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49-78 RESOLUTION
• RESOLUTION NO. A RESOLUTION APPROVING THE INTRODUCTION OF FLUORIDE ION INTO THE WATER SUPPLY OF THE CITY OF FAYETTEVILLE, ARKANSAS. WHEREAS, the application of fluoride ion to a water supply to reduce incidents of dental caries has been approvediby the U.S. Public Health Service, the Arkansas Board of Healthithe American Association of Public Health Dentists, the American Water Works Association, and many others; and WHEREAS, it is the consensus of opinion among health authorities that a maximum concentration of one and one-half (1.5) parts per million of fluoride ion is safe and desirous. NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF DIRECTORS OF THE CITY OF FAYETTEVILLE, ARKANSAS: Section 1. That the introduction of fluoride ion in an amount not to exceed 1.2 parts per million concentration to the water supply of the City of Fayetteville is hereby approved. Section 2. That a copy of this resblution shall be sent to the Arkansas Board of Health. PASSED AND APPROVED this B -day of . aftiptent 1978. a. --A- rearal sow 7 ATTEST:Pid.AA 0-A .1%1% CITY'CLERK 4 .? d at- de APPROVED: Oe'rfrese(0.- di-nea-s-4 MAYOR MICROFILMED DATE OcT 2 0 1978 REEL \1 MINIMS OF A REGULAR MEETING OF THE BOARD OF DIRECTORS 'I-54' "•"^";1545;5--•5^5 -5450455 • 5 51516. 54.5- ;15 • ay. - August 15, 1978 4 - 755 55, • 1;1Po page 8 4 FLUORIDATION: A request by Director Phil Colwell for an ordinance initiating the 'fluoridation of Fayetteville's water supply. [Materials at 1.01; see also item 16G1 elTRAFFIC IMPROVEMENT; Approval of the Fayetteville portion of the"Transpor- Citation System Management/Transportation Improvement Program" for the Fayetteville/Springdale Transportation Study Area. [Elaine Walker of NWARPC will be present at the meeting to 'splain] tri STREET NAMING: A request that the street located south of Zion Road (in front of Urology Associates, P; A.) be named "Venetian Lane". [See 3.01] A MSP WAIVER: A request for a waiver of the Master Street Plan requirements for ilea portion of Stearns Road west of Highway 71. [Correspondence at 4.011 •0^ . tem • 5AC1 9 BONDS: A public hearing regarding the issuance of $500,000 of "Aet lndustrial Development Revenue Bonds. [See 5 01: see also item 16G1 Under the terms of this arrangement, the city agrees to issue approximately 5500,000 in Act 9 bonds to finance the con- struction and equipping of a trucking terminal expansion for Arkansas Best Freight. ABF will pay off all of the costs of the bonds (including both principal and interest, the cost of issuing the bonds, and financing and attorney's fees) through a lease arrangement, and the city will own the facilities until the bonds are paid off. There will be no general tax liability to the public. Similar revenue bond provisions were made for hangar • facilities for Scheduled Skyways, for the expansion of the D. It Baldwin Piano & Organ Plant, and for the construction and equipping of the Hackney Bros. Body Company and American Air Filter plants in the Industrial Park. • 3 5 4 P44 A RESOLUTION APPROVING THE INTRODUCTION OF FLUORIDE ION INTO THE WATER SUPPLY OF THE CITY OF FAYETTEVILLE, ARKANSAS. WHEREAS, the application of fluoride ion to a water supply to reduce incidents of dental caries has been approved by the U.S. Public Health Service, the Arkansas Board of health, the American Dental Association, the American Association of Public Health Dentists, the American Water Works Association, and many others; and WHEREAS, it is the consensus of opinion among health authorities that a maximum concentration of one and one-half (1.5) parts per million of fluoride ion is safe and desirous. NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF DIRECTORS OF THE CITY OF FAYETTEVILLE, ARKANSAS: Section 1. That the introduCtion of fluoride ion of approximately one (1) part per million concentration to the water supply of the City of Fayetteville is hereby approved. Section 2. That a copy of this resolution shall be sent to the Arkansas Board of Health. PASSED AND APPROVED this day of . 