The Fluoridation Fallacy
A
Commentary on
Official Statements
Which support the
Fluoridation of Public Water Supplies
by
R. F. BOYD GAUDIN
B.Sc, A.C.G.I., A.M.I.C.E.
"Nothing is so firmly believed as that of which we know least."—Montaigne.

THE   G.   W.   DANIEL   COMPANY   LIMITED ASHINGDON, ROCHFORD, ESSEX, ENGLAND

First published 1961
©  COPYRIGHT R. F. Boyd Gaudin 1960

Acknowledgments and Recommendations
Foreword
PART I
1.         The Case for Fluoridation
2.         The Ethical Aspect
    (i) The Ethical Blindness of Proponents
    (ii) Chlorine and Fluorine
    (iii) Water supplies "deficient" in Fluorine
    (iv) Fluorine is "harmless" and "beneficial"
3.  Does Fluorine always reduce Dental Caries? 
    (i) Increase in Dental Caries in areas where the water is Artificially Fluoridated
    (ii) Decrease in Dental Caries where unfluoridated water is used
    (iii) Increase in Dental Caries where naturally fluoridated water is used
4.  How "Safe" is Fluoridation?        .         .         .       
    (i) Evidence of Acute Poisoning
    (ii) Evidence of Chronic Poisoning
    (iii) Reports of Injury to Health
5.  Comments on Other Statements made by the Promoters of Fluoridation
    (i) Fluorine in Tooth Substance is proportional to water drunk
    (ii) "Fluorine appears in water in exactly the same state as does the fluorine derived from natural sources"
    (iii) "A recent study carried out in Russia goes so far as to claim that people in high fluoride areas live longer and enjoy better health than those in low fluoride areas"
    (iv) "The cost is only 4d. per head per year"
    (v) Fluoridation of the Public Water Supply is not Mass Medication and the liberty of the subject is in no way impaired. Fluorine is not a drug
    (vi) Mottled enamel due to low fluorine concentration up to 2 parts per million actually "improves" the appearance of the teeth
    (vii) The Pseudo-scientific Propaganda using the technique of the "big lie"
PART II
6.  An Examination of some Items of the North American Fluoridation Trials and an Assessment of their Reliability 
    (i) Introduction
    (ii) Water Supply Analyses not stated
    (iii) Comparable waters become contrasting waters
    (iv) Delay in tooth eruption
    (v) Variations in the incidence of caries in a "control" city
    (vi) Variations in sample size
    (vii) Variations in method of Assessment
    (viii) Unreliability  of the  assessment  of dental caries rates
    (ix) Contrasting Conclusions:
         (A)   Those of Dr. Philip R. N. Sutton
         (B)         „       Dr. Douw G. Steyn.
         (C)   Report of the New Zealand Commission on  Fluoridation  with  Comments
         (D)        „        the World Health Organization   Expert   Committee   on Fluoridation with Comments
7.  A Glut makes a Quandary    
     (i) Turn a Glut into an Asset
     (ii) Discreditable Methods of Promotion
8. The Growth and Signs of Decline of Fluoridation
     (i) The Flow and Ebb in America
     (ii) Rejections of Fluoridation elsewhere
     (iii) A New Zealand opinion on its Commission on Fluoridation
     (iv) The  Expert Committee on Water Fluoridation of The World Health Organization
PART III
Summary and Conclusions  
References 
Appendix
Bibliography                  .         .         .         .         .         .                 

Acknowledgments and Recommendations
I would like to express my appreciation of the help and advice given by The Rt. Hon. The Lord Douglas of Barloch, k.c.m.g., and Mrs. W. M. Sykes who are respectively President and Hon. Secretary of the National Pure Water Association. I would also like to thank my neighbour, Lt.-Col. E. H. Casper, t.d., for his help and encouragement, and my wife for reading through the proofs.

Permission to quote at length from the undermentioned works, given by their authors or publishers is gratefully acknowledged. They contain an exceptional amount of vital information on this subject of fluoridation, without which this essay might not have been attempted. The works are:

Fluoridation: Errors and Omissions in Experimental Trials, 2nd. ed. 1960 by Philip R. N. Sutton, D.D.SC. (Mel.). (Melbourne University Press and Cambridge University Press, London).
The American Fluoridation Experiment. By F. B. Exner M.D., G. L. Waldbott, M.D., and James Rorty, Editor. (The Devin-Adair Company, New York).
The Problem of Dental Caries and the Fluoridation of Public Water Supplies. By Douw G. Steyn, B.SC, DR.MED.VET. (Pharmacol.), D.V.SC.(Tox.), (Voortrekkers Beperk, Voorwaarts, Johannesburg).

All readers who wish to obtain further information on this subject are recommended to procure copies as works of reference.

Before closing I should like to call the attention of readers, to the National Pure Water Association which was formed in March 1960, appropriately enough, at a meeting held in the Moses Room of The House of Lords. The objects are to promote the protection of water supplies from all forms of contamination and to oppose the use of Public Water Supplies for the purpose of mass medication. Readers are invited to join the Association by sending ten shillings annual subscription to the Hon. Secretary, National Pure Water Association, Thorpe End, Almondsbury, Huddersfield. Alternatively, should they require further par­ticulars in the first place they should write and enclose one shilling to cover cost and postage.

R. F. Boyd Gaudin. Farnham, Surrey. September 1961

Foreword
It is understandable that many Medical Officers of Health in making out a case for fluoridation of a public water supply would rely on what would seem to be the most up-to-date and authoritative reports on the subject. It would be quite exeptional for them to have any first-hand experience in the matter.

Hence to base their case on the findings of such bodies the Expert Committee on Water Fluoridation published by the World Health Organization in 1958 and those of The Commission of Inquiry (New Zealand) on the Fluoridation of Public Water Supplies published in 1957 would seem to be wise.

But the fluoridation of a public water supply is unethical and morally wrong and on these grounds alone it should be repudiated. One purpose of this essay is to convince the reader that this is so. The other is to show that these reports are unreliable. They give neither conclusive proof that the fluoridation of water supplies will always give the results claimed, nor that it is without grave dangers to bodily health.

This is not to say that, in some cases, fluoride administered to a child under careful medical supervision might not prove beneficial. If a child should react unfavourably in regard to its general health the doses can be stopped or modified. In such cases the doctor-patient relationship is being maintained and each patient treated as an individual. This is the very antithesis of the "hit and miss" method of the fluoridation of the public water supply.

Even so, bearing in mind the hazards which this reveals, it would appear to be far wiser to teach all children strict oral hygiene, reduce the consumption of caries-producing food and, conversely, encourage the consumption of foods which have not got this unfortunate properly.

PART I
The Case for Fluoridation

The following paragraphs set out the usual arguments used by Medical Officers of Health in favour of adding fluorine to the public water supply when, in their opinion, there is a deficiency.

(i) The increase in dental caries in children is alarming and it is urgent that some way be found to reduce its incidence.

(ii) There are several major causes of this increase. Too much sugar, starchy foods, soft drinks and, in general prepared foods which fail to give the teeth enough work to do. They are acid or acid forming and so the teeth are attacked. In addition there is bad oral hygiene.

(iii) As it is difficult to change habits immediately some other remedy must be sought. It has been found that where the element fluorine is naturally present in the water supply in amounts of one part per million and over, there is less dental decay. The teeth are also stronger and if the fluorine content does not exceed two parts per million the appearance of the teeth is actually improved.

(iv) According to one M.O.H. "all" water contains fluorine, but while this may be doubted, it is known that many do. "The amount of fluorine found in the tooth substance depends directly on the quantity present in the water drunk by the mother and child during the tooth's formation and growth" (1).

(v) Fluorine is one of the trace elements necessary to induce good health; it is, in fact, a nutrient and no harm whatsoever can come to anybody drinking water containing an artificial fluoride, such as sodium fluoride, in the water, provided the total of fluorine does not exceed 1 to 1.5 parts per million. "The cost is negligible and the fluorine appears in the water in exactly the same state as does the fluorine derived from natural sources". "Dental decay is reduced in infants and children to less than half its former level . . ."(1). "A recent study carried out in Russia goes so far as to claim that people in high fluoride areas live longer and enjoy better health than those in low fluoride areas" ( (1) and Appendix (a) ).

(vi) Just as chlorine is added to the water to safeguard against the spread of an epidemic, fluorine can now be a further means of safeguarding health by reducing the incidence of dental caries and secondary diseases that can be fostered by bad teeth. "The cost is only 4d. per head per year" (1).

(vii) As the addition of fluorine to the public water supply is perfectly safe, no one can logically object to the pro­posal and consequently the liberty of the individual is in no way infringed.

(viii) The foregoing information is based upon a vast amount of research and experiment carried out, chiefly, in North America. This information has been examined and reviewed by several expert bodies set up for that purpose. Two may be mentioned. The New Zealand Commission of Inquiry on the Fluoridation of Public Water Supplies whose report was published in 1957 and the World Health Organization Expert Committee on Water Fluoridation who published their report in 1958. Both these bodies commented very favourably on the work carried out and endorsed fluoridation.

