
On

between

fluoridation and increased cancer mortality has not the contrary, preliminary data from

Brmingham, U.K., strongly support the presence of such a link.

rv.
12

TIIE

METITO

DS USED

TO PROMOTB FLUORIDA TTON.

rt fe eecentiar- for anyone who undertakes a study of the fruoridati-on of domestic water suppries to rearn

somethfng

of the methods used to promote this procedure. This should be done before considering the scientific side of this controversy for, without that knowledge, sone of the facets of the fluoridation discueslon wilr be incomprehensible. Nornally, scientific progranmes are accepted or -rejected on their nerite, as judged by studies of the orig'inal data by a group of scientists chosen so that each of the many aspecte which nust be investigated is covered by at reast one expert i-n each fier-d. Fr-uoridation departs fron that custom. rt was conmenced rnainly on the advice of public health dentists and officials with littre participation in the trals by competent statistcians,
chemsts, engineers, pharmacologists, toxicologists and

and by endorsemente, as though it is a commercial product.

rt is notabr.e that much of the criticism of fruoridati-on comes fron scientists traned in those fields. Fluoridatl0n ie the fist measure designed to affect the health of the population whch, instead of being accepted on the consensus of scientists, has been rsoldl to indj-viduals and governnents by propaganda In
a

physiologists.

sense, of course, it is. Professor C.M. IrfcCay, in 1)Jl, said: rrhe whole prograrn of fluoridation has been d.one with too much haste and lvfthout careful research and study.

1'
The trouble Ls that profits emotions have been created

arc lnvolved for in others'r

eome and

Dr A. Aslander 9966) said:

rThe fac that fluoridation has Sained such prominence

iseasilyexplaj-ned.Itispronotedbyveryclever' very lavish and very unscrupulous propaganda' It is adisplayofmasterlycommercia]ism.Andthepromoters I have been able to engage the interest of politcians. The Victorian IIeaIth (Fluoridation) Act, of December 11, 1g?3, provides that the Inet capital costs and expensesl will be rprovided by Parliamentr, and it makes fluoridation compulsory for the whole State by stating that any person or rany water supp-y authority contravening or faiing to comply with any of the provisions of this Act or of the re6ulations thereunder shall be Suilty of an offence against this ct; and shall be liab1e to a penalty of not less than $2OO nor more than $'1 rOO0 and in the case of a continuin6 offence, to a daily penalty not
cxceed,ing xi40.
t

Less than a year prior to the passing of that Act, tlre

Secretary to the Premier of Victoria wrote:

rI arn directed by the Premier to acknowledge your letter of 9th December | 1972' concerning fluoridation of
Victorj-an rvater supplies. I*r. llaner has ashed, me to say that the Government i-s not prepared to nake fl-uordation of water supplies compulsory and will not direct loca1 bodies to introduce (Greenr 19?3a), it.r As no signifi-cant nev information j-n favour of fluoridation
was publishecl durng that yeart why did the Victorian
Governrnent completely

reverse j-ts atttude on this matter?

14

prior to the passing of the Act, statements were made that aII the experte had been coneulted. This wae not the case. Ner-thcr or the political parties sought
information from any of those i-n victoria who were widely known for their opposition to artificial fluoridation. Even Professor Sir Arthur Amies, C.M.G., Dean of the university of Melbourne Dentar schoor for more than thirty years, ras ignored.
The nethods used

to pronote fluoridation wirl

be

considered under four main headin6s:

(t) Q) 3) (4)
(r
)

Political action to introduce fluoridation. honotion of fluoridation by rendorsementsr.

Repressive actions against those who question or
oppose

fluoridation.

Motives of those who promote fluoridation.

Po

litic In 1961 | the

tion to Int roduce Fluori da tion.

published an article by Dr D.R. McNeiI, who said: fle cannot escape the fact that fluoridation has been wrested fron the hands of the scientist and deposited squarely in the middl-e of the political
arena.

Fluoridaton is now a political problen. lrle are striving to reach the nnds of men so that they will take political action. r ,f have seen, and. und,erstood, the reluctance of citizens to become embroir-ed in a vicious hate campaign often unparalJ-ed in the history of the comnuni'ty' r He spoke of rmore funds all0tted by the rl.s. public Health service to finance the battr-es.r I rn short the war should be carried out on a thousand, fronts einul-taneously.
r

15

More rocently, an

articlo ln the Brltleh Dental

Journrl

urged the dental profesefon to roranize for the next

battlesr (Burt and Petteroon, 1972) and said: rFluorl-dation everywhere is a politicaJ- matter and the dental profession bas to be prepared to treat it as
guch.
I

In 1978 the U.S. Publ-ic Health Service journal Public Health Re rts , published an artcIe entitled rFighting the Latest Challenge to Fluoridation in Oregonr. It said that tn 19?6 Llne State fluoridation group rhired
an experienced
campaj-gn

director to coordinate efforts

Although costly, thj.s
was

and

give fuJ-I-time oversight. essential.r

(Rosenstein et al., 19?B).

Ths determination to force in fluoridation is

also seen n Australia. a full-scale education

down

For instance, n 1959, Professor

programme would be
I

N.D. Martin said that before Sydneyrs water was fluoridated

held rto break

public oppostion.

If the decision regarding fluoridation rests on political

rather than a scientific basis, then the oftenrepeated false claim, that rlaymenr should have no part in the decisi-on whether or not they are to be forced to consune extra quantities of fluoride, obviously is not
va1id.

(Z) Pronotion of Fluoridation Artificar

byl Endorsements | .

fruoridation is now endorsed by a nulttud.e of associatons and organizations, fron the trlorld Health
Organization to schooJ- parents clubs.

This impresses

peopre who have not been tralned in ecientific methods, and also some mpreooonable ocicntistc. For i-nstance, in a speech in the House of Representatives, in 1g64, sir Robert Menzies mentioned no fewer than twenty-three

of

these endorsing bodieo.

of course these endorsenrents

are announced by the executve officers, it does not forro'u that the majorityr or even a large number, of the nembers of an organization support fluordatlon. Iofessor II.A. Schweigart (96Z) said that it the government to fruoridate the drinkng water, despite the fact that most of the t5 rooo membcrs had not been intcrviewed. to obtain their views on this problern. He said: tfn a slmilar way the Deutsche Gesellshaft fr Zahn_, iund-unri Kieferheilkunde asked for the fruoridation of drinking water and defarned the opponsls _ many of them with highest scientific reputation _ as not competent and not qualifiec. I However the executive of that society failed to gain the support of its members for that action. He concluded by saying that it is :r great pity that there are para1le1 cases in other countries. Dr A' Irorton (lg?o) asked rwhy the hess seens to infer that the A.Il.A. speaks for allits menbersr when ilIetters to the editorr show that a nunaber of doctors oppose na6s nedication by fluoridation. ,lthy give fluoride in such a haphazard rnanner to everybody? |
should be asked who was responsible for the organi'zation of dentists recluesting
German

17

I do not know of a properly-conclucted brl-lot being held to determine the proportion of Victorian dentists who support fluoridation.
(a)
Some yearc!

a8o there wa a ourvey of

ornall and biassed samPle.

The Dominant Role of the U.S. Pub1ic IIeaIth Service

in the Promotion of Artifc ia1 Fluoridaton. The U.S.P.H.S. was the first, and, rernans the nain, promoter of artificial fluoridation. Its first
endor:ement was on June

1r

1950

only five years and four months after the commencement of lAs a the proposed 1o-year frst fluoridation trial:. reoult of new evid,ence from its Grand lapj,ds project.t (lotrr and Love, 1954). It was pointed out (Sutton and
Amies,

) tfrat, in children who had been drinking fluoridatecl water all their Ives, rat that time very few,
1958 harm

if any, of tlreir permanent teeth had even erupted. I Therefore there vtas no evidence of either benefit or to the permanent teeth, for they could not be
Soon

examined.
was

aftervrards, that key U.S.P.H.S. study

effectively destroyed by the fluoridation of the control The results reported frorn that study are still city.
A report from vridely cited as evidence for ffuoridation. statisticians stated that, j.n that study, rThe authors appear to have demonstrated an unfortunate disdain for
some
.

of the pre-requisites of valid research. I

( De

Stefano 11954)

The .S.P.H.S. stil-I remains the main source of

financial support for the promoton of fluoridation.

18

(U) ustralian

Endorsement

s of Fluori_ dation.

practice of rselr-ingr fr-uoridation to the pubJ_ic and to governmento, by citing the names of cndorsing bodies, has
been adopted

The U.S.

in Australia.

The Federar vicL.-president of

the Australian Dental Association (A.O.A.) recently mentioned as endorsers the r\ustrar-ian Department of llealth, the Health Comnission of N.S.t^I . I the N.S.l,^J. Cancer Council and. seven 'overseas bodies. IIe said that spacc vou1d not permit a listng of the rmultitucle of professionar
associ_ations and

respected indviduar scientists who have encrorsed

fluoridation. | (Australian Dental ssociation,

1g?g).

A.F.c.o., 1g?. ('tgzg) said :

rThe
NII&I'fRC

which atacked what it doscribed as ran organized and ill__inforrned campaign against fluoridation. r (l.11.& I,t.R.c. r A.M.. I A.D.A, and
The Chairrnan

), the A.D.A. and the Austraian lrledical Association (A.M.A.). Recently they joined with the Austrrrian Federation of consurner organizations (A.r.c.o.) in a joint statement

The main endorsing bodies are the National Health and I'ledical Research Council_ (N.H.& M.R..

of Council, N.H.&

I..R.C.

were ur,animous in their support of the controll_ed fluoridation (where necessary) of water, supplies a6 one of the greatest and safest improvements in public heal_th available to us. r
Hon.

0f course, as the forre FederaL Minister for llealth, Dr D.N. Everingham (lg?O) sad:
rThe authoritieo mostly referred to in supporting fluorj-dation are political (.M.A. , IIHO etc.)
r

and journa-istic rather than scentific research soceties like Britainfs Royal Society.

19

(c)

The Basis for Endorsements. The endorsements of

fluoridation by these Australian an{ overseas bodies are not based on studies which they have conducted. As Lord
Douglas of Barloch expressed it,
when

referring to the
V'IIIO,

IJritish Medical Research Council, the

nedcal and dental associations:
rtrone

and various

of these bories has done any original rescarch which rvould justify recommending fluoridation. They have rested themselves upon the opi-nion of ot,hers. tIn the cnd this J-arge and apparently authoritatve body of opinion is seen to be an nverted pyramid restlng mainly upon the interpretation by a few persons of a selection of statistics of the e>:perimental rIt is indeed characteristic that the trials.r opinions expressed upon this subject becorne increasingly dogmatic as each one in turn is based upon the opinion of another and become further removed from the facts which ou6ht to be their foundation. I (Douglas of Barloch, t96O). I
r

(a)

Scj.entific Decision by lia.jority Vote.

It is

frequently stated that the rnajority of scientists favour fluoridation. The Editor of the Journar of the Denta1 Association of South Africa (959 ) said:
rwhether the scientists who favour fruoridation are in

the vast majorty we are not in the position to state. fn any case, numerical strength is no yardstck by which to nreasure rghtness or wronrss. The history of medicine teems with exampes of one lone scientist being proved correct in the face of a hos of opponents.f I See appendix /e p. 266.

(e)

20
Sc

ntists

a nd Sc ie

ntific

nization sO

In the case of fluoriclation it i.s by no neans a cau,e of rone 10ne sclenti-st r, for a very large number of scientists are opposed to that * nro"uuu. M^ny of these are senor nen and. v/omen of conslderable standinS, some of whon have a110wed thei-r nanes to be listed as opponents of fl-uoidati-on. one rist contains the names of twerve Nobel Prize winners who rhave expressed eservations about the safety of the artificial fluoridation of public water supplies.r (London Anti-Fluordation Campaj_gn) . of fruoridation are cited, trrere is never any mention of these scientists, nor of the opposition of prestigeous bodes such as the rnternatlonar_ society for Research on Nutriti-on and Vital Substances. lrlhen it passed its Resolution 3g opposing fluoridation, its scientfic council consisted of rnore than 4Jo rnembers, sfxty per cent of them being professors, drawn ron lJ countries. (professor AIbert Schweitzer was the Honorary president for nine years. ) ALl their resolutions were approved by the entire rnernbership, with a consensus ranging from 9i to .1Oo per cent of the votes. (International Socety 1c)67). , professor H.A. Schweigart, the president, revealed. that the society had frequently dealt with the fr-uorne problem' and that the pros and cons had been carefuly weig'hed' Experts fron several
countri-es had rexamined
when endorsernets

Fluo r da IOn.

conscentiously the argunentationf before their resolution

See appendix

/c, p.

265,

21

nurnber

J)

was

publiohed.

The translation from the German:

Scientific Council of thc Intcrnational Society for Reseat ch on Nutrition and Vital Substances recommends thatallgovcrnmcnto'statePariamcntsandCity councils, concerned with the problern of fluoridaion of drinkinS water and. protection fron dental caries I should refrain from fl-uoridating d.rinking waterr which measure is .rctually a medication, as 1on6 as the scientific aspects of this problem are not satisfactoril-y clarified. | (International society, 1967). (r) A Comrnent on the Endorsement of Fluoridaton by the
rThe

National Health

and lulertical Re search

As sociation.

Council

the

Australian l"fedical

the ustralian Dental

ssociation and the Aus+-ratian Federation of Consumer orranizations. An important insight, into the true value,

in fact the deceptiveness, of endorsements by organizatonst even by those four lcacling Australian ones r was given recently at a meetin6 at the Australian National University' at which I was present. It vas called to hear an American lecturer, Dr J. Yiamouyiannis, and to cliscuss the questi-on of a ].ink between artificial fluoridation and cancer mortality, revealecl by hm and Dr Dean Burlc (lgZZ). The
spokesrnan

appointed to oppoe;e Dr Yiarnouyiannis vas I>r.ofessor

R. Thorp (who is, I u.nderstand, a retired professor of pharmacy). A subsequent statement by Dr I'1. Dieeendorf (lglg) described the outcome very accurately. He said: rIn short, the rrdebaterr was a complete walk-over for Dr Yamouyiannis. This $tas srrprising, because just before Dr Tiarouyanns's amival in Australiat Professor Thorp, opeaking on the media on behalf of the NIIMRC, the Austraian l'ledical Associationt the

22

Austrari-an Dental Associaton and the Austrarian Federation of Consumer Or6anizationo, haci made a etron6 attack on Dr y-amouyiannis and statc.d positveIy that there was no link betwcen fr-uordation and cancer.

and Kin]-en, and olclham and lrer,er-r, rrhose rvork contains the sarne werl-documented error ancr r.rrich in adclition has been scientifieally critcizecl by Dr Yiamouyiannis and Dr Burk. I

since the sporresman for these eminent authorities was unable to substantate his clains scientifically, it seened fair to ask who in ustrara assessed the scientifi.c papers on both sidcs of this controversy and advi-sed the lr'ilc the rrr, the D;\ and the that there is no li-nk betrveen fr-uoridation and ^Fco cancer? To the amazement of the uncornmi-tted menbers of the audience a the I{u crebate, rtofessor Thorp was unable to answer this question. The answer, I suspect, a smply. There j-s no one. The NIIlffiC, ill4, AD/r and AFCO have sirnply, without thinking, accepted the advice of their op:osite numbers ovetseas. These in tun have unthinkingly accepted the resul-ts of thc US l,lational Cancer fnstitute, DolI

Dr Diesendorf continueci

fDoes fluoidation cause cancer ?

it is very difficult

piece of research (published in r.luoridefr volume 10, pa'e6 102-123) whch shows a correlation betveen fluoridaton and cancer death rate and has not been convncingfy refuted in the two years since its publication.
The response of the nedical and dentar authorities has been to produce 10ng lists of au'rorites vrhich have endorsed fluoridati.on, and to marre

epidemioloBy. However, I do know that Dr yiari:ouyiannis and his co-author, Dr Dean Burk, have produced a substantial

I do not know, because to prove causal rinrcs in

nsnuatons

2t about ths charrctor and j.ntegrlt,y of Dr Ylamouylanno and Dr Burk. I

lle concluded:
rDoes

fluoridation caue cancer? I do not l"nowt but one thing io clear: neither d'o the NIIMRCt AMt ADA and AFCO.T (Diesendorf' 19?9).
ReDres sive

3)

Actions.

Recently the more reprehensible sicle of the fluoridatj-on

promotion is becornin6 widely known. This comprises four

elements: (a) fne discoura6ement of acientific discussion (b) ttre repression on fl-uoridation and involvement in it.
and even abuse of scientists and others vhose findings and

publications cast doubt on any aspect of fluoriclation. (c) The suppression or disregard of evidence against () Actions to ensure that new evdence fluordation.
against fluoridation is difficult

to publish.

(a) The Discouraf,ement of Discussion on Fluoridation.

The United States Publ-ic

clistributes
Congress

enormous

liealth Scrvi.ce (U.S.P.II.S. ) funds to ts many agencies. (U.S.

, 197?) . It also finances many researcb. grants, both n the U.S. and in other countries. This control of grants has a restricting effect on the scientific
discusson on fluoridation, which is a process strongly
pronoted by the U.S.P.H.S. American professors have

admitted to ne that they have to thinlc of their 6rants

and, therefore, avoid the subject of fluoridation.

This

is understandable for, apart from the financial aspects,

24

there is the dstinct possibiJ-ity that, if they questioned fLuoridation, they would be abused and rdamned by
assocationr .
I

(fnts matter will be nentioned l_ater.

Mr Ralph Nader said:

r think the way out is first to reco6nize that there are a 6reat nurnber of scientists in this country and abroad who are afrad to speal< out on the subject ffluoriaationJ . the II.E.1r. Illealth, tducation and. viierfare Department, u.s.p.fl.sJ has been known to dear with this kind of person rather harshly in the dissemination of research grants. r And ryou just donrt expect to be treated well by H.E.!rl. in ts massive research granting if you come out against ths type of thing. rtrs a matter of professiona_ intlmidatlon here. r (lrlader, 19?1).

Dr F.H. Quimby (lgzo) cited an article vhich said that Dr A.A. London (who had investigated fluoridation

for

many

years) sought a chance to speak at an American Association symposium on fluoridation.

Dentar.

IIe v.,rnted to
was

mention new evidence on side ef fects. llis recuest refuoed on the grounds that: rlhe theme

of the

symposiun

is not controversy, but additional crocumentation of the universarity of experence of the safety and effectiveness of fl_uoriclation, world wide. presentation of the type of paper you propose would be an insult to the scientifc
corurunity today.
r

T'e Assistant chief, Division of Dentar public Health' u's'p'H'S.r advised Austrar-ian dentists not to permit fluoridation to become a subject for public debate. (Ga1agan, 1g5g). comrnenting, sir stanton llicks said that that advice discl0ses rvr.hat in ny opnion is a dangerous

25

trend in our day and a6e. This is the tcndency of the pseudo-scj-entific expert to use his authority to impose his viewc. r
(ltict<s

| 1961).

InAustraliaracademcsandinstitutionsare refuctant to become involved in the fluorid'ation discussion' In ny eleven years at the university of Melbourne Dental school, except for many discussions with sir Arthur
Amies, the subject of fluoridation was aboo, at least in
rny

hearing.

This reluctance cxtends to instj-tutions. to

cornment

In 19?4 the Victorian branch of the Australian Kidney

Foundatj-on $tas asked

on the safety of usin6

The enquiry was passed

fluordated water for dialysis.

to heir Australan Meilical Advisory Comnittee, which said: r...rr would not contemplate getting involved in a question such as this whch has generated so rnuch
controversy.
I

lwo years later the Foundation said:

rThe AustraLan Kidney Foundation has no specific

statement to make re6ardin6 the fluordation of water in relation to patients with kdney dj-sease. I (KincaictSmith

| 1976). On April 21, 19?9, the Australian Broadcasting

Conmission presented both sides of the fluoridation

discussion n a segment of its progranme fFour Cornersr,

and was subjected

to tremendous criticism for havinE aired clain that fluoridaton is

the subject.

The Bxecutive Producer of rFour Cornersf

cormented on those who

rperfectly safer, saying:

26

fFew oel-f-respecting

avoided fi-lming them wourd have consti-tuted the very bias of which Dr Kramer accuses us., (Reid, 19?9).

scientiste would be so dogmatic in disnfssing the poosibility of evidence to the contrary emerging in the future. r rAnd when experts disagree over natters of public safety, surely trs a legitinate subject for debate in programs rike Four Corners . I rDr Kraner even blanes For:r Corners for filming ba6s of fluoride bearing poison labels. Fluoride s a poison. such warning labers are requred by law. To have deliberater.y conceared these rabers or

(u)
Many

Re

essio n and buse ofO pponents o f Fluoridat ion.

attenpts have been, and are, nade to denigrate those who question the officiar clairs for fluoridation. * This
process haa been goin6 0n

for

nany

years. For nstance,

the Assistant chief, Divsion of Dentar pubric llealth, U.S.P.II.S. r (Ga1a6an, 195 sad that ,the oppositior

individualist,

health beriever, and the person who opposes fluordation for personal notorietyr ancl rthe fourth, or rugged
groupo
I

r... seems to be composed, of four distinct riinds of people.r These he terned: rthe hatemonger, the

pseudo-

r\ssociationrs Bureau of prbr-ic rnformaton, in a re-issue of a publication enttr_ed tOornments on the Opponents of Fluoridationr (196l) grouped , several reputable scientsts with alleged
nembers

The Arnerican Dentar

of

the

Society, the Ku Klux Klan, an escapee from a nental hospitar-, and others, in an obvl0us attenpt to tdann by associationr. That dosser condemned the JOO members of the Medicar-Dental cormttee on the Evaruation
John Dirch

See appendix

/d, p.

266,

27

of I'IuorldatLon, eo1ely because thoy woro euclr a

sma1l

proportl-on of bhe JOOTO0O phyeLcans an<l dentlee ln the U.S. Dr A.A. London 396?) rccounted how, in the early
195os
:

rPromotional zeal threw caution to the winds and lent itself o the use of smeaf, derision and, defamation with intent to stifle and drive out opposition. Thus physicians and dentists rather than chancin6 this type

of abuse are kept in line for fear of

tlinvolve
dlr

becoming

.I

Dr G.!. I'laldbott (924a) stated that he could supply the

names

of more than twenty highly conpetent physicians lit who have either one a Nobe1 Prize winner the U.S.] diagnosed or confirned the cliagnosis of serious illness
from fluoridated vater. However: rThese men are reluctant to present their data to the medical profession: they d,o not wish to become en8aged in a controversy characterized by personal disparagement, threats, and reprisals, to which every scientist who openly opposes fluoridation has been subjected. By merely reporting dat unfavourable to fluoridation they woul-d become known as ilantifluoridationistsrr a designation vhich would alienate them from many of their collea6ues and interfere with their practice.r

Ths repreosion aleo includes journalists wbo have been victimized for having the temerity to assume that the
consumers

of fluoridatect water, the publicr should

have

the right to be inforned of both sides of the

quest5.on.

For instance, the well-known nedical Journal-ist Anne-

Lise Gotzsche, fornerly of the rGeneral hactitionerr,

wrote a tvro-page Special Report on Fluoridation for the

2g

, 197j) , Despite the fact that her article presented both si.des in a factual nanner, and hras accurate, she lost her job. In a ]etter
2

London rsunday Times r (September

to the Lancet (rov. 71 1g?3b) she sad that she had tarked r.. to dentists who have had to give up their research to other medi-car researchcrs who feel it necessary to publicly decrare themserves in favour of fruoridation and yet privately insist that they arc against.
r

she mentioned that oppositi-on to fr-uoridation is growing in American universites

r'.to trre point where at l-east one research pro ject has been started investi6ating the crairns by scentists . who insst that they have becn intimiclated. fn the llouse of Representatives, IIon. D.J. I(il1en (19)
r

sad:

tr object wi-th bitterness to the way i-n vrhich people wil-1 set out deliberately to smear and to slander those individuals who have reservations about fruoridaton or who may have clear-cut opposj-tion to it, At the Tasmanian Royal commssion on Fluoridation, professo J.B. polya eg6?) n his subnission said: |... ny status and, IivLihood have been repeatedly threatenecl by zeal0us supporters of fluoridation., * Such smear tactics, unfortunae1y, st111 occur. Dr J' Yiamouyianns, the co-discoveror of a link
r

between

fluoridation and increased. cancer mortality (Tianouyiannis and Burk, 1g??) visited Austral_a recently. After a ttomid Sydney press conferencer (Eckers]ey, 1g?g) he (not his data) was attacked in full_page
nevrspaper

artificial

advertisnents (Nicholas, 19?9) in Nowra, where he

had

l See appendlx,1a, p. 253.

29

been asked
The

to discuss his findlngs prior to a referendum.

Actin6 Chairman of the Fluoridation Sub-Committee,

as

A.D.A. (Victoria), described himr over the radio,

fsome

crank doctorr from America. (Oakley, 19?9),

One

of the resuLts of hs visit. was the decision

to end the fluoridaton of the Queensland Gold, Coastrs water aupply after it had been in operation for ten years. An Bditorial ('t9Z9a) comment was: rYet, once again, Ioca1
bunbledon preferred to heed the unscientific twaddle and

superstitious scr-rongering of the anti-fluoride Iobby.

lrJhen he was

here Dr Yiamouyiannis said:

rThey have lost out on the science

is character assassination.
(c

all they have 1eft

The .s

ession of Published Bvidence Against

Fluoriciati-on. Ever since the premature endorsement of f.-uoridation by the u.s.P.II.s. in 195o, cletermncd attenpts

or to dsregard published evidence which can be considered to question fluoridation. One technique is to cite only the first study by an author, ignoring later and more damaging ones. (e.g. Taylor, 1954
not 1965
Rapaport

have been made to suppress

1956 not 1959; Sutton, 1959 not 1!6O;

and,

ianouyanns and Burk, prelirninary data, not 19??

19?8,)

Anne-Lise Gotzsche ?gZlV) said.

that

she

had rtarked to despairin6 doctors [in ttre u.K.J who have found it necessary tp wrte off to sweden to obtain the

fu1l factsr on fluoridation.

to
comrnons

Dr E.C. Iiamlyn, Medical Officer to the llouse of Ar1 party conmittee on Freedom of rnformation,

r oaid in 19?8t I r am now a confirmed opponent of the idea of adding fluoride to public water ouppties, and. having 100ked into it r regard the campaign being carried out by the Department of Hearth and others in favour of water fluoridation as perhaps the best possible evidence of the need for a Freedom of rnformation ct to ensure that pubric authoriti-es rnake available to the public such lnfornation as they have a riSht to possess. , * A recent and very important case is the attempt by the u.s. cancer rnstitute to neutrarize the cr-aim by
U.K.

Drs J. yj-anouyiannis and D. Burk (lgZZ) ttrat there j.s

link between arti-ficiar

fruoridation

and, cancer

mortarity.

A U.S. Congressional Inquiry, in 1)ll, revealed that the Institute, which received more than g gOOTOOOTOOO annually as a part of the u.s.p.rl.s., although it had en<rorsed and, promoted fr-uoriclrtion for more than 2J years, had
never

undertaken an experirnental investigation to test whether

fluoride in vrater is carcinogenic. The rnstitute then announced that it was about to cornmence a three-year
on experimental animals.

study

The American cancer researcher

drinking water consi-derably stirulated the growth of tumour transplants n mice. Recently in Austraria there have bee,n attenpts to suppress important evdence. Many articles have appeared.

Dr A. Taylor published studies on animals more than twenty years ago, in 1954. fn 6j he and LIe1l C. Taylor reported hat as litt'e as 1.o p.p.m. fruoride in

I See appendx 6a, p. 264.

t1

in newspapers denyng the, unrefuted, Ink between artiflcial fluoridation and cancer mortalityt whi.ch was
<ilscovered by Dr J. Ylamouyiannis and Dr Dean Burk the

eminent cencer researcher (see American lien of Science

and l"larouis Vlhors V'lho in the l{orId , Vo}. II).

recent visit of Dr Yiamouyiannis provided an ideal opportunity for his critics to rcfute hs claims on scientific or statisical grounds. However, despite
The
many

invitations, not one of them tras prepared to discuss His lecture at the Australian

his data with him.

remrining

National University was reduced to half an hour r the

lecture tine bein6 wasted, because the retired

profesr;or, who used the time, admitted that he knew littLe

of cancer. () Difficulties n Publ-ishin

New

Material which

stions

F1uori-dation. There have to questlon fluoridation. British Dental Journal fluoriclation.

been many cases

reported of thc

refusal to publish letters and papers which were considerecl

A letter to the Editor of the
(Mummer yr

1974) cited instances of

its failure to publish letters vhich questioned In 1974 f .R. Bertrand wrotc:
tThe freedom of the press does not apply to the B.D.,J., one resul-t and its dictatorial policy on fluoridation; of which is that no article against fluoridation has been publohed for over 16 years. I Anne-Lise Gotzsche Q9?5) sad that the Journal

of the

Ameriean Denta1

Association had refused to publish

papers by Dr R. Zielgelbecker

Environental Research.-

of the Institute of Graz; and letters from Professor

3?

Al-bert schatz, on the grounds that he shourd not be arr-owed to use tho qqurnal rrr; ,, rplatf orm for his unti-.truoricrrti.on views.r Recently professor R.S. Scorer (lgZg) stated that

the paper by Drs J. yianouyiannis and Dean lurk, revealing a rink between artificial fr-uoridation and cancer mortality,
was refused

publication by a rprestigious Brtish journarr in case t caused public al-arm.

such difficulties

apply even to books. Two case6 may be mentioned.. professor Albert Schatz (1g6j) reported:
rTwo years elapsed between

pubJ-ieher trdroppedn the book.

the 1!62 symposium firufa i' Bern, Switzerl_and on 15-1? October | 1962, after being transferred frorn Holr-and rbecause of opposition from dentar interests in that countryif and publication of The Toxicology of Fluorine in i964 because of efforts that were made to suppress the book. For example, one publishing house, which puts out dental and medical literature, agreed to print The Toxicolo of FIuorne and invested some IO'OOO Swiss franks in setting the text up in type. But it was then warned that if it went ahead and published this particular book the dental community would stop patronizin6 it. In the face of this threatened econonic boycott and enticed by an offer of compensation to cover al-l expenses incurred (approximately IOrOOO Swiss franks), the
r

It was later published by

My monograph

Schwabe & Co.

Omi_s si-ons

Fluorida tion: Errors and

was pubJ-ished

in

Exper imental

rals

by the Melbourne

university press n i959 and copies were sent to Anerica. (a) The agents there, cambridge university press, vrere mmediately approached by the Executive Director of the Nutition Found.ation Inc. of park Avenue, N.y. (letter Jan. 20, King, 196e). His retter said:

tt
rThe profeeslonal etanding of the Camlrrld6e University Press among scientists anrl educators would seem to to preclude publication of such a boolc by Cambridge Universl-ty Press. I

(u)

The thr ee rBook Reviewsr in the Australian Dental-

Journal were wrtten by authors whose work the monograph criticized and by their associates. (Their comments urere quoted at length in the second editionr and replies 6iven

to the 8l points raised Ln the reviews - Suttonr 1960). (c) The rstackr of type at Melborrne University Press, at hat time always held for at l-east six monthst was melted It cost down 6oon after pubJ-cation, without authority. M.U.P. 40O to reset the type for the second edition. (a) Neither the first nor the second edition was (as would
normally be the case) included n the Index t

ntal

Li-terature

( publ-ished

by the American Dental- Associaton)

nor were favourable conmentaries - but thc adverse

criticLsns vere ndexed. (e) In November, 1959r the Dental

Research Advicory

Connittee of the N.H.& M.R.C. referred the first edition

to a Sub-connitee consisting of Associate Profesor N.D. Martin and the statistlcians Professor II.O. Lancaster and Professor M. BeIz. (Professor BeIz, vrith his staff, had checked all fts conputations pror to publication. ) More than three year6 later Professor Martin nas instructed to subnit a report for the next neetng of the Dental Advf.sory Connittee. (N.H.& M.R.C. | 196. Access to tbat report was refueed.

,4

hofeesor Albert Sohatz (1965) quoted, fn capital Ietters, the words of Thonas Jefferson: frF IIE B00K rs FALSE rN rrs trAcrs,
REFUTB

THM. rF
BUT FoR

rT rs

FALSE

rN rTs RBAsoIrItrc, DrspRorE

rT.

GOD'S SAKE LET US T'REELY }IEAR BOTII SIDES.,

(4)
lVhat

The Moti ves

of Those Vho

Promo te

Fluoridat ion.

are the rotlves engendering ifriu promotional fervour? They nay be divded into: (a) Altruistf.c, (U) financial, and (c) prestige considerations.

(a) Altruistic

tl

otives.

The dscussion on fl_uoridation

started in victora in the earry 195os. At that time r was a mernber of the ten-man Dentar l{ealth Bducation
Cornittee which was set up by the A.D.A. to devise and conduct educational programmes to reduce the prevalence of den'bal cari'es. rt was a thankless task, d.ue mainly to the aLmost total lack of response fron the community.

the concept of fluoridation, strongry advocated by a well-known Anerican clinician who was vsting victora. The idea was enthusiastcar'y adopted by the
Then came

- although two of us had reservations _ ad we enpl'oyed a public relations firn to advance the id,ea.
The response from

Connittee

the public r{a6 practca11y nil. I an convfnced that the nafn notive of noet

dentLsts who advocate fruoridation is stlI their desire to reduce the dental caries pr,oblen,

havin' been asened

t,
by thelr own AesoclatLon, the A.D.A. I tho A.M.., the
N.H.& M.R.C. and others,

that artificial

fluordation is
Of course there
Amies

both very effective and conpletely safe.

are

Eone who have

addLtfonal nrotives. As Sir Arthur

sad, epeakng of fl-uoridation n 19592 rThe paesLon to regulate the llves of others s deepeeated J.n nany individuals. V'lhen this is based on political. expedlency i.t is bad t and, when it is inspirecl by an ldealisn whfcb wshes to infLict benefit on others it can becone d,angerous.r As early. as 1956 dentfsts were told:
rThe groundwork has been carried

out, ancl it now falIs to the lot of the lndividual dentist to become a fanatical protagonist of fluoridation. I (Christensen, 1956).
,

( rI'anatic |

rPcrson fill-ed

wf

th exccsovc & r:lstalen

enthusiaemr. Oxforil Dictionary).

(u)

tr'lnancial

Ad vantages

from Promotinn Fluoridation.

Durn6 the early days of fluoridation in the U.S.

q rChenLcal lrleekt sad that:

r.. the narket potentiaL has the fluoride chemical rStanding to benefit fron the nakere goggle-eyed. t boom are chenical companes and equipnent firms. r ALso lany apathy or oppostion on the part of the publc io nade up for by the USPHSTs zeal in drumning up the progran. It ls asking for federal rnoney to develop ntereet. I (Editoral, 1951),
Many nore

statenente lndcating the financial gain

have

been mad,e.

In

1976

the Roya1 College of phy.sicians

Conrittee on the Fluordation

of Pubric Ttater suppries said that nost of the fluorlde added to water suppJ-ies rwould be

t6 derived from sources that would otherwisc have dlochar6ed into the soa ac wa6te.r
been

The jentor Executlve Engineer, Operations and Ivlalntenance, Vl-ctorian State Rvers and V,later Supply
Commisson

(Hirth, 19??) sad:

rrhere is a tendency at the presen tine for water supply authorties to buy fluoride powders to a price, taking what is virtr.al1y an incidental by-product fron an industrial process, rather than fixing a specification to suit the rear need,s of the authority. t

said that Merbourne use6 a sodium siricofruoride slurry. Drs Gabovich and Ovrutskiy (lgZ said that rhis reagent is a by product of he fertilizer industry, so that it is read-ly available and. cheaper than other
He

reagents.

the direct financiar gain from the sale of fluoride chemicals is the question of decreasing the proben of the disposal of toxic wastes. thi's is a grave problen, and a spokesman for the Reynolds
Alunniun

More important than

is quoted as saying that it is cheaper to pay fines than to control fluorides. (Caldwell and Zanfagna, 1974). rThe manufacturerrs problem is
cornpany

disposing of acid that has been produced

it, sel-1 itr get rid of it.r

The Swedish

(Harper, 1951).

he must ship

scj-entist, Dr A. Aslander (1966) said.: rrhe rear nature of fluori-dation is that it is a vast cornmercar enterprise. Fluoride is a very obnoxiors waste product extrenely difficult to dspose of. The yearly producton of fluorine in the u.s.A. has been estinatea at Sorooo tons a year. Fronr the commercfaL

,?

polnt of vlew fluoridation is brilliant. By spreading fluorine ovor very large areaa, unblushlngly

- agalnot ccientific r-aws - that dentar carles is caused by fluorine deficiency, and just as unbrushingry rnaintaining that fruorine is harmress, a very difficult waste problern has been converted to a very profitable enterprse. r
procrai.min8

(c) PersonaL Prest iAe. A strong motive, possibly the man one, which accor.rts for the tactics which have Just been outrined the contnued promotion of fluoridation

despite the rapidly

rnounting evidence against

it, and the

of scientists and others who oppose it - is the queetion of personal prestige. persons and. organizations endorsing fluoridation, saying that lt s safe and effective, fear the ross of prestige which wirl resurt when the dangers of fluoridation become more widery known and force its aband,onmcnt.
abuse and repression

Professor A1bert Schatz (lg6S) said: rrhere are po$rerful forces which now

have a vested interest in perpetuatng fruoridati-on because their reputations depend on its continuation. For many yearsr certain individuals have clared and inssted that fluoridation is absolutely safe andr consequently, there s neither merit nor purpose in considering toxic effects of fluorde i-n connection with fluoridation. 1o acknow]_edge, at this 1ate date, that the subject s open and fit for discussion would be an adraisson of serious errors n judgenent on the highest levels. r

unfortr:natery, a smilar position has developed in Australia. There are many r-ndviduars and senior

endorsing organizatons and assocatione who must consfd,et

that their reputati.ons are threatenecl by the increasng rejection of f,luorclation. of f,aboratorfes, New york Depa:rtment of later Gas and. Electrie ity (Nesn , 1956) pointed
Ae the Director

out nore than tr,lenty years ago: fOertainly the pf,oponente of fl-uoridation ae not intent upon poLsoniug or harmng anyone, however the d,itenna of presige is a very dj-ffcu1t matter to resolve. r

v.
TIII NATUID OF ARlIFICIAT,
FLIJORID,TION.

39

(r)
n<l FI

r e Fundamenta Difference
dation.

between Chl-orination

At the tine of the passing of the Act the nature of fluoriclation was widely misunderstood. l"lany considered it to be smilar to chrorinatlon, not realizing that there is fundamental difference between those two processeso The
purpose of chl0rination is to treat the rater to render
a

it safe for use, whereas the purpose of fruoridation is not to treat the water, but to compulsorily medicate every individual in the community through their water supply. rt does this both directJ-y, throu.h their drinking vrater,
and indrectly,
when

they

containing products. tchlorination and fruoridation are i' no rvay analogous, nor are they relat,ed cases, except in the sirnilarity of words, and therc it ends. I

or water_ s Dr J.tV. Ilogarth (9eZ) said:

consurne watered.

Q)

Is Fl-uori ne an Essentia I

Element?

The question whether fr-uorine is an essential element, in manr has not yet been decided. In 1963 the V.S. Food and Drug Adnfniotration stated that fr-uoride is not establshed to be essential to human nutrition and vour_cr not be classified as a nutrient. L,he
VIIIO

is not

(lg?Oa) said that it

certainty whether fluorine | ,. , s an essential element in aninal (includj.ng hurnan) netabolsfi,r". rit has not yet been possible to produce an othewise adequate fluorine_free diet for
experinrental animals.
r

known wj-th any

4o

In any caoe this queston is not rnportant for:

rThe need is infinltesimal and the supply in common Fluoridation mcans a food must be sufficlent. surplus of fluorino. | (Aslander | 1966>.

3)
In

Terminolov
1958 l]ne
V'JIIO

Fluorine. Fluoride.

Expert Commttee on lrlater Fl-uoridation said: rF1uordation of water-supplies employs the fluoride ion as the active agent; a nu."nber (at Least six) of simple and conpLex inorganic fluoride salts serve as sources. The element fluorine is not used as such; for this reason rrfl-uoridationrr rather than rrfluornationrt

is the preferred term.

The Corunittee repeatedly used. the term r1 p.p.nl fluorider.

Professor D. St,eyn, a pharmacologist, when comnenting

on

that report, said: rI take it that trfluoridet should read {}uori4e as 1 ppm rrflucriderr woul_d mean less than 1 ppl fluorine. | (Steyn, 1958b).
Ilowever, in the fLuoridation literature

ths inexact

expreesion has been widely adopted (but not j-n Europe),

and t1 ppm fluorider or 11 p.p.m. fluorider means a fluoride salt solution which contains 1 p.p.m. fluorine.

(r) Fluoridation Contravenes

The revoLutionary process

Me

dical Ethics.

of artificial
1945,

fluoridation

contravenes standarcl nedical practice and

first introduced in the u.s.A. in

on animals and without the assent

ethics. rt was without prior tests

who

of the individuals

were used in the experiment. (Hurme, 1952i Taylor, 1g5Z).

4r

sir stanton Hicks (956), formcrly professor of Iluman Physlology and pharmacolo8y, univcrsity of Aderaide, and Advisor to the ustrarian Army on Foodstuffs anil
Feeding, said that:
I

r subnit that nedication of a whore popurace variabre n individual- response, regardless of ind,ividuar age, state of teeth, of generar health, rate of consumption of water, and 60 on, is quite unscientific ancr unethical, and that Fassive acceptance of the ri6ht of a government or munclpal authority to impricate such nedication through its water suppry s to sacrifce a fundaental principle of nedicar practice. Thi-s nay welr redound to our disconforture at a rater date. I
Conce

ration of Fluoride in Natural V'Iater Su Lies. Proponents of fruoridation frequently say that it s only

$ )r

the radjustmen!t of the fluoride lever to the roptimarr one. They brand arl drinlcng water whlch contains l_ess than approxinately 1 p.p.m. fruoride as rfluoride deficientr.
For instance, professor Linus pauling (196?) said that rwater that is deficient in fluorde I should be rbrought up to this leveI by the addition of fluoride t uniit it reaches rthe avera6e for natuaI waterf. Surprisinglrr he did not specify that raveraget concentration.

fruoridation schemes commenced, approxinaj:eIy 4.J per cent of the popuation of the u.s. had raccess to conmwal vrater suppl5_es containing fluorine in the anount of 0.5 ppn or more. r (giff et af. 1949)' However they did not necessarily drink such

Before artificial

water. For instance, in Colorado Springs, which had r..about 2.6 p.p.m" Fr, due to the high prevalence of
dentar fl-uorosisr dentists and pecliatricians
rhave

42

reconnended eLnce

1)JJ fbat parento provicle their childron wfth low fluorfde water during thc development of the pormanent teeth a6 a preventlve measure aganot the disoase. The loca1 dalres have cooperated by supplying low-fluoride (O.2 p.p.m. r.) bottled water. I (Gerrle and Kehr , 195?\,

Artficial fluoridaton ls a nrechanical process which produces an unusuaL condition in the water. As lorcl Douglas of Barloch said in 1960: rIn the first place fluorides in the quantities advocated are not usually found in natual water supples. lrlhere they occur, it rnost commonly is in water from deep wells. It j-s conseguently prna facie improbable that the biological evolution of hunan beings has resulted in a conettutonal need for fluorides. t AIso rcomnuntes can exist whose dental heath is excellent although the water supply contains l-ittLe or negligable amounts of
fluoride.
Surveys
I

of the natural fluoride content of N.S.Vtr. and Tasnanian waters show that less than o.2 p.p.m. fruoide was found n 91% (Jones, 1949) and 93?1o (nei and lrfartin, 1946) of surface watets. Almost all the higher concrtrations vrere in supplies fron springs and, wells. This appears to be the case in all countres. The l'lio chronicre n 1970(a) saicl that 'surface vaters are generally lovr n
fl-uordes.
t

rThe nornal fluoritle level for nost waters range between 0.1 and o.J ppra. This is true throughout the world and 1s the'environment in which nan has evolved and adapted himself to. This s reflected by the

blood level of fluorcle whch s 0.1! ppn. (Tianouyiannts. 1g?B) .

4t

(6)

Ftuo ridat fon

f e Compulsorv

Medic ation.

homotera of fr.uoridation frequently otatc that it provides

a nutrlent, i fs not nass medfeaion. rherefore severar of the many contrary views wj.Il be ccd. Testfying before a u.s. conmittee on chemicals

in Foods, Dr A, Tayl0r (gsz) stated that rfluordation is very defintely a type of nedication, whereas
chlorinaton i.s not. t Dr F.B. Exner n 1961 said: rrrlhether a substance fs a food or a drug is deterrnined by the purpose for which it s used. Ihe U.S. Food and Drug Administration stated, .n 1963,
that

for its therapeutic effect io a d,rug. r fhe rnternational society for Researcrr-on Nutrtion and Vital Substances (1967) said that fluorfdatlon fis fn reality a redication. t In 1962, Dr R. Kerr sad: tFuoridation of public water supples amounts to compulsory nss medication and. is morally quite unjustfiab1e. ft infringes human freed.om _ the freedon of a doctor to treat his patients as he thfnks best, and the freedon of the patient to choose whether to accept or reject the nedication advised,. -/tny doctor can -nov, treat h o young patents with fruoride rf he thnks ft desirable. nd every child can have it in accurate dosage if hs doctors and parents wish it, but there is no need to force the rest of the population to ingest a toxic subctance every day of their lives in uncontrollable doses, knowing that it will quite certanly harm so:ne people, and having no idea whatever wrrat the effect vil' be on the rest.,

fluode

fused,

44

fact that artiffcial fluoriclatLon fs a form of medicatlon ie also acknowlodgecl ln Australia. In 19?O, Dr R. lloron sald that letters to the Australian Medica I
The
l.

Journal show that ra number of doctors regard

maos

nedication as uncertain, unfar, naccurate ancl unethical.r Dr I.R. McDonal-d (1968) of Toowoomba said: rIt would appear

that water is an inappropriate vehicle for fluoride

nedication in this connunity.
I

Professor Sr rthur Amies said, n

19592

rrluoridation of domestic water supplies invorves the administration with therapeutic intent of a chemical preparation to young and o1d, dentate or edentulous, vell and l-1, vrithout individual_ examination and regardless of individual d.esire.
r

Some 1_ega1

aspects of fluoridation are stated n

a 1977 nremorandum by Paul M. l,lccorrnick, Research Felrow, Nuffield Coll-ege, Oxford. He stated:
rFrom

the lega1 point of view fruorictation i-s compursory med,icaion. r is done without the permission of the person at the receiving end. rn English Law medical treatment without consent is onry permitted by court order or for the mentally rr or for minors with the consent of their guardians. rt therefore irnpties that ether a person has forfeited his lega1 rights by criminal activity or that he is unfit through youth or insanlty to exercise them. Fruoridation of the water supply puts every individual in this positon. It s an affront to the human dignity rhich is explicitry recognized as a najor objective in the uni-ted l.iations universar Decraration of Hrman Rights. The foundation of the 1e6a1 rights and liberties of the individua is is the prlnciple of his responsibility for his

4S

conduct and his own interests, chief among rphich is his health. As John Stewart MiIl wrote, nover his own body and mnd, the individual is sovereignn. r

by saying that the principle that the st,ate s sovereign over the mnd and body of the individual,
He concluded
I

however benevorent
r

n any given ca6e, t is the principre

of totalitaranism. Q) Fluorfdat
Convicti ons
a

ious and Pers onal Compulsory medcation j.s abhorrent to

Re

late

many

Writing in the Christi-an Science Monitor, Dr F.B. Exner (tg) said: r.. if the fluoride, n fluoridation, s used. as a drug it violates the religious rights of all who have religious objections to the use of drugs.
r

people.

