Fluoride Action Network

Open Letter to Honorable Yael German, Minister of Health, Israel

June 25, 2014
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  • Dear Honorable Minister German,

    We applaud your decision to end mandatory fluoridation in Israel and we look forward to the time that there is an outright ban on this reckless practice.

    Your position is a model for the public health community both in Israel and in our respective communities. It is sound, based on the current literature and the need to protect the health of citizens from unnecessary ingestion of fluoride.

    It is unfortunate that in making the best decision for the health and welfare of your citizens that you have been subjected to criticism and bullying as noted in the June 22rd article, Backlash against Health Minister Yael German for her decision to stop fluoridation, published in The Jerusalem Post (Siegel-Itzkovich).

    Professor Paul Connett, co-author of The Case Against Fluoride (Chelsea Green, 2010), is willing to travel to Israel and publicly debate any of those who are organizing against you. However, in our experience the pro-fluoridation advocates are unable to defend their position in open public debate. This is not through a lack of debating skills on their part but rather the fact that science simply does not support their claims that swallowing fluoride is safe or that it dramatically reduces tooth decay.

    The following facts and arguments underline the inappropriateness of this outdated practice:

    Delivering any medicine via the water supply is reckless

    Fluoridation violates all principles of modern pharmacology. Once added to water there is no way of controlling the dose or the people who get the medicine – it goes to everyone regardless of age, weight, health, need or nutritional status. Moreover, it violates the individual’s right to informed consent to medical treatment. (http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000445.htm).

    Swallowing fluoride is particularly inappropriate

    Fluoride is not a nutrient. Not one biochemical process in the body needs fluoride. Underlining this fact is the exceedingly low level of fluoride in mother’s milk (0.004 ppm, NRC, 2006, p.40). Formula-fed infants in fluoridated communities (at 0.7 to 1.2 ppm) receive 175 to 300 times more fluoride than a breast-fed infant.

    Making matters worse is the fact that fluoride is known to have toxic properties at low doses (NRC 2006, Barbier et al., 2010; Varner et al., 1998). It also accumulates in the bone and builds up there over a lifetime. Early signs of fluoride poisoning of the bone (skeletal fluorosis) are identical to arthritis and lifelong accumulation can make bones brittle and more prone to fracture.

    Dental fluorosis

    While we do not see the crippling effects of skeletal fluorosis observed in countries like India and China, which have areas of high natural levels of fluoride, children in fluoridated countries are experiencing a very high prevalence of dental fluorosis. According to the CDC (2010) 41% of American children aged 12-15 have dental fluorosis. Black and Mexican American children have significantly higher rates of the more severe forms of dental fluorosis (CDC, 2005, Table 23).

    Fluoridation promoters acknowledge that dental fluorosis indicates over-exposure to fluoride but refuse to admit other harm. A review of the toxicology of fluoride by the U.S. National Research Council of the National Academies in 2006 revealed that fluoride is an endocrine disruptor and causes many health problems at levels close to the exposure levels in fluoridated communities. This panel also reported that bottle-fed babies are exceeding the EPA’s safe reference dose when drinking fluoridated water (NRC, 2006, p85).

    Fluoride impacts the brain

    Many animal and human studies indicate that fluoride is a neurotoxin (www.FluorideAlert.org/issues/health/brain). In 2012, a team that included Harvard University researchers reviewed 27 studies that showed an association between fairly modest exposure to fluoride and lowered IQ in children (Choi et al., 2012). In nine of these studies the so-called “high fluoride” village had fluoride levels less than 3 ppm. Such levels provide no adequate margin of safety to protect all children –especially the most vulnerable- from lowered IQ when drinking fluoridated water.

    An incredible lack of oversight

    Fluoridation is designed to treat a disease but has never been approved by the Food and Drug Administration (FDA); it classifies fluoride as an “unapproved drug.”

    How strong is the evidence that swallowing fluoride reduces tooth decay?

    Fluoridation advocates claim that it is very strong. However, if you look at the actual science it is a different story. The effectiveness of swallowing fluoride to reduce tooth decay has never been demonstrated via a randomized controlled trial (RCT), the gold standard of epidemiology (McDonagh et al., 2000). Two key U.S. studies – both government funded and by pro-fluoridation researchers – have failed to produce convincing evidence of benefit.