(ix) In spite of the findings of these authorities and others equally competent to assess the position there is, as always, "a small vocal minority" who "look for arguments that they might use against fluoridation". "In quite a short time they put together a library of pseudo-scientific propaganda which contains a substantial number of frightening statements that are, without exception, demonstrably false". "They have used the technique of the 'big lie' again and again. Unfortunately the effect of their publications on the uninstructed lay mind can have much the same effect as did the writings of Streicher on the German nation"(1). In view of the findings of the authorities mentioned, you will doubtless discount this 'big lie' propaganda and agree to the facts here presented.

(x) This short statement of facts should enable the public to appreciate the great advantages arising from fluoridation of the public water supplies. It is a simple, harmless and inexpensive means of improving the public health and reducing dental caries in children by at least 50%, and it should be adopted without delay.

The author of this work has tried to make a fair statement of the kind of information given by the proponents of fluoridation, and will now proceed to examine the matter in some detail.

2.  The Ethical Aspect

In the Foreword, the paramount importance of the ethical aspect of these proposals was mentioned, so that before the main argument for fluoridation is considered in some detail, it seems to be absolutely necessary to look into the morality of the proposition.

(i) The Ethical Blindness of Proponents.

Our Western Civilization is derived from Christian teaching. Our Common Law, alas often over-ridden in modern times, is derived from that source. The Christian concept makes it imperative that everybody should have freedom consistent with like freedom in others; but licence should never be tolerated.

Arising out of this conception, it follows that no public authority has the right to misuse its power to interfere with the individual, provided the latter always conforms to the Christian Ethic.

An individual suffering from dental caries is not a source of danger to others, so that, if he objects to drinking flouridated water, he should not be virtually compelled to do so. On the other hand, if he has smallpox or is the innocent carrier of some infectious disease, such as scarlet fever, then he must suffer that loss of freedom to safeguard the freedom of others. The principle is quite simple.

No one then should have his body experimented on without his prior consent. This is completely ignored when public water supplies are fluoridated. Millions of people have been experimented on against their will. Public Authorities have ignored the basic principle enunciated at the Nuremberg Trials in 1947 when it was decreed that "the voluntary consent of the human subject is absolutely essential" before any treatment or experiments can be performed on him.

In fluoridation then, you have an authoritarian concept put in practice by the very people who, as likely as not, took part in the fight for the "Free World"!

(ii) Chlorine and Fluorine.

ARGUMENT: The ethical blindness just discussed is illustrated when proponents argue that as chloride is put into the water supply to kill harmful bacteria which might cause an epidemic, so why not fluorine to reduce caries? Both are preventive measures.

REPLY: There are two different principles involved. A public water authority is under an implied contract to purify the natural water and deliver it to the consumer, inter alia, free from harmful bacteria which might cause an epidemic. The use of sundry chemicals for this purpose, including chlorine, is necessary and ethical. They are not added or used to produce any positive or negative effect (i.e. preventive medicine) on the human organism. As such they do not constitute drugs.

Fluorine, on the other hand, is not added to the water supply to purify it, but to cause an alteration, primarily the tooth structure, in the human body.

In one case chemicals, chlorine being one, are used to ensure that the water is pure and safe to drink. In the other, fluorine is added to treat the human body and it is no part of its function to purify water.

(iii) Water supplies "deficient" in Fluorine.

ARGUMENT: Having decided that water having less than i to i \ parts per million fluorine is "deficient" in fluorine, then to add to this deficient water sufficient fluoride to bring the fluorine content up to this optimum amount is not "mass medication".

REPLY: The amount of the extra fluoride added is not the point. It is the violation of a basic ethical principle that matters. To add any material whatever to the public water supply to treat the mass of the population is no other than "mass medica­tion". To say otherwise is a sophism. (Incidentally New Zealand which has an area comparable to Great Britain and Ireland, has no water supplies serving the public containing more than 0.50 parts per million fluorine and the average of 109 supplies is less than 0.15 parts per million. Report New Zealand Commission).

(iv) Fluorine is "harmless" and "beneficial".

ARGUMENT: There is another argument which states that fluorine in the proportions suggested is quite harmless and everybody will certainly benefit. Fluourine is, in fact, a necessary nutrient and not a drug. How then can it be unethical to do good?

REPLY: The point is not whether the drug fluorine (in this context) is harmless or not, but whether its use in this way is in accordance with established medical practice. This method must, of necessity, ignore the doctor-patient relationship which is implicit in any medical qualification and legal registration. Sir Stanton Hicks in a letter to the "Medical Journal of Australia", Vol. 2, p. 156-157, said; "I submit that the medication of a whole population variable in individual response, regardless of individual age, state of teeth, of general health, rate of consumption of water, and so on, is quite unscientific and unethical, and that the passive acceptance of the right of a government or municipal authority to implement such medication through its water supply, is to sacrifice a fundamental principle of medical practice". Sir Stanton goes on to say; "Once, however, the principle of personal responsibility is abandoned, why not iodine in the water supply in goitrous regions, or aspirin for the mass Australian headache? This is the very essence of authoritarian 'progress' . . .".

Unfortunately, authoritarianism is only too well established. Iron and chalk in bread, iodine in salt and so on. Often we are quite unaware of what we are eating. William Cavendish in The Citizen, Gloucester, on 20th April 1960 in an article called "Go Steady with Those Slimming Tablets!" says: "There is strong scientific evidence that it will soon be possible to prevent much illness by administering the proper drugs in 'invisible' form, just as some towns already add fluoride to their water supplies to reduce dental decay.

Is not this kind of thing very dangerous? Does it not put too much power into the hands of medical administrators in treating whole populations as if they were cattle who must drink and eat what they decree ? Water is needed by everyone. It is time we demanded pure water always and not water, doctored, to the whims of these people.

CONCLUSION
The inevitable conclusion, then, is that on ethical grounds alone, the fluoridation of water supplies is absolutely unjustified.

3. Does Fluorine always reduce Dental Caries ?

The claim that dental decay in children and infants is reduced to less than half its former level seems very remarkable. With so many variables is this really possible?

The Expert Committee of the World Health Organization in their Report published in 1958 says that "hundreds of controlled fluoridation programmes ..." are being carried out (page 20, para. 6), but it quotes only from the results of a ten-year programme of three! (Page 8, para. 1, 7). While the Committee comment on the uniformity in the reduction of caries by 60%, it does seem odd to make such an assertion on such a very small base. Do they select the favourable results and ignore the others? From the information the author has gathered, this appears to be true.

(i) Increase in Dental Caries in areas where the water is Artificially Fluoridated.

In Ottawa, Kansas. Sodium fluoride was added to the amount present naturally to bring the concentration to 1.0 part per million in 1946. At the beginning of the test 82.3% of the children five to six years old were caries-free. In 1949 only 45% were caries-free! (2).

IN NEWBURGH ON THE  HUDSON  RIVER,  U.S.A. This Was a "test" city where the water was artificially fluoridated and comparison was made with the "control" city of Kingston, where the water was fluoride-free. After ten years of fluoridation there were 50% more children with dental defects than in unfluoridated Kingston (3).

Dr. Ast, Chief of the Dental Bureau, who was responsible for this study, said the figures were not representative, as trained examiners were used in Newburgh and nurses and unqualified examiners worked in Kingston! Yet the New Zealand Commission included this as one of the tests which "were designed and executed with great thoroughness".

In Hastings, new Zealand.   Hastings and Napier in New Zealand draw their public water supplies from the same set of artesian wells. The only difference in the water supply of Hastings is that this supply has been artificially fluoridated. Evidence was given under oath to the New Zealand Commission by Mr. T. G. Ludwig, the dental research officer in charge of the Napier and Hastings trial, that there was more caries in the children in the fluoridated town of Hastings than in Napier after about two years' fluoridation. Deductions from his figures:

In Napier     10 decayed teeth, in Hastings 14.1  for 5 year-old children.
  "    "             10       "         "      "       "       23.5  "   6    "     "      "
  "    "             10       "         "      "       "       18.3  "   7    "     "      "
  "    "             10       "         "      "       "       12.7  "   8    "     "      "
  "    "             10       "         "      "       "       10.3  "   9    "     "      "

The reference is to deciduous teeth in the five-year-olds and to permanent teeth in the rest.

The author has searched the New Zealand Report with great care without finding any reference to the matter (4) (appendix f)

(ii) Decrease in Dental Caries where unfluoridated water is used.

It sometimes happens that the "control" city exhibits a reduction in caries as well, but no explanation of this is given. Thus none was given by Ast et al (1951) when between 1945/46 and 1949 the deciduous teeth of the six-year-old children showed a D.F.* decrease from 32.1% to 24.8%(5). Would this fact upset the fluoridation thesis? The city concerned was Kingston.

(iii) Increase in Dental Caries where naturally fluoridated water is used.  

