Water Fluoridation: A Problem in Ethics
Sixty-eight years ago, the beautiful city of
, MI, added fluoride to its municipal water system - and hence, Grand Rapids introduced the world to community water fluoridation.[*][*] America
However, in a fascinating twist, individuals and communities all over the world continue an active effort in removing/rejecting the fluoridation of their local water supply.[*]
The most recent efforts here in the
were among voters in US who emphasized that adding fluoride would violate an individual’s right to consent to ‘medication.’[*] Portland
This rejection of the proposal continues to maintain
as the largest Portland city without fluoride in their water.[*] U.S.
Quicky - History of Rejection
Between 1950 and 1967 there were over 1,000 fluoridation referendums (according to the CDC). Of those, 41 % fluoride proposals were adopted with 59 % rejected.[*]
From 1980 to 1988, there were fewer fluoridation votes, 150 in total, with a 36 % success rate.[*]
In spite of this, fluoridation rates have steadily increased in recent years. Americans living in areas with fluoridated water has increased from 62 % (1992) to 72.5% (2013).[*]
The Elephant in the Room – An Ethics Lesson
Fluoridation is the only water treatment process that does not treat the water itself, but the person consuming it.
Fluoridation is the practice of adding chemicals (fluorosilicic acid, sodium fluorosilicate) to drinking water to raise the naturally occurring level of the fluoride ion to approximately 1 mg/L in the belief that this can reduce the frequency of dental caries.[*][*]
Currently, the Department of Health and Human Services and the Environmental Protection Agency recommended that cities maintain 0.7 milligrams per litter of fluoride in the water supply. (This was recently lowered in 2011 from the original recommendation of 1.2 milligrams.)[*]
Nearly 75% of municipalities follow this recommendation (with many reaching levels beyond the 0.7 ml/L recommendation…personally, my own municipal water supply is included in this elevated bunch).
Given this, there are several ethical issues that fluoridation neglects:
Unlicensed medicinal substance
medicinal substance(noun): any chemical compound used in the diagnosis, treatment, or prevention of disease or other abnormal condition.[*]
To put it plainly, fluoride, when used in the diagnosis, cure or prevention of disease in man (or animal), is a drug that is subject to Food and Drug Administration (FDA) regulation.[*]
Originally, fluoridation involved the sole use of sodium fluoride, however this process is now accomplished mainly (90%) by the use of silicofluorides obtained from the manufacturing process (effluent scrubbers) of the phosphate fertilizer.[*][*][*][*]
While most commercially available formulations of toothpaste that contain fluoride are formally registered as ingestible drugs, neither sodium fluoride or silicofluorides has been licensed as such in the United States.[*]
This is in strak contrast to pharmaceutical products that require strict formal licensing, quality control (in the manufacturing process), and safety testing. Yet, these particular chemicals (silicofluorides) are given to adults and children as unlicensed medicines - without any such safety testing, pharmaceutical-level quality control in manufacture,
In my opinion, fluoridation should be reclassified as medical research. At least in this classification, there are strict ethical procedures and sanctions intended for protection the public.
Voluntary and informed consent
The ethical issues raised by fluoridation can ultimately be referenced in the Nuremberg Code. [*][*]
Research, medical experimentation or even routine medical procedures, must be completed with the voluntary cooperation of the individual, who must be fully informed of the risks and benefits of the medical procedures in which they are involved.[*]
In the case of fluoridation there is no such actions taken (or are planned) at attaining informed consent of the public at hand. The State has taken the power upon itself to assume the rights of the individual.
Obviously, a State’s interest may legitimately override an individual’s consent in the event of a potentially life-threatening and/or contagious disease. However, unless there is a valid public health concern, the request of the individual must take precedence over actions imposed by the state.
In the data and research I’ve completed, tooth decay does not qualify as such a disease requiring the State to assume individual rights. Clearly, because tooth decay is not a life-threatening or contagious disease, the use of fluoridation as a prophylactic medical intervention (without the fully informed consent of the public) violates civil liberties.
There are many health concerns that are debated currently with fluoride ingestion, fluoridation and toxicity – however, I am not going to go into detail here in this post. Rather – this post is dedicated to the ethical issue at hand so I will only address this briefly.
At the heart of any medical ethics debate is the nature of the substance being administered: fluoride chemical compounds added to drinking water.
The National Sanitation Foundation (NSF) standard requires that the chemicals added to drinking water be supported by toxicological evaluation.
However, no randomized, controlled human trials (RCTs) have been completed on the products (hydrofluosilicic acid and sodium fluorosilicate) used in water fluoridation – which makes this section of the post rather short.[*][*]
Nonetheless, there are particular risks when these chemicals are being purchased and added by your municipality that I do want to address.
The more I began to read about how fluoride is added to our drinking supply, it made me wonder - who the hell is responsible to maintain the safety (particularly the processes) of public water fluoridation?
