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Fluoride Study Calls For More Study
VOICES OF REASON, PART 19: Robert Weisman.                               
INTEROFFICE COMMUNICATION
June 9, 2006
To:Tony Masilotti, Chairman and Members of the Board of County Commissioners
From:Robert Weisman County Administrator
RE:  Background and Recommendation on Fluoridation - June 20 BCC Agenda - Presentation

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More than 160 million Americans drink water that has fluoride added to it for the  purpose of reducing tooth decay. The Board approved fluoridation of the County's drinking water 18 months ago.  At that time, there was a pending National Research Council (NRC) Study, sponsored by the USEPA, analyzing the health effects of naturally occurring fluoride in drinking water.  Staff was directed to inform the Board about the report upon issuance.  The results are sufficiently notable to justify further review by the Board.  Fluoride proponents will correctly argue that the Study was not intended to address fluoridation.  However, fluoride in water is similar whether occurring naturally or added artificially, only the amount and chemical source varying.  The Study findings regarding health effects relate to various fluoride levels that can be considered in relation to fluoridation.  Sixty pages of the report reviewed fluoride intake including standard fluoridation levels.  A problem of fluoridation and fluoride intake generally is that there is no control of dosage to the consumer. Consumption is different for each person and effects can depend on body weight, age and other factors.

 OVERVIEW

 1)  We approximately quadruple the natural fluoride of our water from .2 to .8 mg/L when we fluoridate.

2)  Fluoride is an inorganic chemical drinking water contaminant.  The current Federal maximum contaminant level "intended to prevent toxic or other adverse effects" is 4.0 mg/L (MCL)  The secondary level (SMCL) to prevent negative "aesthetic or cosmetic effects" is 2.0 mg/L

3)  The Study does not evaluate either the safety or effectiveness of fluoridation to prevent dental caries.

4)  The Study produced no independent research, but rather gathered and reviewed existing research.

5)  The Study concludes that: "In light of the collective evidence on adverse health effects and total exposure to fluoride, the Committee concludes that EPA's drinking water standard of 4 mg/L is not adequately protective of health."

6)  Areas of medical concern include fluoride's long term effect on bone strength, kidney function, tooth enamel loss and pitting; and "tentative or mixed" evidence about cancer, particularly of the bone.

7)  Two sample comments of concern from the report:  "There were few studies to assess risks of bone fracture in populations exposed to fluoride at 2 mg/L in drinking water.  The best available study suggested an increased rate of hip fracture in populations exposed to fluoride at concentrations above 1.5 mg/L.  However, this study alone is not sufficient to judge fracture risk . . . "; and "It has long been suspected that fluoride, even at concentrations below 1.2 mg/L in drinking water, over the years can increase the risk for kidney stones.’Äù

8)  Health exposure risk of chemicals is typically evaluated on representative studies of limited populations of people and animals.  There can be disputes about interpretations and the accuracy of such studies based upon how they were conducted.  Negative health results need only effect a small percentage of participants as compared to control groups to cause concern.

9)  Intake of fluoride by an individual is highly dependent upon how much fluid is consumed.  Some products such as tea may contain substantial additional amounts of fluoride besides that which is present in the water.  If you are on a fluoridated public water system, the only way to reduce fluoride intake is to not drink the water from that public source.

CONCLUSIONS

The conclusions and comments of the NRC Study were more significant regarding potential health effects of fluoride than staff anticipated.  The Study calls for additional research and urges that the current 4 mg/L maximum contaminant level be lowered.  It also concludes that the 2 mg/L standard for cosmetic effects "does not completely prevent the occurrence of moderate enamel fluorosis" which damages teeth. This means that the MCL and SMCL are likely to be lowered in the future closer to the level of fluoridation.  It could be questionable to add a chemical to the water for one intended health benefit when there could be at least some negative effects on the same population.  On the other hand, one could think the perceived dental benefits exceed the potential health effects which may not materialize or are not yet fully delineated.

RECOMMENDATIONS

Board members need to decide if the Study raises sufficient concern about potential negative health effects to justify ending fluoridation of the County water system.  You may choose to rely on the official recommendation of Federal and State health authorities who continue to endorse fluoridation for its dental benefit and who have not been concerned about Study results because of lower fluoridation dosages.

Contrarily, it is my opinion that the primary goal of our water utility should be delivery of water that is as safe as we can knowledgeably and reasonably make it, that all of our residents can choose to drink with confidence.   In light of this Study, fluoridation does not contribute to this goal and may dissuade concerned persons or prohibit some persons from drinking our water.   The amount of fluoride ingested is different for each person and some may be particularly sensitive to effects due to their consumption habits, health or age.  In my judgement, the Study does raise sufficient evidence about potential negative health effects at levels close to fluoridation dosage to justify a decision to end fluoridation.

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The Canary Club is an educational advisory group with a team of medical advisors headed by Richard Shames, M.D.