GENRE: Email / Research Article
TITLE: Dr Wong, dead wrong: a critique of pro-fluoridation claims
AUTHOR: AFAM Research Division
DATE SENT: 24th December, 2012
STATUS: Emailed; waiting response
UPDATES: Any updates should be posted in the comments section below.
TO: firstname.lastname@example.org Bcc: Many community lists
Dear Greg: Earlier today, we sent out the email below to a select list of individuals, as an initial (first draft) critique of Dr Wong’s claims. Please note, we are also working on a concise version of this critique, along with a more detailed version, both of which we will release at an appropriate time of our choosing. This initial draft, however, we trust will suffice for some interesting Christmas reading, as we know you are interested in this issue:
Dr Wong, dead wrong: a critique of pro-fluoridation claims
By AFAM Research Division [ afamildura.wordpress.com ]
In this post, we critique the pro-fluoridation claims made by former ADA Queensland Branch President, Dr Andrew Wong, on December 11, 2012. In Dr Wong’s radio interview (4BC 2012) with Greg Cary, he attempts to reassure the Queensland public that water fluoridation is a safe, effective and vital public health measure for reducing or preventing dental decay. November-December 2012 witnessed a unique flurry of media activity (fluorideaustralia.org 2012) on the fluoridation issue, in light of legislative changes that restore fluoridation choice to local councils. The claims made by Dr Wong are listed below our critique.
Critique of claims made by Dr Wong
PART 1: Body of scientific evidence | NHMRC review (2007)
The idea that the ‘science is settled’ on water fluoridation lies at the heart of the pro-fluoridation belief system. Dr Wong’s claim that the “overwhelming body of evidence,” drawn from a “a vast number of scientific studies,” demonstrates the safety and effectiveness of fluoridation, is misleading. Fluoridation promoters, including Dr Wong, rely heavily on systematic reviews of the literature to back their public statements on fluoridation. The York Review (2000) and theNHMRC Review (2007) are particular favourites, but one that receives little attention is the NRC Report (2006). There is a very good reason promoters prefer to steer clear of the NRC Report, which will become evident in the following paragraphs. Whilst Dr Wong does not mention the York Review or the NRC Report directly, they are fair game for this critique: a) Because the review that Dr Wong does mention, the NHMRC Review, relies heavily on the York Review for its assumptions and methodology; b) Because the NRC Report is dismissed outright by the NHMRC Review authors. We know what Dr Wong has told the public; now, let us examine what he has not told the public, about this “overwhelming body” of scientific evidence.
According to the NHMRC authors, the York Review ‘found’ that:
“The introduction of water fluoridation into an area significantly increased the proportion of caries-free children, and decreased mean dmft/dmft scores compared with areas which were non-fluoridated over the same time period. The findings… also suggest that cessation of fluoridation resulting in a narrowing of the difference in caries prevalence between the fluoridated and non-fluoridated populations.” (NHMRC 2007, p. 9)
Yet, according to the authors of the York Review, this alleged ‘benefit’ is not so clear-cut:
“The studies were of moderate quality (level B), and limited quantity. The estimates of effect could be biased due to poor adjustment for the effects of potential confounding factors.” (McDonagh et al 2000a, p. xii)
“What evidence we found suggested that water fluoridation was likely to have a beneficial effect, but that the range could be anywhere from a substantial benefit to a slight disbenefit to children’s teeth. This beneficial effect comes at the expense of an increase in the prevalence of fluorosis (mottled teeth). The quality of this evidence was poor.” (CRD 2003)
For overall safety and efficacy, how much high quality evidence did the York Review authors actually find?
“No randomised controlled trials of the effects of water fluoridation were found… It is surprising to find that little high quality research has been undertaken.” (McDonagh et al 2000a, p. xi, p. xiv)
“We were unable to discover any reliable good-quality evidence in the fluoridation literature world-wide.” (CRD 2003)
Thus, it is clear that the NHMRC Review (in which Dr Wong fervently invests his faith) derives its assumptions and methodologies from a previous review that was unable to identify a single Grade A study of any kind, nor a single randomised controlled trial to prove either the safety or effectiveness of fluoridation (Connett 2000, #4.8, Connett et al 2012, #10). This is far from the only shortcoming of the NHMRC Review. A closer analysis reveals – in the words of Dr Wong’s radio interview opposite Dr Paul Connett – “at best, it is a work of professional incompetence or, at worst, an example of scientific fraud, in which scientific information is manipulated to support a preordained conclusion.” (Connett 2008).
