FAN Bulletin 784

March 31, 2007

Dear All,

Usually when I visit countries which fluoridate their water like Australia, Canada, Ireland, New Zealand and the UK, the proponents run for the hills. Not so in Israel – while declining a formal debate – I had three meetings where they made an appearance and I came face to face with the “arrogance of power”. The first day gave me an inkling of what was to follow.

I arrived on the morning of Tuesday March 20, after a long overnight flight from Newark to Tel Aviv. From there I was driven to Betsy Ramsay’s apartment in Gilo, which is a suburb of Jerusalem. Betsy is the daughter of the late Dr. George Walbott, one of the most prominent opponents of fluoridation in the US. He wrote two books on the issue, “A Struggle with Titans” and “Fluoridation: The Great Dilemma.” The latter book, co-authored by Albert Burgstahler and Lewis McKinney, remains in print and is one of the classics in the field. George Waldbott was also the driving force behind the formation of the International Society for Fluoride Research in the 1960s, which has faithfully published the journal Fluoride ever since. Dr. Waldbott insisted that, despite his own opposition to fluoridation, that the society not take an official position on the issue, but instead to objectively follow the best science wherever it led. If proponents had one ounce of his integrity, this foolish practice would have ended years ago. So it was a great honor to stay in Betsy’s apartment.

After a quick 90 minute nap, Betsy drove me to the Israeli parliament – the Knesset. Fortuitously, it was “water day” and was the excuse for a meeting of a parliamentary panel which had already advised a halt to the push for mandatory fluoridation of Israel’s remaining unfluoridated cities until – in the wake of the NRC report and the Bassin study - the safety issues had been studied more closely.

While waiting to go into the meeting I was approached by a man who declared he was on the other side of this issue. His name was Prof. Ted Tulchinski. He said that he was a Professor of Public Health and had written a book on Public Health. My first impression was that he was very charming and I hoped that we would be able to have a rational discussion on this issue. He began by asking me my position on vaccination. I responded that I wasn’t against vaccination per se (dear readers please don’t pummel me on this one, I just cannot take on any more issues right now!) but I felt that any health official who sanctioned the injection of organic mercury (thimerosal) into a baby’s blood stream should be fired on the spot! At this point it was time to go into the parliamentary committee.

The meeting room was very small and crowded, and included a TV crew from channel 2. Sitting on the desk of every member of the panel was an angry letter from two Ministry of Health officials complaining about the panel’s hearing from me. That I, Mr. Connett, had no medical training and that there were over 30,000 studies which showed that fluoridation was safe and effective and that they should hear from someone from the World Health Organization.

After a few introductory remarks from the chairperson, I was invited to address the group. Fighting jet lag I did my best to outline the main arguments in about 20 minutes. Then various panel members – which included the Deputy Mayor of Tel Aviv, a water engineer, a well known environmental activist and several others - offered their opinions. All except one panel member – an officer in the Arab dental association - were opposed to fluoridation. Then, an health official spoke and Dr. Tulchinski – both in support of fluoridation - and both critical of my presence at the meeting. All of this was filmed by the TV crew. Then when I left the meeting I was interviewed in the corridor. At this point, we were very excited because it looked as if a) the footage would be on the national news and b) it was overwhelmingly in favor of our side. Unfortunately, because of a public employees strike filling the news, our story was bumped!

>From the Knesset we rushed to the Hebrew University where I gave a 75 minute power point presentation to an audience of about 40 people largely comprising of students. The meeting was organized by Jerom Hochman, an energetic and committed student who leads a green activist group, who traveled with us over the next few days. The presentation was well received.

After a good night’s rest, on the next day I spoke at the Hadassah hospital in Jerusalem. The meeting was organized there by a lab technician, Maria Westerman. Hadassah authorities while first agreeing to the meeting, made it difficult to secure a decent lecture room. We finally ended up in an out of the way cubby hole of a lecture room. Only about 20 people showed up for this meeting but one of them was Dr. Tulchinski and some of his public health students. After I had completed my power presentation, the organizers asked Dr. Tulchinski to present his views on the matter. He did so.

Tulchinski started by explaining that the issue was a highly emotional one and I had been very selective in the studies that I had discussed. He went on to list all the important agencies – including the highly respected CDC - that supported fluoridation. That if we listened to people like me that next there would be a stream of people coming to Israel attacking other sensible public measures like vaccination and the use of ridalin in schools. He then told the audience that I was opposed to vaccination. In my rebuttal I made it very clear to him (again!) and to the audience that I had not said that I was opposed to vaccination but that I was opposed to injecting organic mercury into a child’s bloodstream. I also pointed out that he had not cited one single study from the primary literature to rebut my arguments. I then asked him if had read the NRC report which I held in my hand (and used extensively in my presentation). He said no. So how, I asked him, could he tell the audience that fluoridation is safe if he hadn’t read this report. I then asked him to name one article on this issue that he had read from the primary literature. To my surprise he refused to answer, so I asked him again, and again he refused to answer. In retrospect, I wish I had asked him how he could claim I was being selective, when he was clearly so unfamiliar with the primary literature!

