Dear Honorable Minister German,

We applaud your decision to end mandatory fluoridation in Israel and we look forward to the time that there is an outright ban on this reckless practice.

Your position is a model for the public health community both in Israel and in our respective communities. It is sound, based on the current literature and the need to protect the health of citizens from unnecessary ingestion of fluoride.

It is unfortunate that in making the best decision for the health and welfare of your citizens that you have been subjected to criticism and bullying as noted in the June 22rd article, Backlash against Health Minister Yael German for her decision to stop fluoridation, published in The Jerusalem Post (Siegel-Itzkovich).

Professor Paul Connett, co-author of The Case Against Fluoride (Chelsea Green, 2010), is willing to travel to Israel and publicly debate any of those who are organizing against you. However, in our experience the pro-fluoridation advocates are unable to defend their position in open public debate. This is not through a lack of debating skills on their part but rather the fact that science simply does not support their claims that swallowing fluoride is safe or that it dramatically reduces tooth decay.

The following facts and arguments underline the inappropriateness of this outdated practice:

Delivering any medicine via the water supply is reckless

Fluoridation violates all principles of modern pharmacology. Once added to water there is no way of controlling the dose or the people who get the medicine – it goes to everyone regardless of age, weight, health, need or nutritional status. Moreover, it violates the individual’s right to informed consent to medical treatment. (http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000445.htm).

Swallowing fluoride is particularly inappropriate

Fluoride is not a nutrient. Not one biochemical process in the body needs fluoride. Underlining this fact is the exceedingly low level of fluoride in mother’s milk (0.004 ppm, NRC, 2006, p.40). Formula-fed infants in fluoridated communities (at 0.7 to 1.2 ppm) receive 175 to 300 times more fluoride than a breast-fed infant.

Making matters worse is the fact that fluoride is known to have toxic properties at low doses (NRC 2006, Barbier et al., 2010; Varner et al., 1998). It also accumulates in the bone and builds up there over a lifetime. Early signs of fluoride poisoning of the bone (skeletal fluorosis) are identical to arthritis and lifelong accumulation can make bones brittle and more prone to fracture.

Dental fluorosis

While we do not see the crippling effects of skeletal fluorosis observed in countries like India and China, which have areas of high natural levels of fluoride, children in fluoridated countries are experiencing a very high prevalence of dental fluorosis. According to the CDC (2010) 41% of American children aged 12-15 have dental fluorosis. Black and Mexican American children have significantly higher rates of the more severe forms of dental fluorosis (CDC, 2005, Table 23).

Fluoridation promoters acknowledge that dental fluorosis indicates over-exposure to fluoride but refuse to admit other harm. A review of the toxicology of fluoride by the U.S. National Research Council of the National Academies in 2006 revealed that fluoride is an endocrine disruptor and causes many health problems at levels close to the exposure levels in fluoridated communities. This panel also reported that bottle-fed babies are exceeding the EPA’s safe reference dose when drinking fluoridated water (NRC, 2006, p85).

Fluoride impacts the brain

Many animal and human studies indicate that fluoride is a neurotoxin (www.FluorideAlert.org/issues/health/brain). In 2012, a team that included Harvard University researchers reviewed 27 studies that showed an association between fairly modest exposure to fluoride and lowered IQ in children (Choi et al., 2012). In nine of these studies the so-called “high fluoride” village had fluoride levels less than 3 ppm. Such levels provide no adequate margin of safety to protect all children –especially the most vulnerable- from lowered IQ when drinking fluoridated water.

An incredible lack of oversight

Fluoridation is designed to treat a disease but has never been approved by the Food and Drug Administration (FDA); it classifies fluoride as an “unapproved drug.”

How strong is the evidence that swallowing fluoride reduces tooth decay?

Fluoridation advocates claim that it is very strong. However, if you look at the actual science it is a different story. The effectiveness of swallowing fluoride to reduce tooth decay has never been demonstrated via a randomized controlled trial (RCT), the gold standard of epidemiology (McDonagh et al., 2000). Two key U.S. studies – both government funded and by pro-fluoridation researchers – have failed to produce convincing evidence of benefit.

A very large study, administered by the U.S. National Institute for Dental Research, examined the permanent teeth of 39,000 children (aged 5-17) from 84 communities. The average saving in Decayed Missing and Filled Surfaces (DMFS) when comparing children in fluoridated and non-fluoridated communities was 0.6 of a tooth surface out of 128 tooth surfaces, and this was not shown to be statistically significant (Brunelle and Carlos, 1990). Even if it were, the average saving is remarkably small considering what risks are being taken to achieve this result.

