Swiss Cheese

PFPC COMMENTARY
© 2003 PFPC

June 15, 2003 (Father’s Day)

FAN’s “Swiss Cheese”

   In the past few weeks we have received a flurry of mails, mainly from Europe and Canada, about the situation in Basel, Switzerland and the reports which have been circulated by the anti-fluoridation movement on this issue. It has become obvious that many anti-fluoridation campaigners are and have been misinformed.

   Of particular concern to most were several bulletins by the International Fluoride Information Network (IFIN) and the present lead article on the newly revamped website by FAN, the global Fluoride Action Network. FAN distributes the IFIN bulletins, which are usually authored by Prof. Paul Connett, to other anti-fluoridation activists worldwide.

   Please be informed that the lead item on the FAN website site entitled "Basel Switzerland Votes to Stop Water Fluoridation" (1) is very inaccurate, highly misleading, and has “as many holes as Swiss Cheese”.

Background

   The FAN article refers to a report by the Commission on Health and Social Issues (GSK) which led to the cessation of water fluoridation in Basel. The report was written on Feb. 26, 2003 and passed on to the Great Council on March 19, 2003. The Council voted upon the matter on April 9th, 2003. The original GSK report has been placed on-line by the GSK (2) as well as the PFPC (3).

   Unfortunately, throughout the FAN article key points of the GSK report are mis-represented.

A few examples:

[1] FAN:

    "In March, the GSK presented their advice to end water fluoridation in a ten page report delivered to Parliament. The two main reasons supporting their recommendation were:

COMMENT: First of all, there were THREE main reasons given by the GSK, not two. They are listed further below. But for now, let's go to the next item, allegedly reason #1:

[2] FAN:

    1) Lack of evidence that water fluoridation is more effective than other, less intrusive, means of reducing tooth decay.

    As noted in GSK's report:

    "No study or investigation can belay clearly that water fluoridation obtains better results as a measure to reduce tooth decay than other uses of fluoride."

COMMENT: Not only is this matter not reason "1)", but the GSK report does NOT say this. The sentence above shows up under reason #3:

    "No study or investigation can show plainly and clearly that water fluoridation as a measure to protect against caries can achieve better results than other measures of BASE-FLUORIDATION."

   This is a VERY important difference.

  Base-fluoridation ("Basisfluoridierung") describes fluoride which is taken up by the masses via the oral/intestinal tract (systemic), while "Individualfluoridierung" (individual fluoridation) means local applications via toothpaste, mouthrinse, gel, etc. Another associated term encountered in the document is the word "flächendeckend" which means area-covering, i.e. both water fluoridation and salt fluoridation cover large population areas, thus are described as "area-covering". This is a very important aspect if we are to discuss "forced medication", but more on this later.

   The fact is: what water fluoridation is being specifically compared to here is SALT fluoridation - another form of systemic fluoride intake by the masses and which is in place in virtually all of Switzerland, the first country to sell fluoridated salt in 1955, and where 85% of the population uses fluoridated salt. This aspect is clearly described in the GSK report [Point 4, Page 5].

   It is hard to understand how this could have been misinterpreted as FAN’s own postings of newsarticles report on the fluoride-salt “ersatz” (4). It is further very hard to understand how an organization campaigning against systemic fluoride intake can show such ignorance.

   Newspaper articles had been circulating on the Internet on this issue since March 20th, specifying the GSK position and its “political” motive - a day after the report was handed to the Great Council (i.e. Tagesblatt Bern, March 20, 2003).

[3] FAN:

    "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."

COMMENT: The  GSK did not ask such thing and should never be quoted as such, really. What the GSK DID ask for were studies which investigated if fluoride in water was any better than fluoride in salt, both being examples of "base- fluoridation" (Feb, 1999). Zurich and St. Gallen are BOTH fluoridated salt areas with "similar population structures", and were therefore proposed. (There are 11 unique ethnic communities). Zurich has used fluoridated salt since 1955.  