Professor Douw Steyn stated that: rrhe fluoridation of drinking-water s irlegar, imnoral and unethicar- and seriously infringes the religious convictions of nany n1r10ns of peopr-e throughout the world. vrre dare not deny any individuar- the right to decide for hinserf, or herself, in this matter as their attitude constitutes no d,anger to their ferlow-beings or to communitiesr fe denta{tdecay is not a d.sease whch is transmissable. ? (Steyn 1g5b). |

of Representatives, lr J.R. Fraser (A.C.T. ) in a debate in 1)6J on t.'e decision to fluoridate canberrars water eupply, said.: rr strr-l maintain my very strong personal 0bjection to the means by which it is proposed to adnini-ster the fluoride, namely by adding it to the water supply. r object to beng requi-red to take a med.cation which I would not myself choose to administer. (The vote was given 55 Ayes and, 55 Noes ).
House
r

In the

46

An

Editorial (1964) in the Melbourne rAge I said that: r.. the problem is not sinply one of bad, teeth, but also of pure water and personal rights, The rgmedy must be one that treats the teeth, not the water supply, the individual, not the comnunity. r
daton rThe Favoured. PoIl utantl.

(B

) 'I

A wIIo rechnicar Report on Environmentar

pollution

prepared.

by fi-ve !Ill0 scientific Groups in 1968, risted fluoride among the rwater pollutants having potentiar rong tern effects.
I

In 1972, Dr C.G. Dobbs called fluorid.ation f the most wdespread and permanent act of polrution of the hurnan
environnent ever contemplated.
r

VI
FLUORIDATION AND DENTAL }NPO!BR RNO UIRF,}4NNTS.

4Z

rt has been claned for nany years that fruoridation wirr reduce the number of dentj-sts required by the cornmunity.
That cl-ain was strongly pressed at the time the Act was being considered. Natural_ly it has a strong appeal to
governments which

dentists.

are faced with meeting the shortage of (The graduate output of the Merbourne Denta1

school has remained essentialJ-y static for many years.) (t ) studies Professor
B . r. Do

l-as.

n 1972 Professor B.L. Douglas and his co-workers studied the rrrnpact of water fruoridation on dental practice and
dentar manpovrerf in seven towns in the u.s. These had water supplies containing o.?-1.z p.p.* fluoride naturally,

with seven towns with tfluoride-deficient, water supplies. contrary to their expectation they found that although dentists in the naturarry fruoridated towns served 14 per cent more people rtheir chaacteristics and practices appear to be vj-rtually unaffected by fluoridationr. Seven years earlier professor Douglas, with Sylva
Coppersnith, reported on a survey by rEealth Bulletin, of the number of practisi-ng dentists in fr-uoridated and
non-

and were fmatchedr

(fLuoridated in 1g4 in 1965 aa a population of ,OTOOO and. JJ dentists, compared with Kingston which had a similar popuration and JB dentists. (rt may be mentioned trat J4 years after Kingston served, as the nearby untreated rcontrolr town ia the Newburgh trial it stil1 rejecs proposals to fluorid.ate.) Grand Rapids
Newbr.rrgh

fLuoridated cties.

48

(fluoridated in 1945) had 115 dentists per l0orooo population, but nearby unfluoridated FLint had only per
IOO'OOO, fO

dentists per 'lOOrOOO. Fl-uorldated Toledo had 80 dentists but unfluoridated Dayton had B/ dentists per
10OrOO0. They concluded:

tThis indicates that there is apparently not a lesser need for dentists in those cities with fluoridation as compared vith fLuoride-deficent cities. I (Douglas and Coppersruith , 1965) . (Z) Denti-sts in BaseI (Switzerland).
The German Association

of

Gas and trlater Bxperts reported,

n 1jlJ, on l,he
They saicl

ef

fect of f luoridat.ion in Basel (switzerl-and).

by

that in 1960 Protessor Gutherz predicted that

1967, as a result of fluoriclation, of the 1O dentists

practiain6 in 1960 only 6 would be reciuired.

years later, after 1O years of fluoridation,

Hovrever, by

196? tha number of dentists had increase , to 11, and three

there were 18

dentists and 5 practisin6 dental auxiiaries. In 19?5, the swiss Health Department suggested that fluoridati-on
should be dlscontnued due to ts ineffeqtiveness.

3) The Nunber of Dentists in Flu oridrted and Fluoridated rRepre sentatve Arnerica n Citiesr.
T]ae 19?6

Non-

(but not the 192? or t]ne 19? edition of C.B.S. Itlews lmanac r published fi6ures shovring the nr.mber of dentists per loorooo population in rRepresentatve Anerican

cities r.

of the 40 most populous cities (lgzo census), 16 of which had been artificially fluordated
These includea 30

llumber
JFr.otroH.l- O,'dctTd FfoP.p oorrjzory PIOo(0ctr (tO^.P..
l-&<'fJl+ lJ-ittljHFtOP.hC

of Dentists per

IOO'OOO
J

Population
J
N) o

o
tJashington

ll+:ccoo oooo

+ o

-t o\

CDIJctOop. .oH.ftdo P,tflcre

(f
r/

ry9tOor< (fr-ttu\o P-O\tlP.hJ oPoo\oo 095rr< ctj'oP P.< oroFJXt cl-Or,Oqc+

AtOOc|'O\clll. (tFr\lltgt c+OO.(DPct J.['HP'om O.P.cl-O Ulvtj ct< OOcrO\Oo,\ SEp,vFJvtF, Frto(DNcf-r oll.oo 9,(tcl-Fra,o O.ctF't-O op,rdlto

P.o5P. q-roq, r-+FJoP= CfHl-.Ht,O<fC' P.ooloo OOtFJci-ttuT ttct'>FJ(D lr-ooro r-JpFrH.olr, o$tcro9, ctO9,oP.,9, oH. oP,ctt-rdo oP.o\oo.r

-l h'l l- . ctofPpo fH. l-P-H pFtoHt- cttrJc4' <t 'c \O l+ 09 l-+, rr l l o\ l-1, HOOO\rIPlJct Fr-ct5 OSHTP.OO loHz9roB

oifooHP. Poooat | Oq

Louisville Oklahona City New ork

MinneapoJ.is San trlancisco

c
H o 4

Philadelphia
Cleve].and. Chicago

lJ.

p c o

p,'

l-L

tJ It .i

V2 a

l.a,

H H
a

c)

B
v,
f'J

o
t a

<)

c)
u, ut
s trt

Buffa]-o

Pittsburgh

lJ.

ci

lil-warkee Denver lo

o o { o

o hc
t,
H H (t)
r-1

Indianapolis Detroif
Ba]-tirore

()

5 p

H 5

(t)

Seattle
Portland
Boston los Angeles
Co]-tz:bus

F
I

z o

San Diego Phoenix l,lenphis Atl-anta Kansas City Ner Orleans Eousfon

H o FJ I,
F'

H)

\o { o\

FJ

P.

o o o

P.

cf

o U
o
H

Fd

cf

H.

C)

F{

o
o

\o

Cincinnai
Nevark

5o

prlor to Dcccrnber 71 , 1969, 14 between 1951 anct ,195? New Yorlc in 1965 and Detroit j-n 196?. (U.S. Dcpartment of H.E.l'tr. | 19?o). The renainin6 ten largest citiee comprsed Dallas (naturally ftuoridated, with 57.5 .cntists per
IOO'OOO

people, and nine cities which were not listed in

that Almanac I two of vrhich vrere naturally and J artificial-Iy fluoridated and 4 non-fluoridated cities. The nunber of dentists per lOOrO0O population rrere:
oridated Cities
New York Chicago

llon-fluoridated Citie s , at
Los Angeles
IIoust on San Diego Boston
Memphis New Orleans

Philadelphia Deroit
llashington
C]-eveland

88. B 6?. 2 ?1. o

Baltinore

1t6. 2

53. 9 49. 6 67. 9 55. 5 64. 4 64. 6

44. 5 61. 9 72. o

6j. 5

Dec. 1969

Indianapolis

Phoenix
Columbus

Milwaukee San Francisco

Pittsburgh
Denver

?t. 2

Kansas City At].anta

Seattle

55.4 46. 6 58. 3 62. 6 96. o 50. o

z o

Minneapolis
Oklahonra

Buffalo

61 . 4

City Louisvill-e

66. 7 77. 1 89. 2 105. 1

Cincinnati
Portland
Newark

37, 5 90. 1

t6. 0

of the totar nunber of dentists in each city was obtained by calcuatin6 the number of dentists per lO0rOOO x population + 10O'OOO. The mean number of
An estinate

dentists per IOOrOOO population vrere:

Fluoridated citis - ?6,?; Non-fruoridated cities - 59,2, Theee data are displayed in Fig. j.

,1
TllJ
NUI,IBDR

OF DENTISTS PIIN

1OO OOO POPU

TTOII

IN ARTIr'T CALLY TL IJOIIDAl':D

TEST

CITIES. IN Tlm u.s.A.

. AND

IN

I\iEL.BOURNE

AND VICTORIAN COUNTRY ANEAS.

200
180
o 'rl
(

Dvanoton
1955
1971 Iewburgh Grand

+,

160
140

-l

o p{

9t

o o o o o
r

Rapids
120
100

1971

197t
1955

1955

o)

R
+,
.r'l

a
o

8o

Avercrge

+) qJ rd

for U.S.A.
1955

6o 4o

1971 lielbourne
19?9 Vjctorian country
1979

o
{

p E J

20
o

I artfficial

mber

of

years
10

.uoridatfon -

261026924

Fig. 2, conparison between the number of dentists per loorooo popuLation in the three rnain American fluordation trial cites, n 1955 after ten years of fluori-dation, and in 1921 after ?4_26 year6 fluoidation. Also, the average n 1)JJ and 1g?1 for the whole of the U.s.A., and, ln 19?9 for Melbourne ancl for Victorian
couatry area6.

than 2l times a6 many dentists per loorooo popuration tha are found ln Mel_bourne.

After 24-26 year6 of artificiar fluoridation the nunber of dentsts per loorooo people in these three tri.ar citieo showed an overarr rncreaee since 1g55 although the u.s. aveiage had remaned the sane. rt was twice the u.s. average, and more

52

(4) The Nunber of Dentists 1n U.S. Fluoridation Tria1 Clties.

Tn 1977

I wrote a letter to the Lancet which nullified

My

one of the claims which it had made in a Leading Article

(19?3),

letter, which was not publshed, pointed out

that, by 1955, the fluoridation trial-s at Grand Rapids

and Newburgh had been in progress for approximately ten

years and the Bvanston one for eight years.

More than
U.S.

fifteen years later, in 1)11, in the

whoLe

of the

the number of dentists per IOO'OOO people was the same as n 1)JJ (i.e. 59), Ilowever, in these tbee artifcial1y fluoridated cities the nrnber of practicing dentists per
IOO'OOO had

ncreased from 1lJ to 121.

(Data from the

U.S.

American Dental Directory 1971 I

1971 and

Statstical Abstracts

ldorld A1manac.

1973

including all practfsing

dentists but omitting acadenics and adrninistraors.)

These

three cties, after approximately 2J years fluoridation, then had more than twice the
IOO'OOO

of artifical
number

of dentists per

people as $ras the average

for the whole U.S.

people per dentst.
many people

Evanston after 2J years of

number

fl-uoridation, had the remarkably anall

of

665

This is less than a third (O.J) ."

per dentist as there are in Melbourne and

as

suburbs QZSZ) and about a fif th (O.2'l ) as many (31?l)

in the rest of the State.

Board, June, 1979.)
These data

(Victorian fgures, Dental

are shown in Fi-g. 2.

5'

$) 99s@.
Dentistr/populatlon ratioe are deternined by nany factors.
Ilowever, the

fact that there wa6 a hgh proportion of dentists in the three mai.n trial U.S. citi-es after approxlnateJ-y 2J yeare of artificial fluoridation (andl. the
other
cla.ta nentioned above) does

not suppot the contention

d,ecrease

that the demand for dental rnanpower wilL introduction of fluoridation.

Footnote.

after

the

Old fallacles die harcl. l-etter, dated August 1, 1979t

written by the Secretary of the Victorian Branch of the

Australian Dental Association, stated:

tIn a

with a fluoriclated water supply the dental manpovrer required to naintain a good standard of dental heal-th n a community is almost halved. I
conrnunity

VTI. TiIE INCREASII'IG REJECTION OF FI,UORIDATION

54

OVBRS

E/\S.

l\t the time of the passin6 of the Act artificial fruoridation was said to be widely, and increasin1yr accepted overseas. Its acceptance is now definitely on the wane.
(1

) llestern lluropq.

Fl-uordation has always been treated with scepticism in Europe. A senior European dental professor, in 1)11,
described lt to me as ran merican madnessr. Since then it has been ciscontinued in
Be-giumr
Sweden,

llolland and I'Iest Germany. rt has now been rejected,

alnost entirely, n l'Iesern Europe, and fruoridaton plants

which had been in operaton for nany years have been

closed. Sir G. Sinclair 39ZZ) asked the British secretary of state for social- services whether he woulcl
reconsider the advisability of continuing fruoridation in view of the fact that he swedish parl.iament had repealed

the l-aw permitting fluoridaton and, after 1/ years of trial, the only fluoridation project in Germany had stopped. Iie stated that France, Germany, ftaly, Luxenbourg, Norway, Austria, Spain, yugoslava and Greece decided against fluoridation.
Denmark, Sweden, The secretary
had

of state for social services quered

he cases of sweden and Germany, saying that he understood

the repear of legislation was not based medical- or scientific evidence, and that in Gerrnany
sweden

that in

on

fruoridation tras 6uspended because of doubts about its

,5

lega1lty, doubto which the Federal' Government was oeeking to romove vrith amending legislation. (Sinclair, 1972). lgg]gt in fact, bd dlscontinued fluoridation in 1969 after a ten-year experimental progranme. They aslced the 1orIc llealth Organzation (wttO) to produce evidence that fluoridation is safe.
(Sweden

No evidence was produced,

19?1 .

and fluoridation vas nade l-Iegal on November 18,

, 19?1). In the FederaL Republic of Gernany fluoridation rejected, as recently as December, 19?8, on the
on

was a6ain

advice of the panel, which advises the governnent

scientifie natters. (German Consul , 1979), Ilolland was the most fluordated country in Europe, with
approximately half of the population drinking fluoridated

water.
19?t+t

In 19?6, after 2J years of fluoridation, all plants 19??>. In 19?6, a study of the opinions of adult
rcompared,

were closed down on medical and 1e6a1 grounds. (l'ioolenburgh,

Danes found

that more than twice as many 'Iere opposed to

fluoridation as were in favour of it and that

with an earlier Danish etudy, a shift towards nore expressed opposition to water fl-uoridation seens to have taken place. I
(Schwarz and Hansen, 19?6).

It has been suggested.that this general rejection of fluoridation n I'Iestern Europe was because of legal Surely, if there vlas any desire to ntroduce fruoridation any such difficurtes courd
been removed by

diffLculties.

bave

legislation.

56

The present

postion in Vlestern Europe is:

France, Greecc, Ilol1and, Italy,
lrl

Reiected fluoridation:

Auetrla, Delgi.wn,
One

Denmark,

Luxenbourg, Norway, Spain, Sweden,

.Gernany and YugosLava.

snall exnerimental

town

fluoridated:

Finland, Portugal, Swltzerland. fn December, 1975 the Swiss llealth Departmcnt su66ested that this one town should cease fluoridation rdue to ts
ineffectiveness
|.

Q)

The united Kin Adom.

have

In the U.K. two of the original four treated towns

dj-scontinued frtoridation.

More han 2J years after those

four prants vrere installed the British have not accepted fluoridation. (Special V,lriter, 19?9), Tn 19?6, Dr M. Bresler said that only 8.6% of Britainrs population drinlc # fluoridated rater. IIe pointed out that: rSelective fluoridation can be used everyl.;here at a fraction of the cost of waer fruoridation. surely this is a more scientific, economic, and acceptable way of preventin6 dental caries. r

3)

The u.s.A.

Even

in the u.s. r which is its

home,

fluoriclation

appears

to be on the wane despi-te the continued strong promotional pressure by the u.s. h.rLlic llealth service, which.wae responsible for the introduction of this process in 1945, rn Ju1y, 1978, fconsuner Reportsr said that since 1)lJ,
tren the victorian Act was passea] voters in hundreds of * see appendix 6b, p. 264,

,?
U.S. citiee and towne have reJected fl-uorldation.
(Anonynous, 19?B).

In Australia, the proportion of the population drnklng 'fl-uoritlated water probably ie now higher than in any other country.
Recently Professor Arvid Carlsson (19?8) of
Sweden, said:

' tl

qute convlnced that water fluordationr in the not-too-clj.oant fuure wiLl be consigned to medical
am

hisory.

VIII.
EIJ-!!ORT

58

rORi AND oPrsITION To

FLUORIDATION BY AUSTRALIAN

MT]DICAL ANI) DENTA L GIIADUATES.

Corres pondence

in the

Medi ca

Journal of Austral ia. 1955-1979.

The suggestion is frequently made that the number of

medicaL graduates who ad.vocate

fluoridation greaty

exceeds the number who are opposed to this redication.

If the very

6ma11 number
l,ted

of 1etters on fluoridation

pubished n the

aI Journal of AustraLia during

the past 24 years is any indication, very few physicians have taken a real interest in this subject. Apart from severar Ineutrarr letters, the correspondence comprised: From dental graduates

measure.

14 letters (from B aentists) in favour of fluoridation.

J letters (fron 2 dentists) opposing this

Fron medical graduates t letters (from 6 physicians) in favour of fruoridation. 33 retters (from 14 physicians) opposing this process.
The statements an. counter-stat,ements mad.e during this correspondence make one thing clear in Australia,

as well as overseas r there is a marked difference of opinion amongst dentar and, nedicar graduates in regard to the safety of artifj-cial fluoridation.

IX
T

59

DITFICULTY

IN

CONTROLLING

FLUORIDE CONCENTRAT ION.

that the lever to which fluorides are to be built up is to a roaximum faverage optmun concentrationt of 1 p,p.m fluoride. (victoran Governmen, 197t). No permssibJ_e range of concentration is statedr nor the period over which the average is to be determined. The rmaximum concentratlon deternined by the eaft$ Conmissiont is not stated.
When

The Heal-th (Fruoridation) Act decrees

the Act was passed the considerable

difficulty in carrying out that nstruction does not appear to have been appreciated. This difficurty was
pointed out by the
Gerrnan

Association of Gas and vlater

Ixperts (gZ4), who said:

rcertainly it is technically possible to adhere to such a dosafge in r-arger works, but the maintenance of he optmar concentration of fruoride throughout the network of pipes to the ultimate consumer cannot be
guaranteed,. r

They added that:

rrhe impossbirity of r:egulating the total quantity of fruorides ingested by any incrividuar nakes nonsense of the demand for very precise dosage added at the
waterworks.
r

This difficulty in the distribution of fruordes in reticulated water also occurs in Inaura11y fluoridatedl water supplies. The authors of the Evanston trial reported that:
I

rn some nstancea reportng comnunities have ind,icated

6o

that the fluorine content of the vater, when davn from its source, dffered from the fluorine content of the same water when it was collected at some point in the distrj-bution system.f (giff 9t al. , 1949). Professor J.B. Polya (96?), of the University of Tasmania, said that:
rSince al-I but the most expensive matera1s for the

retcuration of fl-uoridated water (rubberised pipes or l'lonel netar) react with fruorides, the concentration of fruoride at delivery points may differ greatly from frorn concentrations at the mixing point. r I Failure to obtain the specified concentration of fluoride at the taps of the consumers has been re ported
nany tines from the U.S.
I

In the Evanston study (one of

the four key studies held in the U.S. and Canada), eleven years after the commencement of the study the authors
reported that:
rExcept for the time mmediately after the introduction of the Chtcago fluoridation program, the F.content of the western suburbs has been well below the desj-red optimum l-eveI of '1 .O ppil.r (Uiff gt aI. , 19DB).

other cases of failure to attain and maintain the desired level of fl-uoride have been reported. For
Many

nstance, the booklet Current Status o f the I'Iuoridation Discussion (tondon et al. , 196j) l-ists 1J cites with

leveIs of from O.O to 1.6 p.p.rn. fluoride. (The Ieve1 of 1.6 p.p.n. ie higher than the permissble ,maximum. )

of o.o to 1.2, r,ong rsrand, o.o to 1.J, and Balti-more.- o,3o to 1.40, but the average at that plant
chicago had values

I see appendix 4i, p.

262.

6t

of t]ne readings were below the permitted range at the plant (with 51% below 0.5 prp.mr) ancl 2J/o wete greater than 1.11. Thc
wae O.99
New

p.p.m. fn Hastings,

Zealand,

66%

apparatus vraci then replaced with new equipmen, but stil_I

almost

25%

ot the reading.s at the treatnent plant were not

within the required range (with 8.4% too 1ow and 1 6% too high (Ludwig , 1g5g). * - how high was not reported). In Victoria in 1977, the Hea1th Inspector of tbe town of Merton (Mr ,.c. Morrs) reported to the council that sanrples had reveaLed fluoride concentrations of. 1,?
1.8 and 2.6 ppn, aIr three levers being above that which is pernissible in the u.s., and 2.6 p.p.m. is definitely

in the toxic range.

as
many

arso told the councir that, peopre did not rear-ize that their water vras being
He

fluoridated, they were stilr admj-nistering fruoride tabrets to their children and usng fluoridated toothpastes.
(Many people

in

Merbourne
and.

stirl do not know that the

water

fruoricle-containing toothpastes are eti-Il perrntted to be sord and, n fact, constitute

is fruoridated,

practically the total sales. ) This difficurty n re8ulating the concentration of fluoride has arready been d.emonstrated in !erbourne.
I'fonitoring the fruoride concentration suppried through ' donestic tap , by an electro-chennicar method using an
a

orion el-ectrode (epecfied in lrlHo, International Stanclards for Drnking lrlater . 19?1) has shown a range of readings,

n 1979, from virtuall_y O.O p.p.mo to O.9 p.p.m.r vith rl

See appendix

4j, p.

263.

6z

mean

value of approxJ.matoly O.J prprmr fluorde.

The questlon lvhich arses

is his: If the M.M.B.td. onglneero are adding 1 p.p.m. ffuorido at the water worko, where is the renaining fluoride 6olng? Are 6ome areas of MeLbourne, fronr the same dam and outLet staion, obtaining more than 1 p.p.m. orr as has been observed in the U.S., is fl-uoride accunulating on the walls of pipes? The Director of Laboratories, New York Water Supply, said: rAt the nterface with the walls of the pipes the flow of water is virtuaJ-ly nilr and, concentratlons of ttrace, elenents rnight bc several hundred times that n the movng $ater. r (Nesin, 1962).
.

Ana1yss

of the lncrustation in pipes rernoved, in Seattle showed 1 rO44 pop.n. fluoride on the inside of a pipe and 476 p.p.m. in sluilge. (peniston | 1g?Z),

Overseas reports (e.g. Plunbine Jlngineer , Oct., 1956) indicate that this incrustation and sludge breaks away and,
fLows free n the pipes, bloclcing filter
eystems.

(Insttute of plunbers |

1g5G).

il

See appendix

16, p.

276,

6l

UORTDATION. PLUMBING PROBLEMS RES ULTING FROI,I FL

At the time that the Act was being considered' litt1et if

any, mention was mad,e Of the plrr.mbing problems wich
been reported
have

to follow fluoriclation in

some

cites in

the U.S.A.

after the first use of oodiun silcofluoride solutione in artificial fluoridation,

As early as 1951r aoon

j-t was reported n the Journal of the Arnerican V'fater Works Association that: rsodium siticofluoride solutions have
been found

to destroy steeL pipes very rapidly. | (Earper, 19j1). Mel_borrne uses a rsodium sj-Iicofluoride slurryr. ( itirth, 197?) . In 1956r one early case rIas mentioned in the rQuarterly Newsletterr of the Institut-e of Pl-unbers of Australia 9956). Under the heading rFluorides in Industry, Effects on Water Pipesr, an article nentioned
tha'tr in a large steel tank, protectively paintedt corrosion had taken ptace removing the baked enamel
penetrating the steel-.
and

In a cenent tank the cement had, deteriorated causng the sand to sink to the bottom. It reported: tFLuoridec are doing a real cleaiin6 iob on the inside of the underground water mains of the town of North Andoverrs publc water supply! Their corrosive action will soon requre their replacement. Fluoridation is softening the heavy rust formation that has collected on the inside of the town water nains over the yearst

64

to a semi-soft consistency. As t frees itserf, it carrieo a10n6 vith the water. The watcr bringo this seml-soft sludge to our filters.r In llovc:nbcr,
19?t+,

the Seattle Vrlater Dcpartment

proposed
tb.e

adding 2oo to Joo tons of riure to the supply to solve

rising tide of co*osion complaints. Ilovrcve r, nine nonths l-ater the council revorced their decision as there vras no information on the effect of l.me on people. (ArticLe, 1975). Are the effects nov lcnovrn?
The rsoftnessr of Melbourners waters posed
when fluoridation vras
probJ_ems |

introduced.

D II. llarris (1g?6b)

unj-versity of Aston, Birminghan, said that when artificial fluoridation is conmenced,, rlime water, Ca (OII)Z , wll ar'so have to be adcred, especially to soft waters to stop iron from leachin6 0ut of pipes. r The victorian Minister of vJater supply said that: rrhe most sui-tab'e na.teriar- for pH adjustrncnt is hydrated Ii,,re and t,his wirr be added to the water as part of the fluoridation process.r (Granter rlg?6). The senor Bxecutive Engneer, opcrations and ,a.ntenance,

victorian state Rivers and water supplies comrnission, said: rAt this time laboratory tests on the water (for both l{el_bourne and, the pcninsula) fra shovn that the addtion of fluoride, even in the form of soclium silicofluoride, could depress the pI{ from around abou t 7 to as 10v as Ac and this wour-d oe2 necessitate the additon of about j popor. of hydrated lime at each 2 to fr_uoridation plant, n order to avoid severe corrosion rrred, water in the reticulatj-on systen. , (Uj-rth 'nd , 19??). * He atated that a rsodium si1cofl.uoride slurryr ras to be enproyed in r'{erbourne, and that rit appeared that nowhere * See appendix 1Od, p. Z?j.

65

rLocal1y eLse l-n the rorl-tl l'rns this heing rlone'I This phoophate rock lnportetl ma<lc slurry $tar produced from a

fron

lle said that for the Peninsula scheme the suppllee of powder vere likely to conre fron BelSiun or Denmark. (Both thooe countries have rejectecl
Morocco.

artl,flcLal fluoridatlon'

XI
OF FLUORIDAT ION AND TI{I] SAITIITY

66

TllE

\'iA TEI SUPI'LY.

In 19?6, Dr l'1. llarris of the DePartment of PharmacYt a question which UnlverettY of 'l\eton' I3i-rmin6ham, raisecl
j-n Victoria' does not appear to rave been considered
He

said: rostensibly, line water is added fto fluoridated watefl to stop iron fron leaching out of pipes' s Another rea6on, seldom admittett or forgottent to reduce to provide enough calcium and alkal-inity the cytotoxicity of acid solutions of fluoride' little above What was once a near neutral water a pll 7, becomes an alkaline water having the taste plants spoIed, and, incidentally nraking line-sensitive the less able to cope wth their environment' Since the early fluorid'ation of Birminghamrs water supply in has often been at 1 96os the hydrogen ion concentraton At this PiI there is a danger of Vibrio pI{ 8. 6. weather' and cholerae proliferating, especially in hot so chlorination is, or should be ' maintained a t | (Harris | 19?6b) ' maximum level.

DrsK.HelgeJ-andandJ.I,eirskarreported,LnlgT6,that incellcufturesusinghunanepithelialcellsrwhenthe in the range of pH of the incubation medium was lowered' of fluoride was ?,O to 6.4, an enhanced cytotoxic effect found and also a twofold increase in the intra-cellular
concentration of fluoride ' T. 19?6, the Victorian Minister of lrlater Supply' explaning why it was considered necessary when fluoridating Melbourners water supplies to add line in

addition to fluoride, said:

6Z

in tfeJ_bourne, monitoring of a suburban d.omestic tap has revealed, many pII reacings whfch exceeded B'6r solre of then'ei.rrg as hiSh as 10.O. It will be recalled that Dr llarris (1gl6b) stated that at pH 8.6 there is a danger of Vibrio c holerae proli.f erat j_ng. A spokesman for the l,l.l"f.B.l^I. saj-d that Melbourne water is not chl0rnaed excopt for brief periods, such as after the nstaLlation of nerv mains. (fn passing, it may be mentioned that recently in Melbourne cases of cholera were found in travellers who had just returned from overseas.)

range used by Helgeland and Leirskar (lgzs) in ther study of cytotoxicity. Since fluoridation was introduced

" ' the adcrition of fluoride chenical to the water suppried to the r"letropolis causes the pII of the water to be l0wered to levets which are unacceptable in water suppl-ied for rlomestic consumption. r{elbourners water is generally slightly acidic and the reductr'on in pII occurs largely aG a result of the 10w mineral content of the vater. The rnagnitude of the reducton varies with the source of the water and is as h'6h as 0.6 in water drawn fro,n the Mrroondah Reservoirlr (Granter , 19?6). The 1973 t4.lq.B.r/{. rTypical complete chemical analysis of water suppliecl to l,lelbourne and }tetropolitan Arear showed the pH as 6.5_?,0. ff that pH range rvas red,uced by 0.6, as stated by the Minister, the level vould be berov the figure of 6.4 , the bottom of the pH

6B

If the above-mentioned' atatements are corrcct ' @[. will wo be forced into the followin6 chain of events? (a) As a result of introclucing fluoriitation in an nany attempt to reduce tlental caries, nainly in childrenr of whon, according to a study in Syclney by Enno' Craig and' than Knox g9?6), now rconsume more prepackaged fluids
actual tap waterr, be forced to (U) aitd an maintain

naximunchlorinationofourwatersuppliesto(c)protect us fronr the potential1y dangeroue proliferation of bacteria in alkaline water (Earris | 1g?6b). () This alkaLinity havng
been produced by

the Linre added to the water by the M'M'B'b' (Granter | 19? to rreduce the cytotoxicity of acd solutions of fluoridesr (llarris | 19?6b) and to counteract their effect in producing rsevere corrosion of the water

pipes' (ttirth ,

19?7) .

XII.
IS THII ETTTCACY OF ARTIFTCIAL FLUO RIDATION

69

TIONA]]LE.

tthetimeofthepassingoftheFluoridationAct'claims thatfluoridationwouldreducetheprevalenceofdental cariesbyapproxmatelysixtypercentwerewidelyaccepted. professor I\T. l"iartin 9964) said: rThat means that two out of three decayed teeth are actuallY Prevented. I It is remarkable that, such claims for the marked efficacy' ofartificia].fluoridationinreducingcarieshavebeen accepted for so long, and so widely' As Dr A' Aslander said: rFluoridationisanillusorypromiseramirage'thathas fead many peopler even scientists, astray'r (Aslander'
1966).

Durin6thepastfiveyearstlrerelrasbeenanincreasing avrareness that the claim, that fluoridation is renarkably efficacious, is false. *
(1)
Tre

Determination of C hanAes in

De

ntal Caries Prevalenee.

The decision whether there has been a decrease in dental

caries in a community cannot validly be made on personal opinions, however wel-l- qualified the observer may be. If one doubts that, consid.er the following statement by a very experienced clinician, before luielbourne v{as fluoridated: .. it is a delight for any dentist to inspect the mouths of any of the 5,5 nllJ,ion Australians vrho enjoy the benefits of fluoride.r (Doo1ey, 1977). Lord Douglas of Barlocfr (f960) said:
|

rThe case for fluordation of water supplies rests entirel-y It does not rest uPoD upon statistical evidence.

* see appendix 4b, pr

260,

7o

clinical- evidcnce from doctors who have admnistered fruqridelr to . treir patiento for rong periods and have observed the reeults upon indj_vlduals.l Therefore it is necossary to assess the efficacy of fluoridation from the results of long-term expermental triars' These are of two main types tlongitudinarf trials and rcontroLledr trials.
Q) Lonmitucina I Trials of Fluoridat l-on. Trials without controls, often carled rlon8itudinarr triars because the finar data obtained in the test town are

conparecl

of benefits accruing from fluordation! fthe fluoridated.. community should be used as its ovn control. !

and sometimos even by those who have been. fndeed the N.H.& M.R.C. , in 1965, sa5-d that in r1he assessment

with the original data, are not valid. hofessor W.f .B. Beveridge, in his book The Art of Sc ie n ti. fi c Inv estisation said of such studies: rA common falIacy, for instance, is to compare groups separated by time the data of one yoar being comparecl to data obtained in previous yerrs. Evidence in this way e never'conclusive, thouSh it may be usefully euggestive. rrrf when the tide is falling you take otrt water with a twopenny pail, you and the moon can do a great dea1.r r (Beveridge, 1961). Sr Austin Bradford HII, said: rrhe advent of the controlled triar has led to the rapid abandonnncnt of useLess nethods. | (Uiff , 1966), Unfortunately the necessity to use a control city when setting up a fluori-dati.on triar is not often recognized by those who have not bcen trained in scientific methods _

71

unfortunately every fluoridation trial in Australia llts used this nethod - termed ruseleosr by Sir Austin llradford rrirl (966).

3)

The

Nee

for Controls in

Ex erame ntal

Tria1s.

The assessment

of the cfficacy of artifj-cial

fluoriclation

canbedecidedonlybycarefuland.accuratestudyofdata obtained frorn properly desiSnecl and conducted controlled experirnentaltrialshe]doveraperiodofat]easttenyears.

As Sr Rona1d Fj-sher (951) said:

rIf the desi8n of an experiment is faultyr any method of interpretation which makes it out to be decisive must be faulty too. I The necessity for these trials to be controlledt by the u'se of an untreated city for comparison rvith the test one, is obvious to any trained experirnenter, and vas realized before luorj-dation trialg were set up in Americt n 1)l5. For instance, when the E'anston trial was being organizedt Blayney and Tucker (tg48) said: the first
f

rA study of this nature must have an adequate control.

statement by the Anerican l,later iJorks ssocj-ation 3g+g)

said that the experirnental verification of the fluorinedental cares hypothesj-s robviously necessitates the use of a nearby rtcontrolrt city with a water supply comparable in aII respects to that to which fluoride is being added. I Sir Derrick Dunlop asot in the Medical Journal of Australia

ia 196?, enphasized the neceesity for controls conducting clincal trials.

when

72

rn 1953 a llationrl tlearth anct l"iedical Research council resorution specified the use of a control city in the proposed Austrarlan fluoridation trial which was not eotabr-ished. Unfortunrtel-y, as has bccn mcnr:ionc., t'is robviously
r

necessary requirement has been dsregarded in a1t Australian projects, and in nany others elsewhere. Ilone of them

a contro, and in some there wa.s a narked increase in the dentar care of chircrren soon after the comrencement
empl0yed

of flrroridation.

The same thing has occurred in r,er-bourne

nurses
urere

with the establishment of a course for training dental who wirr provide dental treatment for chir_dren.
100 6raduates

There

in the first two years and it is expected that the annual 0utput will be 40 nurse. per year, all very well trained and hi6hly motivated in preventive
net,ho<rs and

Thio output, all restricted to the treatment of children, is ap:roximately the same as the total ouput of dental gracluates to serve the whol_e community. Obvj-ous1y, the results of a survey of Melbourne chirdren macre before fluoridation cannot valict-y be corn'ared with conditions found in several years , trne
"

instruction.

measures such as inproved diet, partcularly fresh fruits in season i-nstead of sweets drinks, topical application and ncreasedand soft dental care have been acknowred6ed to have been instituted in several U.S. communities. r (ZiegeJ.becker and Thornson , 19?j). Fr-uordation was comrnenced in America in 1g45 by ttre TJ's Pr:b1ic tealth service r+hi-ch ' estabri.shecl the first experi-n:enta1

rsupplementary

Sinilar changes have occurred in other areas.

tial_ at Grand iapids, and the U.S.p.H.S.

has

?t
been promotng fJ-uoridation ever since that tine" (4) The Prernature Establ-ishment of Fluor idation Trials.

Thefirstfluori<lationtrialsverecornmencedatatirnewhen very little was known of the effects of fluoride ' except
those relatin6 to teeth.
An Editori.al in the Journal of the Amerc
Assoc

Dental

ti.on in 19114 (pr r,. Pierce Anthony' Editor) stated: tVlhile these data are certainly speculatively attractive as leadlrrg to possble mass treatment of caries t our knowledge of the subject certainly does not warrant the introduction of fluorine in conmunity water supplies
generallY.

Sodlumfluorideisahighlytoxicsubstance,and while its appllcation in safe concentrations, and under strct control by competent personnel maY prove to be useful therapeutically, under other circurnstances it may be defj-nj.telY harnful. To be effective, fluorine must be ingested into the systen durin6 the years of tooth devel,opment, and. we do not yet know enough about the chemistry involved to anticipate what other conditions nay be prod.uced in the structure of the bone and other tissues of the body
generally.
I

lle concluded:
rBecause

of our anxety to find soe therapeutic procedure tha will promote maGs prevention of cariest the seemlng potentiaLities of fluorine appear speculatveIy attractive, but, in the l-ight of our present know}edge or lack of knowledge of the chenistry of the subjectt the potentialities for harn outweigh those for good. I of artificial "". 94. t"d" that the nhabitants of the fluoridation.
(Dean

Three months later the U.S. Iblic Health Servce commenced

the first trial 1950).

No

nention

74

rial city, Grand Rapids, h/ere consulted, or even notified,

before they wor ued fn tirs exporinent.

()

The smatt Number

of !'luo ridation Trial s vrith

Bx periment aI

Controls.

investgates this subject seriousr-y (instead of rnerely pa*otng the opinions of others, based on
Anyone who

hearsay)

will soon realize that very fcw 6enuine fluoricia.tion trials have ever been attempted. Therefore claims for the efficacy of fruoridation are based on vey rinited e><perimentar data. trt nuet be emphasizecr that the fluoridation hypothesis in lts entfrey rests on a very narrolr base of selected experlmentar infornation. rt i.s this verir base which is vulnerable to scentfic criticism. Ancl, it is upon thi6 very narrow base that the very impressive array of endorsement rests rike an inverted pyramid. I (Ne6in | 1956). The firct four nain trials _ in Grand Rapids, in the u.s. r and at 3randford, canada, are stfll the rnoet cited studies established to test the effi-cacy of artiffcial fruordaion. Iowever very few investgatons of the numericar data pubrished by their authors have been publlshed. Those results have now been repeatedly criticized and the critcisms have not been shown to be ncorrect.
Newburgh and Evaneton,

(6)

ton De mo nstra tions.

sone proJecs, spoken of as fruoridatron triars, were n rd'elonstrationsr fact mere i-n which rthe prestige of official bodes has ar-ready been comnitted to one concr.usion in the

?5

mattcr.r

| 1g5" for instance the British llinistry of lleaLth Sgrr) Ref crence llotc t rofcrrln8 to the areas chosen
(noUs

fortheflrstf]uoridationprojectolnGreatBritain,oaid: tThese areas are to be the subject of controlLed demonstrations, not experiments, for the results to expected are already full-y attested by Arnerican
experience.
The author
I

be

of .-he l.{ew zcaland project at Hastings said: |Astudyhasbeeninstitutedinthiscitytodemonstrate the effectiveness of the programme in reducin6 the prevalence of dental caries' r (Ludwig | 1958) ' Indeed, the Assistant Chief, Division of Dental Publj-c Health'
U.S. Public lleal-th Service, said: rThe fact is that the projects at Brantford, Grand Rapidst rto denonstrate Nevrburgh and Evanston vtere designedr " ' the effectivenesG of the procecure.r (Galaganr 1960).
Q)
The Terms rContr olIed Stud
and

rControfled Fluoridationr

The use

of these terms in reports on fluoridation may nsIead those who are trained j-n experj.menta procedures. The two terns have entirely different meanin6s' rcontrolied otudyr is uscd rarely and, in most cascs, denotes the use of an untreated control city to compare with the test
on

rOontrolled fluoridationr,

however, sinply neans that the

that fluoride feecling apparatus !tas rcarefully controlledr the tap was turnecl on the desirecl amount. The rllio Chronicl-e (WttO, 1969b) referred to rthe controlled application of

fluorides.r

rControlled fluoridationr

vras

defined by the

U.S. Department of l{ea1ih Education and tr{elfare, Public }Iealth

Service ( Fluoridatj-on census. 1969) as rthe conscious

76

of the optfmrr fruoride concentration l.n the wator eupply. I (U.S. Do:t.lloalth E.W. , 1r)?O) ,
rnalntennnce Even the
V/IIO

Expert Lrommittee in r.Jater tr,luoridation

(gsa) used the term in that misreadi-n hray, stating that: rllundreds of controlled fr-uoridation programrnes are no\r 1n operation in many countries. some have been operating for the past 12 years, so that concrusons are
based on experience.
uraa
r

No

reply

received from the

rvHo

to an inquiry regarding

the names of those f contro-rled fr-uoridation programmesr. rn fact, only a very snarl number of studics vrith cont,rol cf ties existed the term rhundredsr vra6 pure myth. At that tine there were only four studies of any irnportance.
When some

of their

numerous shortconings were reportec (Sutton

Dr C.G. Dobbs SgeO) eaid

1g5g),

that it

was:

r.. disturbing that trre various cornrnittecs and professional

bodiee who have considered and published reports favourabre to fluoridation have either failerr to pepceve, or else have chosen to 6uppre6s any nention of these qute obvlous and elenentary grounds for critcism. r

studiccl (Sutton 1959, 1960) , in Grand Rapids,.Newburgh, Evanston anci Brantford (two triaLs
whi-ch were

Those

five main trials

in tsrantford), renain the nain basis of data available o judge the results of fLuoridation. Later, the commencement of other controlled trials
rrere conducted

l0wer than those in the test town, the control was abandoned. (Ludwig,
1958),

the llastngo trial in ler, Zealand, but when the author found that the dental carles rates in the proposed oontrol city of Napier !ere consi-drably
One was

uras

announced.

77

nother

at T1o1-Cul-enberg in lloLlan<l ( Kwant , 19?7). control towns has been The comparability of the teot and the Those critics crltclzoct (ZLeSolbecker and' Thomson' 19?')' trtal
was

aaid:

analysls of the figures of the Tiel/culenburg survey in the Netherlands and those of Grand Rapids' I'lichigant wTrich provides the U.S.A.r after 10 years of fLuoridation cLain of baeis of fluori-dation in llolland shows that the
rn

benefitstoteethfronfluordeaddedtodrinklngwater I is not supported'by he data presented' Tluoridation is now banned in the Netherlands'

(8)

tr Repor

of

uts

and

ons

of FI uordation

!!@.
RecentlymoreinteresthasbeentakenntheresultspublishIt is regrettable that ed fron the few fluoridaton trials' the published data' The very few studies bave been nade of statisticans who have done so are all crltical of the venty yoars ago t was method,s used in these trial's'
pointecl out (Sutton, 1959)

that

enctorsenens

of the efflcacy

ofartificia].fluorictationwerebasednrainlyonthestatecl opinionsoftheauthorsofthosefluoridationtra}s,and of others. Thls continue to be the case and endorsenents are etilL founcled on this nebulous base' In its First Report (ttre only one), the ISHO Expert Conmittee on later Fluoridation (lg58) devoted only 16 lines rResults to the results of fluoridaton. under the heading of FluoridatLonr, instead of resulte belng consdered' wasconfinedto:lReportsoftheresultsafterl0years
connent

?8

of oontrol_lorl fluorlrlaton

n thrco

j.l;ir_,u.

regrettable.

Dxaminatrono of tho rrut obtr.rlnoci in t,hesc trfrls, whch have been pubJ-shed by oncrorcing bodies , rre inadequate, al-most absent. rt s a.n und.erstatement to tcrm trris fair_ure

..

based, and nay not know even the names of the test and contror cities in the trfale which were established. *

actfvely support fluoridation are vory vague about the data on which the whore process ie supposed to be

The re'markable fact of the r-ack of examination of these data continuos to be denonstrated repeatedly. Iurany

who

rn the promotion of fluoridation it is sti.r-l the so_carled rexpert'opinionr of which notice s taken, not the accuracy and the reLabilty of d,ata.
G)
h

Gr

ss Erro

in the I'iain m erica_

ofA rtif 1ca 1FI uor dation rn the very mportant ancl, cespite statements to the contrary, di'oputed queston of the efficacy of artficlal fluoridation, rer'ance is etf.' based,rnainr-y on the orand Rapds, ,rewburgh and Bvanston studies in the U.S. and on one of the tv.o trials held in Brantford, These l{ere oet up betvrecn 1!4J 'anada. and 194?' Twenty years ao many gross errors were forurd ln the reports fron thoee four ria1s and
nunerous

Canad l-an Tr ial-s

has been"

onlssons and nls-statements in them were pointed out. (sutton 1g5g). Not one of those Srounds for critcisn

these five crucial trials. see appendix 1J, p. 2?4.

that: r'he eound basis on which the efficacy of a public bealth neasure nust be assessed is not provided by
r

rofuted.

It

ras concluded

?9

Errors in the Ilvanston 1'r ia1 Data. of In January, 196?t which was the twentieth Lnniversary specal the commencement of the Evanston trial ' an entire As sociation issue of the J ournal of the A meraca n Dental In this ' all the was devoterl to a report on that study'
(ro)
Add L tlona 1

errors t original tables, complete with their gross numerical these bad been pointed vere reprodu.ced, desplte the fact that and sorne of them out some eigbt years earfier (Sutton ' 1959) (Sutton' 1960)' In had been acknowledged by the autbors

additionseveralfaultytableswerepublishedforthefirst time, The tables then showed three different statements regarding the number of children aged 6-8 years who were
examined

in l,vanston during the 1946 examination: (i) 1gg1 children - see Tables 10, 11' 30' 4o and' 4/' (i:-) 1985 c:nlr<lren - see Tables 7, B, 16, 13' 21 and )2' (iii) 1?r4 children - see Tabtes 24 and 25' of There were also no fewer than six different sta-tenents the nuntber of children a6ed 12-14 years examined' in lvanston n 19462 (i) 1?oi cl:rjj-clren - see Tables 1, and 72' (ii) 1?oz chlrdren - see Table 47' (iii) 1?o1 children - see Tables 11 ' 70 ' 41 ' 44 and 4J' (iv) 169? cntrdren - see Tables f, 9, 12., 13, 17r 19' 2?, '1' (v) 1556 cltlldren - 6ee Table 26' (vi) 1146 children - see Tab1e 46' Between the sum of the two highest statements of the number of children examined in livanston in 19461 and the sum of the two lowest statements of children examined in the same year in the same stu<ly in the same city, there is a difference of
294 children

(991 + 1?ot -1?54 ' 1146 = ?94) '

8o

errors vrere mentioned 12 years ago to the Tasmanian Royal Commission on Fluoriclation. since that ti-ne r have not heard of any nention of them or of a criticisn having been nade of the numerical d.ata Bublished in that report. rt appears that, in the manner
These

those erroneous tabres have been accepted at thei-r face varue, without investigation. lwenty years ago it was pointed out (Sutton and
1958) that:

coru'.on

in fluoridation trials,

Arnies,

trhis uncritical attitude to these studies is rife., rAlso, i.t has been assuned, that associations and inclividuals that . .. accepted the respnsi.bility of publicly advocating fluoridation, have undertaken ndepencrent cxaminations of the data, and not merey repeated the opinions of others. r t is pertinent to point out that, in the Forer,ord to that article in the Journal of the Ane rl_can
Dental

F.A. Arnolcl, Jr., the Assistant Surgeon General, chief Dental .fficer, u.s. rtublic l{ealth service, n 196? said:
fJ-uoriclatj-on on dental caries so completely docunented that the article is virtuarr_y a text book for use n further research. ft is an irnportant scientific contribution toward betterment, of the dental health

Associa tion , Dr

r'ere, in a sin61e report, are data on the effect of water

our nation. rt is a classic in this field.,

of

of the e*ors r onissfone and nis-statenento whch abound in the reports of these fluoridaton trials.
example

rt is indeed a classic

- a first-c'ass

8r

when fluoridation is important factor which nay occur in the eruption of teeth' introduced ls that of a delay rThe teeth nray be tlelayed Dr Kaj Roholm said that:

(rt

uestlo

of

de

ed eru

nof teeth.

