Comment by lee_ars
19 days ago
> Second, it completely ignores any debate over effectiveness or side effects. It could well be that fluoride in water is great for teeth but bad for brains.
Except it's not—fluoride in the drinking water concentrations is proven safe and it doesn't affect brains.
> Im not clear the validity of those claims
Thoroughly scientifically debunked. Repeatedly, over decades.
> That seems the core issue- without bias from stakeholders, is the benefit of fluoride proven and the risks disproven? It’s hard to answer because a study needs to span many years and exclude many variables.
No, it's not hard to answer, because all those studies have been done and the results were that fluoride is safe.
> And in general I think that is what needs to happen with these type debates.
What needs to stop happening is people ignoring objective reality just because the results happen to align with the other "team's" position on something.
What needs to stop happening is people ignoring objective reality just because the results happen to align with the other "team's" position on something.
"Out of a population of about three-quarters of a billion, under 14 million people (approximately 2%) in Europe receive artificially-fluoridated water."
The problem I continually see in the USA is the ascription of differences of opinion on [any topic] to America's Great Divide between enlightenment and barbarism. I find it often helpful to just check, what do these policies look like outside of America? It doesn't mean Europe got it right on fluoride, it just suggests against adopting the framing that your POV is 100% objective reality proven beyond doubt by Science™ and no rational person not in the throes of "own the [other team]" bad faith might disagree.
https://en.wikipedia.org/wiki/Water_fluoridation_by_country#...
Fluorinated table salt. Naturally fluorinated water sources. Public healthcare that covers dental
European policy isn't based on modern fluoridation being dangerous, it's based on having alternative systems in place (which vary by country)
In Windsor Ontario, across from Detroit, they took fluoride out of water for nearly a decade before reversing that decision based on results: https://www.cbc.ca/news/canada/windsor/fluoride-water-system...
Maybe Utah will be a place with alternative systems, based on another thread it sounds like they have an interesting Mormon safety net. But I would hope states do pilot tests first at least. If studies show that the historic gap in dental health between fluorinated & unfluorinated communities no longer apply, then that would be data driven policy
But it seems like this policy is based on someone's common sense that you shouldn't put minerals in water
> based on another thread it sounds like they have an interesting Mormon safety net
as long as you're Mormon. Approximately 60% of the state.
It’s iodine in table salt not fluoride. In the US.
Never knew that France fluoridated their salt.
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>Public healthcare that covers dental
laughts nerviously in Dutch
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In many US states, Medicaid covers dental. CHIPs, for kids, covers dental in every state.
Look - all for whatever science says is best, but wouldn’t countries with public healthcare also be incentivised to have fluoride in the water to reduce costs/public efficiency of public dental healthcare?
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When you watch any British tv the first thing you notice is teeth indeed.
Indeed. While the UK and the USA have comparable levels of dental health, in US television actors typically require very good (or rather, cosmetically appealing according to local norms) teeth in order to succeed. In the UK, it's less important.
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in better condition than American teeth, studies find: https://www.bbc.co.uk/future/article/20150602-do-the-british...
I'm not saying you're wrong, but you made multiple strong claims without a single citation or study link. We could have a better conversation with data to look at. There's a decent (though somewhat biased) review of the debate in [1]. It's worth noting that if you read the linked studies there closely you'll find the truth is, as usual, nuanced. Specifically, that "fluoridation is a population-level caries preventive strategy" [which may or may not be effective at the individual or small community level due to other factors]. I.e., good at the national level for statistically significant reduction of tooth disease incidence, but at less-aggregated levels the confounding factors like diet and how often/well people brush their teeth are going to be bigger determinants of efficacy.
It's also worth nothing that 1) over-fluoridation is pretty bad and can affect poor or malnourished communities (ex, [2]); and 2) there are alternatives to fluoride that may be equally effective with fewer risks at higher concentrations (ex. nano hydroxyapatite).
[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC2222595/
[2] https://www.tandfonline.com/doi/abs/10.1080/1064338060067811...
That's a whole lot of words for you acknowledging that I'm right. Fluoridated drinking water, at the appropriate levels, has no effect on IQ.
Would you like to debate the reality of anthropogenic climate change next? This will be another area where any links you dig up will only point to a single conclusion.
> Fluoridated drinking water, at the appropriate levels
Going to hijack this comment to ask about something I've always wondered: how robust are "appropriate" drinking levels to the different things you can reasonably expect people to do with the water? Not all water is simply drunk as is.
