Response PFPC

Rebuttal to Michael Connett (FAN)
Regarding his response to the PFPC Commentary:
“FAN’s Swiss Cheese”

July 7, 2003

   Thank you for your response. In order to avoid any confusion and mis-interpretation, we will quote entire portions of your response, followed by our comments.

You wrote:

    The Key Issue

    First of all, before I address the specific criticisms of the article, I think it's important to place the emphasis where the emphasis most needs to be placed: namely, that the fluoridation of salt, as the PFPC has thankfully highlighted, is a growing, and frequently overlooked, source of fluoride exposure.

    On this note, the PFPC's article serves a *very* useful purpose, as it brings into focus a very important issue (one that, I myself, have not yet paid enough attention to).

    I could therefore probably end my response here, as this (the growing exposure to fluoride from salt fluoridation) is, in the largest scheme of things, the most important piece of information to take in from PFPC's article.

Comment:

   The PFPC commentary deals with a few specific items of mis-information in an article authored by you, and which is presented as the lead item on the FAN website. The FAN website serves as a source of information for anti-fluoridationists worldwide. As a result of this mis-information, the media (such as the National Review) and many well-meaning anti-fluoridationists report on this matter erroneously.

   Additional comments regarding salt fluoridation issues were placed in Italics in order to afford the reader a more comprehensive background on this issue - an issue which has been entirely neglected by FAN. While it is appreciated that you now find this information useful, please note that this is not the first time that FAN leaders have been alerted to the fluoridated salt issue. In fact, it has been an issue since before FAN was officially formed. Besides us, we know of others who have tried to alert FAN to the issues relevant to Europe and elsewhere and other sources of fluoride - to no avail.

   The Ireland Fluoridation Forum Report, which was subject of a “scientific response” by FAN leader Prof. Connett and colleagues, contained an extensive chapter on salt fluoridation, including a table listing the countries with national salt fluoridation programs in South America [Chapter 4, Table 4.1]. How long can one claim ignorance on this matter?

   Now, regarding your response to “specific criticisms” as to the article’s accuracy:

You wrote:

    a) 2 Reasons/3 Reasons?

    As PFPC notes, the GSK - in its report - provided 3 reasons why it was recommending the end of water fluoridation. I was indeed aware of this fact when I wrote the article (I included all 3 reasons in my initial drafts). However, after reading through the 3 reasons, and after careful consideration, I came to the conclusion that reason #1 and reason #3 were interchangeable; that is, they were stating the same thing, but in different ways.

    More specifically:

    Reason #1 states that there's no reason for Basel to be the "lone island" in Switzerland, or continental Europe, by fluoridating its water supply. But why? Why was the GSK opposed to a "solo effort" with water fluoridation? They were opposed to a solo effort, not out of some fundamental opposition to "solo efforts", but rather because they believed that other cities in Europe were equally successful at reducing tooth decay without water fluoridation.

Comment:

   Your interpretation is incorrect. Once again you are failing to convey that the GSK specifically compared water fluoridation to salt fluoridation - not areas without “water fluoridation”, implying “non-fluoridated” areas. Here is the entire paragraph (reason #1) of the GSK report - properly translated:

    Water fluoridation stems back to a prophylaxis-concept of the 1950s when there were different conditions regarding public health and the routines of water consumption. In Europe at the time, water fluoridation was a wide-spread practice. In the meantime Basel unwrapped itself to be a lone island not only in Switzerland, but also on the European continent. All around Basel, other means of caries prophylaxis have long been established (caries prophylaxis - as it relates to base-fluoridation - is already described earlier in the report, in detail [Point 3, Page 5]. We’re at Point 7 here.) Principally the GSK is not against such lone pursuits. A lone pursuit is only then justified if the separate solution truly justifies the effort, if the success is documented by the bottom line. To cut water fluoridation in half is no solution for the GSK.

You wrote:

    To me, this reasoning is the same as that expressed in reason  #3, where the GSK states that it could find no studies showing Basel to have a lower tooth decay rate than in neighboring European cities.

Comment:

   Once again - nowhere in Reason #3 is there a statement by the GSK saying “that it could find no studies showing Basel to have a lower tooth decay decay rate than in neighbouring European cities”. As already stated in the original PFPC Commentary the GSK statement refers specifically to base-fluoridation, and that no studies comparing water fluoridation to other means of base-fluoridation could be found.

You wrote:

    In other words, both Reason #1 and Reason #3 are stating that the GSK believes there is no difference between tooth decay rates in Basel versus other comparable European cities.

Comment:

Again - nowhere - in either reason #1 or #3 - is this stated, not in any words. You continue to interpret as if “fluoridated” was compared to “non-fluoridated”. The fact remains that fluoridated (water) is compared to fluoridated (salt) - only the means of fluoridation is at question.

    In my article, therefore, I cut down on what I felt was unnecessary verbage, by distilling the 2 key and most distinct pieces of reasoning contained in the 3-point-list.

Comment:

You distilled quite wrongly.

Further, you wrote:

    b) "Base-Fluoridation"

    Being that PFPC has people in their group who can speak German, I readily concede that they are more knowledgeable about the language interpretation issues at play.