Leaving aside the other flaws of the NHMRC Review (SEP 2011), for the purpose of this critique, we will focus on what is arguably the most glaring oversight by the NHMRC authors – i.e. the dismissal of the NRC Report; in a single sentence:
“The [NRC] report refers to adverse health effects from fluoride at 2 – 4 mg/L, the reader is alerted to the fact that fluoridation of Australia’s drinking water occurs in the range of 0.6 to 1.1 mg/L.” (NHMRC 2007, p. 15)
i.) It highlights the issue of concentration, whilst failing to acknowledge the issue of dose (e.g. an individual drinking 4 litres of water per day at 1mg/L concentration, will be getting the same dose as an individual drinking 2 litres of water per day at 2mg/L concentration). (Limeback 2000, #4, Connett 2002, Connett 2011)
iii) It fails to note that amongst the NRC Report’s recommendations, were health studies to be conducted within the concentration range 1mg/L–4mg/L (NRC 2006, p. 303) (nb. obviously these recommendations are relevant to Australia, which is fluoridated at up to 1.1mg/L).
iv) It fails to acknowledge that the NRC research team did in fact review studies below the concentration of 2mg/L, even down to 1mg/L. Testimony from Panelist Dr Hardy Limeback (Limeback 2011), well and truly clarifies this matter.
Most alarming is the ‘highway-long’ list of research gaps exposed by the NRC Report, as evidenced by the research recommendations of the authors (NRC 2006, pp. 87, 88, 101, 102,130, 180, 204, 222, 223, 266, 267, 302, 303, 338, 339, 352, 353, FAN 2012). This prompted the Panel Chair Dr John Doull to acknowledge, “when we looked at the studies that have been done, we found that many of these questions are unsettled and we have much less information than we should.” (Scientific American, in FAN 2012)
It is interesting to note that the authors of the York Review likewise confirmed the existence of such research gaps, stating in 2003, “only high-quality studies can fill in the gaps in knowledge about these and other aspects of fluoridation.” (CRD 2003)
So, who has done these studies? Who is monitoring for health effects in the population, in any rigorous, high quality manner? Certainly not the Health Departments of Australia; certainly not the NHMRC; and certainly not Queensland dentist, Dr Andrew Wong.
PART 2: Endorsements
Dr Wong notes that water fluoridation is “supported by the World Health Organisation, the National Health and Medical Research Council of Australia, the Australian Medical Association, and the Australian Dental Association.” This is a typical ploy by fluoridation promoters, yet in light of the research gaps highlighted in PART 1 (above), endorsements substituted for scientific research, mean absolutely nothing. (Connett 2009, Summary, Connett et al 2011, #15, Connett et al 2012, #46-47)
In fluoridating nations, such as Australia, Canada and elsewhere, the glaring dearth of adequate research data, precludes any fluoridation promoter – including Dr Wong – from accurately claiming that fluoridation is “safe” (Connett et al 2008, Connett 2011, Connett 2011) and “effective.” (Connett 2011) Self-serving reviews, such as the NHMRC (2007) review, have failed the public dismally in terms of resolving these matters of safety and efficacy. (Connett et al 2010, pp. 240-242)
PART 3: Fluoride’s topical ‘and’ systemic effects
Dr Wong claims that water fluoridation has ‘both’ topical and systemic benefit, thus providing a ‘universal’ benefit for children and adults alike. Numerous experts and researchers disagree with Dr Wong on this point. (Limeback 2000, Carlsson 2005, FAN 2011, FAN 2012)
PART 4: Personal responsibility
Dr Wong claims that since people cannot be trusted to (because of human nature) maintain good individual oral hygiene and dietary habits, water fluoridation is essential to protect their teeth. Leaving aside the scientific flaws of the claim that water fluoridation is “essential,” moreover, the arrogance of this statement reeks of a ‘nanny state’ mentality, which is plain to see. If human nature dictates a tendency towards poor oral hygiene, it is little wonder why Dr Wong had trouble explaining how this logic applies to people in nations with no water fluoridation and no salt fluoridation (e.g. Sweden, Denmark, Netherlands), who have better teeth (WHO 2012, in FAN 2012) than people in nations with fluoridated drinking water.