For example, I like to make beans in my slow cooker. This involves simmering them for 9 or 10 hours, periodically adding more water. In theory, this will increase the concentration of fluoride because the fluoride doesn't boil off while the water does. I assume, based on how much water I need to keep adding, this could double the fluoride concentration. Is that still appropriate levels? What about a cup that has been left out such that a lot of the water evaporates? That won't increase the amount of fluoride, but will increase its concentration.
I have to assume the "wiggle room" they build into the fluoridation rate handles these cases, but it's been hard to find any details on it since most of the results are about stuff like boiling water removing fluoride or turning it into poison fluorine gas and stuff.
Nevertheless, every time I see discussion where people talk about safe levels, I wonder how that works with all the things people do with water other than just drinking it as is.
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You missed the point. It’s not objectively true in all situations that if you don’t believe fluorinating water is necessary that you’re an a-scientific bad faith actor. One can argue the opposite position in good faith, reasonably. Your statements very strongly supposed that this is a solved case closed topic and any challenges are not supported by evidence. The response was that there is nuance and a better conversation would acknowledge it.
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Please define appropriate levels and then cite some evidence that proves with high certainty that level is safe.
For the sake of argument, assume that only 1% of the US has levels that harm IQ. Would it not be worth it to remove fluoride from the water to improve the intelligence of 1% of the population? Especially when you consider we can get fluoride from toothpaste?
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> Thoroughly scientifically debunked. Repeatedly, over decades.
"The NTP monograph concluded, with moderate confidence, that higher levels of fluoride exposure, such as drinking water containing more than 1.5 milligrams of fluoride per liter, are associated with lower IQ in children"
This is from an NIH meta-analysis. Its a pretty rigorous study.
https://ntp.niehs.nih.gov/whatwestudy/assessments/noncancer/...
"It is important to note that there were insufficient data to determine if the low fluoride level of 0.7 mg/L currently recommended for U.S. community water supplies has a negative effect on children’s IQ"
This is why there's such a fierce debate. Based on the most recent scientific literature there seems to be evidence of a dose-dependent effect of fluorine levels in water and lowered IQ in children, meaning it has some kind of neurotoxic effect. But we don't have robust evidence to say 0.7 mg/L has a similar effect. That doesn't mean it is DEFINITELY safe, it just means more research needs to be done and the current research that does cover the 0.7 mg/L range may not reach statistical significance.
The fact though the NIH suggests 1.5mg/L is likely unsafe, which is only 2x what America's tap water contains, I would not blame people for being uneasy about. It is often the case the that the FDA regulates food additives that have potential negative side effects to be limited to concentrations 10x lower than what is seen as unsafe.
I am not suggesting it's a straightforward choice to defluorinate water, but I see people often repeating claims like you have that dangers of fluoride are "thoroughly debunked" and that's simply not true. I don't blame people for having that sentiment either, because 0.7mg/L is seemingly still considered safe, and some of the loudest advocates of defluorination have no shortage of thoroughly debunked crazy views on things (possibly due to brains half eaten by worms). It makes it very easy to brush off the skepticism.
But it's also important to keep in mind science is built on the premise that one must be ready to re-evaluate past assumptions when new data arises, and generally speaking the new data around fluoride I hate to say seems to show there is indeed smoke.
It's also the case that when the US initially fluorinated water supplies it was a massive public health success, but these days it seems to make a much lower impact now that fluoride toothpaste use is ubiquitous (plus the levels were lowered from 1.0mg/L in the 70s, likely reducing its overall effectiveness). It is IMO both very reasonable to fund more research into this to know conclusively if 0.7mg/L is indeed safe, and also consider public health policy that focuses on promoting dental hygiene through other means in places that do defluorinate.
I do not agree with Utah's decision here mostly because it seems to neglect that defluorination will create a void that requires other public health policy efforts to fill it, poorer and less educated communities will suffer unless government led efforts to promote and make dental hygine affordable are not also undertaken.
> It is IMO both very reasonable to fund more research into this to know conclusively if 0.7mg/L is indeed safe
How exactly do you propose we do this? It's tough to prove absence of harm.
The meta-analysis put together tons of research under different situations, and found a weak and relatively small dose-response relationship above 1.0 mg/L and failed to find a relationship below. The evidence between 1.0mg/L and 1.5mg/L is particularly weak. And, of course, most dose-response curves are sigmoidal, so the failure to find a response under 1.0 mg/L is most easily explained by the inflection point being above that level.
If you're not satisfied when combining 74 studies fails to find a relationship, will you be happy with 75? 76? 100?
