10 Facts* and 41 Informed Conjectures about the...

10 Facts* and 41 Informed Conjectures about the Health Effects of Fluoride

Randall P. Ellis

Boston University

April 29, 2016

Please to not quote or cite.

1

*Currently 13 to be narrowed down to ten.

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0

0.5

1

1.5

2

2.5

3

3.5

4

0 1 2 3 4

F 2 =

Fo

od

F1 = drinking water

Two Dimensions of F Intake

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0

0.5

1

1.5

2

2.5

3

3.5

4

0 1 2 3 4

F 2 =

Fo

od

F1 = drinking water

Correlated Exposure Really Changes Risk.

Result #1

Water Fluoridation in Australia is associated with small but statistically significant negative impact on birth weight. Working paper: Preliminary! The Effects of Artificially Fluoridated Water on Birth Outcomes Marian Vidal-Fernandez, Denise Doiron, and Randall P. Ellis April 19, 2016 University of Sydney, UNSW, BU

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2010 Annual Fluoridation Report

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Four different chemicals used in CA. Only NaF (Sodium Fluoride) was used in clinical trials.

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Fluoride rates fluctuate meaningfully around optimum target

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California 2013 Annual Fluoridation Report

Latest reports omit chemical used and monthly rates.

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A simplified notation F model (All variables subscripted by region j and time t for individual I, but subscripts omitted unless necessary) F = Actual level of water Fluoridation in county Ftar = targeted level of Fluoride ε= error affecting level of F in water F = Ftar+ ε D = Other sources of fluoride (Drugs, food, air, pesticides), measured in units of F AEF = Acute effects of F CEF = chronic effects of F Θ = share of population in a county with F in drinking water W = quantity of water consumed β = Sensitivity to F where possibly β = 𝛽 +υ Y = any dependent variable X = set of other non F-related control variables that affect Y Y = f(F, D, Θ,W, X) Assume one county, j. Assume only one period t, and that AEF responds immediately when F is present, => j and t can be ignored. Assume that the Y = AEF is proportional to total F exposure of a person i in a region j. In the simplest framework, the exposure of person i would be F* Θ*Wi+ Di

Conjecture #22

• F is causes increased rates of a very broad set of health conditions associated with immune disorders • More convincing to show in children, since they have not

yet changed counties or had a chance to vary as much by socioeconomics or been exposed to as many other environmental factors

• Infections, allergies, skin problems, stomach problems likely candidates

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Conjecture #23

• Rates of F sensitive acute conditions will increase when people move from counties or MSA without F to counties with F.

– Counties only available from 2007 to 2010 in MarketScan

– Could look at other panel data

– Stronger effect in acute than chronic conditions

– Delayed impact on chronic conditions

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Conjecture #24, 25

• Among fluoridated water systems, smaller water systems will have greater variability in F than larger water systems

• Incidence of F related conditions will be greater in smaller F systems since the chance of a spike in F is greater

– Reports on daily fluctuations are routinely collected but not reported publicly in the US.

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State of Ca l i fornia -- Health and Human Services Agency Cal i fornia Department of Publ ic Health

Drinking Water Program

MONTHLY FLUORIDATION OPERATIONS REPORT

DISTRIBUTION SYSTEM MONITORING

System Number:

Telephone No:

Month/Year:

1 Monitoring Location (check one):

2 Distribution System Monitoring (per monitoring plan)

3 Entry Point monitoring (must have a single fluoridation system)

4 (Section 64433.3(a),T22,CCR)

5

6 Testing and Monitoring

7 Instrument (Make/model)

8 Analytical test method

9 Instrument Calibration

10 Date

11

12

13

14

15

16

17 Optimal Fluoride Level (mg/L) (c)

18 Fluoride Control Range (mg/L) (c) Low

19 Fluoride Control Range (mg/L) (c) High

20

21

22

23 Split Fluoride sample collection date

24 Split Fluoride sample laboratory result (mg/L)

25 [Add any additional lab results to right of field result, if needed]

26 (Section 64433.3(c),T22,CCR)

27

28

29

30

31

Was CDPH notified of second fluoride sample

level below the control range? (Y/N/NA)

(Section 64433.7(e),T22,CCR)

Was CDPH notified of any fluoride sample level

0.1 mg/L above the control range? (Y/N/NA)

(Section 64433.7(e),T22,CCR)

Were more than 20% of fluoride daily sample levels

outside the control range? (Y/N)

(a)…..If more than one sample is collected per day, leave blank, and attach worksheet. (Section 64433.5(c),T22,CCR)

(b)…..Leave blank when not fluoridating

NA…..Not Applicable

Certified Treatment Operator signature Date(Section 64415(b),T22,CCR)

(c)…..Level and range must be determined from annual average maximum air

temperatures of past five years, and submit temperature value to the CDPH annually.

(Section 64433.2,T22,CCR)

Instrument ID

Day Date

Fluoride Field

Sample Result

(mg/L) (a)(b)

Sample Site ID / Location (a)

System Name:

Contact Person:

Count-Total

Count outside range

Max

Minimum

(one sample per day)

Ave

In addition, we request that you email this form to CDPH Headquarters at: [email protected] Rev 7/11

Outside range %

Count below control range

Count 0.1 mg/L above control range

To be received by CDPH District Office by 10th day of following month

California daily reporting form Data is collected on daily rates

Conjecture #26, 27

• Fluoride is responsible for higher rates of skin diseases, infections, endocrine disorders, blood forming diseases, musculoskeletal, genitourinary in the US, which are more than twice as prevalent at in the OECD countries.

• Such rates in low F regions should be more similar to OECD countries, and OECD country rates in high F areas should look more like the US.

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Time trends point to distinct diseases related to Fluoride: Ratio of US to OECD average diseases

Source: JAMA November 13, 2013 “The Anatomy of Health Care in the United States” Hamilton Moses III, MD1,2; David H. M. Matheson, MBA, JD4; E. Ray Dorsey, MD, MBA2,5; Benjamin P. George, MPH3; David Sadoff, BA4;

Satoshi Yoshimura, PhD4

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http://jama.jamanetwork.com/article.aspx?articleID=1769890&utm_source=Silverchair Information Systems&utm_medium=email&utm_campaign=MASTER:JAMALatestIssueTOCNotification11/12/2013

http://jama.jamanetwork.com/article.aspx?articleID=1769890&utm_source=Silverchair Information Systems&utm_medium=email&utm_campaign=MASTER:JAMALatestIssueTOCNotification11/12/2013

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http://www.cdc.gov/fluoridation/safety/dental_fluorosis.htm

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Normal

Questionable

Very mild

Mild

Moderate

Severe

What does dental fluorosis look like?

• Very mild and mild forms of dental fluorosis—teeth have scattered white flecks,

occasional white spots, frosty edges, or fine, lacy chalk-like lines. These changes

are barely noticeable and difficult to see except by a dental health care

professional.

