From the Brownstone Institute

By  Carl Heneghan,  Tom Jefferson

Politico reports that RFK, Jr. plans to ban fluoridation, and the work is already underway. Multiple news outlets repeated this story, yet none of them checked the evidence.

According to the CDC, adding fluoridation to water supplies was among the 20th century’s top ten public health achievements.

“a cornerstone strategy for prevention of cavities in the US It is a practical, cost-effective, and equitable way for communities to improve their residents’ oral health regardless of age, education, or income.”

The CDC states that fluoridated water keeps teeth strong and reduces cavities by about 25% in children and adults.

To validate this statement, the CDC refers to two studies. The first, is a meta-analysis of 20 studies. Eleven studies examined the effectiveness of self- or clinically applied fluoride, and of the nine that examined the effectiveness of water fluoridation none were RCTs, and all were cross-sectional studies. Also, the review, which wasn’t systematic, included adults and no children. The conclusion was limited to suggesting fluoride effectively prevents caries in adults of all ages.

The second study was a Cochrane review. Notably, most studies (71%) were conducted before 1975, when fluoride toothpaste was widely introduced.

The review concludes that little contemporary evidence evaluates the effectiveness of water fluoridation in preventing caries. The observational nature of the studies, the high risk of bias, and the lack of generalisability to current lifestyles limit confidence in the size of the effect estimates.

The review goes on to say that insufficient information exists to determine whether initiating a water fluoridation program changes levels of tooth decay across socioeconomic status. No studies that met the review’s inclusion criteria investigated the effectiveness of water fluoridation in preventing tooth decay in adults.

RFK, Jr. says he would advise the water districts using fluoridation that a lot of science says safety studies still need to be done. RFK, Jr. considers fluoride an industrial waste. He also thinks a federal court ruling could speed up the end of fluoridation in the US.

A judge ordered the US Environmental Protection Agency (EPA) to undertake a risk assessment. Judge Edward Chen found fluoridation could cause developmental damage and lower IQ in children at the levels found in drinking water.

Following this judgment, four water systems, including Salt Lake City’s provider, have stopped or suspended fluoridation due to the ruling.

At the TTE office, we searched for updated evidence published in the last decade, including 32 reviews. A word of caution: the overworked staff at the TTE office is currently unable to assess the evidence fully.

Dental Caries (tooth decay)

A 2021 review of ten studies on Brazilian populations reported that water fluoridation effectively prevents dental caries in children younger than 13 years, even with the widespread use of fluoridated toothpaste. A further review of fluoride for under-fives reports the evidence supporting oral fluoride supplementation for caries prevention is limited and inconsistent.

The WHO reports fluoride intake has both beneficial effects – in reducing the incidence of dental caries – and negative effects – in causing tooth enamel and skeletal fluorosis following prolonged high exposure.

Potential Harms

Reviews include an assessment of dental fluorosis, which affects individuals of all ages, with the highest prevalence below age 11. A further review reported that in 6-18-year-olds, at a water fluoride level of less than 0.7 parts per million, dental fluorosis occurred in 13% (95% CI: 7.5-18%) of the children. Above two parts per million dental fluorosis prevalence rose to 98% (95% CI: 96‒100%). In some regions, the amount of fluoride in the water represents a public health problem as it exceeds national and international regulation levels.

Reviews also assessed an association with hypothyroidism and children’s intelligence. Regarding neurological disorders, the evidence was inconclusive, and the authors call for epidemiological studies to provide further evidence regarding the possible association. A call for evidence that is repeated for establishing whether there is an association with Hip Fracture  Risk.

Reviews have also assessed the potential correlation with increased blood pressure, association with chronic kidney disease, and risk of fluoride contamination in groundwater and its impact on the safety and productivity of food and feed crops.

The Impact of Stopping Fluoride

A systematic review, including six cross-sectional design studies, indicated that fluorosis significantly decreased following either a reduction in fluoride concentration or the cessation of adding fluoride to the water supply.

A systematic review of 15 studies identified methodological considerations for designing community water fluoridation cessation studies. These studies would permit an assessment of the effects of cessation on dental caries and the impact on reducing harm.

So, Where Does This Leave RFK, Jr.?