On the other hand it sometimes happens that there is an increase in caries in naturally fluoridated water areas. Thus Stratford, Ontario, said to contain 1.3 parts per million fluoride, even more according to some authorities, in its water supply, seemed to have hit a bad spot. In this area the dental caries in 1955 is found to be (Decayed, Filled, Missing Rate) 63%, 67% and 48% higher than in 1948, for the six to eight, nine to eleven and twelve to fourteen-year-old groups respectively! (6).
In spite of this the Ontario Department of Health (1956) says there was "no change". When it happens the other way round, it is called "a very important, statistically significant reduction in tooth decay"!(6).

Riverside, California, received the usual proposal to fluoridate  owing  to  the  deplorable  condition  of the  children's teeth. Subsequent analysis of the water revealed that it already contained the so-called "magic"  amount of fluoride naturally!(7)

Many other instances could doubtless be found to show that results are quite unpredictable. The results show that there are so many factors, many of which are unknown, that there is no assurance that this wonderfully uniform reduction of caries will be achieved. In the next chapter the "safety and harmless-ness" will be considered.

* Decayed, Filled. Now expressed as d.e.f. when referring to deciduous teeth.


4. How "Safe" is Fluoridation ?

''No harmful effects on health will follow the fluoridation of water supplies, whether in respect of the complaints specifically made to us or otherwise."
            New Zealand Commission of Inquiry on the Fluoridation of Public Water Supplies (1957).

(i) Evidence of Acute Poisoning.

Proponents do not deny that if taken in sufficient quantities, sodium fluoride is poisonous, but they argue so are many other foods taken in excess. To illustrate this, in paragraph 199 of the Report of the New Zealand Commission, we find that "A retained dose of 5 to 10 gm. of sodium fluoride probably would be fatal to a human adult. But this lethal quantity would be contained in 550 to 1,000 gallons of water, all of which would have to be swallowed in a few minutes to have a lethal effect". To put it another way, this is to admit that 1 1/4  to 2 1/2 teaspoonfuls of sodium fluoride dissolved in a tumbler of water would be lethal. This is mentioned to illustrate how toxic it is compared to common salt which is sodium chloride. (Deduced from footnote to Para. 65, New Zealand Report.) But from other sources it appears that much smaller quantities than this would be fatal. For example, "School Chemistry for Today", written by F. W. Goddard, m.a., f.g.s., of the Science School, The College, Winchester, and Kenneth Hutton, m.a., d.phil., Headmaster, Hatfield School, Hatfield, states otherwise. Under the subject "Fluorine" there is a note of warning, thus: "N.B. Compounds of fluorine are poisonous; 100 mg. of NaF (Sodium Fluoride) is fatal, but up to 3 mg. per day it may improve the teeth." It is interesting to note that in the description of the properties of the other halogens, no such warning is given.

So we have one authority telling us that it might require as much as 10,000 m.g to prove fatal and another only 100 mg.! What is one to believe ? 

(ii) Evidence of Chronic Poisoning.

Of course no one could drink even 10 gallons of water in a short time and to bring such an elementary fact to the notice of the reader is to try to ridicule those who hold that fluorine can be dangerous. The real danger of fluorine poisoning is from the continual drinking of water containing artificial fluorides over the years. Like arsenic, it is a cumulative poison. "From the chronic toxicity point of view, fluorine is the most dangerous poison known" (Dr. Douw G. Steyn).

But to suggest that there is any real danger from the proponents' point of view is quite absurd. In support of their contention the well known Bartlett/Cameron investigation is quoted. Bartlett contained 8.0 parts of natural fluoride per million in its water supply and Cameron 0.4 parts per million. All official reports on these tests are to the effect that the only demonstrable difference was the mottling of teeth in Bartlett.* This test was conducted between 1943-1953, and the number of participants was 76 in Bartlett and 80 in Cameron(8). Dr. C. G. Dobbs of Bangor, North Wales, when evaluating this study, ^**  points out that in the very small sample taken, the age distribution was so different that 14 deaths in one group is not significantly different from 4 in the other(12). Another quite unexpected result is that the younger population revealed nearly twice the amount of heart and blood-vessel disease as the older! While all the people observed had lived 15 years in Bartlett, only 14.5% had lived there all their lives. What is more, at least 82% of those who have been taking Bartlett water during the bone forming stages, showed evidence of osteosclerosis(9).

Waldbott in a pamphlet published in 1955, gives the following information of the incidence of disease in Bartlett compared with U.S.A. as a whole(10).
 
                                                                  Bartlett            U.S.A.
Arthritis                                                      13-8%           less than 1.0%
Increase in bone density    .                         10.1%            no record
Cataract                                                     10.1%            less than 1.0%
Hearing Defects                                          19-4%           average   7.0%

Of course, if Bartlett and Cameron showed little difference in health, according to the reports, then it must be pointed out that Cameron is also a town with naturally fluoridated water. In New Zealand for example, the average fluorine content is about 0.15 parts per million (11).

* See Appendix (d).
** B. M. J. Feb. 12th 1955.

(iii) Reports of Injury to Health.

In spite of considerable opposition, the town of Andover, Hampshire, was artificially fluoridated. Soon after this was done complaints of illness were made. The Town Council rejected these complaints with the result that at the annual elections candidates supporting fluoridation were gradually displaced until a majority on the Council stopped the experiment.

One of the complainants was Mrs. R. Harvey who was Mayor of Andover in 1949. In a letter to the author she says that "for many years I have been troubled with colitis and ulcers but had always managed to keep about. With the introduction of sodium fluoride into the water I felt too ill to work and, in fact, for several weeks did nothing but rest and feel sick". No other members of her family appeared to be affected. When she got supplies of unfluoridated water the symptoms passed off, but if by accident she took such water she "felt unwell within an hour or so with the old symptom of feeling sick". Eventually she put down an artesian well in her garden at the cost of £200 and neighbours came with their cans and jugs to get pure water (Appendix (e) ).

Another interesting case refers to turkeys dying from drinking fluoridated water from the same source. One of the properties of fluorine is to precipitate the soluble lime in the blood, the absence of which prevents blood from coagulating. In fact the blood becomes so limpid that it will pass through the blood-vessels and cause death by haemorrhagic syndrome (13).

The foregoing happen to be known to the author personally, but there are numerous other cases. Thus in Sheridan, Wyoming, the mayor became concerned about the increasing illness of the inhabitants. A two-year study by Mr. J. F. Raper, The City Attorney, convinced him that fluoridation had been completely misrepresented. Scores of older people were stricken with various ailments mostly relating to the urinary tract. Specialists, upon hearing that they were drinking fluoridated water, advised them to discontinue its use, when the trouble cleared up.

In Saginaw, Michigan, after fluoridation had ceased, "a large number of individuals with stomach troubles, bladder disorder and arthritis, especially in the lower spine, improved or recovered completely" (7).

There are very many other reports, even of deaths, and according to the Boston Herald of 21st November i960, the folly of the Fluoridation Fallacy is fully confirmed by a statement made by Dr. Charles Gordon Heyd, former President of The American Medical Association, as follows:

"I am appalled at the prospect of using water as a vehicle for drugs. Fluoride is a corrosive poison that will produce serious effects on a long term basis. Any attempt to use water in this way is deplorable" (See also Appendix (d) ).


5.  Comments on Other Statements made by the Promoters of Fluoridation

(i) Fluorine in Tooth Substance is proportional to water drunk.

In paragraph (iv) in the argument for fluoridation it is stated that "the amount of fluorine in the tooth substance depends directly on the quantity present in the water drunk by the mother and child during the tooth's formation and growth"(1).

This is not the whole truth, but is calculated to influence the reader to demand fluoridation as if it were the only source of this mineral. Food cooked in fluoridated water is not "drunk" but the fluorine is absorbed by the individual eating it. Tea, fish and doubtless many other foods and beverages contain traces of fluorine. For example, the people of Samoa have excellent teeth in spite of the fact that there is no fluorine either in their soil or water supplies. Many other elements contribute to strong healthy teeth; calcium and phosphorus for example. In fact, healthy food rich in mineral salts probably contributes just as much to the health and soundness of teeth as the vaunted fluorine.

(ii) "Fluorine appears in the water in exactly the same state as does the fluorine derived from natural sources" (1).

Of course fluorine, being an element is the same whatever its source. This is to infer that calcium fluoride, for example, and the artificial salt, sodium fluoride, act in precisely the same way as the fluorine, the active component needed for tooth protection, and is the same in both salts. The sodium in common table salt, sodium chloride, also appears in the water, when in solution, in exactly the same way as does sodium derived from sodium fluoride. Very well then. Take a teaspoonful of common salt, dissolve it in water and drink it. Do the same thing with sodium fluoride. Of course you would not dare to do so unless you wanted to commit suicide. But the lay mind is deliberately misled.

(iii) "A recent study carried out in Russia goes so far as to claim that people in high fluoride areas live longer and enjoy better health than those in low fluoride areas" (1 and Appendix (a) ).

This is a statement made without giving the source of information, but if true it seems remarkable that the Russians do not add artificial fluoride to their water supplies. But they say they do not (14). In fact they say "There are strong objections (to fluoridation) on the grounds that general fluoridation makes the dosage according to individual requirements unattainable" (14). Dr. Gary, D.D.S., N.Y.C, in personal correspondence (dated 25th February 1960) with the "National Fluoridation News" and quoted in their March-April issue of 1960 states, inter alia, "Right now they (the Russians) are rather discouraged about using fluorine and have erroneous reports that they claim are from the U.S.A.". (Dr. Gary at the invitation of the Soviet Minister of Dental Education has taken a 4,000 mile tour in Russia).

