PART II: Why EPA's Headquarters Professionals' Union Opposes Fluoridation
Dr. William Hirzy provides the real truth behind the fluoride controversy in this second part of a two-part article.

(Editor's Note: In the October/November issue of New Life Journal, the first part of Dr. Hirzy's article appeared, providing research on drinking water fluoridation and its damaging effects on the brain and kidneys.)

Cancer is another health issue for which much of the research on drinking water fluoridation is mutually supportive of concern. That is, there are epidemiology studies that are consistent with whole-animal and single-cell studies that deal with the cancer hazard. EPA fired the Office of Drinking Water's chief toxicologist, Dr. William Marcus, who also was our local union's treasurer at the time, for refusing to remain silent on the cancer risk issue\9. The judge who heard the lawsuit he brought against EPA over the firing made the finding that EPA fired him over his fluoride work and not for the reason put forward by EPA management at his dismissal. Dr. Marcus won his lawsuit, getting his job back along with a compensatory damage award.

The type of cancer of particular concern with fluoride, although not the only type, is osteosarcoma, especially in males. The National Toxicology Program conducted a two-year study \10a,b in which rats and mice were given sodium fluoride in drinking water. The positive result of that study (in which malignancies in tissues other than bone were also observed), particularly in male rats, is convergent with data from tests showing fluoride's ability to cause gene mutations (a principal "trigger" mechanism for inducing a cell to become cancerous) e.g.\11a, b, c, d and data showing increases in osteosarcomas in young men in New Jersey \12 , Washington and Iowa \13 based on their drinking fluoridated water. It was his analysis, repeated statements about all these and other incriminating cancer data, and his requests for an independent, unbiased evaluation of them that got Dr. Marcus fired. There are two additional, more recent epidemiology studies reporting a connection between fluoride exposures and cancer\14a,b.

Bone pathology other than cancer is a concern as well. An excellent review of this issue and other aspects of fluoridation health effects was published by Diesendorf and co-workers in 1997 \15. There are now eleven studies \16a-k which show a relationship between increased hip fractures and water fluoridated at 1 ppm and two studies \17a,b showing that relationship for drinking water containing 2 to 4 ppm of fluoride.

There are eight studies \18a-h which purport to show no association between fluoride levels in drinking water and hip fracture, but among these, four \18a-d actually show an association between fluoride levels and bone fracture rates - including hip fracture.

Crippling skeletal fluorosis was the endpoint used by EPA to set its primary drinking water standard in 1986. Skeletal fluorosis occurs in stages, with crippling fluorosis being Stage Three. There have been no investigations in the United States into the extent to which Stages One and Two are being mis-diagnosed as forms of arthritis or other forms of connective tissue pathology.

Regarding fluoride's efficacy in reducing dental caries, there has never been an adequately controlled, double-blind study of fluoride as a caries preventative. There have been many small scale, selective publications on this issue that proponents cite to justify fluoridation, but the largest and most comprehensive study, done by dentists trained by the National Institute of Dental Research on over 39,000 school children aged 5-17 years, shows, at best, a saving of less than one tooth surface out of 128 surfaces, in fluoridated communities\19. This study also shows that two-thirds of the children in fluoridated communities display dental fluorosis on at least one tooth.

The latest publication \20 on the fifty-year fluoridation experiment in two New York cities, Newburgh and Kingston, gave similar findings. The only significant difference in dental health between the two communities as a whole is that fluoridated Newburgh, N.Y. shows about twice the incidence of dental fluorosis (the first, most visible sign of fluoride chronic toxicity) as seen in non-fluoridated Kingston. Other recent studies show that when fluoridation is stopped, rates of dental caries do not increase\21a-e.

A publication by Featherstone\22 revised the theory of fluoride's effect on dental caries reduction. He posited that the effect was topical, not systemic. That is, fluoride works by affecting the tooth surface, especially in the high concentrations present in tooth pastes, rather than by incorporation of fluoride into the tooth structure through swallowing it, as had previously been thought. The Centers for Disease Control and Prevention then issued a report\23 in 2001 which affirmed the findings of Featherstone that the main benefit from using fluoride comes from topical application.