• Moderate and severe forms of dental fluorosis—teeth have larger white spots

and, in the rare, severe form, rough, pitted surfaces.

http://www.cdc.gov/fluoridation/safety/images/fluorosis_5.jpg






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"Very Mild"/Mild Fluorosis

Photo by Hardy Limeback, DDS

"Very Mild" Fluorosis

Source of Photo Unknown

Mild Fluorosis

Photo by Hardy Limeback, DDS

Moderate Fluorosis

13.6

22.2

29.9

33.8

29.4

44.9

1930-40 H Trendley Dean

1978-82 US Public Health Service

1986-87 NIDR

1999-00 NHANES, Age 16-19

2001-02 NHANES, Age 16-19

2003-04 NHANES, Age 16-19

Figure 1. Prevalence of dental fluorosis in various studies over time

Concerning increase in rates of dental fluorosis, a symptom of excess fluoride

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Conjecture #28, 29

• Since dental fluorosis is a strong indicator of excess fluoride in the drinking water, the county average rate of fluorosis should be strong predictor of rates of numerous chronic diseases. – Could use NHANES data which is available across

many years, and sporadically has asked about fluorosis.

– Could look for correlations with F and with other disorders associated with F.

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Conjecture #30

• College students could self report whether they have fluorosis and where they spent their childhood growing up. – One could do a survey of college students asking for

only two pieces of information after viewing these images.

– When you look in a mirror, do you have any white spots on your teeth?

– What town in the US did you spend the majority of your years from age 0 to ten?

– Need IRB review of survey before starting.

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Conjecture #31-34

• School performance will be poorer in areas with high rates of dental fluorosis.

• Incomes will be lower in areas with high rates of dental fluorosis.

• Individuals with dental fluorosis will have lower income and lower rates of high school and college graduation

• Individuals with dental fluorosis will have lower income than individual without fluorosis

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Key Literature

Books National Research Council, 2006 “Fluoride in Drinking Water: A Scientific Review of EPA's Standards” Freeze and Lehr (2009) The Fluoride Wars: How a Modest Public Health Measure Became America's Longest Running Political Melodrama Connett, Beck, and Micklem (2010) The Case Against Fluoride: How Hazardous Waste Ended Up in Our Drinking Water and the Bad Science and Powerful Politics That Keep It There

Articles Glied and Neidel (2010) JHR The Economic Value of Teeth ”Changing from a non-fluoridated to fluoridated community results in roughly one-third of a tooth more

in adulthood, and these results are highly insensitive to numerous county level controls, supporting the exogeneity of CWF.”

“…access to water fluoridation during childhood increases earnings by roughly 2% overall, with a larger effect for women.”

“All results are remarkably robust to alternative specifications, including controls for various trends and numerous community level variables.”

Neidell, Herzog, and Glied, (2010). AJPH "The Association Between Community Water Fluoridation and Adult Tooth Loss" “Methods. Data from the 1995 through 1999 BRFSS merged with data from the 1992 Water Fluoridation Census, indicate that CWF levels in the county of residence at the time of the respondent's birth are significantly related to tooth loss but current CWF levels are not.

Ho and Neidell (2009) NBER WP Equilibrium effects of public goods: The impact of community water fluoridation on dentists

91 Ellis

Three types of studies already done at BU 2012-2014

• Analysis of 2007 MarketScan privately insured inpatient and outpatient claims on 45 million people using 1991 F levels, with all analysis of 2424 counties. Annual levels

• Analysis of 2007 Medicare Part A and B claims on 1.4 million elderly using 1991 F levels in 2424 counties. Annual levels

• Analysis of 2007-2010 claims from Alabama, in 67counties. Monthly rates.

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Preview of Alabama monthly Results

• Difficult to distinguish short run effects of fluctuations of fluoride from what would be expected by statistical chance (using only one state).

• Some evidence of significant increases in payments for fluoride related acute conditions, with offsetting reductions in spending on all other conditions

• Appears to be that a four month moving average of effects works best.

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MarketScan data Analysis of Alabama Monthly patterns

• Used Thomson Reuters Marketscan Commercial Claims and Encounter data for 2007-2010.

• Extracted all of the claims for 1,918,294 people with Alabama county codes for at least one month

• Summarized for each person at the year-month level: – 46,335,432 inpatient and outpatient claims

– 19,687,152 pharmacy claims

• Final sample contains 19 million person-months of observations with up to 48 months of information on each person, spread among 67 Alabama counties

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Current project uses three different datasets

• Water fluoridation levels from the CDC’s My Water’s Fluoride

• Insurance claims data from Thomson Reuter’s Marketscan Commercial Claims and Encounter data, 2007-2010 on 45 million privately insured people

• Area Resource File (ARF) data for county control variables (cross sectional models)

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Marketscan summaries used:

• For each person in each eligible month, identifying each of 394 distinct condition categories (CCs) in which there is at least one diagnosis

• Diagnoses organized by Verisk/DxCG classification system, related to the same system used by the US Medicare program (Condition Categories)

• Counts of diagnoses, claims, emergency department visits, admissions, and payments.

• The frequency of fluoride-related diagnoses and sum of payments on fluoride-related claims.

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CDC provides water fluoridation data on its web site My Water’s Fluoride

• Data by water system

• Monthly and annual tables

• Erratic quality

• 13 states not participating, but statistics on all states actually available on the CDC web site.

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1992

County-Level Control Variables from the ARF

Var Description Sample Mean Std. Dev.

arf01 Average active MDs per capita in 2006 2424 0.00143 0.00145

arf02 Average number of hospitals per capita in 2005 2424 0.00007 0.00009

arf03 Average hospital admissions per capita in 2005 2424 0.107 0.078

arf04 Average inpatient days per capita in 2005 2424 0.959 1.384

arf05 Average medical expenditure per capita in 2005 (1000's) 2424 2.201 1.872

arf06 Average income per capita in 2005 2424 28032 6668

arf07 Percentage of population over 65 in 2006 2424 14.8 4.0

arf08 Percentage of persons in poverty in 2005 2424 14.4 5.9

arf09 percent of persons 25+ with less than 9 years schooling in 2000 2424 8.68 5.01

arf10 percent of persons 25+ with more than 4 years college in 2000 2424 17.19 7.84

arf11 percent urban population in 2000 2424 46.32 29.00

AGESEX 32 dummies for share of sample in various age and sex intervals 99 Ellis

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Fluoride Toxicity Clinical Presentation

Gastrointestinal signs • Hypersalivation • Nausea • Vomiting • Diarrhea • Abdominal pain • Dysphagia • Mucosal injury

Electrolyte abnormalities • Hypocalcemia • Hypomagnesemia • Hyperkalemia • Hypoglycemia

Neurologic effects • Headache • Tremors • Muscular spasm • Tetanic contractions • Hyperactive reflexes • Seizures • Muscle weakness

Cardiovascular • Widening of QRS waves in ECG • Various arrhythmias • Shock • Cardiac arrest

Downloaded from http://emedicine.medscape.com/article/814774-clinical#a0217 on 3/14/2012 102 Ellis

http://emedicine.medscape.com/article/814774-clinical




Chronic and Acute Conditions Associated with Fluoride Each number is a cite (not all peer reviewed)