On his way out of the meeting (he had to go to another appointment) Maria asked him if he knew the source of the fluoridating chemical used in Israel. According to Maria he looked like a startled rabbit and stood there speechless. Then she told him it was hydrofluosilicic acid (hexafluorosilicic acid)- a hazardous waste from the phosphate fertilizer industry.

The next day we drove to Tel Aviv to address the city council. Tel Aviv has never been fluoridated and shows no willingness to do so. Sitting at the table was Dr. Tulchinski and Dr. Nehama Haim, M.D., M.P.H., Director, Public Health Department for the Municipality of Tel-Aviv-Yafo and an aide. In my power point presentation I again went through some of the basic arguments; excerpts from the NRC review and explained why the CDC claim from 1999 that fluoridation was “one of the top ten public health achievements of the twentieth century” cannot be taken seriously. It was six years out of date on health studies and had a laughable “proof” of effectiveness – the infamous graph showing tooth decay in 12-year olds coming down from the 1960’s to the 90’s, while over the same period that the percentage of Americans drinking fluoridated water going up. The simplistic claim that one trend was causing the other is quickly demolished by observing (based on WHO data) the same decline in tooth decay in 12 year olds in many industrialized countries, over the same period, and coming down regardless of whether the country was fluoridated or not. See http://fluoridealert.org/health/teeth/caries/who-dmft.html

Imagine my surprise when Dr. Nehama opened his power point presentation with the CDC (1999) statement! Below I have printed the text which appeared on his slides because it is a classic example of trying to win this argument with “authority” rather than rational discussion on the scientific data. (If the formatting is scrambled – as sometimes happens – and you would like a copy of his power point I will email it you on request.)

Dr. Nehama did not cite a single study from the primary literature and did not attempt to rebut a single argument I made. The thrust was extremely crude: trust us we are health experts. When he finished and after others had spoken, I reminded the audience that Dr. Nehama had started his presentation with the CDC (1999) statement which I had showed was pretty embarrassing. I also pointed out that he hadn’t provided a single reference from the primary literature and I urged the council to ask Dr. Nehama to produce a list of the 60 countries which he says are fluoridated. I said it shouldn’t be difficult to produce a list of the names of these countries. Dr. Nehama said he would have the list tomorrow. He is going to get a little surprise when he tries to do this because the 60 countries “figure” comes straight from propaganda from the ADA, which in turn took the number from propaganda from the British Fluoridation Society. Neither association has been able to produce a list of 60 counties which supposedly fluoridate their water!

During his presentation Dr. Nehama also repeated the charge (obviously gleaned from Kulchinski) that I was opposed to vaccination. As at least 3 people in the audience had heard me rebut this charge the previous day at Hadassah hospital they interrupted and said that this was not so and I then repeated that I was opposed to injecting organic mercury into a baby’s bloodstream. The fact that Tulchinski had heard me deny this two times in two days and used it a third time showed, in my view, that he was not using honorable tactics and had a very clear game plan in mind. My last words to him were “you should be ashamed of yourself” and his last words to me were “You are a charlatan.”

Both my appearance before the Knesset panel and the Tel Aviv council was organized by Shimon Tsuk, a leader of a national environmental organization which has been very instrumental in fighting fluoridation in Israel for several years.

After the Tel Aviv meeting we drove to Haifa where I gave a presentation on fluoridation to a class of environmental science students. Again the students received my information very enthusiastically. After staying overnight at a Kibbutz, I gave another presentation at Haifa University, but this time on waste management ( “From a small molecule to the big picture”). Being Friday, this was the end of the formal part of my visit and Betsy drove me back to Jerusalem. I visited the old city on Saturday and flew back on Sunday.

My overall conclusions. If one can get this message before the Israeli public – especially university audiences – fluoridation will be halted in Israel. The proponents are bereft of any scientifically based arguments to support their case. Even when Tulchinski heard my full presentation at Hadassah and had overnight to cogitate on the scientific evidence I presented, he was unable to provide a scientific response to any argument I made. Instead, he had to resort to the true and tried 60 year double pronged promotion tactic of a) extolling the virtues of the agencies and associations supporting fluoridation and b) attacking the credibility of those who oppose the measure. These tactics did not appear to work with either the Knesset panel or with the Tel Aviv council. The only really disappointing part of the trip was the fact that what promised to be major TV coverage of the debate was bumped from national TV. Meanwhile, while limited in number, there is a group of very well-informed opponents of fluoridation who I believe will work tirelessly to end this practice in Israel.

