Risk, Reverence of Life & The Ethics of Water Fluoridation

Over-Exposure to Chemicals, Individual Medical Consent & Dose Makes the Poison?

“Life,” Rachel Carson wrote at the end of Silent Spring, is indeed “a miracle beyond our comprehension; and we should reverence it…”1 What Reverence of Life is reflected in the fact that the Center for Disease Control – the agency which actively promotes water fluoridation, has found that 41% of Our Nation’s Youth2 have what the World Health Organization has defined as a Disease3 caused by ingesting too much fluoride in the water? Two out of every five adolescents have fluorosis in this country. The paramount issue is: it is known that fluorosis is caused by excessive-exposure to fluoride and we can see “the first visible sign of chronic toxicity” on the teeth of our children.4
Therefore, the public health implications of water fluoridation do not reside in the concentration, the dosage, or even the science of health effects; when its in the water, dosage is inherently uncontrollable, and we can clearly see our youth are consuming too much of a drug that we would otherwise have a choice to use with toothpaste or consume with a prescription from a doctor. Moreover, like any other drug, the doctor would prescribe the dosage relative to the individual patient. In all likelihood, it is a safe assumption there is probably no drug safe for all, at one or any dosage, and especially if dosage is uncontrollable, because medicine is relative, not universal. Water fluoridation is premised on the erroneous notion of a “one size fits all” medical treatment. So, where is an individual’s medical consent with fluoridation?

Ingesting fluoride, in the form of tablets, is not even FDA approved, due to a loophole in the Food, Drug & Cosmetic Act of 1939.5 Being on the market prior to this Act, fluoride tablets are still marketed and they are found behind the counter at the pharmacy. This word – pharmacy – is derived from an ancient Greek word, pharmacon, which has a dual meaning: One substance, at the right dose can be medicine and virtue, at too high a dose, a poison and vice. “As Paracelsus once wrote, ‘the right dose differentiates a remedy from a poison.’”6 This is true of some chemicals like essential nutrients or wine, for instance, but it is undoubtedly false for other chemicals, like Lead and Arsenic, the two primary contaminants in fluoridation chemicals.7-8 No dose of lead or arsenic is a remedy; any dose is toxic because lead and arsenic are poisons per se. No threshold of safety exists for “chemicals totally outside the limits of biologic life.”9 Thus, for some, “the toxicity of a chemical is an inherent quality of the chemical itself.”10

One can see the following sentence on the World Health Organization’s website: “The toxicity of fluorides is due to the toxicity of the fluoride ion, a direct cellular poison that binds calcium.”11 We should therefore wonder if there is a spectrum between poison and medicine for fluoride, or are the properties mutually exclusive? A medicine can be a poison at a high dose, but can a poison be a medicine? Actually, Yes; Radiation epitomizes this ambiguity; it is a poison known to cause cancer, and it is used to treat cancer.12 Radiation may be an effective treatment to cure cancer in some but not all, however, it is poisonous to the body of all. “It must not be overlooked that many chemicals are the partners of radiation producing precisely the same effects.”13 In the opinion of this author, fluoride is an effective topical medication for the average person, and fluoride may be beneficial to teeth, in the average person, if ingested in naturally occurring trace amounts, like in teas and most water, but what about the body? Naturally occurring minerals like calcium fluoride, 14 sounds healthy, but lets not equivocate terms; arsenic is also a naturally occurring mineral. Is arsenic therefore healthy to ingest?

The whole of the body is affected by ingestion of a chemical, nonetheless “a direct cellular poison.” The dose of this poison can be lethal or non-lethal, but nevertheless too high a dose at one time can cause acute poisoning, like swallowing toothpaste. On the other hand, chronic poisoning is consuming non-lethal doses over a period of time. Think about the mathematical proof mentioned earlier: the “optimal” pea-size toothpaste and a glass of “optimally” fluoridated water; both equal a 0.25mg dose of fluoride.15 A federal health law16 based in toxicology recommends you call poison control if you systemically ingest that toothpaste because the Human Toxicity Level of fluoride is between 4 (Very) to 5 (Extremely Toxic).17 Another federal policy18 based in dentistry, which treats oral health primarily on a topical basis, recommends you systemically ingest, in every glass of water you drink, for your entire lifetime, precisely the dose of fluoride the federal health law explicitly implies causes acute poisoning. How is water fluoridation not chronic poisoning? How can a Toxic Poison be Safe & Healthy? For Everyone? Over a Lifetime? Fluoridation means you wash your face with fluoride?