Beware of the swift condemnation of anyone who asks questions. Experts will espouse that fluoride is well-tested, it definitively or significantly decreases caries, and it has no association with any harm—all without reference to the evidence. Furthermore, the argument is lost when an individual who puts forward questions about healthcare exposures is referred to as a denialist. 

RFK, Jr. rightly asks questions about an intervention based on evidence going back to the 1930s. In the meantime, there have been growing concerns about harm and little contemporary evidence evaluating the effectiveness of water fluoridation in preventing caries. So, stopping fluoride in the context of epidemiological evaluations isn’t far off the mark.  

This post was written by two old geezers who regularly clean their teeth, and remain overworked and apolitical.

Republished from the author’s Substack

Authors

Carl Heneghan

Carl Heneghan is Director of the Centre for Evidence-Based Medicine and a practising GP. A clinical epidemiologist, he studies patients receiving care from clinicians, especially those with common problems, with the aim of improving the evidence base used in clinical practice.

Martin Kulldorff, Sunetra Gupta, Jay Bhattacharya. Authors of the Great Barrington Declaration

From the Brownstone Institute

By Steve Templeton 

“At some point in summer of 2020, I decided—what is my career for? If it’s just to have another CV line or a stamp, I’ve wasted my life—that I would speak no matter what the consequences were.”

Many years ago, I was at the wedding of a good friend, a guy who everyone seemed to like. He was/is humble, considerate, kind, and down to earth. I remember telling his mother while at the wedding that I would tell anyone that, “If you don’t like him, then the problem is you.”

I also feel that way about Stanford health economist Jay Bhattacharya. Jay’s nomination by President-elect Trump to be Director of the National Institutes of Health has been a long time coming and is a hopeful signal that national health research policy is headed in the right direction.

Jay was right about all the big things during the Covid pandemic and was an important counter to the destructive hubris of lockdown and mandate-promoting public health leaders and scientists in the US. Along with Martin Kulldorff and Sunetra Gupta, Jay took enormous personal and professional risks in drafting the Great Barrington Declaration in October of 2020. In response to the highly age-stratified mortality of Covid-19 and with the threat of serious collateral damage of continuing lockdowns, school closures, and mandates, the GBD instead promoted the policy of focused protection for vulnerable elderly and infirm people while allowing young and healthy people to live their lives.

The virus was going to infect everyone eventually and establish herd immunity, and there was no evidence that a vaccine (none approved at the time) would stop that natural process. The big question was how to deal with a natural disaster without making the situation much worse. Thus, the debate was focused protection versus unfocused protection—sheltering everyone regardless of their risk of mortality or serious disease until the entire population could be vaccinated with a vaccine of unknown efficacy and net benefit.

At least that’s the debate that should’ve happened. Unfortunately, it didn’t. Jay and his GBD coauthors were attacked, threatened, and slandered. When Jay’s research group published a study showing that the seroprevalence of Covid-19 in Santa Clara County in California was much higher than previously believed, it destroyed the delusion that the virus could be eliminated, that containment was at all possible. Many people didn’t want to hear that, and Jay was subjected to numerous attacks in the media, including a defamatory article in BuzzFeed claiming he was funded by dark money and implied he used questionable methods because he was biased toward the study’s outcome.

The fact that he shortly thereafter authored a paper showing very low seroprevalence in Major League Baseball franchises wasn’t enough to prove his objectivity. The message put forth by the public health establishment would simply not allow any dissent or debate. The policy needed to drive The Science™, and lower-case science could not be allowed to drive the policy.

I signed the Great Barrington Declaration the day it was published on October 4th, 2020. I had seen, and was greatly impressed by, interviews of Jay by Peter Robinson in March and April of 2020 and was heartened by Jay’s calm display of knowledge and humility. Jay described in one of these interviews the uncertainty surrounding the number of people infected and the claims being made by experts like Anthony Fauci regarding the infection fatality rate:

They don’t know it and I don’t know it. We should be honest about that. And we should be honest about that with people who make these policy decisions when making them. In a sense, people plug the worst case into their models, they project two to four million deaths, the newspapers pick up the two to four million deaths, the politicians have to respond, and the scientific basis for that projection…there’s no study underlying that scientific projection.

