Science!! Fucking magnets, how do they work?

I saw this flier at the Capitol Hill library and was appalled. I took the stack and resisted the urge to dump them in the nearest trash can. I was going to use them to line my rats' cages, then a friend of mine gave me the idea to do a breakdown of this sciencey-seeming advert.

Ir starts out admonishing voters to just say no to "fluoridation chemicals." As opposed to? Fluoridation energy? They purposefully use the word "chemical" to play on the chemophobia, "fear of chemicals," prevalent in our lovely city. They could have put fluoridation molecules or minerals, but the word "chemical" has a distinct pejorative connotation, particularly among certain segments of the population. A chemical, according to Merriam-Webster, is "a substance obtained by a chemical process or producing a chemical effect." In effect, this includes everything encountered in everyday life except photons and electrons. I am made of chemicals, and so are you. Water is made of chemicals. Green tea is made of chemicals. Even your favorite herbal remedy is made of chemicals.

If fluoridation "chemicals" weren't scary enough, the flier tells us now that 1.1 million pounds of fluorosilicic acid will be added to the water! I can't even pronounce that! Plus it's an acid! If you look at it with some basic knowledge of chemistry, it becomes more benign. Fluoro- is the prefix for fluorine, -silicic is the suffix for silicates (a.k.a. sand), and being an acid means it has some hydrogen atoms tacked onto it. I checked with the Portland Water Bureau via email and the actual number is 1.2 million pounds or 120,000 gallons, but the fluorosilicic acid breaks down to 215,000 pounds of fluoride, as fluorisilicic acid has a high proportion of water. Comparing that amount to the chlorine and ammonia added to water as disinfectant which, according to the 2012 Drinking Water Report, had a maximum residual level of 2.1 ppm. Optimal fluoride levels are 0.7 ppm. I'm waiting on a reply from the Water Bureau, but my back-of-the-envelope calculations put that at 3.6 million pounds of chlorine and ammonia added to the water supply.

Wikipedia gives a rundown of the chemistry involved in fluoridation:

"Neutralization of solutions of hexafluorosilicic acid with alkali metal bases produces the corresponding alkali metal fluorosilicate salts: H2SiF6 + 2 NaOH ? Na2SiF6 + 2 H2O The resulting salt Na2SiF6 is mainly used in water fluoridation. . . . Near neutral pH, hexafluorosilicate salts hydrolyze rapidly according to this equation: SiF62- + 2 H2O ? 6 F- + SiO2 + 4 H+"
So when you add the fluorosilicate, SiF62-, to water, you get 6 F-,which are the ions of fluorine, 4 H+, ions of hydrogen (cations, because they have a paws-itive charge), and SiO2, more commonly known as sand. The 'fluoridation chemical' they are trying to make us afraid of and the one that gets talked about-fluorosilicic acid-is not actually being put in the water, sodium fluorosilicate is. The fluorosilicic acid is neutralized in a alkali metal base, sodium hydroxide specifically. Either way, fluoride ions are fluoride ions no matter what the source is.

The flier further attempts to generate fear about arsenic and lead but if you compare the levels between fluoridated Vancouver and non-fluoridated Portland in the water report they are nearly equivalent at 1 parts per billion. For every molecule of water there is 0.000000001 (one-billionth) of a molecule of arsenic. That's a tiny amount of arsenic. The small difference of 0.2 ppb (0.0000000002) is orders of magnitude smaller than arsenic levels in food. Recently the FDA has raised concern about arsenic in rice with some samples as high as 500 ppb (0.000005).

The flier also claims that the National Academy of Sciences reported "serious uncertainties and risks from fluoride in drinking water." But they neglect to point out that the EPA was looking at exposure to HIGH levels of fluoride, much higher than the level in drinking water. Has the Centers for Disease Control seen this report?

