[PLUG-TALK] topic of the day ... discuss!

[Keith Lofstrom]

Glen <gepr at ropella.name> writes:
glen> Strikes me as a very ham-handed and lazy approach to the problem
glen> of oral hygiene, an overly general modification to the
glen> environment in order to treat a very specific cohort of the
glen> population.  When applying overly general solutions to specific
glen> problems, you run the risk of an explosion in side effects.
glen> I.e. the cure becomes worse than the disease.  [...]
> 
On Fri, May 03, 2013 at 09:56:54AM -0700, Russell Senior wrote:
> I think it's worth pointing out that there has been significant
> opportunity to test these risks and they have been found to be very
> low in practice.  Except for some mild cosmetic fluorosis of teeth, it
> seems the risks (even if real) are very small and demonstrably not
> explosive compared to the benefits.

People are not peas in a pod.  The minimum effective dose of a
pharmaceutical for one patient will kill another.  Which is why
we expect doctors to pay attention when they prescribe things.
So here we have politicians prescribing fluorine based on 50 year
old studies, with whole-body dosage dependent on how much water
you drink, not on how much fluoride you need in your teeth.

Fluorine has the highest electronegativity of any element and binds
to anything (even Xenon! even weaker oxidants like oxygen!).  That
makes teeth slightly more inert and cavity resistant in small doses,
and breaks bonds and embrittles teeth (and bones!) in higher doses. 
The crossover is different for every individual.

My physician wife opposes fluoridation.  She has patients with
problems like metal poisoning - fluoride interferes with chelation
treatment as well as the natural passage of these metals out of
the body.   Those patients can spend $$$$ for RO water purifiers
and non-local food.  But what about the people who aren't her
patients, who haven't learned from her or other doctors that
they have these risks, and don't know to protect themselves?

We have fluoridated for years, some say, and there's never been
proof of harm.  But it is harder than you might imagine to find such
proof.  People move from fluoridated cities to unfluoridated and
back, they get richer and can afford better dental care, they use
proven-effective fluoride toothpaste topically.  So the positive
effects are hard to tease out of a complicated mess of statistics
and other demonstrable improvements over time.  Fortunately, with
better data collection, better statistical skills, and better
computers and software, we are indeed refining the numbers. 

And the scary thing?  Newer studies show fewer benefits.  It is
now about 10% improvement, the old claims were 2x or higher. 
The studies are popping out regressions for other problems in
other parts of the body, which dentists don't pay attention to.

Like dentists not paying attention to the risks of mercury amalgam.
Which they should have.  There is a fierce battle going on today in
dentistry over amalgam - and since the mercury follows the patients,
you would think definitive conclusions would be would be much easier
to tease out of the data.  Dentists aren't evil or stupid - they
just don't have time to learn everything.

The federal recommended fluoride treatment keeps going down - it
was a couple of parts per million, now it is 0.7ppm.  In larger
doses, the small average benefit turns negative. 

That does not mean that 0.7ppm is optimum for everyone - it just
means that above 0.7ppm the extra damage to the teeth of some
individuals is increasing faster than the extra benefit to
other individuals.  That is what an inflection of a sum means. 
And that curve entirely ignores any other non-tooth effects that
whole-body fluoride can have.  There isn't a single study showing
whole body benefit from fluoride - so why the hell are we treating
whole bodies, indeed whole ecosystems, instead of just the teeth,
and adjusting doses for individual needs and risks?

It took centuries, until the early 1960s, before the connection
between smoking and lung cancer was firmly established.  And that
connection seems obvious as hell to me.  But people can be blind
to complex data.  Diseases with multiple causes (like cancer) are
difficult to analyze and quantify risk versus cause.  Even though
smoking is more-or-less voluntary, smokers with cancer win multi-
million dollar lawsuits against the companies that sold
cigarettes to them.  That is the legal environment today.

So consider genomic variation, the quantified self, massive computer
data mining, and the myriad of "little surprises" science is 
uncovering now.  Consider the entirely involuntary nature of
municipal fluoridation, and the long term sequestering of fluorine
in bones and tissues.  Unless the risks are precisely zero, forever,
we may learn that some of the existing studies showing serious
damage to some individuals are really true.  The organizations
providing that fluoridated water (like the City of Portland) may
be treated like tobacco companies, on the hook for ten million
dollar lawsuits from provably damaged individuals. 

That could include some consumers of 40% of the water Portland
produces, sold to outlying water districts such as Tigard, Gresham,
and West Slope.  While a defense lawyer might convince a Portland
jury that a stricken Portland citizen got what they voted for, a
Washington or Clackamas county jury will see things differently. 
Especially if jury members live in one of the districts where
fluoridation was shoved down their throats without a vote.  They
might be a future plaintiff.

----

If you want to do something for oral health, brush your teeth.
Use fluoride toothpaste, unless you have fluorosis, or your
dentist or doctor tells you not to.  Stop drinking sugar water,
sodas AND sweetened fruit juice.  Teach kids to brush their
teeth.  Get the damned soda machines out of the schools.  

And end the federal subsidies to corn agribusiness.  The glut of
cheap starch-turned-into-sweetener has nearly tripled the sugar
most people consume and rot their teeth with.  Without subsidies,
sweetener prices will rise, and products will reformulate.  Many
consumers will still make stupid food decisions, but low income
families won't choose sugary food because it is the cheapest. 
If we must subsidize something, how about kale and carrots
instead of candy and cookies (corn and wheat)?

In spite of all the nasty things we do to our teeth and our
bodies, dental health is better than ever, and much better in
Portland than most fluoridated cities.  We can make it even
better if we make healthy personal choices, rather than pretend
that the choices others force on us are better than our own. 

Please don't F with our H₂O .  But even if you vote for fluoridation,
thank the Clean Water folk who fought for your right to vote on this.

Keith

-- 
Keith Lofstrom          keithl at keithl.com