An

n 199?, (1940) coul find no in eruption.r However Dr C'D'14' Day in his patients in rndia' evidenee of delayed eruption of fluoride Dr E.M. Short (1944) said that concentrations with delayed eruptiont of 2,6 p.p.n' appeared to be associated
with ess than 2'O pop'lllr but founcl no sgnificant clifferences Theevidenceforctelayecteruptionfol}owing Sone state that delay fLuridatLon is stil-I conflictng' teeth' being less in eruption occurs because the dcciduous retained for a longer carious due to fluoridatont are
comnunities' period than they are in non-fluoridated

IntheEvanstonfluoriclationtrialtheres'asa the number of erupted suggeston of a progressive decline in frst permanent molar teeth n six-year-old children'
Unfortrnatelyrnod'efiniteconclusioncou]"dbereachedbecause clata in the the authors failed to publish the requisite following reports. (sutton, 1959)' Dr R. Feltman and G. Kose1
(11961)

reported tlratt with

the use of fluoride tablets: rThere being a delay in the'eruption of the teetht n aone cases by as nruch as a year fronr the accepted eruption

datesrthismaybeafactorinthelesserincidenceof decay. The teeth dteJ-ayed Ln eruption have the opportunity to mature more prior to becoming exposed r to the foroes that trgger the caries nechanism' Of course, if there is a delay in eruption as a resut of fluoridaton,therewl].beadel.ayintheonsetofdental 1?c)' caries, for unerupted teeth cannot decay. (see appendfx

8z

(ta)

Rerl

t1

or

et rdatlon of dcntal carle: .

AE has becn

nentioned, the asseasment of the resul-ts of the chanBes in dental caries prevarenco ln a popur-ation cannot be made by

clinical npressions. Sir Derrick Dunlop (196?) said: rrhus, thg crinical impression persisted for hundreds of years that blood Iottngs, sweatngs, vomitings and purgings rJere good for people.
r

are obtained fronn a controlred trial there arses the irnportant matter of the interpretation of the results.
The authors of the Evanston riar (r:r.ayney and IIirI, '1967) spoke of tths reduction and retardation of Iesions.,
They said:
rlrle presume

However, even when data

that a 1if etime exposure to fluorde, with the increasin8 resistrnce of the ena.mer_ surface to cares attrck, results in either the carious process beginning at a later time or the decar-cification progres.ing at a slorver rate, or both. t

Thore are two main ways of looking at data frorn fluoridation trals, The first, used in promoting

fluordation, is to expreso the result as a percentage reduction in dental caries in various age Broups, usual.ly using the D.M.F. (decayed, missing and fi1led)
index.

difference between the fist and the rast D.r"r.F. reading is divided by the first reading and the change expressed as a percentage. In the case of a controlled study, the di'fference between the test and the contror is expressed, as a percentage of the contror figure. That rethod has been criticized, anongst nany others, by Dr C. Dillon (t956) wfro rthe calculations of the said that proponents of communal
The

Bl

fluorlrlatlon can support no statstical convicion' IIis argunrent ls too lengthy o be reproduced here ' n engineer, K.l(' Faluev (tg5B) prepared the
I

rpercentage rcductionsl following table to explain the obtaned by that nethod of cal'cu1aton' It makes the reasonable assumption that there is an increase of 1 D'M'F' tooth per year in two childrenr or Sroups of children' and'

that the onset of cares

comnences two years

later in the

fluoridatedgrouphaninthenon-fluoriclatedone.
Tota1 number of decayed teeth at each age'

Age Non-fluoridatect Fluoridated Difference

6
1

Fer cent
I

Reduction
100
1C0

7
8 9
1

2
1

o o
1

2 2
2 2 9
|

4
5

2 3 6

66 5o 4o 6/0

lotal j/15

19

aveagel

=o,60

some remarlcably

inpressive results can be obtained

by this percentage reduction method of expressing data. For instance the Commonwealth Department of liealtir journal llealth n 1961 claimed that in lew z:ealand there had been The clained a rblorld Recordr success rvlth 'fluoridation. dental decay in pernanent teeth on exanination of the data proved to be a rdecreaset of 1.04 D.l"i.F. teeth in a small number of 6-year-old children, in
t?4% reduction 1n

a study wthout any provsion for el-ninating possS-b1e bias by an examiner r,ho had stated that the study was I to d.emonstrate the effectiveness of the programne in reducing the prevalence of dental caries.r (ludwigr 1958).

B4

that fluoriclation rdecreases decay by 60%r has been remarliably Guccessfulr 1t has becone a trulen in eorne circres, but ie now befng questioned by practitioners working n artifcial1y fluoridated areas (Schofiel_d , 1966), The other approach to the same data j.s to conside the di-fference as due to a retardation of cari_es.
Dr R' Weaver (lgttrt 1g4g) in tris study of caries j-n North shields and in nauralr-y fluoridated south shierds, said: I r thj-nk that the nost inportant r-esson to be learned frorn tht" r'rorth and south shelds invest,igation

Tho slogan

is that the caries-inhibitory property of fluorine seems to be of rather short d.uration. r IIe also said: trhere is, therefore, some jusLifi-cation for saying that fr-uori-ne inhibited caries in south shi-er_ds chir_dren to such an extent as to reduce the incj.clence of earies by nearly half _ a reaIy remarkable resut. I suggest, however' that such a conparison can be most nisleading. The 12-year-olrr chilcrren i-n south shields averaged 2.4 DMF perrnanent teeth, vrhilst the corresponding n North Shielcls averaged 4., lir,,F permanent children teet,h. The question which rearly need,s to be answerecl is ItHow rnany years does it take for the figure of 2.4 in South Shields to reach 4.32,, The answer is approxrnately three years. r He concruded that '{:here is in fact no very striking difference rn the ncidence of caries in the two tovrns. r that fluoriclation defers the development of caries tvas menti-oned in an Editorial n he Jour nal of the me rica nDe nta A ssocat on in 1944, rt said: ' it has been found that the presence of fr-uorine " in the drnking vrater has a retard,ing inf_uence upon dental caries. I
This observaton

B5

I DELAY I

]N DENTAL
10
YEAR S

CARTDS RA TEs (D. M.F. )

IN PERI'l,fll[E]IT TEBT]I
IN
TTTRTE
{

AFTER
o

OF ARTITIC IAL FLUOR ID/\T1 ON

t{
+)

CITIIIS
u)

h
d
(,
i

c,

al

o
(1,

14

aH rd

o q-{
c, p
P1

f{

d
0) >

c)

f{

+{

o
c,

f{

t{

(t

d
)

.r{

.rl
+)

o
d

.r{

P{

t o
{

o
{

h0
o)

h0

rl

b0

o qr h0

d o .r{ tu k h0 o
q, 60 cH

) o

+ 'rl
.rl
{

.rl
+)

+t

q-{

>.

d
5

f{

ho 0, bo

-l

t rl

h ( rl

q-.t

c)

o 'r{ l.{ f.{ bo o

0)

'rl
,

bo

-{ qr

h0

r{

(,

.:i

tto

c)

12

1t
14

16

t )

I
!,

16 17

1,5

f6
1?

15

q
a .1

14
14
8

I
o
P
o) (

12

15

3
1

14
11

,
12

.r{

a o

15 +16

11 7

1t

6
1l+

r ()

10
2

10

17

12

7 11 1'J 9
B

12
11

12

7 7

11

I
2
7

7
2

10
9
0 6

I
7

11

10
9

10
9 2 6
1

I
1

7 6

7 6

?
6

Grand Rapids

Brantford

Hastings

Fig. 7, The approxmate tdelayr in dental caries (O.I\i.F.) raee after 10 years artificial fluoridation in Grand Rapidst
U.S.A. Brantford, Canada, and llastings,
New Zealand'

86

'rhat obocrvaton has been made in other naturalry fluoridated areas. In jg6t, f.A. Irvin reported that: | ,.. in the high fluorlne water oupJry area6 n Usse4] there is onLy a d,eferment of the olrset of decay, and despite the fluoridated, water there are stilr decaying
teeth.
r

The same effect has been detected in the data from

fluoidaton trials. Fig. 3 depicts the rdelayr in the D.M.F. rates reported after ten yeare artifical fluordation in the three trial cities:
Grand Rapids,

artiflcial

U.S.A.i Brantford, Canada; and lIastin6s, Nevr Zealand,. The contrors for both the Grand Rapids project and the one at Ilastings, uere a.bandoned early in those trial-s. The Nationar Ilealth and rrrer-fare study in r3rantford had many deficiencj.es (Sutton 1959, 1960) . The rlata from the other two main trials, at r'Iewbur6h and Evanston, rtrer pubrished in such a rnanner tha sinirar cornparisons
cannot

be

rnade.

The rdelayr n these three studios (tat<ing the data at face value) was, except in the youn6est
between tr'ro and

publi_shed

a6e groups,

threc years, similar to trre three-year delay reported by Dr ,Ieaver (194g). Britsh experinental clata were conr:iclered by Dr C.G. Dobbs (l9Z) vrho said that: t"'fter an initial postponernent, the rate of progress of the disease is unaffected" rt has now becone obvious that, in Bitan at any rate, fluoridation does not provide the rnajor sor-ution to the dental caries probrem that vas suggested by the earlier propaganda., Those Brtish data vere depicted by ofessor A.
The

schatz an.

8Z

7
6
C

ontrol
uoridated,

qI i3
2

I
o

B910

1112131
AG]1

Fig. 1. Curveo showi-ng Dl"iF values for chlcJren of <liff eent acs i-n fluoriclated and cont rol arcas.
?
(,

l,.lnorirlate
5

---

Control

r"

At
2
1

o
B

9 tO 11 12 13 10 11 12111
AGE

Control
1Lt

I'luoridated

Fig. 2, Curves from Fig. 1 clrawn with the control noved to the rght to shov that caries develol:s at the oame rate j.n both the fluoridated
and control roups.

Fg. 4. Thie figure is redrawn from tvro fi6ures publiehed by Professor A. Schatz and. Dr J Martin (1 whfch depct D.M.F. values published n 1969 by the 9?2') Britfsh Committee on Resear ch into Fluoridation vhich cLaimecl that rthe fluoridation of vrater su pplies at the level of 1 p,p.n. F is a hi Ahly effectve vray of 'reduc ing dental d.ecay. I (Table 5, I he uoridation St udes in the Unite and the les u s Achieve after ven
ear .M.S.O.

, London.

B8

Dr J. I4artin, see Flg. 4.

their llustratlon

clearly shows that t after the initial

delay

1n the onset of caree, the D.M.Il. rat'c increases at almost

exactly the sane rate in both the control area and the fluoridated
phenomenon

one.

The question should be considered whether

ths delay

s who1ly or partly due to a delay in the erupt,ion Unfortunately, data vhich miht have thrown light lso, there is a consid-

of teeth.

on this nattcr were not published.

erabfe degree of uncertainty fn the caries data released from

the fluoridation trials due to the nany errors in their

experimental nethocta (Sutton , 1959, 1960) ,

3t )

Reports by statisticans.

Tr.renty years ago Professor D.G.

steyn (t95Ba) suglested. that,

before proceeding vlith fluoridation, those concerned. should, in the interests of many ml1-ions of people, rsubject the
Amercan rethod

of statistical

analysis to severe scrutiny In this

way

in the light of the critcisms levelled at it. a great future tragedy nay be averted. I

sone of the shortcomings of the four nain fluoridation trials were pointed out thc fol-lowj-ng year (Sutton , 195 .
Anne-Lise Gotzsche (9?ib)
I

said:

I have shown dental statistics to scientists workin6 n other and unrelated fielde in, for instance, biochemistry and, Irnr afraid, they simpLy 1augh at rrreshuf fllngrt, statl-etcal |tvelghtngt!, the sudden the disappearance of up to 1000 research subjects, &c.l

Judging iron the few publications rvhich consider the

efficacy of fluoridation, those vrho pronote and end,orse

Bg

thfe procese have no taken hofescor steynrs advice. Dr M. Ilarrle ?926a) sairl:
I

know

of no fluoridatj.on investi-geition involving

dentrr

examinaton which vra6 carred out under the direction of an acadernio statistician. r

statisticians are no$r beginning to look at the data published in fluoridation t,ria1o. One of the firet comments by statisticians vas rnade on the first fluoridation tria, run by the united states public Hea1th Service, a Grand Rapicls. Extracts fron their report were pubrished in a county dentar journal (De stefano, 1954,\ and have been ignored. They said: rrhe authors appear to have d.emonstrated an unfortunate dsdain for sone of the pre-reeuoites of vali<l research. And rin the first p1ace, the sampling desgn of the oxperlment fs enbarrassngl-y conspicuou.s by its absence r .
FortunateJ-y,
They

also eaid that: r... tho lack of eophisticaton

sanple leads to

effecs or the extent of the effect of fruoridation. rt ehourd be noted that it was upon the results reported from that study on which the united states publc llealth service
r

shown in selecting the complete bewirdermenb as to the precise

baeed

1ts, very prenature,

end,orsenent

of fruoridation.

Ths was folrowed by encrorsenent by the American Denta1 Aseociaton, leading to he vast superstructure of end,orsements by

all

manner

of societies

and assocations, vhich vrere

nentoned Ln eection IV.

rn 1974, hofessor R.s. scorer of the Departnent of Mathematice, rmperial college of scence and Technology,

9o

London, publlshed sone conrments. They concerned the annual

reporte of the Medical Officer of Health re6ardln6 the

Servloe. /\t that time Angleeey had been fruoridated for nearly 19 years. Professor scorer said: rlt le qufte remarkable that one of the Annua1 Reports ehould bave referred to the Itdranaticn mprovement resulting fron fluoridaton when there are no figures at all to support this. I rThere are no perceptible trende of any kincl, ancl it s quite impossible to detect any lnf1unce of fluordation at all. If anything, teetb have got wor6e.r (Scorer | 19?4). The sane year, Dr R. Zfegelbecker og?4) of the rnstitute for Envfronnentar Reeearch, eraz, Austria, studied the eame
Angleeey Dental
,

reporte and aLso the data publis hed in the fl

s

dation

es n t

Unl.tecl Kin dom and Results chiev ed

after

ELeven Year lo

(See

Fig. 4, p. 8?,)

He said:

rrhe lnescapabre concrusion fron the officia data

concerning he developmen of dental- heal-th in Anglesey fs tbat the fruoridation of drinkng water introduced fn 1)JJ inaa not been ouccessful. r
He

also eaid
rTbe

the deciduons and pernanent dentj.tlons. r hofessor scorer ugzs) also publehed comments on a paper by hofessor D. Jackson et al. , (lg?i) which conpared, chlldren in fLuordated Anglesey wth those in Bangor and, Caenarvon. He commented:

fluoridatfon of drinkin8 water has not resurtect in a reduction in the average number of treatrnents requ_red or 1n the average nunber of fillin8s and extractions in

rrt 1s a v6ry badly designed investgation by even the

9t most modest epidemiologlcal standards. ! rThe study does not come up to the standards worthy

of a universfty, nor would t mort publcation 1n a reputable journal. I Dr Zie6elbecker g9?5) also comrnented on that study (Jackson 9L4. t
1975)

He said:

rThe cause

of this contradiction lies in the exceptional-Iy faulty design and the faulty interpretation of the results of the GIJY{EDD DENTAL IIBALTII STIIDY by its authors. I reoult of the study could have arisen sole1y fron the selections nade and s a flagrant contradiction of other long-tern and official data on Anglesey which provide an incontestable record of the fail-ure of fluoridatlon.l
Unfortunately, even today, twenty years after a study
rThe

wa: made

of the four main (an<l one rninor) American/Canadian fluordation trials (Sutton , 1959 | 1960) | very few publshed
on those key tr.ials.

comments have been made

(tt is pertin-

ent to mentlon that the findings ln that strrdy were checked, in detail, by Professor l,laurice Bel_z and. three members of his staff at the Department of Mathmati-car statistics,
Universit,y of I'elbourne.
)

hofessor Per Ottesta<l, Department of Mathenatcs, Agricult,ural Collego of ltrorvray, exanined the data of
those American/Canadian trials,
Sweden, and

and additionaf naterial frol

said n

1969t

rNo one who ls in close contact with 6ound research and who has serously considered the question of research

nethod, would accept the so-calred scientific bass that 1s being advanced for promoton of fluoridation. r

92

Profesoor Ottestad oaid that a comparlson of the data

published in those trials indicates that:

t.,, a hypothesis that assunes fluoridated water to have the oarne effect as water with the same natural fluoride content, cannot be accepted. The reason, of course, is that there are other factos than fluoride which Lnfluence the DI rate probably other elements in the clrinking vratcr.r *
He concluded:

rThe experiments which have been made on adding fluorides to drnking water vrere oo unsatisfactorily planned and

carried out, that the results are inadequate as a basfs for estimatfng the effect of fluordation in, for exanple, llorth America, and most certainly in Norway if fluoridation is to be practised here. There is no doubt, noreover, that oher factors pay a part. Tvrenty years ago it vras concluded (Sutton , 19j9) that: rrhe sound bass on whch the effi-cacy of a public health measure nuet be assesaed is not provided by these five crucial trials. I since that tlme, not even one of the
many observations on

which that statement was based has been found to be incorrect.

Farticurarly since the results of the British trials have been examined by statisticians, it can now be stated confidently that the clalns for great dental benefits as a resurt of artffLcfaL fruorfdatlon have beenn at roast, greatly
exaggeratecl .
,

* see appendx 4c, p.

261,

XIII.
TOXICITY

97

DIINT\L FLIIOROSIS.

Dental fluorosis or rmottled tecthf has always been an

important factor in the fluorj-dation discussiont for cases

occur whenever artificial

fluoridati-on is
vrhen

commenced.

Thcre ic much r,:risunderctanding regarding this condition.

Some knowled6e

of it s essential

studying the toxicity

of fluoridation and of fluoride ngested from other sources.

Dental fluorosis i-s a condition of the tooth * characterj,zecl by faulty forrnation of the enamel. (Faulty
enanel can al-so be produced by

illness and frora malnurition,

a.ge

the position of the malformation indicatirrg the

shor.r:lng

at

which the child rvas sicJc and the area of tooth affected

the duration of the

il-l-ne,.ss.

(t )

Dental Fluoroois fndicates Chronic Fluorde Pois onng

Denta1 fluorosis vras described, in 19lt3t by Dr D. Ast (who

subsequently becane the main investi6ator in the t,Ielvburgh

fl-uoridation trlaL) as Ithe first objective nrlication of chronic fluorine poisoning. I }Iany sinirar statement,s have
been ade by

othero, including the Medicar Research councir

U94e).

this fact is generally admitted except by the most dedicated fluoridaton promoters. For instance, professor
Noel l,iartin of Sydney, in reply to'a question wheilrer

dental fluorosis is an indicator that people rnight be being, poisoned, said: rllor Dor itts an incticator of fluoride n the diet, itrs an indicator of fruoride afecting the formation of teeth.r (N.D. I"lartin , 19?9). 'F * lIlF See appendx 2b, p. Z5B, JF See appendix 1/d, p. Z?8,

94

Dental fluorosic can develop only during the

fornatve perlod of the enamel of the teeth concerned, to the age of approxrnately four to five ycars in thc case of the incisors.
may occur

Periods of chronic fluoride poisoning which

enamel- development

after the

is cornplete and

when

the teeth have eruptecl vrill not be indicated by rrnottlj-ngr. Q) The Prevalence of Denta1 Fluorosio in a Fluoridated Area. It is
now

admitted, even by those who are in favour of

1:en

per cen t least] of children raised on fluoridatecl water since birth will exhbj-t some degree of dental fluorosis (N.D. [lartin, 19?9), but the c]-aim is made

fluoridation, that

that the lesions are so i-nconspicuous that it recluires an

expert to detect them.
,s

wilL be seen later in this

section, that claim is not correct.

comments

in

some

that the degree of <ental fruorosis,occurring children drinkng fluoridated, water, j-s of rno cosmetic that any clcgree of

importance' ignore the essential point

fluorosi-s is evidence thrt the chirct experienced. a period of chronic fluoride poisoning. As Dr Vt. Gibbs (1958) said:
rThere is no evidence that this damage is directed selectivel.;r to the ameloblast [nameI formn6] cel1s on1y,
r

3)

I'actors Affect r-n the Degree of Dental Fluorosis.

The degree and the appearance

of dental fruorosis depends

on the degree of poisoning whch, usuaIly, varies with the totaL amount of fruo:ride 5-ngested by the individual, their personal susceptibility and the level-s of protective

in the vater and the criet, r.rhicrr have been dlscussed already. The area of tooth affected depends on the duration of the cxposure to toxc dose6.
substances

9'

'lormal

Ques

tionab I e

Very l.li ld

r-ii 1d

l\ioderate Fig. 8.
Photo6raph of the illustration

Severe

published by Dr

H.T. Dean ?942) to explain his descriptions of the appearancesofthevariousclassesinhisclassfication (copyrighl 1942 by the American of dental fluorosis.
Association for the Advancement of Scence)'

96

Professor A. schatz and Dr J. Martin o964) reported:

rUnder certafn conditlons, fluoride toxicity actually fncroaees as the concentration decreasest This is fFor theoc what ls known aB a paracloxlcal cffect. I roaeonc, tho Loeue of fluorlde toxicity cannot bo

resolved by considering only the concentration of fluoride in the water. I

(4)

The Cl-as sificatlon

of

Denta1

Fluorosis.
a

Dental-

fruorosis cannot be considercd sensibly without

of the various grades of danage. These grades were established noro than forty years ago by Dr H.T. Dean g9t4) and, although some slight modificatj.ons
knowledge

of this syeten have been used., his classification s stirl the etandard for assesslng and describin6 clentar fluoroeis.
The following descrptions are abbreviated rnainly

later deocription by Dr Dean in the book Fluorine and Dental Health from which the accompanying irrustration (Tlg. B) wae taken. (Dean , 1942). t@1. The enane- prcoents the usuar- translucent semi.viriforn type of structure. The surface is smooth, gloesy, and uoualy of a pale creamy rvhite color.
from a

Suesti ona bIe. The enamel discloses slight abemations fron the translucency of normal enamer, ranging from a few wh{te flecks to occasional_ white spots. This classificaton fs utilized n those instances where a definite dagnoois of the mirdest form of fluorosis is not warranted and a crassification of ,normarrr not

justified,

Verv Mild .

Sma1l, opaque, paper vhite areas scattered

irregularl-y over the tooth but not invorving as much as approxfmately 2J per cent of the tooth surface. Frequentry included in this classifi.caion are teeth

97

than about 1-2 nm. of white opacity at the tip of the summit of the cusps of the bicuspids or second nolars.
shor,ving no more

IliE. The white opaque areas in the enanel of the teeth are more extensive but do not involve as much as rpant bfown !O per cent of the tooth. I (Dean | 1942). stains are sometines apparent, generally on tbe upper incisors. I (Dean, 1914). rlrloderate. All enamel surfaces of the teeth are affected and surfaces subject to attrition show marl<ed vlear. Brown staln is frequently a disfiguring feature. @.
Includes teeth formerly cl-assified as ilmoderately severerl and rf 6everett. AII enamel surfaces are affected and hypoplaeia s so nrarked that the generaL The na-jor diagnostic form of the tooth may be affected. si6n of this classificaton is the discrete or confluent pitting. Brown stains are widespread and tceth oft'en present a corroded-Iil<e a.ppearance.r (Dean, 19\2).

It should be noted that:

tThe chId is classified on the basis of the severest forn of dental fluorosis for two or more teeth. o (Dean, 1942).

Therefore, i-f only one tooth s classified as rmildr and others as fvery niLdr r the clasof,ication is rvery nildl although the presence of even one rmildf upper incisor

greatly affects the appearance.

$)

The Index of Fluorosis. Each indivdual- is given -one of the

=

This is a score used to indicate the degree of dental fluorosis n a cornmunity"

fol.lowing scores: Normal = Or cluestionable = 0.5r very mild 1, rnild = 2r moderate = 3, severe = 4. The average score

of the community is the Index of Fl-uorosis.

98

(6) tObjectionabLe IrLuoroslsI.

Thls term, or tobjectionabLe mottlin6t, requires
some

explanation. officials.

These

terns are used by public health

They dsguise the fluoross damage to the

most-affected indivdual-s by conbining their degree of

fluorosis with less-affected or unaffected rnembers of the comrnunity. If the degree of dental fluorosis in a town iS said to be Inot objectionablel this does not nean that
no chi1d, or ts parents, vrill regard its mottled teeth as

Inot objectionabler.

On

the contrary, a proporion of

the children can have unsightly nottlin6 which is very objectionable to them, but j-f a sufficient number of or no visible mottl_ng, so that the mean score, the index of nott1in6, is less than O.4, then the nottring in that community is consiclered to be Inot objectionable I from the point of vj.ew of the public health officials. As Dr Colin p. Il,arrison (lg6l) of Mel_bourne expresoed i:
I

children have little

for the person with nottled. condition of his tceth s causing the pubric heal-th authority no sleepless nghts; but by vrhat ri6ht does the authority decide that the mottled. enamel is of no significance to hirn?t
Teeth with
fot tled

may be heart-warning enanel to know that the

rt

(?)

Enane1 are

Inperfectlv

For ne r .

t has been known for more than sixty years that fluorosed teeth are structurally wealc and rwhen the teeth do decay the frail- condition of the ename makes it extremery dlfficult to rnake good and effective fiIlings. r (Black
IufcKay

and

, 1916).

99

Dr Kaj Roholm, in hie cla$sic nonograph

wrote

uorine Intoxication

, Ln 1917

rThe enamel changes must be regarded as lrreparable;

they are very disflgurng, especially when acconpanied. by pigmentation. In the mild degrees the strength of the tooth does not oeem to be reduced and the cares frequency is not remarkably high. In the severe degrees the cnamel is brittle and the tooth as a whole little resistanto [to caries] . Dr C.H. Boissevan Ugll) said:
rOnce

a nottLed tooth starts to decay, however, it deteriorates rapidly, as they are ctfficult to repair because of the brittle enamel and hard dentin. I

Much

of the deflnitive research on dental fluorosis vae done by Drs l,largaret Smth and H.V. Smith (1940). They said:
tThere 1s ample evidence that rnottled teeth, though they are someurhat nore resistant to the onset of decayr are structurally wealc, and that unfortunately when decay does set in, the results are often disasterous.r

I have myself observed such rapid destruction in teeth of

PoJ-ynesian and Micronesian children who had rvery miJ.dt to rmoderater fluorosis. (8)
The Anearan ce

of Dental Fluorosis
McKay

rl,iottled. leethr.

In 1916, Drs G.V. Black and F.S.

appearance

described the

of teeth having dental rnottlingr, saying: Itr'Jhen not stained with brown or yellovr they are a ghastly opaque white that comes proninently into notice when the the lips are opened, which nateriall.y injures the expression of the countenance of the individual. rn the pro-fluoridation literature, teeth which were described as tghastly opaque whiter are now cal-Ied rpearly white,. An
e

100

artlcle n the .Iournnl of the merican Derrtnl Associat l.on

by

Dr V.L. Dlefenback 9$!.(965) claimed that fluoridatl_on is a rcoemetic enhancementr making the teeth more beautiful_.
Tbe

lesione of dental fluorosis are initialty the degree of

damage, and unknovn

vrhite but,

d.ependin6 on

factors, the

area may later take up brown stain, rnost comnonly seen.on

the upper j-ncsors.

preEence

Attenpts to remove this stain are usually unsatsfactory, and the stan returno. As their

ruins the appearancc of the child, and nay induce a narked psychological reaction, they must be renoved by
crowning the teeth or in some cases flring

the affected

areas.

Abrason of t,he stained areas vrith pumice (a

practice amongst Micronesians) rnay rcmove most of the staj-n but, of course, eevercly damagee and weakene he tooth.
(Sutton

| 19?8),
Prevalence of Dental Fluorosis

(e)

The Unkn own

in Vctori a.

rt s not

suggeeted

that a large proportion of children in

fluoridated vater since birth wilI, when their teeth erupt, exhibit dental fluorosis which wJ-II 1n a few years time become stained. present

Melbourne who have been cri-nlcing

is inadequate to aosess the risk but, because of our exceptionally rsoftr water, it is very likely that the prevalence of fluorosis rvilL be unusually high. (Twelve
evidence

insurance conpaniea rrere aproached to find out whether they would ssue a poJ-cy to cover the cost of repairing the

to teeth frorn dentar fruorosis. refused to write such a policy. )

danage

/rrr of lived

thom

"o""t atolls until the age of at leas sx years and,, during the

The Mcroneer.ans rnentioned above

or,

101

devel-opment

of their tooth enamel

dran.-

rainwater ancl water

from ehallow welle containfng O.2 to 0.7 p.p.m. fluoride.

The atmosphere was

fee of fluoride from industrial

some

pollution, but they woulct obtain

from sea spray and

from their det whi.ch contained seafoods.

(

ro)

The fmnortant Factor of Climate

DaiI y Temperatures.

Snith and. Smith (1940) said: r.. to one who is familiar vith the disfiguring defect known ao nottled enamel which affects the teeth of every person who drinks water containing as little as 1 p.p.rn. of fluorine during the years of tooth formation, this recommenclation [to introctuce f luoriclrtion] seems, to put it mildly, unsafe. I Their observations were
made

in Arizona, where Drs D.J. in 1953, that:

Galagan and G.G. Lamson found.-

rln the water supplies of the Arizonr conmunities studied, concentrations of fluoride above O.B ppm resulted in objectionable fluorosis; concentrationo of 0.6 to O.B ppm resulted in an occasional diagirosis of fluorosis; , concentratlons belorv o.6 ppm did not cause objectonable
f

luorosi.s.

In those commuhities thb

between,

mean inh\ra1 temperature vlas

l9 and 22 de6rees C, which is sirnilar to that of Melbourne rvhich s 19.! degrees C. (Of course inland
country districts are higher.
)

The eummer temperature, not the mean annual one, is

the temperature to be conedered when discussing the question of tlental fluorosis. Normally the consumption of water,
and therefore of the fluoride it contains, increases in

102

eiummer. unrees t,hat increaoe is offset by a decrease in

the intake of fl-uoride fron food and ot,her sourceg, the probabillty of thc development of fruorosls, and of its more severe grades, is increased. rn Metbourne, the mean maximun
temperature for January is 26.J degrees c

that for July, 17.! degrees C (Bureau of Meteorol-ogy). The importance of he high summer tenperature
which has been disregarded here

almost

twi_ce

Russia.
I

s wer recognized n

Drs R.D. Gabovich and G.D. Ovruskiy (1g??) saiC:

rt is advisable to send chl-dren living in centers of endemic fluorosis to a resort for z-3 months i-n the sunmer where the vater is low in fl-uorine. Examinations which we made in communites whose drinking water contains 1,5-2.5 ng/r fr-uorne showed that children vho Ief t a given locality for 2-3 months for a number of years in earry childhood either had no signs of fluorosis or were affected with nild forms of the d.isease. The majority of chrdren vuho dicr not leave the encenc regon reveal-ed fluorosis danage, including severe forms. vilI those chirdren who develop fruorosis here show evidence of a seasonal_ variation in intensity?
r

(l t ) Shorr Periods of Chronic Fluoride Poi.sonin g Produce Dental FIuo rosi.s.

is deveLop.ng, only short periods of chronic fruoride poisoning (or poisonng from some illnesses ) are sufficient to produce a band of nottred enamer. rt s surpri-sing, but that basic fact s not alvays understood,. Even the chairman of the Fluoridation conmittee of the N.s.vf. Branch of the Australian Dental Association in 196g assured the public that 116 yearsr constant exposure to 2 mg. per
!'Ihen enamel-

10';

day s necesary to pr.ocluce vleibly objectionablc fluorosis.l

(Freemanr 1968).

The short periods required were demonstrated, as long ago a6 19771 when Drs }fargaret Smith and Edith Lanl.,z fed

fluoride to albino rats or gave the animaLs subcutaneous 01. By injecting intranuscular injections wth sodium fluoride. fluoride revery other dayt, they foundt in erupting incisors: tEight ringe of abnormally dul1 white and corroded areas alternating wlth normal pi6mented. areas. I rAs in the case of hurnan teeth, normally formed enamel did not become mot1ed upon fluoride intake.r

(re)

The Concentrations

of Fluoride at which Dental

Fluorosis 0ccurs.

In Colorado, fluoride naturally present in the water supplies

produced clental fluorosis which was conmonly known as

fgoloado brown stainr.

fn 1933, Dr C.Il. tsoissevain

analyzed 169 water supplies in that area and compared the I'Ie found rvery results with the prevalence of fluorosis.

litt1e mottled

enameLr

in two cities wih O.J p.p.m.

and

O.2 p.p.m. fluorj-de, and said:

rWe have seen

that wherever fluorine-containing water is drunk, mottled enamel aPPears.r

lle concluded by saying: tChildren less than five years old should drnk water free from fluorine. I

104

Desplte such reports, supporters of fluoridation

used

to say that no dental fluorosls could occur with fl-uoridation at 1.0 p,p.m. They now admit that ten per cent of children who drink water containing that concentration, from birth, r^rill develop some degree of dental fLuorosis, (N.D. Martin, 19?9). It is
hi6hJ-y probable

that that estimate is a coneervatve one, for there have been many reports of dental fLuoross occurring at much lower concentrations of fruoride. seveal of these, from di-fferent tmes and from different locations, will be nentioned to llustrate that point. Dr D.c. Badger (g+g) said that ldentar fruorosis was

in Jo per cent of the children who drank water containng O.9 p.p.m. of fluorine. I ro K.A. Rosenzweig and I" bkewitz (lg6l) studied an area in rsrael which drew its drinking water from twenty werIs.
observed

Their fLuoride content ranged from O.t5 to O.95 p.p.m., rmost of the 20 wells containing O.66 - O.lJ ppmt . They said that the rfruoride content of the locar. water supply
.

i.s

definitely too high, and the anount of fluorosis observecl is not justified by the sli6ht reduction of caries prevarence.r
Dr K. Ueda et al., (t964) for.rd that, in Japan:

rcontrary to the prediction, considerabr-e numbers of very nild and mild cases were stilr found in the doestic water group consuming as littLe as O. to 0.6 ppn bf fluorne.
r

Dre R.D. Gabovich and G.D. Ovrutskiy ('tgZ said

that n

countries with a hot climate, such as rnd.ia and lr{orocco,

105

severe dentar fluorosis damage io widespread whr.re

fLuorfne concentration in drnking water is only O.r_O.5

mg/r,
I

Dr S.S. Joll-y et aI. (,tg?lU) studied enderic fl,uorosis ln the Punjab, fndia, and ead:
fBecause

fLuorosis.

the ninfnun threshold for the causatfon of dental fluorosis is well bel0w 1 ppn possibly in the range of 0.5 ppn the rever of 1 ppn fluoride in water accepted as safe in the western word is not applcable in India. ft rnust be emphasized that no linear relationship exsts betvreen the r-evels of fluoride in water and the inciclence of dental
r

The fluoride content of the water supply is only one factor, although a very mportant one, in cleterminin6 whether fluorosfs rvil_I develop in an

individual.

There

are nany other factors vrhich will be rentoned r_ater _ in the water supply anrl in individuals vhch modfy the prevalence of dental fluorosis.

XIV.

106
I ' O}']]TMIJM

TIIE

ITLUORIDI

C'ONO]JTITIIIITI

Or{

Ill

Ul(IlIf,IltC

t'TttR.

n the ftuoridati-on riterature the words roptimarr and. toptimumr are used frequently in connection vith the fluoride
concentration of the drinkng water and,, much less often, when speaking of the totat fruoride intake, includ.in6 that provided by the r+aer supply.

a naturarly or artificially fluorid.ated water supp-y is described as having an roptimal fr-uoride concenl'hen

trationr, the author considers that the concentration is the nost favourable for the teeth. !,Ihether the ingestion of water containing fruoride at that rever is ad,vantageous or detrinental to the other parts' of the body is very rarely considered. l\s one consultant physician said to me: thinrr that the body was nothing more than a set of teeth. lIhen the roptimalr concentration of fruoride is under riscussion, not only are other organs of the body ignored but also the period.ontar tissues vhich support the teeth and' attach them to the bone surrounding trreir roots. Few comparisons have been made betureen the condi-tion of the periodontar tissues of people rivng in naturalry fluordated areas and the condition founrl in those
r

rYou wour-d

who have

ln any case, it should. not be assumed, as has been d.one, that the resurts of artificial fluori-daton wirr be the sane as those found. in naturally fluoridated areas. professor per Ottestarl (1969) said that

low-fluorj.de water supplies.

107

a comparf6on of the clata publiohed 1n fLuoriclrtlon trials

Bhows
t.

that:

. a hypothesis that assunes fluoriclated vrater to have the same effect as water vrith thc sarne natural- fluoride content r cannot be accePtecl. I l4ost aclvanced perioclontal disease, J.cadi-ng to extensj.ve logs of teeth, s seen in adulto aged io years or more. As artifj-cal fluoridation comnenced in Anerica and, canada just over thirty years ago, it is still too soon to
gain any real idea of its effects on thc prevalence of
advanced

periodontal disease n adults j-n llorth America.

Of course the effects in Victoria, rvhich has exceptionally

soft water supplies, could be considerably different frosl

those seen in Arnerica.
One

inporLant factor in producing periodontal dsease

is the presence of abnormal trauma betveen contacti-ng teeth. This is usually reduced by attrtion the wearng away of
a

lart of the teeth. It is etated that artificaI fluoridaton will harden the tooth enamel - with higher fluoride concentrations in the water brittle enarnel is forrned. This
hardenn6 may reduce the rate of nornal attrj-tion bet,ween

teeth, and therefore increase the trauma on her, leading to an increase in periodontal disease and to tooth loss
adults.
The idea of instituting
j-n

artificial

fluoridation

aroee fron observations made in the U.S.. that, although

dental fluorosio occurred n naturally fl.uori-dated areas the caries rates were low.
The leveL of 1.o p.p.m. fluoride was selected for use in the Grand Rapids project because it

108

was considered

to be the hJ-6hest concentratlon of fruoride whlch could be added to a water suppry wr.thout the
associated indcx of dentar fruorosis being sufficientry bigh to be of public health significance.

n 1950, Dr II,C. Hodge publshed a graph (using a logarithmic scare) vhich clepicted the avcrage index of dental fluorosis, in children aged 12-14 years, n 2j u.s. cites.
These varues were d.ravln as tvo

straight Iines,

one for towns vith 1ess than 1.0 p.p.t1 fl_uoride in their water and the other f or the reroaining tovrns, wth a third

straight line shorvin6 trr.e avcrage dental caries experience for those chirdren in each town. These three rines intersected at a point indlcating approxinately 1 p.p.m.
f

]uoride, IIe said: rThis poi-nt is probaby thc best availrbl-e guicle for the selection of the concentration of fluoricle to be establis:ed artificiarry in crcmonstration studies of tbe effectiveness and thc safety of fl-uorides in the control of denl"al cares. Later the fluorire concentration usecr in American
r

adjusted to take into considcration the crimate. The .Jtlo ch::onicle said that the f optimum level is not an absolute va1ue, it may range frorn 0.6 pp, to,l.2 ppr.,
schenes vas

(r,vtto, 1g6gb).

fn

1953

t..it is emphasized that concurrent research r-s essential in order to assese the resur-ts of the treatment of the water and to determne accurately the optiraum concentration of fruoride unde Austraian conditions.
r

the N.ll.& 1.1.g. resolved (in part) that

109

The N.H.& M.R.C. contnued:

fTho anount of fl-uorlno to bo adrlcd nuet bo carefully detorminod and adJuotod to meet climatic and environmental changes. I

IAproperlycontrolleclnationalstudyofwater fluoidation under Ausralian conditions should instituted irnmediatelY. I

be

Unfortunately, no stucly was commenced' The Drector-General- of the Wi.lO (969a) said: rFluordation of public water supplies requires an accurate maintenance of the optimal- Ievel, which may vary from 0,6 to 1.2 p.p.nt. for clifferent geographic and climatic areas and. according to seasonal changes in mean temperature and average d'rinking-vater
consunption fi6urs
l.iowever
oI

, in 1)11 , the N.H.& I'i.R.C. recomnended that, in Australian fluordation projccts, ra uttiform concentration shoulcl be maintained irrespcctive of seasonal variations in the particular area concerned. I That advice has bcen
adopted by the victorian llealth Commission -

confirmedt

as far as

possibe, by nonioring the erratic donestic concentrations. The important factor of rseasonal changes in mean temperature I rnentioned by the Director-General of
\^ras

the

VJHo.

(1969a) has been ignored.

Also' although the

raverage drinking-water consurnption fisurcE;r, if they were

known, would alnost certainly be considerably different in,

for instance, Mildura and l4elbourne r th Act leaves it to the discretion of the llealth Commission to specify the
maximum

concentration of fluoride to be uoed. Another

prepacka6ed

factor is the increasing use by children of drinks.

The fluoride content of those sold in Sydney

110

, 19?5; Enno et al. , 19?6), Those promoting fluoricration otrivc to give the inpression that water containing approxirnately 1 p.p.trr. fluorlde is the normaJ- situation, and that arr- waters which have a lower fluoride concentration are rfluoride deficien,
(Enno

varies considerably

waters.
Co nte t

The official

fi6ures, j.n the book lriatural,Fluotide

of

Comm

of Hear-th, Bducation and rIelfare , 1g5g), show that, at that tne, only 1 r9O3 conmunities, with a populatlon of rgjzrJoz lna, one or more water source conanlng at 1east O.Z p.p.m. fLuoride. The authore of the fluoridation trial in Evanston (Uiff et al. , 1g49) said tapproxinately 4,to? per that cent of the entire population of the unrted statesr had racces. to a cornlunar
containLng fluorine

(u's'

unal Water S pplic s fn the Unj.ted S tates

Depa'tment

water eupply
r

in the anount of O.5 pprr or rore. Therefore, Goon after artficial fluoridation comrnenced, in thc u"s., more than g5 per cent of the populatfon

water supples contaning less, in nany cases considerably 1ess, than half the leveI of approxinately 1.O prp.m fluoride
used

lrere usinS

n artficaI fluoridation.

usually contan hig.her Ievels. Therefore, d'espite sta'bements by those pronroting fluordation, domestc water eupples containir?g approxiroately 1 p'p'nr. fluoride naturalry are not the usual conditon
r

for the fluori-de content of domestic water supplies is not known, but the WIIO (,tg6gA) stated in ts Chronicle that: rSurface waters are generally 1ow in fluoricles (lees than 1 ppn) vrhle underground. or subsoirwaters, which have ' a greater opportun'ty to contact fr-uorine-bearing rocks,

of couree the vorld average

in

111

untrcated watere.

the contrary, they are distnctIy unusual, and comprise only a very 6maII minority of natural
On

water6.

tIt is consequently prima facie improbable that the biological evolution of hunan beings has resulted in a constitutional need for fluorides. I (Doug1as of Barloch | 1960), In many area6 t is obvious that the level of 1 'O
pop.rh. fluoride in a water suppl-y is too high, even 0.6

the lower end of the range of concentrations This is mentioned by ti-re 1rIHO Director-General (1969a) . p.prr inclicated by the development of levels of dental fluorosis which are t objectionable I even to the public health

offj-ciaIs.

(senstbl-e people who know tha.t fluorosis is

sign that chronic fluoride poisoninS has occurred., surely must consider that any levef of fluorosis is unclesirable.)
As was seen in section XfIIr in certain areas
many cases

of fluorosis rtere observed although the fluoride concentration was as Iow as o.5 p.F.rn. (tcaa et aI ., 1964)
and even O,J to O.! p.p.m. (Gaboviclt and Ovrutskiy, 1977).
The

resolution on fluoridation passed by the Twenty-second Worlcl Eealth Assembly (WHO, 1969c) | said that fl-uoridation
should be introduced rwhere the fluoride intake from water
and other sources for the given population is below optinal

levels.r

Therefore, in areas in whj-ch the amount of

sourc.)s

fluoride ingested fron

other than water is

sufficient to produce dcntr1 fluorosis, the optimum concentra.tion of fluoride j.n the water supply is zero.

xv.
OTITBR SO URCDS

112 OII FL RIDE.

the

rosolutfon on fluortdatfon ( 1969c) etatod that rothe sourcea0 0f fluoride nuet be taken into account when deternining the fluorrde concentration considered desr,rable
WIIO

for a donestic water supply. sources of fluoride other than fron water supplies incrude: (r ) Food , (z) Toothpaste and medicaments and (l) rne atnosphere. 3) Ftuoride t-n Food. In the inportan etudy

Environme ntal Fl uoride 19 ??

factors.
which

contaning fertilizers. Drs R.D. Gabovich and G.D.Ovrutskiy (lgZZ) said that the anrount of fluorine in the diet is affected not onl_y by the amount in indlviduar- foods, but also by a number of other
r

Marier, 19??) it was stated: r.ne of the major factors thought to be contrbuting to the increase n human exposure to fluoride is the increasing fruorde content of foods. such an ncrease can ariee fron three main 6ources, namely, the use fluoridated water in food and beverage processing, of the exposure of crops to airborne fluoride (and to waterborne fr-uoride in areas rrigated. vith fluoridated water Auermann, jg?, ) and the use of fluoride_ -

(Rose and

They {nclude the nature

of the peoplesf
amounts

is determined by he quanttative

foocl

food products in the diet, culinary technique, the anount of fluorne in seasonngs and preeervativee and, ffna'ly, he

of indivdual

11' possible tranefer of fluorine to food from the cooking That posclbllity wae raioed by a study tn 1975 veseel. which found that when fl-uoridated water (t p'p'ln' ) was

boiled

by between a half and a third of its volume the concentration of fluoride increased to nearfy , p.p.lll.
d,own

(futf and Parkins, 19?5), Fluorideismuchlegstoxicj-nfoodthanitisn water (Steyn | 1g58b) and the rate of absorption from solid foods is slower and Less coutplete. (Weddle and iuhler, 1954t
N1arie

' Dr G.L. Vialdbott (g6l) surveyed the fluorid'e

1964) .

content of foods, and concluded: rFluoride is present Ln nearly every food; the highest concentraticns are found in tea, seafood. bOne neaI, spinach and 3elatj-n, the least in citrous fruitet vegetables, eggs and milk. The amount of fluoride ion taken into the system in food is unpredictable; it is dependent on numerous factors pertaining to the food, its processing, and preparation, and on the food habits of the individual- consurxer.l At present there is a I gener.al l-ack of current information on the fluoride content of foods and beverages. | (Farkae
and Parsons, 19?4).

In view of the increasing

consumption
,

of bottled and canned. drinks, a study in Syd'ney (Enno 9!-4. 19?O is of interest, for it found that a najority of those drinks had rfluorde concentrations well below that of
Sytlney

waterr, which is fluoridated.

Another factor wlL arise if we folow the present American ctaze for drinking bottled Imineralr vrater.
rAmericans are expected to spend $ tff million on the stuff

this year.r (tAget, Aug. 2?t 19?9).

In America, Iow-fluoride

114

vrater
.Dr

is sold for children, to prevent

dentar_

fluoross.