1978. APPROVED- oss wars CRAMMWA P.A. AW SCRESfleA0 J. B. HAYS. D.D.S. FRANK C. GRAMMER. D.D.S.. Pail DIPLOMATES. AMERICAN BOARD OF ORAL SURGERY Board of Directors City of Fayetteville Fayetteville, Arkansas You are presently offered an opportunity without parallel in disease prevention. The dental profession, and indeed, the entire scientific community, is convinced that fluoridation of municipal water supplies is of major importance in combatting that most common, painful, and costly of diseases, dental caries. The dentists of Fayetteville think it is important to eKpress our conviction that fluoridation of community water oysters is effective in caries prevention, economical, and safe. The dentists of the Fayetteville area, through the Fayetteville Dental Study Club, unanimously endorse fluoridation of the Fayetteville water system and strongly urge the Board of Directors to immediately pass an ordinance allowing our citizens the benefits of this disease prevention measure. Respectfully submitted for the members of the Fayetteville Dental Study Club by, , Ph.D. Piyetteville D-eaMiat'udy Club BUREAU OF PUBLIC HEALTH ENGINEERING Donaghey Building, 13th Floor Seventh end Main Streets Little Rock, Arkansas 72201 Mr., Don Grimes y 4 City Manager City Administration Building Fayetteville, Arkansas 72701 • Dear Mx. Grimes: Per Mr. Bill Parette's request, we are enclosing copies of 1. The procedure for inaugurating fluoride. 2. An example of a resolution that should be adopted by the City Council. fluoridation cost estimates. 4.• • • _ page 1.04 ARKANSAS DEPARTMENT OF HEALTH Little Rock, Arkansas CONTROLLED FLUORIDATION OF DRINKING WATER SUPPLIES PrOcedure to be followed b a munici alit Considerable interest has developed among municipal water works and health officials, and the medical, dental and engineering professions concerning the con- trolled fluoridation of drinking water supplies. Conclukive evidence as to the beneficial results of the practice probably will not be known for several years, but initial results indicate that dental caries can be reduced considerably through the applicatiom of fluorides to the drinking water. The State Board of Health, on July 26, 1951, adopted a resolution endorsing and recommending fluori- dation of public water supplies to aid in the prevention of dental caries /mac- cordance with procedures established by the State Board of Health. ' ' A written request for approval of fluoridation must be submitted to the Arkansas State Board of Health by the proper official or agent of the water works together with two sets of detailed plans and specifications of the proposed equip- ment, layout. method of application and means of controlling the fluoride dosage. The application shall give the following information: Amount of natural fluoride in the water. The flouride compound proposed for addition. Type and capacity of feeding equipment. Details of storing and handling fluoride Compound, including safety equipment for operators. . Point of application for the fluorides. Outline of proposed operating and laboratory control procedures. The qualifications of personnel who will be in control of the process and make laboratory tests. The request shall also be accompanied by a copy of a resolution by the City Council approving the application of fluoride. The responsible water works official shall notify the State Board of Health of the date proposed for commencing fluOridatiOn in order that an engineer of the State Health Department can be present at the start of the program.. The engineer will check the installation for agreement with approved plans and instruct the operator in making fluoride residual tests. It is expected that the consulting engineer and equipment manufacturer's • representative will make final adjustments of the equipment to assure proper opera- tion and will give full instructions to operating.personnel in the operation and maintenance of the equipment. or utilit in inau •• atilL fluoridation DeSiRfl Criteria Chemicals Sodium fluoride, sodium silicofluoride and hydrofluosilicic acid are commonly used. Information concerning these chemicals is given in Appendix A. The avail- ability, cost, and ease of application are important factors in the selection of the chemical to be used. e-• • • • 1 • 1 .0 Page • Chemical Feed Equipment , The equipment and accessories must provide for dependable, efficient and , • accurate fluoride control. The equipment shall have sufficient capacity to main" lain a fluoride content in the treated water of about 1.2 parts per million. In- 1 , formation concerning feeding equipment is contained in Appendix B. Feeders lust .. be located so as to provide for easy maintenance, protection against dust hazard 6 and for ready access to the chemical storage area. Feeders must have an accuracy -, tolerance of at least 0 5 per cent. r " Dry feeders mist be provided with scales for weighing the chemicals used:Ic". Where loading operations may create dust hazards, special.consideration must be 42(i # orgiven to dust collection and filtration. Dilution water lines should be equipped ‘ . with automatically operated valves