(iv) "The cost is only 4.d. per head per year" (1).

In spite of statements to the contrary, it is only children and expectant and nursing mothers, the latter as sources of nourish­ment to children born and unborn, who can "benefit" from the fluoridation of water supplies. Suppose this is one half of the population. The average water used per head per day of the population may be taken at 50 to 60 gallons of which say, a gallon per head is drunk and used for cooking. Therefore only about one gallon in every 11 o is useful, even supposing fluoride to be beneficial. To put it another way, the community is called upon to pay at least 110 times more than it need for a very doubtful benefit!

And even 4.d. per head looks like a very low estimate.

A report in the U.S.A. (Norwich Bulletin of 19th April 1960) states that a privately owned water company estimates that the cost of using modern equipment in Jewett City, Connecticut, is between $1.0 and $2.0 per head per annum. Even allowing for the difference in prices between America and Europe, it looks as if this estimate is fantastically low.

(v) Fluoridation of the Public Water Supply is not Mass Medication and the liberty of the subject is in no way impaired. Fluorine is not a drug.

This is a monstrous statement divorced entirely from simple facts. Any substance (note the word "any") usually taken internally, used as a basis or ingredient in medical preparations; a potion, a poison, is a drug. Fluorine is a poison. The public water supply is being used as the vehicle of this poisonous drug and in this way mass medication of the community results.

The New Zealand Commission says the liberty of the subject is not infringed and in support of this quotes Mr. Justice Harlan speaking for a majority of Judges of the Supreme Court of the the United States. He stated:

"We are not prepared to hold that a minority residing or remaining in any city or town where smallpox is prevalent,. . . may thus defy the will of its constituted authorities, acting in good faith . . .". The quotation applies to control over the individual when dealing with an infectious disease. Quite necessary of course in that context. But it has nothing whatever to do with fluoridation. (Para. 505, "New Zealand Report on Fluoridation).

So it was that the House (Delaney) Select Committee, having heard expert witnesses on both sides of this controversy, reported to the U.S.A. Congress in 1952 that "It is safe to say that fluoridation of water supplies is mass medication without parallel in the history of medicine".

(vi) Mottled enamel due to low fluorine concentration up to 2 parts per million actually "improves" the appearance of the teeth (See Chapter 1 (iii), also (1) ).

Whether the appearance of the teeth is improved by slight mottling is surely a matter of opinion. The owner should be the judge of that. Bearing in mind the grim warning mottling provides, one is tempted to compare the "improvement in appearance" with that of a pupa acting as host for an ichneumon fly grub.

There is no doubt whatever that tooth mottling from fluorine is a warning of future disease even although at the moment it is not felt. According to Shortt et al (34) it takes twenty-five to thirty years before the first toxic symptoms appear. These are a recurrent and general tingling sensation in the limbs and over the body generally. Pain and stiffness next appear and, with the passing of years, pain especially in the lumbar region of the spine. Other unpleasant conditions arise and the patients exhibit definite cachexia. Finally the patient becomes completely bedridden, though death usually occurs from intercurrent disease.

(vii) The Pseudo-scientific Propaganda  using the technique of the "big lie" (1).

The author will refrain at present from commenting in detail on this type of statement, but from his study of the fluoridation problem has never come across extravagant language used by opponents of fluoridation; it has, in fact, been just the other way round.


PART II
6. An Examination of some Items of the North American Fluoridation Trials and an Assessment of their Reliability

(i) Introduction.

In the first part of this essay a reply has been given to the claims of the promoters of fluoridation. The documents supporting their claims have been, in the main, the Reports of the Expert Committee on Water Fluoridation which was published by the World Health Organization in 1958 and the New Zealand Commission of Inquiry on the Fluoridation of Public Water Supplies which was published in 1957.

Most of the information drawn on by these bodies comes from the Grand Rapids Study, the Evanston Study, the Brantford Studies (two in number) and the Newburgh Study. All took place in North America. They have been carefully considered by a number of eminent scientists, dentists and doctors who, in contrast to the promoters' views, find very serious shortcomings in them. Let us now consider some of the many shortcomings revealed in these Studies.

(ii) Water Supply Analyses are not stated.

In 1949 the American Waterworks Association pointed out that the experimental verification of the fluoride-dental caries hypothesis "obviously necessitates the use of a nearby 'control' with a water supply comparable in all respects to that to which the fluoride is added". (The author's italics.) Dean, Jay, Arnold, McClure and Elvove (1939) recognized this by stating that the composition of the water in other respects may also be a factor that should not be overlooked. "For this reason it seems highly desirable that dental caries studies should be accompanied by a complete chemical analysis of the dam waters, including a search for comparatively rare elements".

Yet in not one of the reports on these world famous trials was the composition of the water stated! (15).

(iii) Comparable waters become contrasting waters!

Thus in regard to the Newburgh/Kingston study reports taken in chronological order give the following information.

1950 (Ast et al) These waters "at the outset of this study were comparable and have remained so".
1953        (The   United  Kingdom   Mission)   Newburgh  water  is from "Surface water".
1954        (The U.S. Geological Survey [Lohr and Love] ) Kingston's   water   is   from   "Mountain   spring   impounded".

The same authority publishes the analyses of the finished waters made in February 1952. Some of the contrasting features of this analysis are given below.

                                        Newburgh                    Kingston
Calcium   .....                 35.0 ppm                         6.6 ppm
Magnesium        ....         3.6    „                            0.9    ,,
Hardness .....               102.0    „                          20.0    „    (16)

(iv) Delay in tooth eruption.

In the Evanston study there appears to be a progressive decline in the number of the first erupted teeth in the six-year-olds. In 1946, the year when fluoride was added to the city's water supply, the mean of the first molars erupted per 100 children was 189, in 1948 it was 156, in 1950 it was 140 and in 1951, 132. No further data were published. It is permissible to wonder why? It should not be overlooked that in 1951 the then six-year-old children had spent most of their lives under fluoridation. In fact this may give a clue to the much advertised "reduction" in caries. As the teeth are not erupted there can be no decay!  (17).

(v) Variations in the incidence of caries in a "control" city.

The "control" city in the Grand Rapids study was Muskegon. This city served that purpose for six years when in 1951, when comparisons would have been most informing, the water was fluoridated. Between 1945 and 1951 the d.e.f. (decayed, extracted and filled deciduous teeth) and the D.M.F. (decayed, missing and filled permanent teeth) differed considerably from those at the first examination. As Sutton points out on page 12 of "Fluoridation", the changes which occurred would have been 40.7% instead of 1.5% in the six-year-olds, and 32.7% instead of 15.5% in the eleven-year-olds if the results had been computed in 1946 instead of 1951. These changes indicated a reduction of caries. Yet Arnold et al in 1956 reported that the rates in Muskegon "remained unchanged" during the period 1945 to 1951.

Of course a reduction of caries, if any, in a "test" city was always the result of fluoridation.

(vi) Variations in sample size.

To get any reliable information about the incidence of dental caries in different age groups one would have expected that great care would have been taken to have the sample groups as near equal as possible. But what do we find? In Muskegon, in twelve categories, fewer than twenty children were examined. One "group" consisted of one child and the largest of 462! In Grand Rapids, the "test" city, it varies from 1,806 to 3! (18).

(vii) Variations in methods of Assessment.

A comparison of the Evanston D.M.F. rates, where X-ray methods were employed, were compared with the rates for Aurora, Illinois, where only clinical methods were used! (19). What reliability can be placed on the results, particularly when the X-ray technique is much more searching?

(viii) Unreliability of the assessment of dental caries rates.

As every examiner has his own technique, he may have bias in spite of himself and have his "off days", it would appear essential to lay down checks which would reduce errors to a minimum. For example, to eliminate bias as far as possible, children from "control" and "test" cities might have been mixed to some extent so that the examiner would be unaware from which city the subject came. No evidence of this kind can be found to show that such steps were taken.

To show how much examiners can vary, two studies of Brantford, Ontario, serve as an illustration.

Age                     City Health Dept. caries    Canada  Health  Dept.     %
                                      per child                       caries per child
6 to 8   .                          0.84                                 1.41                     +68
9 to 11 .                          3.37                                 4.07                    + 21
12 to 14 .                       6.11                                  7.68                     + 25

The above table refers to permanent teeth for the same group of children in the same year! Almost like comparing a fluori­dated with a non-fluoridated city!(20)

Another example refers to the findings of the Delaney Select  Committee which  ". . . cited the results of an investigation by a Minneapolis caries study group* in which eight dentists  examined thirty-three subjects. Each patient was examined by  three dentists who knew their findings would be checked and  had unlimited time,. . ." ". . . in the case of five examiners. .. agreement would occur once only in 50 to 100 times." (21)

* Jnl. Amer. Dent. Assoc. December 1941.

(ix) Contrasting Conclusions.