"Yes, CDC considers comprehensive reviews by the NRC and other systematic scientific studies in its recommendation that community water fluoridation is a safe, effective, and inexpensive method to reduce tooth decay among populations with access to community water systems. Water fluoridation should be continued in communities currently fluoridating and extended to those without fluoridation."
The leaflet promotes the baseless idea that fluoride lowers IQ (As someone who lived the majority of his life in a fluoridated city, I take that as a personal affront.) and causes thyroid disease, using the National Academy of Sciences' report but neglecting to say add that it is high levels-much higher than anyone would reasonably be exposed to-of fluoride. Healthy Kids, Healthy Portland points out,

"The National Research Council only studied and reported on optimally fluoridated water fluoridation in 1951, 1977, 1993, and most recently 2007 - each time reporting on the safety and effectiveness of water fluoridation. In 2006, the NRC did not study optimally fluoridated water but instead evaluated areas of the U.S. where the natural fluoride levels in well water or aquifers are unusually high. These natural fluoride levels are about three to five times higher than the level used to fluoridate public water systems."

Opponents of community water fluoridation continually cite the 2006 NRC report ad infinitum, and ignore the rest including the 2007 report:

"In this report, the NRC considered research issues related to the medical geology field on connections between earth science and public health, addressing both positive and negative societal impacts. This report identified fluoride as a mineral that can positively influence human health, and although earlier NRC reports were not conclusive in their opinions, this report concluded that fluoride was considered to be an element essential for human life based on its role in cellular functions involving metabolic or biochemical processes. The report further stated that fluoride in drinking water has two beneficial effects: preventing tooth decay (dental caries) and contributing to bone mineralization and bone matrix integrity."
We're also warned about mixing fluoridated water with infant formula. What does the American Dental Association say about this?

"Yes, it is safe to use fluoridated water to mix infant formula. If your baby is primarily fed infant formula, using fluoridated water might increase the chance for mild enamel fluorosis, but enamel fluorosis does not affect the health of your child or the health of your child's teeth. Parents and caregivers are encouraged to talk to their dentists about what's best for their child."
What does the American Academy of Pediatric Dentists say?

"As the Environmental Protection Agency/Department of Health and Human Services' recommendation for optimizing community water supplies to 0.7 ppm F is instituted, fluorosis due to reconstituting infant formula with fluoridated water will be less of an issue."
That's right, with optimal fluoridation it will be less of an issue; even though, enamel fluorosis is a cosmetic issue that accompanies good teeth. The ADA explains,

"Enamel fluorosis can result from ingesting greater than optimal amounts of fluoride in early childhood. Enamel fluorosis is a change in the appearance of the tooth's enamel. In the United States, the majority of dental fluorosis is mild and appears as white spots that are barely noticeable and difficult for anyone except a dental health care professional to see. Tooth surface changes can be more extensive in the moderate and severe forms, which are less common. In the rare, severe form of dental fluorosis, pits may form on the tooth's surface. Enamel fluorosis occurs only when permanent teeth are forming under the gums. Once teeth break through the gums, they cannot develop enamel fluorosis."
I'd rather have enamel fluorosis than "Multnomah mouth," as some dentists in the area call it.

The flier then says there are better alternatives, without actually saying what those better alternatives are; "instead of spending $7.6 million from increased water rates to build a new fluoridation plant, we should focus on real solutions for kids' dental health, such as increasing access to care and prevention education." Of course, I support increasing access to care and prevention education, but I don't see how that would be cheaper in the long run, since every dollar spent on fluoridation saves $38 in the long run. Fluoridation will save us money. Furthermore, access to care and education are not panaceas and it would be logistically harder to extend the benefits to all children. In New York State only 27% (47% for high-income and 17.8% for low-income; in NYC, the rate is 12.2%) of 3rd-graders have access to dental sealant; furthermore, only 26.9% of 3rd-grade children in New York state use fluoride tablets. People have to seek out the care and use the education for it to be effective. Many families cannot do that. And how long would it take to get this education program off the ground? How long would it take to bring better access to dental care for the 121,000 children, including the 20,246 living in poverty, in this city? According to a recent UNC-Chapel Hill report, everyone, adults and seniors as well, can reap the benefits of fluoridation at once and not even realize it.