to prevent water wastage when the feederls nor • in operation. • i r 1/2 i. •• , A4c2.1 Solution feeders must be provided with two corrosion resistant containeis; one for making up the stock solution and the other for the solution pump auction. Containers must be provided with non -corrodible, over -lapping covers, and all openings must be constructed to exclude the entrance of contamination. A chlorine residual must be maintained in the batch solution container. -Suitable scales for'. weighing the chemical shall be provided. Special corrosion resistant parts are required in the pumps when concentrated acid is fed. 0 i , , se Point of ApplicatiOfl The point of application shall be selected so as to obtain uniform -distribu- tion of fluoride. Solution feeders mina discharge against continuout ptesidre in such a manner that concentrated flUoride solution cannot be hiphoned into the system., . .- A‘ ' •Si'latilSmItrol , • r Automatic start -Stop operation and proportioned feeding ere required. Con- trols exist eliminate any possible hazard of overfeeding. Separate installations are required where distribution from individual sources will not peimit fluoridate ing at a common point. . a IISS11-2-Maae Suitable anti -siphon provisions must beAprovided for all make-up end dilution water lines to prevent any back -siphonage of concentrated fluoride solution into the supply. Either a free fall atmospheric break or approved siphon -breaker in the water supply line serving the feeders on the discharge side �t the control valve must be provided. Solution Water Soft water should be used for preparing brch solution and for dry feeder solution water. If soft water is not available, consideration should be given to the use of a small softening unit or to the feeding of polyphosphates. • Chemical Store e Adequately ventilated and lighted, conveniently located and dry storage facilities are essential for proper operation. - . . , • *je •- • 2 d • 'Jr Aoa• • ••• leSionnel Protection lubber glntet and SStvttal respitst ros of an approved type must be provided Va• tack installation. Dabber aprons and protective goggles should also be made available. Facilities most be provided for metering the meter delivered to the diatribe - tins system. laboratory Control :Facilities for the adequate and reliable determinatinstof the fluoride con - castration shall be furnished. Details of the testing equipment shall be outlined In the specifications. Sampling taps shall be made available so that representa- tive samples of treated and untreated water may be obtained. Where the fluorides_ are introduced into a closed pipe the location of the sampling point should be at It 20 feet downstream from the point of application. Control tests oust be made at least daily on the rim, treated and distribution system water. In addition, at least one sample per meek for eight weeks and one per mouth thereafter must be submitted to the State Ryglesic Laboratory for check purposes. Ihnords locords most be maintained on plant operation. A copy aka, daily record shill be furnished monthly to the State Sala Department oa proper forms. Sueb fern shall show the amount of chemical added, the amount of water treated, bind orchemical used, and the residual fluoride test results. An individual see of records most be maintained for oath installation. • competent and responsible oparator most be in charge of the fluoridation process and controls at all OS. 3 - D, • Fluoride Compounds • page 1.07 APPENDIX A . FLUORIDE COMPOUNDS ; Ii! inforthation concerning the fluoride compounds available is as follows: J 1. Sodium fluoride (NaF) 1 • Commercial sodium fluoride may be purchased in various grades containing 90 to 98 percent sodium fluoride by weight equivalent to 40 to 45% aVialable fluoride ion. Its solubility is 4%. The composition of the salt is such that the 90% grade requires 20.4 lbs. Per mil. gal. to apply a 1.0 p.p.m. fluoride ion and the 95% grade, 19.4 lbs. per mil. gal. The cost of this compound has varied from 11 to 14 tents per lb. delivered; resulting in an average cost for fluoridation of about $2.50 per M.G. It is packaged in 100 lb. bags, 375 lb. • barrels or in 125 and 375 lb: fiber drums. The material is in the form of a fine powder, it is dusty to handle, contains insoluble matter of varying per- centage and a variable moisture content, though 0.5% is a recommended maximum. (See ANNA Tentative Standard Specifications for Sodium Fluoride 5N1.90 -T (1950)). Some operating difficulties have been reported Such as clogging of Solution piping by accumulated depositions of inert materials, presence of foreign material in the sodium fluoride resulting in jammed feeders and lumping of the compound while in storage. 