E. Auermann (19?3) pohted out that: tDuring thc course of ycars, the totar- fluoride uptake increases because of trre rise in fruoride revel in food products. r rKnowr-edge concernin1 the dietary total fl-uoridc uptake in humans is stirl lirnited in spite of tre worldvride propagation of fluoridation of drinking
water.
I

A review of the toaI fruoricre intake and fruorlde content of cornrnon foods (Caro1 S. Farkas, 19? e uggeeted
tha

the data on the fruoride content of foods ehourd be updated,

and said:

trn current publicatione and textbooks most data regardlng the fluoride contcnt of cornmon foods as well as tables sho'ing the average <laily intake of fluoride in varfous count'riesr are based upon vorrt carried out up to thirty_ seven ycarj ago. Such work does not al_Iow for the effect of fruorictated clrinkin5 water on fluoride levels of processed
rData in tabl_es published in ilre 1lOts, cj,ting average fr-uori.e in6estion, were found to be based upon a smal' sarnpJ-ng. some figures presented were found to include misquoted data. r
The author mentioned cases
anc cool<ecl foocls.
r

of:

prominent promoters of fLuoriclation for more than twenty years. ) The review conti.nues:

... the biased choice of data whi_ch constitute the basis for the conclusion that [diets are usually low n fluoride and remarkably uniforn world widen. (she cites Drs H.c. Ilodge and F.A. smit'as the authors of that claim, both of whom have been
r

rrn view of these factsr one cannot but question the reliability of or-der data in tabros utilized n 1g?o

115

and later to indicate that little

fl-uoride is

consumed

in the diet.
(a)

tr.luoricle

in

processed f oods. Dr

E.

Auerrnann (19?7)

said that the ftuoride l-evels in processed food: | . . . dif fer f rom those of rar'r products t dependin8 upon the method used in processing and the naterial with vhich the food. comes in contact during processin. On the other hancl, in food which was prepared vith fluoridated water, 2 to I times higher fluoride Levels were found than in food in a nonfluoridated area. I It was estimated that the: r... widespread use of fLuoridaterl vrater (1.O ppm) in food processin6 and preparation wil-l- probably nean a foodborne fluoride intake of cq 1.O-1 .2 mg per day. I (Mari.er and Rosc | 1966). rAlthough the Marier ancl Rose data vlere avai-l-ab1c in the literature, the 1970 'I'IHO report on Fluorides and
ilurnan Health

rcliccl upon the 1949 figures by l"lcO1ure instead of the more recent data.' (Farkas, 1975). ('f nis section of the VrlHq
book vas
f

rvritten by Dr J.C. lttuhler, another prorninent

ad,vocate.
)

luoridation

()

Fluoride in

bevera4es.

rTea, dependin6 on its source

and grades, contains large concentrations of fLuorides.l

(McCIendon and Oerston-Cohen,

1957).
6OO

the

many publj.cations
The

on this subject cite considerablr different, values.

range is a Least from BO to

and Schatz, 1972).

p.p.nl. fluoride.

(Schatz

A Russian report (Gabovich and

Ovrutskiy, 197?) said that if it is taken into consideration that the average amount of fruorine in domestic vareties

116

of tea is lO ng/l<g,, then with the prcsence of ?Oilt, water_ soluble fLuorine, 1 g of tea is the r;ource of O.O! nrg of fLuorine. In Britain, otrong tea crn cont,rin up to 0.61'4 ng/r of fuoride
f

anc

a cup of tea as nuch as 0.5

rng

of

luoride (t'artin , 196j) . rn a tea-dri'nking community, such as victoria, an important source of fluoride. In beer, the
aynount

tea must

be

of fl-uoride depends on the fluoride concentation in tre water, and is cr_ose to it,.
(Gabovch and Ovrutskiy

19??).

caror Farl<as u9?5) ponted out that thc reliability of older data shourd be questioned even thou8h it has been
used in tables published recently. tAn j_nteresting case in poj_nt
She saicl:

is the figurc given for the fluoride content of beer in the r,rJlio tabre, namely O.2O pprn, a value dcrived from a paper by p. Clifford n 1945, as recorded in l,tcClure rs 1919 table. For beer processed with fluoricraterr v,,ater l4arier and Rose obtai ned .68 pprn fl_uoride. Yet the hltlO report in 19?O presented the 1ower 1945 da-ta by McClure. r (C1ifford,
oc

P
.tl

off

28

J.

PubI

Hlth.

Rep .

| 64: 1061,
tables.

z 277 , 1945; trcC]ure,

1949),

(c)
and

F1 uor ide

in watere dve

Professor A. Schatz

Dr Vi-vian Schatz in 19?Z pointed out that: rvlhat happens vhen fluorine

on such factors as the forn i-n rvhich it is applied, the amount of fl_uorine, how rnuch lime ancl phosphate are present, the species of plants Brown, and the soil type and its geol_o;y. r

is

adcled

to the soil

depends

cited severar papers whicrr indicate that there can be a considerable ncrease in the fluorne content of common
They

11.7

foods, nainly due to the use of fertilizers.

In

one

distrlct

in Japan, durin a poriocl of ceven years the fruorido content of wheat rose by 64!1, of pumpkln by 4zgl
The 12th rnternatonaI convention on vital substances,

and in waternelons it increased Uy B3l%.

I"trutrition, and Civilzation Diseases, at hague, said that: rrhe fluoridation of drinkin6 water rercases a fluorine circut which incLudes ve6e bables, fruit ancl other horticul-ttrral products as wel1 as nilk, and has an uncontrol-1abIe effect on the human organisn. r (International Society, 196?) .
Recently Dr B.s. l{a.lker Ogzg) of canberrar .;ointed out that

far more water is used to irri4ate vegetabre gardens than reaches the nouths of scho1-age children, and. that vegetaton
absorbs fluorine fron the sol.
I

IJe then askecl:

rf

rn the light of the above, can anyone experrr or not, give me an absor.ute assurance that the r-ettuce grown in my backyard virI never become toxic throu6h excess fLuorine.
That problem d.oes not appear to have been inveotigated.

() Fluoride

d fruits

an dve

tables.

Fluoride

residues on and in fruits and vegetabJ-es, from the use of a6ricutural sprays, can be considerabre. rn 196g ttre

{.il.& }',I.R.C. listed

rsubstances vrhch, rvhen used as directed, usuarly result in detectable residues in or upon foods and for which the followng tolerances app1y. r

This List inclucles soclium silicofluoride

(l'1e1bor-rners

(as F), ?

ppm.

water is fluoridated by aclding a sodium

118

ofllcofluorde slurry _ Hirth , j9??). Slnilar]-y, n 19?6, the U.S. Itnvironmental

Protection Agency stated: rA toreranco of ? parts per milr-ion of cornbined fruorine io estabr-ehed for resdues of the insecticidal fluorine compoundo cryolite and synthetic cryoite (sodiun aLuminium fr-uoride) n or on each of the forloving rav,

agrfcultural commodities. t The r-ist mentioned 4g varieties of vegetabres and fruits. According to Dr D.C. Badger (1949), that level of Z p.p.n.
was established by

the U.s. Food and Drug Administration the testimony of Dr H.V. Smith ancl co_vorkers.
fEach

on

[ree g""mJ apple thcn contains 1.16 mg of fluorne or the equivalent of 1.16 ppra of fluorine in 1 liter of water' This wourd cause m'd mottling of the enamel if apples are eaten consistently, even though hcre is no fluorine in the drinking rvater. r (Smith , 1949), The use of agrlcur-tural oprays has increased greatry.
IIov

often

nowadays doos one

find a 6rub in an appJ-e, or

even

between

the 1eaves of a green vegetable?

mouthwas he s

() Fluoride n tooth Pa ste.

The J.mportance

and

t,a blets.

to the attention of the publi-c, and children are pernitted to use fluoridated toothpaste without supervision. Dr J.L. 'Hardwck (lgzs) found that 'chir-dren aged 4 and under are prone to swa110w nuch or alrof the d.entifrice they use.
r

of toothpaote ar a source of fluoride intake hae been dlorogarcled. The danger of repeatcdly srvalrowing fluoride tn toothpaste, two or three tines a <ay, in a comrnunity with fruoridated water has not been brou6ht

119

The Departnent

of Hea1th,

German

Federal Republic

g9?6) said that

vrhen

fluoridation is present it is of the

utmoet importance that a simultaneous additive intale of

fluoride from toothpaste, tablets or oalt does not take

place.

IIost toothpastes sold in Victoria contain fluoride. American trial-s used concentrations of frorn fOO to 2O0O p.p.n. F (Stookey | 19?O), The amount of fluoride ingested fron toothpaste varies in d.ifferent studies t but it can be considerable. In teenage children a single brushing with
O,15% sodiun

a dentifrice containing
6O%

fluoride resulted in

a fluoridc retention, for each time of brushin6t of about ot the solutrle fluoride and io% of the total fluoride
content of the clentj-frice (vink.ler et aI. , 1953). l/ith the recent introduction of fluoriclated toothpaste with

various attractive tastcs, thc quantities svrallovred

may be

expected to fncrease, particularly in the case of young

chiLdren who, with their 1B'ht body weight! are extremely

susceptible to an overdose. 'l

Dr Ingricl TIellstrom ?960) found that rfol-1owin6 the

use of a 0.1% NaF mouthwash, an average of 2.0 rng of fluoride

in adults and of O.85 nS in children was retaineclr.

young children consuming fS.uoride tablets.

That

is nore than three ti.lnes the dose recently su,ggested for

(Council
on

Dental Therapeutics, 1977).

Of course, if the

rnouthwash

was used more han once a day the overdose would be even

greater.

* See appendix 1!, p.

2?6.

120

s not fluorirlalied. rntially the dose reconnended tablet (1 m6 F) per day, but because of the

For many years the use of sodiurn fluorr.de tablets, containng 1 mg fluoride, has been advocated by somo clinf_ ciano for children living in areas n which the water suppry
wae one

dental fluoro,sie in many chlldren usng that dose, n 1g67 tbe American Medical Association suggested that, for cbildren less than three years old, the daily doee must not exceed o'l mg. rn 19?? the counci.l on Dentar Tberapeutfcs agai.n
halved that dose, for chrdren less than two years o'd, to O.ZJ mg per day quarter of the dose origlnally

development of

for those chir-dren. Tabrets containing O.J mg fluoride are now available and O.25 mg, ones will be on sale soon. This matter is discussed in section xxvr whlch dernonstrates that there s no safcty rnargin with
rconmended

fruordation.

n important problcm whrch occurs he practice of some parents continuin6 fl-uorirte table bs to children drinkng

in victorla, is

to administer

fluoridated rater. Fluordation was introduced nto lufelbourne wlth very lfttle publicity, ancl nany people stilr clo not know that they are drinking fluoridated water. *

al-., 1g?g), However, in Australia pro-fr'oridatfon spokesnen have taken the opposite view. professor N. vrartin (lg?r), * Se" appendix ,tb, . 255.

not only unnecessary but was defnitery contraindicated. (llalabott et

supplernents was

rn 1962, the u.s. public llealth service ssued a warning, through professor p. Jay, that in areas with fluoridated water the use of floride tablets and other

121

n a statelnent endoroed by the Fluoridation of Public l{ater suppllcs Advioory council of the N.s.l1l. Dcpartment of lleal-tltt
said:

tfter the age of six when the artterior teeth are fully formed, and there is no possibility of any unaesthetlc fluorosisr a parent..... could be advisecl with safety to continue the oupplement which was being usetl prior This woulrl then at the maximum level to fluoridation. of intake represent no more than the consumption of a drinkingvlatercontainingtwopartspermillion.I The chairman of the Fluorirlation sub-co'nmittee of the victorian Branch of the Australian Dental Association
(Levant

| 19??) said: rThere is an extremely wide tolerance, ancl the talcin8 0f tablets after the introduction of fl-uoricle into the t water supplies is not clangerous. r

The chairman

of the FLuoridatj-on committee of the N.s.lJ. Branch of the Australan Dental Associaton (Ireenanf 1968),

at the time when sydney water was being fluoridated, oa.d that rthe approprate authoritiesr recommend that children ingesting fluoride eupplements continue to use those
supplernents for approximately six nonths. Iie said:
t

It is obvously possible that r at times up to this cutoff date sot chil-dren will be ingestin6 the equivalent of 2 n6. of fluoride per day. It should be clearly understood that no harm whatsoever occurs at ths leve. I rOver a period of rontbs onlyr t is reasonable to expect no discernible effecto. I He consiclered that r16 yearsr constant exposure lo 2 m6,. per day is necessary to produce visibly objecti-onable fluorosis. I
known

That is an extraordinary statement for it is widely

* See appendix 2a, P.

255.

122

that, far frorn requiring r16 yearsr constant exposure to 2 nlo pI. dayt, ciental ftuorosiG can develop within a short period (even a few weeks) of exposure to a toxlc intake Indeed, all fluorosis in the incisors, of fluoride.
incluclng t vlsibly objectionable fluorosisr , must during the first
have

developed when the enamel of those teeth was forming

five years of life.

mg

(See section XIII).

The dose of 2

fl_uoride from water and tablets, every

tr'reernan, and by

}4artin (9?t) t to be safe for children, is a toxic d.ose. For that reason the Gernan Federal Republic Department of lleal-th said that it day, stated here by is of the rutmost importancer that fluoride
supplements

are not talcen sirnultaneously with fluoridated water. * (Departrnent of I'Iea1th, 19?6).
The u6e of tablets without the fluoridation of the

water supply s widely advocatedt provided that the parents

are ful1y informed of the hazards. This would elininate religous and ethical objections to fluoridation, it would
be nuch cheaper, and would adhere to the medical princp1e

of giving a measured dose to the patient (and not to others). Dr R. Feltman and G. Kosel (961) adninistered fluoride tablets to children and to gravid
rOne

women, and said:

per cent of our cases presented evidence of undesirable side effects from fluoride therapy. It is poi-nted out that if a patient is affected by fluorid.e, by this method, the allergen or intoxicant can be removed readily from the diet by discontinuance of the dietary supplement. I

t See appendi-x 1c, p. 255.

12t

(t)

A'trnospherfo FLuoride.

of the importan problem posed by the fncreasLng polrutfon of the atmosphere by fLuoride. rt Le a true pollutant for, except in mnute amounter it is not normalry found in the atrnosphere. Except
awarenens

There 1s st111

Littl-e

actvity, all soluble fLuoride found n the air in excess of o.oJg/nt can be assumed to havo orgnated fron o,an-made sources.
(Rose and

under exceptional circumstances, such as vorcanic

Marfer, 1g?Z).

(a) Absorption of fluoride from the atmosphere Airborne fluoride nay be absorbed either directly througrr the lungs
ndirectly. from food. Dr A.L. Knght (gzs) pointed out that: rAirborne fluorldes are readlly absorbed in the trr.gu., There

or

is refficent and probably essentially-comprete evidence of absorptlon of lnhaled ftuoride into the bocly. | (Rose and
Marier, 19??),
sone

airborne fruori<le is self-administered as

result of usfng those aerosor products in vrhich the properlant contains fLuori-ce, and some is absorbed fron breathing air which is contaninateil, mainry by industrial emLssfone. The fluori.de content of some anaesthetics is of importance to operating roon staff. Inhalation fron cigarettos rrnay be another sgnficant source of fl-uoride intake by hurnans.r (Rose and }farJ.er, 19??). Those authos saicl that Okanrura and, Matsuhsa (965 found a range of from 35 to 640 ppm F in

124

of 16' cigaretteo, with an average

ppm

for

Japanese

cigarettesand2g6forAmericanonesyielding,respectvely' 157 and 244/^8 F Per cigarette' that fluoride is a In view of the present evidence major factor in it could weII prove to be a carcinogen, smoking and lung cancer' the association between cigarette Envir onmental PoIl"uton l/IlO rePortt 'Resear ch into in the loca1 fluori<le, with arsenic and beryllium' includes 1on6-term effects have air potlutants rbecause serious living in communties adjacent occurred in man and animals In a table listemitting these substances'r to industries or potential long-term ing tAir pollutants with reco6nized levels I the report on health at usual air-pollution effects and rpromotes or said that fl-uoride causes fluorosis I | (tnlito 1968 ) ' accelerates lung disease ' '
Both Melbourne rnd Geelong have isted as major emitters a nurbcr of ndustries of the types

(r)

Indus trial-

I l-ut ion .

of fluorj-de Pollutants ' The situation in 4elbourne

povrered po'Ier

{.i}

may improve vlhen

the new gas-

(brown station replaces the present briquette only four miles' and coal)- povrered one which is situated' Tn 19?4r of the city' usually to windvr'tr<l, of the centre by staff of the the journar Fluoride abstractecr a study 19?3) on fLuoride university of Dresden (Dss1er gg-4. r This power plants' enissions from brorvn coal- electrical

r.lasinstitutedwhenitwasfoundthattterel,'asanncreasing Fluorides mortality amongst bees near those install-ations' cleah of bees in are considered to be a major cause of 19ar ' 282' r see appendix 12a p. 271' {# see appenclix

125

industrial areas. They found that when the coal was burned at IOOO degroes C, between ZB and 1OO per cent of the fluorlcle contcnt eetcapos as a gaoeouo eompound. The authors estinated that emitted fluoride gas traveJ.s between one and two kilometers, in contrast to dust contalnng particulate fuorde which has a wider expansion radius aepeaing on the topography of the area, ,re height of ,re chimneys, partj.cle sj-ze and, rnany other f ctors. They said that enisson of fluoride from power plants has received little attention and damage to the environment near such pJ'ants is usuarJ.y atributed main.r1, +^ SOr. * mainly to c^ fluoride emitted fron the pont I-Ienry alumniurn plant has been monitored, vrhen atmospheric conditions are favourable, as far east as Mount Elza, a distance of approxirnately J5 miles. However most of the fl-uoride emitted rfalls outr vithin a two_mile adius of the p1ant. (Hayes, 19?g). ** This problenr is a najor one for : trndustriar- fluoride enissions into the atmosphere the United States total in ro than loorooo tons per year and BB?/o cones fron ,;"u t1e' srass, porcelain, ro;"'"-' or coal.' (l.Iationar
The atmospheric

"t;"ff,

";:Ji,"j"jl;

;#;:tion

Academy

or sciences,

Drs R.D. Gabovich and G.D. ovrutstriy (.tgZZ) estimated that around fluorine plants rman inhal_es from 1 .5 to 12 ng fl_uoine rith air per day. I They said that rfn one ndust_ rial region of Lincolnshire (Eng.J-and) ttre ar is so polluted t with hyclrogen fLuoride that the grass contained * See appendix .19b, p. ZBZ, ilt See appendix 19c, p.up to 22OO ZB3. *l* 5"u appendix ,t/a, p. 2T6.

126

in this regi.on suffcrerr from ooteomar-acia, tho fl-uorino content of thcir uri.ne reached 69 n6,/r and 15rooo ms/ks in bones. niong chiLdren livng
ncar the plant crentar fruorosi. rras vrid,espread and the fluorne content of thelr urine was 4.2 m6/I.t Drs R.A. papetti and, F.R. Gil_more reported n 1)11 , , that: rAir pollutants that have caused widespreacr injury to livestock in the united states are confined chiefry to two substance6, fluorine (fluorides) and. arsenic (man]y rThese compounds settl_e as Asr.r).r on or react with animar fodder, and accunur-ate to concentrations much 6reater than occur in anbient air. r,ivestock eating this fodrrer suffer acute or chronic poisoning, resulting i-n oss of strength and vreight, and frequently i-n de-rth. I llowever the main sourcc of fluoricte n dairy cattle can be the rnineral suppr-ements in purchased cake or grain balancers. (Crirtitrrs-Jones, 19??) .

ng/kg fuorlne.

cowe pastured

) The spreact off luoride contami nation . Fluoride ination of the atmosphere affects people,

(c

contam_

not only in the immediate vicinity of fluor-de-emitting industries but also for a consicrerable p1ant.

animals and plants

dist,ance fros the

For instance cattle ln the Columbia River valley developed advanced chronic fluorosis, rvt,h bony svrellings,
lameness ancl poor conditon althou.gh sorne 8 oiLes fron the source of the fluorde

of the herds
an

vJee

pollution,
st ion

aluninum plant.

(Udall and Ke1ler, 1952).*

booko The

fJ

In her very accurate

Fl uorid e

Q.ue

Anne-Lise

*See appendix 14, p. Z?5, ** See appencix 1/b, p. 27?.

12?

Gotzsche

(9?5) said:

tAt the first Buropean Congrese on rrThe Infl-uence of Air Pol-Iution on P1ante and Animalsrr at i'lageningen in ApriJ1968t itwao stated that arborne fluorides had destroyed It was also 40Or0o0 hectares of European forests. claimed that in I'Iorway, fluoride injurS-es to coniferous forests coul-d occur at a distance of 72 kil-ometres from the emtting source. t was stateil at a symposj-un in Barcelona 1n 1969 tnat a German survey of areas with coaf-burning industries revealed that rainwater could contain up to 14 ppn f J-uoricle, or 88 times the l-eve1 in the control areas. These leveLs correlated directly with those found in vegetationo l"loreover, grazng near a fluoride-esritting factory could result n a lO-1OO j-ncrease in intake. fn one German survey, forage was shown to supply nore than 90 percent of the fluoride in6ested by cattle. I
Dven when

a serious attenpt is nade to elminate this problem a grave situation may persist. In 1973 t was reported

that, as a result of fluoride pollution in l.fontana: rForest insects were found to accumurate fluorides. r rEven though the company reduced fluori-de emissions by 6? percent between 19?O and 1971, data collected in 19?1 indicated that ve6etation in Glacier l,iational Frk, ? air rnLes distant from the source, was stirl accunurating abnormal anounts of fluoricle. r (Carlson , 19?3) . rn the discussion regarding the proposed estabrshnent of a very large auminiun smelter at porttand saj_d to be the largeet fn the worLd when ft tE fulry devLoped = e menon seems to have been made of the effect whch atmospheri_c pollution with fluoride nay have on the surrounding pasture lands nor much more lmportantly on the heal_th of the population (see pa6es '16?-,168),

128

()

Dlverse

t vnes of

dama pe

from fluoridc.

The very

diverse typea of

damage which

fLuoride emisslons Lnto the

atmOsphere may produce

in man, anlmals and pLants, are well

lllustrated by lnformation from Czechoslovakia. A report n the Journal Science of the first meeting of the International Society for I'luoride Research (fariert 1968),
mentfoned

a series of papers from Bratisl-avafs Research Insttute of ilygiene (Balazovar Lezovic and 'acuch). The

report eaid that ln industrial regions: rAir concentrations as hiSh as 1.11 mill"igrams of fluoride per cubic meter were recorded; close to the factory tbe flurlc distribution was 61 per cent solid and 79 percent gateoua. Farther avray, the distribution was 1 percent eolld and 85 percent Baseous. In afflj.cted. areas, fallout from fluoride-bearing particles was 711? kfLograms of fLuoride per square kilometer that isr a 90fold l-ncrease ovcr the 8e ftfograms per square kiLometer found ln a control area. Surface waters, at a 10klometer dLstance from the factory, contained 10.9 hlihin a J-kilometer millJ.grans of fluoride per Iiter. distance tree l-eaves vlere necrosedt had a decreased chlorophyl content, and the amount of fluoride was 7 to 72 tmes more than that normally found. Vegetables and frult were diofigured j.n shape and. colort and cont,ained from J to 21 times more fluoridc than did control samples. Al1 bee colonies had died, and 95 percent of the cattle this condition was trere affl-lcted with fluorosis; conffrned by fluoride analysis n several tissues. I
Marferre report on these Czechoslovakian papers continued: rIn conparison wth a control group, 1ocaI children had decreaoed hemoglobin and increaeed erythrocyte level, wlth two to three tj-mes more fluoride in their teeth, fingernails, hair, and urine. The childrenrs dalty
a

129

intake of fruorde was estinated to be 2.15 mirligrarns per dayr of which 1.40 milligrams bra6 0btained from food, 0.55 milllgrarno from air, and o.20 rnirrigrams from drinking water (deep well: rou ftuoride content). rn the contror area totar daily intake of fruori-cle was 1.o milligram of which o.8 milligram was ingeoted with food. The fruoric intake in the inclustrial area was therefore moro than twce that found n the control region. rft as these authors rcported, children can in6est
r

fron atnoepheric pollution o-55 mp of fruoridc per day nore than half the suggested roptJ-nwnr intarre from drinking
been taken into account when the revel of fruoride to be adcred to vlctorian waters bras decided. No evidence has been found that that was done.

water, and nore than the total dose now suggested for young chirdren slsly this source of fuoriu shourd have

(e)

tmos

rt-c

uori

is not monito red

the Vic torian

| the American Associatlon for the Advancement of science risted fluoride as the third most serious ar pollutant i-n a group headed by eulphur dioxlde and ozone. In 1966 tne lIationa1
196?

En viro nment

Prote c tion Au thority.

tIn

conference on rporr-ution ancr our Environment,r decided that 'rprolonged exposure to ambLent

in air

l"rontreal

concentratlons of lese than 1 part pen thousand nillion

parts of air volume of fluoride nay create a hazard ... n thfs respect fluorides are 100 times more toxic than
sulphur dioxlden. r
t

(Gotzsctre, 19?j),

Deepite thie, the most recont report of the Environnent protectfon Authorty (19?g) of

Victora

does

1ro Recently a member of the staff of not mention fluoride. and do the E.P.A. staLed that they do not monitor fluoride not know of any Sovernmcnt departmcnt vhich does' IIe said: * rlrle bave not been asked to do so'l It is renarl"able that the llealth Departnent ' which has supported fLuoridation for many years, has not asked' for

the testng of atmospheric fluoride, at least snce it Report becarne widely known, throu6h the 1968 VllO Technical in o Bnvir onnental Pollution , that rserious longReseareh

termlrealtheffects}raveoccurred'inmanIincotnmunities Both I'felbourne which have industres which emit fluoride. t such industrj"es' *
and GeeLong have many As Anne-Lise Gotzsche wrote in 19752

tAgain, as n so rany other fields of fluoride sciencet the pubJ-ic hasnrt been told, the work hasnrt been donet and the public hasnrt been told that the vork hasnrt been d,one. Fluoride Bollutj.on is not supposed to exist.r TrutY as Dr C.G. Dobbs said n 19722 Fluorne is rThe avoured Pol-Iutanr.

see appendix 4h, P. 262. It See appendix 12b, Pr 2?4,

XV. TI{E IOIXIIMUM' TOTAL }'LUORIDIj

INGIT|STIOI'1.

1rt

The Twenty-second lrlorld l{eal-th Assenbly passed

of the

IHO (1969c)

a resolution on Fluoridation and Denta1 Health. This said (in part) tfrat the Assenrbly:
rRecomrnends l{ember

States to examine the possibflity of introducing and where practicable to introduce fluoridation of those conmunity water supples where the fluorlde ntake from water and other sources for the gven population j-s below optinal levels. t

That resolutlon can be expressed as: o - i = f, where ror is the roptimal levelr for total fluoride intake per

day; rir is the total- daily intake of fluoride rfrom water and other sourcesr for the given population; rfr is the addftional daily amount of fluoricte which shouLd
provlded by he fluoridation of the water supply.
be

It is obvious that tbe value rft will be a strong influence in determining the fluoride concentration required in the water,
and.

that until rfr is

known no

rational approach can be nade to the fluoridation of a comnunity water supply. Furthermore, the value of rfl cannot be known unress both ror and, rir are known. (.or
consideration of rir see sections XV and XVIII. ) Therefore, before commencng the fluoridation of a water suppry it i-s essentiar to know the toptimalr total dairy consumption of fluoride by the population concerned.
One would

expect that this fundanentar varue wourd

be readily avairabre, but a search of nuch of the literaure

1tz

will 6oon ehow that it ie very elusive - the hIHO Resolution dld not otate the optimal Ievelr, nor dld its DirectorGeneral (WIIO, 1969a) , nor has anyone e16e.
Those who mentlon

the matter of total fluoride

l{HO book

intahe stII place much reliance on tables published in the

early 1)lOs, such as fn the

I'Iuorides and

Euman

Health (wEo, 19?ob). However, Roee and Marier (gZZ) sadl: t[arkas l'tgZSJconcludes that composite tables on fluorde intakes published prior to and during the early 1)lOts were based on nsuffcient data and ncruded nisquotecl data" Having examined the original sources, vre conclude that these Tabes require major revision. r (See aleo section XV. )

of endemc dentar fruorosis (see ection xrrr) are due to nany of the population having an excessive ota1 intake of fluorde, but generarly other factors are ignored and the effect is attrbuted solery to the fruoride content of the water supp-y being too high. rso, in a cornmunity, the rndex of Fluorosis (see section xrrr) is used to denote whether the total fluoride intake is too high, other examinations are undertaken only rarely. Ilor"ever, denta fl-uorosis is an unoatisfactory indication of current fruoride ingeston becuse it is alr,rays out of date. For instance the prevalence and the degree of fluorosis in the anterior teeth of 14-year-o]-d chitdren provides no information
Areas

regardn6 the current ingestion of fluoride, but it gives

of their lever of fluorde intalce when the tooth enareel vras formng 9 to 14 years previously. Therefore, even f the fruoride content of the drinking water remains the
sone idea

17'

r it is almost uscless as an ndfcator of the present level of fluoride ln6estion, for thcre 1s little rioubt that
sane

of fluoride obtalned from sources othcr than vater is increasing. Professor A. Crrlspon (1978) eaid: rfnformation frorn the U.S.A. and Canada shovrs that a considerable increase in total fLuoride intake has occurred during the Last decades. I
amount

thc

that estimates indcate that the present fruoride intake in localities without fluoridation is as great as the
He said

initially

calculatcd intake n fluoriclated areas.

Any cons<ieration of the roptimunnr or of the maximum

perniesible totar daily ingestion of fluoride must tal<e into account the a6e and the body weight of the individual.
Tberefore the question of total fluori<le intalte will
considered under three headings: (i) ttre foetus, (ii)
be

children, and (iii) adults. (i) The foetus . Drs R. Feltman and G. Iiose1 (1961), in their study of the administration of ftuoricie tablets
n6 t, to t61 pregnant vromen (witb 240 controls) ane 6?2 children tthrough thcir eighth year of rife' (wtir 46r contrors), found that:
mg and O.BZ5

containing 1.0 ng, 1,2

r.. fluoride ingested by gravid. women enters the maternar circuration, is stored in tr:e placenta and passes throuh the placental barrier to enter the foetar brood supply.l Dr r. Gedaia and hs three associates (964) conpared sanples of maternar brood, cord brood and rvhore pracental
tissues, in three groups of wornen who vere consuming water with low (0.06-0.15 ppn F), medium (0.5-O.6 ppnr f.) and high (0.6-0.9 ppm F) fluoride contente. They reported that:

4
r.. when tho fluorids ntake is Iow, fluoride freely paoces through the placenta, but when the fluoride ntahe 1s high, the placena plays a regulatory role ancl protects the foetus fron excess.r
Drs R.D. Gabovich and G.D. Ovrutslciy 997?) said:
I

It can be asslred that the comparativeLy rare inc j_dence of fluorosis in deciduous tecth is connected with the ability of the placenta to inhibit considerably the intake of fluorine by the foetus. I if
occurs, s contrary to the

Therefore the custor of prescribing fluoride tablets to

pregnant vlomen, which still

physiological requirenents of the foetus, and the snall amount of fluoride which passes throu6h the placenta wourd
be obtainable from the norral naternal diet.

(ii)

Children. Drs Gabovich and Ovrutsk-iy (1g??) said that: r.. motherrs mlllc contains very smaLl- amounts of fruorne, even when water containing hi6h concentrations is
consuned.
I

They anaryzed breast milk in two cities.

l,rith water

contanng o.3 p.p.m. fuoride the average milk content vas o.163 nB/\, and with a water concentration of 4.1 p.p.n. the niLk contained O,2?5 ng/I fLuorid.e. They cornmented:

rrherefore, it can be concrucled that increased consurnption of fluorine increases its content n breast milk but only slightly (approximately the sane as n the blood). I
Tn 1973, the l,fectical Journal o f Australia published an articre on roptimun Fluorde rntaker by professor N.D.

Martin, which was enrr.orsed by the Fruorcration of pubric rlater supplies Ad,visory comnittee of the N.s.hr. Departnent of Hearth and radopted as a statenent of policy on this natter. r

See appendix

1fg, p.

28O.

135

1)rofessor Martin srld:

r.. a6 the amount [of fruoricte] cxcrotod, in b:reast mirk fo extromely owr .. rthe breact-fccl chircl should be given a fruoride supplement evcn ilrorrgh the mother is consumln6 flUOridated water. r IIis reccmmendation vras rhalf a rnirligram of fr-uoricre per day for children to the age of one year. I
commentinB on

that recommendation a pharmaceutical chcmist

, 1g?3) said frhe breast-fed baby creates rear problerns for the fluoridation theory. professor luartin acknowredges that the breast-fed baby receives rittle or no fluoride from breast milk. A lo8icaL anrl accepted ar6ument runs that breast mirrr contains optimum amounts of nutriens for proper development of the child, and the absence of a particular substance is evidence that the substance is not required for any normar crevelopment of the chi1c1. Even when the feedin' mother is on a righ fluoride d.ie, lor^r fl-uoride breast mirk 1:rcvails, This stubbornness might lcad the reader to question assertions that fluor_ ide is usefur and rrarrIesc to the breast-fed child. r IIe concluded by saying that: f" the concept of fluoride-deficient motherrs nilk is too difffcult to accept. I Professor A. Carlsson (lgZg) pointed out that animal
Kausman

(1.,.

experinent's have ehown that drugs can rproduee speciffc pernanent dsorders n the learnin' abirity and other subIe behavioual componentsr, and said:
rone wonders what a lo-fold increase fluori-de, sueh as occurs in infants

in the exposure to bottre-fed wth luoridated] water-diluted preparations, may nean for the developnent of the brain and other organs. r

116

Professor Carlsson continued:

tAgain, problems associated with thls can be solved only by precise and, comprehensive epideniological studies in which, for example, breast-fed and bot,tle-fed babies are compared in localities with a varying vrater fl-uoride content. No atudies of this kincl have yet been made.r

It should be noted that the CouncI on Dental

Therapeutcs of the merican Dental Association sug6ested.,

in 19?7, that for children less than two years of age the
dose of fluoride in tablet forn shoulcl be 0.25 mg daily.

In a Report, it said that if the water supply contains

more

than O.2 p.p.m. fluoride that d,ose must be red.uced. (Driscoll and Horowltz | 19?B). This is only haLf the dose, previously sug6ested. Therefore, those who still
adhere

to the advise 6iven by the N.S.W. Department of Health at the tine when the Victoran Fluoridaton Act was passed, are administering twice the cr:rently-reconmended dose to the young children under their care. As a result, at Least of these children are developn6 fluorosis in their font teeth how severe the fluoroeis is only time will reveal.
some

The

councir on Dentar rherapeutics

recomnendecl

that

children aged 2 to J years should receive 0.5 mg fruoride per day and those a6ed three year6 or nore 1.0 ng daily. rn bcth cases they specified that the dose nust be reduced if the domestic water supply contained 0.2 p.ponro or more fluoride.
The council also specified that if the fluorid,e
reconmended

level exceeded 60% of rthe concentration

community water

for

fluoridation in a geographic regionr fluoride

13?

suppler[ents nuet not be prescribed. (DriscoII and Horowitz,

1g?8). *
Unfortunately the Victorian publf.c has not been inforned of

that prohibitJ.on andn judging from the large number of fluoride tablete which are stlll
soldlr
many

chidren nust

be ingesting far too much fluoride r particularly f the

anount absorbed fron fluordated toothpaste is taken into

account.

(See

also sectione

XV and XXVI.)

The Councj.L on DentaL Therapeutcs said:

rThere is no evidence that the d.oses reconnended by the Council produce esthetically unacceptable clental fluorosis. I (Driscoll and llorowitz, 19?8).

(In section XIII some conments were made on the tern fobjectionable fluorosis I whlch is used n tlre jargon of public health officialc, now called raesthetically
unacceptable

I fluorosis. ) The above-nentioned etatement

by t,be Council on Dental Therapeutcs is a tacit admission that some degree of dental fluorosis occurs j.n chiLdren

ingesting the doses of fluoride which it suggests.

Therefore, even in the U.S. vith its hard waters, there ls little
doubt that the doses recommended by the Council on Dental Therapeutics
O,2J mg to age two years, 0.5 mg between tvo and three years old and 1.O ng for

chil-dren aged three years or nore r per day roptinumr level of fluoride ingestion. the

are

above

Adutts. Dr c.G. Dobbs (gZz) said: rSo far, after 26 years of fluoridation, neither the actual nor the rroptimarrr fruoride intake has ever been determined for any tr6iven populationfr served by a * See appendix !b, p. 268.

(rii)

1t8

water suppl-y. Hitherto rel-iance has been placed upon wild extrapolaton on a national basis from a few dietary stud.les, some of them as od as I'{cClurers in 1941.t
community

In 1971, Ralph Nader related that Professor Bamy

Commone,

harl asked the U.S. Fubllc l{ea1th Service to provide

informatlon on total fluoride intake. They did not reply. After fconstqnt hammerngr, about eighteen lnonths 1ater they gave a figure for the average ntake for adults in p.pome, but did not give data for children.

In 1972, Carol Farlcas

made

a survey of rover

2OO

rrexpertsrr in thc felds of nutrition,

crentistry and medicinel

regarding the maxinum safe daily ntalie of fluoride fror all sources. Professor II. Jenkins repliec.:

r do not thnk there is yet a consonsus on the ;raxmum safe dose of fluoride ingeston. other repl-ies vhich she receiverl bear that out, for the estimates for the safe dail' ingestion by adults of fluori<le from all sources ranged from 2-3 m6 to 6-l rit6. n even
I
r

higher value was stated by Dr J.L. Ilardwick (1g?5) vho sad: r..the consistent in8estion of fruoride at the 1evel of about 8 mg dairy in adurts appears to be safe from cumulative hazards. I These rrexpertsr did not state the figure which
they

considered to be the roptinumr one.

Irowever, as that value

was

cannot exceed the maxintrn permiseibl-e one, unress there generar agreement that the roptmumr $ras 2 ng or ress,

their

opinions regarding bhe roptmumr value wourd criffer.

1t9
The 15th Internatlonal Convention on Civil.ization

Diseasos, Vita1 Substanceo and

Nutrition, hcld from Bth to

14th Septenber | 1969, passed a Resolution No. VIII whch

was published

in its Bulletin J9a. (rnternationar socety for Research, 1969). Thio considered the Resolution on
two

nluoriclation and Denar llearth whl-ch harr been passed nonths prevousIy by the I^IIIO (969c) ,
The Convention conrnonted:

rrhe Resolution passed by the w.H.o" is an aclmission that

fluoridation ras not yet been investigated carefully enough from the nodical and scientfic point of view. This l-s borne out by the second part of the Resolutlon which requests the Director-General to continue to encourage research into the etiology of dental_ caries, the fluorde content of rliets, thc mechanism of action of fruoride at oiitmal concentrations in drinking vrater and into the effects of greatly excessive intarce of fluoride from natural sources.
r

The Convention sa:Ld that: rl-rom this the conclusi_on can be crawn t)rat

various foods.'

1. the etiolo6ical circumsta'ces of dental caries have not yet been eatisfactorily elucidated, 2. not enough is knovn about the nechanisn of acton of fluoride, 7. not enough is known about fr-uoride ntake from

Bulletin J9a continued: r.. these matters were discussed and evidence from a number of researches was assenbled. vhich red to the concrusion not to recommend fruoridation of drinkng water supplies but to chose trre arternatve of dental care combned with otber vel_l-tried method.s instead,. r

140

The ondorsement of fluoriclation by the IrIHO (t969c) has received nuch publclty and many people vrouLcl expect

it to be scientficaIly fluoridaton.
Direc

reliabLe

ancl based on

a careful

study of the availabl-e evidence both for and against

It followed a report prepared by the

1969a) .

WIIO

tor-General (wtto,

The Int,ernationaL Conventi-on said: rMention shall be nade of the fact that unfortunately the documentation of the report of the Director-General of

the tforld Health Organization is very incomplete, because no mention is made, and no reference gi_ven to, the principal researches on fruoride toxicity rgr Rohohnrs rrFruoride Intoxicationrr, the researches of CoI. Shortt and his successors in rndia fron 1 917 to thc present time, Theorerr on enzyme inhibition, Rapaport on niongolism, Rodriguez in span and steyn in south Afrca on s-,eretar fLuoross, Fel-tnan and Koser on sde ef fects of f luoricle, uadbott on fl-uoricle alrergy and many others. Thcre are no reports and otatements of experts I cornr:rittees rncl study groups and reeolutlons of organfzatons against fruoridaton of drinking vrater suppree. The often discussed pubJ-cations and resol-utons of our society, the opnions of eminent , scientists, and, the decisons of Governments not to permlt fruoridation of pubtic wator suppLes are not rnentioned. I ( rnternationaL sociey for Research 1969) . , The statenent in favour of fluoridation is contained in
paragraph 2 of the Resolution of the UHO (gf>9"), nost of which was cited at the corencement of this section. rl_uori-dation
vras suggested
:

r.. where the fluoride intake fron water and other sources for the givcn population is below optimal level_s r.

141

Thc International socloty for Research on civilizatlon Diseases and Vital Substances (969), comtnenting on that

statemcnt in the

WIIO

Resolutiont oaicl:

rVJithout going into tho details of the argument attention rnust be drawn to the fact that it will be impossible o give effect to this resolution, because it does not state (neither does the report of the Dircctor-Genera1 on r,hch j.t was based) vhat is thcrroptimal levelrr of intale of

fluoride.
There cannot be any optimal levcI of intake for a given population. It is thc intake of each individual This is certainy not the same for each which natters. individual. It r'ill vary with age, sex and indviduaL bodily reacton. Some individuals are more sensitive to fluoride than others, for exaurpe persons suffering from kidney trouble are less able to excrete fluoride and more liabIe to injuries from it. In any case even if the rroptimal level-tt of fluoride intake were l..nor^rn, it is impossi-ble to achieve it by adding fluorde to the public water supply, because of the very 6reat differences in consunpton of water by different individu'.Is (one Lo 12 litres per Oay). Talcing into account these differences, the daily intahe of

fluoridated drinkin6 water can introduce into the organisn quantlties of fluoride which toxicologists, pharnacoJ-ogists and hygiensts consider toxic. I r,{e end this section almost where we began, for we do not know the f optirnum intaker of fluoride. However, r^re now
lnow

that there is no such varue and that the I'IHO resoluton endorsing fluordation cannot be carried out for it specifies

a method for deternrining the fntake of fl-uoride fron water supples which is irnpossible to execute.

XVII.
rIT]T FACTO R OF TEIVIPERATURIJ AI{D S]iS ONAI, VAIIATIONS.

142

The concentration of fluoride to be used in victorian vater

supplies, which 1s laid indivdua

in the Act, is close to, but provided that each no exceeding, 1 p.p.nro fluoride.
down

Ij-tre of water per day, by drinkng it or n prepared food, the dose of fluoride ingested wj.ll
consumes one

be one mIligran. That is the dose specified when admnstering fluorfde to chl-dren who are nore than three years of age.

A fal_lacy of the fLuoridaton case is the cJaim that all people drfnk about the same amount of vrater. of course they do not. Apart from personal preference, there are

other factore, one of vhich is the daly temperature. Ths has an effect, sonretimes a marked effect, on the amount of wate:r coneumed and, therefore, on the d.ose of fluoridc irlgested from water. Recently, professor T. Davson (19?9)
many

said that workers at Broken Hilr drink ur to 1 1 litres per day. rf thle bad been fluoriclated water or beer made ruith fluoridated water they woul-d have been j-ngesting fron beveragee aloner approxmatery 11 mg of fruorde daily, which is far in excess of even the highest estnates nade for the safe total daiJ-y ingeston of trtuorie fom arr sources.
Both the u.s. and the victorian cImates can be carred ttenperatgt ones, but the mean annuar temperatures are very

The s shown in Fig. 5, which compares the mean annuar temperaturee of he Austrarian capitar cites with those of the four major fruoridation test ci-ties in the u.s.

dfferent.

14t

M]IAI.I A}.IIUAI, TB}iIIIRA TUREI]

D

25

20
A

1'
c
o
.r'l

1-I

r'{
()

()
u

10

c) c)

h 0 )

B
5

r'r

E
GR

Australian Capital Cj.ties:

Hobart Canberra Melbourne

Artificially
Brantford

Fluoridated

Tria1 Cities:
Newburgh Grand Rapid.s

Adelaide
Sydney

Perth
Bri.sbane Darwfn

Evanston

F19.5.

of the Australian Capital Cities compared, with those of the four main American and Canadian fluordation trial cftiee.

The nean annual tenperatures

144.

It can be seen that, by our standardo t the weather in those four cities s cold - nuch colder than 1n Hobart their mean annual tenperatures are only half that of cInate and those of the teot cities in America, the
concentration of fluoride specified in the l\ct is the
same

and

l'leIbourne. Despite this narlced difference between our

as the 1 p.pomr sed 1n Grand Rapids, Evanston and. Brantford,

and only slightly less than the 1,2 prp.m used n '.Iewburgh.

In addition, no evdence has been found that there is a variation in the fluoride concentration in the
water between the sunmer and the winter periode.
d,espi-te
MeLbourne

This is

the fact that the mean maximum temperatue here Ln January (26.5 <legreee C) is alnoct exactl-y twice that (13.5
de8rees C) found in July. As tr,e.s pofned out fn eectfon XIII, only short perlods

of hi-gher fntake of ftuorde are necessary to produce cirronic fruoride poisoning and, thereforer areas of dentar fLuorosie n developing teeth (apart from offects on other organs). T.n 1954, the N.H.& M.R.C. said that the concentratons
considercd appropriate for sunmer and for winter should be averaged and the resulting value Inaintained wthout

variation throughout the year. I

However

it s the

maxinum

tenperature which natters when consid.ering denta fluorosis. Therefore that recommendation of the N.H.& M.R.C. is
unsound and

it is not in

accord.ance

with the practice in

many

Anorcan communities.

As the dairy temperature is an important factor in deternining the fluoride content of water vhich is consid.ered

145

to be deelnabre, the comparcons

fluorfde
reconmencled,

ehown above

Lndicate that

(ar,art from othor congLderations) the concentratLon of

for vlctorian waters, 5-n tho Act, is particu1arly in the summer months. too high -

XVTI.
TIIE
FLUORTDD CONCNNTRA TION SPBCIFIED

146

IN

TTIB ACT

IS

AN

ARBITIARY O}IE.

Paragraph !. ) of the Health (Fluoridation

Act 1g?t

statee: fNothing n this Act shall authorze a water supply authority to add fluoride to an extent that results in an aver.ge optJ.mum concentration in excess of one part fluoride per millon parts of waer. I
1so, paragraph 6. 3) states:
rThe water suppfy

authority adding fluorde to a public

water supply (a) ehall eo regulate the concentration of fLuoride that such concentration sha1l not exceed the maxinum concentration deternned by the
uommrssLon.
.a

lleither of those paragraphs specifies the acceptable range of the concentraton or the period over which the ravera6e u/4tever that rreans optinwn concontrabiont - is to be -, calculated. It is assumed that the obJective is to
naintaln a coucentratj,on clooe to, but not exceedingt
1 p.p.n. fLuode. The VJHO resolution (1969c) su6gested introducing

fluoridation:

0.. where the fruorde intake from water and other sources for the given population is below optiural Ievelo. r That etatenent was reinforced by an article in the WHO
|

Chronicl-e ('l 969b) vhich sad:

r0n1y when the natural

fluoride ntake fron al1

sources

147

(includln wator) hae bcen asuesscd ls it pooeible to calculats the level to whlch the fluoride content of water supplies needs to be adjustcd. In tropical areac the level rnay be about 0.6 pprn, irt tenperate area6 1.O1.2 ppn.'

Therefore, if it is decitecl to add fluoride

to the domestic
be

water eupplieo, before determning the concentraton to

added, it s necessary to know, for each area supplied:

(i)

The fluoride intake from rother Bourcesr, and

(ii ) rne t optJ-nal leve1 r . Those rother sourcesr include fluorid.e in food, toothpaste, tablets and medicaments, and in the atmosphere. l\s has been seen, the fluoride content of foods is considerably differentr even in the same type of foodt the
concentration varying with the soil in which it is gro$tnt

the use of agrfcultural sprays, method of cookingt other factors.

and

fn a place like Melbourne, where there are

large ethnic groups with considerabry crifferent food habits and methods of cooklng, there are more than usual variations in indivitlual food Breferences, quantities eaten and drinki_ng habits. The factors to be considered in attempting to
assess the fluoride content of the food of a community are

almost endless.