When asked about the potential for collateral damage to lockdowns, “It’s not dollars versus lives, it’s lives versus lives.” An understanding of the responsibility to avoid collateral harm of lockdowns was essential yet was in extremely short supply. Jay was attacked for this nuanced message. He got emails from colleagues and administrators telling him that questioning the high infection fatality rate was irresponsible. Yet, someone had to do it. However, the interviews went viral, because Jay gave millions of people something they didn’t have and desperately needed. He gave them hope.

As the year went on, Jay became the face of the opposition to unfocused protection, appearing in countless interviews and writing countless articles. He became an advisor to Florida Governor Ron DeSantis, who vowed to not lock down the people of Florida again after an initial wave of closures. When waves of Covid inevitably hit Florida, Stanford students papered the campus with pictures of Jay next to Florida death rates, implying Jay’s nuanced message was responsible for the deaths of thousands of people. When the age-adjusted mortality rate of Florida ended up being rather average compared to other states, including lockdown and mandate-happy California, no one apologized.

YouTube censored a public forum with Jay and Martin Kulldorff and Governor DeSantis, where they made claims about the hazards of continuous lockdowns, school closures, and mandates that months before wouldn’t have been at all controversial. After the GBD was published, Jay and Martin were invited to the White House by Covid advisor Scott Atlas to discuss the idea of focused protection with President Trump. Despite that meeting, the political battle continued to be an uphill fight.

The response of federal officials was shameful. Fauci and White House Covid Advisor Deborah Birx boycotted the meeting. Then NIH Director Francis Collins called for a “swift and devastating takedown” of the GBD’s premise and called the authors “fringe epidemiologists.” There simply was no appetite at the highest levels for a nuanced message or any debate whatsoever. Media coverage of Jay and other Covid response critics continued to be toxic.

Yet Jay’s appearances and message continued to inspire millions of people and give them hope. I began writing in support of focused protection and against the constant doom-saying that was harming everyone, especially children. I met Jay in the fall of 2021 because of my writing, at a conference organized by Brownstone Institute. “I think we are making a difference,” he said after shaking my hand. Like many other people he had inspired to take a stance against Covid hysteria, I needed to hear that.

The next day, Jay was preparing to give his speech in front of a small crowd in the ballroom, and I sat next to him while he reviewed his notes during the previous speaker’s talk. Although he was dressed in a suit and tie, when glancing down, I noticed Jay had a hole in his dress shoe. This truly wasn’t about money or even status. He was simply doing what he believed was morally right.

Later on, Jay helped spearhead a couple of Covid-related projects I was also involved in (I was there largely due to his influence). First was the Norfolk Group, which produced a resource document for the US Congress titled “Questions for a COVID-19 Commission” and the second was Florida’s Public Health Integrity Committee formed by Governor DeSantis and led by Florida Surgeon General Joe Ladapo. Both groups attempted to bring accountability for the US public health response, and I believe they were successful in spotlighting just how wrong and harmful lockdowns and mandates were for the very public they were supposed to help.

During the initial Norfolk Group meeting, Jay often talked about the moment of no return, “crossing the Rubicon,” as he put it, the moment that each one of us made a conscientious decision to stand up against the mob. He later recalled in an interview with Jordan Peterson: “At some point in summer of 2020, I decided—what is my career for? If it’s just to have another CV line or a stamp, I’ve wasted my life—that I would speak no matter what the consequences were.”

The world has benefitted from Jay’s crossing of the Rubicon. His nomination, after years in the wilderness and on the “fringe” of public health and health policy, restores a sense that there is in fact justice in the world. Now he moves on to the significant task of reforming health research policy. We should be cheering him on all the way.

And if you don’t like Jay, then the problem is you.

Republished from the author’s Substack

Author

Steve Templeton

Steve Templeton, Senior Scholar at Brownstone Institute, is an Associate Professor of Microbiology and Immunology at Indiana University School of Medicine – Terre Haute. His research focuses on immune responses to opportunistic fungal pathogens. He has also served on Gov. Ron DeSantis’s Public Health Integrity Committee and was a co-author of “Questions for a COVID-19 commission,” a document provided to members of a pandemic response-focused congressional committee.