2. Sodium silicofluoride (Na2Si116) Sodium Silicofluoride contains 592 of fluoride ion as contrasted to the 43.52 • • average for NaF. It can be purchased in 100 lb. moisture -proofed paper Saga, 350 lb. barrels or 125 lb. drums in a grade containing 98.52 sodium silica• - fluoride. Its cost is about 7-9 cents per pound. The material is a white, free flowing, odorless, non -hygroscopic crystalline powdet containing no Water of crystallization. It has a low solubility (about '0.42) which limits ite use in fluoridation to dry feed application only. Sodium silicofluoride has a tendency to form incrustants also even though the compound formed, calcium silicofluoride, is more soluble than calcium fluoride. The degree of incrus- tation is much less and normal maintenance practice should keep ahead of the difficulty. Some arching of this compound has been encountered in feeder hoppers. Use of a timer device which allows the feeder to °notate at a higher rate of feed at intermittent internale or a hopper vibrator are controls for such a problem. •• • 3. Hydrofluosilidic acid (H2S116) • Hydtofluosilicic acid is available as a 302 grade which gives 23.752 fluoride ion, is non-volatile and not irritating to the skin. It is packaged in 50 gallon (420 lbs.) wood barrels and 100 lb: rUbber.drums. Cost a the liquid SB about 5 cents per pound F.O.B.'shipping point. The overall cost of a fluoridation program using hydrofluosilicic acid would amount to approximately $2.25 per m.g. One gallon (10.8 lbs.) o2 hydroflussilicic acid will treat 307,000 gallons of water at 1 p.p.m. fluoride: The chief advantage in the use of this acid lies in its solubility as compared to NaF at 42 and Na2 SiF6 at less than 0.4%. 4 There is a greater degree of simplicity in the. use of hydrofluocilicic not enjoyed by the other compounds so fir mentiOned. Spacial mixing is not required to obtain a solution of water soluble cOnsistency. The product is, added as received., 4. Hydrofluoric acid (HF) • , r , r Hydrofluoric'acid is obtainuble in either 60 or' 702'coidenttatfOn. HydrOs' 4 .141uoric acid is packaged in 110 gallon (000 110, 55 gallon (450 lb.) and 20 gallon (160 lb.) steel barrels. The use of ihia°aeid tanrbe indtitUted only upon the expressed permission of the State HealthkDepariment. " C f page 1.09 APPENDIX FLUORIDE FEEDING EQUIPMENT • Feeding Equipment Several factors enter into the determination of the feeding method. These briefly are type and cost of chemical, number of installations required, personnel available for maintenance, construction and location of stations, budget and ability to feed within the desired accuracy. It is recommended that a registered engineer be employed to advise the local responsible officials. Frequently, before the engineer is employed, equipment manufacturers have long since given the com- munity excellent guidanc.! to thc above. This Department does not encourage the use of one method over the other. The method selected by the water department or utility is subject, however, to the approval of the State Health Department. 1. Solution feed of sodium fluoride Equipment used for feeding sodium fluoride solution is identical to the hypochlorite feeder. It is a constant -rate of feed, positive displacement, diaphragm or plunger type pump with adjustment of both stroke frequency and stroke length. This feeder has a capacity of about 40 lbs. of concentrated sodium fluoride per day and will accommodate flows up to about 2 m.g.d. when applying the fluoride at 1 p.p.m. This equipment can fluoridate the water under pressures up to 125 p.s.i. Feeding under suction is not recommended. Automatic feed is obtained when inter -wired to the starting switch of a pump -motor. The method of adding the sodium fluoride solution to a water supply is simple. First, the rate if discharge of the water pump is determined. Second, the feeder is set to deliver the amount of sodium fluoride required. Third, upon start of the water pump the inter -wired diaphragm pump starts and draws sodium fluoride solution from the solution tanks and injects it into the discharge line. Water pumps usually discharge at a fairly constant volume. However, if discharge is variable, a flow proportional device can be installed in the line to insure accuracy of feed. Auxiliary equipment for a sodium fluoride solution feed set up usually includes two ceramic crocks, 30 to 55 gallon capacity, a zeolite water softener if the water is moderately hard, a small scale, respi- rator, rubber gloves and fluoride residual colorimetric tester. 