John Colquhoun's publication on this point of efficacy is especially important\24. Dr. Colquhoun was Principal Dental Officer for Auckland, the largest city in New Zealand, and a staunch supporter of fluoridation-until he was given the task of looking at the world-wide data on fluoridation¹s effectiveness in preventing cavities. This paper provides details on how data were manipulated to support fluoridation in English speaking countries, especially the U.S. and New Zealand, and it explains why an ethical public health professional was compelled to do a 180 degree turn on fluoridation. Professor Hardy Limeback, Head of Preventive Dentistry, University of Toronto and a former spokesperson for the Canadian Dental Associations program pushing fluoridation in Canada, also has reversed his position and now opposes the practice \25.

In addition to our concern over the toxicity of fluoride, we note the uncontrolled-and apparently uncontrollable-exposures to fluoride occurring nationwide via drinking water, processed foods and beverages, fluoride pesticide residues and dental care products. What other effects besides the epidemic of dental fluorosis cited above may be occurring, un-noticed, because of this excessive exposure is anybody's guess. For governmental and other organizations to continue to push for more exposure is irrational and irresponsible at best. In June 2000, I testified\26 on behalf of the union before the U.S. Senate Subcommittee on Fisheries, Wildlife and Water asking for a moratorium on fluoridation programs in the U.S. while studies were undertaken to determine whether these excessive fluoride exposures were resulting in neurotoxicity and bone pathology among America's youth.

Many people ask why the federal government and organizations such as the American Dental Association (ADA) continue to press for ever more fluoride to be put into the nation's water supplies. Several answers come to mind. Reluctance to admit a mistake-if not a fraud-with concomitant concern for liability, certainly applies to both government entities and the ADA and its various spokespersons. EPA has stated \27 that it regards the use of waste hydrofluosilicic acid, recovered from phosphate fertilizer manufacturing, in fluoridation systems as "an ideal environmental solution to a long-standing problem," because "water and air pollution are minimized, and water utilities have a low-cost source of fluoride available to them."

In other words, the material that goes into ninety percent of the nation's fluoridated water systems\28 would be classified as a toxic air and water pollutant if it were released into the atmosphere or dumped into rivers, but EPA says it's perfectly fine for this untested, corrosive and toxic acid waste to go directly into your drinking water-no problem there! The solution to pollution is dilution.

Given all the facts on toxicity of fluoride and excessive exposures to it, the evidence that it doesn't reduce cavities when ingested, the nature of the industrial waste used for fluoridation and our oath to preserve, protect, and defend the Constitution (and the laws enacted under it), we Civil Service professionals took the stand that we did regarding this public policy.

Finally, we applied EPA's risk control methodology, the Reference Dose, to the neurotoxicity data published by Varner et al.\4, and used the results to protect EPA workers. The Reference Dose is the daily dose, expressed in milligrams of chemical per kilogram of body weight, that a person can receive over the long term with reasonable assurance of safety from adverse effects. Application of this methodology to the Varner data leads to a Reference Dose for fluoride of 0.000007 mg/kg-day. Persons who drink about one quart per day of water from the public water supply of the District of Columbia, which contains 1 ppm of fluoride, receive about 0.01mg/kg-day from that source alone. This is more than 100 times the Reference Dose. On the basis of these results the union filed a grievance, asking that EPA provide un-fluoridated drinking water to its employees. In response, EPA offered to cost-share a bottled water purchase program.

The implication for the general public of these Reference Dose calculations is clear. Recent, peer-reviewed toxicity data, when applied to EPA's standard method for controlling risks from toxic chemicals, require an immediate moratorium on the use of the nation's drinking water supplies as disposal sites for the toxic waste of the phosphate fertilizer industry, something which we asked Congress to act upon\26.

What can citizens do? Get the fluoride out of your own water supply. I am a resident of the District of Columbia, a fluoridated city, and I distill all my family's drinking and cooking water using a relatively low-cost still that is widely available. Reverse osmosis filtration is another option. Ordinary filters do not remove fluoride. Organize to fight this well-intended but outdated and now proven dangerous policy. Citizens in Escondido, California have filed suit against local authorities1 to prevent fluoridation of that city. Write Congress demanding a full-fledged hearing on the evidence regarding the practice2.