Sinilarly, the individual"

tbe fluoride intake from toothpaste,

d.epends

tablets and medicanents

on the personal habits of

Ng evidence has been found

of a survey

havng been nade n victoria to deterrnine the fl_uorLde

intake from food,, toothpaste and med,icaments.

149

One

thlng Lo certain, the lmportant factor of lnhalatj.on

The conclueLon Ls

of atmosphoric fluorlde haa not boon investigated by the

Environment lrrobection Authority (19?8),

the fluoride intake from rother sourcesl in Victoria is not known.

inescapable

Resolution ltlo. VIII of the 15th InternationaL

Convention on Civj.Iization Dieeases, Vita1 Substances and

Uutrition (International Socj-ety, 1969) saicl (in part):

rThere cannot be any optinal leve1 of [ffuoriae] intake

.for a given population. It is the intake of each indivicluaL which matters. This is certainty not the sane for each lndfvidual. It wL1 vary vrith a6e, sex and indivdual bodily reaction. I

In Victoria, values are not kown for both of the factors which the blHO stated must be consdered when
deterninng the fLuoride concentrrtion of a water supply.
Therefore it is obvious:
The fluoride concentration speci-fieci, in the Act is an

arbitrary

one.

xIx
THE TOXICITY OF F],UORIDTION AND THE DFTECT OF
CONSTITUENTS OT TIIE VtrATER.
OTITBR

149

Toxicity from ingesting fluoride

A thrd category

may be acute

or chronic.

long-tern has been sug6ested, in which the toxc effocts d.o not appear until after the ingestion of fluorde has coninued for
!hen speaking many years.

of the toxiciy of fluoridated rvater

many

(approximately 1.0 p.p.m. I.) the discusoion is of chronic

toxicity from the ingestion of

small doscs of fluoride

and, possibly, of 1on6-tern results.

It ie irreaponsible

to suggest that, in the ordinary course of events, people will develop acute poj,sonfng from drinking fluoridatecl water. (0f cource, as mentioned in section XXV, 6ome
indj-viduals are sensitve to,
doses of fluoride. )
and. become

irl

from, very snall

severar rare cases of acute poisoning

from drinking fluoridated water haven however, been reported.

to the nrarfunction of the fluordation apparatus. For instance, on Apri1 16, j9?4, at a rural school in North carolina, twelve adurts and 201 students
They vrere due

experlenced nausea and vorritng two to five ninutes after

drinking orange juice prepared with water. Ione of the otber 126 students becane ilr. rt was found that the fluoride feeder had. continued to operate arthough the water punp had faIed. Laboratory anarysfe of the orange a fruoride coutent of zlo ng/ritre nstead (Clark et a. , 1g?4). * of 1 ngrlIitre.
ehowed

juice

* See appendix 'loa, pr

27o,

150

Fluorldatfon pronoters frequently nake the deceptve clafn that lt 1s neceosary to drfnk more than fifty
bathtubs furr of fruoridated water before being posoned. That claim is based on tbe likl-ihood tbat acute fl_uoride poisonlng wourd en'ue f the fruoride content of that

rarge anount of water was concentrated and drunk as a s1ngIe doso. spokesrnen makin6 that statement are either fgnorant or are out to deceivc. The usuar problem fron fluoride fngestion is ilre cumulative effect of the many

snall

doses taken each day over a long perj.od. The possible long-term hazarcrs

of fruoridation, and the necessity to maintain studies to test for ilrem, have been mentoned by a number of scientists. r.n 1965, Professor D.G. steyn, the chicf Research officer, Life science. Divisi.on, tomic rl'ncrgy Boarcr, pretoria, saic: rAs harnful effects of the ingestion of mimimar amounts of fluorides may be i-n evicrence only after some .eca*es, ft fs obvious that the above observations, tests, etc. ehould be conclucted over periods of at r-east twenty to forty years. I
rnternationar society for Research on Nutrition Vital- Substances Og6Z) agreed, saying:
The
and.

r..' long-range crinical investigations and bioro6ical tests shourd be conducted over several crecades, since it is inposcible to corne to rer-able concrusions as to the danger or rrarmle'cnc.s of fluoricrati_on of crinking water before that time. since numerous factors have to be conslderect in thi-s fiercr of research, t vroulcr be necessary to incrude as many test persons as possible, thereby covering the entire terain, which includ.es age,

151

pregnancy, feeding of mothers, statc of health, drugs, water, nutrition and bevera6cs. I
No eviclence has beon found

that tIon6-range clinical

investigations and biological teotsr are being conducted

here.
An important dlscovery which

affects consideration
g

of the toxicity of fluoride was that I there are two forrs of fluorde in serurn, exchangeable and non-exchangeable.
(Taves

| 1968). That finding was confirned by Drs Ii.,J.D. Arnstrcng ancl f,. Singer (gZO) who said that blood
r..pIasma contains two forms of fluoride.
One form

free and ionic, the other bound rnd non-ionic. the former kind of plasma fruoride that can be expected to participate in physiological reactions.r rn a paper given to the rnternational society for Fluoride
Research, H.A. Cook QSZS) saicl: rThe fluoride ion, r.rhi-ch is what we nean by rrfluoridett,

is It is

s intenscly toxic to arl life. rt inhibts essential enzymes and kills Iivng cells, but onlr i it is free and thus able to exert its toxic effects. llowever it has a very great propensity to be combined, or bound, and this fortunately reduces its toxiclty. vriere this not so, then the ubicuity of its distribution vouId ensure that there vould be no riving organisn on the
earth. I rrhe toxicity of the fluoricle ion is thus shown to be e:<erted when it is free, and it can be sa-id to be proportional to the degree of freedon of the ion, vhfl-e the conpretery bound fLuoride ion s non-toxic. r Professor N.po Buu-Hoi (1962) said:

r.. he most spectacular manifestations of fruoridotoxicosis are connected with irnpaj_rments in the nnaniford

112

functious of calclum 1n the

body.

In 1946r J.T. Irving founrl, ln the tceth of rats, that: t.. urhen the blood calcium is raised thc action of fluorine on the predentn is greatly lessened or prevented, while when the blood calcium is J-owered, this effect of fluorne is caused in rats prevously found not to show it. These observations strengthen the theory previously put forward that the action of fluorine on tecth is reLated to the ]-evel of the blood
caLcium.
r

It should be realized that sensitvity to fluoride varies

considerabry and is different n different classes of anmar.

It s important to knovl, when considering the results of animal experiments, thrt rman is nuch more sensitive to fluorne than the ratf (Roholm, 1932)
timee more sensitive.
Arthough the concentration of fruoride in clrinking vater is an important frctor in determning the amount

between

six and ten

ingested anrl the prevarcnce of fluoride toxicity,

i-t is

not the only factor.

Profeseor A. Schatz and Dr J.J. I,tartin hg64) said:

r.. the issue of fluoride toxcity cannot be resolved by considerlng only the concentration of fLuoricle in the water aLone. I
Drs R.D. Gabovich and G.D. ovrutskiy (19??) concurred, saying:

r.. ths incidence of fluorosis and its frequency are not due on]-y to a certain concentration of fruorinc in the water. Naturar and social conditions, affecting the react'ivity of the body and the physioJ_ogical condition of the centrar nervous systen, can intensify or weaken the effect of fluorine.r

157

They founr that increasing the calcium in food decreascs

fluorldc retentlon ln the ekolotons of animal-o,

an<l s;aid:

rThe excretion and rleposition of fluorine in the body can be affected by the acid-base equilibrium as well as by the amount of proteins and vitanins in food. For example, lack of vitamin C in the diet increases the deposition of fl-uorine n thc body and enrichment of diets with ascorbic aci-d and severaf other vitamins which stimulate metabolic processes reduces the

depostion of fluorine. I They srid that no specific anti-fl.uorosis agents are knovrn, but for protection against fluorosis rthe goal is a fu11y
adequate diet from the physiological_ point of view. There are considerabl,e difficulties
r

in recognzing

the effects of fluoride toxicity in its early stages.

Bven when marked, symptoms occur they are

not obviously

due

to fluoride toxicity for they mimic other diseases. Dr P.li. Springefl g9?5) pointed out that, with a pollutant: r.. it is extrernery di-fficult to dia6nose subclinical effects, and thus to decicle whether there is a threshord, below which there are no uncesirable symptoms.r Dr Stephen Boyden (lg?Z_), Urban l]iology Group, A.I,tr.U., said: runfortunately, the tests to which chemical compound.s are usuarry subjected in efforts to cletermine their so-cal_led rrmaxi-mum perrnissible doses or concentrationsrr d.o not take into aceount possibr-e changes in mental function, moocr and so on, and also would often fail to pj_ch up ong_ term or chronic effects on the organism. Furthermore, the tests are seldom, if ever, designed to pick up possible synergysti-c or adctitive effects of dfferent environmental poJ-lutants of this kind. The danger is thus a very rear one that, because of pseudoadaptation ... an insidious deteri-oration of health rnay occur i_n a

154

populatlon aB a consequence of fncreasing envlronnental chemoalfzatLon, without producnB any appreciabJ.e effect on mortalJ.ty and fcrtllLty rates r and, without eociety even reco6nizng that a state of iIl healh exlsts. I
human

llowever,

in

some

people, obvious illness does occu from

Drs R. Feltrnan and G.

ingesting snal1 doses of fluoride.

cent of pregnant
under
vronen and

Kosel ?961) reported that side effects occurred. in one per

chll-dren given fluoride tablets

supervision. They said: tBy he use of placebos, t was definitely cstablished that the fluoride and not the binder rtlas the caustive agent. These reactions, occurring in gravid vromen and, in chIdren of all ages in thc study group affectecl the dermatologlc, gastro-intestinal and neurological systems. Eczema, atopic dernatiti-e, urtlcaria, epigastric distress, emesisr and headache have all occurred. with the use of fluoride and disappeared upon the use of placebo tabl-ets, only to recur r.lhen the fluoride tablet vras, unknowingl-y to the paten'b, given again. The daily intake of fluoricle from a fluoriclated. water supply is supposed to be sirnila.r to that from taking a tabtet contaning approxirrnately 1 rn6 fluoride, such as vrere adrLnistered by Drs Felturan and KoseL. fn a large city, if the proportion of people (or of children and, pregnant wonen)
I

affected even approaches the one per cent which they observed, the nrnber of peopre with recognzed, or unrecognized, side

effects from ngesting fluoride wII be very large.

Professor Arvid Carlsson ?gZB) of the pharnacol_

ogical rnstitute, university of Gteborg, pointed out that: |f we assune for a monent that later fluoridaton brn6s

115

about an increase of 5 - 1/" in any comnon dioease rgr cancerrl "..lthe pc rc e ntane increaoo is so small that only precloe epidemlolo6ical studie6 on a vcry ar6c aruount of material can be oxpected to revcal i.t.r

said also: rOur hearth authorities wirl in future be involved to an even greater extent wth the problerns which this pollution brings in its train, problems of a very high de6ree of conplexity as regards difficultes in quantitive surveying, interactions with othcr substances, etc. Our communty will require .even greater resources to be put to use to hold chemical exposure down to an aeceptabre lever. The fact that in this situation a poison shourd deliberately be distributed throughout our environment in enormous quantities represents an i1r-considered. action. I When claims are being made for the safety of the long-term inBeston of fruoricle, despite its toxicity, it
He

s h16h1y l1kely that ilre Bartlett-cameron study wit-l- be cited. The reeults of this study were pubrished ln the
u.s.P.H.S. j ournal Public Ileal-th Reports
(Leone

g[_3!. r

1954). Thie otudy has been cited on a very large number of occasions. Dr A.. Lond,on ?geZ) said: rBref'y, a group of 116 people in Dartl-ett, Texas, with a natural fluorde content of B ppm in its rvater eupply, vras compared with a eo-carled rrcontrolr group of 121 people in Caneron, Texas, with about O.5 ppm fluorid.e fn its water supply. Canreron cannot be considered a non-fluoride city. I The ffrst examination was macle in 1943. Fourteen of the Sartlett eubJects and four of the cameron ones ded before the seconci examination, ten ycars 1ater I n 1)JJ; rwhil_e about 6o to 90 in Bartlett, Bo to 90 in cameron remained at

156

risk in the stucly areao and were re-examined, for various abnormalities, by an entirely different team in 1)JJ.r His paper considered that paper n eome detail and he referred to I the ludcrous inadequacy of the BartlettCaneron study a6 a basis for assurances of rreafetyrr.t Professor D.G. Steyn (1964b), referring to that study, sadl rGrave d.oubts as to the validity of thfs, so very often
repeated, statenen'b exist.
I

He'cited his earlier paper (t964a) which harl consdered several aspects of the etudy, one findin6 beng that, of

the people who had been dentally examined in Bartlett in 1951, only 11 had lived there all their lives an, 60% came

years. Also, there was considerable doubt regarding the hstory of the rvater supply in Bartlett. Professor Steyn safd thatn prior to the few years which preceded the study, the fluoride content of the wells used vras Brobably substantialry less than I p.p.rn. Drs R"D. Gabovich and G.D. Ovrutekiy (gZZ) sairl:
1lr
rThe

to live thore aftor the age of

varied character of the groups (by age, knd of

vrork) and
The

ther srnall
I

nulber deprive

this work of

conviction.

fact that this study continues to be cited,, over and, over again, indicates that there is stilr no better evidence to suggest that the long-tern ngestion of fluorides, at the concentration of 8 poprn., -s safe. (Apart from, of courser the development of very robjectionabler dentar fruorosis.) rt s renarkabr-e that this obviously deficient study should continue to be cfted as strong evidence for the safety of fl-uorlde ingestion for atr people, everrwhere.

15?

In 1958 hofessor Steyn 119J8a) diccussed the toxiclty of fluoride at eome length J.n hs book The Problem of Dental s and the Fluoridation of Water Supplies which has 558 references. Iater tbat year (1958b) he sad: rIt is the authorrs consdered opinion as a toxicologist and pharmacologst of rnore han lO years experence that under certain conclitions, especially with certan types of water, artificial fluoridation of public water
supplies may, and does, constitute a grale danger to hunan healtb. r- ]l
The recent book: Fluoridation: The Great Dilemma (Waldbott

9!-4. | 1978) | considero nany nore aspects of the toxicity of fluoride than it has been practicable to mention here.
To concl-ude thcoe general comments on the

toxicity

of fluoride, the opinion of Professors T. Gordonoff and lI. Minder 3960) wilr be citcd. rn the Surrnary of their revew of fruorine in the book lrforld Review of lfutrition and Dietetcs t hcy said: rBecause of its varied activites, there can be no question of anything but an accuratel.y measured, suppl.enent, and in no circumstances an aclditon to drinking water, lvhch makes impossible a'y kind of
exact dosage and control,
I

Final"ly, in ths discusson on the toxicity of fluoridation, the effect of the other constituents of the water will be nentioned, because this aspect is of

particular interes in victoria for our water supplies are exceptionally soft.

See appendix

/b, pr

265,

158

since the fluoride content of Merbourners water supplles has been raieed fron Leee than 0.1 p.p.n. to approxrnately 1.o

t there also have been changes Ln the concentrations of some of the other constituents of the water. one of
these, as has al-ready been mentroned, has been intentfonal 1n ordor to protect the water pipes fron corrosion due to

prp.nr

the lncrease n the fluoride concentration. (Itirtn, 19??).

of other Constituents of the Water trlhen considering artificiat fluorid.ationr many people speak only of the fluoride content of the water, ignoring the infuence of the other constituents. However, the5-r mportance
(r
)

The Imnort ance

years. In 1949, the American ItJater Works Associatfon sald that the experimentaJverification of the fl,uoride-dentar cariee hypothesis: r... obvously necessitates the use of a nearby ttcontrolrl city with a water suppry comparable in aIr respects to that to which fluorj-de is being added.
has been reco6nized

for

many

Professor D.G. Steyn ?lg58U) said:

I

rt s obvious that the resurts (in regard to dental decay and, toxicity) observed in a'particular prace with
fluorine-containing water can, and. shourd, not be applied to a different, vater suppry, 1et aLone to water suppres in different countries.r

In 19?2, Dr Margaret Crawford referred to:

f. o. a problem concerning fluoridation of water supplies in ths country which has not received eufficient attention that s, the relati-onship between fruorde and other ions present in drinking-vrater, in particurar
iod.ine. I

119

HARDNESS OF WATER SUPPTIES

4oo

a
Et

tr{
a

,oo

P{

r^ o C)

()
o
.

qt

200

Q
.D

GR ES
100
(,
H

(,

f{
.

tri

I r{ 0

f{

0)

Teet Cities Fi.6.

Fluoridated Cities

:,::::

Sheboygan (U.S.A.) and

visited by the United Kingdom Mission (,tg5Z), Test citiee: Marshall, Newburgh, Grand Rapids, Evanston,
Brantford (Canada).

;,' ": :' 13',, :'"T; i::,;" l, ;; l;'",, "i

:::"

160

CAITUM IN

TER SUFPLIES

Calciun
prpr!1r
6o

5o 4o

to
20
10 0

Melbourne

NEGRB

Test citi.es

Ffg.

7.

The Calclun content of Melbourne water (M.l.f.B.rd., 19?3) compared with the four main fluoridation trial cites.

llelboune Newburgh Evanston Grand Rapfds Brantford

.6

p. p.t

75.O p.prtre tB.O p.prnlr JJ.O p.p.m, 60.0 p.p,nr.

161

Q) The rsoftne6st of
vrlhen

l,lelbourne Water.

consfdering other characteriatlce of the water, a factor of particular intercst fs the rhardnesf of the water, due
E

nainry to ito caLcium and nagnesiun eontent. l{erbournef water suppJ.es are partcular1y rsoftr.
Merbourne and Metroporitan Board

of hrorks rtypical analyseer of our water in 1)lJ showed a hardness of 1o.o ( as cacor) with calcium 1.6 and magnesiu-m 1.1 ng/L, The same varues were gven for the sylvan dam in the 1plg repor, but, the cardinia dan had a hardness of z? ng//!, vrith carcuu
6.0 and nagnesiu^n Z.O mg/I,

Figs. 6 ancl ? shor^r the lrlelbourne (Sylvan dan) calciun and hardness revels and, for comparison, the varues for the American test ities and, for other ctes visied by the u.K. I'fission 3g5z) to inspect Amercan fruoridation projects. soon after their vsit, two of the ftuoridation test cties, l{arsharr anct sheboygan, ceased to pubrish data.
the exceptionar softness of r,rerbo'rne water (Syvan) and its vry low calcium content. Many references are nade to the rnaturarry fruoridatedf
town of lIest }lartrepool, has a hardness
Those dagrans show

in England, rts water supply of 5OO, with 1OO p.p.m. calciun and 15O prpono

magnesum. (Fremlin and Mathieson,

196?). These figur;es are, respectfvely, 50, 62 and, 136 ll,nes those for the sylvan dan. (M.M. B.t/. r 19?B) ,

162

TIie llirmin6ham, Errgland, water

fo

consLdercd

to

bo

a soft water by world standarde for i.t contains ronly about

of calciumr and 1 ppm of magnoeium. That calclun concentration is 7.5 times the figure for Sylvan and twice that of Cardinia. It was found that, when concentrated by boJ.ing, rnaturalfy or artificially fluoridated waters behave in nuch the same way but 1n a way entreIy diff,erent from he solubility-product theory. I (Frenlin and Mathieson,
12ppm

1967),

3)

V'Iater Ilardness

Calcium and Magnesiurn.

In considering the toxicity of fluorid.e in water, ite hardness ls of 6reat fnportance. Calcium is the accepted antidote for fluoride poisoning, J.ime water or calcium chloride being used to wash out the stonach and, calcium gluconate is injectecl intravenously. (Jacobziner ancl Raybin, 1964i Martindale, 19?2). The very great differences, shown in Figs 6 and 7, between the hardness and the calcl_um content of l,lelbourne water and those of Anerican test cities, indcate that considerable caution should be shown when basing the expectation of the toxicity of fluoridated water Ln Merbonrne, or in victorian country area6,-on results obtained in American cites wth nuch harder water supplies. The rnternationaL society for Research on Nutriton and vital substances eaid that: fFluorine acton involves prinarily the antagonism between fruorine and other elenents, especially calcium. I (International Society , 196?).

161

the ,ancet ead: fFruorides usual-ry occur natural-ly in water wih a high calclum content, and the effects of fluoride may werl be nodifLod in soft water. rNo conpounds are known that vrill compretely prevent the toxic effects of ingested ftuoride, but conrpounds of calcium and phosphorus have been found to red,uce the toxcity in snal_l 1aboratory aninrals. Dr H. spencer gg.g!. , (lg?8) said that r lower incidence of endemic fluorosis is reported n areas rvith water'high
196O,
r

In an rOccasfonal Surveyr in

f-n nagnesfuru and calcun.

Professor S.S. Jolly 9L-*., Qg?la) also nentioned,the protectlve effect of calcium and magnesiun, saying:

r... other chenical constituents of drnking water which are protective aganst the development of fruoross such as magnesium, calcium and total hardness, r rmagnesium 6eens particularly mportantr .
rn experiments with rats t was found that increaeing leveIs of lonzabre oalts of ma6nesium, aluminium, or calcium (in increasing order of effciency) progressively reduced
depos{tion of minerar fr-uoride by a factor of fron one-

third to three-fourthsn respectively

1954),

(Weate and. Muhler,

rn 1926, before fruorde was kncwn to be the cause of srottled enarnel, Dr C.A" pierle reported that: I rt is possible to produce mottlng and brown stain r.n the teeth of animals by J-owerfng the calcium intake bel-ow that needed for the growing aninal.r ,It is also possibre to prevent nottrin6 by supplyng the carciu.n requrenent of the animal. The inportance of the carclnn content of tbe hunan diet n
r

164

realucing the prevalcnce

of dental fluorosis was obeerved by Drs M. I'{assl-er and I. Schour ln 1952. They found that: rThe nutritional status of the populatont eopecially the calciun fntake, affects the prevalence and the degree of mottling caused by the fluorine concentration n the water supply. The poorer tbe nutritional status and the lower the calcium intake t the more
prevaLent and the rnore severe the notling.
They found
I

Italian town with 1.1 p.p.n. fLuoride in ts water supply, 6U/o of the people had nrottled teeth and the index of fluorosis vas 1.2. However, in Joliet, Illinois, with the eame fl-uorid,e content of the water, 25.1% }r.aa mottled teeth and the ndex of fluorosis was O.46. that fn
one undernourished (4)

Naturallv Fluoridated

hlat ers

are usual Iy

Harc.

Deopite the evidence to the contrary I some stllt

say that

the other constituents of the water can be disregarded, for at the Low levels used n fluoridaton there is almost
conplete ionization 1n the water suppty.
happens when an

However, the

queoton is not what happens in the water supply but what

indivduaI

svral-Iows

fluoridated water.

In tnatural-ly fluoridatedr areas the fluoride is alnost always present in hard waters with a considerable calcirn
c

ontent .

rParticuLar ernphasis should be placed on the Ca and Mg of hard waters which may constitute a protectve nechanism not avaiLable in extrenely soft $raters. t (Marier g!4. , 1963) .
As bas been 6een, Melbourners water

ie extrenely soft.

165

In

RuseLa

it has been found that calcium definitel-y has

protcctive effect wth high concentrations of fruoride in tho wator (of the orclcr of 1.o-1,j n6,/. (Gabovlch an<l Ovrutskiy 1977). (It is of interest ilrat these workers the concentration to whch our waters have been mechanically raieed as a thgh concentrationf of fluorde. ) Therefoe r when an individuar swallows naturarry

regard 1,o mg/L

fluoridated hard water, both the fluoride and ts antidote, calcium, are swallowed in the same mouthful. rNatural fluoride ion cocentrations much greater o.1 in the fresh rvater systems of the vorr-d are rare., (Harris | 1g?6b). Generally speaking, normaL surface
ppm

than

water supples, derived frorn rainwater feeding streams, have a very row fluorlcre content. lerbournc had such a

water before fruoricration comnenced.. on the other hand, water fron runnaturalr supplies, such as deep weIIs, is much more 1kely to have a high fruoride contcnt, and is usually a hard rater.

It has been knorvn for nany years that vlhen soft water contains approximatoly 1 p.p.m. fluoride, that
dentar fluorosis is likeIy to occur in some chirdren. rn 1942 Dr C.F. Deatherage said:
I

rt is these soft, waters which causc the most severe mottled enamel.
r

As Melbourne has a particularly soft water, it is tIcely

that our chirdren vi1I creverop more d,entar fruorosis than the proponents of fluoriclation expect.

xx
166

skeretal fruorosis is ran unnaturar thr.ckenin6 of bones _ vertebrae, pervis and long bonee, sornetmes wlth severe

arise from drinking water contalning 4-8 ppn fluoricte. (I.Iarris | 1g?6b).
A decade ago it would have been consdered absurd even to oonsder he possibrty that skeletar fruoross could occur here, even after fngestin8 fruoridated water for nany yearg. At that time he cases reported in the llterature were in adurts who had drunlc vater containing

paf-nr which can eventuarly

fluorfde at 6 p.pon. or more for long periods. However, a brief nention of ths subject is

now

requlred becauee of several papers published conparatively

recently. # rn 19?i, Dre K.A.v.R.

Krishnamachar and Kamara Ibishnasvrany

reported on twenty-four male patients with genu-valgum deformfty, n rncria. rAlr had eviclence of spinar osteo_ sclerosfe al0ng wth extensive osteoporotic changes in the
bones

of the extrenities. r
some

They rere

subjects who vrere r_ess than ten years of age and ther water supplies contained from j,j to 6 p'p'm. fluoiide. rscr-erosis was observed

renarkably, incruded

all severe cases and,

in the spine

even anong

osteopoross is an expression of envr.ronmental fluoride toxclty. t see appendix 1/f, p. ZgO.

childre under jO yearci of age. I rllhe fact that they beloriged to different vrlages situated miles apart, but that all the villages l"fere enrreoc for fruoroefs, and the similarty of the crinical picture, otrongly suggeets that the syndrome of genu valgum and

167

That skelotal fluorosis is due to onvironmental

toxcity, and not only to fluoride n the drinking water, is establ-ished by data cited n an editorial articLe in The article states: Fluori-de in 19?? (). rsubsequently in a systematic survey cf 2B4Z residents of the city of Dohna, DDRt Schnidt establshetl that 29 persons (24 nen, ! women) were afflicted with skeleta]fluorosis. None of these persons vrere employecl at the nearby hydrogen fluorde pIant. They l{ere residing JJO lo 2100 m ctistant from the pant. Near the smeJ.ter, the air contained from o.JZ to o,?5 ng,/m1 (Maximun Allowable Concentration O.oJ mg,/m1) .' A nore recent (19?9c) editorial article, a].so 1n Fluoride
cites the case of a 2l-year-o1d nur6e
vho

ilicit1y

had been

inhaling the fluorinated anaesthetc methoxyflurane (Penthrane) for about p years. The article states:

r...thi6 patientrs skeletal changes were preceded for 4 years by a variety of srnrptoms which had baffled the attendin6 physicians; they had been unable to rnake a diagnosis. These symptoms vlere vague pan, trexceedingly painful bonerr, headache, polydypsia, po3-yuria, and epgastric distress. In addtionr she had narked bypertension. (ttooa preosure 2?O/1 JO) which gradually subsded as she irnproved. The presence of a gastric ulcer s notable in view of recent reports by Czerwinski and by Franke which lnk fluoride with gastric uIcer. The patient al-so exhibited rrmul.tiple, fixed, exquieitely painful nodules on her extrentiesrr probably a chemLcally induced l-ymphadenitis. She also had severe mental depression, another synptom often encountered in pre-okeletal fluorosis, which required extended hospitalization on the psychlatry service. t

168

(tt ir unfortunrrtc that thc journar Fl-uoridc, with its wearth of medicar informat,ion on thi-s subject, is not l.lsted as held in any medical library in Australj-a. Therefore the artlcres and abstract,s which it pubrishes are not readily available to physicians. rndeed., the sole hording listed s at the Australian Nationar ribrary, canberra.
)

The question .shour-d be raised.: lrlilr cases of skeLetar_

fluorosis in time deverop in vctori-a? consider the facts: (a) chronic fluoride poisonlng can occur in chirdren drinking fruoridated water, indicating a degree of chronic fluoride poisoning in early childhood. (U) IjnfortunateJ-y undr_
nourshed children exst in Victoria.

(c) Sone ind.ividuaLs

are intolerant to fluoride and develop marked, side effects after only sma1l doses. (d) Mer-bourne water is extremely soft. (e) the are increasingly subject to ingest fluoride from sources other than water, such as fron food and t,oothpaste, and to i.nhale fr-uoride in the atnrosphere.
We

summer

tenperature is high.

(f)

factors were menti-oned by sir Edward Dunlop (9?5) of Merbo.'ne, in expressng his strong opposition to fluoridation. Much of his criticism was based on
his observati'on of hofessor Arnarjit singhre patiento wth

Ar-1 these

crippling fluorosis. These rndi.an vilrages had water suppries with a fluorid.e. content rangJ.ng fron j.j to 5.2 p.p.m. As cases of skeletal fluorosis have been reported from
Engrand, Germany and Aneri-ca in people liv-ng near fruoride_ emj-tting factories (Editoriat_, 1g??b), it is most irnpotant to consider the possibir-ity hat skeletal fluorosis
may devel0p

in Victoria.

XXI.
FLUORIDATION3
PSYC HOLOGICAL

169
REACTONS TO DBNTAL FLUOROSIS

AND DIRECT EFFECTS ON T ITE CENTRAL }IERVO US SYSTEM

the discuseion and the pronoton of fluoridation has been almoet competely concerned with ts effect on the teeth.
The known changec produced by

fluoride on bones and soft tfeeuee have received vory l-ittLe mentiont d'espite the fact that the nraJority of papers in the medical, veterinary. ancl agrfcultural literature are concernecl with ito toxicity. One nportant aspect which appears to have been forgoten, n Englioh-speaking countries, 1s the effectwhich
fLuorlde ln drfnklng r.rater may have on the central nervous
systen and the psycholo6ical effects of unsightly denal

fluorosle.
(r
)

Peycholonical Reactons to Dental Fluorosis.

Little concern has been shown for, or study nade of, the reactons of chldren who have developed. visible d.ental fluoroeL aa a reeult of ngesting the fornrerly-recommended dose of fluoride in tablets or through consunring fluoride ln their drlnking water. The nental stress, to both the obId and lts parents can be considerable, and stress can be a factor fn the ilevelopnent of acute dental caries. (suttont 1962t 196jt 1966).
The inportant eubject of, the psychologcal reactions

sixty years ago by Drs G.V. Black and F.S. I"lclhy (916), They said: to dental fluorosis
rA
was mentioned. over

natter which should not be overlooked in this, s the nental attLtude of these per6ons. I have found it very

17o

dlfflcult to obtain a good opportunity to examine these teeth fn the nouth becauee th persone have been so eensltLvo to such ob,servation. one of them told ne thrt hs had armoot cornpretely rotirerl fron oocioty because people stared at hin as though there v6 sothing about his countenance that was uncanny. r Such unei6htly degrees of dental fluorosis may occur as a result of consurning fluorfde tablets, but it rnay be said that they cannot arise when the fluorid.e content of the water {s only 1 p.p.n.. That io no so. Even f one
ignores he certainty that fluoride is ingested from other

toothpaete, numerous reports have been publehed that the lever of fluorosi-s in a cornmuniy was
fobjectionabler athough the water supply contained less than 1 p.p.n. fluoride. (Galagan and Lamson, 1g5t; Rosenzweig
and Abkowftz,

EOUrce.r sucb ae

et al., 1964). My personar et,ucries of Micronesians

Ueda

1963i

and. polynesians

who drank both rainwater and water from verls conta'ing a naxfnum of O,7 p.p,m. fluoride, have included
many

subjects wth rnildr and rmocrerater fluorosis vith

brown

staining. Thei-r appearance was so objecio'abre to them that they endured the process of having their incisgrs
abraLded, generalLy with a pumlce rstoner,

{n order to

reduee

the etained appearance. (Sutton,

1g?B),

of Aus tralia Dr N Long asked: rwhy should pre-war teenagers of outback Nhir-l requi-re arl thelr mouldy-looking fluoride teeth renoved before enterng tho na*iage narket, when ther bore drnking_ water only contained O.B ppn of fluoride?r (I,ong, 1g?O).
Jo

fn the

Med lcal

naL

171

rt i-s sad that the daily consumption of a fruorid.e tabret (t m6 F) wrrl produce a similar reeurt to drinking
wator containing approxmately 1 ppm fluoride. fn 19?6, Dr K. Johnson reported mottling of the teeth of sono of his patients in Melbourne, sayng:
I

in a eniIar ncidence of enanel mottling n the patents in this practice as ln the U.l(., but the percentage of teeth invol_ved is greater, 11.4 per cent as coropared with ?.9 Bet cent. r of the f8 children of average age 12 years given tabrets,
15 G9%) hact fluorosed teeth, but there were no opacities in 10 other children. He said. that:
enamel

was found that the datly consunption of the recomnended dose of one fruoride tablet has resurted

It

1.. several parents have expressed. clismay at their childrens I appearance ancl even gong so far as to state that rrhey wish they had never given them fl_uoride
tabletsll.
way.
I

know

three physicians whose chirdren have been

damaged

in

ths

rn the present obsession with the question of the reduction of dentar- carles rates n populatons, above arl othe considerations, concern for the ndividuar child has largely been r-ost" For instance, professor Linus pauling said that:

rln general, only nId or very nild nottling of the enanel is caused by the concenration of fluoride ,recotnmencred n the ftuoricration of drinking water" r Ee expressed his opinion that:
rrhe dsadvantage of occasionar nild nottling of the enanel

172

1s far outweighed by the advantage of groat decrease in dontal carieo. I (Pauling, 196?).
As hae bsen scen, the appearance

of every child. affliced

with rmildr dental fluorosis is ruined.

(e)

Direct Effects of Fluoride on the Central

Nervous

System.

hofeesor D.G. Steyn (1958b) said: rFluorde is a rero-

toxin, and the central nervous system tissue contains neuro-kreatin. r AIso rit is knovn that some fl-uoride
accurulatee

in those parts of the body where kreatin is

Ruseian book Fluorine
1977)

located.

In the En6lish translation of thc

the authors state:
rFrom

in Stomatoloqy and Hyniene (Gabovich and Ovrut skiy,

the above it becomes evident that fluorine, affecting metabolisro in nerve celIs and disturbing receptor functon and the tranomission of nerve inpulses, can influence the function of hgher sections of the central nervous oysten, which should be reflected n the cortical regulation of vegetative proceroes and conditioned reflex actj.vity. I

They nenton

that Gabovich,

when

studyfng the'ability of

spinal centers to eummarize sublimnal lmpulseer found

cleviatfons in rato consuming water with a fluorine

concentration of 6 ng/L,

(nats are between six and ten

nan. )
New

tines

more resstan

to fluoride toxicity than is

the Executive Director of the Feingold Association of York for Hyperactive Cbildren said, in 19?62

tFl-uoride is one additive that cannot be toLerated by children in this group. It has a severe adverEe reactlon upon ther nervous system. I (GelardJ., 19?6),

17t

Possl- b t_ e Psvcholoqi cal Res ults

from Fluoridation.

In 19?2, the Auetralian Metllcal I ournal contalned an artlcle by Dr Stephen lJoyden, of the Urban Btology Group,
Australian National university.
one

Dr

Boyden

pointed out that

of the nost maked envfronnentar changes which is taking place is the increasing rchenicalzationt of the environment.
Ee

said that:

r.. it is inportant to appreciate that the first synptoms of exposure to nany toxc chemicals ae not

physiological, but psychologcal-, and nclude such symptons as confusion, personalty changes, fatigue, loss of menory and nental dulIness. Or, to put it another way, behavour is exquisitely sensitive to toxic substances rn the environment. r (Brown, 1966;
Boyden, i97Z).

rf such symptons occur fron exposure to ncreased doees of toxlc fruoride, as a result of the fruorictation of the is it likery that more than a few peopr-e will suspct that the cause of those symptons io to be found in the water supply?
donesti-c water,

XXII.
FLUORTDATION AND CANCER MORTALITY.

1?+

A very f-mportant developnent since the passing

has been the publication

of the Act

of a paper by Drs J. yiamouyianni-s and D. Burk n 1977, in the specialist j ournal Fluoride. This paper revealed a rink between artficial fruoridation and increase in cancer nortaLty in the ten largest fruoridated cities (t96o census) n the united. states. f, rt is understoocl that Dr yiamouyiannis addressed tbe commj.ttee durin6 his recent vlsit to Austraria, t,herefore the data presented in that study will not be discussed here.
(t

) Earl

Papere whic h

st that

Fluo ride may affect

Qancer.

For nany years data have been avairable which suggest that

the ingestion of fruoride raay affect cancer, but r-ittre investigation has been und.ortaken. ror nstance, the .s. National cancer rnstitute has promoted fluoridation for many yealsr but at the congressional investigation into s work (U.S. Congrees, 19? it was reveal_ed that it had not

to deternine whether fruorid,e affects crcr The rnsttute then announced that it about to conmence a thrss-year study on animals. Dr R"A. Holnan said, n 19612
conducted even one study
tMany observations have

was

that agents which d.ecrease 'uggestecl the catarase of cerls nay predispose to tu.uror fornation.r since fr-uoride can inhibit catarase and. since it is a cunulative poson, the danger of i.ncreasing the cDCr_ inducng potentiar in humans must be consdered. I Ee added: t /rlthough there s not to my knowledge any good posftive See appendix 4f, po 262.

175

llnking fluorlde wth known cancer caseG, the whole questlon of fluorido intake from foodr.vrater, insecticidos, and lndustriaL processes should be much more thoroughly nvestigated. I Professor Douw Steyn (Ctriet Research Officer, Divison of
evLdence

Ilfe Sciencea, Atomic Energy Board, Pretoria, South Africa) ln

1964(q)

oaid:

rThe fLuorf.de J.on, beln6 an active general enzyme poison, may be a factor in triggern6 cancer.r rIn this respect, we must 6ive special consideration to catalase.l fCatalase tnhtbltion s known to be associated with mutagenlc proceesee and the dovel-opnent of viruses, and 1t ls known that nany of the proven carcinogenic a6ente can inhbit this nzrrso I

Profeesor Steyn (1964a) said that he agreed with the

statenent of Dr Eolnan (962) tfrat:

rSodium

fluoride ie a potent catalase poison and 5.s cumulatve. The use of sodlum fruoride is frau8ht vith great danger, and ln any case 1t does not deal with the prime cauae of dental caries, which is generally recognized as being a sophisticated and chernically adulterated food supply. t
Comments bv

Q)

hofeeoor ALbert

Scha tz.

T.n 19?6,

Professor Albent schatz vas avrarded, the Grand prix

r the highest distinction in tr'rance for neritorous eervice to hunanity, in recognition of his outstanding scfentlfic achievenents. rn 19?2 Professor schatz and Dr vivian schatz statecl: tFluorine is, among other things, a carcinogen. It is therefore fuoportant to ninnrize our total daily fluorine
HurnanitaLre de France

intake.

176

They nade the follown6 conmente:

rOkanura and lulatsuhLea became

interosted 1n fruorine as a result of their reeearch on the geographicaL distrLbution of nortallty due to gastric cancer. r (Okamura and Iulatsuhisa, jg6?). rThey found a correlaton between fruorne content of rice and, death rates for gastric cance. There !ere also geographical and annual correlatlons between Lhese death rates and the anounts of phosphatic fertirLzers applied to rice paddes. The fertilizers used contained O.01 to 9.BB% ffuorine. okanura and Matsuhlsa (lg65u) also found. that the 1960 tleath rates fron gastrl-c cancer correrated vith the fLuorine content of ItMisot in 28 prefectures of Japan. rrMisorr is a fermented product nade from rice and soy_
t

beans.

They continued

rour analysis of officiar health statistics from Birnnghan,

England, show that the death rates fron Lerkenia and from all typee of cancer vrere significantly greater fron 1965 to 1969 rter the fluordation of Birmin6ham n 1964] than from 1908 ro 1964, (Blrmingham, l96}i Mj.IIer,
1970) ,

fAs recently as 1970, Soviet investigators expressed concern about the possibrlity that fluorine in drinkin6 water might cause cancer. r (Gabovich and Tsipran 19?O). , ,In 1)6J, Taylor and Taylor found that fluorine and other halogens accer-erated the growth of tumor transprants fn mLce and enbryonated eggs. As lttle as 1.O ppn of sodiun fluori-de in the drinking water stimurated growth of tumor transplants in mice. Fluorine also produced defornities in toad enbryos (Kawakara and Kawaharao 1954) and melanotic tumors n Drosophila (Rapaport , 1963). Fina]ly, fluorne eaused Ita consistent antt hghly sfgnificant increaserr Ln

177

rrthe production of recessive letha1 nutationo by X-rays l.n Droeorhila spern.'r (l{ul<kerJee and SobeIs , 1968 ) . Theee ancl other roporte validate Alexander Levittrs warnlng, in 1948, that fluorine ancl other halogens rfnay be responsb1e for geographlc or regional occurrences ofil several rldiseases, ncl-uding cancer.rrl

(t)

Paners linkinn F]-uordation with Cancer l4ortality.

Tno papers baeed on

offical figures

may be

nentoned briefly.

(a) In 197?, Margaret

Rrady reported on data

fron the

Birnngham, U.K., Health Report'-

1973.

Sbe

said that:

fBirmingham began fluorclaton towards the end of 1964, and in the preceedJ,ng ten years from 1954 th'ere vas litt1e or no over-a1l riso in the cancer death

rates, but after the introduction of fluoridaton in 1964 tyrere was a marked riee as is shorvn in the acconpanying graph, just as in the report for raany American cities by Drs. Tiamouyiannis and Burk. lrlhile this graph does not proye that fluoridation was responsbIe for al-L of the higher cancet death rates, it gives cause for great concern. I () In
19?? Dr V"A,

CecIioni reported that he had obtaned

for the years 1966 to 19?4 from the Vital. Statistics for the Provnce of Ontario, Canad.a. This
cancer death data covered 26 fruordated and, 2J non-fruoridated cies vith

populations of 1or0oo or more (971 ontario census).

The

of cancer deaths for the 9-yea period was 16,6% bigher ln the fluoridated cities. When 12 of those cties were. compared with 12 non-fluoridated ones of similar sizerthe crude cancer death rate per IOO'OOO
number

totar

population vras 27% heher in the fluoridated cLtfes"

1?8

earrler, Dr cecrriont (lgz4) tra studied the incdence of cancer in the steel cty of Hamirton, Ontaro. He said:
Three years

rA revfew

of the rortaLfty ratee for cancer for the years 1966 to 1g?o in Hamilton revear-s a considerably hlgher death rate fron cancer n l.Iamrton than r.n the lees industrialized cty of Ottawa. The higheot rate (65 per loorooo) occurred in the proximity of the steer nil-lsr compared wfth the cleath rates (2J an 12 per 100r00o) farther distant. Adrnission records at two
large Hanirton Hospitals a close correlation the daily polruton

showed between reepi-ratory disease and

index. r

Dr cecilioni had previousry found that airborne fruoride rras a maJor containant derived fron the rnanufacture of

steel.

(4)
Re

Conments on the Report

by Drs Burk and

Yiamo uyianns

dinr
Mo

Link

betwee n

Artific ial Fl uori-dat on

and Increase d

Cancer

rtali ty.
Und.er

exanination, both of these authors estabriohect hat they had considerabre expertise on statistical matters. I{ovrever, they also

(a) Statistical aspects.

had

the eminent statstcan, Dr rr. Edwad.s Dening (See lrlho's I,ho in America 38tn Id. ) " The Chairnan of the 197? congressional Enquiry nto the activities of the IIatonal Cancer Institute asked Dr Hubert
thenn

to advise

Arno1cl,, Departnent

of Mathernatics, University of California, Davis, for an as.essment of the Burk-yiamouyianns etudy. Ee reeponded: fr have exanined that study and find that they have nade a very thorough exaoinaton of the extensive avaiabr_e

179

dataandthatthoyhavecorrectlyapplletlvalid staistical methods. their conclusions that there ls a definite link between cancer and fluori.des in the drnkin6 water of a nunber of large cites s valid statistically.' (Arnold, 19?7).

(u)

ssoc :Le

ri on and causati on

The

point hae been made

by several commentators that the Brk-Yiarnouyiannls study reveaLs merely an assocation, and that association does

not prove causation.

That is eo, but it shoul-d be renenbered that it was the demonstration of a like assocation, only an associatiOnt
between

cigarette smokng and the prevalence of

1ung

cancer, which caused the tremendous oucry against

smoking, and which motivated government efforts to reduce

this habit.

As Sir Austin Bradford IIilI

9966) ponted
rhow we

out, action on the basis of probabitity is

usually
I

conduct the affairs of medlcne as weLl a our Iives.

In a eituation such as the present one, in whch a chernical is beng administered to the whole population. which may shorten the lives of a large number of people t great care mu6t be taken.
v'lhen

it is found tha a strong

association such as the present one exists, based on a very large sample, and when the obvious variables of age, race and sex have been considered and determined not to
be

the naj.n cause of the association; until another factor or factors is establshed as the cau6e of the association,
prudence dictates that the adninstration of the chenicaL

be discontinued.

180

(c)
Cancer
Mo

Res

nse

Auet
6

atot

se Fluordatio

1it

te.
and Yfanouyiannis have been attacked

The ffndlngs

of Drs Burk

n AuetraLia in

particularly ence thl-e fluoridatlon/cancer link was nentioned in the A.B.C.rs fFour cornersr televisJ-on programm on April 21t 1979,
newspaperar

Thecritics,asusua},cteclauthorities,inthiscasethe 19?6), the U.S. National Cancer Institute (Iloover 9!t Roya1 CoJ.tege of Physicians g9?6) Do1l and Kinlen ?9??) and the Royal Statistj-cal Society (Othan and NerveIIt 1g??). They did not mention the replies, such as by Dr Yiamouyianna (glZ) nor the proceedings in the U.S. cour
case

in

19?B

mentioned below.

fn Hol1and, the disclo6ure of this fluoridaion/cancer nrortality lnk was an mportant factor leading to the abandonment of fluoridation after many years experence. However, in Auetralia the reacti<n to this same infornation
by bodies, such as the N.H.& M.R.C.r the A.M..t the A.D..
and Public HeaLth groups has been most

ocld. .'fter al.lt

shouLd.

the nain responoi.bility of these bodies

be the health

of the popu-ation, and they therefore shoul-d be expected to study this new development. Instead the response by the epokesnen for their Executives has been (as pofnted out Desendorf , l9?9i !,lal-ker, 1979) enotional, unscientific and nisinforrned. Indeetl, many attempts have been nade through the medLa to aosure the public that such a link does not exst, by citing out-of-d.ate articles which have been proved to be based on inconplete and faulty data.

181

For lnetance I in the Houee of Representatrves the

Actng Minlster for Health (Hon. hl.C. Fife, 19? sad rrhe cl-an of recent evLdonce 6u6geotlng a r-ink between

fluoridatfon and cancer hae been rejected categoricalry by the united states cancer rnstitute and other international authorities. I

In 19?8, senior lepresentatlves of the u.s. Nationar cancer rnstitute and of the rother internationar authori-tiesr rnentioned by the
Acting Minister for Eealth, gave evid.ence, under oath, in a U.S. court. They includ.ed Dr L. Kinlen (lgZ of the RoyaJ- College of Phyeicians and Dr D.J. NeweII (192g) of

(a)

The U.S . Court Hearinqs and Decision .

of those witnesses were forced to adnit that the data in their papers rrefutingr the fndings of Drs Burk and yi.amouyiannis were incomprete and faulty, and were no obtained from original sources but from the u.s. National cancer Institute. fndeed, Dr R. Hoover the Director of that Institute wrote to Dr Kinlen on Sept. Z6t 19??, saying (in part): rr am 6orry for ths error, particurarty since it seens to have been perpetuated by yourselves and, the Royal statlsteaI society. r am a bit distressed atso that neither you nof the Socfety checked some of the orgnal numbes. | (Unitea States Con6ress t 19??). sone of these original figures are readily available. (severar years ago r personarly checked the originar BrkYamouyannie clains by obtaining the d,ata from the
Both
Melbourne pubLic Library.
)

the Royar statistical society.