    This, in fact, was one of the troubles I ran into when writing the article.

    After I accessed a pdf file of the GSK report on the internet, I was eager to read it. Not knowing German, I used an online translation device which translated the article into - admittedly rather crude - english.

    This is where the problem arose. And looking back, I confess that I should have exercised a bit more caution. For in the specific quote that the PFPC highlights, I mistakenly assumed that the phrase "Base-Fluoridation" was referring to fluoride exposure in general, which, as PFPC notes, it was not.

Comment:

   Had the words “base-fluoridation” only occurred in the specific phrase highlighted by the PFPC, the mistake could have easily been excused. However, the term “base-fluoridation” appears throughout the entire GSK report.  In fact, point 3 on page 5 of the report deals specifically with this issue and what the term actually means. Here are the entire three paragraphs as found on Page 5, Point 3 of the GSK report:

    3. Base-fluoridation as caries prophylaxis

    The fluoridation of drinking water is a form of base-fluoridation as caries prophylaxis. Base-fluoridation means that fluoride is delivered orally and absorbed through the digestive tract. This is in contrast to individual fluoridation, by which is meant the local application of toothpaste, mouth rinse or tooth gels.

    In most European states and the whole of Switzerland, except in Canton Basel-Stadt and the three surrounding communities Allschwil, Schonenbruch and Binningen, it is not the drinking water, but common salt which is the means of base-fluoridation. Concerning salt fluoridation it serves to differentiate between the availability of fluoridated table salt, and the also area-covering fluoridation of bag- or baker’s salt, which is used in the food industry. Fluoridated bag-or baker’s salt is used in Switzerland in the Cantons Glarus and Waadt and partly in Tessin. A consequent and area-covering application of fluoridated bag salt would be possible only as a measure for all of Switzerland. Fluoridated table salt is available for sale in all of Switzerland.

    Moreover: To avoid overdosing with fluoride, there should be no fluoridated salt actually available on the store shelves in Basel-Stadt. The Canton, however, does not have the legal means to prohibit the sale of fluoridated salt in the Canton area. Earlier there was a sort of Gentleman’s Agreement between the Canton’s Laboratory and the wholesale distributors. Today, however,  fluoridated salt is widely available also in Canton Basel-Stadt.

You wrote:

    c) GSK's request for Studies

    PFPC takes objection with my statement that the GSK called for studies comparing the tooth decay rates in Basel with the tooth decay rates in other Swiss cities.

   We took objection with your statement which left out entirely the fact that the GSK specifically asked for studies comparing water to salt fluoridation.

You wrote:

    I think, however, that the PFPC has gone a bit too far with this one. Yes, it is true that the GSK was primarily interested in comparing the effectiveness of water and salt fluoridation. However, to do so, the GSK wanted comparisons between the tooth decay rates of Basel with other comparable Swiss cities (i.e. Zurich & St. Gall). This is stated clearly in the GSK report.

Comment:

Exactly. It is stated clearly in the GSK report. Once again - both Zurich and St. Gallen are salt-fluoridated areas, with similar population structures as Basel.

    Thus, while it is correct that the GSK wanted comparisons
    between salt & water fluoridaton, it is also correct that they wanted comparisons of tooth decay rates between Basel and Zurich/St. Gall. (It is the comparisons between Basel & Zurich/St. Gall that would help provide an approximate sense of the efficacy of water vs. salt fluoridation.)

    Thus, I think PFPC's statement that

    "The GSK did not ask such thing (comparisons between Basel & Zurich/St. Gall, MC) and should never be quoted as such, really"

    is a bit misleading.

   Again, the criticism referred specifically to your interpretation of what the GSK had actually asked for, not the cities involved. Perhaps you misunderstood. As a reminder, you wrote:

    "In 1999, the GSK had asked public dental clinics to investigate whether Basel had a lower rate of tooth decay  than 'areas or cities with similar population structures, such as Zurich or St. Gall'.  Four years later, these investigations had yet to be conducted, or if they were, the results were never  presented."

Now - here is what the GSK actually asked for, in its own words:

Excerpts from Point 4, page 5

    4. Efficacy of the fluoridation of drinking water:

    In it’s report concerning the suit Rene Brigger “regarding fluoridation of drinking water in Basel” from Feb. 3 1999 the GSK of the time found faults regarding the lack  of comparison studies on the efficacy of base-fluoridation by means of drinking water or common salt. The GSK suggested to the public dental health clinics to conduct comparison studies in areas or cities with a similar population structure, as, for example, Zurich or St. Gallen, which build on fluoridated salt as a measure of base-fluoridation. As the GSK of the time wrote, “A change from fluoridated drinking water to fluoridated salt ought to be considered, in case such investigations could not confirm the advantage of water fluoridation over salt fluoridation”.

    The present GSK took up the issue again in February 2001, but had to note that any  comparing investigations did not exist at that time. To state beforehand: an investigation which provides a serious comparison on the efficacy of fluoridated drinking water as compared to fluoridated salt, doesn’t exist even today.”

You wrote:

    d) Tooth decay rates in Switzerland

    According to PFPC, "It is further untrue that most other Swiss cities have very low rates of tooth decay."

