Tuesday, June 23, 2015

Medical Malpractice and Water Fluoridation in the Republic of Ireland

The Irish Health Research Board (HRB) in their recent review say that they found no definite evidence that community water fluoridation has negative health effects. Yet remarkably, and extraordinarly, the review did not in any way access the exposure of the Irish population to fluoride; including the contribution of water fluoridation, food or beverage consumption, medicines or occupational exposures to fluoride from major industries that are known to be significant sources of fluoride such as computer manufacturing, aluminium processing, coal fired electricity generation, chemicals industry, cement, brick, glass or fertilizer manufacturing all of which have large workforces in Ireland. From a risk management perspective there is only one accurate way to access exposure and therefore risk, and that  is to use established biomarkers of fluoride exposure by measuring the fluoride content in human blood, urine or bone, as well as measuring the fluoride content in commonly consumed beverages, foods as prepared with fluoridated water and to determine the exposure of the population to fluoride releasing medications that are commonly prescribed in Ireland. For engineers and scientists the concept of cumulative exposure is  well understood, as it is applied in environmental, flood and pollution risk management and impact assessment. However, when its comes to the consumption of a known and established bio-accumulative toxin that is deliberately added to the water supply, it appears that the rigours of scientific assessment do not apply. In the case of the HRB review not one of these most basic tasks were undertaken.

In addition, the review while examining the literature on fluoride and neurological disease somehow managed to exclude the recently published study in the Journal Environmental Health, titled “Exposure to fluoridated water and attention deficit hyperactivity disorder prevalence among children and adolescents in the United States: an ecological association”. After controlling for socioeconomic status this study empirically demonstrated an direct association between more widespread exposure to fluoridated water and increased ADHD prevalence in U.S. children and adolescents [1]. This large scale ecological study, the first of its kind to investigate this association was published the same week as the study by Peckham and associates who also found a significant association between water fluoridation and hypothyroidism disorders in the UK [2]. The latter study was included in the HRB review but the former was not? Why not?

As for the prevalence of thyroid disorders in Ireland, we must assume that the HRB are aware that the third most popular prescribed drug in Ireland is for the treatment of hypothyroid disorders [3]. From the sheer number of prescriptions and the normal prescription patterns for this drug, the data suggests that almost 10% of the Irish population suffer from hypothyroid disorders. This would indicate that Ireland has the highest prevalence of thyroid disorders in the developed world and would agree with the findings of Peckham and associates that water fluoridation was associated with a 60% increase in thyroid disorders among the population.

Overall, their desk based review entirely excluded the published literature which has found that many common medications can cause fluoride intoxication. This is a matter of significant public health concern, as the European Food Safety Authority noted that medications can contribute over 75% of the daily fluoride intake for infants alone [4].  So did the HRB review access fluoride intake from medications? No they did not.
Neither did the HRB review determine the fluoride intake and exposure from tea in Ireland, which is by far the most significant dietary intake source of fluoride for the Irish population. Over 60 published studies have been published internationally which have found excessive concentrations of fluoride in tea, yet remarkable not a single study has every been published in Ireland documenting the fluoride exposure from tea. As the worlds largest consumer of tea and with mandatory water fluoridation this omission is simply extraordinary. So did the Health Research board measure the fluoride content in tea products sold in Ireland? No they did not.

In fact, tea as a source of fluoride was only noted in their report as it was previously documented by myself in correspondence almost two years ago to the Chief Medical Officer, Minister for Health, Minister for Food and Agriculture among others, where I warned about public safety from excessive fluoride exposure and to which I have received neither a reply nor acknowledgement. Despite this, the HRB review could only conclude without actually testing tea products for fluoride content that “tea leaves contain proportionally higher levels of fluoride than CWF water that is used to make it”. This statement reflects a gross misrepresentation of the facts. Tea contains substantially higher concentrations of fluoride than CWF.