Another one of the claims is that supporters are comparing decay rates between Portland and other cities but using the data for Oregon's data to other states. Yes, rates of decay are lower in the Portland metro area than outside of it, but this could very well be due to the generally higher income of people in Portland to those outside Portland. Less than 20% of Oregon residents have access to fluoridated tap water; across the entire US, the coverage is 73.9%-that's over 200 million people. However I did try to compare Portland's rate of 54% with New York City. A study by Mitchell et al. had these results:

"Compared to data from the National Health and Nutrition Examination Survey III, mean DMFT (3.36 vs 2.53; P<.01) and the prevalence of untreated disease (36% vs 16%; P<.01) were significantly higher for northern Manhattan adolescents. Of the adolescents evaluated, 13 percent had at least one severely carious tooth with pulpal involvement that required either extraction or endodontic therapy."
Of the 566 children in this study, 64% were Hispanic, 28% African-American, and the rest are not identified. According to the Oregon Department of Human Services' Oregon Smile Survey 2007, Portland's rate of untreated decay in Hispanic children is 46%. And that 54% of untreated decay for New York state? That is an average for all children. Low-income children are at 59.6%, and high-income kids are at 48%. Income is definitely a factor. American Indian and Alaska Native 6- to 9-year-olds have it especially bad:

"Almost half of 6-9 year-old AI/AN [American Indian/Alaska Native] children (47%) in the Portland Area had untreated decay. This compares to 47% of all children screened by IHS [Indian Health Service], 17% of 6-9 year-old children in the general U.S. population and a HP 2020 target of 26%."

The poor who have less access to dental care receive more of the benefit of fluoridation. The flier then claims that this is all irrelevant anyway and that fluoridation won't solve untreated decay; that may be true, but it can go a long way in preventing it from happening in the first place. No one who supports fluoride is against making it easier for children (and everyone else) to have better access to dentists.

The makers of this flier try to paint it as an either/or issue, fluoridation or dental care. That is a false dichotomy. We should be doing all we can in a multifaceted approach. The Smile Survey puts it succinctly:

"The four key community-based preventive measures that have been proven effective in reducing tooth decay are: community water fluoridation, early-childhood caries prevention programs, school-based dental sealant programs, [and] school-based fluoride supplement programs." (emphasis added)
Now to their celebrity endorsements. It's surprising that they include doctors on here since part of their campaign is generating distrust in doctors. Are doctors only trustworthy if they agree with you on the issue of fluoride? That seems disingenuous to me. The first is Dr. Yolanda Whyte, a pediatrician who is quoted as saying, "The recent science has made clear that there are real health risks of swallowing fluoridated water and few to no benefits." What science is this? This seems to contradict the plan for giving fluoride tablets to children also mentioned in the flier. Is fluoride good or bad for you? The antifluoridationists seem to go back and forth whenever convenient. Stephen Barrett of Quackwatch looked into her credentials and found,

"The Web site [containing Whyte's bio] does not mention whether or not she is board-certified. The American Board of Medical Specialties does not list her in its database, which means she is not. The HealthTap Web site (for which she answers questions) stated that she was, but this was removed after I asked the management to check. The description of her practice suggests that she does mainly locum tenens work (temporarily filling in for other doctors)."
It seems though that Dr. Whyte doesn't necessarily disagree about optimal levels of fluoride. When asked the question "How much fluoride is unsafe?," she responded:

"Percentage may not be the correct term, but recently, the Centers for Disease Control, Environmental Protection Agency and Health and Human Services all determined that the current concentration of 1 ppm-part per milion- found in standard drinking water was too high and caused dental fluorosis, a permanent tooth condition. They recommended lowering fluoride concentration to 0.7 ppm." (emphasis added)
Dr. Whyte also agree with Dr. Tom Frymark, who answered the question "What can too much fluoride do to your teeth?" with:

"Too much of a good thing, that is fluoride in too high a concentration, can cause tooth straining during tooth development only, between the ages of one to eight. This would only occur if fluoride intake is not monitored by public officials or supplemental fluoride is not measured." (emphasis added)
But then Dr. Whyte mentions the pineal gland a few answers later. If she had read the ADA's Fluoridation Facts, she'd know that