    NOTE: Numerous cantons in Switzerland fluoridate all salt destined for human consumption, thus fluoride is taken in from all processed foods, bakery products, in restaurants, cafeterias, canteens, etc. - in short, any food item with salt. In those areas, the daily intake of bread alone may already provide more than 1.2 mg per day of fluoride - per person (5). Such measures certainly are “forced mass-medication”, and worse than any water fluoridation, as now all foods made with such salt contain much more fluoride.

[4] FAN:

    Adding to these doubts were recent findings showing that tooth decay had risen in Basel's children since 1996, coupled with an absence of any evidence showing Basel to have a lower rate of tooth decay than other Swiss cities (most of which have very low rates of tooth decay).

COMMENT:

   This is also an incorrect and misleading statement. Again the impression is created that “other Swiss cities” are “un-fluoridated”, which is entirely untrue, as discussed above. It is further untrue that most other Swiss cities have very low rates of tooth decay.

   The GSK reports on the position statement given by the Director of Public Dental Clinics, who said that caries had become clearly worse between 1996 and 2001 in Basel. Especially for seven-year-olds caries occurrence had actually doubled. The GSK report states this with special emphasis ("Verdopplung!"). However, a similar situation exists in Zurich, and a similar increase is seen in this age group. From the year 1992 to 2000, caries prevalence in 7-year-olds increased by 64% in Zurich (6). (Please note that nowhere in Switzerland can there be any “fluoride deficiency”. There are extensive school-brushing programs with fluoride toothpaste, almost all people use fluoride toothpastes (w/ organic fluoride compounds), fluoridated salt is used by 85 % of the population - yet there is such an alarming increase in caries?

[5] FAN:

    According to extensive data collected by the World Health Organization and various national/regional surveys, unfluoridated countries in western Europe have experienced - without exception - the same general decline in tooth decay over the past 30 to 50 years, as that experienced in the US. As a result, children today in unfluoridated countries such as Denmark, Germany, The Netherlands, and Sweden have as low - or even lower - levels of tooth decay as US children.

   This is sheer nonsense and it boggles the mind how anyone can speak of “unfluoridated countries” here, or even attempt to compare caries rates without any apparent knowledge on fluoride exposure and intake in these countries.

   If the Netherlands are “unfluoridated” - how come Dutch public health officials in 1988 calculated total daily fluoride intake to be up to 6.0 mg of fluoride? Food was estimated to be the source of 80-85% of fluoride intake; intake from drinking-water was 0.03-0.68 mg/day and from toothpaste 0.2-0.3 mg (7). “For children, total intake via food and water is decreased because of lower consumption. Intake of food and water relative to body weight is higher, however, and is further increased by the swallowing of toothpaste or fluoride tablets (up to 3.5 mg of fluoride per day)” (8).

    NOTE: For comparison - in 1991 the US PHS estimated daily fluoride intake of adults in “optimally” fluoridated areas of the US to be up to 6.6 mg/day (9).

   In Germany, fluoridated salt has within a few years grabbed the major share of the market, driven by a PR campaign initiated by salt producers (13). Dentists have been lobbying to have regulations lifted to allow bakeries and large kitchens to use fluoridated salt. Test case has been the kitchen at the University of Heidelberg which has used fluoridated salt in its foods since 1999.

   FAN has a special page alerting to “other sources of fluoride intake” (10). However, fluoridated salt is not mentioned at all.

THE GSK's THREE REASONS

1) No reason for Basel to be the "lone island" in Switzerland. As around Basel other methods of caries prophylaxis are in existence, and no unique benefit of fluoridated water could be identified, the GSK felt this "lone island" approach of water fluoridation was not justified. The GSK rejected the idea to “half the fluoridation” (fluoridate at 0.5 ppm), as had been proposed by Peter H. Miehl, the Director of the Public Dental Clinics. [It is noted in the report that fluoridated salt is available in Basel as well, posing another problem commonly described in the literature as “overlap”. Earlier there had been a sort of "gentleman's agreement" with distributors "sacrificing" sales, but now fluoridated salt was once again widely available.]