As part of the “Iowa Fluoride Study,” where children’s tooth decay and fluoride intake has been tracked from birth, researchers examined the relationship between tooth decay and individual exposure to fluoride from all sources, including water, food and dental products. They were attempting to find the so-called “optimal dose” needed to reduce tooth decay, however they concluded that, “achieving a caries-free status may have relatively little to do with fluoride intake…” (Warren et al., 2009).

The most likely explanation for the weak evidence of benefit

Even fluoridation advocates have acknowledged that the predominant benefit of fluoride is topical, not systemic (CDC, 1999). In other words, fluoride works on the outside of the tooth not from inside the body. This acknowledgement removes the whole rationale for fluoridating water and forcing people who don’t want it to ingest it.

Most countries don’t fluoridate their water

The vast majority of countries (including 97% of Europe) neither fluoridate their water nor their salt. However, WHO figures indicate that tooth decay in 12-year-olds is coming down as fast in non-fluoridated countries as fluoridated ones (http://fluoridealert.org/issues/caries/who-data/ ).

Tooth decay in low-income families can be reduced by safer means

Many countries have been able to reduce tooth decay in low-income families using cost-effective programs without water fluoridation. The Scottish Childsmile program involves a) teaching tooth-brushing in nursery schools; b) advising parents on better diets; c) annual check-ups and d) fluoride varnishes where necessary. The number of 12-year-olds without caries has increased to over 70% using these methods and in the process costs have been cut by half (BBC Scotland, 2013).

Added benefit of emphasizing education

Making education, not fluoridation, the center of the fight against tooth decay has the added advantage of attacking the cause of obesity, an issue which threatens to cost health services billions of dollars over coming decades.

References after signatures

Sincerely,

Paul Connett, PhD, Director, Fluoride Action Network, USA

Mary Lou Andersen, MS, Bellingham, Washington

Eve-Marie Arcand, DMD, Sherbrooke, Québec, Canada

Douglas Amell, ND, Moose Jaw, Saskatchewan, Canada

Alexander J. Audette, R.Ac., TCMP, B.Eng.(Chem), Guelph, Ontario, Canada

David M. Augenstein, MSc, PEng, Akron/Canton, Ohio

John Bain, DDS, Farmington, Arkansas

Kellie Barnes, MOMT, MPT, Portland, Oregon

Jane Beck, BSc, MBBS, Thames, New Zealand

James S. Beck, MD, PhD, Professor Emeritus of Medical Biophysics, University of Calgary, Canada; Co-author, Case Against Fluoride (Chelsea Green, 2010)

Bobbie Beckman, DDS, Bassano del Grappa, Italy

Kathleen Bernardi, RDH, King City, Ontario, Canada

Rosemary R. Bishop, MS (Health Ed), Pensacola, Florida

Jo Thomas Blaine, L.Ac, San Diego, California

Zuzka Borovjakova, CNP (Certified Nutritional Practitioner), Toronto, Ontario

Barry Breger, MD, Montreal, Québec, Canada

Gene Burke, BA, Woodland Hills, California

Roger Burt, MS (psychology), Portland, Oregon

Robert Button BScPharm, RPh, CDE, CRE, Dryden, Ontario, Canada

David Buttorff, Louisville, Kentucky

Elizabeth Caliva, PE, MS, Encinitas, California

Neil J. Carman, PhD, Austin, Texas

Leo Cashman, MA, Executive Director of DAMS Inc. (Dental Amalgam Mercury Solutions), USA

Anthony Cipolla, DDS, Williamsport, Pennsylvania

Griffin Cole, DDS, President, International Academy of Oral Medicine & Toxicology, Austin, Texas

