My Turn: Report mandates more study before fluoridation

Posted: Sunday, September 30, 2007

As chairman of the Juneau Fluoride Study Commission, I have watched with considerable interest the campaigns about the fluoride ballot issue. The debate has been civil and respectful, but I don't think it has provided voters with the information they need to make an informed decision.

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The better funded campaign is the one favoring fluoridation. It speaks in generalities and says fluoridation has proven safe and effective for many years. But has it? The commission reviewed hundreds of documents and studies and found the evidence to be much more mixed and equivocal, especially in recent years. I repeatedly asked proponents to provide us with a study that demonstrated the safety and effectiveness of fluoridation, but none was ever identified.

The group opposed to fluoridation raises claims that fluoridation is neither safe nor effective. Many of the papers making that claim are clearly junk science, but some raise serious questions. They raise the questions, but they don't prove the claims.

Faced with this division of authority, the Fluoride Study Commission, after public hearings, extensive independent research, and review of hundreds of documents, decided to wait for the results of a study by the National Research Council of the National Academy of Sciences, which was conducting the most comprehensive review of the data on fluoridation ever conducted.

The NRC report was finally released in March 2006. The focus of the study was the effect of fluoride in water at 4 mg/L, the maximum allowable level established by the Environmental Protective Agency in 1986. It found that level to be too high and not adequate to protect the public from harmful levels of fluoride. It also found that EPA's standard of 2 mg/L does not adequately protect against the occurrence of moderate enamel fluorosis, which is shown by brown stains on the teeth.

The EPA report stated that it did not evaluate the risks or benefits of fluoride concentrations of 0.7 to 1.2 mg/L, the levels commonly used in municipal water fluoridation. Juneau was fluoridating its water at the lower end of that range.

Following issuance of the NRC's report, the Juneau commission sent its report to the Juneau Assembly. Three members recommended continuation of water fluoridation. Two members recommended discontinuation of fluoridation because it was unsafe and ineffective. I cast the last vote, and recommended not to continue fluoridation not because it was proven to be unsafe, or not effective, but because the evidence on both points was inconclusive. The ancient maxim for medical practitioners of "first do not harm" seems to require that we not engage in a practice whose benefits and safety are subject to serious question.

Following the Commission's 3-3 vote on whether to continue fluoridation, the Assembly voted 5-4 to discontinue fluoridating our municipal water supply. The debate since then demonstrates that the evidence and public opinion are divided.

The NRC report did not directly analyze the effects of fluoride at the levels used in municipal water fluoridation. But it found data raising serious concerns about the risks of bone fracture, adverse effects on IQ, a risk of developing Alzheimer's disease, a risk of adverse endocrine effects, especially in children, and other health effects. The 2006 NRC report expressed increased concern from what the NRC had said in 1993 about whether fluoride is carcinogenic in humans, finding the literature to be mixed and equivocal. On all of these issues it urged further study.

The need for further study is undisputed. I believe that study should be conducted before we commit to resuming fluoridating our city water. Other programs for topical fluoride are available as an alternative and should be considered. For anyone interested in taking an independent look at these issues, the Juneau Fluoride Study Commission Report and supporting documentation is available at the city clerk's office.

• William B. Rozell is a Juneau resident and chair of the Juneau Fluoride Study Commission.

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