2) The second reason was that fluoridated water has a "Streuverlust" (scatterloss), meaning it is being scattered, not used for drinking or cooking, but ends up being wasted. The report states: "with fluoridated food salt, as is used in the rest of Switzerland for base-fluoridation, this scatter-loss and with it the unnecessary burden on the environment would be considerably less."

3) Here it is stated that the "island solution" as well as "scatterloss" could only be justified if there were no other alternative and comparable means to base-fluoridate available. It is here where it is stated that no study exists which can show that fluoridated water is better than other means of base-fluoridation - meaning fluoridated salt - NOT "other uses of fluoride" or “less intrusive measures”, as stated by FAN. It is here that the report also addresses the question of "personal freedom" and "forced medication" imposed upon by water fluoridation. This has been a political item since 1990 when a Basel couple sued because fluoride-free water was not available and the case made it to Supreme Court (Bundesgericht)[see Point 2, page 4 ].

   SO - the GSK recommended to stop water fluoridation, and to use fluoridated salt instead. Has the government stopped “fluoridation”? No, it will chose another medium to fluoridate the people. The GSK report further states that the transition from fluoridated water to fluoridated salt should be accompanied by a one-time info-campaign,  and that this could be done when water bills were being sent out by the IWB (Industrial Works Basel).

   Please also note that elsewhere in the report [Point 6, page 7] it is stated that the IWB cannot sell its water to other cantons or countries because of the fluoride content. The GSK claims that it has not concerned itself with this aspect of the "Politikum of TWA" (fluoridated drinking water). One can see this point also stressed in the submission by Ziegelbecker from the day before the report was made (11).

   The report further states that no longer fluoridating the water of Basel will save 200,000 francs a year. Fluoridated salt has no costs what-so-ever to the state.

    NOTE:This fact is very advantageous for dental public health officials everywhere who, long aware of the political implications in water fluoridation, now quietly go about starting massive fluoridated salt programs. More on this below.

   Fluoridated salt is no more expensive than other salt, and is actually sold under a slight subsidy, making its selling price just a bit lower than other salt (Yewe-Dyer, 2002). The "poor" family  - which really doesn’t exist in Switzerland where 99% of the population is literate and the average income is above US $28,000 a year - will go for fluoride salt, the cheaper salt. Marketing is aggressive and has been very successful, aided greatly by salt producers - as in many other countries. Now even common recipes call specifically for fluoridated salt (12).

98% fluoridation- free?

   Often encountered on FAN’s website is the statement that 98% of Europe is “unfluoridated”. Anyone who knows about the global drive to fluoridate salt supplies knows how wrong such a statement really is. “Fuzzy Math”? Perhaps one day soon FAN will wake up and take its mandate to “minimize fluoride exposure” seriously and actually pay a bit of attention to the remaining 98% NOT affected by water fluoridation programs, but other means of “base-fluoridation” and “mass-medication” programs?

   While it was estimated in the 1990s that worldwide 230 million people received artificially fluoridated water (13), the number of people now affected by fluoridated salt programs greatly exceeds those affected by water fluoridation. 350 million people were added in 1996 alone when the Pan American Health Organization (PAHO) launched a massive salt fluoridation program in Bolivia, Dominican Republic, Honduras, Nicaragua, Panama and Venezuela (14).

   The project was part of a multi-year plan launched by PAHO in 1994 to “fluoridate the entire Region of the Americas”. The project was funded - once again - by a multi-year deal grant from Kellogg’s (15).

   Since then many other countries have been added and many more are currently in the process. In Jamaica, Costa Rica and Columbia all salt destined for human consumption is fluoridated (“universal” salt fluoridation).

   Forced Medication?

   Just like in water fluoridation - where it was presumed that people would drink 4 glasses of water every day and thus take in the “optimal” intake of 1 mg of fluoride/per day - salt was fluoridated at 250 ppm. Here it was presumed that “individual application” (meaning use of the salt shaker at the table - the “sprinkling over food”) would contribute 1 to 4 g of the daily total salt intake, thus a person would take in 1 mg of fluoride a day at 4 grams a day - the “optimal” dose of fluoride intake to “protect against caries”.