(Sure, a big proportion of the studies and study power focused on higher levels of fluorination-- and I always support filling gaps in research; but it's not like we have an absence of research below 1.5 mg/L).
Well I mean the flip side is... does community water fluorination at its current levels actually help?
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...
The Cochrane Collaboration's research is near the gold standard, and yet they find surprisingly limited evidence of benefit for CWF in the modern research:
"These low‐certainty findings (a 4 percentage point difference and 3 percentage point difference for primary and permanent dentition, respectively) favoured CWF."
3-4% reduction in cavities is not nothing, but it's a far cry from the 60% drop observed in the 1940s and certainly much less than what I think most strong proponents of water fluoridation would have you believe. The ongoing discussion I find quite legitimate given we're no longer living in the 1940s and CWF seems to have a substantially lower benefit than it once did, and likewise we do notice a concerning trend with fluorine neurotoxicity that has only emerged in the last few decades of research.
Public health policy is all about a risk/benefit analysis, and CWF is one of those topics that I feel legitimately should be discussed because much has changed over the many decades since the US first introduced it and since then the risks seemingly have gone up and the benefit has astronomically gone down.
Again, I do not think there'd be much discussion if current water fluorination was at 0.15mg/L, and we started seeing a negative trend at 1.5mg/L. But I don't think its actually at all unreasonable for public health officials to be worried and possibly start considering alternatives to CWF out of an abundance of caution.
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> but it's not like we have an absence of research below 1.5 mg/L).
But it is?
>> "It is important to note that there were insufficient data to determine if the low fluoride level of 0.7 mg/L currently recommended for U.S. community water supplies has a negative effect on children’s IQ"
Yes you would need a higher powered study to rule out the potentially smaller effect, but when your treatment can affect tens of millions of children, it doesn't seem crazy to ask for more funding.
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While I would like to think that I have gotten a lot smarter in the last 20 years it seems more likely that other people have on average gotten a lot dumber.
While I’m sure there are many causes I’m of the opinion that no stone should remain unturned when looking for answers. Fluorine in water has a viable alternative (toothpaste that is spit out) so out of an abundance of caution my preference is for unflurinated water. In my past life as an applied researcher I have learned to be rather distrustful of academia and the ‘science’ that is produced, ‘fruit from a poisonous tree’.
The conclusion from the largest and strongest studyies is that there is a certain level of fluoride that harms IQ: https://ntp.niehs.nih.gov/whatwestudy/assessments/noncancer/....
"The NTP monograph concluded, with moderate confidence, that higher levels of fluoride exposure, such as drinking water containing more than 1.5 milligrams of fluoride per liter, are associated with lower IQ in children"
They found fluoride in drinking water concentrations was associated with lower IQ, the opposite of your claim of "proven safe".
Show us some evidence that is proven safe, so far as I can tell all evidence points to unsafe or "we're not sure".
> What needs to stop happening is people ignoring objective reality just because the results happen to align with the other "team's" position on something.
I couldn't agree more. The study that is cited above started when Obama was president by the way.
Why did you omit the sentence immediately after the one you quoted?
> The NTP review was designed to evaluate total fluoride exposure from all sources and was not designed to evaluate the health effects of fluoridated drinking water alone.
…or the following sentence, which they bolded to ensure the reader wouldn't miss it?
> It is important to note that there were insufficient data to determine if the low fluoride level of 0.7 mg/L currently recommended for U.S. community water supplies has a negative effect on children’s IQ.
So no, they very explicitly did not find that fluoride in drinking water concentrations was associated with lower IQ.
The study and my quote literally say " drinking water containing more than 1.5 milligrams of fluoride per liter".
It did not find it lowered IQ in all drinking water concentrations, but it definitely found it in some drinking water concentrations.
So yes, they did explicitly find fluoride in drinking water at certain concentrations was associated with lower IQ.
Are you defining "drinking water concentrations" as "concentrations that have not been shown to be associated with lower IQ."?
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Anyone who talks about who was President when a study was done is immediately clarifying for you that they have a political agenda.
If there’s a problem with a study, or a study is particularly strong, that should be due to something about the study itself (methodology, significance of results, etc), not its political environment.
I know why! I know why! Pick me!
It's because it doesn't help prove their incorrect point.
> Except it's not—fluoride in the drinking water concentrations is proven safe and it doesn't affect brains.