PART 5: Fluoridation chemicals
Dr Wong delivers a masterclass in ‘spin,’ when discussing the chemicals used to fluoridate drinking water. Apparently, ‘hazardous industrial waste, laced with toxic contaminants’, doesn’t sound as good as ‘from rocks in the soil and tested for purity.’ Dental students, get your notepads out, because you are in for a shock:
“Hydrofluorosilicic acid is recovered from the smokestack scrubbers during the production of phosphate fertilizer… Fluorosilicates have never been tested for safety in humans. Furthermore, these industrial-grade chemicals are contaminated with trace amounts of heavy metals such as lead, arsenic and radium that accumulate in humans… Long-term ingestion of these harmful elements should be avoided altogether.” (Limeback 2000)
“I could not believe that we were actually dumping lead, and arsenic, and even radium [into the drinking water], which is produced in the process of making this pollutant… my concern is that we’re building up the contaminants in our system.” (Limeback 2000)
“To answer your first question [Professor Masters] on whether we have in our possession empirical scientific data on the effects of fluosilicic acid or sodium silicofluoride on health and behavior, our answer is no… our colleagues at NHEERL were [also] unable to find any information on the effects of silicofluorides on health and behavior.” (EPA 2000)
“Further recognizing that, claims to the contrary, SiF treated water is not like NaF treated water because [SiF6] 2- (a) is unlikely to dissociate completely under water plant conditions, producing only free fluoride and silicic acid without side reactions; (b) is likely to react with Al(OH)3 to produce several derivative compounds; (c) dissociation status depends on pH and concentration so that incompletely dissociated SiF residues may re-associate both at intra-gastric pH around 2.0 and during food preparation, producing SiF species including silicon tetrafluoride, (SiF4), a known toxin; and (d) commercial SiFs are likely to be contaminated with fluosiloxanes, arsenic and heavy metals, and radionuclides, since they are waste products from fertilizer manufacture and uranium extraction from phosphate rock.” (Coplan & Carton 2001)
“In plain English, senior EPA research staff now believe their staff needs to go back to the lab for at least another year or two to find out if the EPA’s longstanding confidence in the “virtually total” dissociation of SiFs may have been misplaced.” (Coplan & Masters 2001)
“If this stuff gets out into the air, it’s a pollutant; if it gets into the river, it’s a pollutant; if it gets into the lake it’s a pollutant; but if it goes right into your drinking water system, it’s not a pollutant. That’s amazing… There’s got to be a better way to manage this stuff.” (Hirzy 2000, in FAN 2003)
“Silicofluorides… a class of fluoridation chemicals that includes hydrofluosilicic acid and its salt form, sodium fluorosilicate. These chemicals are collected from the pollution scrubbers of the phosphate fertilizer industry. The scrubber liquors contain contaminants such as arsenic, lead, cadmium, mercury, and radioactive particles, are legally regulated as toxic waste, and are prohibited from direct dispersal into the environment. Upon being sold (unrefined) to municipalities as fluoridating agents, these same substances are then considered a “product.” (NTEU280 2003, I)
“Essentially no studies have compared the toxicity of silicofluorides with that of sodium fluoride, based on the assumption that the silicofluorides will have dissociated to free fluoride before consumption.” (NRC 2006, p. 53)
“This is a hazardous waste – no question about it.” (Connett 2010)
“I didn’t realise that we weren’t using natural fluoride, so-called natural fluoride… but we were using a common industrial waste. This industrial waste is coming mainly from the super-phosphate industry, but also recently, industrial waste from China, of which we really don’t have a good idea of the origins… it’s not a pharmaceutical grade; it’s an industrial grade. Some of the contaminants are aluminum, mercury, low levels of uranium, beryllium, cadmium; and this has quite shocked me.” (Harms, in SEP 2011) (SEP, FOI 2010)
“If you ask most dentists… what they’re putting in the water, most dentists would say, sodium fluoride – pharmaceutical [grade] sodium fluoride, the same stuff that is in toothpaste.” (Connett, in FAN 2011)
“In the process of converting phosphate rock into soluble fertilizer, two very toxic fluoride gases are released: hydrogen fluoride and silicon tetrafluoride. In the past, the phosphate industry used to let these two gases vent freely into the atmosphere. This, however, caused severe environmental damage among downwind communities, including widespread cattle poisonings, scorched vegetation, and various human health complaints. Eventually, as a result of both litigation and regulation, the phosphate industry installed “wet scrubbers” to trap the fluoride gases. The collected liquid in these scrubbers (hydrofluoroslicic acid) is entered into storage tanks and shipped to water departments.” (FAN 2012)
“Fluosilicic Acid is an aqueous solution of 20% H2SiF6 used for the Fluoridation of drinking water. Incitec Pivot manufactures the product in Geelong and Portland, Victoria, and distributes it nationally. Fluosilicic Acid is the most widely used fluoridation agent in Australia, and has several advantages over powdered fluoridation products, including the elimination of manual handling, dust control, and slurrification. The product is particularly suitable in mid sized to larger water treatment plants.” (Incitec Pivot 2012, Product Information)
“[Fluosilicic Acid is] classified as a Schedule 7 (S7) Poison using the criteria in the Standard for the Uniform Scheduling of Drugs and Poisons (SUSDP).” (Incitec Pivot, Fluosilicic Acid MSDS, p. 6)
“Fluorosilicic acid is a particularly aggressive and hazardous chemical and requires specific operator training and awareness.” (Hydramet 2012)
Dr Wong says, “the compound is pure and free from contaminants.” We rest our case.