Abnormal Sweating (18) Birth Defects (5) Decrease in Testosterone (32)

Eczema (2) Glaucoma (174) Inflammatory Bowel Disease

Acne (2,3) Blind Spots (3) Delayed Eruption of Teeth (28)

Edema(3) Goitre (2) Inner Ear Disorders (2,5)

ADHD/Learning Disorders (4,7)

Body temperature disturbances (13)

Dementia (2) Eosinophilia (15) Growth Disturbances (1) Irritability (18)

Allergies (2) Breast Cancer (5) Demyelinizing Diseases (2, 35)

Epilepsy (2) Headache (2) Joint Pains (8)

Alopecia (Hair-loss)(18) Cachexia (wasting away)(2)

Dental Abnormalities (2) Excessive Sleepiness (8) Hearing Loss (5) Kidney Failure (2)

Alzheimer’s Disease (5,6,46)

Carpal Tunnel Syndrome (5)

Dental Arch smaller (27) Eye, ear and nose disorders (8)

Heart Disorders Lack of Co-ordination (2)

Anaphylactic Shock (2) Cataracts (2) Dental enamel more porous (29)

Fatigue (2,13) Heart Failure (3) Lack of Energy (8)

Anemia (15) Change in blood pressure(=/-) (2)

Dentral Crowding (23) Fearfulness (1,18) Heart Palpitations (13) Loss of Appetite (2)

Aorta Calcification (2) Chest pain (26) Dentral Fluorosis (Mottling of teeth)

Fever (13) Hemorrhage (1,2) Loss of Consciousness (2)

Apnea (Cessation of breath)

Cholelithiasis (Gallstones)(2)

Depression (8) Fibromyalgia (2) Hepatitis (2) Loss of IQ (25)

Arthralgia (2) Chronic Fatigue Syndrome (2)

Diabetes Insipidus (36a,b)

Fibrosarcoma (3) Hives (3) Loss of Spermatogenesis (33)

Arthritis (8, 13) Cold Shivers (13) Diabetes Mellitus (2) Fibrosis (3) Hoarseness (18) Low Birth Weight (5) Asthenia (Weakness) (18)

Collagen breakdown (3) Diarrhea (8) Fingernails:Brittle (1,3) Hyperparathyroidism (2) Lung Cancer (3)

Asthma (2) Coma (1,3) Dizziness (8,13) Fingernails:Lines/Grooves (1)

Hypertension (8) Lupus (3)

Ataxia (2) Concentration Inability (13,8)

Down Syndrome (10) Forgetfulness (3) Hypoplasia (40) Magnesium Deficiency (2)

Atherosclerosis (3) Constipation (52) Dry Mouth (2) Gastric Ulcers (2) Immunosuppression (3) Memory Loss (13)

Autism (169) Convulsions (2) Dyspepsia (8) Gastro-disturbances (8) Impotence (3) Mental Confusion (20)

Back Pain (2) Crying easily for no apparent reason (18)

Dystrophy (3) Giant Cell Formation Incoherence (8) Migraine (8)

Behavioural Problems (3) Death (3) Early/Delayed Onset of Puberty(14)

Gingivitis (19, 173) Infertility (2,3) Monisiliasis (Candidasis) (162)

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More fluorosis/high altitudes (30,31)

Polyneuropathy (2) Skeletal Changes (2) Uterine Bleeding (2)

Mouth Sores (2) Polyurea (2) Skin Irritations (13,8) Uterine Cancer (23)

Multiple Sclerosis (4) Premature Delivery (16) Skin Pigmentation (2) Vaginal Bleeding (5)

Muscle Cramps (3) Pruritis (Itchy Skin) (3) Sleep Disorders (2) Vas Deferens Alterations (5)

Muscle Stiffness (3) Pulminary Edema (2) Slipped Epiphysis Vertigo (8)

Muscle Weakness (2) Pyelocystitis (2) Sluggishness (2) Visual disturbances (13,8)

Muscoskeletal Disease (3) Recurring Colds (18) Spondylitis, ankylosing (5) Vitiligo (white spots/skin) (2)

Myalgia (Muscle Pain) (2) Respiratory Complications (13,8)

Stillbirths (2) Weak Pulse (13)

Myotrophy (Muscle wasting) (2)

Restlessness (13) Swallowing Difficulties (Dysphagia) (13)

Weight Disturbances (2)

Nausea (8,13) Retinitis (2) Swelling in Face (Angioedema) (3)

Zinc Deficiency (2)

Optic Neuritis (2) Rhinitis (38) Telangiectasia (166)

Oral Squamous Cell Carcinoma (22)

Sceroderma (3) Testicular Growth/Alteration (2, 42)

Osteoarthritis (2) Schizophrenia (18) Thirst (13)

Osteoporosis (2) Secondary teeth erupt later (16)

Thrombosis (39)

Osteosarcoma (22b) Seizures (13) Thyroid Cancer (22)

Otosclerosis Sensitive to light (1,17) Tingling Sensations(18)

Parkinson’s Disease (5) Shortness of Breath (13) Tinnitus (8)

Pins & Needles (18) SIDS (16) Ulcerative Colitis (41) Polydipsia (2) Sinus Infections (2,8) Urticaria (2)

http://poisonfluoride.com/pfpc/html/symptoms.html 104 Ellis

Finding associated diagnoses

• With help from BU RA Karim Nagib, I hired remote coders to look up the ICD-9 diagnoses for each of these conditions.

• 2282 out of 15,000 diagnoses were on this list

• 1062 are considered acute conditions related to fluoride

• Full list, and chronic list were used to sum: – Number of acute and all F-related diagnoses

– Sums of payments in month with at least one F-related diagnosis

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Acute Conditions Associated with Fluoride

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Tired

anemia

atherosclerosis

chronic fatigue syndrome

excessive sleepiness

fatigue

fibromyalgia

headache

migraine

muscle cramps

restlessness shortness of breath

sleep disorders

weak pulse

Lazy behavioural problems dizziness lack of co- ordination lack of energy sluggishness

Sore allergies arthritis asthma back pain carpal tunnel syndrome chest pain

collagen breakdown constipation convulsions diarrhea dry mouth dystrophy edema fearfulness fever gastric ulcers

gastro-disturbances gingivitis thirst tinnitus

ulcerative colitis

Sore.2 hoarseness

inflammatory bowel disease

inner ear disorders

joint pains

lupus

muscle stiffness

muscle weakness

myalgia

myotrophy

nausea pruritis

pyelocystitis

rhinitis

scleroderma

sensitive to light

sinus infections

spondylitis

swallowing difficulties

Sad crying easily for no apparent reason

depression

impotence

irritability

loss of appetite

loss of consciousness

Forgetful

concentration inability incoherence memory loss mental confusion

Ugly

acne

alopecia

eczema

fingernails:brittle

fingernails:lines/grooves

hives

mouth sores

retinitis

skin irritations

skin pigmentation

swelling in face

telangiectasia

urticaria (hives)