   How dentists ever convinced public health policy makers that the same salt (also called “cooking salt”) wasn’t also used for all cooking, including breadmaking, soups, etc. is anyone’s guess.

   Fluoridated salt - which also has plenty of contaminants (16) - has one quality much worse than fluoridated water: an individual's preferred level of salt may be raised or lowered by progressively raising or lowering the actual level over a period of time. In other words, the amount of salt you use today might not be enough for you a month from now when you will be adding a little bit more! Salt consumption has shot through the roof, and worldwide efforts are underway to reduce overall salt intake to 5 g/day. In Costa Rica - just as one example - all salt is fluoridated at 250 ppm and people consume on average 10 g of salt per day, ensuring a daily fluoride intake of 2.5 mg/day from this source alone.

“Fluoride-free by 2003”?

Not this way.

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

SEE: FLUORIDATED SALT FAQ

  =================

1) FAN - "Basel Switzerland Votes to Stop Water Fluoridation" May 26, 2003 [Note: The FAN article has been updated to accomodate information which had been given in this essay. While previously it was stated on the site that this was done because of the PFPC criticism, this statement is no further given. As a matter of fact the article now still has the May 26 publication date, although it is now vastly different from the original article. Key facts are still distorted.] Elsewhere on the site the fact that salt fluoridation is substituted for water fluoridation is again not mentioned. [Before - After]

2) GSK - "Bericht der Gesundheits-und Sozialkomission des Grossen Rates zum Anzug Rene Brigger betreffend Fluoridierung des Basler Trinkwassers" [9229/P975485]
http://www.bs.ch/ber-9229.pdf

3) PFPC site - GSK Report: "Bericht der Gesundheits-und Sozialkomission des Grossen Rates zum Anzug Rene Brigger betreffend Fluoridierung des Basler Trinkwassers" [9229/P975485] http://64.177.90.157/pfpc/ber-9229_Basel_document.pdf

4) FAN- “Basel Parliament Votes 73 - 23 to Stop Water Fluoridation
http://www.fluoridealert.org/news/index.php/news/content/view/full/1153

5) PFPC - “Our Daily Bread” (2003)

6) Menghini G, Steiner M, Marthaler T, Helfenstein U, Brodowski D, Imfeld C, Weber R, Imfeld T - "Caries prevalence among students in 16 Zurich districts in the years 1992 to 2000" Schweiz Monatsschr Zahnmed 113(3):267-77 (2003)

7) Slooff W et al., eds. - "Basisdocument fluoriden" Bilthoven, Netherlands, National Institute of Public Health and Environmental Protection, 1988 [Report no. 758474005], also in:

8) WHO: Water and Sanitation, Protection of the Human Environment - Guidelines for drinking water quality: Fluoride, Guidelines for drinking-water quality, 2nd ed. Vol. 2. Health criteria and other supporting information.  Geneva, World Health Organization, pp. 231-237 (1996)

9) US PHS - “Review of Fluoride Benefits and Risks” Department of Health and Human Services, p.17 (February 1991)

10) FAN - Other Sources of Fluoride
http://www.fluoridealert.org/f-sources.htm#I

11) Submission of R. Ziegelbecker (February 25, 2003)

12) Recipe
www.birgitwulff-oeko.de/rezepte/rezbolognese.html

13) Marthaler TM - “Salt fluoridation in Europe, comparisons with Latin America” 8th World Salt Symposium (2000); Volume 2: 1021-1026 (2000)

14) PAHO Press Release, Aug. 23, 1996

15) PFPC - About Kellogg’s

16) PFPC - What’s In Salt?

“Salt fluoridation can be considered as equivalent to fluoridation of drinking water.” (Kunzel, 1993)

(Kunzel W - "Systemic use of fluoride - other methods: salt, sugar, milk etc." Caries Research 27 (suppl.1):16-22 (1993)

Yewe-Dyer M - "My view on fluoridation" BDJ 192(10):551-553 (2002)