In 2006, the National Research Council of the United States (NRC) stated that in the UK consumers can ingest 9mg per day of fluoride from tea drinking alone and that making tea with fluoridated water contributes to excess fluoride intake and the risk of chronic disease. Furthermore, the NRC (2006) reported that consumption of just half a cup of brewed tea with an average fluoride concentration of 3.3 mg/L would equal the total background intake of fluoride from all food sources [5]. Moreover, in 2008, the Department of Public Health in Taiwan conducted a risk assessment on fluoride exposure from tea drinking measuring the fluoride content in over fifty specimens of tea using de-ionized water. The concentration of fluoride in the majority of tea samples was found to exceed 4 mg/L [6]. The authors found that elderly persons, who generally consume greater quantities of tea, would exceed the Acceptable Daily Intake (ADI) for fluoride from tea drinking and concluded that caution should be undertaken in considering fluoridation of water in Taiwan in order to avoid side effects. Drinking water is not fluoridated in Taiwan, but more importantly, per capita consumption of tea in Ireland is significantly higher than Taiwan.

The HRB must clearly be aware, that Ireland has the highest per capita consumption of tea in the world, 17% higher than the UK, 14 fold higher than the United States and over 40 fold higher than countries such as Spain, Belgium or Portugal [7]. Tea is consumed by 91% of adults in Ireland [8], with the average person consuming four cups of tea every day [8]. The European Food Safety Authority (EFSA) have established that the upper tolerable intake for fluoride to prevent chronic disease for a healthy adult is 7 mg/day [9]. Furthermore, the EFSA estimated that drinking just 2 cups of tea per day, combined with an average consumption of fluoridated drinking water and use of fluoridated tap water in the preparation of food, but excluding all other sources (including solid foods, toothpaste and dental products), would provide a daily dietary intake of 6 mg per day [4].  So what does this say about fluoride intake among the Irish population? It clearly suggests that chronic fluoride intoxication is a major public health problem in Ireland and that the authorities are turning a blind eye in order to protect a public policy of mandatory fluoridation.

One must assume that the HRB and Food Safety Authority would also be aware that the Regulatory Authorities in China recently banned the importation of tea from Kenya, due to toxic levels of fluoride that were found in tea produced in Kenya [10]. Obviously, the HRB and Food Safety Authority are aware that 90% of tea leaves consumed in the Irish market are sourced from Kenya. If they are not aware of this, or indeed the fluoride content in tea products consumed in Ireland, than this further demonstrates that they are not protecting public health.

So what does this say about the HRB review? Clearly, it is plainly obvious that the HRB review found no definite evidence that water fluoridation was causing harm, because, as with every other review on fluoridation undertaken in this country, they failed abjectly in their duty to protect Irish consumers, by actually measuring the fluoride exposure of the population. On the basis of a large body of published studies and risk assessments of fluoride intake from tea and certain medications, there is absolutely no doubt that the Irish population are chronically exposed to fluoride and that water fluoridation is further contributing to this overexposure. The MRB, Department of Health  and Food Safety Authority of Ireland have a legal responsibility to determine the actual exposure to fluoride among the Irish population from food, beverages and medications. Only when they have undertaken this can they determine if the risk of water fluoridation is acceptable. In the absence of such robust studies and the abject failure of regulatory health authorities in Ireland to understand that it is total fluoride intake and exposure that is important when assessing the risk of water fluoridation, any claim that water fluoridation is safe is  unscientific and unreliable. To allow this farce to continue may indeed breech medical and public law.