Monthly Effects of Fluoride in AL (Alabama) Using four different lagged levels of monthly average CDC F,

(imputing missing with natural levels) F No Lag F-1 F-2 F-3

Utilization measures Mean Coef T-ratio Coef T-ratio Coef T-ratio Coef T-ratio

# of claims 2.447 0.044 1.03 0.040 0.88 0.055 1.17 0.095 ** 2.15

# of diagnoses 3.110 0.082 1.11 0.083 1.08 0.134 * 1.73 0.198 *** 2.68

ER visits 0.026 -0.001 -1.51 -0.001 -1.35 -0.001 -0.55 0.000 -0.04

Admissions 0.012 0.000 -0.22 0.000 -0.06 0.000 0.29 0.001 1.19

total payments 7.049 -0.447 -0.48 -0.678 -1.10 -0.481 -0.93 -0.397 -0.87

Subsets of # of diags

F-related diags 1.062 0.008 0.23 0.009 0.24 0.030 0.82 0.058 * 1.71

Non-F-related diags 2.049 0.074 1.49 0.074 1.45 0.104 ** 2.10 0.140 *** 2.80

Acute F-related diags 0.828 0.010 0.36 0.010 0.32 0.032 1.05 0.025 0.86

Non-acute F-related diags 2.283 0.071 1.31 0.073 1.29 0.102 * 1.84 0.173 *** 2.97

Subsets of total payments

F-related $ 106.49 -5.17 -0.61 -2.65 -0.32 3.03 0.37 10.32 1.36

Non-F-related $ 260.27 -19.33 -1.30 -16.80 -1.15 -17.00 -1.22 15.77 1.14

Acute F-related $ 75.04 5.15 0.96 7.36 1.48 7.08 1.36 7.06 1.52

Non-acute F-related $ 291.72 -29.66 * -1.68 -26.81 -1.54 -21.05 -1.25 19.04 1.16

Observations 3216 3149 3082 3015

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Monthly Effects of Fluoride in AL Using four month moving average of county CDC F,

(imputing missing with natural levels) F_MA(4)

Utilization measures Mean Coef T-ratio R-square Treatment effect # of claims 2.447 0.119 1.63 0.723 5% # of diagnoses 3.110 0.248 ** 2.14 0.734 8% ** ER visits 0.026 0.000 -0.29 0.649 -2% Admissions 0.012 0.001 0.51 0.196 6% total payments 7.049 -0.657 -0.81 0.090 -9% Subsets of # of diags F-related diags 1.062 0.065 1.22 0.688 6% Non-F-related diags 2.049 0.184 ** 2.32 0.693 9% ** Acute F-related diags 0.828 0.046 1.00 0.731 6% Non-acute F-related diags 2.283 0.202 ** 2.33 0.677 9% ** Subsets of total payments F-related $ 106.49 11.33 1.24 0.217 11% Non-F-related $ 260.27 -11.86 -0.56 0.199 -5% Acute F-related $ 75.04 15.82 ** 2.35 0.211 21% ** Non-acute F-related $ 291.72 -16.35 -0.69 0.201 -6%

Observations 3015

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AL results: Time series regressions using four month moving average F to predict 394 CCs

showing Cs with N>500 cases per month, and t>1.96

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CC

Monthl

y Cases Mean Coef

T-

ratio CC Label

Treatment

effect

CC295 547 0.0011 0.00079 *** 3.74 Chronic Kidney Disease Up To Stage IV and Unspecified 72% ***

CC250 561 0.0011 0.00074 *** 3.40 Arteriosclerosis / Aneurism / Other Vascular Disease 66% ***

CC138 691 0.0014 0.00087 *** 3.89

Anemia in Chronic Illness / Other Blood and Blood Forming

Organ Disease 63% ***

CC110 938 0.0019 0.00071 *** 2.68 Bone Cysts and Other and Unspecified Bone/Cartilage Disorders 38% ***

CC133 651 0.0013 0.00041 ** 2.06 Upper Extremity Soft Tissue Disorders 31% **

CC115 1050 0.0021 0.00062 ** 2.03 Other Musculoskeletal and Connective Tissue Disorders 30% **

CC044 8910 0.0178 0.00259 *** 3.24 Diabetes with No or Unspecified Complications 15% ***

CC388 9080 0.0182 0.00202 ** 2.04 Other Postsurgical States / Elective Surgery / Aftercare 11% **

CC234 17790 0.0356 0.00367 *** 2.73 Hypertension 10% ***

CC323 2200 0.0044 -0.00108 *** -2.84 Uncompleted Pregnancy With No or Minor Complications -25% ***

CC296 1202 0.0024 -0.00069 ** -2.24 Urinary Calculi / Stricture / Reflux / Retention -29% **

CC039 1992 0.0040 -0.00124 *** -3.48 Other Benign, Uncertain, and In Situ Neoplasms -31% ***

CC093 925 0.0018 -0.00076 *** -2.75

Pathologic Dislocations and Miscellaneous Pelvic Joint

Disorders -41% ***

CC381 685 0.0014 -0.00070 *** -3.05 Rehabilitation -51% ***

CC252 600 0.0012 -0.00073 *** -2.58 Superficial Thrombophlebitis / Varicosity -61% ***

CC387 528 0.0011 -0.00073 *** -3.60

Non-Joint-Replacement Orthopedic Aftercare and Arthrodesis

Status -69% ***

CC CC Label T-ratio

Treatment

effect T-ratio

Treatment

effect

Annual

rate per

10,000

ACC001 Infectious and Parasitic 0.59 4% 6 11% *** 790

ACC002 Malignant Neoplasm 0.69 5% -1.05 -4% 150

ACC003 Benign/In Situ/Uncertain Neoplasm -1.83 -10% * 1.41 3% 735

ACC004 Diabetes 3.30 14% *** 3.71 12% *** 439

ACC005 Nutritional and Metabolic 0.69 3% 4.44 8% *** 1335

ACC006 Liver 1.51 18% 0.36 1% 101

ACC007 Gastrointestinal -1.10 -5% 4.9 9% *** 1084

ACC008 Musculoskeletal and Connective Tissue -1.59 -4% 4.99 6% *** 2463

ACC009 Hematological 0.09 1% 1.61 5% 220

ACC011 Substance Abuse -0.74 -10% 3.03 14% *** 122

ACC012 Mental -1.30 -7% 1.48 4% 598

ACC013 Developmental Disability -0.97 -11% 3.42 13% *** 114

ACC014 Neurological 0.80 4% 4.29 8% *** 582

ACC016 Heart 2.41 8% ** 5.09 9% *** 1279

ACC018 Vascular 0.88 11% 4.88 17% *** 159

ACC019 Lung -0.81 -5% 4.44 8% *** 969

ACC020 Eyes -0.46 -2% 2.75 7% *** 823

ACC021 Ears, Nose, and Throat 1.44 4% 7.17 10% *** 2680

ACC022 Urinary System -0.24 -1% 4.15 8% *** 547

ACC023 Genital System -1.51 -7% 2.63 6% *** 786

ACC024 Pregnancy-Related -3.00 -23% *** 2 6% ** 178

ACC025 Skin and Subcutaneous 0.81 4% 2.5 4% ** 1237

ACC026 Injury, Poisoning 0.33 2% 1.46 3% 791

ACC027 Symptoms, Signs and Ill-Defined Conditions 1.15 3% 7.88 10% *** 2671

ACC030 Screening/History -0.42 -1% 3.69 4% *** 3640

CC009 Other Non-Chronic Infectious Diseases 0.32 2% 6.1 11% *** 738

CC036 Benign and Uncertain Digestive and Urinary Neoplasms 0.23 3% 1.13 6% 128

CC038 Benign Neoplasms of Skin, Breast, Eye -0.99 -8% 1.69 4% * 338

CC039 Other Benign, Uncertain, and In Situ Neoplasms -3.48 -31% *** -2.24 -7% ** 182