What's amazing is these anti-science wackos are rejecting the largest-scale experiment of all time, with the best evidence that anyone is ever going to have on the subject. We have both temporal and spatial boundary conditions with and without community water fluoridation, where a large population has it and another large population doesn't have it. There is no evidence that the without-fluoridation population has higher intelligence! There is a huge body of evidence that the people without fluoridation have more decayed teeth.
Before calling them "anti science wackos", why not review the evidence or cite some of your own. Ironic that the "wackos" seem to be the only ones providing any evidence for their claims.
There is high quality evidence that fluoride at levels contained in some US water supplies is associated with lower childhood intelligence. For lower levels, the conclusion is "we don't know", not that there is no harm.
https://ntp.niehs.nih.gov/whatwestudy/assessments/noncancer/...
There is also high quality evidence that in the age of fluorinated toothpaste, fluorinated water "may slightly" improve dental health.
“The evidence suggests that water fluoridation may slightly reduce tooth decay in children,” says co-author Dr Lucy O’Malley, Senior Lecturer in Health Services Research at the University of Manchester. “Given that the benefit has reduced over time, before introducing a new fluoridation scheme, careful thought needs to be given to costs, acceptability, feasibility and ongoing monitoring."
https://www.cochrane.org/news/water-fluoridation-less-effect...
The literally bold-faced conclusion of your article is that no evidence exists that community water fluoridation affects childhood IQ.
We have a natural experiment running for 80 years where each arm of the experiment has N > 100e6. If there was going to be evidence of community water fluoridation lowering IQ, it would have emerged by now.
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> fluoride in the drinking water concentrations is proven safe and it doesn't affect brains.
We can never be sure who funded the studies and whether or not the results can be trusted. Studies have shown that studies cannot be trusted. I err on the side of caution.
You're welcome to put it in your own drinking water if you trust the studies.
> What needs to stop happening is people ignoring objective reality just because the results happen to align with the other "team's" position on something.
Nobody can perceive objective reality. Everyone is delusional concerning just about everything. The people who think they know what's going on, are most delusional of all.
Dark times are ahead, I'm afraid, and people's trust-meters are going to be valuable again.
> We can never be sure who funded the studies and whether or not the results can be trusted. Studies have shown that studies cannot be trusted. I err on the side of caution.
What does this mean for you in practice? Do you see just fluoride studies this way, or "studies" in general? If the former, what makes those different? If the latter, what is your stance on science-backed decision-making and policymaking in general?
Just listen to the dear leader, they use common sense and need no science to see obvious
> Studies have shown that studies cannot be trusted.
Well, that's basically the end of the debate, isn't it? Before we can have reasonable discourse, everyone has to agree on some points. Sure, individual studies have problems. That's why we make them reproducible and aggregate the results. So yeah, don't trust some individual paper; but if you're distrusting the aggregate, well, you're distrusting all of science.
> Nobody can perceive objective reality. Everyone is delusional concerning just about everything.
This is the entire point of the scientific method. It's why we make sure tests are reproducible by other people in other teams in other countries. Each with their own funding and biases. What remains after all of that is as close to objective reality as possible without decompiling the universe.
> Dark times are ahead, I'm afraid, and people's trust-meters are going to be valuable again.
You know what else has been shown to be unequivocal bullshit? People making decisions based on their "gut". Your personal "trust-meter" is just another form of that. Dark times are indeed ahead, but it's because there are people out there who want to do whatever the hell they want- and it's easier for them to get away with it if they discredit science and get the population to do so as well. This is what you're helping by spreading such things. Please stop.
> We can never be sure who funded the studies and whether or not the results can be trusted
> Nobody can perceive objective reality. Everyone is delusional concerning just about everything
This is just hyper-cynical fear mongering. An excuse to reject inconvenient things you see and substitute them with your own alternative reality.
The people who sell fear and things like alternative medicine love to push this angle: They want you to distrust everything. Everything except what they tell you, of course.
> We can never be sure who funded the studies and whether or not the results can be trusted. Studies have shown that studies cannot be trusted
the growing prevalence of anti science thinking like this has been a disaster for humanity. There's so much time and good faith effort put into trying to better understand our reality then people like you come along and handwave it all away because "well can we really know anything"
How does one live or even function with no trust? You’re going to do your own experiments on everything in your life? Do you purchase any food, take any medicines, travel in any vehicles, or use any technology? You’re relying on products that are the outcome of studies if you do. Sure people are fallible and sometimes have agendas or are wrong, but approaching objectivity is not impossible, it just takes a little work. Science is the best thing we’ve got, it has brought humanity further and faster than anything else ever. There’s nothing else to even compare it to. If we throw our hands up and insist on trusting no one, dismantle public health and public education and public trust, then yeah we could go back to the dark ages. If instead we trust that science works over time, and we are diligent about electing leaders who stop stoking fears and using pseudoscience and intentionally eroding trust in science and education, then we might have the chance to be able to trust each other and make forward progress.
