1. Adding Fluoride to Water is a Bad Idea – The Short Version Presentation to the Valparaiso City Utilities Fluoride Committee By J. William Hirzy, Ph.D. June 25, 2014

2. Some Brief History First proposed in 1939 by Gerald Cox, funded by ALCOA. Opposed by ADA. Fluoridation endorsed by USPHS in 1950, half way through a “ten-year” experiment on safety and efficacy (without evidence of either, or informed consent of test subjects). Editorials in Journal of the American Medical Association (6) and Journal of the American Dental Association (7) expressed reservations.

3. Summarizing the arguments against fluoridation It is unnecessary (Our kids are already getting more than enough fluoride from other sources – dental fluorosis rates(1). It is inappropriate (if fluoride works at all to fight tooth decay it works TOPICALLY. It doesn ’ t do any good to swallow fluoride, only harm(2)

4. Summarizing the arguments against fluoridation It is a bad medical practice to use the public water supply to deliver medicine because A) you can ’ t control the dose B) you can ’ t control who gets it C) it violates the individual ’ s right to informed consent to medication – It is unethical (because of C)

5. Summarizing the arguments against fluoridation There is no adequate margin of safety to protect the whole population from KNOWN harmful effects – including damage to the brain, bones and endocrine system Fluoridation may actually be killing a few young men each year with osteosarcoma(5) The risks far outweigh the benefits

6. Summarizing the arguments against fluoridation It is ineffective (the evidence that swallowing fluoride reduces tooth decay is very weak. Most countries don ’ t fluoridate their water and their children ’ s teeth are as good if not better than those that do – WHO figures. (3) The fluoridating chemicals are not pharmaceutical grade and contain human carcinogens like arsenic(4)

7. Figure 2: Tooth Decay Trends for 12 Year Olds: Fluoridated Vs. Unfluoridated Countries. Data from World Health Organization. (Graph by Chris Neurath).

8. Fluoridation, as supported by U.S. EPA, is not about dental health, but is about managing 260,000 tons/year of hazardous waste while profiting the phosphate fertilizer industry. Taxpayers in communities buying HFSA are subsidizing this waste management program – more than 98% goes straight down the drain. And exposing themselves and their families to neurotoxicants and carcinogens.

10. Source: USGS 2011 Fluorspar Report In 2011, three companies produced byproduct FSA 1 at phosphoric acid plants (part of phosphate fertilizer operations). J.R. Simplot Co., Mosaic Fertilizer (a subsidiary of The Mosaic Co.), and PCS Phosphate Co. In 2011, FSA sold for water fluoridation was 65,900 t valued at $12.1 million, and 4,230 t valued at $1.33 million was sold or used for other applications. 65,900 tons of 100% assay = 264,000 tons of 24% (commercial grade) $12.1 million ÷ 264,000 = $45.83/ton. Value reported to USGS Water utilities pay from $700 (Washington DC) to $2300 (NYC)/ton. So annual sales revenue is $185,000,000 to $528,000,000. 1. Fluorosilicic acid a.k.a. hydrofluorosilicic acid (HFSA)

11. Arsenic in HFSA By 2010 over 118 million people were getting HFSA in their water supply (8). By the end of this year about 200 of those people will have developed lung or bladder cancer caused by the arsenic in typical HFSA. Treatment costs for those cases are over $700 million in 2001 dollars.

12. U. S. Populations exposed to HFSA starting in years since 1965 Population data from CDC Fluoridation Census websites, some of which have been taken down by CDC.

13. (0.99 μg/L ÷ 0.078 μg/L) x 30 μg/L = 380 μg/L Annual lung/bladder cancer cases in the U.S. caused by arsenic contamination of HFSA compared to cases from arsenic in pharmaceutical grade NaF. From Hirzy et al. Environ. Sci. and Policy 38 282-284 (2014)

14. Lung/Bladder cancer cases in cohorts exposed staring in years since 1965 and associated treatment costs in constant 2001 U.S. dollars Cohort sizes from Table 1 reduced by 0.8%/year mortality. Number of cases and treatment costs based on risk assessment methodology from EPA Arsenic in Drinking Water Rule. FR 66 (14) 6975-7066 Jan. 22, 2001

15. By 2020, if no change in policy is made, 2100 of those people will have developed these cancers, at cost of over $7 billion, in 2001 dollars. But this isn’t the worst of it…………..