Probably Safer & Healthier to Simply Drink Clean Water:
Calculated Risk & The Lack of Scientific Consensus

            Three out of twelve members of the 2006 NRC have signed a “Professional Statement to End Water Fluoridation.”19 One member of the NRC, Dr. Kathleen Thiessen, a Senior Risk Analysis Scientist, joins Dr. William Marcus, former Chief Risk Assessment Toxicologist at EPA’s Office of Water.20 To date, the most avidly and publicly outspoken scientists against water fluoridation have been the Toxicologists, Biochemists, and Statisticians at EPA,21 as well as a former Professor Emeritus in Environmental Chemistry, Dr. Paul Connett, founder of Fluoride Action Network.22
Scientific opposition also extends to the dental profession: a second member of the NRC, Dr. Hardy Limeback, past president of the Canadian Association for Dental Research joins Dr. John Colquhoun, a former Chief Dental Officer in New Zealand – two former proponents of water fluoridation who have since reversed their position.23 See Colquhoun’s publication: “Why I Changed My Mind About Water Fluoridation.”24 Both publicly oppose water fluoridation alongside a Dr. David Kennedy,25 a past president of the International Academy of Oral Medicine and Toxicology.26
Lastly, the third member of the NRC is Dr. Robert Isaacson, a Neuroscientist and Professor Emeritus of Psychology.27 Out of the 4,000 scientists, medical doctors, PhD’s and dental professionals who have signed Fluoride Action Network’s “Professional Statement to End Water Fluoridation,”28 perhaps the most preeminent name on the list is a Pharmacologist, Dr. Arvid Carlsson, the 2000 Nobel Laureate in Physiology or Medicine,29 who, in the 1970s, advised the Swedish Parliament to successfully reject water fluoridation for going “against all principles of modern pharmacology.”30 Logically, it is dissent from scientists in precisely these fields, which impugns any claim of scientific consensus about the safety of water fluoridation.

These are the ones Who Walk Away From Omelas,31 an allegory representing the inherent conflict between the utilitarian ideal of the greatest good for the greatest number and the deontological right of the individual, which in this case, is the principle of medical consent, freedom of choice, and freedom from an obligation to endure risk.

Those Who Walk Away: Epistemic Uncertainty, Bioethics & Care Duty

Omelas is the quintessential Utopia, albeit with a caveat, one condition: it depends on the eternal suffering of a young boy, locked in a broom closet, with no window, no human affection, nothing beyond a paucity of food [with fluoride pesticide residues] and [“optimally” fluoridated] water for subsistence. Everyone is aware of the compromise; if the boy is loved or freed, the Utopia ceases. Those Who Walk Away choose to do so voluntarily because they find themselves unable to justify sacrificing an Individual’s access to the Good Life, in exchange for their own.
Water fluoridation parallels this allegory in that it would be utopic if water fluoridation was the ultimate “safe and effective” panacea, to cure us all of our cavities. However the comparison may be somewhat incommensurate, as our access to the good life is debased by the fact that fluoride is not an essential nutrient.32 Nevertheless, assuming efficacy, this paper calls into question the issue of safety as it relates to the Health of the Individual. Dr. Colquhoun posed the ethical dilemma succinctly: “How many cavities would have to be prevented to justify the death of one man from osteosarcoma?” What Reverence of Life is posited in the justification of uncertain, perhaps seemingly small risks? One in a million? 200 million people means a 550% possibility that 200 young boys who drink fluoridated water between ages 6 to 8, may develop osteosarcoma by age 20.33 If the 2006 NRC report concludes “bone cancer is a particular concern,”34 and the chair of the NRC says “questions are unsettled”35 after 71 years of water fluoridation, is anyone in a position to make truth claims about the extent of this possibility, the magnitude of risk? This is a de facto unknown.