A special thanks to Iris Atzmon from Haifa for translating my power point presentation into Hebrew.

Paul Connett

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Dr. Haim Nehama’s presentation before the Tel Aviv council, March 22, 2007

Community Water Fluoridation

One of the Ten Great
Public Health Achievements
of the 20th Century

Dr. Nehama Haim, M.D., M.P.H.
Director, Public Health Department
Municipality of Tel-Aviv-Yafo

(Slides 2-3 cover page of the CDC (1999) - MMWR Weekly Report, April 2, 1999, Volume 48 No. 12) and list of Ten Great Public Health Achievements – United States 1900-1999)

Slide 4. Community Water Fluoridation

Fluoridation is safe.
More than 60 years of research and experience have shown
that fluoridation at optimal levels
does not harm people or the environment.

Leading scientists and health professionals,
numerous professional organizations
and governments around the world
support community water fluoridation.

Slide 5. Community Water Fluoridation

Studies have shown that water fluoridation can reduce
the amount of decay in children’s teeth by as much as 60%.

Today, even with the widespread use of fluoride toothpaste,
mouth rinse, and professional fluoride treatments,
fluoridation has been shown to reduce tooth decay by 18-40% among children and by nearly 35% among adults.

Slide 6. Community Water Fluoridation

Over 405 million people in approximately 60 countries
enjoy the benefits of optimally fluoridated water.

In the United States, approximately 170 million people
(about two-thirds of the population on public water systems)
benefit from fluoridation.

Slide 7. Community Water Fluoridation

Fluoridation benefits everyone.

Fluoridation benefits the entire community:
children, adults, and senior citizens.

Community water fluoridation does not discriminate
against anyone on the basis of income, education, or race.

Simply by drinking fluoridated water,
everyone in a community benefits,
especially those who don’t receive regular dental care.

Slide 8. Community Water Fluoridation

Fluoridation of community water supplies is
the single most effective public health measure
to prevent tooth decay
and to improve oral health for a lifetime.

Slide 9. Community Water Fluoridation

According to the Centers for Disease Control and Prevention, approximately 66% of the population
received fluoridated water in 2000.

A United States national health objective for the year 2010
is to increase to at least 75%
the portion of the population served by community water systems
providing optimal levels of fluoride.

Slide 10. Community Water Fluoridation

Fluoridation of community water supplies
is supported by:

The World Health Organization (WHO)
The U.S. Public Health Service (USPHS)
The American Dental Association (ADA)
The American Medical Association (AMA)
American Academy of Pediatrics (AAP)
National Institute of Dental & Craniofacial Research (NIDCR)
Task Force on Community Preventive Services

Slide 11.Community Water Fluoridation

World Health Organization (WHO)

Most recently, efforts have been made to summarize the extensive database (on fluorides) through systematic reviews. Such reviews conclude that water fluoridation and use of fluoride toothpastes and mouth rinses significantly
reduce the prevalence of dental caries.

Water fluoridation, where technically feasible and culturally acceptable, has substantial advantages in public health.

Slide 12. Community Water Fluoridation

U.S. Surgeon General

Community water fluoridation continues to be
the most cost-effective, equitable and safe means
to provide protection from tooth decay in a community.

A person’s income level or ability to receive routine dental care is not a barrier to receiving fluoridation’s health benefits.
Water fluoridation is a powerful strategy in our efforts to eliminate differences in health among people and is consistent with my emphasis on the importance of prevention.

Slide 13. Community Water Fluoridation

Center of Disease Control and Prevention (CDC)

CDC has recognized the fluoridation of drinking water
to prevent dental decay as one of 10 great public health achievements of the 20th century.

Slide 14. Community Water Fluoridation

American Dental Association (ADA)

The Association endorses community water fluoridation
as a safe, beneficial and cost-effective
public health measure for preventing dental caries.
This support has been the Association’s policy since 1950.

Over the past 60 years, optimal fluoridation
of community drinking water has been a major factor
for the decline in rates of tooth decay.

Slide 15. Community Water Fluoridation

American Medical Association (AMA)

The AMA recognizes the important public health benefits
of drinking properly fluoridated water and
encourages its member physicians and medical societies
to work with local and state health departments,
dental societies, and concerned citizens to assure the optimal fluoridation of community drinking water supplies.

Slide 16. Community Water Fluoridation

American Academy of Pediatrics (AAP)

Because frequent exposure to small amounts of fluoride
each day will best reduce the risk for dental caries
in all age groups, the work group recommends that all persons drink water with an optimal fluoride concentration and brush their teeth twice daily with fluoride toothpaste.

Slide 17. Community Water Fluoridation

National Institute of Dental & Craniofacial Research (NIDCR)

The NIDCR continues to support water fluoridation as a safe and effective method of preventing tooth decay in people of all ages. Community water fluoridation is a public health effort
that benefits millions of Americans.