16. Neurotoxicity 1 ppm F - in drinking water: – Al build-up in brain and kidney – damages brain structure – damages the kidney – damages immune system (Varner 1998) Prenatal dosing: hyperactivity (Mullenix 1995) Key brain lipids depleted (Guan 1998) Many more on biochemical impact on brain function http://SLweb.org/bibliography.html

17. Recent History- IQ Loss in Kids In 2012 a publication by Choi et al.in Environmental Health Perspectives, a highly respected, peer reviewed journal presented data showing an average 7 IQ points lost in children exposed to fluoride in drinking water (9). This Spring two highly respected public health scientists, Grandjean and Landrigan, added fluoride to their list of agents causing damage to the brains of children. (10)

18. Implications of the Choi et al. Study Lin et al. 1991Xu et al. 1994Hypothetical 3mg/LWang SX et al. 2007 Drinking water fluoride~mg/L 0.881.83.08.3 Average daily water intake ~mL/day 500 Average daily dose~mg/day 0.440.901.54.2 Uncertainty & Safety Factors 100 a 100 SEL C ~ mg/day0.00440.00900.0150.042 MCLG ~ mg/L0.00570.0120.0190.055 The first row gives drinking water levels at which IQ losses were observed in the studies which are identified above each column. We assumed water was ingested at 500 mL/day by the children in these studies, based on EPA/NRC data for U.S. children. The third row gives the estimated daily doses of fluoride that caused the IQ losses observed. The fourth row shows uncertainty/safety factors used by EPA in risk assessments like this multiplied together: 10 (to convert to a dose unlikely to cause the effect) x 10 (to account for intra-human differences in sensitivity. The fifth row gives the expected Safe Exposure Level. The last row is a calculated “safe” level in drinking water if no other exposure occurs.

19. Lin et al. 1991Xu et al. 1994Hypothetical 3mg/LWang SX et al. 2007 Drinking water fluoride~mg/L 0.881.83.08.3 Average daily water intake ~mL/day 500 Average daily dose~mg/day 0.440.901.54.2 Uncertainty & Safety Factors 10 SEL C ~ mg/day0.0440.0900.150.42 MCLG ~ mg/L0.0280.0560.0940.26 If one assumes only a single factor of 10, instead of two such uncertainty/safety factors, the following SEL C and MCLG values obtain:

20. IQ and population Very Bright Mentally handicapped 95 100 Number of Kids With a Specific IQ IQ

21. TABLE 6 Mean DMFS of U.S. Children with Permanent Teeth By Age and Water Fluoridation Exposure (11) 5 6 7 8 9 10 11 12 13 14 15 16 17 All Ages 0.03 0.14 0.36 0.64 1.05 1.64 2.12 2.46 3.43 4.05 5.53 6.02 7.01 2.79 0.10 0.14 0.53 0.79 1.33 1.85 2.63 2.97 4.41 5.18 6.03 7.41 8.59 3.39 Percent Difference No Water Fluoridation Exposure: Mean DMFS* Life-Long Water Fluoridation Exposure Mean DMFS* Age 70 0 32 19 21 11 19 17 22 8 19 18 *All means adjusted to age and gender distribution of total U.S. population ages 5-17. 1.) 3.39 – 2.79 = 0.6 Tooth surface out of 128 = 0.47% Tooth surfaces saved! 2.) Authors: 0.6/3.39 x 100 = 17.7 ~ 18 % Difference

22. 50 USA States and DC Percent National Survey of Children's Health. http://mchb.hrsa.gov/oralhealth/portrait/1cct.htm http://mchb.hrsa.gov/oralhealth/portrait/1cct.htm U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. The National Survey of Children's Health 2003. Rockville, Maryland: U.S. Department of Health and Human Services, 2005 http://www.cdc.gov/oralhealth/waterfluoridation/fact_sheets/states_stats2002.htm Ave: 83 S.D. = 2.3 Ave: 54.2 S.D. = 8.2