The whole ethical conflict of the allegory is based on whether the Life of a Child – a Supreme Value, can be compromised. In this case, can we justify the possibility of risking Life? Children are dependent on us for protection; their life is in our hands. This is Care Duty: an affirmative ethical obligation to acquire knowledge requisite to ascertain potential risk, so as to inform our actions to avoid or prevent Harm, and therefore to ensure safety and protect Life. Thus care duty means one actively seeks out knowledge so as to assess risk, and if potential risk is found, takes actions to minimize the potential. Likewise, a breach of care duty is either failing to seek out such knowledge, or, being knowledgeable of potential risk, but failing to act. Either way, this is Negligence; through “unreasonable carelessness,” one exposes Life to the Risk of Harm, and hence, is subject to moral culpability and liability. As such, the “Hippocratic Oath” affirmed by medical doctors upon initiation to their profession, begins with: “First, Do No Harm.”
Essentially, whether public health implications exist therefore depends on our knowledge of risk. If your rationality judges the recent science presented in this essay to be a fair preponderance of evidence to maybe support the possibility of health risks, then this constitutes knowledge of potential risk. The only certainty, therefore, is uncertainty:

“To know we do not know what we do not know,
and to know that we know we know,
that is true knowledge.” –Henry David Thoreau

The Scientists Who Publicly Oppose Water Fluoridation choose do so voluntarily because they know they are uncertain if water fluoridation is safe; they find themselves unable to justify the possibility of risking the Life of an Individual, even if it may be for the greater good. This choice is premised on the fact that our freedom is dependent on the freedom of others – as each individual has a Right to Life. This right is sourced from an inherent dignity, which springs from our rationality as an end in and of itself. This is why the debate regarding water fluoridation ought to be refined down to the issue of choice; this is your life, your health, and your body. Fluoridation is a violation of the principle of informed medical consent, as it is unambiguously and indubitably mass medication.
Nevertheless, “The nature of uncertainties in the existing data could also be viewed as supporting a greater precaution regarding the potential risk to humans.”36 This was the conclusion of the 2006 NRC regarding the cancer-fluoride evidence. They were certainly referring to the Bassin study, i.e., bone cancer in young boys.

The Other Road: Risk, Reverence of Life & The Precautionary Principle

If the National Research Council of the National Academies of Sciences is “uncertain” about the “potential risk” of fluoride as a carcinogen to children, why should the public give fluoride the benefit of the doubt? We therefore find ourselves at an ethical juncture as it relates to Risk & Reverence of Life. One Road is to give fluoride the benefit of the doubt. This is tantamount to the assumption that chemicals are innocent until proven guilty; and so we presume safety until we are certain studies have proven risk through finding harm. Hence, we must wait for the public ­– us – who were never asked for our consent, and obligated to endure an uncertain risk, to be harmed? If the only study of its kind,37 conducted at38 and published39 by Harvard University, finds a 550% statistically significant probability that fluoride in water may cause bone cancer in young boys, why would it not make sense to speculate that this chemical may be guilty? Is it not reasonable to simply turn the knob off at the water treatment plant, and drink just clean water until we are 100% certain fluoridation chemicals are safe?

This is the Other Road: We know there is no risk from drinking clean water. This is to abide by the Precautionary Principle; in the presence of a preponderance of evidence to support the notion that water fluoridation may cause a risk of harm to public health, and in the absence of counter-evidence to warrant safety, the action to be taken is therefore twofold: we walk down the only road we know is safe: just drink clean water, and then concomitantly ask for more knowledge via further research, with the burden of proof falling on those who endorse and actively promote water fluoridation. Precaution is proactive; the public shouldn’t have to wait to be harmed, to prove fluoride guilty.