CITATIONS
4. Chronic administration of aluminum- fluoride or sodium-fluoride to rats in drinking water: alterations in neuronal and cerebrovascular integrity. Varner, J.A., Jensen, K.F., Horvath, W. And Isaacson, R.L. Brain Research 784 284-298 (1998).

10a. Toxicology and carcinogenesis studies of sodium fluoride in F344/N rats and B6C3F1 mice. NTP Report No. 393 (1991).

10b. Results and conclusions of the National Toxicology Program's rodent carcinogenicity studies with sodium fluoride. Bucher, J.R., Hejtmancik, M.R., Toft, J.D., Persing, R.L., Eustis, S.L., and Haseman, J.K. Int. J. Cancer 48 733-737 (1991).

11a. Chromosome aberrations, sister chromatid exchanges, unscheduled DNA synthesis and morphological neoplastic transformation in Syrian hamster embryo cells. Tsutsui et al. Cancer Research 44 938-941 (1984).

12. A brief report on the association of drinking water fluoridation and the incidence of osteosarcoma among young males. Cohn, P.D. New Jersey Department of Health (1992).

13. Time trends for bone and joint cancers and osteosarcomas in the Surveillance, Epidemiology and End Results (SEER) Program. National Cancer Institute. In: Review of fluoride: benefits and risks. Department of Health and Human Services.1991: F1-F7.

14a. Regression analysis of cancer incidence rates and water fluoride in the U.S.A. based on IACR/IARC (WHO) data (1978-1992). International Agency for Research on Cancer. Takahashi K, Akiniwa K, and Narita K. J. Epidemiol. 11 170-179 (2001).

14b. Relationship between fluoride concentration in drinking water and mortality rate from uterine cancer in Okinawa prefecture, Japan. Tohyama E. J. Epidemiol. 6 184-191(1996).

15. New evidence on fluoridation. Diesendorf, M., Colquhoun, J., Spittle, B.J., Everingham, D.N., and Clutterbuck, F.W. Australian and New Zealand J. Pub. Health 21 187-190 (1997).

16a. Regional variation in the incidence of hip fracture: U.S. white women aged 65 years and older. Jacobsen, S.J., Goldberg, J., Miles, ,T.P. et al. JAMA 264 500-502 (1990)

16b. Hip fracture and fluoridation in Utah's elderly population. Danielson, C., Lyon, J.L., Egger, M., and Goodenough, G.K. JAMA 268 746-748 (1992).

16c. The association between water fluoridation and hip fracture among white women and men aged 65 years and older: a national ecological study. Jacobsen, S.J., Goldberg, J., Cooper, C. and Lockwood, S.A. Ann. Epidemiol.2 617-626 (1992).

16d. Fluorine concentration is drinking water and fractures in the elderly [letter]. Jacqmin-Gadda, H., Commenges, D. and Dartigues, J.F. JAMA 273 775-776 (1995).

16e. Risk factors for fractures in the elderly. Jacqmin-Gadda, H. et al. Epidemiology 9 417-423 (1998).

16f. Water fluoridation and hip fracture [letter]. Cooper, C., Wickham, C.A.C., Barker, D.J.R. and Jacobson, S.J. JAMA 266 513-514 (1991). 16g. Water fluoridide concentration and fracture of the proximal femur. Cooper, C. et al. . J. Epidemiol Community Health 44 17-19 (1990).

16h. Exposure to natural fluoride in well water and hip fracture; A cohort analysis in Finland. Kurttio, P.N. et al. Am. J. Epidemiol. 150 817-824 (1999).

16i. The effects of fluoridation on degenerative joint disease (djd) and hip fractures. Hegmann, K.T. et al. Abstract # 71 of the 33rd annual meeting of the Society for Epidemiological Research, June 15-17, 2000. Published in Supplement Am. J. Epiedemiol. PS 18 (2000).

16j. Fluorides in drinking water. Keller, C. Unpublished results. Discussed in Gordon, S.L. and Corbin, S.B. Summary of Workshop on Drinking Water Fluoride Influence on Hip Fracture and Bone Health. Osteoporosis Int. 2 109-117 (1991).

