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The 2002 MRC Report see also: British Medical Journal - Rapid Responses September 22, 2002 Dear Practitioner, As reported by the BMJ (1), the UK Medical Research Council (MRC) released its long-awaited report on the health effects of fluoridation on September 5, 2002. The report is entitled "Water Fluoridation & Health" and is available at the website of the MRC (2). WHY THIS REPORT? As a result of earlier "findings" by the York NHS Review (2000) (3), the MRC had set up a Working Group to identify "areas of uncertainty regarding the balance of benefits and risks of water fluoridation", and to make appropriate recommendations for further research to address any such uncertainties. The MRC based this report on the studies which were admitted by the York Review according to its "inclusion criteria" for the review into the efficacy and safety of the fluoridation of drinking water (3). YORK REVIEW Please note that in 1999 we, as parents of children who have suffered from fluoride poisoning, submitted over 100 studies to the York Review, all dealing with fluoride effects upon thyroid hormones, i.e. inhibition of hormone conversion in peripheral tissue, inhibition of hormone transport, de-iodination effects, actual thyroid gland damage (goitre), etc.. As thyroid dysfunction was usually seen in our children once the appropriate tests were done (complete thyroid panel), we considered this of utmost priority in any assessment of fluoride toxicity. We notified York of the fact that all documented symptoms associated with fluoride poisoning were identical to those observed in thyroid dysfunction. We sent a detailed list of over 150 such symptoms and associations to all panel members, along with scientific references. This included information on the enamel condition known as "dental fluorosis" (4). For over 80 years it has been known that the enamel disturbances observed in dental fluorosis are identical to those found in thyroid dysfunction (5). That fluoride and iodine have mutually interactive effects upon dental fluorosis has been shown many times since in animals (6,7,8) as well as humans (9). Meanwhile, the field of dentistry STILL doesn't know the exact mechanisms which lead to dental fluorosis (i.e. 10, 11), yet it does not hesitate to declare the condition a mere "cosmetic effect" only. When challenged, dentistry cannot cite ONE study which they have ever conducted comparing the overall health of children afflicted with dental fluorosis to those without. Needless to say, endocrinologists would ever declare a goitre to be of cosmetic concern only, would they? We also asked the York Review to consider the effects of water fluoridation in the context of TOTAL intake, as tea consumption is obviously very high in the UK, and UK tea may easily contain 5 mg of fluoride per litre (12), ensuring fluoride intake way above any so-called "optimal" dose for the majority. The York Review rejected our submission on the grounds that the data consisted of fluoride sources OTHER than water fluoridation, such as tablets, tea, injections, topical applications, air, etc.. There was data from humans, animals, as well as in-vitro experiments. We were told that the protocol did not allow for this to be considered, and that protocol could not be changed. When we notified the Committee that the protocol - as posted at the time - actually stated that studies on "fluoride at any concentration provided from sources other than drinking water" were to be included, the York Review simply changed its protocol (paragraphs 4.2 and 4.4) to state that only drinking water studies were to be included in its review, thus effectively avoiding the inclusion of our data. [Please also note that these particular protocol changes were never addressed in Appendix M of the Review (13) which supposedly lists all protocol changes undertaken during the entire review process.] The 1999 exchange between the PFPC and the York Review is available on the Internet (14). MRC REPORT Now to the MRC report. It always takes a lot more effort and time to show how someone has erred, and this 48-page report is no exception. This report is so faulty that it would take an incredible effort to address it all in detail. Considering the time restrictions we will only focus on the information dealing with the thyroid issue. Regarding fluoride effects upon the thyroid, the MRC report offers merely one short paragraph [5.3.7]: Thyroid (goitre)
Why the York Review only listed three studies is anyone's guess, as there are many recent studies from around the world documenting effects of fluoride in drinking water upon thyroid function (i.e., 9, 15). We shall address the last study mentioned by the MRC. We had submitted the Lin Fa-Fu et al. study NOT through the York website as is claimed by York, but as part of an Open Letter which was sent to all panel members on September 30, 1999 (16). Both the York Review and the MRC state that this study looked at goitre as the outcome. It did not. To state this as fact not only shows incompetence, but one is led to wonder if the MRC actually read the paper at all. Goitre prevalence was only mentioned "in passing". Lin Fa-Fu et al. investigated what is now called "subclinical endemic cretinism", a term which is used to describe the milder forms of somatic and psychomotor maldevelopment known to be the result of iodine deficiency. Detailed thyroid tests were done including TSH, rT3, rT3/T3 ratio, I131 uptake, as well detailed IQ and hearing tests. Dental fluorosis was also investigated, as was bone retardation. We urge all to read the actual paper as one may get a picture as to how these