PART 6: Europe
Dr Wong claims, “a lot of the water supplies are small, independent water suppliers; so, logistically and economically, it is difficult to implement water fluoridation over in Europe. Instead, what they have done is to choose to fluoridate their salt.” The truth is, nothing could be further from the truth!
European nations generally cite both ethical and medical reasons for not fluoridating their water supplies. In fact, some started and then ceased for reasons of ethics, public and parliamentary opposition, or ineffectiveness. (FAN 2012) Obviously, if they started and maintained fluoridation programs in the past (FAN 2012), Dr Wong’s claim, is completely false.
His claims of widespread salt fluoridation are also misleading. A number of European nations fluoridate neither their salt, nor their water (FAN 2012), with just as good if not better teeth than fluoridated nations.
PART 7: Dental fluorosis
Dr Wong very sneakily focuses on the result of toxic overexposure to fluoride, avoiding the cause, mechanism and implications. Dental fluorosis is a well-known biomarker of systemic overexposure to fluoride in the developing years, yet Dr Wong focuses only on the visible effects, downplaying these as easily and economically treatable.
The truth is, “it is illogical to assume that tooth enamel is the only tissue affected by low daily doses of fluoride ingestion” (Limeback 2000, in FAN 2012); and that, ”common sense should tell us that if a poison circulating in a child’s body can damage the tooth-forming cells, then other harm also is likely.” (Colquhoun 1999, in FAN 2012). Thus, when the promoters of fluoridation first began the program in the United States, “the key gamble… was that fluoride could damage the child’s growing tooth cells, by some undetermined biochemical mechanism, without damaging any other growing tissues or organs in the child’s body.” (Connett 2009, The Great Fluoridation Gamble)
This ‘gamble’ is still being played out by Dr Wong and other promoters, and the chips on the table are the children of Australia.
PART 8: Mass medication | dose
Dr Wong states, “with any sort of substance, you want to have the appropriate dose that is of therapeutic/health benefit.” He is correct! But, one wonders how he plans on ensuring the appropriate ‘dose,’ considering the vastly different quantities of water people consume on a daily basis (Mullenix et al, in FAN 2011), not to mention, the fluoride they receive from other sources. (FAN 2012)
Dr Wong’s claim that fluoridation is not mass medication is countered by basic logic: A foreign substance (i.e. a toxic industrial waste product, see PART 5, above) is being added to drinking water, with the express intent of delivering both a systemic and topical treatment, to a mass number of patients, to treat or prevent a disease within the bodies of those patients – hence, ‘mass’ and ‘medication’ = ‘mass medication.’ Regardless of the effectiveness, safety or ethical issues surrounding the practice, the fact remains unchangeable, that the treatments is – by any logical definition – ‘mass medication.’ (FAN 2012)
Dr Wong uses the example of Vitamin A as an essential nutrient, and equates fluoride with the same principle – essential, in the right amount. Whilst Vitamin A is a scientifically-proven essential nutrient, fluoride is not. There is no scientific evidence to prove that fluoride is essential to human health. (Connett et al 2012, #6) If fluoride withdrawn from the diet, a disease will not develop as a direct result of the withdrawal (this includes tooth decay). Dr Wong’s use of the Vitamin A example alongside fluoride, is scientifically ‘shifty,’ but a great public relations tactic. He knows most consumers are ‘vitamin-conscious,’ in a world where vitamins are ‘big business‘, thus they will naturally equate fluoride with ‘health,’ if it appears in the same sentence as Vitamin A and emanates from the mouth of one of their respected Queensland health professionals.
PART 9: No evidence of health issues
“The absence of studies is being used by promoters as meaning the absence of harm.” (Connett et al 2012, #45, Refer to PART 1, above).