    A very large study, administered by the U.S. National Institute for Dental Research, examined the permanent teeth of 39,000 children (aged 5-17) from 84 communities. The average saving in Decayed Missing and Filled Surfaces (DMFS) when comparing children in fluoridated and non-fluoridated communities was 0.6 of a tooth surface out of 128 tooth surfaces, and this was not shown to be statistically significant (Brunelle and Carlos, 1990). Even if it were, the average saving is remarkably small considering what risks are being taken to achieve this result.

    As part of the “Iowa Fluoride Study,” where children’s tooth decay and fluoride intake has been tracked from birth, researchers examined the relationship between tooth decay and individual exposure to fluoride from all sources, including water, food and dental products. They were attempting to find the so-called “optimal dose” needed to reduce tooth decay, however they concluded that, “achieving a caries-free status may have relatively little to do with fluoride intake…” (Warren et al., 2009).

    The most likely explanation for the weak evidence of benefit

    Even fluoridation advocates have acknowledged that the predominant benefit of fluoride is topical, not systemic (CDC, 1999). In other words, fluoride works on the outside of the tooth not from inside the body. This acknowledgement removes the whole rationale for fluoridating water and forcing people who don’t want it to ingest it.

    Most countries don’t fluoridate their water

    The vast majority of countries (including 97% of Europe) neither fluoridate their water nor their salt. However, WHO figures indicate that tooth decay in 12-year-olds is coming down as fast in non-fluoridated countries as fluoridated ones (http://fluoridealert.org/issues/caries/who-data/ ).

    Tooth decay in low-income families can be reduced by safer means

    Many countries have been able to reduce tooth decay in low-income families using cost-effective programs without water fluoridation. The Scottish Childsmile program involves a) teaching tooth-brushing in nursery schools; b) advising parents on better diets; c) annual check-ups and d) fluoride varnishes where necessary. The number of 12-year-olds without caries has increased to over 70% using these methods and in the process costs have been cut by half (BBC Scotland, 2013).

    Added benefit of emphasizing education

    Making education, not fluoridation, the center of the fight against tooth decay has the added advantage of attacking the cause of obesity, an issue which threatens to cost health services billions of dollars over coming decades.

    References after signatures


    Paul Connett, PhD, Director, Fluoride Action Network, USA

    Mary Lou Andersen, MS, Bellingham, Washington

    Eve-Marie Arcand, DMD, Sherbrooke, Québec, Canada

    Douglas Amell, ND, Moose Jaw, Saskatchewan, Canada

    Alexander J. Audette, R.Ac., TCMP, B.Eng.(Chem), Guelph, Ontario, Canada

    David M. Augenstein, MSc, PEng, Akron/Canton, Ohio

    John Bain, DDS, Farmington, Arkansas

    Kellie Barnes, MOMT, MPT, Portland, Oregon

    Jane Beck, BSc, MBBS, Thames, New Zealand

    James S. Beck, MD, PhD, Professor Emeritus of Medical Biophysics, University of Calgary, Canada; Co-author, Case Against Fluoride (Chelsea Green, 2010)

    Bobbie Beckman, DDS, Bassano del Grappa, Italy

    Kathleen Bernardi, RDH, King City, Ontario, Canada

    Rosemary R. Bishop, MS (Health Ed), Pensacola, Florida

    Jo Thomas Blaine, L.Ac, San Diego, California

    Zuzka Borovjakova, CNP (Certified Nutritional Practitioner), Toronto, Ontario

    Barry Breger, MD, Montreal, Québec, Canada

    Gene Burke, BA, Woodland Hills, California

    Roger Burt, MS (psychology), Portland, Oregon

    Robert Button BScPharm, RPh, CDE, CRE, Dryden, Ontario, Canada

    David Buttorff, Louisville, Kentucky

    Elizabeth Caliva, PE, MS, Encinitas, California

    Neil J. Carman, PhD, Austin, Texas

    Leo Cashman, MA, Executive Director of DAMS Inc. (Dental Amalgam Mercury Solutions), USA

    Anthony Cipolla, DDS, Williamsport, Pennsylvania

    Griffin Cole, DDS, President, International Academy of Oral Medicine & Toxicology, Austin, Texas