John J. Collins, DC, Newberg, Oregon

Michael Connett, JD, Los Angeles, California

Gerald W Cooper, PENG, B Eng, MBA, Toronto, Canada

Karl Cox, PhD, Brighton, Sussex, UK

Michael Czajka, PhD candidate (Chemistry), Melbourne, Victoria, Australia

Lady Carla Davis, MPH, Queensland, Australia

Catherine L. Deptula, DVM, BS, Brandon, Florida

Robert C Dickson, MD, CCFP, FCFP, Calgary, Alberta, Canada

Michael F. Dolan, PhD, Amherst, Massachusetts

Dr Jayne LM Donegan, MBBS DRCOG DCH DFFP MRCGP MFHom, London, UK

Aviva (Zack) Dycian, DMD, Ramat HaSharon, Israel

Irucka Embry, M.Eng., BS, Nashville, Tennessee



Hart Nadav Feuer, PhD, Agricultural Sciences, University of Bonn, Germany

Gerald A Fillmore, DDS, MS, Orthodontist (retired), Gridley, California

Laurence Fisher, BDS, Wellington, New Zealand

Naomi H. Flack, BS, EdM, Palm Beach Gardens, Florida

Gary Fortinsky, DDS, Toronto, Ontario, Canada

Matt Freedman, Chiropractic Physician, Eugene, Oregon

Brenda L. Gallie, Professor, University of Toronto, Ontario, Canada

Elsa Noeline Gannaway, MA. Dip Ed., Wellington, New Zealand



Michael Godfrey, MBBS, Tauranga, New Zealand

Sara Gold, DAMS International (Dental Amalgam Mercury Solutions) – Israel Activist, Certified Energy Health Practitioner, Betar Illit, Israel

Dorothy Goldin Rosenberg, MES, PhD, Toronto, Canada

Yarden Goldstein, DDS, Tel Aviv, Israel



Anna Goodwin, MD (Medical Oncologist), Hamilton, New Zealand

Michael Gossweiler, DDS Indianapolis, Indiana

Stephanie Grootendorst, DC, DACNB, Chiropractic Physician, Diplomate Chiropractic Neurology, Portland, Oregon

Ian Gregson, Wellington Chapter, Weston A Price Foundation, New Zealand

Ronald A. Greinke, PhD, Medina, Ohio

Sophie Guellati-Salcedo, PhD, Miami, Florida

Chris Gupta, P.Eng., London, Ontario, Canada

MC Hagerty, RN, BSN, MA, Carlsbad, California

Merilyn Haines, B App Sc Med Lab Tech, Brisbane, Queensland, Australia

Kathryn Hall, RN, Berkeley, California

Gerald F Harris BSc, BEd, Peterborough, Ontario, Canada

William Harris, MD, Honolulu, Hawaii

Leslie C. Hatcher RN, BSN, Southlake, Texas

Simeon Hein, PhD, Institute for Resonance, Boulder, Colorado

James M. Heltzel, DMD, Las Vegas, Nevada

Nancy R. Heltzel, RDH, KOHP, Las Vegas, Nevada

David R. Hill, PEng, CEng, FBCS, Professor Emeritus, Calgary, Alberta, Canada

J. William Hirzy, PhD, Washington, DC

Vic Hummert, Author, Lafayette, Louisiana

David W Horwood, MAgSc, Melbourne, Victoria, Australia



Professor C. Vyvyan Howard, MD, PhD, University of Ulster, Northern Ireland; Past President, International Society of Doctors for the Environment

Cheryl Hughes, RN, Cove, Texas

Ann Huntsman, RN, MS, Cupertino, California

April Hurley, MD, Santa Rosa, California

Lisa Intemann, PhD, BA, BAppSc, DipSocSc, Port Macquarie, NSW, Australia

Bo H Jonsson, MD, PhD, Department of clinical neuroscience, Karolinska Institutet, Stockholm, Sweden

Susan Kanen, BS (Whistleblower to lead in drinking water Washington DC), Anchorage, Alaska

Barry S. Kendler, PhD, FACN, CNS, Professor of Nutrition, University of Bridgeport, Connecticut

David Kennedy, DDS, Past President, International Academy of Oral Medicine and Toxicology, San Diego, California

George Knorr, Professor of Physics Emeritus, University of Iowa, Iowa

Robert Kopitzke, PhD (Statistics), Fort Collins, Colorado

Stephen M. Koral, DMD, Boulder, Colorado

Deborah Landowne, CCH, RSHom(NA) Classical Homeopathy, San Rafael, California

Neima Langner, MD, FRCP(C) Community Medicine and Public Health, Ottawa, Ontario, Canada

Isabella Leviyev, Physician Assistant, Queens, New York

Louisa Liberman, PhD, Hillsborough, North Carolina

Hardy Limeback, PhD, DDS, Former Head, Preventive Dentistry, University of Toronto; Past President, Canadian Association for Dental Research; Member of the 2006 National Research Council panel which reviewed the toxicology of fluoride; Mississauga, Ontario, Canada