It is clear that Dr Wong has made numerous superficial, incorrect or misleading statements. Whether he has consciously misled the public; or whether he is simply blinded by the all-pervasive fluoridation religion and thinks he is telling the truth, we will leave the reader to speculate. Either way, however, we strongly suggest that Dr Wong spends less time on the ADA website, and more time reading the work of his more qualified opponents.
Claims made by Dr Wong
- The overwhelming body of scientific evidence shows that water fluoridation is a safe and effective means of reducing dental decay, particularly amongst children.
- Water fluoridation is supported by organisations such as the World Health Organisation, the National Health and Medical Research Council of Australia, the Australian Medical Association, and the Australian Dental Association.
- Water fluoridation has beneficial effects, both topically and systemically. Children, as their teeth are forming, benefit particularly from the systemic effect.
- Water fluoridation has a universal benefit to the community. Since people cannot be trusted to (because of human nature) maintain good individual oral hygiene and dietary habits, water fluoridation is essential to protect their teeth.
- Even with good oral hygiene habits, water fluoridation is still necessary, since water fluoridation acts in combination with fluoridated toothpaste to further reduce dental decay amongst adults and children. Water fluoridation is a way of helping prevent dental decay across an entire population. You need good oral hygiene and diet, and also fluoridated water, for maximum benefit/protection.
- At the appropriate level of 0.9 ppm, it has been scientifically shown by a vast number of scientific studies that water fluoridation is safe an effective. The NHMRC review (2007) looked at the top quality scientific studies that have been done on water fluoridation to answer two questions: ‘is it safe?’ and ‘is it effective at reducing dental decay?’ The answer, emphatically, to both questions, was ‘yes, it is safe’ and ‘yes, it does reduce dental decay between 20-40%, compared to communities that are not fluoridated.’
- The fluoride that we get in Australia is derived from rocks in the soil. The only fluoridation chemicals that are allowed in Queensland’s water supply are: fluorosilicic acid (liquid), sodium fluorosilicate (powder), and sodium fluoride (powder). The reason only these three compounds are allowed to be used in the Queensland water supply, is that they all dissolve 100% in water. In terms of safety, before these compounds are placed in the water supply, they all undergo regular testing to ensure two things: 1) that the compound is pure and free from contaminants; 2) that the compound is of the appropriate concentration.
- The reason why they (i.e. European nations) do not universally adopt water fluoridation, is that in Europe, a lot of the water supplies are small, independent water suppliers; so, logistically and economically, it is difficult to implement water fluoridation over in Europe. Instead, what they have done is to choose to fluoridate their salt, and that’s how people in Europe get the protective benefits of fluoride. Salt fluoridation does not provide the topical benefits/protection that are provided by water fluoridation; salt only provides systemic benefits/protection.
- One of the associated/possible complications with fluoridating the water supply, is dental fluorosis (mottling of the teeth – white or brown specs). The incidence of fluorosis in a populations, where the water supply is fluoridated, is about 20%. Having said that, the vast majority of dental fluorosis in a fluoridated community is not detectable to the naked eye; although a dentist may be able to identify it. Of that 20%, an even smaller percentage may have moderate dental fluorosis, which is easily treatable with conservative and economical measures. Very rarely, people get severe fluorosis (where pits occur in the teeth – some discolouration), which is also quite conservatively treated, and the teeth can look excellent again (the patient’s smile can be restored virtually to normal).
- It is surprising that the public fluoridation debate continues, because the vast majority of Australia (regional and metropolitan) is fluoridated. Queensland was the last state to come on line with water fluoridation. Queensland, prior to water fluoridation, had one of the highest decay rates in all Australia (second only to the Northern Territory, which has more rural/remote towns, and a higher indigenous population). Water fluoridation is safe, it’s effective, it’s a community benefit [re-stated]; and the primary reason that public debate continues in Queensland, is primarily because Queenslanders are a passionate, opinionated people.
- Fluoridation is not mass medication; it is basically just altering something that’s naturally-occurring in the water supply, to a level that will benefit the health of all.
- With any sort of substance, you want to have the appropriate dose that is of therapeutic/health benefit, and not at high levels where it could potentially cause issues. For example, Vitamin A is an essential nutrient for health, but too much of it can cause serious health issues.
- In terms of thyroid issues, skeletal fluorosis, or cancer – which some people claim could be a potential side-effect of water fluoridation – we just have to look at the evidence; and over many decades of water fluoridation throughout other states and other countries in the world, there is not an increased rate of those issues compared to a state such as Queensland, which has only recently introduced water fluoridation.