 Only a part of the available evidence from these five crucial trials has been marshalled in the foregoing paragraphs, but  enough to show many anomalies. It seems opportune, therefore, to cite some of these contrasting conclusions drawn from the same evidence by different authorities.

(A)  The Conclusions of Dr. Philip R. N. Sutton in Fluoridation: Errors and Omissions in Experimental  Trials,  2nd ed.   1960. (See Appendix (b) ):

Dr. Sutton says "The reliability of the results reported is affected by: (a) odd experimental and statistical methods; (b) failure to consider random variation and examiner variability, and to eliminate examiner bias; (c) omission of relevant data; (d) arithmetical errors; (e) misleading comments". He then points out that (f) "Controls were either doubtful or inadequate", (g) "No control was employed in one trial", (h) "The published data do not justify the statement that caries rates remained the same in control cities". His final conclusion is that "The sound basis on which the efficacy of a public health measure must be assessed is not provided by these five crucial trials".

(B)   The Conclusions of Dr. Douw G. Steyn in The Problem of Dental Caries and the Fluoridation of Public Water Supplies  (22).

As this work deals with other aspects of fluoridation not covered by that of Dr. Sutton his views are of particular value. After referring to the unfavourable reports on these trials he makes the following points: (a) "The concentration of fluorine recommended as prophylaxis against dental caries is dangerously near the concentration which causes chronic fluorosis". (b) "It is most unscientific, inadvisable, and dangerous to permit many millions of people, irrespective of age, sex, occupation, susceptibility, climatic conditions, disease, eating and drinking habits, to consume water containing the same concentration of fluorine", (c) "There appears to be a possibility that it may temporarily inhibit dental decay but after some years enhance dental decay and in later years of life cause periodontal disease", (d) "No reliable experiments or observations to determine the median chronic toxic dose of fluorine, have as yet been conducted", (e) "There is no consensus of opinion among authorities as to its safety and well founded grounds for seriously doubting its safety to human health", (g) "It is safer, and equally effective, to apply fluorides (stannous fluoride) topically at regular intervals".

Dr. Steyn reminds his readers that "from a chronic toxicity point of view, fluorine is the most dangerous poison known".

In view of the foregoing utterly unfavourable reports, it is extremely informing to quote the authoritative bodies on which so much reliance is placed.

(C)    The Report of the New Zealand  Commission on the Fluoridation of Public Water Supplies (1957).

This Commission reports that "All these investigations were designed and executed with great thoroughness". (Para. 70).

This Commission consisted of a judge, a biochemist and a merchant. They were assisted by a lawyer but there is no evidence that they engaged the services of a trained statistician. Yet they assert that "We have examined the statistical evidence brought forward by the advocates of fluoridation, and the conclusions they have drawn from that material..." "We have found nothing to invalidate these statistics or cast doubt on their reliability". In para. 100 they say "We are satisfied that the supporters of fluoridation have drawn the correct conclusions from the data and that the effectiveness of fluoride in reducing dental decay is established beyond all doubt".

Among their conclusions they say:

    (a)      "The process does not involve medication of community supplies.
    (b)      "No question of personal liberty arises in regard to fluoridation".

If they believe the foregoing it is not surprising that their final conclusion reads:

"As the process would not be acceptable if it were ineffective or hazardous, any objections to it based on personal rights should be evaluated as objections to a public health measure which is not merely beneficial but also safe".

(D)    The Report of the World Health Organization Expert Committee on Water Fluoridation.

The Experts mention "hundreds of controlled fluoridation programmes" but name only the Newburgh, Grand Rapids and one of the Brantford Trials, the last being the one carried out by the Health Department of that city. Less than sixteen lines are devoted to stating the objects of these trials, but they say that "The studies were carefully planned and controlled....".
The conclusions are interesting, and as follows:
    (a)      Drinking-water containing about  1  ppm. fluoride has a marked caries-preventive action.  Maximum benefits are conferred if such water is consumed throughout life.*
    (b)      There is no evidence that water containing this concentration of fluoride impairs the general health.*
    (c)       Controlled fluoridation of drinking-water is a practicable and effective public health measure.

So often have the experts been wrong, but it is perhaps unique that such important authorities should come to such utterly unjustifiable conclusions. It would seem that a number of relevant facts have been kept from them. There may have been motives for this which will be discussed in the next chapter.

* How can this be known when a synthetic fluoride in the artificial fluoridation of public water supplies has been used less than a lifetime? At the time of writing this essay it started fifteen years ago, in 1945.

7. A Glut makes a Quandary

(i) Turn a Glut into an Asset.

The reader may well wonder why, in view of the conflicting evidence given in the first parts of this essay, the promoters of fluoridation still force one-sided views on the public and ignore or try to denigrate those who throw doubts on the safety and effectiveness of the process ?

Many years ago it was noticed that people living in some areas where there was natural fluoride in the water appeared to have harder teeth more resistant to dental caries. Nearly all these teeth, however, were mottled and the excessive hardness rendered them liable to fracture and difficult to treat. These latter facts have been "played down" by promoters and it is even suggested that slight mottling "improves" the appearance of teeth! Yet this is a pathological condition indicating unbalanced bodily metabolism and a warning of the build up of a crippling disease, such as osteosclerosis.

Medical Officers of Health who have only heard part of the story have been consequently influenced to accept the alleged advantages without question, particularly when supported by authorities whose standing, at first sight, should be unquestioned.

It is common knowledge that an aggressor often accuses a neighbour of some act of which he is quite innocent, in order to pave the way for aggression himself. You will remember how Hitler said that the Sudeten Germans in Czechoslovakia were being ill-treated, and made that the excuse, or one of the excuses, for invading that country. Similarly in America the promoters of fluoridation have in some cases adopted a similar technique. In the United States an opponent of fluoridation is often called "someone with something else to sell" implying a commercial interest offering an alternative remedy, which if accepted, would be an advantage to the opponent. But that is just what the commercial interests in favour of fluoridation want themselves. Certain industrial processes produce dangerous fluoride wastes. Smoke and fumes from such sources can contaminate pastures, causing bony swellings, stunted growth, damaged teeth, diarrhoea and sometimes death to farm animals. Apart from the intense suffering to animals, their economic value is destroyed, pastures are ruined and compensation has had to be paid to farmers.* But if this poison could be distributed all over the place and made to do good, commercial and medical interests would be satisfied!

So it came about that the tests were started with the results we have already discussed. We are told that some 30,000,000 people are drinking artificially fluoridated water in the U.S.A. There has been a very satisfactory price increase from 1.5 cents to 15 cents per pound for the fluoride (24). It does not take a genius to discover that the sale of fluorides has now become a very profitable business which must be kept going and in­creasing by all possible means.

(ii) Discreditable Methods of Promotion.

So we come to the discreditable methods of promotion practised in the U.S.A. It takes two forms, one being promotion pure and simple, the other silencing of opponents. Let us take examples of the latter first:

(a)     In a letter by H.H.L. (M.D.) to Dr. W. W. Bauer, the following paragraph appears: "Are you aware of the fact that Section 20 of their (American Dental Association) Code  of Ethics,   prohibiting  dentists  from  expressing themselves publicly against the position of their organization, was added expressly to eliminate all opposition to fluoridation?" (25)
(b)     J. E. Waters (d.d.s.) of Coronado, California, who had prepared a series of anti-fluoridation articles for a San Diego paper, was warned that if they appeared, disciplinary action would be taken against him.  By such tactics the pro-fluoridators got their way at first and the city adopted fluoridation. But it was only a short lived victory as the city has now abandoned fluoridation of its water supplies (26).
(c)  J. Forman, b.a., m.d., f.a.g.a., f.a.a.a., giving evidence before the President and Members of the City Council of Columbus, Ohio, U.S.A. said "... I am greatly disturbed by the fact that dentists who disagree with the majority are not allowed to speak for fear of losing their membership of the Dental Society, and thus their protective insurance, and suffer other indignities" (27).

* A Report on Fluorosis in Cattle in The Columbia River Valley, by D. H. Udall and Keith P. Keller and reprinted from The Cornell Veterinarian, Vol. XLII, No. 2, April 1952. Also Medical Research Council, Memorandum, No. 22 on Industrial Fluorosis. "A Study of the Hazard to Man and Animals near Fort William," Scotland 1949.

(d)  Writing on the "stifling of opposing views", Waldbott (23) states:
The ruthless stifling of opposing views is being reported from all over the United States. Any opponent is labelled "emotional", "a religious fanatic", "crackpot", or "someone who has something to sell". An investigation of the background of some of these opponents revealed that they are scholarly and brilliant scientists (35).