Mel Litman, MD and Maya Litman, BA, B.Ed, Metar, Israel



Dennis Lobstein, MTCM, PhD, Los Angeles, California

Theresa Lynch, Ed. D., Charlottesville, Virginia

Douglas J. Mackenzie, MD, Santa Barbara, California

Peter Mackinlay, Dip Arch, A G Inst Tech, B Arch, Geelong, Victoria, Australia

Joy Margulies, RN, BS (community health), Arverne, New York

Elizabeth McDonagh BSc(Hons), Cert. Ed., Doncaster, South Yorkshire, UK

Lisa McLaurin, RN, CCRN, Castaic, California

James D. McNabb, MD, CNS, Austin, Texas

Philip Michael, MB, BCh, DCH, DRCOG, MICGP, Hon Sec IDEA, Bandon, Co Cork, Ireland

Spedding Micklem, D.Phil (Oxon), Edinburgh, Scotland; Co-author, Case Against Fluoride (Chelsea Green, 2010)

Howard W. Mielke, PhD (Environmental Pharmacology), New Orleans, Louisiana

Deborah E. Moore, PhD, Executive Director, Second Look, Worcester, Massachusetts

Tatyana Moore, CPA, Syracuse, New York

John J Mulrooney DC, Portland, Oregon

Janet Nagel, Ed.D (Public health educator, ret.), Greensboro, North Carolina

Ted Ninnes, MA, MSc, PhD, Kawhia, New Zealand

Bill Osmunson DDS, MPH, Portland, Oregon

Eugene L. Packer, DC, N.Easton, Massachusetts

Ian E Packington MA (Oxon) Cert Tox (Barts), York, UK



Dr Geoff Pain, Monbulk, Victoria, Australia

Gilles Parent, ND, Co-author, Fluoridation: Autopsy of a Scientific Error, 2010. Québec, Canada

Professor Stephen Peckham, BSc, MA(Econ), University of Kent; Director, Centre for Health Services Studies, Canterbury, UK

Doug Piltingsrud, PhD (Inorganic chemistry), Eyota, Minnesota

Michael Pinkerton, Doctor of Chiropractic, Petaluma, California

Christian Pires, Systems Engineer, Portalegre, Portugal

Betsy Ramsay, Journalist, Teacher, Author, Jerusalem, Israel

Hagen Rampes, BSc MBChB FRCPsych, London, UK



Elizabeth W. Reed, PhD, Oak Ridge, Tennessee

James W. Reeves, PhD, Lafayette, Louisiana

David W Regiani, DDS, MIAOMT, Founding member, Past president of the International Academy of Oral Medicine and Toxicology, Ortonville, Michigan

Curtis Rexroth MA, DC, CCN, Moline, Illinois

Robert H Riffenburgh, PhD, MS, PStat, FASA, FRSS, San Diego, California; Author, Statistics in Medicine, 3rd Edition (Elsevier, 2012).

Cynthia L. Rochen, BSN, BSAg, Silver Spring, Maryland

Terry Rose, BSc., BDS, Otago New Zealand

Michael Ross, LHP, Toronto, Ontario, Canada

Troy Ross, MD, MPH, Reno, Nevada

Teresa Rouse, BSN, RN, CRRN, Green City, Missouri

Jean Ryan, BSc, Nutrition and Dietetics, RN, Brisbane, Queensland, Australia

John A. Ryan, MBBS, MSc, Nutrition, FRACGP, DCH, FAMAC (Acupuncture), FACNEM, Brisbane, Queensland, Australia

Holly Satvika, RN, FNP-BC, Asheville, North Carolina

Andrew W. Saul, PhD, Editor, Orthomolecular Medicine News Service, Rochester, New York

Michael B Schachter, MD, Certified Nutrition Specialist (CNS), Suffern, New York

Judy Schriebman, Certified Classical Homeopath, RSHom(NA), San Rafael, California