CC044 Diabetes with No or Unspecified Complications 3.24 15% *** 3.68 14% *** 367

CC049 Hyperlipidemia 1.87 9% * 3.86 9% *** 881

CC052 Thyroid/Testicular/Ovarian and Metabolic/Nutritional Disorders-1.16 -7% 1.7 6% * 361

CC055 Disorders of Fluid/Electrolyte/Acid-Base Balance -0.80 -11% 4.4 21% *** 109

CC076 Other Chronic Gastrointestinal Disorders -0.57 -4% 3.2 8% *** 359

CC077 Other Gastrointestinal Disorders -0.99 -5% 3.5 9% *** 546

CC098 Intervertebral Disc Disorders, Spondylosis and Allied Disorders - Lower Back/NOS0.79 5% 3.1 12% *** 150

CC102 Nonspecific and Other Backaches/Pains/Disorders - Upper Back and Neck-1.18 -7% 3.06 15% *** 270

CC104 Nonspecific and Other Backaches/Pains/Disorders - Lower Back and NOS-1.05 -5% 2.73 11% *** 442

CC111 Osteoarthritis, Except of Spine, Hip, or Knee -0.21 -2% 1.12 5% 121

CC114 Other and NOS Soft Tissue Disorders -1.18 -6% 0.33 1% 238

CC125 Pathologic Dislocations and Miscellaneous Joint Disorders of Leg or Multiple Joints0.20 1% 3.64 9% *** 310

CC131 Shoulder Joint and Soft Tissue Disorders -0.19 -2% 3 3 10% *** 167

CC134 Injuries and Joint Disorders of Forearm and Hand 0.37 3% 2.2 5% ** 293

CC141 Nutritional Deficiency and Other/Unspecified Anemias and Blood and Spleen Disease-0.95 -8% 1.17 5% 129

CC159 Other Psychiatric Disorders -1.07 -11% 1.27 4% 184

CC168 Major Depression -1.30 -14% 0.15 1% 104

CC170 Depression 0.60 9% 0.28 1% 174

CC202 Mononeuropathy, Other Neurological Conditions/Injuries -0.12 -1% -0.12 -1% 138

CC203 Migraine and Tension Headache 0.83 8% 3.5 12% *** 150

CC204 Other Headache -0.05 0% 5.03 15% *** 190

CC219 Coronary Atherosclerosis/Other Chronic Ischemic Heart Disease4.07 44% 0.76 4% 127

CC234 Hypertension 2.73 10% *** 4.46 10% *** 825

CC257 Viral and Unspecified Pneumonia, Pleurisy 1.83 25% * 2.2 9% ** 104

CC265 Other Lung Disorders -0.31 -3% 4.93 12% *** 542

CC267 Asthma -0.30 -3% -1.28 -4% 217

CC277 Cataract -1.64 -22% -0.07 0% 104

CC278 Other Chronic Eye Disorders 0.47 6% 1.76 8% * 104

CC279 Glaucoma 0.55 6% -0.2 -1% 116

CC280 Other Non-Chronic Eye Disorders -0.20 -1% 2.33 7% ** 405

CC284 Other Chronic Ear, Nose, Throat, and Mouth Disorders 0.62 3% 4.37 10% *** 717

CC285 Other Non-Chronic Ear, Nose, Throat, and Mouth Disorders 1.62 6% 6.32 10% *** 1882

CC296 Urinary Calculi / Stricture / Reflux / Retention -2.24 -29% ** 2.57 10% ** 101

CC300 Other Urinary Tract Disorders 0.91 12% 2.83 14% *** 101

CC305 Acute and Other Urinary Tract Infection -1.06 -7% 0.83 2% 307

CC309 Perimenopausal and Other Congenital and Acquired Female Genital Disorders-1.10 -7% 3.19 9% *** 304

CC310 Vaginal/Cervical Diseases / Other Female Genital Disorders -1.04 -8% 0.55 2% 174

CC329 Cellulitis, Local Skin Infection -1.59 -12% 0.01 0% 232

CC330 Other Chronic Dermatological Disorders -0.69 -9% 1.19 4% 120

CC331 Other Dermatological Disorders 1.57 8% 2.73 5% *** 870

CC340 Other Injuries -0.51 -3% 1.31 3% 365

CC342 Poisonings and Allergic Reactions 1.36 21% -2.46 -11% ** 120

CC346 Persistent Sleep Disorders / Other Chronic Problems 1.46 12% 4.13 18% *** 114

CC347 Other Major Symptoms, Abnormalities -0.51 -2% 5.89 10% *** 1120

CC348 Dyspnea, Distress, Other Respiratory/Chest Symptoms 0.53 4% 4.17 12% *** 225

CC349 Minor Symptoms, Signs, Findings 0.97 3% 5.12 9% *** 1332

CC381 Rehabilitation -3.05 -51% *** 4.07 29% *** 124

CC383 Screening/Observation/Special Exams -0.58 -2% 2.15 3% ** 3332

CC384 History of Disease 0.37 4% 4.91 17% *** 269

CC388 Other Postsurgical States / Elective Surgery / Aftercare 2.04 11% ** 6.9 28% *** 348

Comparison of monthly time series (AL, 2007-10) and cross sectional results (National, 2424 counties, 2006)