> Except it's not—fluoride in the drinking water concentrations is proven safe and it doesn't affect brains.
You mean like this: Fluoride Exposure and Children’s IQ Scores A Systematic Review and Meta-Analysis, https://jamanetwork.com/journals/jamapediatrics/fullarticle/...
"Findings: Despite differences in exposure and outcome measures and risk of bias across studies, and when using group-level and individual-level exposure estimates, this systematic review and meta-analysis of 74 cross-sectional and prospective cohort studies found significant inverse associations between fluoride exposure and children’s IQ scores. [...]"
Maybe you should reconsider that what you heard once was the definite truth.
Isn't this talking about naturally-occurring fluoridation, not added? The concentrations they describe as having an inverse affect are far higher than what gets added to water on purpose:
What the study measured:
"For fluoride measured in water, associations remained inverse when exposed groups were restricted to less than 4 mg/L or less than 2 mg/L but not when restricted to less than 1.5 mg/L"
And what the US federal government recommends (or I guess soon, previously recommended):
"Through this final recommendation, the U.S. Public Health Service (PHS) updates and replaces its 1962 Drinking Water Standards related to community water fluoridation—the controlled addition of a fluoride compound to a community water supply to achieve a concentration optimal for dental caries prevention.1 For these community water systems that add fluoride, PHS now recommends an optimal fluoride concentration of 0.7 milligrams/liter (mg/L)" [1]
Note, too, the study's section on Study sample;
"No studies were conducted in the United States."
[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC4547570/
The source of fluoride is irrelevant, the effect of fluoride is cumulative. If you're getting half of the "harmful dosage" just from your water, you're much more likely to pass that threshold than if the water had no fluoride. In nations with easy access to fluoridated toothpaste and where dental hygiene is common, the cost-benefit is not at all clear.
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If people getting under 2mg/L were getting harmed, doesn't it seem logical that people getting 0.7 mg/L would also get harmed, just by a smaller amount?
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> For fluoride measured in water, associations remained inverse when exposed groups were restricted to less than 4 mg/L or less than 2 mg/L but not when restricted to less than 1.5 mg/L;
So this study found no negative effects on IQ when the fluoride concentration is less than 1.5mg/L
The U.S. Public Health Service recommends 0.7mg/L of fluoride[1]. This study supports the idea that the amount of fluoride used in the US drinking water is safe.
I couldn't find any information on how much fluoride is in utah drinking water as a whole, but a report from Davis County shows that they stay between 0.6mg/L and 0.8mg/L [2]. I'd say its fair to assume basically all the water in Utah doesn't have too much fluoride, and if it did, lowering the amount to 0.7mg/L would be enough to address the health concerns.
1: https://pmc.ncbi.nlm.nih.gov/articles/PMC4547570 2: https://www.utah.gov/pmn/files/962361.pdf
https://news.ycombinator.com/item?id=43525098
Hah. Maybe, as noted by others, you should read the study cited before assuming its conclusions support your argument. Which they do not.
I think you should read it. It literally says fluoride in higher concentrations is linked to lower IQ. It says there is insufficient evidence to draw any conclusions in lower concentrations. NOT that fluoride in lower concentrations is definitely without a doubt safe. It leaves open the question. And, it studied fluoride in urine, which means even if the drinking water levels in the US are in the “insufficient data” range, the cumulative effect of multiple sources of fluoride is still a factor.
Also note that in reality 0.7 mg/L is the “low” value and 1.5 mg/L is the high water mark from the study. That’s not a huge window by any means…
Maybe apply some critical thinking and notice that the water levels from fluoridation add on top of any other sources of fluoride people ingest, eg. toothpaste, food, etc.
That is not a study of drinking water concentrations, but much higher naturally occurring levels. Its also has pretty poor confidence intervals:
https://journalistsresource.org/home/how-to-read-this-study-...
https://jamanetwork.com/journals/jamapediatrics/article-abst...
I would be careful throwing a single study around as proof of anything, here is one with a different conclusion:
https://journals.sagepub.com/doi/full/10.1177/00220345241299...
The source of fluoride is irrelevant, the effect of fluoride is cumulative. If you get 0.7mg/L from drinking water and then add toothpaste and other sources, you could easily surmount the level where harmful effects occur.
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