"The pineal gland is an endocrine gland located in the brain which produces melatonin. Endocrine glands secrete their products into the bloodstream and body tissues and help regulate many kinds of body functions. The hormone, melatonin, plays a role in sleep, aging and reproduction. A single researcher has published one study in a peer-reviewed scientific journal regarding fluoride accumulation in the pineal gland. The purpose of the study was to discover whether fluoride accumulates in the pineal gland of older adults. This limited study, conducted on only 11 cadavers whose average age at death was 82 years, indicated that fluoride deposited in the pineal gland was significantly linked to the amount of calcium in the pineal gland. It would not be unexpected to see higher levels of calcium in the pineal gland of older individuals as this would be considered part of a normal aging process. As discussed in Question 22, approximately 99% of the fluoride present in the body is associated with hard or calcified tissues. The study concluded fluoride levels in the pineal gland were not indicators of long-term fluoride exposure. The same researcher has theorized in unpublished reports posted on the Internet that the accumulation of fluoride in children's pineal gland leads to an earlier onset of puberty. However, the researcher notes that there is no verification that fluoride accumulates in children's pineal glands. Moreover, a study conducted in Newburgh (fluoridated) and Kingston (non-fluoridated), New York found no statistical significance between the onset of menstruation for girls living in a fluoridated verses non-fluoridated area." (emphasis added)

Jay Harris Levy, a Portland dentist, says, "Current science takes what we thought we knew about water fluoridation and turns it on its head." This statement carries little weight. And again what science? The NAS report that opponents incessantly cite that doesn't say what they say it says? Next up is Rev. Bernice King, daughter of MLK, who asks us to join her in calling a halt to water fluoridation. I am a huge fan of MLK, who was one of the greatest Americans of all time, but being the offspring of his loins does not an expert make. She is also a pro-lifer and has been anti-LGBT until very recently-though her views on homosexuality are a tad primitive for my tastes:

"I also don't believe everybody's born that way. I know some people have been violated. I know some people have unfortunately delved into it as an experiment."
They are born that way, get over it.

Another reverend, Rev. Dr. Gerald Durley, says that fluoridation disproportionally harms members of the black community. Water fluoridation at the optimal level doesn't harm anyone, no matter skin color; moreover, African-Americans in Portland suffer from higher rates of decay than whites. So they would disproportionally benefit from water fluoridation. Durley then says, "We need to focus on helping people get access to dentists." Yes, of course! The false dichotomy again. We need to focus on improving dental health, using all the tools available. One of those tools is water fluoridation. Rev. Dr. Durley also states, "Lack of fluoride does not cause cavities." This is true but misleading. Eating sugary food causes cavities, but fluoride has been proven to help prevent them.

Dr. Hardy Limeback seems to have a habit of disagreeing with the conclusions of studies he coauthors; "[t]he evidence is that fluoridation is more harmful than beneficial is now overwhelming." Dr. Limeback was a Panel Member of the National Academy of Sciences "Fluoride in Drinking Water" report that doesn't say what the antifluoridationists keep saying it says. Dr. Limeback also coauthored a University of Toronto study on the long-term effects of fluoridation on the human skeleton that concluded:

"Municipal water fluoridation has notably reduced the incidence of dental caries and is widely considered a public health success. However, ingested fluoride is sequestered into bone, as well as teeth, and data on the long-term effect of exposure to these very low doses of fluoride remain inconclusive. Epidemiological studies suggest that effects of fluoride on bone are minimal. We hypothesized that the direct measurement of bone tissue from individuals residing in municipalities with and without fluoridated water would reveal a relationship between fluoride content and structural or mechanical properties of bone. However, consonant with the epidemiological data, only a weak relationship among fluoride exposure, accumulated fluoride, and the physical characteristics of bone was observed. Analysis of our data suggests that the variability in heterogenous urban populations may be too high for the effects, if any, of low-level fluoride administration on skeletal tissue to be discerned." (emphasis added)

Not fluoridating the water is the real risk we can't afford. Community water fluoridation is the least we can do for public health; it's safe, noninvasive, and cost-effective. Please vote yes on Measure 26-151 this May!