16k. Hip fracture in relation to water fluoridation: an ecologic analysis. May, D.S. and Wilson, M.G. Unpublished data. Summary of Workshop on Drinking Water Fluoride Influence on Hip Fracture and Bone Health. Osteoporosis Int. 2 109-117 (1991).

17a. Effect of long-term exposure to fluoride in drinking water on risks of bone fractures. Li, Y. et al. J. Bone Mineral Res. 16 932-939 (2001.

17b. A prospective study of bone mineral content and fracture in communities with different fluoride exposure. Sowers, M. et al. Am. J. Epidemiol. 133 649-660 (1991).

18a. Patterns of fracture among the United States elderly: geographic and fluoride effects. Karagas, M.R., et al. Ann. Epidemiol. 6 209-216 (1996).

18b. Community water fluoridation, bone mineral density and fractures: prospective study of effects in older women. Phipps, K.R. et al. Brit. Med. J. 321 860-864 (2000).

18c. The fluoridation of drinking water and hip fracture hospitalization rates in two Canadian communities. Suarez-Almazor, M. et al. Am. J. Public Health 83 689-693 (1993).

18d. Use of toenail fluoride levels as an indicator for the risk of hip and forearm fractures in women. Freskanich, D. et al. Epidemiology 9 412-416 (1998).

18e. Effects of fluoridated drinking water on bone mass and fractures: the study of osteoporotic fractures. Cauley, J. et al. J. Bone Min. Res. 10 1076-1086 (1995).

18f. Fluoride in drinking water and risk of hip fracture in the U.K.: a csae control study. Hillier, S. et al. The Lancet 335 265-269 (2000).

18g. Hip fracture incidence before and after the fluoridation of the public water supply, Rochester, Minnesota. Jacobsen, S.J. et al. Am. J. Public Health 83 743-745 (1993).

18h. Drinking water fluoridation: bone mineral density and hip fracture incidence. Lehmann, R. et al. Bone 22 273-278 (1998).

19. Special Edition. Brunelle, J.A. and Carlos, J.P. J. Dent. Res. 69 723-727 (1990)

20. Recommendations for fluoride use in children. Kumar, J.V. and Green, E.L. New York State Dent. J. (1998) 40-47.

21a. Rise and fall of caries prevalence in German towns with different fluoride concentrations in drinking water. Kunzel, W. and Fischer, T. Caries Res. 31 166-173 (1997).

21b. Caries prevalence after cessation of water fluoridation in La Salud, Cuba. Kunzel, W. and Fischer, T. Caries Res. 34 20-25 (2000).

21c. Caries trends in 1992-1998 in two low-fluoride Finnish towns formerly with and without fluoride. Seppa, L, Karkkaimen, S and Hausen, H. Caries Res. 34 462-468 (2000).

21d. Patterns of dental caries following the cessation of water fluoridation. Maupome, G. et al. Community Dent. Oral Epidemiol. 29 37-47 (2001).

21e. The effects of a break in water fluoridation on the development of dental caries and fluorosis. Burt B.A., Keels, and Heller K.E. J. Dent. Res. 2000 Feb;79(2):761-9.

22.The science and practice of caries prevention. Featherstone, J.D.B. J. Am. Dent. Assoc. 131 887-899 (2000).

23. Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States. MMWR Vol. 50, No. RR-14; 1-42. Centers for Disease Control and Prevention.

24. Why I changed my mind about water fluoridation. Colquhoun, J. Perspectives in Biol. And Medicine 41 29-44 (1997).

25. Why I am now officially opposed to adding fluoride to drinking water. Open Letter. Limeback, H. Faculty of Dentistry, University of Toronto. April 2000.

26. Testimony of Dr. J. William Hirzy before the U.S. Senate Subcomittee on Water, Fisheries and Wildlife, June 29, 2000.

27. Letter from Rebecca Hanmer, Deputy Assistant Administrator for Water, to Leslie Russell re: EPA view on use of by-product fluosilicic (sic) acid as low cost source of fluoride to water authorities. March 30, 1983.

28. Fluoridation Census 1992. U.S. Public Health Service, Centers for Disease Control. Atlanta, Georgia. 1993.

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