Daily Archives: December 27, 2014

Claim that Communal Water Fluoridation is “Cost Effective” is Unpersuasive

Studies such as this are periodically published in certain journals in an attempt to convince readers that communal water fluoridation is cost-effective. The study sounds convincing. But hidden inside are certain assumptions that drive the conclusions. In the end, the study ends up showing what it has already assumed from the start. But the major weaknesses are quite easily to understand. People, adults and children, are not statistical categories. When grouped into artificial statistical categories with assumed health outcomes and assumed costs just about any claim could be “proven” cost effective on paper. 

Tchouaket E, Brousselle A, Fansi A, Dionne PA, Bertrand E, Fortin C. The economic value of Quebec’s water fluoridation program. Journal of Public Health (09431853); Dec2013, Vol. 21 Issue 6, p523-533

Aim: Dental caries is a major public health problem worldwide, with very significant deleterious consequences for many people. The available data are alarming in Canada and the province of Quebec. The water fluoridation program has been shown to be the most effective means of preventing caries and reducing oral health inequalities. This article analyzes the cost-effectiveness of Quebec’s water fluoridation program to provide decision-makers with economic information for assessing its usefulness.

Methods: An approach adapted from economic evaluation was used to: (1) build a logic model for Quebec’s water fluoridation program; (2) determine its implementation cost; and (3) analyze its cost-effectiveness. Documentary analysis was used to build the logic model. Program cost was calculated using data from 13 municipalities that adopted fluoridation between 2002 and 2010 and two that received only infrastructure grants. Other sources were used to collect demographic data and calculate costs for caries treatment including costs associated with travel and lost productivity.

Results: The analyses showed the water fluoridation program was cost-effective even with a conservatively estimated 1 % reduction in dental caries. The benefit-cost ratio indicated that, at an expected average effectiveness of 30 % caries reduction, one dollar invested in the program saved $71.05–$82.83 per Quebec’s inhabitant in dental costs (in 2010) or more than $560 million for the State and taxpayers.

Conclusion: The results showed that the drinking-water fluoridation program produced substantial savings. Public health decision-makers could develop economic arguments to support wide deployment of this population-based intervention whose efficacy and safety have been demonstrated and acknowledged.

Promotion of Communal Water Fluoridation is Misguided

[Adding fluoride to drinking water has minimal if any dental benefit. Promotion of communal fluoridation is a political exercise to protect a sacred cow. The problem of dental caries is real but communal fluoridation is misguided.]

NEW YORK, Oct. 15, 2014 /PRNewswire-USNewswire/ — Government health authorities knew over 50 years ago that black Americans suffered greater harm from fluoridation, yet failed to warn the black community about their disproportionate risk, according to documents obtained by the Fluoride Action Network (FAN).

In 1945, Grand Rapids, Michigan, experimentally added fluoride chemicals into the water supply anticipating that children’s tooth decay would decline without causing fluoride’s unwanted toxic effects – dental fluorosis (white spotted, yellow, brown and/or pitted teeth).

Prior to Grand Rapids, government fluorosis studies focused exclusively on white children. But little publicized results from Grand Rapids showed that black children were more susceptible to fluorosis than whites.

A January 10, 1962internal memorandum, from a U.S. Public Health Service (PHS) official, F.J. Maier, revealed that “negroes in Grand Rapids had twice as much fluorosis than others.”

Based on this, Maier asked, “In a community with a larger number of negroes (say in Dekalb County, Georgia) would this tend to change our optimum fluoride levels?”

No change was made. Worse, government officials have taken no steps to educate the black community about their heightened fluoridation risk.

A FAN team led by attorney Michael Connett uncovered the 1962 memorandum and a trove of other soon-to-be released documents that shed light on how political pressures have stymied open discussion from government and industrial authorities on the hazards of fluoride.

In 2005, the Centers for Disease Control (CDC) acknowledged for the first time that the black community has higher rates of dental fluorosis. It took a Freedom of Information Act (FOIA) request, however, to learn the full extent of this disparity. According to recently released FOIA documents, 58% of black children were diagnosed with dental fluorosis in CDC’s 1999-2004 national survey, versus 36% of white children.

“The epidemic of fluorosis now seen in the black community,” says Connett, “is the visible legacy of the government’s failure to act on what it knew.”