1Bz

Durng that court case the Burk-Yiamouyiannfs data were open to examfnation by critlcs who were excoptionally

well qualifled to locate and point out any errorc.

Graham, counsel

Inlr tI.R.

for the plaintiffs

(who opposed

fluoridation),

gave hio final sunmation on September 25 1g?8. He said:

rlrJe cornmend

the defcndants and their counsel n this respect: their presentation has been the best possible. They have called witnesses from hi6h places in the scientific worrd both here and abroad. They have crossexamined vigorously, and offered every objection knovn in biology, medicine, and. epidemiology to the thesis advanced by the di-stinguished doctors who have testified on behalf of the pIantiffs.

Despite this, the clain that there s a linl<

betv",cen

fluoridaton and cancer nortality rac not refuted. In his sumrning up the Hon. Judge J. Flaherty

(who

has recently been appontecl to the Supreme Court) sad

(in part): rPont by point, every criticism defendants mad,e of the B-Y study was met and explained by the prantiffs ["to opposed fluoridationf often, the point was turned, " round against the defendanto. rn short, this court viras conpellingly convinced of the evidence in favour of plaintif,fe. t Judge Flaherty then said that Dr D. Taves ra vitness clled on beharf of def,endants, acknowJ_ecigect certain unresol-ved doubts concerning the safetl of fuoridation, and was then asked. Itshffting your rores from scientist to doctor of medicne following the Hippocratic Oath ... wold. you as a doctor of nedicine recommend, that fluoricle be dumped nto the public water supply?"r A coloquy followed, tThe climax was

18'

,rQ. Is your testirnony that you recommend fluoridation in public rtater suppl.ies? A. I donrt want to otate on tha"rr
I

The Judge thn said:

rV'lhenever

the public health nay be threatened, a court of equity bas a duty to act. Therefore, a prelimnary lnjunction prohibitin6 the additlon of fluorcle to the waer suppIy... shall issue.r (Flahertyr 19?8)

Dateil November , 16, 19?8.

Visit of Dr Yiamouyiannis to Australa. In June 1979, Dr Yiamouyiannis visited Austral.ia. This provided, an opportunity for his data and fi.nclings to be discussed and, if faulty, dscredited" Despite the fact that his visit was well publicizetl, and that many personal invitations were issued in an attempt to engender discussion, none of those who had criticizecl his findings in the nevrspapers ''ra6 prepared to discuss then vith him. At a meeting in Nowra, Dr Joyce Ford, the Drector of the centrar cancer
The

(e)

Registry, N.S.W.; trtonecl unpublished data being collectect

in sone towns n N.S.tf . , but dlit not conment on the data of Dr Yanouyiannls. During the whole of his visit, nedj-cal conment on his d.ata was notably 1acking. I vas present a a neeing at the Australian National UnversLty which was arranged so that Dr Tiamouyiannis could present his case" surprisingly, half of the one-hour ecture tine was, with littIe notice to Dr yianouyiannis, arlotted Lo a retired professor of pharmacy who admtted that'he knew little about cancer and. spent most of hie F see appendix /a, p. 265.

184

lecture tLme discueeJ-n6 dontal aBpects of fluorldation

and doser/regponse rates.

Durlng queation time Dr Yianrouylanns wae agaln attacked

that s the appropriate word - because of his assocfatlon with the National Hearth Federation which s a non-profit consumer-oriented organization devoted exclusively to health matters. According to the U.S.

of July . 19?8 (Anonynous, 19?B), several of the officiars of the Natfonar llearth Federation rwere convicted of misbranding dietary products with false nedical claims.r the last tine that these events lere sai-d to have occured was n 19, that is gLeven yeare
before Dr Yamouyiannis became scientific Director

fConsuner Reportr

his first associ-ation wi-th the Federation. In the U,S. court case in 19?8, when the

defense

attorney attempteil to attack Dr yianouyiannis because of his aesociation with that Federation, the Judge aeked
counsel whether he courd show any evidence Yianouyiannis va6 connected
Defense'

that

Dr

wth rthese al-reged fraudsr. counsel: fNo, r canrt. I The Judge then said:

rThen, ny goodnessr why wouJ.d you be here fnpugning the reputati.on of this fndividual due to some other individuals t arreged. fra'dulent activties? That flouts in the face of due process of Iaw and every_ thng we stand for in this Co.rt. r (F]aherty, 19?g),

to this S b ect . Ina paper publshed in January, 19?9, Drs f.A. Strassburg and s. GreenLand criticized earry naterial'obtined by Dr J.A.
PubI
Re

(r)

tions

lat

185

TiamouyiannLa, which they sald wae Inot published

in a ecientl-fic Journalr but was rpopularly circul'atedr. It would appear that the nanuscript of their paper waE rlostt for upwards of two years. Te latest reference which they cite was datecl 1975. They do no mention the correct reference for the work of Dr Tiamouyiannis t which s the paper wbich he and Dr Dean Burk published l-n 1977 in the journal F1uori9e, eighteen months before Drs Srassburg and Greenland published their critque" That paper n J'lugride ncludes data fron the cities of Bostonr Cincinnat and New 0rleans which the critique sad fwere excluded fron Dr One wond,ers why this out-of-date Yiamouyiannis r study. I criticism nas published. In ,January, 1979, Dr Dean Burk considered the d,ata obtalned by Dr L.J. Knlen regarding the incidence of cancer, in six parts of the bod.y, in Angl-esey, Watford and Birmngham (f1uordated in 1955 1956 an,1964 respectively). Dr Kinlen (9?5) tra concluded that there r^ras no increase over the cancer incidence up to 1969r as compared wth rratchedl control aras with 1ow fruorid,e level-s in their water oupplies.
Dr Burk stated: rAs evident in Table 1, Kinenrs conclusion appears to be untenabre, and England is now faced vith a denonstration of the exlstance wLthfn its own borders of a fluoridationcancer incidence link that is readily derivable fron Kinlents ovrn data. lfhether the data are adjustect for age and sex, in the nanner carried out by Kinlenr.or lef unadjusted, the fluoridated populations shov cancer incdence increases for the six organs of respectively I and 13%. These are very large increases for the time

186

perlods lnvolved, and ars even greater than corresponding fncreages ln cancer rortality ouch aa reported Ln the Unlted Statoe, for even longer poriode of observatlon, and for approximately ten-fo1d greater populations. Cancer inoLdence fs, of course, greater than cancer mortallty 1n a given populati-on, and this appears to be true for cancer increases associated with fluordation. I
As Dr M. Diesendorf Ogzg), who was present

JF

at the meeting

at the Austral-ian National_ Universty in June, 19?9, said: r... a correLation between fluordation and cancer death rate . o. has not been convincingry refuted in the two years since its publicaion. (Diesendorf, 19?g),
rn a reply to the chairnan of a u.s. congressional Inquiry in 1977, Dr H.A. Arnold. of he Departnent of I'tathenatics, University of California, sad: rrhere are 6ome who argue that causar relationships are not provable by statistcar studies in the Iarge, but only by controrr.ed laboratory or crinical experinents in whch cau6e and effect can be obaerved j-n ndlvidua].s and groups of inclividuals. on the basis of published researcb and the Burk-yiamouyiannis etudyr t is no$r unquestlonabry tine to perform these experinents and to suopend arL nechanical fluoridatlon of public waters untfr defnitve resurts have been obtained. The experiments should, be funded and performed by, and under the supervision of agencles in no sray connected with any agencies th-at may have commi-tted thenselves to previous opinions or stances, negative or positive. I That is so. vhile hs ftuoridation/ cancer link remains unrefuted it is foJ-ly to continue fluoridation. JF See appendx 18, p. 28O.

XXIII.
TIIE INFLUENCE OF TLUORIDB INGESION ON
MONGOLISM

18?

GBNETIC CIIANGES

Recent fndings,

that

even row concentrafons

of fruorid.e in

the drinklng water can produce genetic changes, suppor the obeervations of Dr r. Rapaport u956, 1959t 1961) ttrat:

r.". paralleJ-ism has been observed betwecn the ncidence of this disease fnongolisml and the fluorine content of
drnkng vrater.
I

In 1976, Professor A.H. Mohanmed reported that: fAs littre as 1 p.porlr of sodiunr fruorde in drinking water can produce pernanent genetic damage in nice. The chromosomar damage and breakdown observed in the study ls believed to be the direct result of fluoricle acting on the D.N.A. etructure. r activity of inorganic fruorde compouncls rra6 studed by Dr E.A" Guleva et 4. (gzz). who concluded that fluorrle stlnulates the fornaton of mutagenic netabolites in the organisnr of rats. In 19?3, Drs B. Mitchell and R.A. Gerdes said: rrheso data denonstrate that under the test condltions sodium and stannus fluorides are nutagenic to Drosophila rnelanogaster. r
The nutagenic

stoller of l"lelbourne has d.one considerable worl< on the etiology of mongolisn. In 1963 he said that
Dr Aran

there are:

r.. two separate aetiotogical processes one affectfn8 younger mothere and independent of mternal age ancl the
otherr a xnore frequent
e

phencmenono

affecti.ng old.er

nothers.

See appendix 4e, p. Z6j,

1BB

D StoLler mentloned that Myers (19t8) founcl that where

there was a high incdence of maternal thyroid disease there was a hlgb lncidence of mon8ol-ism. (Moderate
concentrations of fluoride in drinking vater can block
iodj.ne absorption, Crawford, 1972.)

Dr Stoller said in 1963t

rThe ageing oocyte

is the most constant factor in the primary producion of mongolism. Such an oocyte would,, in some way, appear to be vulnerable to attack by vrus, with a resultant, mutation leading to a nongoloid chi1d. r later, with Dr R.D. Col-lman, he said:

Two years

1.. we are in no doubt that there is an environmental_ factor operative in a high proportion of these congenital abnormalities. r (Sto1ter and Colhnan, 1965). Dr f . Rapaportts first study (956) reveal-ed a
relationshS-p between the incidence of mongorisr and the anount of fruoride in the drinkin6 vater" certaln aspects

of that study vrere crticz,ed, therefore he conpleted a

second study which was designe<l to meet those criticisns,

and he acknowled8ed. the advice of Dr .L. Russel Chief of the Department of Epidemioogy and Biouretry of ilre u.s, I'IationaL rnstitute of Dental Research" rn ths study he found that, as the fluoride content of the dr,lnking waters
used by the mothers increased fron O.O-O.A, to O.3_O.? to

1.0-2.6t the nunber of ca6es of mon6olism per IOO,OOO recorded 1n the official records, lncreased from Jtv,1J Eo
4?,o?

to

?1

.59 (p <o.oo1

).

rre sad:

frhe ole of the advanced age of the nother, in ilre etol-o6y of nongol_ism, woul_d 6eem to reflect, a slow and progressive accumulaton of fl-uorine in the notherfs body. i (Rapaport, 1959).

189

Two years

later (961) Dr Rapaport oaid: rheee facts have 1ed up to put forward the hypothesio that fluorine plays a part f.n the pathogenesis of this
disoaee by brlnging about a rnetaboric change simrtar to the innate faurt tn the metaboriem which recent research

s
He was

now revealing.

referrlng to his fincling that:

rSodun fLuoricle, incorporated in the diet, produces n drosophllae nelanic tumors. This shovrs a change in he metaboLism of tryptophane. Thie change n metabolisn

fs oimilar to that shown n chirdren suffering fronr (Rapaport | 1961). mongolisn. frst publication, a study waE conpleted in England by Dr lf.T.c. Berry (lgs) which only slight difference6 n the prevalence of n the fluoridated and non-fluoridated rs
showed mongoren

FolJ-owing Dr Rapaportrs

Professor IIu6h sinclar, tn 1)lJ, said that he had had two dscussions in the U.S. with Dr Rapaport about his vorl on Downrs syndrome and that he had rread the ress extensive work n this country of rny friend Dr Berry. r rr
and,

fluoride

bel-ieve further studies are requred before Rapaportrs work and conclUsions are. disniosed. r

Dr Berryrs work was also criticized, on several grounds, by Dr H.L. Needleman (lgZ and his co_workers.

Their main objection being rthe sparcity of d,atar " They also criticized Dr Rapaportrs work, nainly on ilre ground that of mongood births was too sma'I. However, hs study was essentially a nrathenatical one, using official
number

the

data. He dd not deternine either trre total number of births nor the nunber of non6ols" No suggestion has been
nade that the official

records were biassed.

19o

gj_4. (gZ4) studied the prevalence of Downre syndrome fn Maesachusetts between 195O and 1966.
Needleman

They concluded

that:

r.. the data provide strong evidence that fluoriciation does not cause any inportant elevation in risk for Downre syndrome, at least not for several years after its introduction. r Connrenting on that paper, Dr J.R. Lee said: rI found most interesting the authorsr attempts to disparage their ourn results with assunptions about adnttedly rfunknorn compounding factorsfr. I rI believe that, the authors I data provide eug8estive evidence that fluoride nay cause an el-evation in the risk of Downrs syndrome and that they reach an unwarranted ooncluson when they etae , in the abstract, that their data provide rrstron6 evidencett against ths relation.r (T,ee, 1g?5).
The IIon. Dr

D. Everingharn,

when he was

Austrarian I'[inister

for Health
would

between 19?2 and

1JlJ,

asked

his

Departmental

advisors to provido him with the scientific evidence which

refute the suggesbon that there was an increase in Downrs syndrome (mongol-srn) with increase j-n the fluoride content of. drnking water" severar years later, n 1)ll, he safd: r am still waiting to see such refutat,ion.r As Dr lee said in 19?5: f Thu,s, the questlon of Downro syndrome renains a question.r

XXIV.
oTHER I-IEDICAL ASPECTS OF FLUORIDATION.

19t

tilhen

artificfal fLuoridation
on the

wae

first

commenced

in

194J Uy

the U.S. Public Hoalth Servfce, amost the whole concern

teeth - the retardation of, dental caries and the flr effect of the production of dentar fLuorosfs, known to be due to chronic fLuoride poisoning.
was There was

for its effect

little concern forr even speculation about, the poesible effects on the rest of the body. Aninal experfnents to teet its effects on the other organs vrere almost total-ly lacking. It is now known that fLuoride, even in low concentratfons, has a wiclespread effect on the bocly, a few aspects of which wiI be mentfoned briefJ-y.
(t ) Fluoridation and the thyroid.
The anonymous author

of a paper in the VIHO Chro-nie1e

(19?Oa)

sald that fluoricle has no specff-c toxic effects on the thyroid glanil. rFluorfne neither accumurates in the thyroid no.r fnterferes vith the uptake of iod,ine from nornal
d,ietary solltlcos
|

Eowever nany

others boLd opposing vews:

Professors T. Gord.onoff and w. tvrlnder stated, in 1960: rrhere is a true antagonisn between fluorine and the arnounts of odne taken up by the thyroid. This nay resurt ln an approximateJ-y zo to Jo per cent reducton

in function. r

Professor N.p. Buu-Hoi (96Z) etated tbat f fluoride ions

are known to interfere in the production of thyroid bormones",

192

(t964a) said: 'The result of this experfment lndicates that there 1s a fluorine-iodine
Douw Steyn

Ibofessor

antagonfenr.

In 1972, an articlc in the I,ancet (T.K. Day and P.R. Powell-Jackeon) reported the results of a study of the preval,ence of goitre n 1? Himalayan villagesr The wde variatLone $rere not due to differences in iodine intake but rvariations ln goitre prevalence v'ere found to correlate cloeely wfth the fluoride content (= O,74; p<0.01) and wlth hardness (p= O.??; p<0.01) of the water in each vfllage. I The pnovaronce of goitre vras hgher in
watere and 1n those with more fluorides. The fluoride contente of the wate:rs ranged from 0.1 p.p.m. to o.J4 poprtrrr

the harder

of the exceptional softness of Melbourners water euppliee (sylvan has a totar- hardness of only 10; M'M.B.vt. t 19?B) tte comments of Dr Mar6aret cravrford, an authority on blologlcal effects of eoft vrater, are of particular fnereet. She said, n 1jl2z
vLew

rn

r4r Day and r'rr powerl-Jacrcson denonstrate a cr-ose aseociatfon between rrardness and fluoride concentrations

lodine. I fNaturaLly eoft waers, however, have little or no fluoride and the fodine is therefore ar' availabre for absorption. rf fluoride s added to soft waters this wfll not be so and a proportion of the populaion nay cone to have euboptimum iodine uptake. The effects

in drlnking water.and the prevalence of gotre in hrl villages in Nepal. These results raise a probJ_en concernfng fuoridation of water supplies in this country [U.fJ which has not eceived suffieient attentr-on - that fs, the reratonship between fruorde and other ione preeent in drinking-water, in particular

19'

nght be eubtle and slow to develop and wouLd certaJ-nly not be picked up by the crude ecreening used at preeent.r

It ie not
here.

known whether

thie posslbilfty le being

examined

Dr J.R. McLaren ?gZe) has rade rA review of the

voluninous l-iterature on the relationship of fluorides and

tbe thyroid glandr. A photocopy ie

appended because

this

is not avaflable 1n Melbourne, (e) the Aorta. ln 1967, Dr F.B. Exner cited an investigation by Drs Cal-l, Greenwood 4. U965, Pub. HIth. Rep . 80: 529) saying: rThey found that fluorine accuruulates in alJ. soft tisoues; and that the levele n different tisues are not consistently high or low in different individuals. For example, the peroon with the hi6hest leve1 in one tissue ni6ht have one of the lowest fn another. Consequently, tissue retentlon cannot be governed so1ely anil directly by fluorine intake, rnuch less by the concentraton 1n
the water supply. . But by far the highest leveLs in any sof tissue (rp to 258 ppm) were found n the walIs of the aorta, the main artery leading fror the heart" I
That hi6h level of fluorde in the aorta vras ecipsed in more recent report. Dr G.L. Waldbott (19?4a) sail:
a

rRecent data concerned rvith fluoride in water portend serous damage to hunan health: A pIIS fU.S. publc Heal-th serviceJ report (Geever gL4. , 19?1) dscrosed a autopsy 8r4oo ppn of fluoride in the aorta (the large artery of he heart) of two persons who had been residing fn Grand Rapids, Michigan (fluoridated since 194, for

less than twenty years and 2rJ4O ppm in another

1ess

194

than twenty yearo oLd from a New York State nonfluorj.dated communlty, I rTheee lovoIs are h6her than thosc j-n bones of cages of advanoed orippllng rkoleta1 fl-u.orosis. No clinicaL data on thoee caee6 vrere reported to establieh whether and to what extent such extraordinarily high leve1s of fluoride had danaged the vascular system. I
Dr laldbott had reported other cases

in 1962, saying: rThese obeervatlons raise the question whether or not Fnight contribute naterfally to sclerosis of arteries. I
Ttre Kdneyo.

(t )

It hae been eaid that Auotralans have the highest prevalence of kidney dfseaee to be found anyvrhere. rrn the human body, the kidneys are probably the most crucial organ durlng the course of row-doee long-term exposure to fluorida. | (Roso and Marier, 1g??) ,
The eane authors had

previously roportecl that: rllcarthy

6A%

kdneys excrete 50 to
and Rose 1971),

of the ingested dose., (llarier for

Research on

The International Society

Civilization
|

Diseases and Vita1 Substances (1969) said:

.. persone suffering from kictney troubre are l_ess able to excrete fluoride and more lab]e to injuries from it. 0f partfcur-ar interest, ie the question of poisoning fron fluoride durfng dalysis of ki<rney pabients, due to the
very large volumes of water used duri-n6 this proce.ss. Dr .J. Johnson ?gZ of the Artificial Kidney center, l,tayo

are currently using non-fluoridated water for arr- patients under our care.
r

clinic, Mnneeota, rn

1g73

.aid:

rwe

195

lle nentioned that 11 out o 12 patents exposed to fluorde

for two years or

more had developed I symptornatic bone

I In disease, rib fractures and severe bone painr ' addtion, two patients experienced extreme wastingt

sug6estin6 other toxic effects of fluoride'l Dr D.R. Taves, ancl his co-workers ?965) were among the first

to investigate this problem and, after finding an increased concentration of fluorirle in the blood serum during dialysis said that 'it would ""ur nrtdent to use nonfluoridated di-aysate baths for }ong-term hemodialysis'r In 1974,
Dr J. Jankauskas said:
tAlthough no definite conclusions can be drawn at this time, severaf inveetigators have advised the use of nonfluordated diaJ-ysate' baths for long-term hemodialys. I
The

Australian Kidney Foundation, in 1974r said that

the question whether fluoride shoul-d be renoved from the water used for dialysis tis a matter for the indivdual doctor and we would not contenplate getting involved in
Two
a
I

question such as this which has generated so much controversy. years later thc Foundation said they had I no specific
statement to nake reparding the fluoridrtion of water in

relation to patients wih kidney disease.r (Kincaid-Snith,

19?6) ,

From recent

inquiries from the dialysis centre at

the Prince Henryrs Hosptalt it appears that in the dialysis

treatments carried out in most, if not

t hospitals, fluoride-free water is used, but that almost all of the

a1J-

196

diryr:is machines obtain thoir water directl-y from the domestic tap. rn Merbourne this water is fruoridatea.t
home

Apnrt from avoi-din1 poooltrJ-o

darma1c

from thc ron6-

term use ol' 1irr6e vol-umes of fl-uord.ted water, it would appear that the use of deionized water has other advantages.

rn an editorial articre which appeared l-ast year in the Journal of the American l4edical Association (4), lr S. Vaisrub ('tgZB) said:
I

rmpressive evidence has accumulated to ncrininate al-uminium in the causation of dialysis encephalopathy with dementia (aiarlysis dementia, dementia dialytica) as the striking manifestaton. r rNo further cases of encephalopathy were noted amon6 29 patients after the subsequent reduction of the aluminium content of the dialysis water with the use of a deionizer. r This rerated to fan outbreak of encephalopathy that affected ei6ht of 14 patients in a sma1l dialysio unit.r

Dr Vaisrub concluded:
rlrfi-th

the burk of evid.ence incriminating aluminum, the door is left open to effectve prevention of the dreaded dernentia dialytica.
r

(4)

or

cond

tions.

rngested fr-uoride reaches all the organs of the body through the br-ood. Many effects have been reported but they wilr

not be considered here. .ne subject which has engendered conflicting reports is that of the use of fl_uorde to treat osteoporosis. This
use of fluoride i-s not approved by the u.s. Food and Drug Adrinistration. rn an editora' articr-e in JAMA n 19?8,

Dr s.J. Iifarx said that, outside of an investig,.ationar setting * See appencix 1Ob p o Z?O . ,

19?

r...f1uorides should not bo prescrbed for generalized or localizcd osteopenLa untl f-nvestigations have documented the efffcacy of high tloses without unacceptable toxicity.
Sone iclea

of the rane of organs vJhich nay be

affected by fluoridc in6estion can be galnecl from recent issues of Fl-uoride. They include : lleart (Jansen and
Thomson

t 19?i Kidney, (Jankauskas, 19?4); Hair (ltuechniak, 19?il; Thyrod , (l'lcLaren, 19?6); Blod, (Mrer' , 19?6) i skin, (Editorial, 19??; Bones, (Eriitorial, 19?7b); stomach,
(Iditorial , '19?? ; anrl Periodontal disease (Domzalska, tlith the emphasis of the effect of fluoridation
19?B) . on

dental caries in children - a promised study on aduLts vrho fluoridated water has no been published drnk artficially (nst, t944; Lonrl,on, 1967) littre attention has been pad to the influence of fluoridaton on periodontaL disease in * adults. * see appendix 1le, P.
279.

xxv.
INTOLER/\ NCE TO TLUORI DA TED ll,JTER.

198

at a There are many reporto of intoterance to fluoride level produced

when

the

arnount ingested

is inoreased

by

the fluoridation of drinking vuater'

(t )
The Denia1 b y

the

Ame

rican

Ac ademY

of A11erqy.

Those promotng

fluoridation deny that cases of allergy and sensitivlty to fluoridated water occur and cite thestatementonthissubjectbythemericanAcademyof Allergy . Ilowever , Dr G . L. Vlaldbott stated that : widely circulated statement by the eleven-member Executive Board of the American Academy of AJ-Iergy asserted that rrthere 1s no evidence of allergy or intolerance o fluorides as used in the fluoridation ofcomnunalwatersuppliesl|doesnotconstitute tthis statement was scienific evidence.r tIe said that requested by the u.s. Public llealth servicer the same organization which is not only promoting fluoridation but has also been financing the research of the eleven scientists. I (watuott , 1)J4a) ' He raer wrote that two sentences had been onitiea when tba letter of his was published. one of them said:
rThe

t[.n TQl1, for instance, four of the eleven received

$ 78Of621 dollars in research grants from the P.H.S.l

Q)

Pre-fluoridation evldence of intolerance to fluoride. artificial fluoridation wa6 commenced, cases of

Even before

lntolerance to fLuoride were pointed out by Dr H. Trendley Dean (often called, the 'father of fluoridation') and Dr
F.A. ArnoLd tlr.
Both these nen urere members of the team

199

whlch oet up tho

spoal<lng

ffrot fruorclatfon trral ln crancr Rapicrc. of obsorvatLono in naturarJ-y frrrori<atcd areas,

tn

1942

Dr Dean eaic:

lndivduals of even an apparentJ-y homogeneous group there are natural- clifferences in sensitiviy (or reeistanco)r [to ttuoride in waterJ. He also said that there are rmarked variations within the group. I The following year, with Dr Arno1d (lgt+3), Ue stated:
rAnother important factor in this rerationship of concentration and effect is the tolerance of the lndlvidual. The oame amount of fruorine that causes a n1ld toxic eaction in one individuar may cause a severe reaction n a'other. rn other words, ve are

rAmong

deallng with a 1ow-gracle chronic poisonl_ng of the fornatve dental .rgan, in vrhich case some ind,ividuals nay ehow a more .evere reaction than others having a comparable fluorirle intake r .. rpro6nosis vith respect to one indivldual is obviously unwamanted. r This intor-erance nay be due to a reduced ability to excrete fluorde. Resorution lIo. vrr of the 1!th rnternatonal conventlon on crvlization Diseases, vitar subctancer: and. Nutrltion eaid (in part):
rsome

lndivlduals are more sensitive to fr-uoride than others, for example persons suffering from rrj-dney trouble are less abl-e to excrete fluoide an. more liab1e to injuries from it. ( rnternaionalj_eiy
r

fo Research,
rnrol-e ranco

soc

1969).
IIat

(r)

to rti f icially Fluo ridated

er

Dr G.r,. trlaldbott (19?4 stated that he knew nore than twenty hi'hry competent physicians who had

eitrrer diagnosed
invrved in

or oonfrned the diagnosls of serious il_lness from fluorrdated water, ,but did not wish to become

200

Dr Vlaldbottro observatlons the fluorldatlon controversY' altLrou6h he is a very have been attacked for many year6 '
IIe said: well qualifiecl specialist allergist' rBy far the maJority of ny cases had no bearing on sinus allergy (hives, asthma, all-ergic nasal and intolerance to disease, and so on) ' They pertained to (valauott 1974a)' fluoride, that is, true poisonin8'r ' Ln 1iJ)' The medical publishing company C'V' Mosby' published his book on I'lealth Effec ts of Environnental
Pol lrrtantswhichreferstothepublicationsofsornel'O0O Fr,uoride Ls one of the.pollutants mentioned

authors.

anclthebookcontainsnumerousreferencestodamageand + from its ingestion' illnesses

ItsofsignifcancethatinthelgTScaseinthe Court of Comnon Pl,eas of Allegheny County, Pennsylvania' water Dr V,Ialdbottrs evidence of allergy ancf intolerance to fluoridated to 1 p.p.m. 'bas runcontested and unrefutedr t no r^ritness being called to attempt to rebut his statements'
(winner
(4)

g!3!. |

19?8).
by Double-Bl-ind Tests.

Confirnation o f Intolerance

'hechargehasbeennadethatDrtrrfa].dbottistheonJ.y persontoobservethesymptomswhichhedescribes.Ilowever' in 1974(b) he said that he had received personal communcatons fron sixteen clinicians each of
whom

had diagnosed

poisonin6 fron fluoridated water, and that Dr H'P' of Atkin, Minnesota, hacl Just reported 2f cases. Dr P.E.
?,anfagna

?gZ6) has aLso observed cases and has rcviewed

the subject.

il See appendix pa, p.

267.

201

A very carefuly conducted etudy rras completed in Iloll-and by Dr lr.c. Moorenburgh and his co-workers, using

a double-brind technique with tho key data deposited with a notary. (Moolenbur6h , 1g?4, 19??; Grimbergen, 1g?4). They found that, contrary to their expectation, the side effecte fron drink-ng fruoridatecr water vrere not due to arlergy but to low grade poisonin6. Dr Moolenburgh (lgZZ) said: I rt appeared that some ind.ividuars showed he effects of tbis poisoning earlier than the rest of the popuration, but as more and more fruorde was put in the water or in6ested from other 60urces , more and nore people wouLd show side effects until at rast all of them might have had compJ-aints. The first 1?/. of people with eide effects rvere just the forerunners in the so caLled curve of Gauss. rrt arso appeared trrat the side effects in our patiente flickerecl on ancr off . I rApparentry fluoridation as a form of 10v 6racre poisoning l0vrers the genera adaptation to attacks from noxious influences in the environnent.
r r

in Vict orLa from FI uori dated Wa ter. It is understood that a 1ar6e number of Statutory Declarations i-s to be presented to the committee which
describe i.l-effects experienccrl after drinking, and, cooking food in, fluoridated water, i.I-effects which disappeared when distilr'ed vrater was oubstituted for tap water.

G)

Recen + Compl-ain ts

unfortunately an even greater number of individuals nay be suffering ih this way, but the associaton with fluoridated. water has not yet been realized. A typical case is that

202

of

Diana l4artin, who recentJ-y ?gZg) stated:

r.. after tbe water was fluoridated I startetl having healtb probLens.r rIt took ne two years and flve specialistsbeforeleventuallyfoundoutthatltwae the fluorlde that caused ny probens" I now havo to to remain $, ny water at $ ? fot a 2O-litre container healthy. Why do I, and others like me, have to go to all ths trouble, when the chil-dren could be given a | * tablet at school like they used to be given nilk? It is not to be expected that more than a sma1l number of such people will attencl an indvidual general practitior! Dr Nornan Long, in the Medical Journal of Australia' said: rI of only one case of total body rash and voniting 1n an infant following - and due to - drinking fluoridlated water; .but then, I am a radologist and this s not my sphere. t (Long | 1970) '
know

(6)

the Diffic ultv in

ne I ntolerance to Fluoride.

Dr H.C. Moolenburgh (gZZ) said:

rone

of the nost difficult thn6s n diagnosis of low grace fluoride poisoning is the genera character of the conplants" Low grade poisoning is seldom detected when you are not looking for it. I
.

Sr Arthur Amies said, in 19752 rlt is vain to state that doctors in Australia and other countres have often failed to observe fluoride toxicity j.n thei area6. The directives which they have receved from public healtli authorities have all too often indlcated that no untovard side effects can occur. Medlcal practltioners can hardly be blanedr thereforet if they fai1- to link certan srnptons and signs with fluoridation. I
.

* see appendix 8, po 266,

20,

lord Douglao of Barlooh said, n 19?2, that health author{tlee rely on the aseertion that: r.. doctore fn fluoridated areas have not reported any 111 effecte of fluoride. Thie statement does not carry conviction, for these sane authorities advise doctore ft*no generally do not know the synptons of chonlc fluoride poieonng! that there cannot possibly be any fLl-cffeote. r Ee recalled the Long tine t took after cigarette smoking

to eetabLlsh that, it vras a principal- cause of lung cancer. * The aide effocte reported by Dr Moolenburgh (lg??): rBabes screanng wfth inflated tumries, lots of peopre wlth panful aores n their rouths, people with Loose stools, urinary troubles, head,aches, dizziness, and qulte a lot of people with recurrence of allergic troublee lfke asthna ancl skin rash that had not troubled them for years.r
became conmon

(z)

rn

eto

ridated Tooth ste .

of rgores ln the nouthsr e.caIls the fact that there have been nany reports of reactono to fruoridated tootbpaete whicb cloared up when it was no ronger used.
Mention
More than tweqty years ago Dr T.E. Dou6J_as (lg16)

reported ca'ee of etonatitis, rerated to the use of fLuordated tootbBase or tooth powder. These occurred

patente of arr. ages from thee years to more than nfuety year of age. Thirty-two patients cooperated by
173

ln

ndergolng rpeated

couees. After the symptoms had.

cleared up oonpretely, eaoh courge iconsisted of uee for three weeke of the dentifrice contaJ.ning fluorides followed
See

appendfx

lb, p.

ZG4.

204

by use of non-fluoride dentifrfce until normalcy hacl been nafntained three week6. I
and
Two

patients endured six

coursea

flve saw the effects of five courcies. It was noticed that, n several patients, tsymptomatology was increased, by as much as forr fold after two or three cour6eE - both 1n severlty and tfme required for completely clearing of
the lesiorrg.
Two cauee
I

recent reports: rFluoridated toothpaste:

of perf.oral dermatitisr by Dr J.R. Mellette g!-3!.

g9?6) and a paper by Dr M.A. Saunders 9976) who said tha Dr Emery Kocsard of Sydney had told bin that he had treated !O patients with fluoride-related perioral dermatitfs all of which responded favourably after the
cessaton of fluorde toothpaste.

(8) The hoblen of IntoLerance to Fluori-de will

There can be no doubt

Grow.

that

sone individuals are intolerant

to fluorde at the lncreased Level produced by the use of fluoridated water. Tbeir problens wil.l grow. Although they nay, at considerable expenne and inconveniencer obtaj.n distilled water or fnstall. an on exchange fluoride rfilterr, the evidence already available indicates tbatt
a6 a

result of fl-uoridation, the fluoride content wiJ.l increase in the vegetables and canned. foods which they
purchase.

Dr Moolenburgh (lgZZ) suggeeted that those who are

at present intolerant to fluordated water represent one ttaIr of a Gaussan curve, If, that j.s sor the aunhef of
people ehowing side effects nay be expected

to increase

20,

rapldly aB the totaL intake of fluoride

lncluding water, food and air, lncreases.

from all sources,

The Internatlonal Soclety for Research on Nutritl_on and Vital Substances (g6Z ) polnted out t,bat:
rThe

fluoridatl-on of drinlcS-ng water releases a fluorine circuit which incl-udes vegetables, frut and other hortj-cultural products as well as nilk, and has an uncontroLlable effect on the human organism. I

(g) The Great Difficu!-ty in Obtainin g Compensation for

I1 lnee s Caused bv Fluoridation

In Victora, those unfortunate people who are obviously affected by ingesting fluorLdated vater, if they wish to
obtaj-n conpengation for their disabil-lties are faced with

a great, and unusual, difflculty.

which states:
rNo person

This is due to tbe repressive paragraph 4 of the HeaLth (Fluoridation) Act shall have any right of action against any water supply authori.ty or any member of such authority n respect of anything done in re6ard to the fluoriclation of a publc water suppry in accordance with the proveons of this Act.r (Victorian Government, 1g?3).

A barrlster has stated. that, because of that paragraph of the Act, even a person who has been proved,

by the noot rgorous medicar tests, to have becone ir-I due to drinking f-luoridated water supplied through their domestic taps, wourd have no practicar way of seeking

conpensaton. Their only course would be to sue the victorian Governnent, a course, whch would prove to be
expensive as to be prohibitve for the average citzen.

so

The
memorandum

eltuatlon is dif ferent in Unglancl. L 19?7

by I'au1 M. 4c0ormick, Research Fellowt

Nufffeltt College, Oxford, atated: rlrlhen one arm of the Executive offers (as ras been done) an indennity to the water authorities to cover succesfuL legal clairnE agalnet then arLElng out of fluoridation, the Law ls rnocked. The water authorties are freed fron the le6al consequences of their actfone and thereby encouraged to break the Law. Law is one of the fret casualties in the battle for fluoridation. I

XXVT.

207

TIIERE

IS

NO

MARG

IN Otr' SAFETY !'JITH ARTIFICIAL

FLUORIDATION.

of the nargin of safety of artiffcaI fluori<tation has received IitLe consideration. This nay be due to the w<lely held inpression that there s a wide margn of safety when water is fluoridated at 1 prp.Ill
The fmportant question

(t)

The Neetl

for a Vlid,e Margin of Safety for

I

Substances

Adde<i

to the lrlater Supplies.

of the management of water quality, the Dl-rector of the Division of Santary Engierng, Pennsylvania Department of Ilealth, said that the rlack of precision and reliability nakes it essential that adequate factors of safety be employed.r (Lyon, 1968).* **
Speaking on the general subject

Dr C.G. Dobbs ?957) pointed out that:

rThere

ie no leve1 of intake at which fuoride changes from a toxic to a purely rrbeneficialrr substance; and oince it is the total lntake which atters, the queston at lssue is not the safety of fluorides at 1 p.p.m. but the safety of any pernranent addition to the general intake of fluoride, especially by tbose
fntake 1s already high.
t

whose

In regard to fluoridatlon, in 1950 Drs G.J. Cox and I-I.C. Hod6e (two of the main early proponents of fluoridatLon) saicl that, with the lncreased use of fluoride in vrater, toothpastee, topical appllcations and, nouthwashes, vitanin tablets and cheving gum: !.. it is proper to nsist that d.ue attention be paid. to the possible hazards and to nsst that there be a large factor of .safety. Fluorine and its compounds
have 1on6 been known as posons.
I

jl see appendix l, p. 258.

*t see appendix 10c, p.

2?1.

208

Profeesors 1. Gordonoff and W. Minder (tg6O) said: rAl,I authorities agree that fluorine is in no vay an
innocuous substance; moreover, since its therapeutic range is so very small, t easiLy lends itself to overdosage. I

Ths was well known even in 1940, for Drs Margaret

C. Smith and II.V. Smith said:

fThe range between toxic and non-toxc l-evels of fluorine ingestion is very sma1l. Arry procedure for increaslng fluorne consumptiop to the so-called upper limt of non-toxicity would be hazardou6. This rvould be especialy true in thc case of the addition of fruorine to public food or water suppries where uncontrollable individual fLuctuations in intake wourd be encountered. r

(Z)

The Recent Marked Decreases

in the

Recommended

D ose

of F1uoride.
This narrow therapeutic range is welL ilrustrated by the
marked decreases

in the

recomrnended

levels of fruoride

ingestion from tablets, which have been forced by the increasing evidence of dentar fruorosis in chrdren gven the previously reconmended dose. rn a study usng the old l-evel-s of 0.5 rng F up to the age of three years and, thence 1.O mg F daiIy, it was found that 6??6 ot the children included in the study since birth had dental fluorosis. the group fruoroois index was o.88, which is well above the level of o.6 which constitutes a pubJ_ic health problen:. (Aasenclen ancl peebles, 1g?4). originally one tablet of coiun fruorde per day ( t ng F) was reconmended f or alr ages. rn 67 thl,. was changed, the American Medical Association then saying that

?.o9

the usual fluorde eupplement 1e O.5 ng per day for children up to the age of three years r and 1.O m6 per day from 3-14

years. suppl.ements should not exceed thoee amounte rin order to insure that mottling of the teeth does not occur.l Recently the recommended daily dose for children Iess than two years of a6e has a6an been halved, to 0.2J mg, (Council on Dental Therapeutics, 19?? Eilitorial, 19?8i Drj-sco11 and Iorowilz, 19?8). therefore the newly recorimended dose is oni one quarer of the dose orlginally prescrbed. That statement nrust be qualifi-ed. by the recent warning of the American Dental Associationrs Council- on
Dental Therapcutics: rBefore a fLuoride supplement is prescribed' the fluoride concentration of a childrs drinking water nust be deternined to avoid the possibilty of the chilil deveioping dental- fluoroais from excessive intake of fluoride during the crucial periods of tooth calcification. For areas that have natura.l fluorides at a concentration of O.2 ppn or greater in the supply of drinking watert appropriate clownward, adjustnents must be nade in the dosage sched,ule. The Council on Dental Therapeutcs of the A.nercan Dental Association bas suggested that fluorde supplements shoulct not be prescribed when the concentraton of natural fLuorde exceede 60% of the concenration .recommended for connunLty water fluoridation in a geographc region. r (Driscoll and llorowj-tz , 19?B).

Therefore, the present

Melbourne,

common

practce, n fluordated

of provlding young children wth fLuoride tablets is a dangerous one, partcu.arly in regard to the l-iklihood of the developnent of d.ental- fluorosis. It s clear3-y contrary to that recent recomnendation by the Council on Dental Therapeutics of the American Dental Association.

210

The subject of the fl-uoride ingestion by young

chIdren obvousl-y is in a state of confusion.

on Dental Therapeutics pointed out that:

The CounciL

rn addti-on to the crosage schedure recommended by the council, various fei-grrtJ other schedul-es have been used or proposed. rn sorne nstances, these schedules are more conservat,ive than that of the councir for the early years of a chil_dts life; in others, a higher dosage is used or suggested.r (Driscoll- and Horowitzr jg?g). 3) False Cl-ains that there is a with Fluoridat Lo n.
The
Wide

l4arein of Safet v

that with fluoridated. water (at approxinatery 1 p.p.m. fr-uoride) tbere is a rarge margin of safety. TvJo papers are typical of the cl_aims mad.e: A paper which is repeatedly cited is one in the Journal of
mad.e

claim is often

the American
He

Den tal

Associ-ation by Dr A.p. Black (1955).

said:
rA wide mar6j-n of safety is thus provided, inasmuch as i-ntakes of fr-uorine about fifty per cent above the idear dose produce very mild evdences in the appearance of the teeth of such excess. r

An

article,

by an anonymous author, in the

vrIHo

chronicl_e

said that rthere is a very wide safety margin between the optimum leveI and the lowest leveI at which harmful effects have been detected. r The article adnritted that mottling
can occurr rbut only when the r-ever_ of fluoride is at least

4-6 times greater than the optimun leveI. I The roptimum levelr vras sald to range from 0.6 to 1.2 p.p.m. depending on the climate. (wHo t 1969b),

211

the followi.ng year, Professor A"II' Slddiquit ln another WIIO Publication, the book Fluorides and Iuman lAt 6 ppn the incidence of mottllng &Bl!!, stated that:
However,

Ls 1OO%.r (Siddiqui, 19?O). Thie has been known for nany years. Drs If.C' Ilod6e and F.A. Smth (t954) in

FIuor t

, stated that at 4 p.p.n. l-ees tlian 5% of the teeth are nornal, almost half have rnoderate or -evere fluorosls, and at 6 p.p.n. no n as a Public lleal h
l,feasure

teeth are nornal.

Notwithstanding those well-known facts (to those
who read

the literature) incorrect statements are stil]. being made here. In 19?? he Chairnan oi trto Fluoridation
sub-committee

of the victorian Branch of the Australian

Dental Association said: rThere is an extremely wicle tolerance, and the takng of tabLets after the introductl0n of fluo::ide into the l water supplles is not dangerous. (Levant, 19??).

In contrast, the Gernan Federal Republic Department of Health said, in 19762 rIt is of the utrost importance to make sure that a simultaneous additive intake of fluoride from fluoride tablets, fluoridated tooth-paste and fluoridated salt does not take place" (Dcpartment of Health, 1976). Regrettably, fluoricl.e tabLets are still readily
avallable in Melbourne -and are used - despite the fluoridation of our water supplies, and nearly aII toothpaste
ou sale eontains considerable concentrations

of fluoride.
doses of

It is

now known

(as has already been nentoned) that

may swallow

children, a particular

significant

fluoride fron toothPaotes. fi

See appendJ-x

2a, p. 255.

212

(4)
Marq Ln
uJ

edc

dence 1n Clalms

Re

a Safet

lth Fluori dation. confidence Ls stiLl. bein6 ehown in thc clalns that thore fe a wLde safety margin with fruoridation, even by government, advLsors. For instance Mr K.D. Green, secretary to the of victora, in a letter r.ritten in 19?4 to reaosure a vfornan who was worried by the prospect of havng to be forced to drink fluoridaterl water, said:
Premer

rrhe concentraton of fruorlde proposed for fluorid.aton is but 1 part per nilIion. At that lever, no matter hovr much wate you drinkn no barm from fluorid.e shourd
occur. r

clearly, whoever briefed lrlr Green r{as unaware of the'situation. In a Letter to ne on Novcmber J, 1g?t$) _ and an identically worded one to Sir Arthur Anies , Jan l, 19?4 _ Mr Green said that the decision to proceed vith fuoridation was onry reached after rong and exhaustive investigation of aLl available material_" I that term rexhaustive r recalrs the statement by the in ilre llouse of Representatives in 1964. He said that the fountain-head readng to the fruoridation of canberraf s water supply uras a report of r u,ru-conmittee of the Territory Advisory Council. IIe commented; That report has been described varously as befng critical, exhaustve, and extenslve and, as apprasing every known facet of fluori.dation. r rBut this sub_ conmittee cf the Advisory councir dealt with this great issue in five paragraphs, ot 124 words. Each of the paragraphs represented a proposition not supported by gkemick of evidenee. r one
Hon. D.J. Kir-r-en

213

()

for a rPatentlv Naive r.

CIaims

Saf ety

Ma

rRin wi th Flu oridation are

!'or more than thirty yearo the cl-aim that there is a wde fluoridated water has margin of safety with artificially
been known to be false.

supplyt The Director of Labor.tories, Department of tlater

Gas and

Electricity,

City of

New

York (B'C' Nesin ' 1956)

said: rrhe proponents of fluoridaton have tried to demonstrate various factors of safety which are patently naive ' They speak of factors of safety of 2t or B etc' with litt1e comprehension of the meaning of this term as A factor of safety of used in water supply practice' 2 or 8 on theLr terms is no factor of safety at all' It has been customary to consid'er a minimal factor of safety of not l-ess than 'lO for substances which nay be admitted to water supplfes' This would nean that ten times the amount of the proposed substance when presentinthewatersupplywouldbedefinitelywthout harm to human or beast. It is obvious from the knowledge of fluoride toxicity that such a factor of safety cannot be established when fluoride is added to the water suppy at ttre J-evel recommend'ed by the proponentsoffluoridation.Inviewofthefactthat theran6eofwaterconsumptionrnayvaryoveraratioof 20toltheinsistenceuponafactorofsafetyoflos
exceedinglY moderate.
He then said:
I
I

It must be conclude<l that the fluoridation of public water supplies s a hazardous procedure, people are bound to get hurt, it remans to find out how many and
when.
I

XXVII.
TgE TNFL UNNCE OF FLUORIDATIO}T
ON

21t MANIS ENVIRONMENT.

Diecussiona on the effocte of fluoridation have, until

recently been concerned with the effects on the teeth andt to a much lesser extent, on the rest of the body. The effect on mants environment has been overLooked or ignored. The International Society for Research on Nutrition and Vital Substances (96?) said that:
rThe fluoridation of drinkin6 water releases a fluoride

circuit which includes vegetables, fruir and, other horticuLtural products and consumabes, and has an uncontroIable effect on the human organism. I
Man ls unquestionably influetrced by hie environment. Therefore, although the Terms of Reference for the Committee refer to rthe effects on hunans of fluoridation

of water supplies',
environment. (r
)

6ome

consideration shoul-d be given to

the question of the effects of fluoridation on manrs

The rF1uorde Circuitr Arising from Fluoridation.