23. CDC, MMWR, 48(41); 933-940, Oct 22, 1999 “ Fluoride ’ s caries-preventive properties initially were attributed to changes in enamel during tooth development because of the association between fluoride and cosmetic changes in the enamel and a belief that fluoride incorporated into enamel during tooth development would result in a more acid- resistant material. However, laboratory and epidemiologic research suggest that fluoride prevents dental caries predominantly after eruption of the tooth into the mouth, and its actions primarily are topical for both adults and children… ” KY 100% fluoridated; 38% edentulous (no teeth)(12)

24. To Better Serve Valparaiso Citizens….. Educate kids and parents on brushing and diet impacts on dental health…...and instead of paying thousands to the phosphate industry for the honor and privilege of using your drinking water system to dispose of its waste …. thinking you are helping poor kids to have better teeth, in spite of evidence from CDC … Worry more about those kids’ intellectual deficits caused by fluoride and the impact of that on your community.

25. Alternative Fluoride Delivery for Valparaiso Population: 32,000 Assume everyone in town wants the amount of fluoride that would come in 2 liters/day of drinking water that would require adding 0.5 mg of fluoride/liter. Everyone in town would receive 1.0 mg/day fluoride supplement. 1mg/day-person x 32,000 people x365 days/year = 11.7 x 10 6 mg/year 11.7 x 10 6 mg = 11.7 x 10 3 g = 11.7 kg Pharmaceutical grade NaF costs about $7/kg and is 45.2% fluoride Total annual fluoride cost: (11.7 kg F x $7/kg) ÷ 0.452 = $182/year

26. References 1.Beltran-Aguilar, E.D. et al. 2010. Prevalence and severity of dental fluorosis in the United States, 1999 – 2004. NCHS Data Brief. United States Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. November 2010. 2. Fluoride’s predominant effect is posteruptive and topical. Centers for Disease Control and Prevention. (2001). Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States. Morbidity and Mortality Weekly Report 50(RR14): 1-42. 3. World Health Organization. Collaborating Center for Education, Training and Research in Oral Health. http://www/mah.se/CAPPWeb Access June 17, 2014.http://www/mah.se/CAPP 4. NSF 2014. NSF/ANSI Standard 60: Drinking Water Treatment Chemicals - Health Effects. Available: http://www.nsf.org/newsroom_pdf/NSF_Fact_Sheet_on_Fluoridation.pdf. Web Access May 13, 2014. http://www.nsf.org/newsroom_pdf/NSF_Fact_Sheet_on_Fluoridation.pdf 5. Cancer Causes Control. 2006 May;17(4):421-8. Age-specific fluoride exposure in drinking water and osteosarcoma (United States). Bassin EB, et al.

27. References-con’t 6. Chronic fluorine intoxication. (editorial) Journal of the American Medical Association 123 (1943) 150. 7. Effect of fluorine on dental caries. (editorial) Journal of the American Dental Association 31 (1944) 1360-1363. 8. Corrigendum to: Comparison of hydrofluorosilicic acid and pharmaceutical sodium fluoride as fluoridating agents-A cost-benefit analysis. Environmental Science and Policy 38 (2014) 282-284. 9. Choi, A.L., et al., 2012. Developmental fluoride neurotoxicity: A syematic review and meta-analysis. Environmental Health Perspectives 120(10): 1362-1368. October 2012 10. Grandjean, P. and Landrigan, P.J. 2014. Neurobehavioural effects of developmental neurotoxicity. Lancet Neurology 2014; 13: 330-38. 11. Recent Trends in Dental Caries in U.S. Children and the effect of water fluoridation. J.A. Brunelle and J.P. Carlos Epidemiology Branch, National Institute of Dental Research, National Institutes of Health. www.slweb.org/NIDR-DMFS.html www.slweb.org/NIDR-DMFS.html 12.www.statemaster.com/../hea_ora_hea_los_of_nat_tee-health-oral- loss-na. Access June 25, 2014

29. And http://www.childstats.gov/americaschildren/tables.asp