(e)  Positive promotional work has taken the following form:
At the Fourth Annual Conference of State Directors with the Public Health Service and the Children's Bureau, Bull,   Director  of Dental   Education,   State   Board   of Health, Madison, Wisconsin, U.S.A., discussing "Promotion   and   Application   of  Water   Fluoridation"   is reported to have said,  ". . .  these fellows   (the  'anti-fluoridators') can just take the statements of the American Dental Association or the United States Public Health Service, the Deans of dental schools of research workers . . . and they can prove to you that we are absolutely crazy for even thinking about fluoridation. . ." ". . .When we are having the Press in, and the public in, DON'T HAVE ANYBODY ON THE PROGRAM who is going to go ahead and oppose us because he wants to study it some more."  "Your local component dental societies have also got to have programs on fluoridation. When they have the first meeting at the local level, that is the time to get the press in, AND AS A RULE DO NOT EVER WAIT FOR THAT. If we are going to present something THIS EVENING ... we get over to the newspaper office this afternoon". "You know the series of articles that was gotten out by the Cleveland Press on fluoridation?"  (For which the Lasker Foundation paid $500.00 and a gold cup.)  "You remind them that the press has been one of the greatest factors in the PROMOTION of public health". There is much more in the same  style.   Later  he  states  that  "THE  MEDICAL AUDIENCE IS THE EASIEST audience in the world to present this to . . ."(28)

(f) Mr. W. A. Penlington, President of the Hastings (New Zealand) Anti-fluoridation Society, reports on a confidential official document setting out the tactics to be employed to put over fluoridation. The theme is to work quietly and avoid a fuss, not to worry about population as a whole, but set about getting support of small pressure groups,  then report to the public  authority councils the demand from the public. Let any doubt as to its safety  get into the minds of the councillors and they will  refuse to act and so on.

(g) Sincere but misled, the M.O.H. quoted on page 28 is an apt pupil of these promotional tactics. He talks of  "Pseudo-scientific propaganda". He says "This propaganda contains a substantial number of frightening  statements that are, without exception, demonstrably false".  "They have used the technique of the 'big lie' again  and again". "Unfortunately the effect of their publications on the uninstructed lay mind can have much the  same effect as did the writings of Streicher on the German  Nation" (1).

In the debate on fluoridation in the Jersey States in February 1960 Deputy Macpherson considered this last sentence 'a scandalous remark to make'. In the end fluoridation was rejected (1).

Thus the views expressed by Dr. Douw G. Steyn in his book The Problem of Dental Caries, seem justified. With Dr. Steyn's permission the author quotes them as follows:

"The story of fluoridation of public water supplies in the United States of America makes very sad reading. Sad, because some of our colleagues in that great country appear to have lost sight of the extreme importance of the pros and cons of this proposed method of combating tooth decay and have indulged in attacks of a personal nature".

8. The Growth and Signs of Decline of Fluoridation

When a gigantic campaign, backed by funds and world authorities, is set in motion, it would be surprising if some initial success were not obtained in putting over the Fluoridation Propaganda. Its greatest success has been in the U.S.A. and its complete lack of it has been in France. In the latter country, although a Bill was introduced into the French Chamber in 1954, neither the Ministre de Sainte Publique nor the Institute Pasteur approved, while the final coup was given by Professor Fabre, Dean of Pharmacy at the University of Paris, who gave a lecture on fluorine poisoning on the occasion of the French Dental Day in Paris in November 1954 (29).

(i) The Flow and Ebb in America.

In America the Public Health Service of U.S.A. said that the water supplies of 1,085 communities representing some 21 million people were being fluoridated in 1955. Yet some 500 cities had either rejected it or abandoned it. These represented some 40 million people (30). So already in 1955 there were signs of a decline. Amongst those who gave it up are San Diego in California, Northampton and Williamstown in Massachusetts. New York refused it. That was five years ago at the time of writing this essay, August 1960.

In confirmation of this Mr. Arthur Flemming, United States Secretary for Health, said at a news conference on 9th February 1959, that less Americans in proportion were drinking artificially fluoridated water. He gave out a report prepared by the Public Health Service which stated:

"Of special concern is the steady decline in the rate of community acceptance (of fluoridation) in the past six years.....1953 was the peak year, during which 378 separate communities adopted fluoridation. Since 1953 the number of communities starting fluoridation programmes has dropped each year . . . Moreover, the number of communities which discontinued fluoridation programmes has steadily increased".

There are now over a hundred communities in the U.S.A. which have discontinued fluoridation. This is partly due to mounting American medical and dental opposition. About 700 communities have now refused fluoridation (31).

Up to April 1960 (from 1st January), at least 29 American communities rejected or stopped fluoridation.

(ii) Rejections of Fluoridation elsewhere.

In England. Amongst those communities that have refused it are Dover, Cardiff, Darlington, Sheffield and Andover. The last of these, as already mentioned, turned the Council Members who supported fluoridation out of office.

In Australia. Brisbane, Melbourne and other smaller places in spite of high pressure propaganda by Health Officials.

In new Zealand. In the elections of 21st November 1959 New Zealanders rejected all proposals to fluoridate water supplies!

This, in spite of the findings of their Commission on Fluoridation. In Dunedin,* one of the main centres of fluoridation propaganda, only 37% of the votes cast were in favour. In Havelock North, which had endured fluoridation for six years, only about the same proportion voted for its continuance.  But perhaps the most spectacular defeat was in Auckland, New Zealand's largest city. The City Council had refused a referendum. The pro-fluoride mayor was unseated and replaced by the President of the Anti-fluoridation Society as mayor!

In other countries. The information is scanty and conflicting, but in general it is safe to say that fluoridation is not received with favour.

* Dunedin is the centre of the New Zealand Medical & Dental Schools.

(iii) A New Zealand opinion on its Commission on Fluoridation.

(a) The Commission consisted of a judge, a merchant and a professor of Biochemistry selected by the Department of Health.
(b) Opponents of fluoridation were given no assistance whatsoever towards the cost of gathering evidence and presenting their case. Proponent witnesses were generally backed by public and professional funds.
(c) The opponents request to present a final address was refused.
(d) No steps were taken to get personal evidence from scientists who had made research into the medical effects of fluoridation.
(e) The expert evidence consisted mainly of second hand opinions.
(f) The occurrence of ill effects in Hastings (fluoridated in 1953) was the main cause of objection. Some thirty complaints were made to the Commission but no medical examinations were carried out, in fact the Commission was not competent to do so. Thus the Hastings complaints have never been disproved.
(g) It gave considerable space to American statements, but hardly any to first hand information available in New Zealand.
(h) The 1955 Hewat Report on Dental Caries in New Zealand was hardly mentioned. This report disclosed that the relatively "high" natural fluorine content (0.5 pmm) had no significant decrease in tooth decay. Yet Dr. R. E. T. Hewat is resident in New Zealand.
(i) It failed to report the greater decay of children's teeth in the fluoridated town of Hastings than in the unfluoridated control town of Napier.
(j) It does not tell of the highly successful New Zealand experiment with a tetradecylamine tooth-paste which gave 50 % to 55 % reduction of decay in thirteen and fourteen-year-old boys respectively.
(k) The report fails to uphold the basic principle of personal liberty and adopts the curious view that because fluoridation is "harmless" nobody has the right to object to this mass medication. It suffers, with many, from complete ethical blindness.
Note. Most of the foregoing was deduced from a report made by the Hastings Anti-fluoridation Society of 703E St. Aubin Street, Hastings, New Zealand.

(iv) The Expert Committee  on   Water Fluoridation  of the   World Health Organization.

Sutton points out that if the expression "carefully planned and controlled" when speaking of the North American Trials, as from the context he has every right to believe, made by this Expert Committee is their considered view, then the "inaccuracy of that statement is astonishing".

Sutton points out that "far from being carefully controlled" the Brantford (City Health Department) study "was not controlled at all". The control of Grand Rapids was given up after six years and the Newburgh trial following the unexplained decreases in the D.F. rates for deciduous teeth in the control city of Kingston between 1945-1946 and 1949 no further rates for such teeth were published. There are other points which Sutton makes, but enough has been said to show how completely unreliable the reports of these authoritative bodies can be (32).


PART III   

Summary and Conclusions

The amount of literature which has been published on this vexed question of the Fluoridation of Public Water Supplies is so voluminous that the author has only been able to cite a very small proportion of it. He has tried to take a fair sample which he hopes is enough to convey to the reader that the "Fluoridation Fallacy" is, indeed, a fact.

The argument for fluoridation has been given in some detail and the ethical blindness of the promoters discussed at some length. The false arguments about chlorine and fluorine, and "deficiency" in fluorine as a reason for adding more to the water supply have been rebutted. The abandonment of the personal doctor-patient relationship has also been criticised. On ethical grounds alone there is no case for the mass medication of a whole population even if the results were certain.

The results are not certain, but when they work out the wrong way they are frequently suppressed.

The harmlessness of artificially fluoridated water is a fiction and chronic poisoning and even deaths can occur.*

Consideration has been given to the reports of some of the trials which show that the most elementary precautions to ensure reliable results have been omitted so that they are of  little value.

The possible source of the drive to add fluorine to the public  water supply has also been discussed and some of the discreditable methods of promotion stated.

A short account of the growth and decline of the fluoridation campaign have been given as well as strong criticisms of the New Zealand and Expert Committee's reports.