The fact that only a cmall proportion of the water fluori-

by the popul-ation has bcen recognized criticized by many people on economic grounds. Little
datect

is

consumed

and

consideration has been given to the effects on

environment of the fwastedr water.

manrs
used,

Part of this is

for washing and other donestic purposes and, with nuch of the portion consuned by the population, is gathered up in the sewerage systenr. The remainder is spread on the grcund partly by the watering of plants and vegetables" It
has

215

been found, for instance in Japan (Okamura and Mateuhiea,

1965b, 1967) that Ln eomo districts

there ha,s been a

Much

marked

increase in the fluoride content of cros. is a result of uoing superphosphate fertilizers

of this

which

contain f luorlde " rlrlhat happens when fluorine is added to the soil depends on such factors as the forn in which it is
appl-ied, the amount of fluorine, how nuch lime and phosphate

are present, the species of plants grovrn, and the soil type and geology. (Schatz and Schatz, 19?. V,latering with also have an effect. Recentry Dr B.s. vrralker (gzg) said that nuch more water is useci to irrigate home vegetabre gardens than reaches the
w11-

fl-uoriilated water

mouths

of chIdren. ife said rFruorine is one of tho nost chemicalry-active of alL the el-ements, reacting readiry with organic matter to form fluorocarbons, already strongly suspect for their possible effect on the environment; Soluble fluorides are admittedly poisonous; chenicals applied to the soil in even very smalr concentrations may bufld up, over time, to quite surprloin6 anounts; Vegetation absorbs fLuorine fron the soi1"

He added:

In the J-ight of the above, can anyone, ,expertr! or not, give me an absoltrte assuance tha the lettuce grown n ny backyaril wir] never become toxc through e]:cess fuorine" As an ex-agronomist, and keen gardener, I should like to hear argument on that pont. I At present there does not appear to be an ans$rer to that
I

q'uery.

216

(2)

Fluorlde Dnmane

to

Tree s r Plant s and Cut Flowere.

man and

part fron the effect on

atmosphere and

anlnals, fluoride in the

ln water has becn ehown, in numeroue etudlest to affect trees and plants and also some cut flowers'
1977 wben

Thesearticlesusuallyappearinagriculturaland bortLcultural Journals and were little known in the Act was Passed.

Drs R.D. Gabovich and G.D. Ovrutskiy ?gZZ) found

that the accumulation of fluorine in plants fs affected by factors other than the anount of fluorine in the soil, for
exarnple, by the plant nourishment. They found dissmilar

accumulation of fluorine j-n different plants.

There are

ptants which are rfluorine accumulatorsr such as spinach (28,7 ppm) and, to a lesser extent, lettuce and parsl-ey

'

(tottr

11.3 ppn)

(schatz and Schatz | 1972). Dxposing Valencia orange trees to hydrogen fluoride

"

gasr with a fluoride concentration of I p.p.b. that is

1l I TOOOTO0O'OOO Is found- to produce rfluoride

damage

n the form of reduccd leaf size n reduced total leaf area and reduced top vreight [wblch] remained proportional to total fluoride accumulaton. I (Brewer -4. t 1969).
An nportan questlon is (even without consderlng the

effecL of atmospheric polluton wth fluoride) whether vratering trees with water containng 1 p.p.rl. fluorider which
i-s a thousand tines the above-nentioned concentrationr will
produce a similar type of damage.

Not only the trees are affected by atmospheric

fluorides but aLso the insects associated with then.

An

important observatlon reported by Gabovich and Ovrutskiy

217

(lgZZ) wae that of G. Bredemann (lcaclemie-VerJ-ag, 1956,

Berrin) who found that the accumulatfon of fr-uorine in flowering plants, polluted with fluorne-contai.ning

of bees. rn the bod,iee of clead bees there were frorn Jo to 11rfoo mg of fluorine per kg dry wei6ht, as against O.5 ng/kg in the control. courd a sinilar effect resurt fron vraterln8 flowerf.ng plants with fluoridated water? No etudes to determine this point have been found.
subject of the effects of airborne fruoride and ts effects on vegetation has already been mentioned
The

emfssione, causes nassive death

fs also mentioned in the book Health Effects of Envronmental Po llutants (watdott , 19?3). one unusual fact is that vegetation tends to inpede or intercept fluorfde ln air that is noving through the foriage, thus creatlng an adjacent down-wind area of r-ower airborne fluoride concentration. (Rose and Marier, 1g??). rt s now welr d.ocumented that fluoricrated water (t prp.!r. fruoride) hae a detrinentar effect on the keeping quality of some cut frowers. ilgher concentrations
and produce more marked effects.

brefly

Dr t.8. 'Iaters (r968a) reported

that rthe keeping quat-ity

of rose cut-flowersr

rdecreased greatly as the dssorved

l- level. increased in the holding eolutions. r The decrease 1n the flower quality index after four clays vras g% at 0,6?

at 1"20 ppn F and 45% witn t.tj pln Fr compared with the coutrole. That ie: fone ppn F rnduced moderate toxlcity synptons and 3 ppm F nduced .evere toxicity synptons. r
ppm tro 21%

?-18

Dr F. Spierin6 s 9969) observed

to Sladiolus f l-orets in fluoriclated vater. Fluoride was shovrn to be the main factor in producng deterioration and vas the only specific
dama8e

ionthatwastoxicatveryotlconcentrations.'Peta} deterioration lncreased n a highly linear or quadratic rnanner as the fluoride content ncreased"r (tlatersr 1968b).
The

cluality rating decreased by

26%

r'rith 1'1f ppn F'

Dr

vaters salci that rv'Joltz demonstrated that g3-adiolus fol-iage is extremely suscepttbl to fluorides acquirecl through the

or roots. | (Woltz et al. , 1951i llo1tz | 1964)' At 1.1/ ppm F the number of days tbat chrysanthemum foliage Iasted was decreased. by 1J/r, but this regression was not
ll-eaves

sufficiently

high to be significant.

(Vrraters, 1968b).

Ln 19?6 it was fcund that the use of superphosphate containing 1.O% F produced leaf scorch in ]ilj-es anrl gJ-adiolus. (Voltz
and larousky, 19?6) .

3)

The Svnthesis

of Ornanic Fluoride

Comnounds

A possible hazard of fluoridation, whj-ch docs not appear to

have been taken into consideratior\ vtas mentioned by hofessor

Sinclair (gel) , nour Director of the International Institutc of lluman NutrJ-tion, Oxford. IIe sairl that probably
IIu6h

he greatest aut,hority on organic fluoride compounds is Dr

B.C. Sauriders of Cambridget who stated: tI, too, aB'very woried about the fluori-dation of publc rI am parti-cuIarly worried, about the water supplies.r possiblity of a buiful-up of I- nto organic conpounds containing the C-r' link when aII said anrl done the plant rrgifblaarrr is able to do preciaely this. Are r^re sure

219

that there are no other plants or bacteria which can bring about this lcthaJ- synthesis?l rlofeosor Sincl.rir explalned that by !lcthal synthesisr Dr
Saunders vras

referrin6 to the fact that rgfblaart

malces

fluoroacetic acid which is synthesized in the body into fluorocitric acid, and this poisons rcspiration in ceIs" sir Rudolph Peters (t964) pointed out that fluorocitric acid is a very potent
poir.;onn because minute amounts mg

of it block

the nornal metabolisrn of citric acid, 0"1

weight can ki1I a dog.

per kg body-

Thcre are variations in the toxic

many other
Rud.olph

doses. Thc rnonkey is less sensitive than

aninals, and this aprears to be truc for man. Sir

Peters said that at comparatively low concentratione, broad.

beans and cabba.ges become very poisonous to aphids, and that those who worked on thls problen fwere worried by the clanger

implicit ln the persistence of the

conpound.s

in the soiL.

In Queensland and the Northern Territory rGeorgina poisoningr has seriously affected cattl-en sheep and goat
production since late last century due to eatin6 Acacia Aeorfij-nae,' (Barnes, 195. The plants in different areas exhiblt a wide ran8e of toxicity to cattle, and there may

also be a seasonal variation of toxicity in individual trees. (Murray et ar," | 1961). rt has been found that this prant can synthesize fluoroacetic acid as d,oes the south African r6ifblaarr rnentionecr. above. (oelrichs and McEwan | 1961)
"

rn 1)lJ Dr A.L" Knight said that fluoroacetate is found in certain prants in ustrala, Brazir and south Afrca"
He

said:

lThere is no antidote. A couple of drops

220

by any routc s l-lke]y to be fatal. I

In IsraeLt rpproximately

)6 epectes of plante vhLch belong to varlous botanical farniltes are known to contain fl-uoroacetate.r (Egyear 1973)' Is it possible that such a tlethal synthesisr could be nade by a Victorian plant when watered with fluoridated water (which j-t has not encountered in its evoution) nsteacl of with rainwater or water having its normal t pre-' fluoridation, very lov level of fluoride?
(4)
I,/'l1I

Fluoridation Affect

Mar ine

Lfe in Port Phillip

Bay?

Another uninvestigabed, or at least unreported, aspect of

fluoridation of }elbourners water, is the question of the effect of the discharge of fluoridated watcr into Port Phillip Bay. to its shape, there is comparatively. littl-e interchange between its water and the ocean, and nost of this will affect, prinarily, the bay water near the Heads.
Owng

Evaporation wiI increase the salinity of the water, lncluding

the fluoride concentration, and rainfall will d.ecreasc j-t. A former Minister of Hearth (scanlan, 1973) stated that the fluoride level was 1.4
ppmr

a concentration which

cJ.osely

approaches 1.JppmF, which is the U.S. maximum tolerance lirnit

for narine life in oceans and estuaries. (U.S. Environmental , 1976). In 19?4, the German Association of Gas and lrlater Experts expressed rits decisLve reJection of fluoridatonl
/tgency

Protecton

becauae

-t produces:

0.. o an unjustifi-ab1e encroachrnent on the environnent of a toxic substance which would find its vray back into our food through waste waters and water coursee in an uncontrollable fashion. I

?_?_1

In Melbournc,
rr.:ach

much

of thnt

ura,ste r,vatcr

will ultimately

the llay. t
The Deperrtmr:trt, oI IIe.rIthr of
l,

l'e' Cerman 1,'edcral

Republic said, in 1976, that: rl{here fluorldation of drinhing water has been introduced, it will be necessary to also supervie and study the possible ecolopical side-effects and possible hydroleochemical impi-r ct on the areas into which tlre fluoridated water io dis charged. This w111 be necessary to detect such Lnfluences and take countermeasures before irre parable damane can occur. I
Bishop ilarbour in Tampa Bay, Florida, has becorne a marine

graveyard due to fluoride waste frorn a cheaical company

(St.I'etersburg Tmes, Llar. 14, 19?O). It has since

reported that in t'fay, 1976, Captain Jaques Cousteau
confirrned that finding.
The question is:

been

**
tr/i1l-

the adclitional fluoride

content of thc river,.-i and drains frorn fl-uoridation of our vater sup.rl:les, adderl to the direct dj-scharge into the 13ay

of fluoride wastes from industry, be sufficient in the future to enable the 1977 Level of 1.4 p.p.n. fluoride to approach a level which is critical for marine life? **r
The

possibility should be studied carefulJ-y.

* See appendix Ja, p. 263. it t See appendix 20, p. 284. ltt See appendi-:c 4a, p. ?-j9.

XXVII.
CONCLUS

222

ION.

Just before the llealth (Fluoridatlon) ct was pasoed ln 19?7, the hesiclcnt of the victorfan Branch of the Australian Dental Associatlon sald that fluoridaton ris absolutely
eafe fron the redlcal viewpointr ancl that the dentaL
advantages are vel-I proven. (Dooley , 1977) .

Sinilar

clains were nade on beh.alf of other endosing botlies. It is clear that those assurancea vrere accepted by the nenbers of Partiament, otherwise the Act would not have been'passed.
Those

clains are of

nov, untenabie.

The German Association

I

Gas and lrlater

Experts (9?S) said:

ff there e a poten tia]- d.aneer that a certain substance may cause chronic clisease n nan, then its use for human consuraption should be banned even if there ls no patent
evidence tbat

it

w111 do 60. I

Sinilarly, Sir /trthur /\mies (9?5) eaid: rThe ease against fluorldation medically requires only ouch evidence as ls necessary to support a reaeonable doubt. V'Ihere the publicrs health is concerned no
reasonable doubt can be ignored.
He considerecl
I

that the doubt about fLuoridation r.as rmore tban reasonable, it is considerabLe. I A recent editoiial artc1e (9?9U) in ttre rGeelong
Advertioerr
denanded

a more stringent standard:

In health terms, the question we have to ask ourselves is whether it has been proved beyond a.l-L doubt - not fluorclation of beyond reasonable doubt - that the water supplies is safe. If there is doubtr then compul-sory fluoridation of our water supply systens shoud not procced. I |r ik see appendix 49, p. 262,

227

In the four years since Sr rthur Anies said. that the doubt about the eafety of fluoridation vas rconsid.erabler, the evidence against its safety has greatly ncreased. There j.s now no doubt that eone people are intol-erant to fl-uorclaed
vater and become obviously ilt
when

they drink their domestic

water.

Almost certainly far more people are less affected,

the side effects being attrbuted to the stress of Life or to other causes, the last factor to be suspected beng the
water in their
home taps.

Of particul-ar inportance is the f-nding of Drs Tiamouyannis and Burk (lgZZ) that there is a correlation
between

the use of artificial

in cancer nortality"

fluoridation and an increase rntensive and expert criticisns of

that finding (mentioned'in section )o(II) failed to fault ether the data or the statstical methods used. Therefore this correlation thas not been convncingfy refuted n the two yeare since its publication. r (Diesenctorf , 19?9)j nt
During the past year the pubJ_ic has becone avrate of the disasterous effects of some of the drugs vhch have
been prescrbed, and n some ca6es obtained ready without

prescription, for up to thirty years before being banneil. Many papers have been published recentry which dear_ with the 11-effects of fluoride on the total- environment. rt would nor{ ,'een prudent to investigate vrays of decreasing, not increasin6, the totar amount of fruoride to which people are exposed. one consderation is the cost of health services to the affectett people and the ross of producton due to undi.agnosed illness from fluoride intorerance. l+ See appendix 18, p- aO. -*I See appendix 11, p. Z?t, lrl !"" appendix 4d, p. 261,
iXll'.

225
IlllF.lIlllllC I:fl

/\ number. of the following rcfercnces rcfer to newspaper reports, for the great majority of l-etters re6arding

fluorldation were not sent to scientific journals.

Aasenden, R. , and PeebJ-es t T.C

Cited
PaBee

on

(1974)

rch. OraI
on the

208

ry' t
@ion.

192 321'

.haerican Dental

Aesociation

(1961 )

Comments

26

Bureau

of
.^.

Pub1ic

Inforrnatfon, A.D.A., Chica6o. Arnerican t"ledica1 l\ssociatj.on (19)

merican Vrlater Works

.f

llevs

ug. 19.

208-g
71

Assocaton 9949) ,. Amer. ttrater

158

Jorks Ass. Amies, Amies,

, 41t 5?5.
75
44

A.B.Ir. (1959) 43g!-Dcn.!.-|., 4.: ?6. A. B. P. (19?5) Actdress, I'lelbourne Tor+n IIaII, (gZB)
consumer Reports

2O2t 222

June 4,
nonymo us

, Ju1y, p.

392;

57,
j-n
151

184

August, p.

48O.

Arnstrong, W.D., and Singer, L. (19?o) oistribution

body-flufds and soft tisgues.

Human

In Fluorides

and

}lealth I

lV.H.O., Geneva. pp. 94-104,

ancl
Bo

Arnoldr r.,A. Jr. , (96?) Forevrord to .T.R. Blayney

r.N. rrill Qg6?). rnold, lI. (lgZZ) U.S. Con6rees.

Sub-Comrnittee

of

the

1?B-g

186

Connittee on Government Operations, Ilouse of

Representatives. National Cancer Progran, part II. U.S. Govt. Prnting Office, I'iashin6ton. p. 58O,

/trtc'Io SSZS) tseattle Timesr, Aug. 11.

64

?26

Paes

Aclander, . (1966)

Pakietan Dent
Rep.

Rev .

r 16: 86.

Aet, D.B.

('lgtr) puut. ttrth.

58r 85?.

69 93

11, 36-7,
197

llO,

Aot, D.B. U944) fluorine 1n DentaL PubLic llealth.

of the New York Inot. Clfn. Oral Pathol. lI.Y. City, Oct. 9O (CtteA fron .A.London). uermann, E. (tgZl) Fl.uorfde , 6: 78. Australfan Dena1 /Ieeociation (9?9) Federal VLce Synpoefrrn

1121 114-5
18

Preeident,

tSyd.ney Morning

IIeraIdr,

li,a;y

7.

ArotraLian Kldney Founilation

U9?4) I,ettor, fed.ical

25

195

Secretary, Canberra. Mar. 21.

D.C. (f949) Amer. J. I)is. chlld. , ?B: ?2. Brrnee, J.E. (1958) Auct. Vet. J. , J4: 281. Berry. l,.T.C . (lg59) mer J Ment. Dcfic . r 6z 6tt. Bertrand, F.R, (19?4) Brit. Dent. J. , 176: 405. Beveritlge, }tr.I.B. ('tg6l ) ttre Art of Scj_entLffc
Badger,

104,
219 189
31
7O

118

llercury Bool.,s, London. pp. 19-ZO. Birnln6ban City (1968) ne rt of tho McdLcal OffLce r
a

fnvestinatLon

1?6

of Health for tha Year 1 968. Citv of Birnin nhan (England). (Cite fron A. Schatz and V. Schatz,
1972).

Black, A.P. (1955)

BJ.ack,

.f

. Aner. Dent .

s6

.r 5or 655,
Cosplos,

210

G.V., and McKay, f .S. (1916) Dont.

9B_9, 169_?0

58 129" BLaynoy,

J.R., and [lllr

f.l{. (196?) J. ner. Dent.

V.8,

BZ

Aqs,r ?42 257.

Blayney, J.R. and Tucker,
27 2?9.

(1948) .I. Dent. Res.,

7'l

22?
Pafles

Bossavaln,
Boyden,

c.il. gtt)

Colorado Med.

7Oz 142.

99, 1ot
153-4,
177 56 216

s. (92) Ig!.|..!5[.t 1z 1229t June 10' Brady, Margaref g9??) Cancer cont. J,, 5z 157' 1 z 697. lfar. 29 ' Breeler , M. (9?6) @!,
Brewer, R.F., Sutherlandr tr'.H., and, Perezr R.O' 9969)

177

t 942 284. BritJ-eb Minletry of Health (gSS)

Aer.
Sc..

J.

Hort,

The Fluoriclation
Decay.

?5

of I'Iater and the h

Roferenco Note No. Browu,

eve ntion

of Dental

9.

lI

.I.S.O.

London.

E.v. (g66) {:-1Qgg$.,

ugzg)
Cancer

8z 561.

17t
185-6
J .l
15

Cont, Soc. , J: No. ,/4. Bnrt, B.A. and Petersonr E.o . OgTz) Brit. Dent. Burk,
137257..

D.

Buu-Hofr N.P. Ug6Z) tFluorotoxicosisr and

151-2,
of

191

rFluoridotoxicosie

|.

In The ToxicoLo

F1uorlne.
Scbwabe &

Symposiun, Beru, Oct. 15-17.

Co., Verlage, Basel/Stuttgart.

(19?4)

Ca1dwe1l, Gladys, and Zanfagnar P.E.

a

)o

Top-Bcol

Press,
Cant

Reeeda

Ca. p.12.
Reo rt

, A.F.

('t9zz)

to the Hon. J.T. Tonkin t

Government

M.L.A.. Prenier of t,lestern Australia. On the

Fluoridation of Publ ic tJater Supp1ies.

Printer, Western Australia.

228
PaAes

Carlaonr c.E . Carlsson, A.

SgZl) Fluoride, 6:

12?.

'12?

USZS) Current Problems Relatins to the of Fluorides.

',?7r:s133-6 '

PharnacoloEy and Toxlcolo y

Pharnacologlcal Institute, Unversity of

ctoborg, Swoden. (Mineo.

Cecltioni, V.A. (19?4) Fl-uoride , 7z 1r7. Cecillonl, v.A. g9??) letter to tNatona1 Fluoridatlon News I, July-Sept., 1977 .
Cbrietensen, G. (1956 ) Australian Dental ssociation
(QueensLancl

178
177

75

Branch) Annual Report | 1955-1956.

C1ark, R., 'IeJ.ch,

J., Leiby, G., Cobb !{.Y. and

Comnunicable Disease Center,

149

MacCormack, QgZ4) Morbidity and MortaLity Week1f

Egg$r 212 199.

Coolcr

U.S.P.E.S., Atlanta.

H.A. O9?6) Papor read at the Conference of the Internat. Soc. Fluoride Res., Zandvoort, Feb. 8-1O. Conmonwealth Departnent of Ilealth (lg6l) Dep, Iltth. {.,
Ase

151

B' 119-20,

Decenber

1961

r pp.

105-6.
2Og

Council on Dental Therapeutics, mericaa Dental

ociation g9??)
and Bodge,

cce

ed Dental Thera

utics.
207

7? edr, ner, Dent, Ass., Chicago.

Cox, G,.[.

E.C,

?95O )

,f

. Aner.

Dent

8.,

40:

440.

Crawford, Margaret

D. (.lg?Z) Lancet, 1: 1Tgt, Jwre 10. 158, 1BB,

192-3

229

Dseler, II.G. Bijrtitz, S., and Auoriltrr Eo (gZl) Z. Gccamt e IIy eno , 192 568. (Abstr. in Fluorfcle ?z 223.)
Dawson,

T. gg?g) tte Bocly Prograrier 'B'C',

Aug'

!'

142 8r
192

Day, c.D.l/1. (1940)

Brit. Dent. J. , 68: 409. (o9??) ]@! Day, T.K. ancl Powe1l-Jackson, P.R' 1: 1175. \[aY 2?. Dean, E.T. ?9tU) J. Aner. Dent. A6s. , 21 z 1421, Deanr II.T . (g42) The Investgatlon of Pbysiolo85-cal
Effects by the Epidemological l'lethocl' In FIuorlne and Dental Health. F.R. Moultonr Ed. t
No. 19. Amer. Ass.-Adv. Sci. Wasbington' PP' ?7-'1' Dean, II.T. r and Arnoldr F.A. Jr. (9+l) {499!'

96-?

95-?,

199

99

M.',
(195|0-

7oz 12?B'

Dean, H.T., Arnold, F.A. Jr. r Jay, P', and' Knutsont J'VI'

7t
65

) Publ. IIlth.

Rcrr.

652 1401.

Deatherage

, C .F. 9942) lottted enare1 fron the otandpoin of the public health dentist. E Fluorine ancl Denta1 Health. F.R. MouLtont Edi, Amer. As6. Adv. Sci.,
81-101 .

llashfngton. pp.
Department

of Hea1th, Gernan Federal Republic OgZ6) Letter to tho Minister for Youth, Fanily an
HeaLth. Feb. 16,
19?6.
Co.

119,1?21
211

De

Stefano, T.M. (1954) BuII. Iludson

23 20.

Dent.

Soc. t

1?t
100

89

Defenback, V.L., Nevittr G.., and Franlcel J'M'

(196r) J. Arner. Dent. Ass.

, 71 1129,
186, zzt

Diesendorf, M. (19?9) tThe Canberra Tirnesr, JuIy 11.

21-1t

180,

2to

Panes

Dillon, c. (lgSe) Dent. Dig., 6z 36?_. Dobbs I C.G . (195?) Brit .De nt. J .r 1O7r 26?. Dobbs, c.G. (1960) Lancet, 1z ?6g. April 2. . (lg?z) Ibotectio Vitae , No. 15O, 7/?2, p. 1o4. Do11, R., and Kin1en, L. (,lgll ) Lancet, 1: 13OO.
Dobbe,
C.G

Bz-l

?4-5t
76

zo?

4.6, 86, 17o,

'137-B 130

.une 18.

E. (19? 8) Fluoride , 11: 1O7. Dooley, B. (lgZl) Melbor.rrne tAge,, Oct. tO.
Donzalskar

197

69,
4z-8

222

Douglas,

8.L.,

and Coppersnth,

Sylvia 9965) N.y.

S'ta.te Dent.

J.,

112 479.
T?

Douglas,

8.L., Wallace D.A. Lerner, M., and, Coppersmith, Sy1via B. (lgZZ) J. Amer. Dent.

49., 842 755. Douglas of Barroch (rg6o) Evidence to the ontario

Fluoridation InvestigatJ.ng Comnittee, Toronto.

6g

19,
?o,

L2

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1, 1960. Douglae of Barloch (9ZZ)

March

ttre

sent Status of

203

FLuoridaton. paper to the Annua1 Conventlon, rnternat. soc. Res. on Disea'e. of cvirlzation,

Berlin, Septenber, 19?2. Doug1aa, T.E. (1956) NortXrest Me_., Sept. p.1Oj?. Dniscollr !,1.S., and, Horowitz, H.S . (1g?B) A
discussion of optisral dosa e for clie fluori-de

2ot-4
1t6-?

2Og-1O

supplement. A Report of the Council on Dental

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J.
Dunlop, Dunlopr

t 96:. 1oJo, D. (196?) Med. L]!EjL., 1: h1z. M"rcb 4. E.E. (lgZS) uelbourne Town HaIl, ,June 5.
Ame

Dent

71, 8z
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Pages 28

Eckersley, R. (979)

'Sydney }lorning lleraldr t June 2J.

Editorial (t94r) J. Amcr Dent. s6. 112 1760. Editorial ('t95t ) Chemical V'lee< , July 7r p. 14. Editoria (1964) Melbourne rger, Au6ust 21. Editoriar (9??a) Fluorirle , 10: 1, Bdl-torial U9??b ) Ffuoride , 1O: 45. Editoral l19??. ) Fluoride , 10: 149. dttorial (gZ8) J. /tmer. Dcnt. Ass. , 962 1158.
Bditoria](t9?9^)
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Edi-torial Editora1

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(rgzga)

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29 19

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129,

J" Dent. ss. Soutlt Africa

215.

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220
110
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Enno, Anna, Cra6r G.G. r and l(nox, K.W. (19?6) Ied.

68,11o,
113

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2:

J40. August 28.

Envronnent Protoction Authority

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6Z/?8.
18

for 1977.
Everingham, D.If .

Report

llo.

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?,
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45

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2tz

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, Caro1 S. (l9ZZ) Conoiderrtion of a Safo Maxfmum Dallv Intake of llluordes. Society to Overcome f'olution, Montreal-, Canada. (,imeo. ) Farkas, C.S. (lglS) Fluorlde, B: gB.
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138

114-6c 132
113

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51,
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Feltman, R. , and Kose1, G, (tg6l )

162 19O.

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f no Desinrr

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, I. (1951)

Experimen ts.

Ol-iver and Boyd, Bdinburgh. pp. Zt 1g.

I'Iaherty, J.

(lgZA) liilcenheacl g al. v. Dorou6h of l'Jest View st al., Court of Cornmon pleas of Allegheny county, pennsylvania. civir_ Division.

182-4

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542 192.

l.1,1 .

(19?r) ,i. Dent.

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113

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Fl_uorne

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in

Stoma t ol-

and IIyi ene .

?B-?85. u.s. Dep. Hear-th Education and rrelfare,

Bethcda.

233
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GabovJ-ch, R.D.

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Schatz

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Geclalia, I., Brzezlneklt A't Zulcernan' H" and 472 669' Mayeredorf , A. (1964) J' Dent' Reg"

101,

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Leet I'l'A' Geeverr 8.F., McCannr H'G', McClure ' F'J'r Services ancl Sobiffernann, E. (92'l) IIealt h
and M.H.A,H.R.

191

86: B2o. (cite from G'L'

172

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Gelardi, VJ-ckie I,. 3gZ6) open Letter' Feingord Association of New York for Ilyperactive Children'

APril 2/,
German

19?6,

gg?4) Associatfon of Gas and lrlater Experts ter. Statement on the FIuorIcla ti-on of Dr
August 26, 1g?4. Translated

59,

220

lnto EngJ-ish' g9?5) German AosocLation of Gas and Water Experts

tation
cler Trinltwa sser-

IrB, zzz

fluoridierunr. ZIGIr-Verlag GnbH, Frankfurt' of German Consu1 (gZ Letter, Conoulate General tbe Fecleral Republic of Germany' Jan 10' 1979'
Gerier N.tr'.
Dd

55

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.:.

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1: 697' tPtil

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154

2r4
Paces

Gordonoff, T., and Minder, W. (1960) F1uorine. In Vlorld Iovlow of Nut rlt lon nnd DLototca , VoI. 2.
G.H. Bourno, Ed.. pitnan. London.
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157

191,

208

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2?-B

2,

197r,

Gotzsche, Anne-Liee Gotzsche,

69D Lancet, 2z 1025. Nov. 3. Anne-Lfee (19?5) fno Fluoride Q.uestion.

the

z8-9r

BB

DavLe-Poynter, London, Graban,

31 t 126-71 129-30

J.R. (lgZ8) Final sunmation on behalf of Plal.ntiffe. In Altkonbead v. V,Iest View, of

Comnon p1eas.

182

Allegheny County Court

No. Z8-4585. September zJ, j9?8.

Granter, F.J. (19?6) Victorian Minister of l,Iater Supp1y. Letter, March 22, 19?6.

64,

66-8

K.D. ('lgZla) hemierrs Departnent. Letter, January -, 1927, Green, K. D. ( I 9?1b) henier I e Departnent . Letter ,
Greenr
Novenber

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212

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19?7.

. (19?4) henier f s Departnont. Leter, April ] , 1971+. Griffltbe-Jonoe, W. (lgZZ) Veter Record
Greenr K.D

212

100;
GuLevar

126
201

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Grinbergcn, G.W. (.tgZ4)

E,A.

(19?Z)

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FT uoride t

18?

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(19?8)

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Eardwfck,
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16,

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c"n.-{'.

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communication'

125

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(tgz6)

66-z

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BelJ-stron, Ingrid (1960) Acta odont' Scand'" 18: 267' Ei.cks c.s , Jg56) Med.. J. Aust. , 2z 116. July 28. EckE, c.s. (1961)
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Med.

J.

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HilI, I.N. t Jelinek,

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(1949)

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Hirth, c. g9??) AgE' 232 4. Hodge, E.C. (r950) J. Amer. Dent. Ase. , 40: 416.
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36, 67-8, 18, 158

OB

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Sorae

publj-c health

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aepecte

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39

tfashington. Bogartb, J.t'I. (f96 Ug5!|!gg[., 1z 496. March J1. 1z 1110. pI. 15, Eolnanr R.A. (1961) $!!-q!-|., Eolnan, R.. (1962) Internat. J. Vitalstoffe Bd,. 7 Fobruary, Po1. (gited, fron D.G. steyn, 196ha) ' Eoover, R.N., MoKay, F.W., and Fraumenir J:F. Jr. (1976)
AEs. Adv. Sci.

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fnstitute of

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Interuatlonal Socl-ety for Research on Nutrition and Vita1 Substancea 3962) Vital.stoffe Zi.v. , 12t
and

79

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162t 2O5,214

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Internatonal Society for Research on Civilfzation

Diseaeee and

vltal substances ug6g) Resorution No 1g4t vrrr' 15th rnternational convention on civirization Diseasesr vitar subotances, Nutrition. Ilanover. September 8-t4, 1969. frving, F.A. (1963) Ilealth, tceth and the natural 86
sallne watoro of Essex. In
Symposium
o

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,

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t.8.

(19?5)

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J . r 138: 165.
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Jacobzner, II., and Raybin, H.N. (f g6+)

Pharmac oL

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162

., 1z 72.
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197
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Janl:auskas,

194-5

237

PaFe;

Jolly, S.S.r Praoad, S., Sharna, R., and Chandcrt R. (19?1a) FIuoide I 6t 4.

16'
105

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S.

Sharna, R., and Chanderr R.

J ., 212 211.

(tgZ*) Fluoride, 6:106. Jones, Pamela B. (g4g) A.ust . Dent. L.J. (gZl)
d. J.
Aus t .!

42

Kausmant

Me

2z 47o. sept. 1.

135

Kawaharat Exp.

8,, aud Kawaharar K. Med ., r: 98. (Abstr.

Med.

(1q54) Tokushima J.

1?6

in
2z

!, 4:

16?,

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l(err, R. g96?) Brit. K1}l-en, D.J. (g6l )c

Debate s

J.r

1?6. oct.21'

4l
28

nvealth Parlianentar
Re resentati.ves.

(Hanoard). Ilouse of

October

10. p.
(1964)

1667.
Comrno

KiLlonr D.J.

th Parlamen tarv of Rerrresentatives.

212

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Aprll 16. P. 1140.

Kincaid-srnith, PrsciIIa (9?6) Letter from the Australian Kidney Foundation, I'ledical antl

25,

195

Scientifc Advsory Comnlttee' June 4, 1976' I(ingr C.G. (f 960) Certified copy of a letter from he ltrutriton Foundation t Inc ' to Carnbridge Univcrsity Prees, New Yorl<' January 20, 1960'
I(in1en, L.J .

72-7

Brit. Dent. J. , 17Bz 221. Kinlen, L.J. (r978) ccrtified copy of transcript. In itkinhead . VJeot Vew, llegheny County Court of Comnon Pleas. No, ?8-4585'
?9?5)

185
181

2rB

Panes

Knlght, .L.
Meclfcine.

?975) Fluoridee.
Princnlos
ancl

In Occurrational

123t z1g-zo

Practlcal pplicationB.
Ch:i.ca6o. 19?
66

C. Zenz, Ed. Year lJook I'ublicatlons,

Krechniak, J.

(9?r)

Fruoride

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Krishnarnacharl, K.A. V.R., and l(rishnaswamy, Kamala

Q9?t) l,ancet, 2z B?7. octobcr 20. Kwant, G.W . ?9?7) Fluori-dr: , 6t 49.

77

Artl-cLo ('lgZl) Lanceg, 2: BB9. october Lee, J.R. (19?j ) I'telu Eng. J. IIeg. , Z92z 161 .
Leading Leoner N.C., Shinkin, M.8., Arnold, Zlnmerran, 8.R., Geiser,

20.

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90 C. A 155

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(gS4)
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21, 211
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Levant, B. (tgZZ) n..C. Rdio, public Affairs,

2J, 19??. Lohr, E.l., and Love, S.K. (1954)

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Pa

Geolo1J.ca1 Surve v

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s

The Industrial

urilit

Publ-i-c lIater Su
1

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ates Bast of the Missi a Biver. U.S . Govt. printing Of fice , liVashington. Londou, .A. (196?) pakistan Den t, Rev or 17 127.
Lc,ndonr

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197 6o

A.A., Dowling, l., Bernstein, H., l"laroney, V.E., Rexer, !f . r Meoolnar J., and Liltendahl, ,.I.R. Jr.

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Diecussion. 2ed. Boonton, llew Jersey. Iondon. Antl-Fluoriclatfon Campaign.. Undated panphlet:
ut h orities
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20

tlon Fluorida tion.

U.K.

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2r? Jo),).y, S.S.r Praead, S., Sharma, R., and Chandert R.

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105

Jollyr S.S.r Prasad, S., Sharma, R., and Chandert R. (91lh) Fluoride, 6:106. Jones, Panela B. (tgt+g) Aust . Dent r__. , 21 z 2t1 .
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Kil"l"enr D.J.

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1140.

Kincaid-Snith, Priscilla

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25 195

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the ltrutrition Foundatj-on, Inc' to
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32-t

Univcrsity Prees,

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I(inlen, L.J. ?9?5) Brlt. Dent J .l 17Bz 221. Kinlen, L.J. (1978) Ccrtified copy of transcript.

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SgZl) Lancet, 2z B??. octobcr

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G.!{.

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A.A., Dowling, l., Bernstein, g. r lularoney, V.E., Rexcr, W., Meeeina, J., and Li1liendahlr J.R. Jr. ?g6t) urren s lius of the Flu oridation Dlecussion. 2ed. Boonton, I,Iew Jersey.
campagn; undated pamphle:

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Au

20

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Lyon,

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115

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44: 156.
MedicaL Reeearch

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nclustrial Fluorosis.
Melbourne

, London. and Metropolitan Board of lIorks (977)

H.M.S.O.
Ana lyss

6?, 159-6t

Tvpical

of

Vrlaters

(Mimeo. )

Melbonne and Metropolitan Board

of V,Iorks (gZ8)
(l'time o . )

161

1gz

cal ch.

na

is of .,

tr{aters.
and.

Mel1ette, J.R., Aelin6r ,J.L.,

A

Nuss, D.D. (19?6)

2c'4

Dermatol-

1122 73O.
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16

I,lenzieo, R.

Uge+)

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Ilouse of Renr esentatives

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16,

p.

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1?6

Mi1ler, E.L.M. (l9ZO) Medical Officer of Health, Birningbam, England. personal communications of
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to A.Schatz

aad V.Schatz

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l,litchel-l, 8.,
l.lohanmed, A.H and, Gerdes,

R.. (9Zl)
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542 30.

BZ

Mcolenburg, H.C.
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('tgZ4) superior court of faaen,

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55t

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4,

19?4.

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MukherJee

59,
6't

2o1-4

R.N.

and, Sobe1s

r F.H.

(t 968 )

Mutation

1?6-?

&9.
Mr:mnery,

6z ?17,
1162 4o5,
31

R.v, g9?4) Eillen.!5|.,

(19?6) Fruorde, 9:
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MGer, E.E.

197 219

Mnrray, !.R., Mc0onnell, J.D. r and lrlitten, J.H. ?961)

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24, EB
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?2t
144

1o8-g

J6. J8.

Resol-uton

1. pp.

16-18.

National Eealtb
Session

and, Mectical Research

Councl- 9954)

Appendix rrAtr.

National Eealth and Medlcal Research Council (959)

Session

tt
i,
7o

48. p. 55. pr 60. pr

24.

National EeaLth and Medical Research Council (lg6l)

Session
28.

National Eealtb and MedLcal Research Council 3g6S)

Sesson
71.

I'lational Hoa1tb and Medical Research Council (1968)

Sesson

117

67, pp. 58-59.

?42
Partes

Natlonat Hea1th
Sessfon

andl Medlcal Regearch

Council

(19?1)

109

72. Dental llealth

Comrittee Report.
1B

Natlonal Bealtb antl Medfcal Research Council (19?9)

Open

letter fron Dr G. Howell-s, Chairman of Council,

18

July 4 19?9. ational Eealth and Mectloal Research Council-, Australian

Modical Associatfon, Auatralian Dental Associaton,
and

Australian FederatLon of Consuner Organizations

Melbourne

(gZg)
Needlenan

,Aget. Jue 16,

1g?9,

8.L., hreecbel, S.M., L'ls!L-E4A._ J. Me4. , 291 : 821 .

and Rothman,

K.J.

(19?4) 189-9o

Nesin, B.C. Nesln,

9956) J.
0962)

!,Iater Ut1

Ase . Asa

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1?,

38, ?4,
6z
181

213

B.c.

J. Maine Water Util

.r 54i

Newel1,

D.J. (gZB) Certified copy of transcript. Aitkenhead, et aI. v. Borough of l,Iest View et aI. Court of Conmon Pleas of Allo6heny County, Pennsylvania, Civil Divlaion. Re6fsterr.
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Nj.cholae, P.LI. (19?9) Newepaper advertisnent, rsouth

Coast

2B

2lr p.5.

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oakley, G.R, (lg?9) Radio , lrvl, Jury 16, (19?9) Melborrne tAge r 0 tBrlenr Ir.G ,

1g?g.

29

I
16'
219

243

Ohamta,

T., and Mateuhf-ea,

Soc.
JaD.

T.

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Food
Ro6e

Hvs lene

, 6z t\z.
I'

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and Matsuhisar

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Bl
126

Papettlr R.A.
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Brrd

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41, i71-z
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Report fron Food, Chenical and

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163

28,

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the Fluoridation of, Vtrater Supplies.

244

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('l9ZO) I'luorirlat j-on: A Modern

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, I.

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75-6t

1BO

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Jr.

(J9?6)

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16

B9-90

90-1
32

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5I-5

246

Pancc
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15?-B,

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55

,SFS.

19?1?

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Departnent (19?5) Letter to

19?5.

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29-to

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Ueda, K.

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, fuka,

1oll,

111

1 1?o

5t 70.
159t
161

United Klngdour Mission (l9SZ) ttre F]-uorj.da ton of

Donestl
Vrlater
S

ee

in

North

Ame

rca.
of the
of
27t 30t
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Represe nt atves.
SuU_Conmittee
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Committee on G overnment Operatio nB.

House
I

'

Natlona I Cancer Pro

Part ff

uoridation of Domestic Drinkn llater. Charn:an L.H: Fountain. U.S. Govt. printing Off., Washn6ton

zI9

Unfted States Departnont

of IIeaIth, Educatlon,

and

llelfare ?gSg) Natural Fluoricte Content of

Communal Water

SupDlLee. P.H.S. Publlcation

Of

No. 655. U.S. Govt. Printing

f . , l,Iashington.

United Statee Departnent of Health, Education, and

50, ?5-6

rIelfare (lgZO) Fluoridation Census. 1969. Divsion of Dental Health, Bethesda.

Unlted Statee Envlronnental Protectfon Agency (9?6) 118,22O

letter fron Dept. Health, Educaton, and hlelfare citing Paragraph 180.145 of Envronnental data. Uaited Statee Food and Drug Adninistration (19) lettere of Auguet 15 and Sepbenbe 17, 196j.
(Cite by A..
L,ondon

,gt 4l

196?).
196

S. ('tgZg) !ASA, 24oz 16to, Victorfan Governrnont gg?r) .O,n Act to Reeulate the
Valsrub,

at of Pub1ic Water Other Purposeq. No. 8506.

1es

and for

146t 2O5t

6, 13t 59,
222

Decenber

11,

19?7.

Waldbott, G.L. (1962)

F1 uoride

j.n

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Int.
l{aldbott,

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G.I,

(1967)

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J. CIin

Nut ., 122 455,

117

VaLd.bott, c.I,

(19?t)

th Effe ct e of Envr onrnental

2OO, 217

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C.V. Moeby Co. St.Louis.

no

lrlaldbott, G.L. (lgZ4a) Envronment , Vol 16,

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gB-200

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Senfnar, ntce llnfversfty, Houeton. October 16.

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Coronado Prees, Iawreaco, Kansas.

12Ot 15?

Walker, B.S. (19?9) rThe Canberra Tfnesr, July

11 t

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284.
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119

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(19?B)

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of Law and Srunnation of Evidenco in Favour of a PreJ-ininary Injunction. Aftkonhead et,al, v, Borough of lrlest Viev et al. Court of Conron Pleae of Allegheny County,
Menorandum

Plaintiffrs

Pennsylvanfa, Cvi1 Dvision.

woltzr s,s . 3964) hoc. FLa. Stat e Eort..

77

Soc .t

218

z 511,
218

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lrl.E. lrlate16, 1968b).

251

Panes

toltzr S.S. trd. Marouekyr '.,J. (19?5) oc. Fla. f,tate llort. Soc. , 88: 609, World Heatth organlzation (1958) Expert Commt tee !,Jater Fluo ridatLon. First Reort. Tech. Rep. Serles No. 146, lHO, Geneva. Wor1d Eealth Organizatloa (968) Reeearch into
1

218

on

40, ?6-8

46, 1z4t ltol

Envlronnen

l,utlon
'llrlllO,

IIIO

Tech. Rep. Serieo

Geneva. pp. j?-78 59. World Health OrganJ.zation ?g69 Report by the
No. 406.
Dfrector-GeneraI.
Annex

1O9 r

rl- uoridatlon and Dental Hea1th.

132t 140

111 |

9. ltlflOr Goneva. l{orld Eearth organizatioa (gega) FruorLdation , Wor1d Eea1th Organization (969c)
WHO

and

Dental Eealth.

Chronicle

272 5O5.
aZn lVortd

146-7

?5 lOBr 110,

21O

111-2, 131,
E9-4o

Asenb1y, rTuly 2J.

V'IHO

Chronicle , 2Jz J12,

trtlHO

146

Vlorld Hea1th Organizatlon (Jg?Oa)

24 A?1,

Chronicle t

191

79,

42,-

Wold Health Organizaton (l9ZO)

Fluorides and

Human

115t 132

&gJII.

V'IHO, Geneva.

Yianouyiannsr.f. (lgZZ) lgryg, Z, 296, Auguet 6. llanouyiannis, .I, (lgZ B) Conments on the Ef fectiveness of Fluoridation (1 ppn). (Mineo.)
iamouyfannis, J., and Br:rk, D. (lgZZ) Fluoride,
10:1O2.

1Bo

42

21
1

74

, ,

28-tor
227

252

Paces

TlanouyfannLe,

D. (19?B) CertlfLed copy of tranecrfpt. Aitkenhead et al. v. Borough Court of Connon Pleas of of ttest VLew 9!_. Allegheny County, Pennsylvana, Civil Dive1on. J.,
and Burk,

29

P.E. 9976) tr'luoride , 9z 36. Zegelbecker, R. ?9?4) Conment on the tr'luoridation of Drinkinn V'Ia ter. Anlesea , from the Institute of
Zanfagna,

200 9o

, Gtaz, llustria. Jan. I . (Mimeo. ) Zj-egelbecker, R. (19?5) The Fluoridation of _Itrnkng Water n Anelesea (II). A Critique . Gtaz, Austria.
Bnvironnental- Research

9',!

8, 1g?5, (Mimeo.) Ziegelbecker, R., and Thonson, H.l{. (lgZl)

January

Conunents on

72

77

the paper by G.Vt. Kwant - Sixteen years of rater fLuoritlation in the Netherlands and its influence
on dental

decay. Fluoride, 6: 49t

19?3,

?_5t

APPENDIX

Since this submission vras completed j-n /\ugust , 19?9, important reports have come t,o hand which support or recent mat,erial appears below:
1a. (See p. 28).
The Melbourne

many

supplenent the points mentioned in the subrnission. Ths

rTruthr of October 20,

1g?9,

rnentioned the case of Dr Geoffrey smith, formerly the dentist

at the hospital in Proserpine, Queensland, where the water supply is artj.ficat-y fluordated to O.Z p.p.m. The artcl-e stated that Dr smith had said that the Queensrand
hearth authorities had forced him to reaign because he conducted a hl6hly controversial_ investigaton.
had

This found that j2 of the 1JO children (21%) attendlng the Proserpine primary schoot had dentar fruorosis.
Dr smith sai-d that the details of his examination and his concluslons $rere sent to the Queensland heatth authorites,
and later stated (rTruthr, November 24, 197 that no
moves

to check his findings had been i-nstituted 'untir Truth put the pressure onr. Two days later an investigation was
by two Health Depart,ment dentists, and the resurts were published on october Jo videroni, !t.T., and McEniery, T.M. (tg?g) , An Inves t tion of Children uncler Trea tnent at the Prose ne State Schoo1 De ntal Clinic with Particular
commenced

Reference

to Fluoros aS.

smithrs fincring that there was a high prevalence of dentar fluorosis in proserpine children. They exanined t]ne 779 children at the State

Those examiners confirrned Dr

254

School- Dental

Cl.inic, and reported:

1... excluding lrqucstfonablerr flrrorosis, therc were a total of 55 cases in therrvery mildrrcategory or above. This 6ives a general prevalence rate of 16,2%.. It is apparent that the authors incl-uded all the rtquestionablerl
cae6

with the rrnornalrt

ones

r thus minirnizng the prevalence

of fluoosis. Their report does not state the sex or ages of the childrcnr nor how many of them were in each of the three groups of children: (i) fExclusively Proserpine Town Waterr, rFluoride Tablets durj-ng the first four yearsr and (ii) children who had not, lived in Proserpine for the of their first four years nor taken fluoride tablets at time during that period. In the absence of those data, (iii)
rvhore

any

calculation, using the published fluorosis indices, suggests that those groups contained J6, 84 and 1!p subjects, respectively, and that there were approximatel.y 3Z
rrquestionablerr cases in the third group of (lg9Z) children.
The authors

did not rnention that group

vhen

they stated that

there were J4 cases of rrquestionableil in the (84 + 562) chil-dren in the first two groups. (ttre figure of 84 was cited by the Queensland Mnister for Health. ) If, as is usual, these approximae1y 66 34 + j2) cases of frquestionablerl had been lncluded in the fruorosis group, the prevalence in the 779 chlrdren attending the whore state school would have been i-n the re8ion of 16%, instead of the j6,Z% given in this
Health Departnent report. Dr Smithrs finding was the presence of dental

fluorosis in

21%

of the 15o children in the prinary school.