Thus, federal public health agencies as well as dental associations are therefore obligated to prove fluoride innocent; and solely critiquing the methodology of studies that find harm, is not equivalent to proof of safety. Studies must try to replicate results, i.e., look for harm in all sorts of individuals, in all systems and organs of the body, account for confounding variables, in randomized, double-blind trials, over a long period of time. This is the criterion for a Grade A Study, according to the UK’s National Health Service Centre for Reviews and Dissemination at York University.40

In 2001, the “York Review” systematically reviewed epidemiological studies41 examining the safety and efficacy of artificial water fluoridation. This is unlike the 2006 NRC, which examined safety based on recent toxicological, epidemiologic, and clinical data,42 both in vitro and in drinking water, which consequently included studies on naturally occurring fluoride in water. The “York Review” found Zero Grade A Studies.43 “What the ‘York Review’ on the Fluoridation of Drinking Water Really Found,”44 is published on the University’s website:

“We were unable to discover any reliable good-quality evidence in the fluoridation literature world-wide… The evidence about reducing social inequalities in dental health was of poor quality, contradictory and unreliable.”

The Chair of the “York Review,” Professor Trevor Sheldon, in an open letter:
“The review team was surprised that in spite of the large number of studies carried out over several decades, there is a dearth of reliable evidence with which to inform policy. Until high quality studies are undertaken providing more definite evidence, there will continue to be a legitimate scientific controversy over the likely effects and costs of water fluoridation…”45 [dearth in original]

“Legitimate Scientific Controversy”

Dr. Trevor Sheldon has also signed Fluoride Action Network’s “Professional Statement to End Water Fluoridation.”46 If there is “legitimate scientific controversy,” the Precautionary Principle sides with epistemic uncertainty, humility, and ignorance, as “ignorance is preferable to error; he is less remote from the truth who believes nothing, than he who believes what [may be possibly] wrong,” Thomas Jefferson. Furthermore, “the conventional view that the ethical dilemmas posed by water fluoridation can be solved by balancing the benefits and harms actually begs the question, for it presumes that such a balance can be achieved.”47 For example, how can a balance be achieved if the 2006 NRC says: “fluoride has an effect on thyroid?”48 What kind of effect? Why would 0.7ppm of fluoride not effect thyroid, for at least some people?
“Many people believe that since so many people do not feel any immediate effect, [fluoride] must therefore be harmless,”49 however continuously ingesting non-essential50-3 chemicals into our bodies, permanently bio-accumulating within calcifying tissues54 like teeth, bone55 and the pineal gland in our brain56 – this may have “consequences remote in time and place.”57 “That there are no immediate symptoms [therefore] is of little consequence to this issue, for the toxins may sleep long in the body, to become manifest months or years later in an obscure disorder almost impossible to trace to its origins.”58

The ethical conclusion we arrive at is: one exception, one counter-example, will refute the theory of water fluoridation as safe for all, for a lifetime, in its entirety. If there is a possible risk that fluoridation chemicals may adversely affect the health of at least one person, then it is not safe for all. If it touches all, it should be safe for all, right? Thus, concerning the notion of balance, is it logically consistent to balance Reverence of Life with the possibility of Risk to an Individual? The Risk is: one’s access to the Good Life.
Plus, “How can it be ethical to be putting industrial waste in our drinking water?”59 Is it right to dose someone, nay – an infant, with a chemical that we know is not an essential nutrient, indefinitely, for a lifetime, with medication, through the public water, without their consent? Infants cannot even give consent; and so we have a Duty to Care for them. Can we justify this, knowing we do not know how much they will ingest into their body from drinking water? What about toothpaste, twice a day, every day? Insecticide residues on food? 6.8ppm in Gerber Grape Juice?60 8.38 micrograms per gram in infant foods?61 A kiwi – 15ppm?62 What about boiling food in fluoridated water, in a pot with Teflon coating? Food is carbon-based and the C-F bond is the strongest bond in organic chemistry because fluorine is the most electro-negative element and hence the most reactive chemical in the periodic table.63 What about bathing in fluoride? Is fluoridation an efficient means to an end, knowing 99% of it goes down the drain…?