When the PHS first endorsed fluoridation in the early 1950s, the NRC estimated that the “safe level” of fluoride is exceeded when “more than 10 to 15 percent of children” have “the mildest” type of fluorosis.

Black children now far exceed the NRC’s safety threshold. One study from fluoridated Augusta, Georgia found 17% of black children suffering from advanced forms (moderate and severe) of fluorosis, the kind of fluorosis that was once only seen in high-fluoride communities. (Williams 1990).

Despite being fluoride-overdosed, blacks still suffer from higher rates of tooth decay, with many low-income minority communities suffering from what health officials have called a “silent epidemic” of untreated tooth decay.

Not only are fluorosis and cavity rates higher in the black community, but so too are various health conditions, such as diabetes and kidney disease, that increase susceptibility to fluoride’s harmful effects.

Because of this, a number of civil rights advocates have begun calling for an end to fluoridation, including former Atlanta Mayor Andrew Young, the Reverend Dr. Gerald Durley, the Reverend Bernice King (daughter of Dr. Martin Luther King), and LULAC (the largest Hispanic civil rights organization).

“Dental fluorosis is only the most obvious effect of fluoride, because you can see it,” says Connett. Fluoride is an “endocrine disrupter” that can affect thyroid function according to a 2006 report from the National Research Council, and a neurotoxin that can damage the developing brain, according to a 2014 paper in The Lancet.

More about Racial Disparities in Dental Fluorosishttp://fluoridealert.org/studies/dental_fluorosis02/

SOURCE Fluoride Action Network

Manganese and Cancer in Huai’an City, China

Several questions come to mind regarding this study. The concentration of Mn in Huai’an City area drinking water is an order of magnitude greater than the US secondary standard. A weak correlation with cancer incidence at such high concentrations is hypothesis generating – the plausibility of the assertion that Mn is related to cancer is not discussed.  Mn does not occur in ground water (or the environment) by itself and the presence (co-occurrence) of other known cancer causing contaminants must be considered. This is especially the case in such an industrialized  area. In general there are other contaminants of more concern than Mn but perhaps not for this particular population.

Zhang Q, Pan E, Liu L, Hu W, He Y, Xu Q, Liang C. Study on the Relationship between Manganese Concentrations in Rural Drinking Water and Incidence and Mortality Caused by Cancer in Huai’an City. BioMed Research International. 2014;2014:645056. doi: 10.1155/2014/645056. Epub 2014 Nov 3.

Background. Cancer is a significant disease burden in the world. Many studies showed that heavy metals or their compounds had connection with cancer. But the data conflicting about the relationship of manganese (Mn) to cancer are not enough. In this paper, the relationship was discussed between Mn concentrations in drinking water for rural residents and incidence and mortality caused by malignant tumors in Huai’an city.

Methods. A total of 158 water samples from 28 villages of 14 towns were, respectively, collected during periods of high flow and low flow in 3 counties of Huai’an city, along Chinese Huai’he River. The samples of deep groundwater, shallow groundwater, and surface water were simultaneously collected in all selected villages. Mn concentrations in all water samples were determined by inductively coupled plasma-mass spectrometry (ICP-MS 7500a). The correlation analysis was used to study the relationship between the Mn concentration and cancer incidence and mortality.

Results. Mn concentrations detectable rate was 100% in all water samples. The mean concentration was 452.32 μg/L ± 507.76 μg/L. There was significant difference between the high flow period and low flow period (t = -5.23, P < 0.05) and also among deep groundwater, shallow groundwater, and surface water (F = 5.02, P < 0.05). The ratio of superscale of Mn was 75.32%. There was significant difference of Mn level between samples in the high flow period and low flow period (χ (2) = 45.62, P < 0.05) and also among deep groundwater, shallow groundwater, and surface water (χ (2) = 10.66, P < 0.05). And also we found that, during the low flow period, Mn concentration has positive correlation with cancer incidence and mortality; for a 1 μg/L increase in Mn concentration, there was a corresponding increase of 0.45/100000 new cancer cases and 0.35/100000 cancer deaths (P < 0.05).

Conclusions. In Huai’an city, the mean concentration of Mn in drinking water was very high. Mn concentration correlated with cancer incidence and mortality.

The paper is here (Open Access).