Ellis 110

CC CC Label T-ratio

Treatment

effect T-ratio

Treatment

effect

Annual

rate per

10,000

ACC001 Infectious and Parasitic 0.59 4% 6 11% *** 790

ACC002 Malignant Neoplasm 0.69 5% -1.05 -4% 150

ACC003 Benign/In Situ/Uncertain Neoplasm -1.83 -10% * 1.41 3% 735

ACC004 Diabetes 3.30 14% *** 3.71 12% *** 439

ACC005 Nutritional and Metabolic 0.69 3% 4.44 8% *** 1335

ACC006 Liver 1.51 18% 0.36 1% 101

ACC007 Gastrointestinal -1.10 -5% 4.9 9% *** 1084

ACC008 Musculoskeletal and Connective Tissue -1.59 -4% 4.99 6% *** 2463

ACC009 Hematological 0.09 1% 1.61 5% 220

ACC011 Substance Abuse -0.74 -10% 3.03 14% *** 122

ACC012 Mental -1.30 -7% 1.48 4% 598

ACC013 Developmental Disability -0.97 -11% 3.42 13% *** 114

ACC014 Neurological 0.80 4% 4.29 8% *** 582

ACC016 Heart 2.41 8% ** 5.09 9% *** 1279

ACC018 Vascular 0.88 11% 4.88 17% *** 159

ACC019 Lung -0.81 -5% 4.44 8% *** 969

ACC020 Eyes -0.46 -2% 2.75 7% *** 823

ACC021 Ears, Nose, and Throat 1.44 4% 7.17 10% *** 2680

ACC022 Urinary System -0.24 -1% 4.15 8% *** 547

ACC023 Genital System -1.51 -7% 2.63 6% *** 786

ACC024 Pregnancy-Related -3.00 -23% *** 2 6% ** 178

ACC025 Skin and Subcutaneous 0.81 4% 2.5 4% ** 1237

ACC026 Injury, Poisoning 0.33 2% 1.46 3% 791

ACC027 Symptoms, Signs and Ill-Defined Conditions 1.15 3% 7.88 10% *** 2671

ACC030 Screening/History -0.42 -1% 3.69 4% *** 3640

CC009 Other Non-Chronic Infectious Diseases 0.32 2% 6.1 11% *** 738

CC036 Benign and Uncertain Digestive and Urinary Neoplasms 0.23 3% 1.13 6% 128

CC038 Benign Neoplasms of Skin, Breast, Eye -0.99 -8% 1.69 4% * 338

CC039 Other Benign, Uncertain, and In Situ Neoplasms -3.48 -31% *** -2.24 -7% ** 182

CC044 Diabetes with No or Unspecified Complications 3.24 15% *** 3.68 14% *** 367

CC049 Hyperlipidemia 1.87 9% * 3.86 9% *** 881

CC052 Thyroid/Testicular/Ovarian and Metabolic/Nutritional Disorders-1.16 -7% 1.7 6% * 361

CC055 Disorders of Fluid/Electrolyte/Acid-Base Balance -0.80 -11% 4.4 21% *** 109

CC076 Other Chronic Gastrointestinal Disorders -0.57 -4% 3.2 8% *** 359

CC077 Other Gastrointestinal Disorders -0.99 -5% 3.5 9% *** 546

CC098 Intervertebral Disc Disorders, Spondylosis and Allied Disorders - Lower Back/NOS0.79 5% 3.1 12% *** 150

CC102 Nonspecific and Other Backaches/Pains/Disorders - Upper Back and Neck-1.18 -7% 3.06 15% *** 270

CC104 Nonspecific and Other Backaches/Pains/Disorders - Lower Back and NOS-1.05 -5% 2.73 11% *** 442

CC111 Osteoarthritis, Except of Spine, Hip, or Knee -0.21 -2% 1.12 5% 121

CC114 Other and NOS Soft Tissue Disorders -1.18 -6% 0.33 1% 238

CC125 Pathologic Dislocations and Miscellaneous Joint Disorders of Leg or Multiple Joints0.20 1% 3.64 9% *** 310

CC131 Shoulder Joint and Soft Tissue Disorders -0.19 -2% 3 3 10% *** 167

CC134 Injuries and Joint Disorders of Forearm and Hand 0.37 3% 2.2 5% ** 293

CC141 Nutritional Deficiency and Other/Unspecified Anemias and Blood and Spleen Disease-0.95 -8% 1.17 5% 129

CC159 Other Psychiatric Disorders -1.07 -11% 1.27 4% 184

CC168 Major Depression -1.30 -14% 0.15 1% 104

CC170 Depression 0.60 9% 0.28 1% 174

CC202 Mononeuropathy, Other Neurological Conditions/Injuries -0.12 -1% -0.12 -1% 138

CC203 Migraine and Tension Headache 0.83 8% 3.5 12% *** 150

CC204 Other Headache -0.05 0% 5.03 15% *** 190

CC219 Coronary Atherosclerosis/Other Chronic Ischemic Heart Disease4.07 44% 0.76 4% 127

CC234 Hypertension 2.73 10% *** 4.46 10% *** 825

CC257 Viral and Unspecified Pneumonia, Pleurisy 1.83 25% * 2.2 9% ** 104

CC265 Other Lung Disorders -0.31 -3% 4.93 12% *** 542

CC267 Asthma -0.30 -3% -1.28 -4% 217

CC277 Cataract -1.64 -22% -0.07 0% 104

CC278 Other Chronic Eye Disorders 0.47 6% 1.76 8% * 104

CC279 Glaucoma 0.55 6% -0.2 -1% 116

CC280 Other Non-Chronic Eye Disorders -0.20 -1% 2.33 7% ** 405

CC284 Other Chronic Ear, Nose, Throat, and Mouth Disorders 0.62 3% 4.37 10% *** 717

CC285 Other Non-Chronic Ear, Nose, Throat, and Mouth Disorders 1.62 6% 6.32 10% *** 1882

CC296 Urinary Calculi / Stricture / Reflux / Retention -2.24 -29% ** 2.57 10% ** 101

CC300 Other Urinary Tract Disorders 0.91 12% 2.83 14% *** 101

CC305 Acute and Other Urinary Tract Infection -1.06 -7% 0.83 2% 307

CC309 Perimenopausal and Other Congenital and Acquired Female Genital Disorders-1.10 -7% 3.19 9% *** 304

CC310 Vaginal/Cervical Diseases / Other Female Genital Disorders -1.04 -8% 0.55 2% 174

CC329 Cellulitis, Local Skin Infection -1.59 -12% 0.01 0% 232

CC330 Other Chronic Dermatological Disorders -0.69 -9% 1.19 4% 120

CC331 Other Dermatological Disorders 1.57 8% 2.73 5% *** 870

CC340 Other Injuries -0.51 -3% 1.31 3% 365

CC342 Poisonings and Allergic Reactions 1.36 21% -2.46 -11% ** 120

CC346 Persistent Sleep Disorders / Other Chronic Problems 1.46 12% 4.13 18% *** 114

CC347 Other Major Symptoms, Abnormalities -0.51 -2% 5.89 10% *** 1120

CC348 Dyspnea, Distress, Other Respiratory/Chest Symptoms 0.53 4% 4.17 12% *** 225

CC349 Minor Symptoms, Signs, Findings 0.97 3% 5.12 9% *** 1332

CC381 Rehabilitation -3.05 -51% *** 4.07 29% *** 124

CC383 Screening/Observation/Special Exams -0.58 -2% 2.15 3% ** 3332

CC384 History of Disease 0.37 4% 4.91 17% *** 269

CC388 Other Postsurgical States / Elective Surgery / Aftercare 2.04 11% ** 6.9 28% *** 348

Comparison of monthly time series (AL, 2007-10) and cross sectional results (National, 2424 counties, 2006)

Three hypotheses for why some changes are negative (beneficial)

1. Nothing is really happening; it's all a statistical artifact.

2. There really are offsetting beneficial and negative effects of fluoride.

3. We are seeing the anticipated adverse effects, but they are crowding out some other types of visits. – My conjecture #35 is that it is the last one: People go

in to complain about acute effect.