    John J. Collins, DC, Newberg, Oregon

    Michael Connett, JD, Los Angeles, California

    Gerald W Cooper, PENG, B Eng, MBA, Toronto, Canada

    Karl Cox, PhD, Brighton, Sussex, UK

    Michael Czajka, PhD candidate (Chemistry), Melbourne, Victoria, Australia

    Lady Carla Davis, MPH, Queensland, Australia

    Catherine L. Deptula, DVM, BS, Brandon, Florida

    Robert C Dickson, MD, CCFP, FCFP, Calgary, Alberta, Canada

    Michael F. Dolan, PhD, Amherst, Massachusetts

    Dr Jayne LM Donegan, MBBS DRCOG DCH DFFP MRCGP MFHom, London, UK

    Aviva (Zack) Dycian, DMD, Ramat HaSharon, Israel

    Irucka Embry, M.Eng., BS, Nashville, Tennessee

    Hart Nadav Feuer, PhD, Agricultural Sciences, University of Bonn, Germany

    Gerald A Fillmore, DDS, MS, Orthodontist (retired), Gridley, California

    Laurence Fisher, BDS, Wellington, New Zealand

    Naomi H. Flack, BS, EdM, Palm Beach Gardens, Florida

    Gary Fortinsky, DDS, Toronto, Ontario, Canada

    Matt Freedman, Chiropractic Physician, Eugene, Oregon

    Brenda L. Gallie, Professor, University of Toronto, Ontario, Canada

    Elsa Noeline Gannaway, MA. Dip Ed., Wellington, New Zealand

    Michael Godfrey, MBBS, Tauranga, New Zealand

    Sara Gold, DAMS International (Dental Amalgam Mercury Solutions) – Israel Activist, Certified Energy Health Practitioner, Betar Illit, Israel

    Dorothy Goldin Rosenberg, MES, PhD, Toronto, Canada

    Yarden Goldstein, DDS, Tel Aviv, Israel

    Anna Goodwin, MD (Medical Oncologist), Hamilton, New Zealand

    Michael Gossweiler, DDS Indianapolis, Indiana

    Stephanie Grootendorst, DC, DACNB, Chiropractic Physician, Diplomate Chiropractic Neurology, Portland, Oregon

    Ian Gregson, Wellington Chapter, Weston A Price Foundation, New Zealand

    Ronald A. Greinke, PhD, Medina, Ohio

    Sophie Guellati-Salcedo, PhD, Miami, Florida

    Chris Gupta, P.Eng., London, Ontario, Canada

    MC Hagerty, RN, BSN, MA, Carlsbad, California

    Merilyn Haines, B App Sc Med Lab Tech, Brisbane, Queensland, Australia

    Kathryn Hall, RN, Berkeley, California

    Gerald F Harris  BSc, BEd, Peterborough, Ontario, Canada

    William Harris, MD, Honolulu, Hawaii

    Leslie C. Hatcher RN, BSN, Southlake, Texas

    Simeon Hein, PhD, Institute for Resonance, Boulder, Colorado

    James M. Heltzel, DMD, Las Vegas, Nevada

    Nancy R. Heltzel, RDH, KOHP, Las Vegas, Nevada

    David R. Hill, PEng, CEng, FBCS, Professor Emeritus, Calgary, Alberta, Canada

    J. William Hirzy, PhD, Washington, DC

    Vic Hummert, Author, Lafayette, Louisiana

    David W Horwood, MAgSc, Melbourne, Victoria, Australia

    Professor C. Vyvyan Howard, MD, PhD, University of Ulster, Northern Ireland; Past President, International Society of Doctors for the Environment

    Cheryl Hughes, RN, Cove, Texas

    Ann Huntsman, RN, MS, Cupertino, California

    April Hurley, MD, Santa Rosa, California

    Lisa Intemann, PhD, BA, BAppSc, DipSocSc, Port Macquarie, NSW, Australia

    Bo H Jonsson, MD, PhD, Department of clinical neuroscience, Karolinska Institutet, Stockholm, Sweden

    Susan Kanen, BS (Whistleblower to lead in drinking water Washington DC), Anchorage, Alaska

    Barry S. Kendler, PhD, FACN, CNS, Professor of Nutrition, University of Bridgeport, Connecticut

    David Kennedy, DDS, Past President, International Academy of Oral Medicine and Toxicology, San Diego, California

    George Knorr, Professor of Physics Emeritus, University of Iowa, Iowa

    Robert Kopitzke, PhD (Statistics), Fort Collins, Colorado

    Stephen M. Koral, DMD, Boulder, Colorado

    Deborah Landowne, CCH, RSHom(NA) Classical Homeopathy, San Rafael, California

    Neima Langner, MD, FRCP(C) Community Medicine and Public Health, Ottawa, Ontario, Canada