For more than half a century, water fluoridation has helped improve the quality of life in the U.S. through reduced pain and suffering related to tooth decay, reduced tooth loss, reduced time lost from school and work, and less money spent on dental care

Slide 18. Community Water Fluoridation

Task Force on Community Preventive Services
Oxford University Press, 2005

Task Force recommends CWF on the basis of strong evidence
of effectiveness in reducing dental decay.
This finding should be applicable to most people in the United States who use public water systems,
regardless of age, race, ethnicity, or socioeconomic status.

Slide 19. Community Water Fluoridation

This chapter was written by the members of the systematic review development team:
Benedict I. Truman, MD, MPH, Office of Minority Health, Office of the Director, CentersOral Health 319for Disease Control and Prevention (CDC), Atlanta, Georgia; Barbara F. Gooch, DMD, MPH, Division of Oral Health (DOH), National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), CDC, Atlanta; Iddrissu Sulemana, MPH, MA, Division of Epidemiology and Surveillance, National Immunization Program, CDC, Atlanta; Helen C. Gift, PhD, Division of Social Sciences, Brevard College, Brevard, North Carolina; Alice M. Horowitz, PhD, National Institute of Dental and Craniofacial Research (NIDCR), National Institutes of Health (NIH), Bethesda, Maryland; Caswell A. Evans, Jr., DDS, MPH, NIDCR/NIH, Bethesda; Susan O. Griffin, PhD, DOH/NCCDPHP/CDC, Atlanta; and Vilma G. Carande-Kulis, MS, PhD, Division of Prevention Research and Analytic Methods/Epidemiology Program Office (DPRAM/EPO)/CDC, Atlanta. Consultants for the reviews were: Myron llukian, Jr., DDS, MPH, Boston Public Health Commission, Boston, Massachusetts; Eugenio Beltran, DMD, DrPH, DOH/CDC, Atlanta; Aljernon Bolden, DMD, MPH, Boston University, Goldman School of Dental Medicine, Boston; Maria Teresa Canto, DDS, MPH, NIDCR/NIH, Bethesda; Timothy R. Collins, DDS, MPH, Los Angeles County Department of Health Services, Los Angeles, California; Stephen B. Corbin, DDS, MPH, Special Olympics, Inc., Washington, DC; Teresa A. Dolan, DDS, MPH, University of Florida College of Dentistry, Gainesville; Thomas F. Drury, PhD, NIDCR/NIH, Bethesda; Harold Goodman, DDS, MPH, Office of Oral Health, State of Maryland Department of Health and Mental Hygiene, Baltimore; Larry Hill, DDS, MPH, Cincinnati Health Department, Cincinnati, Ohio; Lori Hutwagner, MS, Division of Public Health Surveillance and Informatics, EPO/CDC, Atlanta; Amid I. Ismail, BDS, MPH, DrPH, University of Michigan School of Dentistry, Ann Arbor; Robert Isman, DDS, MPH, Office of Medi-Cal Dental Services, California Department of Health Services, Sacramento; William Kohn, DDS, MPH, H/NCCDPHP/CDC, Atlanta; Jayanth Kumar, DDS, MPH, New York State Health Department, Albany; Raymond A. Kuthy, DDS, MPH, University of Iowa College of Dentistry, Iowa City; Corinne E. Miller, DDS, PhD, Michigan Department of Community Health, Lansing; R. Gary Rozier, DDS, MPH, School of Public Health, University of North Carolina, Chapel Hill; Randy H. Schwartz, MSPH, American Cancer Society, Atlanta; Robert Selwitz, DDS, MPH, NIDCR/NIH, Bethesda; Mark Siegal, DDS, MPH, Bureau of Oral Health Services, Ohio State Health Department, Columbus; Janet Stansell, MLM, NCCDPHP/CDC, Atlanta; Scott L. Tomar, DMD, DrPH, University of Florida College of Dentistry, Gainesville; Steven Uranga McKane, DMD, MPH, SUM Consulting, West Hills, California; and B. Alex White, DDS, DrPH, Kaiser Permanente Center for Health Research, Portland, Oregon. Articles included in the reviews were abstracted by: Dionne Johnson; Kim Johnson; and Virginia Noland.

Slide 20. International Organizations
that Recognize
the Public Health Benefits of
Community Water Fluoridation
for Preventing Dental Decay

(slides 21- 25 reproduction of list of organizations from the ADA booklet “Fluoridation Facts”)

Slide 26. Community Water Fluoridation

The key points to remember about water fluoridation:

• Fluoridation is safe.

• Fluoridation of community water supplies benefits everyone.

• Fluoridation is cost-effective because it saves money on
dental treatment needs.

Slide 27. Thank You

(Picture of handsome Israeli with beautiful teeth and a picture of what looks like a savage with missing teeth)