Ellis 113

TABLE 2. Recommended optimal fluoride levels for community public water supply systems (31,32) =================================================================================================== Annual average of maximum daily Recommended Recommended control range air temperatures (8,9) fluoride (mg/L) 0.1-0.5 ------------------------------- concentrations --------------------------------- F C (mg/L) Below Above ------------------------------------------------------------------------------------------------------------------- 50.0-53.7 10.0-12.0 1.2 1.1 1.7 53.8-58.3 12.1-14.6 1.1 1.0 1.6 58.4-63.8 14.7-17.7 1.0 0.9 1.5 63.9-70.6 17.8-21.4 0.9 0.8 1.4 70.7-79.2 21.5-26.2 0.8 0.7 1.3 79.3-90.5 26.3-32.5 0.7 0.6 1.2 Source: http://www.cdc.gov/mmwr/preview/mmwrhtml/00039178.htm#00001294.htm Downloaded from the CDC web site on April 24, 2016

Standards Shown on the CDC Web Site still suggest levels that have Not Been Changed Since 1953

http://www.cdc.gov/fluoridation/engineering.htm

Galagan DJ. Climate and controlled fluoridation. J Am Dent Assoc

1953;47:159-70.

114 Ellis

http://www.cdc.gov/mmwr/preview/mmwrhtml/00039178.htm



2016 CDC web site still shows Fluoride Standards for School Water Supplies Advocate 4.5 Times the Community Water

Supply Average TABLE 5. Recommended optimal fluoride levels for school public water supply systems (31,32) ============================================================================================= Annual average of maximum daily Recommended air temperatures (8,9) fluoride Recommended control range (mg/L) -------------------------------- concentrations -------------------------------- F C (mg/L) 20% Below 20% Above --------------------------------------------------------------------------------------------- 50.0 - 53.7 10.0 - 12.0 5.4 4.3 6.5 53.8 - 58.3 12.1 - 14.6 5.0 4.0 6.0 58.4 - 63.8 14.7 - 17.7 4.5 3.6 5.4 63.9 - 70.6 17.8 - 21.4 4.1 3.3 4.9 70.7 - 79.2 21.5 - 26.2 3.6 2.9 4.3 79.3 - 90.5 26.3 - 32.5 3.2 2.6 3.8 --------------------------------------------------------------------------------------------- + Based on 4.5 times the optimal fluoride level for communities. Source: http://www.cdc.gov/mmwr/preview/mmwrhtml/00039178.htm#00001294.htm Downloaded from the CDC web site on March 6, 2012

115 Ellis


Recommended fluoride overfeed actions for community water systems, United States (31) (Guidelines are from Reeves TG 1986, but as still listed on CDC website in 2016) =========================================================================== Fluoride level Actions Recommended ------------------------------------------------------------------------------------------------------------- up to 2.0 mg/L 1. Leave it on. 2. Determine malfunction and repair. 2.1 mg/L to 4.0 mg/L 1. Leave it on. 2. Determine malfunction and repair. 3. Notify supervisor and report to appropriate agencies. 4.1 mg/L to 10.0 mg/L (0. Leave it on.) 1. Attempt repair. 2. If the problem is not corrected quickly, turn it off. 3. Notify supervisor and report to appropriate agencies. 4. Test water samples at several points in the distribution system. Retest if results are still high. 10.1 mg/L or greater + 1. Turn it off immediately … ------------------------------------------------------------------------------------------------------------- + The state might require public notification to prevent consumption of high levels of fluoridated water. Source:http://www.cdc.gov/mmwr/preview/mmwrhtml/00039178.htm#00001294.htmDownloaded April 24, 2016

116 Ellis

Daily intake (mg/person)

Endemic area Coal type Food

Drinking-

water Air Total

Sichuan Soft coal 8.86 0.10 0.67 9.63

Hubei Anthracite 4.12 0.45 0.55 6.12

Jiangxi Anthracite 2.54 0.50 0.24 3.28

Hunan Anthracite 1.81 0.52 0.31 2.64

Huber Anthracite 1.86 0.42 0.15 2.43

Jiangxi (control) Firewood 1.14 0.24 0.11 1.49

Source: WHO, Table 2.4, Downloaded 4/28/2012 from

http://www.who.int/water_sanitation_health/publications/fluoride_drinking_water_full.pdf

Table 2.4 Daily fluoride intake in different endemic areas of China using

Fluoride is also a problem in other countries

117 Ellis

US Fluoride Time Line

1916 The first evidence of brown mottling of teeth is reported in the US, eventually found to be caused by fluorides in water. 1950 The U.S. Public Health Service officially endorses the fluoridation of public water supplies. 1953 Galadan proposes F levels are .7ppm (parts per million) in hot areas, increasing to 1.2 in colder climate areas, with the rationale being that people do not need to drink as much water in colder areas 1955 Crest Fluoride toothpaste is first marketed 1955 “Fluoridated toothpaste should not be used where the water supply is fluoridated." A later decision stipulated that "children under 6 should not use Crest". Both warnings were abandoned in 1958. 1967 Fluoride pills are generally available for free to children from dentists. 1969 The World Health Organization endorses water system fluoridation 1971 Germany bans water fluoridation 1972 Sweden bans water fluoridation 2011 January, the US DHHS and EPA jointly announce a new recommended level for water fluoridation of .7 ppm.

118 Ellis

• 1945: Fluoride's affinity for magnesium and manganese ions enables it to deplete their availability for vital enzyme functions. (Borei, H., "Inhibition of Cellular Oxidation by Fluoride", Arkiv.Kemi,Mineral,Geol., 20A, No. 8, 1945).

• February 10, 1951 issue of JAMA Medical Literature: Symptoms of chronic fluoride poisoning, include "dental fluorosis. Fluoride also tends to accumulate in bones, leading to hypercalcification and brittleness. Ligaments and tendons also become calcified. Serious symptoms may ensue, such as loss of mobility of joints, easy fractures and pressure on the spinal chord. Other effects include baldness in young men, accompanied by increased fluoride concentrations in hair and nails, anemia and decreased blood clotting power due to the binding of calcium. Dysmenorrhea, alterations in growth and weight, lowered birth rate, high incidence of fractyre, thyroid alterations and liver damage have been observed in regions of endemic fluorosis.“

• 1962 A study in Portugal revealed that fluoride at 1ppm concentration caused a 25% decrease in activitiy of the enzyme succinic dehydrogenase in liver tissue, both in test tubes and in animal experiments. In vivo, fluoride at 1ppm inhibited liver activity by 6.4 percent. In kidneys this enzyme activity was reduced by 47.8 percent by fluoride at 1ppm in drinking water. The authors concluded, "significant enzyme inhibition due to prolonged fluoride administration demonstrates the impairment of an important step in cellular metabolism". (Sullivan, W.D.,S.J., and Von Knobeledorff, A.J., Broteria Serie de Ciencias Naturais, Lisbon, 21, No.1, 1962).