    Unless Zurich is a remarkable exception (note: the World Health Organization cites Zurich tooth decay rates to represent Swiss tooth decay rates - see: http://www.whocollab.od.mah.se/euro.html ), the tooth decay rates in Switzerland are quite low in relation to what is considered a success here in the US.

    For instance, according to a recent study (published in 2003), the average DMFT of 12-14 year old children in Zurich in the year 2000, was 0.9 - 1.27 respectively. See:
                   http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12708326& dopt=Abstract

    To put this in perspective, the US NIDR's 1986-87 survey of tooth decay in US children, found an average of roughly 2.0 DMFT in 12 year old children. See: http://www.fluoridealert.org/DMFTs.htm

    While the NIDR's data is now a bit out of date, the fact that the NIDR's findings were seen as evidence of a major public health success in reducing tooth decay, coupled with the fact that Zurich's tooth decay rates in 2000 were 50% lower, provides evidence that Switzerland's tooth decay rates are - in the western context - pretty good.

Comment:

   We really don’t care how many studies on 12-year olds you provide here - what both the PFPC commentary and the GSK report refer to is caries prevalence in 7-year olds. That was clearly stated. The 2003 citation you provide above is the one we supplied in our Commentary, under #6. If you want to learn more about how caries at age 12 relates to both earlier and later caries, you might want to read some recent relevant material, such as the work by Haugejorden [J Paediatr Dent 12(5):306-15 (2002)].

    I'd be interested, however, in any data that PFPC may have which shows that it is "untrue" that Swiss cities have low rates of tooth decay. I'd also be interested in the yardstick they use to gauge whether tooth decay rates there are high or low. (The fact that tooth decay rates have increased there in the 1990s - a trend which is present in almost every western country - does not mean that decay rates are high, at least not yet.)

Comment:

See above. Further you should know that we’re not really interested in tooth decay rates. We are dealing with fluoride poisoning every day of our lives. Teeth are only of concern to us as it relates to timing of fluoride overdose. That said, we can easily show you how all of FAN’s information on tooth decay and fluoride is highly flawed. But that is like opening a new can of worms.

You wrote:

    e) Definition of "Unfluoridated"

    A point made throughout PFPC's critique is that my article, and the FAN site in general, is incorrect when it states that Basel has stopped "fluoridation", or that western Europe is 98% "unfluoridated."

    I have mixed views on this point. On one hand, I think - as noted earlier - that it is important that we - FAN & all groups working on fluoride - start focusing more on salt fluoridation, and that it is good that PFPC has brought the issue to the fore.

    However, on the other hand, I think it is clear both in the Basel article and on the FAN site in general, that when we speak of Basel & Europe rejecting "fluoridation" we are referring to "water fluoridation." For instance, in regards to the Basel article, it is clear from the outset that it is "water fluoridation" which is being referred to. This is evident from the

    a) title
    b) first sentence
    c) summation sentence of introduction

    all of which specify "water fluoridation" as being the policy which has been rejected.

Comment:

   Fluoridation is fluoridation. The fluoridation of drinking water is just one way to fluoridate the masses, just one example of base-fluoridation. Fluoridating the salt supplies is much worse, for reasons already stated in the commentary

  Regarding the FAN website there are countless examples of how the term “fluoridation” is abused. The 50 reasons against fluoridation, the Fluoride Action Network's Citizen Tool Kit are just a few examples. Worst is probably the page “Tooth Decay Trends: Fluoridated Vs. Unfluoridated Countries” where Switzerland is listed as an “unfluoridated” country.

    That said, I do think I could have provided a more critical spotlight on Basel's decision to allow salt fluoridation. While I refer to the GSK's preference for fluoridated salt over fluoridated water, I do concede that I didn't discuss this aspect in the depth that it deserves.

    Thus, while I think the Basel article is going to provide a welcome headache to water fluoridation proponents in the US, England, Australia, and elsewhere, I do think I could improve the article by including a link to an article discussing the problems of salt fluoridation.

We don’t think it will provide much “headache” at all. As a matter of fact that point is the easiest to shoot down by any pro-fluoridationist, as has been shown by the comments made by the Ireland Fluoridation Forum in response to Prof. Connett’s “50 reasons”.

    On that note, perhaps if the PFPC, or someone else, is interested, they could write such an article and I could provide a link to it from the Basel article. I would just ask that the article stay focused on the problems with salt fluoridation, and not on inter-group disagreements.

Comment:

   The information in the FAN article on Basel is wrong and misleading. There are no other words for it. A link from it to anywhere else does not correct the false information inherent in the article. If FAN wants to retain any credibility at all, the article should be pulled immediately, and a correct statement be issued.

    If anyone has any suggestions or questions on this, or anything else on the FAN website, please feel free to contact me, either by email or phone.

Comment:

We’ve tried that before.

Regards,

Bob Johannsen, Rainer Neuhaus & Andreas Schuld
Parents of Fluoride Poisoned Children (PFPC)
Vancouver, BC, Canada
PFPC Website:
http://www.bruha.com/pfpc
E-mail:
pfpccanada@shaw.ca