.)c:E

1b. (See p. 12O), This

QuecnIrntl

Health Department re1:ort by

Videroni and McEniery indicated the danger of ingesting fluoride

tablets in fluoridated areas.

They found that n the 84

children rwho had taken fluoride tablets during any of their Frst Four Yearsr, the inclex of dental- fluorosis
vras O.53

obtained from 12 rrni-drr cases, 9 rrvery mildrt and 2t trquestionabletr ones. The prevalence of fluorosis was stated

to be 24%

be rrnornalrr for this cafculation of prevaence.

rrquestionablerr cases obviously vere considered to

1c. (See p. 122),

Minister, Sir V,Iil-liam Knoxt utas reported in the Brisbane rCourier Mailr of l{ovember
The Queensland Health

2, 1979, as sayng: r... among 84 children who had becn given fluorirle tablets or drops durin,g any of their first f our years, the fluorosis index was .5j. This was only slightly below the index of .6 at which fluorosis could be described a publlc health problen. I rI believe it warrants a strong health education programme airned at ensuring that parents do not over-fluordate their chifdren.
r

The main lesson

to be learned from these Proserpne

when

data is that the much publicized wide margin of safety,

dr-nking fluoridated water, exists only in the minds of

fluoridation promoters.
2a

| 211), An exactly opposite statement, o that nade in 1977 by Dr Levant, was mad.e two years ater by Dr Gavan oakley the charman of the A.D.A. rs Fluoridation
121

(See pp.

conrnittee.

The Medical Reporter of the Melbourne rAger of

?56

December

l, 19'79 said that Dr

Oak1ey ha(l

statcd that fluoricle

where

suppLements should

not be taken wlthout a prescription

the water ls fluoridatcd ancl tlxrt, in additfon to increaslng

the chances of rnottling, fluoride tablets present a health risk fron overdosing, especially when the tablets are
flavoured.

to make this tardy warning by rlisclosures in the Melbourne tTruthr,

commencing on October

The Fl-uoridation Committee vras forced

20, 19?9, that a boy aged two years

had

died after swallowing four fLavoured fluoride tablets, that there uras a high prevalence of dental- fluorosis in children
vrho had

ingested fluoride tablets in proserpine,

Queensland,,

also in a private dental practice in Mel-bourne. This warning, that fluorde tablets should not be used in
and'

fluoridated areae, vas issued 1/ years after a simlar one was given by the U.S. Publc Health Service (see p. 120). It
appears that the Fluoridaton comnrittee has tried to hide

from he public the fact that it is not difficurt

for

children, in particul-ar, to ingest toxic

d.oses

of fl-uoride.

The 'Truthr report of December 8 said that when Dr oakley was asked why tl're Australian Dentar Association not previously warned strongly about fluorid.e tabets,
sal.d:
had
he

rltm pretty sure that it got covered. (in tne rnedia) ut it may not have got wide cover. Irte tended to bow out of the event after the towns became fluoridated. because it vras a . pretty controversial issue and we had won the fight. Irm not saying we acted irresponsibly. others consider it vas rrresponsible for the members of the
r

?_57

tr'-l-uorfrlation

, who rrcr,iumabl,v lrncw the da.n4er, not to make -urc that the public, nct pharmacists in part.Lcular,
Commit,
1;o<l

were sufficient.ly warncd. Dr Oalclcy attentrt:crl to place the blame on drug manufacturers and pharrnacists ( rTruthr
December
,

8) by sa'ing:

rAll, chemists shoul-d know that particular l"inc of drug shouldnrt be sold to people. Drug manufacturers should if theyrre going to put fluoride tablets on the shelves have a big notice saying: 'rNot to be taken in fluoride
areas.
I

This failure by all the health authoritj-es to publicize adequately the dan6er of consuming fluoride tablets in areas with fluoridated water, has nade rnany Australian children unwtting experimentrl subjects for a study of effects of fLuoride overdosage. The Merbourne rrruthr of December B,
1979t reported that Dr Herschel Horowitz, of the u.s. National

Institute of Dental Research, said that Austraria was the only

country which has double fluoridatlon. He stid: rltlerre avrare of the recommended regimen in some areas in Australia. From the epideni_c .standpoint itrs very interesting because rre know of no other country in which this practice io being done.r Austrarian chiLri,ren are being given taddtlona-l- a.mounts of fl-uoride beyond what is considered optlnal n most countries of the world. r trt is of interest to see what these kids loolc Ii.ke. r

the report said that Dr Eorowftz wirr be one of a four-fln TrIEO team whlch s to visit Australi-a next June to examine
hundreds of children.

rt is an indcation of the rigid pro-fluoridation stance of Australian health authoritj-es that they have done nothing to investigate this problem, obvious to anyone who

?,8 inows hc rlarr;crc

ol'

l'-l

uoride

1.rtgc,';t-i.ort,

which t.ltc

WIIO

b,:-.rm

cxpecta
2b

to

completr-'

ln a portod of only
uras

bhrec' weolrir.

(See

p. 9t).

Dr Oakley

reported in tre Melbourne rAgel

made

of

December

5, 1979t to have

tl:e

ru-marlca.Lrle

claim that:

rVery milcl mottling of teeth in fluoridated areas s a sj.gn of sound teeth. I

(See

p. 2O?). Mention of precision and reliability

recalls

the deecription of the fluoridation pla.nt at Proserpine, given by thc speci:rl investgator of the rTruthr newspaper,
October 20, 1979. He .said:

r... fluoride r,as added to the cityts water supply n a crudely constructecl shed on the banks of a dry rj.ver bed. Stacl<ed in one corner ras a pallet of f luoride bags, each labe11ecl with the word rrPoisontr. opposte this were two 1ar6e meal- vats in whlch the councir workmen srid. the fluorfde was mixed. A few fcet away vres a simple putrlp u;od Lo inJecl; t:hr: fl_rro.nirle into the wate:r supply.
r

ThJ-s appears

to be a very printive syctem, judgecl by the very stringent regulations for comprex machinery 1acl down by
,

Gabovich and Ovrutsl,_y ?9??)

One wonders what happened when, soon

afterwards,

severe flooding lnundated thls area of Queensrand, hoserpine being particularly seriously affected.
4.

70, 1979, Dr J. -Benolt Bundock, Senior Adviser to the Minister of Environment for euebec, Canada,
On Augusb

referring to bill
f

rt88tt which requested

fruoridaton throughout

the province, said:

On

the basls of preliminary scientifc evi-clence the actuaL governnent, which took office in Novenber 19?6 decided to

2r9
ral<t: t l;horou6h

review of the whoLe problem before

r

fmplementing that measure.

This governmcnt decioion resulted ln an important study, which included several rittle-investi-gated irsper:ts; of fluoridation,
by a conmittee of ten (Lamontagne et aI. ). Their full report is not yet availabl-e to the public. The folrowing rnaterial

is taken from the Abstract of the Denartmental Connittee R ort on the t of the Environment and the Fluorida tion of Drinkin o Waters.
Environment Protection Services for
Quebec (mmeo., undated).

4a' (see p. ?-21). That abstract ma.,-es some irnportant observations regilrding the ef f ects of f luoricle on acuatic life. It stated: tRecent studies have shown that the exposure of rivng organisms to concentration of flr,:orides above certtin limits in the water environment produces currul-ative effects of fluorides. Biochemical and morphologicar chanpes may occur in these or8anisms. Directly or indirectry these changes may restrict the capacity of these organisms to naintain their ecorogical postion within the overar_I natural ecosystem. The accumulation of fluorides in aq,atic prants and fauna is a very irnport,ant phenornenon because of is potential impact on arr- animals consuming these organisms. Recent studes sug6est that the concentra-tion of fl-u,orides along the food chain is certainly not ress thin 10 to one. I rrt is lso known that severar- aquatic plants can easily accumurate fluorides at lever-s which exceed by far the l-evel- reached by their environrnent. r Lamonta6ne et al. contj-nu_ed:
tFishes and ot'her aquatic species tend to accnnurate fl-uorides in their body manly within the skel-eton a-nr the exoskeleton.

t60

These aecuru]-:tt,ions

nry be vcry 5-mportant according to different ripecies. Furthermore, in thc case of certain organisrns (for extmple the crab) this accurnulation may be responsible fo louerin6 the rate of growth with a corresponding loss of weight and reduction of size of thc inc'lividu,,. l. In other cases, such as the fro6, tLre ernbryonic clevelopment of their eggs is delayed when they are submitted to a concentrrtion of 1 p.p.r,n. of fluorides. Sinilar effects are observcd whcn tac'Lpoler; (larva of thc frog) are exposed. I rMore specifically, the e6gs of trout do not hatch r+hen tJrey are expor:d to concen'urations [ofJ 1.1 p.p. nil].ion of fluorides. I . there is enough evidence to conclude that the c bual presence of fluorides above cert,ain levels in the aquatic envronment is causin irnportant biological damage to both plarrt and anj-ma- systems.
r

The conclusion of the comnittec was:

I..

4b. (See p. 69).

This committee appointed by the Government of Quebec referred to: r... the medi-ocrity of the l-iterat're demonstrating its efficiency in the prevention of dental caries. I

After mentioning laboratory experiments which showed that excess fluoride can produce intoxication of celLs formng the teeth, the committee said.: ton the other hand, it is nuch more difficurt to accept arguments to the effect that vater fluoridation at the proposed 1,2 ppm level- is highly efficient in the preventj-on of dental decay. This level- of admini-stration appears to be a cornprornise between tan acceptable level_ of dental fluorosisrr and some poseill-e reduction in dental d.ecay.r

261

4c.

(see p. gz).

Lamont,a,;ne

et al-., referring to the experimentar

study of tre-. r:fficacy of f-Luoridation, said: rrt rnust be realizerS, however, tha,t what aprears a sir,rple routine experiment is rcarJ-y a char-ten6ing problem thich to thi-s day has not been sorved satisfactor-ry. rt must be realized that the processes impticated in dentar caries are estirnated to be undcr the influenco of a large nunber of variables.
r

They listed more than fifteen of theoe, ancl sai-d:

rMultivari-ate analyscs cannot cope with more thn three or four variables and stilr- retain some credibility. on the other hand longitudinaf studi-es r-astin6 for some twentyfive years are mpossible to carry out. one rnust then turn to animal experi-mentation under controlled conditons. After nentioning the rmajor difficurtiesr of such experiments they said, regarcling t:re effcacy of fluoridation:
runder those conditions, it is not surprising to find that

there is no consensus within the scientific

comrnunity.

4d. (see p. 22.

comment:

This

Quebec Government cornmittee made

a simlar

fft would seem therefore that our preoccupations for the present shoul_d center on fluori_de i-ntoxication rather than deficlency. r
4e.

Referring to Dr Rapaportrs work, whch found an associati-on between increasing fluoride concentrations of l'ater supplies and an increasing prevalence of nongol births, Larnontagne et aL. said.:
1B?)

(sec p.

rBecause

of the inherent r-irnitations of such a study it wour-d not have receive<l a great deal 0f irnportance in the context of fluoride toxici-ty had it not been confirmed indirectry by studies carried, out on other riving systems.

262

Therle othe' studie; hve now shown cluite convincingly tint fLuorites, by some unknown mechanismr scem to pro<luce These reports of chromosome breaks and/ot aberrations. un$uspccted cel-Iular damage are righly disturbing and merit all the attention of the scientific cornrnunity. r

4f.

(See p.1?4).
rThe second

The corurittee continucd:

disturbing study is that of Yiamouyiannis and Burk which showed a higher cancer death rate in fluoridated cities than in comparable non-f luoridated ones. lrlhen first published, thj-s stud.y r^ras ridiculed by Public Hea1th Officials. More recently, however, it has been reaccredited before a court of l-av as a scientifie study done according to the state of the art. It is rather amusing to find that courts of law are d.oing the work that Public Heal-th Official-s should have been concerned with. I
A.s

49. (See p. 222),

committee:

a result of the recommendations of the

rThe Quebec Govcrnment declarcd

a moritoriurn on compulsory water lluoridation starting August 192?. It is still

enforced today.
r

4h. (see p. 1t.

rn adclition, this abstract states that, due to the recommendations of the committee: rFluoride is nonj-tore by the Environmental Protectio Services of the Quetec Governlnent.
r

4i.

(See p. 6o).

Lar:onta6ne

et aI. saic:

rDistribr.rtion systems mad.e of cement ancl asbestos or those rnade of cast, iron coated with concrete linings tend to precipitate fluorides wth a corresponding de crease in the leve] of fluorides vhen the ater reaches the tap.r (A spokesman or the Melbourne water authority, the M.M.B.l.

in January,

19(JoI

nrrlti that, except for ilrc ;mlrest

co1.rp

.r'ut

nainst the Boardrs policy i; to l-ne arl- nains with cement. hacticalry al-l thls worl.- has becn compretecl, ancl the remanin6
pipes would be lined. arj joon as money is available. The fact that we have pipes rined with cement may account partially for

the failure of the Board to deriver fluoridated water at the specj-fied concentration tt d.omestic taps, as mentioned on page 61 and in appendx 16. 4. Referrin8 to technicar- probrems regarding the maintenance of roptimumr lever-s of fluoride, this Quebec conrnttee cited an American st,ud,y, based on 6zo 10ca1 fluori-dation systerns distributed throughout 12 southern states. Ths showed that 29O of these systems (46.8%)
rwere

(see p. 61).

distributing fluoridated watera whose concentrrtions vere outsj-de the prescribcrl limi_ts I of from O.f to 1.2 p.p.ln.
5a.

The fact that chemi-car revels can build up in the Bay wa: mentioned. in the Melbourne rAge I of November

(see p. 221).

1979. rts science Reporter (p. Roberts) said that hofessor John waid and Bruce Ricrrard.son, of La Trobe llniversity, had found that the 1evel_ of hi6h1y toxic pCB chemi-cals (polychrori'ated biphenyrs) in port phillip Bay is as high as that found in the indusLrial regions of the united states. l{r Rchardson is quoted as saying: rPCBrs are an j-ncredibly long_livcrl cliernical. Once they get into the environment trey persist for a rong time, more than Jo years. At this stage we know very tfttle about the l0ng-term effects on human bei-ngs of very 10vr
doseg.
r

21 ,

264

5b.

p. zot). This tget report furnishes another illustration of the time it nay take before the toxicity of a substance is reco6nize<1. It said that the safety of PCBs, which are related chemically to DDT, was first questioned in 1966 aftel^ it had been 1n common use fot 37 years.
(See

6a

p. 30). The campaign for fluoridation by the U.K. Department of Health has now boen questioned official-ly. The london rDaily Expressr of October 12, 1979 reported that
(See

the British Government had be6un to show doubt over the questl-on: Is fluoridc in drinkj-ng water safe?
The Eealth

Minister, Dr Gerard Vaughan, met Dr Dean Burk and said: rI regard Dr Burkers [Burkts] evidcnce as too important to ignore and I have asked my official-s to go into it thoroughly and report to me. I
The

article said that the Tory

MP I,1r

Ivan Lawrence,

who

lntroduced Dr Burk to thc Minister, had said that: rVery serious questions are raised about the effect comrnunity health. t

on

6b. (See p. 56). This tDaily Expressr article provides an up-to-date (October 12, 19?9) estj.nate of the number of
people in the U.K. who drink fluorj-dated water. It stated,: tThere is an officiai fund to hclp introduce the chenical, and the Department of Health under eccessive Governments has encouraged it.r Despite that encouragement: rso far

only a limj-ted number of health authoritj-es, like Birmingharn and vest Midl-ands, have gone in f or fruoride involving 4r5OOrOOO people.
r

26's

7.

Fl'aherL;7 r'trote to 1')?9' Ju;ticc John P' Robinson' from the Lorcl l4'ayor cf Auclcler'ncl' N'2" Sir Dovc-Myer

0n Jul'y

11

theSupremeCourtoftheCommonwealthofPennsylvanaU.S.A. letter: The following quotes are from that

la. (see p . 1Br). (Earry in

19?9

a runour was circurated in

AustraliaandNewZealandthatt}reDecisionofJudgeFlaherty' nentionedonpa6elSJ,h'a'r].'oeenoverrulecl.)JusticeFlaherty
wrote:
rYou

the arc correct that I entered an injunction againot a arge portion fluoridation of the public water supply for after a of Allegheny Countr, Pennsylvania' I did this I very lengthy series of hearings on the issue ' been Contrary to your inforrnation' my decree has not Presently' the issue is on set aside by a higher court' but the appeal to the Commonwealth Court of Pennsylvania' court appeal involves merely the ,jurisdiction of the itdoesnotinvolvethesustantivemeritsofthecase.I

?b

(See p. 15?),

Justice FlahertY sad: rThe trial brought into my court e-':perts on the subject of fluoridaion,andIneticulouslyconsideredtheobjective evidence. In my view, the evidence is quite cotlvincing thatthcaclclitionofsodiurnfluoridetothepublicwater to supply at one part per million is extremely cleleterj-ouo thehurnanbody,anrlareviewofteevidencewilldisc}ose I that here was no convncing evidence to the contrary.

that: ?c. (see p. 20). In his lstter, Justice Flaherty revealed rsince my decision [against fluoridation] , I have received hundredsofletters,cluiteafewofwhichhavebeenscnt byphysiciansanddentists,allconcurringwithmydecision.l

266

7d,

Justicc Flaherty s;ric that during the A'legheny County court case he had found that: r..the proponentc of fr-uorirlation cro notrr.ing more than try to irnpugn the objectivity of those who op'ose fluoridation.
(see p' 19) ' comrnents by many proponents of fr-uoridation demonstrate that they have not
careful_r_y studied

(See

p. 26).

7e

the original Justice Flahert, observed this during the cour hearings, ancl wrote: rr serously believe that few responsibr-e people have objectively reviewed the evidence. I data' the evicrence is voluminous. rn his court case there vrere twenty-eight hundred pages of testimony and many lengthy exhibits.
o (J

some cafles

(see p. 2o2).

The !,Iel_lington,

october 2/, 1g?gt published the for-l0rving remar.rable story, written by its columnist David McGj_1.l:

N.2., ,Evening post, of

fAt the age of 12, Helen Murray bean fainting. Doctors diagnosed epilepsy, then rheuma-toid arthritis, finally a kilrer arthritis. For seven years Helen was bedridaen, her pain relj.evcd wi_th cortisone. The story 'says that Helen read a booi on nutrition by Dr Eva Hill, and then vsited her. The story
r

continues: rDr Hill took one r-oorc at the huge rotten peach bruises parts of IIelenrs bo<ly and diagnosecr fr-uoide poisoning. Helen is now on the raw fruit diet and non-fr-uoridated water frorn a spring' she is up ancr about, shipping
dancing.
t

on

and

?.(tl

9a. (Seo p. 2OO). The Melourno rTruthr of Novenbcr tt reported Lhrt a two-year-orrt boy, who harl bcon 6iven

j<)?9
onc

fluoride tabret a day since his first birLhday, had died j.n Brsbane fve days after becomj-ng irr due to tal<in6 for:r additional flavottrecl fl-uoricle tablets. The death certificate
gave the cause of death as: rFl_uoride poisoningr.

mnediatery after swalloving the tablets the boy was taken to a physician who purnped out his stomach ancl recovered

four tablcts, but he bccarne unconscio's and. was taken to hospital. Unfortunately the hospital staff did not hnow that fluoride is a severe poison. The senior registrar is quoted
as saying:
rltle

wernrt even atIare it had a possible lethal dose level. r dontt think it was even risted in the poisonc book.r

she said that the motherrs explanation that the chird had taken fluorlcre tu-brets had been rured out because:

r...there t^ras no reeord.ed case (of fluorj-de poisoning) in Australia that we knew of.
r

Dr Hans Moolenburgh of Amsterclan, Ilollanc, (see pp. 2o1-2ol+) was reported in that article in frruthr to have saidr
over the telephone, that:

r'luoride is a poison that accurnurates in thc bocry. obviously this crrild was very sensitive to fruoride but the dagnosis of fluoride poisoning is clear because everything happened so soon a:[te:r ingestion. | ,When the body is saurated. with fruoride, it takes only a snarl additional dose to push him over the lillj-t. Uj_th this history, I think the extra tablets ki1led him. I

.6)

()lr. (Sec p. 1t?).

The

lulc'l

lOurne

rTruthr r.'l

Dcct..ml,,.-'r'

B,

19?9

pointed out l.hat, <iesplLe Llrt-' [tc. L that l'lclbournt- I s wrter is

fluoridated, ffuoritle tabet are 6tiII In Auust, 19?8, the Chief

Department

on c;ale.

Pir,ermrcist

of the

U.K.

of HeaIth and Social Security issued a directive

to alL fGeneral Practice Pharmacist Contractorsr .regarding the supply of sodium fluoride tablets, saying that they would
be retuired to comply wth certain cond.t:Lons. That letter

followed the

pu blication

in Accepted Dental- Thera peutics

37 ed,, of the rccommendations of bhe Counci.l- for Dental

Therapeuti.cs SSZZ) of the American Dental Association.
(See

pp. 120 and 2O9).

However, in Victoria, at least six manufacturers stll

(January, 198O) sell- fLuoride tablets the packages of which

do not conply with those U.K. regulations, nor do the labe1s

specify the doses and usage l-aid down by that council, in the follovring ways: (t) In five cases the label did not 6ive
radvice to consul-t a dertar or nedical- practitioner or
a

pharnacist before administering the preparations.r (Z) ffre necessity to reduce the dosage in fluoridated areas rvas not
mentioned by threc manufacturers, one stated that the dose

should be halved and one said to take onl;' " directed if the water supply contained O.Z p.p.m. fluoride. (The Councll
on Dental Therapeutics reconmended downward. adjustment of the dose f the vater contains 0.2 p.p.m. fruorde or nore, anrl

cessation of medication when the water contains 60 per cent

of the roptimumr for the geolraphic area.)

?69

A1l six brands solcl pacl;:aes with more Lhan 1OO tablets, but only one cornplied with the U.K. directive by using a child-proof container. (4) One brand cid not specify any 3)
dose for children aged l-ess than two years, but in the five

remainin6 ones the sug,qesteC. doses 'sr-' twice that rcconnended

by the Council for children less than twelve months o1d, four
tires the recommended dose for those aged 1 to 2 years r and

in al six brands the suggested dose for children a6ed 2-J (5) Five years was tce that recorrirnendecl by the Council .
brand.s sug;ested

that

pregn.nt women shoul-d consut:re 1yt

tablets

(1.5

mg

fluoride) daily.
The r0anberra Timesr of December 6 t 1979, said. that

a spokesnan for the N.H.& M.R.C. had said that there is no evidence to show that pre-natal fluoride supplements (to
women

living in areas with fluoridated water) might benefit

reconmend the

the unborn child, and the Council did not prescription of srrch supplements. Fluoride surremcnts to pregnant drink fluoridated water or not,
U.S. Food and Drug Adrninistration.

vromen, vrhether they

r/ere banned

in 1966 by the 19, 1978,

New Jersey,

On December

the Chanceflor of Fairleigh Dickinson University,

referred to that ban, and also pointed out that the

Department of .A,griculture advises farmers not to use

U.S.

fluoridated water.
One wondere how

long it will be before the dangers of

fluorde overdosage are recognized by our health authorities and before our regulatons fal-I into line with current practce overseas.

?-7O

1Oa.

p. 149), A recent caee of failure to control the addition of fruorldo at the water worle had tragic resul-ts for the patj-ents on kidney machines in one clinic in Annapolis, U.S.A. The various stages of the inveotigation, into this incident were reported between November 20 and 2!,
1979t in at l-east five newspapers: (i) rrre rrrtashington postr, (ii) the tlrlashington starr , (iii) the Baltimore rsunr (:-v) , rMercuryt anrl (v) the Annapolis rEvening the San Jose

(See

CapitaIt.
was

However,

this very nevrsworthy item apparentl.y

newspaper.

not

rnenti.oned

in any Australian

The accident i-nvolved

the discharge of looo exce's

gallons of fluoride eolution, due to a worker reaving the varve of a chemical storage tank open during a period of i6-

the fruorde concentration to rise to 1J tines its normal level. (i).

caused

1B

hours. Thls

1ob. (see p. 196), This recent incident in Annapolis is a dranatic iLruetration of the danger of using fluoridated
water for diarysis, not only for J-ong-tern treatnent but also, if an accident occu.rs in the addition of fluoride,

for a very short treatment period. The physici-an in charge of the clinlc, Dr G. Mitchell, said (i): r.. eight patients began to suffer nausea, vomiting, weaknee. and burninS sensations in the chest after an hour or so of treatment. A1r were taken off the machi,,6. Deepite thls, one patlent dled that evening. An assi.stant
even

medical examiner said:

rrhere is no question that the fluoride caused the death. r rrhe man had a bad heart, but the fluoride overdose added

27t

an extra strerc hle; cyotem couldnrt handle,I (1j.). rThere war; JO timee t,he norlrr .l ,rmount of .lluoride in (trio Uoay) tiesues. I (fv). Another patient suffered a heart attack, but recovered. State

tests confirmed that there rrere high lcvels of fl-uoride in the (iii). seven surviving patients.
The rWashington Starr said that:
rvbire

the federar government strongly recommends extensive purification for water used in dial-ysis, neither state nor federal l-aw requires such cleansing procedures.r

It stated that:
rrhe Bo-Medicar Applications diaryss center was using tap water filtered through a water-softening rnachine which is incapable of removing fluoride. r (ii).

After the patients

i1l- the clinic $as cl-osed, but planned to open soon after the rinstallation of nevr filtersr. (i). Presumabl-y the new filters I were capabJ-e of removing fluorid,e.
became

such incldents make nonsense of reassuri-ng statements

regarding the safety of fluoridation apparatus, such as that

of the fifteen-nan committee on the Fruoridation of vlater supples. of the Royal colrege of physicians. rn ther 1926 publication Flu de. Teeth and Health they stated:
rRegular or continuous monitoring of the fluoride concentration in water suppties together with fail-safe devices en'ure the maintenance of the fluoride revet withn narrow

Iints. I rrechnical advances have ensured the efficiency of fluoridation prants and any temporary i-ncrease in the fluoride level automatlcally resur-ts in the fruoride feeder being turned off.
r

u2
1Oc .

(See p. 2O?).

Thc truth o1' thc strt<-'mcnt, that aclecuate

because by

safety frctors should be employed when treating water of thc lack of precision and reliability, the Annapolis accident.
The report in the Annapolis

1s established
I

rEvenlng Capitalr of November 29 | 1979 commented.:

rState authorities oaid, yesterday that the accidental sp1I1 of 1,OOO galLons of fluoride nto the cityrs drinking water supply probably would have gone undetected if kidney patients had not become 111. I rThe effects of the fluoride overdose ls unprecedented because spills have never occurred in a city where a dialysis center is Located. r (v).

It is clear that the plant operators did not realize the danger. The spil1 occurred on November '11 and was d.iscovered the next day, but the state authorties were not notified. The Baltinore rSunr reported that:
fUnder the federal Safe Drinking llater Act, the spi1l should have been reported inmediatery after it occurred., heal-th officlaLs said. city officials said water departnrent officlals arrrare of the leak did not know the federaL raw and dld not think the leak posed any health probren. r

(rne cleath, and the illness of these patients, should not have occurred for they did not undergo dialysis untI a day after the epill was diecovered. ) sanples taken three days after the spiIl showed a level of 27 p.pono (iii). rt is uncertain whether any acti-on wourd have been taken if the epll had been reported, for the chief of
Maryrandrs Departnent of communj-cable Diseases said that:

r... he did not berieve the water posed a health hazardf (iv). Also r... healthy person would have had to conEurne l0 to 100 gallons of the contaminated water to be in danger. r (ii).

2.7t

Nevertheleso, the Department of Health

I

rnd Menti.l Hygiene

ordered Pepsi to destro 25ooo cases of soda and coer-cora

an undetermined

rmount

of that of

proruct

The &.1-timore rsunr

November

. (iii, v ) . 29, jg|g, mad,e the

remarkable statement that

rstate officials said they sinply do not know the effects of the hi6her concentrations, although they stressed that water vith fluoride as hi6h:rs Bo parts pcr nrilrion is used reurarly in other parts of Lhe worrd rvith no more ill effects than nottled. or brittle teeth.r (iii). rf that statement correctry reports the remarlcs of the rstate

officials, it is obvious that they were dangerously mis_ informed, even if BO p.p.m. was intended to be B.O p.p.m.
10d .

of l-ime to fr-uoridated water, to reduce the aci-cit',' producccl by the fr-uori-cre, is comnon practice. The Annapolis fEvening Capitalf of Noverjr,er 29, 19?9, reported: tltlhen public works personnel first noticed an increase in acid l-evel of the 'water after the spilr, rime was dumped into the system to neutrarize the water as prescribed by norna proceclures. pubric v{orks Director tloseph Axer_rod said that r-ime was i-ntroducecr. to conbat the hig.h acidic eve1s caused by the high amounts of fluoride whire prant personnel were tracring down the cause of the probrem. He wao unable to say how much rirne w.-r; put into trre rater. (v).
r

(see p. 64).

The adrrition

11, (See p. 2?-3).

July p , 19?9, the Seryior Advisor to the Environment Minister for euebec, canada, Dr J. -Benoi.t Bundock, wrote to Judpe Flaherty acknowledging receipt of his opinion
On

in the Allegheny County court case. Referring to the fi-nding of the inquiry into fluoridation set up by the

(November, jgZB)

224

Governrnent o1' Qucbcc, Dr Bundocl" uaid:

t.. in so far as the carcinogenic cffects of fl.uorides are concerned our Review Committee reached the s.me concl-usions as you dj-d in your Opinion.
r

Judge

Flahertyrs Opinion (see p. 182) statecl that he rnas

rcompellingl.y convincedr by the evidence presented in his court

regarding the validity of the study that was conducted by Drs Yiamouyj-annis and Burk (19??), which found. that cancer

mortality ratee werc hi6her in fluoridated than in fLuoridated. cities in thc U.S.A.
12a. (See
p

non-

, 124). The Mel-bourne tAge, of Decernber 11 , 19?g, reported that the European uranium organization urenco-centic
wants to build a $5ooro00roo0 uranium enrichnent prant in south

Australia.
Parry,
rWe
sa

The technicaf

director of Urenco-Centic, Mr J.

j-d:

are cea1in51 vitl'i a safe, clean process which has no effl-uent. rn Europe and the uK, our plants are situated close to centreo of very high popul_ation. This is the safest industry vre know. r

Despite Mr Parryrs claim that there is Ino effruentr, he is reported to have said that the only ]nazard, from an enri_chment

but that very stringent precautions were taken to prevent gas lealcages. He did not state how effective these rstringent precautionsr were in preventing the
release of this highly toxic gas from estabrished pants.

plant

was hexafluoride gas,

12b, (see p. lto). The Merbourne rAge, of Januar! Zjr 198or said fhat three new arurnnium groups have begun talks aired at
settin1 up smeJ-ters i-n victora.
The

state Electricity

275

Commleefonra chalrman sai-d

that thc:re

were

s1* or

ceven
naw

potontl.al aprlfcantn for lmsltor.

Alcoa Portl-and emelter would havc' a

IIo rcvor1od tlrrt thc

1'5?.rOOO

tonne capacity ln

the first

stage

capacity.

r and this could be expanded to a 5ZBTOOO tonne (tfrts would be more than five times the output of
Geelong.
)

the present large Alcoa smelter near

11,

(See

p. ?8).

those who are not satisfied with

secondhand,

opinions and wish to examine the orgina]- data from the Grand Rapids, Newburgh, Evanston and the two Brantford trials, wr1 find the fu1t. references in Sutton ?959.- 1960), which comnent
on the control-s used

in those t,riars.

Bocause

of the many
are

instances in which dfferent reports from the same trial

not in agreement, it ls essential- to read, and conpare, arr the reports from each triar rather than rerying on the data and
statenents made in the final report.

details of those fluoridation trias were published in the following journalo:

The

Alqer. tl. Publ. H1th., 1g5o;

1956i

Canad.
1951

J. Publ. EI th .t 1951,

1954

J.

Arner .

Dent.

Ass .t

1954-1958;

J. Canad. Dent.

J. Dent. Res.
SurA.

1948, i95o-50, 195?; OraI

(w ash. )

1951;

Publ.

Hl-

th. Ren.

, 1950, 1953, 1956.

14. (see p. 126). The spread of fluori-de contamination was mentioned recently by hofessor God.frey Tanner of Newcastr_e University, N.S.W. He was commenting on the proposal to
establieh alurninlum smelters at ronago and Farrey, near Newcastle. The Sydney rDaily TeJ_egraphf of December 1!,
1979, reported hin as sa,in6:

2?6

rEnglneer6 are anticipatlng one kilogram of solld fluorlde proriueed for evcry tonne of refinetl a1rnnLum produced.

Wltbln a 5 kn radius of the Alcan smelter at Kurrl Kurri there 1e evldence of plant damage. If they donrt Lmprove the pollutlon control above the present level, there ie certainly going to be danage to peach trees and other plante wLthln a 5 to 10 km radiue of Tonago and Farley. This damage is not, therefore t going to be in Just a snall area. It w11- affect the western euburbe of
Newcastle.
On
I

the A.B.C. television progranme rWork that was: Futureel

development

on tlanuar! 24, 198O, Dr Keith Windechuttle pointed out that

fluoride frrres severely affect the

of

grapes.

Therefore the establishment of these very large proposed emelters in tbe Eunter ValJ-ey may menace this nost inportant
wine producing area and affect ts large tourist industry.

1r,

(See

p. 119),

It s of interest that, according to

Decenber 1O, 19?92

rThe

Australiant of

rThe biggest toothpaste maker

t

fn Japan has stopped adding

fluorlde to dentlfrice. rThe Lion Dentifrice Conpany, of Osaka, has quietly switched to non-fluoridated paste, though it says t does not bel-ieve that fluoride causes any j.lI effects on teeth. The ewitch was discovered after a town council in Hyogo Prefecture anp1e-tested all avalJ-ab1e brands of toothpaste. 16, (see p. 62),
Another nstance of the lack of control of the

fluoride concentratlon in the Merbourne supplies was clted in the rSun Eaeterly Suppl-ementt of December 1J, 19?g. ft stated that the llaverley Council had found that the fl-uoride levels at taps at seven infant welfare centres varied, between 0.41 and

?_77

1,O8

ng/L.

The lowest and

the hi8hest values were obtained

from eamplee talcon fron trrps at the lrtellngton contrc in

Auguet and October.

Early j.n
Works

December

the Council asked the Board of

for an explanaton for these variatons, but no reply had been received. (on January 21, 1980, the Ohief Health

Surveyor sald that, 6even weeks after that request, the waverley council stlll- had not received a reply fror the
Board.
)

1la.

p. 125). A recent paper reported hat the emission of fluoride into the atmosphere fron one alr:mniun smel_ter was 139 Kg, per hour between 1909 an. jg6, and about !1 Kg per
(See

hour fron 1968 to 19?3. At that tirne the emission

decreased

was

to the 19?? tate of 74 Kg of fluoride per hour, whfch is !0.816 metric ton per day. I
Those data were obtained fron ment

entitled

ial-

F].

ide
Ca

Pol-

a special /o-page suppreution Chr onic Fl,uoride

Poieoninq in Cornwall Island

tle

by L. Ihook and G.A.

Mayln, contained in the Apri1, 19?9, ssue of rhe corner-I Veterinar l-an (Cornel-I Universlty, Ithaca, N.y. ). This

inportant paper should be read by those intere ste d in fluorosis. The authors stated. that: flhe object of the present study is to record yet another man-made pollution disaster and, to interpret the pathogenesis of the os.eous changes in view of recent advances in the understandng of bone metabolsm. r the souce of the fluoride polr-uti-on was an ar-uminium

snelter ereeted n 1g5g by the

Reynords Metals company on the

2?8

Bouth bank of the St.Law::ence Rver, State of

Nev

York, cloee

to Cornwall Is1and,

Canada,

the population of

whLch

is

c.xcluslvely l'lohawk Indian.

17b.

(See

p. 126).

The Cornwaf Isfancl farms surveyed were betreen

1.6 and 6.2 kn from the aluminium plant.

The authors stated:

rChronic fluorde poisoning in Cornwall Island cattle was manifested clinica-Iy by stunted growth and dental- fluorosis to a degree of severe interference with drinking and nastication. Cows died at or were slaughtered after the third pregnancy. The deterioration of cows did not allow further pregnancies. I

1?c. (soe p. 81). It.

was found

An important observation
\^ra6

fact that there

a marked

ln this study is the deray j.n the eruption of teeth.

that:

rDelay in eruption of I,,' exceeds 1.) years, of Ia years, J r rThe cause of delay of lr 7 years and of 14 2.5 years. i-n tooth eruption was shown in the present material_.

Fluoride arrests resorption of d.eciduous teeth roqts and of the supporting bone. By inducing one disease, fluoride delays the manifestations of another. r
That comment ie of the utmost nportance when considering
whether fluoridation is effi_cacious.
17d,

(See

p. 9t).

Although the work was d.one on cattle, ths

paper gives a coneiderable lnsight into the development of

rrottledr teeth as a result of fuoride ingestion. Krook and Maylin reported that: rMottling was not seen in deciduous teeth but the incidence was great in permanent teeth. The incidence decreased with age, which, agai-nr'indicated that the more severely affected cattle had died. r

?'79

It is wel-I faulty

known

that the aneloblasts (which form tooth

clcntal fluorosl-a, which hao long

enamel)

are readlly affectcd by small- overdoseo of fluoride, producing

enamo.l., termod been

recognized as rthe flrst

objective ind,ication of chronic fluorine poisoning. I (Ast, 194r). It is often assuned that the ameloblasts are the only cells affected. However, in this study it was found that:
rrhe target cells for fluoride in chronic fruorosis were shown to be the arnelobl-asts, the dentar pulp cells and the odontobrasts [which form dentine] , and, in bone, prinarily the resorbing osteocytee and also the osteobl_asts.r

the original paper shourd be consulted to study the microphotog;rarphs and

other evdence which support that statement.

As a result of the poor quality of the enamel and

dentine in fruorosed teeth, excessive attrition (wearin6 of the biting eurfaces) resur-ts. The authors reported: rrhe ncidence was great in permanent teeth.
The
waB

away

attrtion

very often so severe that the pulp was exposed. The edges of the teeth became very sharp. Attrition therefore interfered severely with mastication and this was, no d.oubt, a contributing factor to emaciation in aging cattle. I
17e.

Ths paper reported the effects of fruoride on he periodontal- tissues of 116 cattr-e. The authors divided then into three groups, and said that bulging of the gingiva

(see p. 1g?).

o a group of 98 cattle with decid.uous teeth only, in 88 -6% ot 44 cattle which hacl both decid.uous and. permanent teeth and in 91.4% of j4 cattle with pernanent teeh onIy. They found that:
?9.6%

(gums) occurred

in

280

rBulglng of the gingiv occurred becauee of recession of alveolar bone with or without gingivitis from excessive rnobility of teeth. I
Four casea were subnittecl for necropsy:
ma1e,
(1

) a

4-month-o1d

Q) a 1-year-old male, (1) a J-yeat-old fenale and (4) a 4- to !-year-old. fcmale. In case (4) therc was a mild

of l-oss of the al-veolar bone surrounding the teeth and in case 3) this l-oss vj.s pronounced, the mandble was much
degree

enlarged in the nrol-ar region and the bone was brittl-e

and,

shattered easlIy.

The authors said

that the
bone.

cau:ie

of this

alveolar recession was necrosis of the

17f.
(See

p. 166). The data

obtrined from

cattle on Cornwall

rsland show that fluorosis can arise not onry fron ingesting

fluoride from waer, but also that he fluoride content of food and industriar polrution of the atmosphere with fl_uoride rnay both be important factors. In this study, stunted growth was the most obvious clinical sign ancl laboratory teste tprovided concLusive evidence that the stunted growth
the resurt.of chronic fruorosis. r rt was found that the target cells in bonc for fr-uori.cre r.ere rprimarily the resorbing osteocytes and also the ostcobl_asts. r
was 178,

fact that fr-uoride is transmitted transplacentally in cattl_e was demonstrated. by findlng the rremarkable I l-ever of 45o p. p.n. f luoridc in a /-rnonth-old
The

(see p. 134).

foetus.

It4aylin

Fina1ly, one very important observation by Krooir and. regarding fluoridrtion, already mentionecr in appendix

?_81

17c should be repeated. They saicl: rrhe delay in eruption of pcrrn.ncnt teeth has arso been reported ln childrcn in fluoridated communities. rrhe cau6e of delay n tooth eruption rr,as shown in the present material. Fluoride arrests resorpti-on of deciduous teeth roots and. of the upportng bone. By inducing one disease flfluorose] , fluoride derays the manifestatons of another [dental cariesJ.
r

'18.

(See

pp. 186 and z1t).

issued a news release.

symposium on

Late n Decemberr lg?9, Dr Dean Burk rt was basecr on the summary of a

paper rvhich he 1s to presont to the 4th rnternational

the Prevention and Detection of cancer, to be held in London-!{emb1ey, July ?-6-31, 1980. rt stated that, to have one of the highest, of any large city

according to studies made by the Dean Burk Foundation,

Birmingham has now been found documented, increasng cancer death raes

in the worrd.

The basic popurati-on-mortarity data for this

study were obtained from the office of population censuses and Surveys (OpCS) in London, through the courtesy of Sr
Ermanuel Kaye.

graphical data issued by Dr Burk on December 1u 19791 show that n Birminghan, for ten years prior to the introduction of artificial fluoridation in 1964 the cancer
The

death rate per lootooo people fr-uctuated from year to year, as is usual , d.ue to various factors. The mean l_evel was
approximateLy 212, with a range of between 204.5 and zzz.jl but it dd not show any upvlard trend. However there uas a narked rise in the cancer death rates, recorded i-n these

28z

official

figures, after the introduction of artificial

fluorldation in 1)61, By 1967, three years after fluoridation, the rate was higher than at any time in the preceding twelve years, and it continuecl to riee rapidly (with the normal
annual fluctuations) until by 1)16-1977 t approximated
290
2!OO

cancer deaths per IOO'OOO people (that is, approximately

far higher than the figure of 222.! which was the highest rate recorded in any pre-fluoridation rero
The news release saj-d

for Birmlngham)

that:

fFl-uoridated Bj-rmingharn has now been compared with nonfluoridated Manchester over the years 1971-197? | adequate OPCS data for which are available. After simu.ltaneous standardizatlon of all data for different age and. sex population distribuions in these two ci_t,ies, with one of a variety of appropriate standardizing populations examined, it was found that over 10OO standardized excess deaths per year are nour rinked with fluoridatecl drinkng water in Birmlngham as compared to Donfluoridated Manchester, and this otandardzed d.ifferentlal is increasing at a rate of over 1OO per f,r. I The rerease stated that all supporting taburar and graphic

details of the foregoing analyses had been deposited. for review with the Department of Hearth and. social security (ogss) in London, and with other org.'izations and parties in Britain and elsebhere.
1)a.
(See p. 124).

An inportant recent discovery regardfng

poll-ution in Melbourne and Geelong, is that a giant vortex of wind over Port Phillip Bay is ensring that Melbourne rgets ts own pollution backr. That statement

was made by

the science Reporter of the Melbourne rAger on Decenber 1J,

2Bt

1979, when reportin6 recent dscoveries by researchers at the

csrRO

dlvlslon of atmoopherfc physico.

He eafcl

that

Dr

Kevln spilane had exptained that the vortex was the

wake

eddy cauoed by winds hittng the Arps, and that the 1oo-

kilonetre wide eddy was present on two out of three of Mel-bournets high-polluton days. This articre stated that the level of photochenical smog, especially ozone, is already high in Melbourne, and that the ozone leveI exceed.s the
lorrd Eealth organization standard on one d.ay in fve, reached 2l parts per million in 19?6.
1

and

9b.

(see p, 125),

Most of victorars electricity

is generated

in the latrobe Vall_ey by burnng brown coa1. Dssl-er qt al_. (9?r) reported t.hat there is a massive escape of fluorde gas fron European brown coal erectrical power plants.
Presumably our generators, a1so, produce

fluoride polruti-on.
the

A part of this may be reaching Melbourne and Geelong, for Dr spil-lane 1s reported to have said that pollution from

northern Latrobe valrey courd reach this port phrlip eddy, which covers both those cites. The tAge t reporter eaid that this csrRo fnding could have inplications for the sltlng of industry near Geelong and in the Latrobe Valley.
19c.

Dr spirlane said that porrution fron Geelong woul-d take about 4o hours of stable weather to reach Merbourne. (rnis rnay include atmospheric fluoride pollution frorn the large aluninium smelter near Gee1ong. )

(see p. iz5).

284

20.

(See

p, 221).

There

is

conslderable pollution

of

Port

Phltltp Bay by lnduotrlal waete. For lnstancet Alcoa of Auotralfa Li"mltod has an a6roomont with the Envlronmcnt hotectlon Authorty of Victoria (Licence no. EA OOO198/6 of
June 1 , 19?7, amended December 20, 19?4).

This permits

Alcoa to dfscharge rvertically upwardsr into the atmosphere 1J toxlc waste componente. rFLuorj-ne Compounds as Hydrogen

Fluoridet hour.

may be dLscharged

at a

maximum

rate of 16.83 Kg per

No mention

is

made

of dust containing particulate

On page 12J

fluoride, but this nay be included in the 11O,5t Kg of rd,ustl

which nay be diecharged every hour.

of the

present submission it was mentioned that fluorj-de fron that srnelter has been nonitored approxirnately Jl niles fron the source, but that nost of the fluorde ffalls outr within
a

two-nle radius of the plant.

Much

of tbis wil-l faLl into

amended. on

nearby Corio Bay, a part of Port PhiJ-lip Bay.

In addlti.on, the E.P.A. (by an agreement

June 10, 19??) permits Alcoa to discharge fluoride waste

directly l-nto Corio Bay at the rate of 1)J cubic metres per
24 hours, he maximun concentratlon beng 20 grams of fluoride

per cubic meter.

The

responsibllity for the monitoring is

left to Alcoa but the E.P.A. monj-tors fluoride concentration in the discharge on a random basis, usually every two lonths.
Conclusion.

This appendix contains reports which reinforce the previous

conclusons

that to ingest or inhale fluoride is to animals, as well- as to nan.

Irfhen

dangerous

the Health (Fluoridation) Act was passed by the

285

vlctorlan fs

Governmont

l-n 1971 Ilttle

mention wae made of what

the absorptlon of fluorlde from Bource6 other than water, including atnospherfc pollution. our parlamentarians were assured that
now known

to bo a very lmportant frctor

fluorldatlon was eafe.

even more obvioue

However, this new evidence makes it

that those aEsurances were not justified. et aI.,

The Quebec Governrnent conmlttee (Lamontagne

see p. 259) said:

frt would Been therefore hat our preoccupatione for the present should center on fluoride ntoxi-catlon rather than deficfency. I
step 1n preventing fruoride intoxicati-on tn the population, and the po1Iuton of our environment by fluoride,
The first

s to halt the ntentlonal spreading of this toxc substance. This has been done by countres in ttestern Europe which, after
nany years of experience, have banned fluoridation.

foll-ow their read and discontinue forthwith the practice of adding fluorlde to our water supples.
ItIe must