(Unfortunately, I was unable to find the exact answer to this – however, here are three recent lawsuits in the US pertaining to water fluoridation which may add to the confusion of who is wholly responsible.)
To the best of my understanding the State is responsible for monitoring the safety of water fluoridation (please correct me if I’m incorrect). However, not one state’s public health department requires monitoring results of any water system’s fluoridation program; this information is purely on a voluntary basis from each water municipality.
How exactly is safety (principally the level of fluoride) being monitored if it is not required to declare/report it?
75% of drinking water in this nation is being treated with chemicals by corporate workers and engineers with no medical qualification or clinical experience. The training recommendation (mind you -not required, just recommended) by the CDC is that managers working in fluoridated public water systems should have 6 hours of fluoridation training – that is the end of it.[*]
This is disheartening to say the least, you see, when a community fluoridates its drinking water, a potential exists for a fluoride overfeed (this is per the CDC). The CDC also confirms that some fluoride levels in fluoridated municipalities can be high enough to cause immediate health problems. Of course, it is instructed that all overfeeds should be corrected immediately because some “have the potential to cause serious long-term health effects”.[*]
And what if they do? Who is responsible – and what about the case that the public are NOT required to be notified of fluoride overfeeds occurring – ?!
One size-fits all approach
In pharmacology, it is understood that individuals respond differently (sometimes very differently) to the same dose of a given drug/medication.
Consequently, the dose of a medication that is considered safe for one person may be harmful for someone else – in some cases dangerous.
The data and understanding on this particular issue is still developing, nearly 70 years after the initiation of fluoridation. However, the premise that fluoridation is safe at the same dose for everyone (irrespective of age, health, and nutritional status) is not well held by scientific evidence – in fact, data point to the contrary.
Formula fed infants (younger then 12 months)
Not only do infants receive a larger dose then their adult counterparts, they have an impaired ability to excrete fluoride through their kidneys.[*]
Current studies have discuss the possibility that infants in this age group (0-12 months) may be consuming more fluoride than necessary. In March 2006, the National Research Council (NRC) cautioned that infants can fluoride-overdose via reconstituted baby formula.[*]
Individuals with poor kidney function (particularly dialysis patients)
A 2006 National Research Council report indicates people with kidney disease are more susceptible to fluoride’s bone and teeth damaging effects. Particularly, dialysis machines cannot use fluoridated water because it is understood to be potentially dangerous to patients. An NKF statement indicates some people receiving dialysis treatments died or were poisoned from fluoride after it leeched through machine filters.[*]
Individuals with iodine deficiency
Research has shown that fluoride exposure worsens the impact of an already occurring iodine deficiency. When iodine intake is inadequate during early childhood, the brain can suffer permanent damage. An iodine deficiency coupled with fluoride exposure produces a significantly more damaging effect on neurological development than iodine deficiency alone.[*][*][*][*][*][*][*]
Children with Polydipsia
Children with medical conditions that induce polydipsia (excessive thirst) are at particular risk of developing severe fluorosis (marked by brown and black staining of the teeth, often with extensive pitting, chipping, and crumbling of the enamel).
Diabetes insipidus is one such medical condition that produces polydipsa and has been confirm by research to be adversely affected by fluoridation.[*][*][*][*]
Fluorosilicic acid and sodium fluorosilicate is delivered to everyone regardless of age, health or nutritional status – this is done without individual oversight by a medical professional and without control of dose.
The underlying point here is that there are members of the population that are more susceptible to adverse reaction when fluoride is added to their water source. Water fluoridation does not allow medical personnel to monitor reactions.
In general, any professional that participates in a medical act (even preventative) are subject to legal and ethical imperatives – with careful attention to the needs of each patient. This is simply not done with regards to water fluoridation.
The Centers for Disease Control and Prevention list water fluoridation as one of the top 10 public-health achievements of the 20th century.[*]
Whether adding fluorine compounds to municipality water sources carries benefits or risks – the underlying issue is one of ethical allowance.
To put it plainly, silicofluorides are widely used in public water fluoridation are unlicensed medicinal substances administered without informed consent by an unqualified medical practitioner.
The Convention on Human Rights and Biomedicine:
No one may in principle be forced to undergo an intervention without his or her consent. Human beings must therefore be able freely to give or refuse their consent to any intervention involving their person.[*]
There are circumstances in which it could be considered acceptable for the State to impose measures on a population as a whole in the interest of public health – however, fluoridation raises an ethical issue because it is an infringement on personal liberty – unless you purchase a whole house RO filter, you are drinking , cooking, bathing and washing your clothes in water that has been enhanced with hydrofluosilicic acid and sodium fluorosilicate for the sole purpose of reducing dental caries.[*]
When I first set out in writing this post I was originally researching the endocrine-disrupting properties of fluoridation and the effect of early on-set puberty, however, I could not completely focus on that topic until I addressed the underlying issue: water fluoridation, in my opinion, is unethical.