Karilee Shames PhD, RN, Sebastopol, California

Richard Shames, MD, Sebastopol, California

Nestor B Shapka, DDS, Bonnyville, Alberta, Canada

Ruth W. Shearer, PhD (toxicologist, retired), Lacey, Washington

Davorin K. Skender, BSE, Bloomington, Indiana

Rick Smith, Network Manager (CAAS), Providence, Rhode Island

Kristine L. Soly, MD, FACC, Holistic Cardiologist, Crossville, Tennessee

Joerg Spitz, MD, PhD, Schlangenbad, Germany

Carol Vander Stoep, RDH, BSDH, OMT, Austin, Texas

Kathleen Thiessen, PhD, Senior Scientist, Oak Ridge Center for Risk Analysis, Tennessee

Sheldon Thomas, Director ‘Clear Water Legacy’, Retired Manager of Water Distribution, Hamilton, Ontario, Canada

William Thornton, ND, DC, Santa Monica, California

Eric Turk, PhD (Neuroscience), North Hills, California

Shimon Tsuk, M.Sc., Kiryat Ono, Israel

Ruth Tudor, RN, Olympia, Washington



Hilary C. Walton, PhD in Evolutionary Behavioral Ecology, Cleveland OH

Barbara Warren, RN, MS, Albany, New York

Joy Warren, BSc. (Hons, Env. Sc.), Certificate in Health and Nutrition, West Midlands, UK

Declan Waugh, Environmental Scientist, Cork, Ireland



Charles Weber, MS (soil science), Hendersonville, North Carolina

John J. West, CET, LAFT, Wallingford, Vermont



Donna Westfall, Former Councilmember, Crescent City, California

Raymond R. White, PhD (Biology), San Francisco, California

Shirley Williams, RN, Bellingham, Washington

Mae W. Woo, DDS, Billings, Montana

Loty Zilberman, Chemical Engineer, MSc, Ghivataiim, Israel

References:

Barbier O, Arreola-Mendoza L, Del Razo LM. 2010. Molecular mechanisms of fluoride toxicity. Chemico-Biological Interactions, 188(2):319-33.

BBC News Scotland. 2013. Nursery toothbrushing saves £6m in dental costs. November 9.

Brunelle JA, Carlos JP. 1990. Recent trends in dental caries in U.S. children and the effect of water fluoridation. Journal of Dental Research, 69(Special edition):723-727. Excerpts at http://fluoridealert.org/studies/nidr-dmfs/

CDC 1999 (Centers for Disease Control and Prevention). Achievements in public health, 1900- 1999: Fluoridation of drinking water to prevent dental caries. Mortality and Morbidity Weekly Review (MMWR) 48(41): 933-940. October 22.

CDC 2005 (Centers for Disease Control and Prevention). Surveillance for dental caries, dental sealants, tooth retention, edentulism, and enamel fluorosis–United States, 1988-1994 and 1999-2002. MMWR Surveillance Summaries, 54(3):1-43.

CDC 2010 (Centers for Disease Control and Prevention). Beltrán-Aguilar, Barker L, Dye BA. 2010. Prevalence and Severity of Dental Fluorosis in the United States, 1999-2004. NCHS Data Brief Number 53. November.

Choi AL, Sun G, Zhang Y, Grandjean P. 2012. Developmental fluoride neurotoxicity: a systematic review and meta-analysis. Environmental Health Perspectives, 120(10):1362–1368.

Connett P, Beck J and Micklem S. 2010. The Case Against Fluoride. White River Junction, Vermont: Chelsea Green Publishing.

McDonagh MS, Whiting PF, Wilson PM, et al. 2000. Systematic Review of Water Fluoridation. British Medical Journal, 321(7265):855–59. Note: The full report that this paper summarizes is commonly known as the York Review and is available at http://www.york.ac.uk/inst/crd/fluorid.htm

NRC 2006 (National Research Council of the National Academies). Fluoride in Drinking Water: A Scientific Review of EPA’s Standards. Washington, DC: The National Academies Press.

Siegel-Itzkovich J 2014. Backlash against Health Minister Yael German for her decision to stop fluoridation. The Jerusalem Post. June 22.

Varner JA, Jensen KF, Horvath W, Isaacson RL. 1998. Chronic administration of aluminum-fluoride or sodium-fluoride to rats in drinking water: alterations in neuronal and cerebrovascular integrity. Brain Research, Feb 16;784(1-2):284-98.

Warren JJ, Levy SM, Broffitt B, et al. 2009. Considerations on optimal fluoride intake using dental fluorosis and dental caries outcomes – a longitudinal study. Journal of Public Health Dentistry, 69(2):111-5.