[1] Malin AJ and Till C. Exposure to fluoridated water and attention deficit hyperactivity disorder prevalence among children and adolescents in the United States: an ecological association Environmental Health 2015, 14:17  doi:10.1186/s12940-015-0003-1
[2] Peckham S, Lowery D, Spencer S. Are fluoride levels in drinking water associated with hypothyroidism prevalence in England? A large observational study of GP practice data and fluoride levels in drinking water. J Epidemiol Community Health. 2015;Jul;69(7):619-624. doi: 10.1136/jech-2014-204971.
[3] Barry M. Economies in Drug Usage in the Irish Healthcare Setting, National Centre for Pharmacoeconomics, St. James’s Hospital, RoI. http://www.lenus.ie/hse/bitstream/10147/66358/1/economies_drug_usage.pdf  [Accessed 12 June 2015]
[4] Scientific Opinion on Dietary Reference Values for fluoride, EFSA Panel on Dietetic Products, Nutrition, and Allergies: EFSA Journal. 2013;11(8):3332.
[5] National Research Council, Review of Fluoride in Drinking Water, U.S. National Research Council 2006.
[6]  Lung SC, Cheng W, Fu CB. Potential exposure and risk of fluoride intakes from tea drinks produced in Taiwan. J Exposure Sci and Environ Epidem. 2008;18:158–166.
[7] Beresniak A, Duru G, Berger G, Dominique Bremond-Gignac. Relationships between black tea consumption and key health indicators in the world: an ecological study. BMJ Open. 2012;2:e000648. doi:10.1136/bmjopen-2011-000648.
[8] North/South Ireland Food Consumption Survey, Irish Universities Nutrition Alliance; 2001.
[9] Kavanagh D, Renehan J. Fluoride in Tea - Its Dental Significance. J Ir Dent Assoc. 1998;44(4):100-105.
[10] China rejects tea from Kenya over high fluoride levels. Business Daily, Kenya. 16th April 2015 Web: http://asokoinsight.com/news/china-rejects-tea-from-kenya-over-high-fluoride-levels/  [Accessed 12 June 2015].

Thursday, November 13, 2014

Misrepresentation of Dietary Exposure to Fluoride by Food Safety Authority of Ireland: A Threat to Public Health

In 2002, a study published in the International Journal of Clinical Chemistry measured the fluoride levels in beers available in Great Britain.[i] The highest fluoride level measured was in Guinness, which the authors reported contained 1.12mg/L of fluoride. The authors of the study concluded that beers brewed in locations with high fluoride water levels may contribute significantly to the daily fluoride intake, particularly in alcohol misusing subjects and this may contribute to alcohol-associated bone disease. The high levels of fluoride measured in this study are to be expected.  Guinness, like all major beer producers in Ireland use fluoridated public water in the production of beer. 

In 2011, the Food Safety Authority in Ireland reported that the fluoride levels in beer produced consumed in Ireland were less than < 0.05mg per litre. Astonishingly, no data was provided on the brand of beer tested, the number of alcoholic beverages tested or whether the beer was produced in Ireland or imported.  
It is inconcievable that beer products produced using fluoridated water would contain this concentration of fluoride.  To confirm this fact I undertook independent scientific testing of forty two alcoholic beverages undertaken using the American Society of Testing and Material (ASTM) and EPA standard methodologies for fluoride determination. The results conclusively demonstrate that the levels of fluoride reported by the FSAI are grossly inaccurate. The results determined that the fluoride levels in beers and stouts produced in Ireland vary between 0.4 and 0.8mg/l.  Similar levels were measured in New Zealand beers where fluoridated water was used in the production process. This evidence demonstrates that the reported level of fluoride in beers as reported by the FSAI was in the order of 16 times below the concentration present in beers and stouts produced in the Republic of Ireland. 

Quality Standards in Scientific Studies

In any scientific study basic quality standards must apply. The first is that sampling must be representative and the chain of custody must be documented. The second it that the analysis, procedures and controls must be adequate to ensure that the study is objective and every measure must be taken to ensure that basic quality control procudures were adhered to.

I have sought from the Food Safety Authority  the chain of custody records for their study, in order determine the quality control procedures, identify who took the sample and what brand of beer or other products were tested. No information could be provided by the FSAI. The only logical conclusion one can make from observation is this is that the sample of beer tested was one that was an imported beer from non fluoridated Europe. 

Similarly, when the fluoride level of tea was measured by the FSAI, the fluoride level was found to be significantly below the reported concentrations measured in all international studies. When queried on this, the FSAI reported that the sample of tea was not taken by the FSAI itself but rather by a staff member of the Dental College in University College Cork.  