    Isabella Leviyev, Physician Assistant, Queens, New York

    Louisa Liberman, PhD, Hillsborough, North Carolina

    Hardy Limeback, PhD, DDS, Former Head, Preventive Dentistry, University of Toronto; Past President, Canadian Association for Dental Research; Member of the 2006 National Research Council panel which reviewed the toxicology of fluoride; Mississauga, Ontario, Canada

    Mel Litman, MD  and Maya Litman, BA, B.Ed, Metar, Israel

    Dennis Lobstein, MTCM, PhD, Los Angeles, California

    Theresa Lynch, Ed. D., Charlottesville, Virginia

    Douglas J. Mackenzie, MD, Santa Barbara, California

    Peter Mackinlay, Dip Arch, A G Inst Tech, B Arch, Geelong, Victoria, Australia

    Joy Margulies, RN, BS (community health), Arverne, New York

    Elizabeth McDonagh BSc(Hons), Cert. Ed., Doncaster, South Yorkshire, UK

    Lisa McLaurin, RN, CCRN, Castaic, California

    James D. McNabb, MD, CNS, Austin, Texas

    Philip Michael, MB, BCh, DCH, DRCOG, MICGP, Hon Sec IDEA, Bandon, Co Cork, Ireland

    Spedding Micklem, D.Phil (Oxon), Edinburgh, Scotland; Co-author, Case Against Fluoride (Chelsea Green, 2010)

    Howard W. Mielke, PhD (Environmental Pharmacology), New Orleans, Louisiana

    Deborah E. Moore, PhD, Executive Director, Second Look, Worcester, Massachusetts

    Tatyana Moore, CPA, Syracuse, New York

    John J Mulrooney DC, Portland, Oregon

    Janet Nagel, Ed.D (Public health educator, ret.), Greensboro, North Carolina

    Ted Ninnes, MA, MSc, PhD, Kawhia, New Zealand

    Bill Osmunson DDS, MPH, Portland, Oregon

    Eugene L. Packer, DC, N.Easton, Massachusetts

    Ian E Packington MA (Oxon) Cert Tox (Barts), York, UK

    Dr Geoff Pain, Monbulk, Victoria, Australia

    Gilles Parent, ND, Co-author, Fluoridation: Autopsy of a Scientific Error, 2010. Québec, Canada

    Professor Stephen Peckham, BSc, MA(Econ), University of Kent; Director, Centre for Health Services Studies, Canterbury, UK

    Doug Piltingsrud, PhD (Inorganic chemistry), Eyota, Minnesota

    Michael Pinkerton, Doctor of Chiropractic, Petaluma, California

    Christian Pires, Systems Engineer, Portalegre, Portugal

    Betsy Ramsay, Journalist, Teacher, Author, Jerusalem, Israel

    Hagen Rampes, BSc MBChB FRCPsych, London, UK

    Elizabeth W. Reed, PhD, Oak Ridge, Tennessee

    James W. Reeves, PhD, Lafayette, Louisiana

    David W Regiani, DDS, MIAOMT, Founding member, Past president of the International Academy of Oral Medicine and Toxicology, Ortonville, Michigan

    Curtis Rexroth MA, DC, CCN, Moline, Illinois

    Robert H Riffenburgh, PhD, MS, PStat, FASA, FRSS, San Diego, California; Author, Statistics in Medicine, 3rd Edition (Elsevier, 2012).

    Cynthia L. Rochen, BSN, BSAg, Silver Spring, Maryland

    Terry Rose, BSc., BDS, Otago New Zealand

    Michael Ross, LHP, Toronto, Ontario, Canada

    Troy Ross, MD, MPH, Reno, Nevada

    Teresa Rouse, BSN, RN, CRRN, Green City, Missouri

    Jean Ryan, BSc, Nutrition and Dietetics, RN, Brisbane, Queensland, Australia

    John A. Ryan, MBBS, MSc, Nutrition, FRACGP, DCH, FAMAC (Acupuncture), FACNEM, Brisbane, Queensland, Australia

    Holly Satvika, RN, FNP-BC, Asheville, North Carolina

    Andrew W. Saul, PhD, Editor, Orthomolecular Medicine News Service, Rochester, New York

    Michael B Schachter, MD, Certified Nutrition Specialist (CNS), Suffern, New York

    Judy Schriebman, Certified Classical Homeopath, RSHom(NA), San Rafael, California

