Israeli authorities last week unveiled a nationwide ban on the controversial practice of adding the chemical fluoride, labeled a “neurotoxin” by a top medical journal this year, to public water supplies as a medical treatment. The decision by the Health Ministry to ban what critics call a dangerous, involuntary mass-medication scheme drew applause from many medical and some dental experts around the world. However, it also prompted outrage and vicious attacks by proponents of fluoridation, who say the chemical can provide benefits to children’s teeth. The ban is a major blow to supporters of using the water supply to medicate the public.
Despite attacks from the establishment press and some professionals and politicians, Israeli Health Minister Yael German decided against allowing municipal governments to have the option to fluoridate public water supplies. She said the decision would allow Israeli parents and doctors to decide on their own whether to provide fluoride to children, in what doses, and in what manner. The order banning the forced consumption of the chemical goes into effect on Tuesday, August 26.
“We congratulate [Health Minister] Yael German for resisting the bullying tactics of fluoridation proponents,” said Dr. Paul Connett, a retired chemistry professor and the director of the anti-fluoridation Fluoride Action Network (FAN). “She has offered the international public health community the model to follow on the fluoridation issue.... We would dearly like to see the same integrity from health officials in countries that continue this outdated, unethical, and reckless practice.”
The health minister was quoted in news reports as saying she recognized that the chemical could be effective in reducing dental caries (cavities). However, at the same time, German also pointed to data from the World Health Organization showing a decline in cavities in countries without fluoridation. Experts around the world hold differing views on whether or not fluoride actually causes more harm than good when it comes to teeth. As such, in the interest of free choice and savings for taxpayers, German chose the ban.
Either way, Israelis will still have the option of obtaining the chemical if they wish to ingest it — just not in the water supply, where everybody is forced to consume it at levels that may or may not be appropriate for each individual. In an interview with the Jerusalem Post, Professor Arnon Afek, an expert in pathology and medical administration who serves as director-general at the Health Ministry, applauded the decision and suggested that choice in individual medical matters was key.
“Mandatory fluoridation is medical treatment,” he told the paper, which was widely criticized for its biased reporting on the debate. “Individuals have the right to decide if they want it or not. The question is not if fluoride is beneficial but how it should be delivered. We cannot force people. It is legitimate that experts in the field oppose the health minister’s decision, but we have a policy. The ministry supported it for over 40 years, but this is a new era. The world has changed, and we can educate parents.”
“With fluoridation of tap water, there is no free choice,” Afek added.
Amid the debate in Israel, forces on both sides of the issue were mobilized. On one side were those who either supported fluoridation or at least allowing municipal governments to decide on their own. In 1970, the Health Ministry mandated the addition of fluoride to water supplies in all towns and settlements with 5,000 or more residents. That meant that over two thirds of Israelis consumed the chemical, which has been found by researchers to diminish intelligence levels in children in addition to causing a problem with teeth known as dental fluorosis in high enough doses. As late as June, media reports suggested that leaving local authorities with the option to fluoridate was being considered.
Among other groups, the Israel Dental Association, a lobbying group that represents dentists, urged authorities to continue fluoridating the water, claiming it helps reduce cavities. Separately, a coalition of public health and dental experts wrote a letter slamming German for the decision. “She is the first-ever health minister not to listen to the advice of professionals and bring to her office ideology that is not based on scientific facts and irresponsible decision making,” they wrote, adding that more than 400 million people around the world drink water that is fluoridated by authorities.
However, on the other side of the debate, prominent experts and critics of water fluoridation cited health dangers, the immorality of forcing individuals to consume medication without informed consent and potentially at inappropriate levels, the costs of the program to taxpayers, the alleged lack of dental benefits, and more. Around the world, leading high-profile voices weighed in, urging the Israeli Health Ministry to take action to protect the public from water fluoridation and mass medication. In an August 15 letter to German, for example, Dr. Hardy Limeback, Ph.D., DDS, professor emeritus of preventive dentistry at the University of Toronto, strongly urged her to act.
“I have looked at this from all angles and I have to conclude that fluoridated cities would save money on fluoridation costs, parents would save on costly dental bills treating dental fluorosis, dental decay rates would remain unchanged or even continue to decline (as has been demonstrated in many modern fluoridation cessation studies) and the health of city residents would improve when industrial waste products are no longer added to the drinking water,” he wrote, referring to the source of most fluoride in public water supplies. “I find it absurd that the fluoride used to fluoridate drinking water is derived from industrial waste without purification, increasing carcinogenic heavy metal levels, such as arsenic and radionuclides, in the drinking water.”
Of course, the debate over water fluoridation has been raging in the United States, Israel, and around the world for decades. In recent years, though, the tide has started shifting further against water fluoridation. Dozens of communities around the world have decided to end the controversial practice just in the last few years, and the overwhelming majority of the world never adopted it in the first place. The trends appear to be accelerating, too.
An especially devastating blow to pro-fluoridation forces came in 2012, when Harvard researchers published an explosive peer-reviewed study in a U.S. government science journal suggesting that children exposed to the chemical suffered dramatic decreases in IQ. Especially at risk, the authors said, were pre-born children, who the researchers said could suffer permanent harm from fluoride.
“The children in high fluoride areas had significantly lower IQ than those who lived in low fluoride areas,” noted the Harvard research scientists about the results of their study, echoing claims by the Environmental Protection Agency (EPA) that there is substantial evidence of developmental neurotoxicity associated with the chemical. “The results support the possibility of an adverse effect of high fluoride exposure on children’s neurodevelopment.”
The researchers also expressed concerns about the potential of fluoride to cause irreversible brain damage and neurological effects in unborn children. “Fluoride readily crosses the placenta,” they observed. “Fluoride exposure to the developing brain, which is much more susceptible to injury caused by toxicants than is the mature brain, may possibly lead to damage of a permanent nature.”
Many experts now say the chemical ought to be classified with other dangerous substances. “Fluoride seems to fit in with lead, mercury, and other poisons that cause chemical brain drain,” noted senior study author Philippe Grandjean, a professor of environmental health at Harvard. “The effect of each toxicant may seem small, but the combined damage on a population scale can be serious, especially because the brain power of the next generation is crucial to all of us.”
More recently, echoing the recent findings of the Harvard study, The Lancet, one of the world’s most prestigious medical journals, also classified the chemical as a harmful neurotoxin. “Our very great concern is that children worldwide are being exposed to unrecognized toxic chemicals that are silently eroding intelligence, disrupting behaviors, truncating future achievements and damaging societies, perhaps most seriously in developing countries,” explained the authors, citing fluoride as one of about a dozen dangerous “developmental neurotoxicants.”
In the overwhelming majority of countries, authorities do not mass medicate the public via fluoridation. Exceptions include the United States, where more than half of Americans drink fluoridated tap water, and Ireland. In some nations such as Sweden, Holland, and the Czech Republic, national governments actually ban the practice by law. Israel now joins the group of nations where the practice is explicitly forbidden.
Organized dentistry and other interests are fighting tooth and nail to preserve governments' powers to fluoridate public water. However, anti-fluoridation activists hope that as awareness of the potential dangers and ethical problems spread, involuntary mass-medication will eventually become a relic of history.