Very serious questions have to be asked as to why the FSAI allowed the Dental College to take samples and why no records are available as to who took the samples or what brand of products were tested.  It is entirely unacceptable that such  poor standards of scientific research are tolerated for what is essential research into the dietary intake of fluoride by the Irish population. 

Remarkably, the FSAI study is used as evidence by the Minister for Health to demonstrate that the population of Ireland have low dietary exposure to fluoride. Yet thefluoride levels in beer and tea reported in this study are in the order of 2000 and 4000 per cent below the actual measured levels . 

In the FSAI study, not one of the most basic requirements for ensuring scientific accuracy were met, but more importantly the misrepresentations of dietary intake of fluoride present a significant threat to public health.

[i] Warnakulasuriya S, Harris C, Gelbier S, Keating J, Peters T. 2002. Fluoride content of alcoholic beverages. Clin Chim Acta 320:1–4.

Tuesday, November 11, 2014

Good science and accurate reporting of science must prevail.

Nick Cohen noted in his article (It’s not just on Ebola that good science must prevail, published in the Observor, 1st, November 2014) that Sinn Fein is leading a vigorous anti-fluoride campaign in Dublin and suggested "that its progress for the IRA to go from blowing off peoples heads to merely rotting their teeth."

Mr. Cohen is perhaps unaware that the largest party in Government in the Republic of Ireland was the leading political party opposed to mandatory fluoridation in Ireland for over four decades. In the 1960s, when mandatory fluoridation was first introduced in Ireland, Fine Gael (FG) voted unanimously against legislation mandating that all public water supplies be artificially fluoridated. FG, the current party of Government, were in their own words “violently opposed’ to this policy.[i]

That was 1960,  more recently in 2001, FG promised that they would end mandatory fluoridation of water in Ireland if  they were elected to Government.[ii] Just over ten years ago every Local Government and City Council throughout the Republic of Ireland, where FG had a majority, voted overwhelmingly to end fluoridation of water. Back then as now, the Government refused to acknowledge or accept the democratic voice of elected representatives or local government. Ironically however, on this occasion it is the very political party that previously 'violently opposed' fluoridation which now ensures  mandatory fluoridation continues in Ireland.

Mr Cohen then goes on to refer to David Robert Grimes, a physicist who has no  background in fluoride chemistry, toxicology, pharmacology or environmental health and who believes that those opposed to fluoridation are quacks, violent fanatics or conspiracy theorists. There are many notable experts in toxicology, dentristry, pharmocology, chemistry and medicine who oppose fluoridation of water and who are far more experienced and qualified than David Grimes on this subject. Included among them are Nobel laurette Professor Avrid Carlson a neuropharmacologist at the University of Gothenburg who was instrumental in stopping the introduction of water fluoridation in Sweden;  Professor  Robert Isaacson, Professor in Neurological  Behavioural Science, Professor Hardy Limeback PhD in Biochemistry, Doctorate in Dentristry and and Dr Kathleen Theissen, one of the leading experts in the field of environmental toxicology in the world. The latter three experts were key  members of the United States National Academies of Medicine and Sciences scientific commitee established to investigate fluoride, their report was published in 2006. Each of these four internationally respected experts devoted many years of research to examining  the science behind fluoridation and all are vehemently opposed to fluoridation of water. Contratory to David Grimes opinion, their views are not based on superstitution but rather on their keen understanding of science, toxicology and human biology. In the interest of journalistic integrity im sure the public would welcome the Observor reporting opposing views so that the public can indeed access information from scientists who have been prepared to make a case against fluoridation, and in so doing make up their own minds on this subject.


[1] http://oireachtasdebates.oireachtas.ie/debates%20authoring/debateswebpack.nsf/takes/dail1960110900056?opendocument

[1] http://www.independent.ie/irish-news/fg-election-promise-to-ban-fluoride-in-drinking-water-26099298.html