factors were related. The study has been posted on the Internet (17). HIGH FLUORIDE? Lin Fa-Fu et al did NOT investigate HIGH fluoride as stated by the MRC. The levels described as "high" in the Lin Fa-Fu paper were 0.88 ppm - LESS than is considered "optimal" for water fluoridation, which is 1 ppm (-> part-per-million, or 1 mg per liter) LACK OF PEER REVIEW? Regarding lack of "peer-review", please note that the Lin Fa-Fu et al. study was a three-year project funded by UNICEF, undertaken by the Chinese equivalent to the U.S. CDC, and was published in the August 1991 edition of the ICCIDD Newsletter, the official publication by the International Council for the Control of Iodine Deficiency Disorder. [ICCIDD is a group made up of a network of researchers, epidemiologists and experts in public health and salt, who work with governments at the national level to implement iodized salt programs, which are in place worldwide. Dr. Jooste is the secretary.] Regarding the studies by Jooste et al. and Gedalia & Brand we invite you to look at the data yourself, as posted by the York Review (18, 19). You may draw your own conclusions as to their "significance". The trend is most obvious: the higher the fluoride content in water, the higher the goitre prevalence. RESEARCH PRIORITIES Regarding "research priorities" the MRC states that the effects of fluoride upon thyroid hormones are of low priority. How anyone who doesn't even know the mechanisms leading to dental fluorosis - although clearly related to thyroid dysfunction - can make such a statement is beyond belief. There are easily over 40,000 biochemcal studies available on MEDLINE alone, describing in great detail fluoride effects upon thyroid-hormone-dependent events (20). On May 22, 2002, the WHO reported that some 50 million children in 2001 were born with mental and physical delays caused by "iodine deficiency" (21), an issue of "most urgent concern". Over 80 years ago it was found that "iodine deficiency" in many areas of the world was not due to lack of iodine at all, but to excess intake of fluoride from water, food, and air. These findings led to the highly successful use of fluoride medications in the treatment of hyperthyroidism (Basedow) (22). Basedow's Disease was characterized by high iodine levels in blood. After many tests showed that fluoride reduced such iodine levels, fluoride therapy became the first line of treatment for over three decades in Germany and other countries. In India alone 66 million people suffer from fluorosis, 6 million of which are children. UNICEF has now identified 25 countries where fluorosis is endemic (23). A cure is not known. It is high time that this public health issue gets addressed properly. Recently Belgium became the first EU country to ban fluoride in tablets, drops, chewing gum, and salt (24). In India the Health Ministry warns the people to stay away from fluoride toothpaste and black tea (25). These are steps in the right direction. The MRC has failed miserably. Andreas Schuld, Trent Harris & Wendy Small REFERENCES: 1) Mayor S - "UK report recommends further research on water fluoridation and health" BMJ 325: 564b (2002) 2) MRC, 2002 - "Water Fluoridation & Health" 3) University of York NHS Center for Reviews and Dissemination "Fluoridation of Drinking Water: a Systematic Review of its Efficacy and Safety" (2000) 4) Symptoms/Associations of Fluoride Poisoning & Thyroid Dysfunction 5) McKay FS - "Progress of the year in the investigation of mottled enamel with special reference to its association with artesian water" J Natl Dental Assn 5:721 (1918) 6) Wilson RH, DeEds F -"The Synergistic Action Of Thyroid On Fluoride Toxicity" Endocrinology 26:851 (1940) 7) Zhao W, Zhu H, Yu Z, Aoki K, Misumi J, Zhang X - "Long-term Effects of Various Iodine and Fluorine Doses on the Thyroid and Fluorosis in Mice" Endocr Regul 32(2):63-70 (1998) 8) Zhao WY -"A preliminary study of the interaction of iodide and fluoride in experimental iodide-goiter and fluorosis" Chung Hua Yu Fang I Hsueh Tsa Chih 22(3):146-8 (1988) 9) Desai VK, Solanki DM, Bansal RK - "Epidemiological study of goitre in endemic fluorosis district of Gujarat" Fluoride 26 (3):187-190 (1993)
10) Kirkham J, Brookes SJ, Zhang J, Wood SR, Shore RC, Smith DA, Wallwork ML, Robinson C - "Effect of experimental fluorosis on the surface topography of developing enamel crystals" Caries Res 35(1):50-6 (2001) 11) Gerlach RF, de Souza AP, Cury JA, Line SR - "Fluoride effect on the activity of enamel matrix proteinases in vitro" Eur J Oral Sci 108(1):48-53 (2000) 12) UK TEAS 13) York Review: APPENDIX M 14) UK REVIEW 15) Bachinskii PP, Gutsalenko OA, Naryzhniuk ND, Sidora VD, Shliakhta AI - "Action of the body fluorine of healthy persons and thyroidopathy patients on the function of hypophyseal-thyroid the system." Probl Endokrinol 31(6):25-9 (1985) 16) OPEN LETTER #2 17) Lin Fa-Fu, Aihaiti, Zhao Hong-Xin, Lin Jin, Jiang Ji-Yong, Maimaiti, and Aiken - "The Relationship of a Low-Iodine and High-Fluoride Environment to Subclinical Cretinism in Xinjiang" ICCIDD Newsletter, Volume 7 Number 3 August (1991) 18) York Review: APPENDIX C12 19) York Review: APPENDIX C11 20) PFPC: 40,000 biochemical studies: 21) WHO Report on IDD (May 22, 2002) 22) PFPC Newsletter #3 (1999) 23) UNICEF 24) HUME Magazine: Interview with Health Minister Aelvoet (July 30, 2002) 25) Times of India - "Book by Minister" (Aug.8, 2001) ====== A) Gedalia & Brand, 1963
B) Jooste et al, 1998 - 6 villages investigated:
(The trend is all-too-obvious...Why only the village with 1.1 ppm fluoride showed conflicting results clearly should have been point of investigation).
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