• 1966 Testimony presented by John J. Miller, Ph.D, Chicago, Illinois at fluoridation hearings in San Jose, California on March 11, 1966, included the following statement: "Fluoride acts to tie up magnesium - forming magnesium fluoride - an insoluble compound which thus prevents the essential enzyme from using magnesium. As a result, mental processes are seriously interfered with, and nerve reactions throughout the body depressed ... this sort of toxicity is shown by research to play a role in epileptic seizures and other convulsions." [Ref: Fluoridation and Truth Decay, 1974, p.93]

• 1967 The July 1967 Annals of Allergy reported dermatitis and gastro-intestinal conditions from fluoridated toothpaste; and headaches, fever, and blood in stools from Tri-Vi-Flor given to children.

• 1972 The prestigious journal Science, July 14, 1972, requested doctors "Perform Tests and/or Examinations on People Who Have Shown Sensitivity to Fluorides from Fluoridation", and to send the results to a Fact Finding Committee in Milwaukee, Wisconsin, chaired by Dr.R.J.H. Mick in Laurel Springs, New Jersey. The project consisted of a double-blind study using the provocative sub-lingual testings with varying dilutions of a fluoride solution up to a concentration of 1 ppm. The project, held at the Red Carpet Inn in Milwaukee on August 5 and 6, 1972, was a 'continuing study to determine the immediate side effects of individuals extremely sensitive to fluorides'. A number of individuals developed immediate symptoms of headache, burning in the throat, dizziness, nausea and vomiting to test solutions whose concentration were much less than 1 ppm, whereas the placebo (unfluoridated tap water) elicited no reactions.

119 Ellis

120 Ellis

121 Ellis

122 Ellis

New York City 2011 Drinking Water Michael R. Bloomberg Supply and Quality Report

• (Bold text highlights added.) Water Treatment Drinking water entering New York City’s distribution system is treated with chlorine, fluoride, food grade phosphoric acid and sodium hydroxide. New York City uses chlorine to meet disinfection requirements. Fluoride, added since 1966, helps prevent tooth decay. Phosphoric acid is added to create a protective film on pipes that reduces the release of metals, such as lead, from household plumbing. Sodium hydroxide is added to Catskill/Delaware water to raise the pH and reduce corrosivity, which also helps reduce potential exposure to lead.

Fluoride DEP is one of the many water suppliers in New York State that treats drinking water with a controlled, low level of fluoride for consumer dental health protection. According to the United States Centers for Disease Control and Prevention (CDC), fluoride is very effective in preventing cavities when present in drinking water at an optimal range of 0.7 to 1.2 mg/L. The New York City Health Code requires a fluoride concentration of 1.0 mg/L, and the NYSDOH maximum contaminant level (MCL) for fluoride is 2.2 mg/L. During 2011, fluoride was not continuously supplied due to maintenance to the fluoride feed system and other aqueduct construction activities that required the system to be turned off. Fluoridation on the Catskill and Delaware aqueducts was offline 7% and 20% of the time, respectively. There was an extended period of frequent fluoridation interruptions during a 106-day period, from March 15 to June 28, 2011, due to construction work at Delaware Shaft 19. The New York State Dental Association has indicated that a continuous interruption of fluoridation is not expected to have a significant impact on dental health. Outside of this time period, DEP met the required fluoride levels more than 85% of the time. On January 13, 2011, the United States Department of Health and Human Services requested public comment on its proposal to lower the optimal fluoride target dose to 0.7 mg/L. In response NYSDOH issued guidance to public water supplies indicating that water suppliers in New York State could reduce the optimal fluoride target dose to 0.8 mg/L. Based on these developments the New York City Department of Health and Mental Hygiene authorized DEP to lower the target dose for fluoride to 0.8 mg/L. This dosage change took effect on February 14, 2012.

Ellis 123

Speculative Conjecture #35

New York City’s discontinuation of F for 106 days from March 15 to June 28, 2011, provides a powerful natural experiment to look for improvements in acute fluoride-related health conditions during this period and resumption of such conditions afterwards.

Ellis 124


Fluoride may be causally related to Alzheimer’s Disease (NRC 2006) report p. 234: “Because of the great affinity between fluorine and aluminum, it is possible that the greatest impairments of structure and function come about through the actions of charged and uncharged AlF complexes (AlFx). …In a study of more than 3,500 French men and women above the age of 65 (Jacqmin et al. 1994), a significant decrease in cognitive abilities was found when their drinking water contained calcium, aluminum, and fluorine.”

Ellis 125


Fluoride reduces Human IQ (NRC 2006) report p. 221: “In assessing the potential health effects of fluoride at 2-4 mg/L, the committee found three studies of human populations exposed at those concentrations in drinking water that were useful for informing its assessment of potential neurologic effects. These studies were conducted in different areas of China, where fluoride concentrations ranged from 2.5 to 4 mg/L. Comparisons were made between the IQs of children from those populations with children exposed to lower concentration of fluoride ranging from 0.4 to 1 mg/L. The studies reported that while modal IQ scores were unchanged, the average IQ scores were lower in the more highly exposed children. This was due to fewer children in the high IQ range.”

Ellis 126

Rat studies suggest neurological effects

NRC (2006): Page 222:

“Long et al. (2002) reported changes in the number of acetylcholine receptors (nAChRs) in the rat brain due to fluoride. …These results are of interest because changes in the nicotinic receptors have been related to the development of Alzheimer’s disease (Lindstrom 1997; Newhouse et al. 1997) and, in frontal brain areas, to schizophrenia (Guan et al. 1999).”

Ellis 127

Conjecture #38

Fluoride causes Schizophrenia

See previous quote from NRC (2006) p. 221

Ellis 128

Conjecture #39 F is causally related to Goiter, an Iodine deficiency

Ellis 129

NRC, 2006, p.231.

Or less spectacularly in Nepal

Ellis 130

NRC, 2006, p.230.

Ellis 131

0

50

100

150

200

250

0 10,000 20,000 30,000 40,000 50,000 60,000 70,000

Au

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School Enrollment

Relationship Between Town School Enrollment and Rate of Autism, 2004-5, in 299 Massachusetts School Systems, Fluoridated and

UnFluoridate systems

Fluoridated Systems Unfluoridated Systems

Linear (Fluoridated Systems) Linear (Unfluoridated Systems)

Conjecture #40, 41

• High school and college teams in town with fluoridated water should have poorer success than those with unfluoridated water systems

• Professional sport teams with stadiums or arenas in areas without F should have better winning percentages than those in F regions.

Ellis 132

10 Facts and 41 Informed Conjectures about the Health Effects of Fluoride

Randall P. Ellis

Boston University

April 2016

Please to not quote or cite.

133

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