It is noted that proponents never give unfavourable facts. Nowhere do they say that tooth eruption is delayed by fluoride in the water supply, they say teeth are stronger but omit to say they become brittle as well. They never say such teeth are difficult to treat and that the loss of teeth in the end is compar­able to the loss in non-fluoride areas. There are many other disturbing facts,  such as the high incidence of periodontal disease in these areas, which are passed over.*

Finally, the throwing of disgraceful epithets at honest scientific workers by a section of the profession, particularly in America, is to degrade the whole controversy to the rough and tumble of the political hustings.

In spite of all this, Jean R. Forrest, the Senior Dental Officer of the United Kingdom Ministry of Health who was a member of the Expert Committee of World Health Organization on the Fluoridation of Water Supplies, is stated to have contrasted "the emotional type of opposition" to fluoridation, to "the precise statements of scientists"! This lady was their rapporteur and one can only conclude that the facts which have been collected for this essay were not all known to her.

In 1925, Hampton Frost in An Outstanding American Epidemiologist (Bews, 1951) said:

"It is frequently easy to exhibit some figures which, though not really to the point, will nevertheless serve to impress an uncritical public, and the temptation may be great to give them, at least by implication, an unduly favourable interpretation. It is more difficult and more tedious to present the full argu­ment, based on all the facts, and it is perhaps a little humiliating to admit that the statistical evidence is deficient because we have failed to collect it; but to do this is not only more scientific, it is in the end more convincing, and after all there is no free choice, because it is the only honest method, whether it be convenient or not. Finally it is the only way of progress, for the first step towards collecting better evidence is to recognize the deficiencies of that which is at hand" (33).

Conclusions.

(a)  The fluoridation and the public water supplies is unthical and a gross infringement of individual liberty.
(b)       The efficacy of the system is not proven.
(c)        It involves grave dangers to health.
(d) Many proponents have used unscrupulous methods of propaganda which have misled the public.
(e) All possible steps should be taken to inform the public of these facts.

* The American Fluoridation Experiment, by Exncr, Waldbott and Uurly.


References
1.   "Report of the Medical Officer of Health for Jersey, Channel Isles", March 1959.
2.   Scrivener,  G. A.   (1951):  Unfavourable report from Kansas community using artificial fluoridation for a three-year period. "J. Dent. Res.", Vol. 30, p. 465.
3.  Waters,  J.   E.   (J955):   Are   Experts   Scientists?   "National Fluoridation News". Vol. 1, No. 4, p. 2 (U.S.A.).
4.   "Report   of the   Hastings   Anti-fluoridation   Society",   703E St. Aubin Street, Hastings, New Zealand.
5.    Sutton, Philip R. N., Fluoridation, Errors and Omissions in Experimental    Trials,   2nd   ed.    1960.    (Melbourne:    Melbourne University Press; London: Cambridge University Press) p. 57. See also Appendix (b).
6.   Sutton, Philip R. N., Fluoridation, Errors and Omissions in Experimental    Trials,   2nd   ed.    1960.    (Melbourne:    Melbourne University Press; London: Cambridge University Press) p. 46. See also Appendix (b).
7.   "The    National    Fluoridation    News".    March-April    1960. Riverside p.3, Saginaw p. 4, and Sheridan p. 1.
8.   Zimmerman et al (1955). Oral aspects of excessive fluoride in a water supply. "Journal of the American Dental Association", vol.  50, p.  272-277, quoted by Dr. Douw G.  Steyn in  The Problem of Dental Caries p.  84.   (Voortrekkers Beperk, Voorwaarts, Johannesburg). See also (22).
9.    Exner, F.  B.   (1955). Fluoridation of Public   Water Supplies. A report prepared for the City of New York. Published by North West Medicine. Quoted by Dr. Douw G. Steyn in The Problem of Dental Caries p. 85. 
10.  Tabulated from a pamphlet published by G. L. Waldbott in 1955 called Fluoridation of Public  Water Supplies 11. Promotional Aspects. See p. 87 of the Problem of Dental Caries by Dr. Douw G. Steyn. See also (22) and (23).
11.  Report by the New Zealand  Commission on Fluoridation of Public   Water Supplies in 1957,  p.   168.  Calculated from  data given.
12.  In    The   American   Fluoridation   Experiment   (The   Devin-Adair Company, 23 East 26th Street, New York  10, N.Y.), F. B. Exner, m.d., discussing this experiment (The Bartlett/Cameron Report) points out that if "you limit the figures to those persons who were fifty-five or less in 1943, the death rate among the Bartlett subjects was almost SIX times as high as among the Cameron subjects".  While expressing no opinion as to the cause he is emphatic that this sixfold difference demands investigation. "Not only was there no such investigation; the fact of the higher rate and the need for explanation are con­cealed by a carefully worded equivocation". (See also (23) ).
13.   Letter   to   author   by   veterinary   surgeon   responsible.   See Appendix (c).
14.   "The National Fluoridation News" March-April 1960, p. 2.
15.  Fluoridation 2nd ed. i960, by Philip R. N. Suttoti, p.II lix
16.   Idem, p. 49
17.   Idem, p. 27
18.   Idem, (Quoting Arnold et al (1953) ) p. 10
19.   Idem, p. 28
20.    Idem, p. 44
21.   Extract from a letter by Sir Stanton Hicks in 1950 to "Med. J.  Australia", vol. 2 p. 156-157.
22.           Douw G. Steyn, B.SC, Dr.MED.VET. (pharmavol) D.V. (TOX), Professor of Pharmacology,   Medical  Faculty,  University of Pretoria.
23.           Dr. G. L. Waldbott graduated from the University of Heidelberg in 1921 as M.D. He is a Fellow of the American College of Physicians, the American Academy of Allergy, etc. He made the first complete fungus survey in the U.S.A. He was the first to report a death from penicillin. He has made many other notable contributions to medical science such as important contributions to the development of the technique of pollen treatment in hay fever.
                Dr. F. B. Exner, M.D. specialized in Science, Chemistry, Physics and Biology. He graduated from the Medical School of the University of Minnesota in 1927. He has served as a consultant to the State Departments of Health and Vocational Rehabilitation.
24.   "American Capsule News", 30th November 1957.
25.    L., H. H. (1954); Dr. Bauer's letter. "National Fluoridation News", vol. 1, No. 10, p. 1 and 3, U.S.A.
26.    J. E. Waters (1955). Fluoridation and Freedom of Speech. Prevention, vol. 6, p. 98, U.S.A.  (Reprinted from Oral Hygiene, March 1954). Also quoted by Steyn in The Problem of Dental Caries, p. 74 and Waldbott in The American Fluoridation Experiment, p. 190.
27.           Forman, J. (1956): "A statement in opposition to fluoridation, April  2nd",   (Statement  to  The  Honourable  President  and Members of the  City Council of Columbus,  Ohio,  U.S.A. Reprint.).
28.   Proceedings 4th Annual Conference of State Dental Directors with the Public Health Service and The Children's Bureau, Washington, U.S.A., 6-8th June 1951.
29.   Reported on p. 113 in The Problem of Dental Caries by Dr. Douw G. Steyn.
30.    "The American Fluoridation Experiment", p.10.
31.    The Mew  Times, Melbourne, Australia, 30th October 1959. Article Section.
32.    Fluoridation 2nd ed. by P. N. Sutton, p. 70.
33.    Fluoridation 2nd ed. by P. N. Sutton p. 66 and 67.
34.    H. E. Shortt, G. R. McRobert, T. W. Barnard and A. S. M. Nayar, "Endemic Fluorosis in the Madras Presidency", Indian J. M. Res. 25. 553-568, October 1937.
35.    Quoted on p. 76 in The Problem of Dental Caries by Dr. Douw G. Steyn.


Appendix to References

CHAPTER I (v)  AND REFERENCE (I)
(a)  Russia.

The M.O.H. of Jersey gives no authority for his statement. If true it is remarkable that the artificial fluoridation of water supplies has not been tried in the U.S.S.R. An enquiry directed to the U.S.S.R. was answered in the following way on 1oth February 1960:

"The Institute of General and Community Hygiene at the Academy of Medical Sciences, U.S.S.R., informs that the fluoridation of drinking water supplies in the Soviet Union was not experimented with".

The British Dental Journal (105. 199-202, 1958) contains the following comments by F. J. Ballard about his visit to Soviet Russia. He writes:

"There are strong objections on the grounds that general fluoridation makes dosage according to individual requirements unattainable".

(A similar report is given by Wm. Ludwick, Office of Naval Research, London, England. Tech. Rep. ONRL-76-58, 9th October 1958.)

Nevertheless, Dr. Jean Forrest, Senior Dental Officer, U.K. Ministry of Health, tells U.S. Dentists in New York City that "the Soviet Union is one of the seven countries engaged in fluoridating".

CHAPTER 3  (ii) AND REFERENCE  (5)
(b)  Philip R. JV. Sutton.

As many quotations have been taken from his book Fluoridation, the following information about the author is of importance. Philip R. N. Sutton, D.D.SC. (Melb.), L.D.S.(VIC). He is Senior Research Fellow, Department of Oral Medicine and Surgery Dental School, University of Melbourne. His labours have been assisted by Professor Maurice H. Belz and Dr. Rupert T. Leslie, of the Department of Statistics, University of Melbourne. The first part of his book is written jointly in collaboration with Sir Arthur Amies. The investigation has been supported by grants from the University of Melbourne.