    Karilee Shames PhD, RN, Sebastopol, California

    Richard Shames, MD, Sebastopol, California

    Nestor B Shapka, DDS, Bonnyville, Alberta, Canada

    Ruth W. Shearer, PhD (toxicologist, retired), Lacey, Washington

    Davorin K. Skender, BSE, Bloomington, Indiana

    Rick Smith, Network Manager (CAAS), Providence, Rhode Island

    Kristine L. Soly, MD, FACC, Holistic Cardiologist, Crossville, Tennessee

    Joerg Spitz, MD, PhD, Schlangenbad, Germany

    Carol Vander Stoep, RDH, BSDH, OMT, Austin, Texas

    Kathleen Thiessen, PhD, Senior Scientist, Oak Ridge Center for Risk Analysis, Tennessee

    Sheldon Thomas, Director ‘Clear Water Legacy’, Retired Manager of Water Distribution, Hamilton, Ontario, Canada

    William Thornton, ND, DC, Santa Monica, California

    Eric Turk, PhD (Neuroscience), North Hills, California

    Shimon Tsuk, M.Sc., Kiryat Ono, Israel

    Ruth Tudor, RN, Olympia, Washington

    Hilary C. Walton, PhD in Evolutionary Behavioral Ecology, Cleveland OH

    Barbara Warren, RN, MS, Albany, New York

    Joy Warren, BSc. (Hons, Env. Sc.), Certificate in Health and Nutrition, West Midlands, UK

    Declan Waugh, Environmental Scientist, Cork, Ireland

    Charles Weber, MS (soil science)Hendersonville, North Carolina

    John J. West, CET, LAFT, Wallingford, Vermont

    Donna Westfall, Former Councilmember, Crescent City, California

    Raymond R. White, PhD (Biology), San Francisco, California

    Shirley Williams, RN, Bellingham, Washington

    Mae W. Woo, DDS, Billings, Montana

    Loty Zilberman, Chemical Engineer, MSc, Ghivataiim, Israel


    Barbier O, Arreola-Mendoza L, Del Razo LM. 2010. Molecular mechanisms of fluoride toxicity. Chemico-Biological Interactions, 188(2):319-33.

    BBC News Scotland. 2013. Nursery toothbrushing saves £6m in dental costs. November 9.

    Brunelle JA, Carlos JP. 1990. Recent trends in dental caries in U.S. children and the effect of water fluoridation. Journal of Dental Research, 69(Special edition):723-727. Excerpts at http://fluoridealert.org/studies/nidr-dmfs/

    CDC 1999 (Centers for Disease Control and Prevention).  Achievements in public health, 1900- 1999: Fluoridation of drinking water to prevent dental caries. Mortality and Morbidity Weekly Review (MMWR) 48(41): 933-940. October 22.

    CDC 2005 (Centers for Disease Control and Prevention). Surveillance for dental caries, dental sealants, tooth retention, edentulism, and enamel fluorosis–United States, 1988-1994 and 1999-2002. MMWR Surveillance Summaries, 54(3):1-43.

    CDC 2010 (Centers for Disease Control and Prevention). Beltrán-Aguilar, Barker L, Dye BA. 2010. Prevalence and Severity of Dental Fluorosis in the United States, 1999-2004. NCHS Data Brief Number 53. November.

    Choi AL, Sun G, Zhang Y, Grandjean P. 2012. Developmental fluoride neurotoxicity: a systematic review and meta-analysis. Environmental Health Perspectives, 120(10):1362–1368.

    Connett P, Beck J and Micklem S. 2010. The Case Against Fluoride. White River Junction, Vermont: Chelsea Green Publishing.

    McDonagh MS, Whiting PF, Wilson PM, et al. 2000. Systematic Review of Water Fluoridation. British Medical Journal, 321(7265):855–59. Note: The full report that this paper summarizes is commonly known as the York Review and is available at http://www.york.ac.uk/inst/crd/fluorid.htm

    NRC 2006 (National Research Council of the National Academies). Fluoride in Drinking Water: A Scientific Review of EPA’s Standards. Washington, DC: The National Academies Press.

    Siegel-Itzkovich J 2014. Backlash against Health Minister Yael German for her decision to stop fluoridation. The Jerusalem Post. June 22.

    Varner JA, Jensen KF, Horvath W, Isaacson RL. 1998. Chronic administration of aluminum-fluoride or sodium-fluoride to rats in drinking water: alterations in neuronal and cerebrovascular integrity. Brain Research, Feb 16;784(1-2):284-98.

    Warren JJ, Levy SM, Broffitt B, et al. 2009. Considerations on optimal fluoride intake using dental fluorosis and dental caries outcomes – a longitudinal study. Journal of Public Health Dentistry, 69(2):111-5.