Some of the statements made in the first edition were criticised by reviews in the Aust. dent. J. and the N.Z.dent.J., but the author has asserted in the preface to the second edition, that "These have not indicated the necessity for any modifications in Parts One and Two which are therefore reprinted unchanged. However in this edition a Part Three has been added in which these criticisms are reprinted at length, and some comments made".

The author of this essay has therefore quoted Dr. Sutton with complete confidence as all criticisms of his work have been fully answered and his statements remain unaltered.

CHAPTER 4 (iii)  AND REFERENCE  (13)
(c)  Fluoridated water kills Turkeys.

The veterinary surgeon concerned in a detailed letter to the author explained that he was responsible for the health of thousands of birds on large turkey farms. The birds were fed on a carefully balanced diet which was the same for all the farms. Until the water supply was fluoridated he had never lost a bird from a haemorrhagic syndrome "which is a complaint in which multiple extravasations of blood are found in the muscle tissue and generally there is a failure of the blood to clot".

The water supply of Andover is hard and in order to ensure that the fluorine was not precipitated as calcium fluoride a sequestering agent was used, probably Calgon, so that in effect the sodium fluoride was added to lime free water.

The fully grown breeding hens that died were folded on a clay pocket in an otherwise chalky field. Without the presence of the fluorine the calcium in the food was ample for the good health of the birds. Dressing the plot with chalk avoided further deaths, but birds died as before when it was used up.

The local M.O.H. agreed with the diagnosis.

CHAPTER 4 (ii) AND (iii)
(d)  Fluorine Intoxication without Mottling of Teeth.
Mottling of teeth has been regarded as a very sensitive pointer to fluoride intoxication, but an important article entitled Skeletal Fluorosis and its Neurological Complications by Amarjit Singh, M.D., Professor of Medicine, Patalia Medical College, Punjab, and his colleagues, appeared in "The Lancet" of 28th January 1961. This article revealed that in spite of very severe fluoride intoxication, producing compression paraplegia in some cases mottling was often absent.

In commenting on this Dr. R. A. Holman,¹ M.D. wrote a letter to "The Lancet" on 8th February 1961 pointing out that of the forty-six cases mentioned in the article, 25% exhibited no signs of dental mottling, even though the water contained 14 ppm fluoride. This he considered a "serious blow to those among us who advocate the addition of this agent to water supplies". He goes on to say that "Dental fluorosis (indicated by tooth mottling) is generally recognized as a good indicator of cumulative fluoride intoxication, yet if it does not occur in such a high percentage of cases showing serious skeletal fluorosis it is illogical to assume that it is safe to medicate water for human consumption even if the level is kept below the proposed permitted maximum of 1 ppm (which can result in objectionable mottling)" ²

CHAPTER 4 (III)
(e) Long Term effects of Synthetic Fluorides on Health.

The effects of artificial fluoridation revealed on page 23 indicate the paramount necessity of keeping a very careful check on the general health of the community.

The United Kingdom Mission in their report on their visit to U.S.A. (H.M.S.O. 1953, p. 20) when recommending that fluoride be added to the water supply of selected communities, as study centres, said "full medical and dental examination at all ages is desirable" (author's italics).

Observations of the effect on adults were to be made by the U.S.A. authorities concerned, yet as far as the author is aware it has never been carried out. It will be interesting to learn of the findings in this regard in the U.K., bearing in mind the increasing hazard of alarming fluoride intoxication in the course of, say, 25 years.

Further, while some statistics appear to show that children up to ten years of age have less dental caries f where the water supply is fluoridated, is this good enough when eventually it transpires that the benefit is ephemeral, while in the long run chronic illness may result ?

CHAPTER 3 (i)
(f)   Omission in Mew Zealand report

The fact that no reference in the New Zealand Report could be found regarding Mr. Ludwig's statement seemed so extraordinary to the author that he contacted Mr. Penlington, the President of the Hastings (New Zealand) Anti-fluoridation Society, who confirmed that there is no reference. The actual data submitted by Mr. Ludwig are as in the table on page 50.

It will be noted that the teeth of the older children sometimes have more decay in Hastings and sometimes in Napier.

Napier has been given up as a control city, as it is suggested that vegetables grown in Napier have the benefit of the rich mineral soil left above sea level after the great earthquake. But these vegetables are marketed in both cities.

Subsequent reports do show some slight improvement in the teeth of the Hastings children of the same age, but as the figures given are the number of teeth decayed per child instead of per 100 teeth as stated above, it is impossible to compare the returns. In any case it indicates some slight delay in the development of caries only; not a permanent reduction.

At the time of adding this note, June 1961, no report after 1959 has come into the author's possession.

One would expect the examination of teeth to take place just before the Hastings experiment started, but no examination was so made. In Hastings, fluoridation started in March 1953 but the examination of the teeth did not begin until September 1954 in Hastings and April 1955 in Napier.

And finally, by way of comment, "Flurident" tablets are on sale in New Zealand at 3/- for 200. Why, then, not leave well alone and let those who believe in fluoride use such tablets to the extent necessary ?   

1.   Dr. Holman is Senior Lecturer in Bacteriology at The Welsh National School of Medicine and Hon. Consulting Bacteriologist to The United Cardiff Hospitals and The National Infirmary, Cardiff.
2.  Galagan, D. J., and Lamson, G. G., Public Health Report (Washington) 1953, 68, 497.
3.  Report of the Council on Drugs and the Council on Foods and Nutrition: Efficacy and Safety of Fluoridation of Public Water Supplies, Amer. Med. Assn., 1957.
4. Weaver, R., in Fluorine and Dental Caries: Further investigation on Tyneside and in Sunderland, "Brit. Dent. J.", 6th October 1944, reported that at a level of 1. ppm.:
(i) The effect of fluoride is limited to postponement of caries in the younger age groups by a few years; and
(ii) The protective effect does not extend to adults' teeth.

Bibliography
1    Borei, Hans, Inhibition of Cellular Oxidation by Fluoride, (Almqvist and Wilkesells Boktrykeri A.B.).
2    Cannell, W. A., m.r.c.s., l.d.s., r.c.s., Medical and Dental Aspects of Fluoridation (H. K. Lewis and Co. Ltd., London.).
3    Carroll-Clark, E. H., l.d.s., r.c.s. and Harvey Day, How you can Save your Children's Teeth (Edmund Ward (Publishers) Ltd.).
4    Day, Harvey (see 3 above).
5    Douglas   of Barloch,   The  Rt.   Hon., The Lord, m.a.,   ll.d., k.c.m.g.,    Brief   against   Fluoridation.     (Edmonton    Pure     Water Association, P.O. Box 624, Edomonton, Alberta.)
6    Exner,  F.  B.,  M.D., Fluoridation: Its Moral and Political Aspects. Obtainable  from   "Greater  New  York  Committee   Opposed   to Fluoridation, Inc.", Room 909, 342 Madison Avenue, New York 17, New York. Price f 1.00. Exner, F. B., m.d. and G. L. Waldbott, m.d., Edited by James Rorty. The American Fluoridation Experiment. (The Devin-Adair Company, New York 10, New York). Wholesale distributor in England: Mr. R. S. R. Hutchinson, 60 Arno Vale Road, Woodthorpe, Nottingham.
7    House Select Committee, House of Representatives. Chemicals in Foods and Cosmetics. Hearings before the House Select Committee to Investigate the Use of Chemicals in Foods and Cosmetics, House of Representatives, Eighty-second Congress, second session, Part 3.
8    Medical Dental ad hoc Committee on the Evaluation of Fluoridation. Synopsis—A critique on the Recent Opinion of the American Medical Association on Fluoridation of Public Water Supplies.*
9.  Newton, Robert, M.C, Ph.d., D.SC, L.L.D., F.A.I.C, F.R.C.S., The Case Against Fluoridation*. Price 3d.
10. Rorty, James (see 6 above).
11. Spira,   Leo,   M.D.,   Ph.D.(med.),   The  Drama   of Fluorine—Arch Enemy of Mankind (Lee Foundation for Nutritional Research).
12   Steyn, Douw G., B.SC, Dr.med.vet.(pharmacol), D.V.SC.(TOX.), The Problem of Dental Caries  (and the Fluoridation of Public   Water Supplies).   Voortrekker  Press.   Obtainable  from  Die   Transvaler-Boekhandel P.O.  Box 8124, Johannesburg,  South Africa.  Price £2 $s. od.
13   Sutton, Philip R. N., D.D.SC.(MELB.), L.D.S.(VIC), Fluoridation, Errors and Omissions in Experimental Trials. 2nd Edition. Australia: Melbourne  University;   United  Kingdom:   London,   Cambridge University Press.
14  United Kingdom Mission, Report of The Fluoridation of Domestic Water Supplies in North America as a means of Controlling Dental Caries. (H.M. Stationery Office.)

* Obtainable from the Secretary, National Pure Water Association, Thorpe End, Almondbury, Huddersfield.

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