2. Solution feed of saturated solution of sodium fluoride A potential weakness of the sodium fluoride solution feeding method is the "human factor" of accurately weighing a fixed amount of compound for adding to a fixed volume of water. One chemical feeder company, to remove this factor, introduced an accessory development - the saturator tank - to assure a simplified procedure. Insteld of weighing out a fixed amount of compound, an entire barrel of sodium fluoride is added to a tank. A saturated solution is automatically made up by means of a float valve to last for days and even weeks. A contact period is provided to produce a saturated solution at draw - off rate. The size of the tank varies with the.chemical feeder capacity. The tank contents are sufficient to fluoridate 15 to 20 million gallons before a recharge is necessary. 6 4=rman: k A page 1. 10 • 1 t It has been observed that, even with soft water make up, precipitates form in 4 the tanks which if not periodically removed will plug the feeder. Periodic back -washing of the tank, however, brings the sludge to the top where It can Y be removed. 4 5 3. Liquid feed of hydrofluosilicic acid h The very newest approach to fluoridation is the liquid feeding of hydrofluosilicic acid. The feeding of this relatively non -corrosive acid is not a greatly different from the feeding of any common water works chemicall„solUtion.:., The same type of feeder used in sodium fluoride solution application, with ; minor adjustment, is able to handle hydrofluosiliciC acid directly and accu- rately without the need for dilution, provided the water pumpage rate is suf.*, ficiently high. Hydrofluosilicic acid application can only be at a point ‘'". where positive pressure 14; assured at all times. Reason for this is the much greater concentration of fluoride ion being fed from the container. Though the chemical feeder has a spring loaded back pressure valve to prevent back siphonage through the unit, failure would result in siphonage of a highly concentrated fluoride solution into the system. Application against pressure where no negative head can occur is a precautionary control. 4. Liquid f?ed of hydrofluoric acid The liquid feed of hydrofluoric acid is a highly dangerous procedure And doei not warrant serious consideration by any city except under extreme circum- stances, and the use of hydrofluoric acid shall be instituted only upon the expressed permission of the State Health Department. • 5. Dry feed of sodium fluoride or sodium silicofluoride A majority of the fluoridation programs to date have chosen the dry feed method. Either a volumetric or gravimetric feeder can be selected for measuring the sodium fluoride or sodium silicofluoride. As was true for solution feed, application methods using dry feeders are of no mystery for again one could call upon years of experience with such equipment as used in other phases of water treatment and purification. Besides, manufacturers had, prior to 1945, developed dry feeders for feeding enriched concentrates in the flour processing field - a development which required accuracy upon the part of the equipment. a. Volumetric dry feed For the intermediate sized supply up to approximately 5 m.g.d. the volumetric dry feeder is most popular. This type feeder gets its name from the fact that compound applied is measured on a volume basis. Accurately machined grooves in the feeding disc or slow moving polished stainless feed rolls assure positive volumetric measurement. Feed rate is adjusted by a calibrated feed slide or disc which varies the feed from minimum to maximum. The feeder is mounted on a platform scale which permits almost instantaneous checking on the amount of material fed into the dissolver or solution mixing chamber. For application against pressure a constant level tank and a pump Or ejector must be included in the installation. Each installation must also include a siphon breaker on the raw water make-up line to prevent back -siphonage of concentrated fluoride solution. Overflow and drain 7 • 5• 4 Id .0 lines frit thole:peanut level box diiehargelisto fres space before connection with a sewer. Problems have occurred in dry feed operation most of which, however, have been attributed to thirchemical. In some installations larger ejectors were zequired as experience showed incrustants were still plugging the feed line. The resulting higher velocity through the ejector has resulted in trouble free operation in those installations previously troubled with incrustation. Experience has also shown that having a large amount of water passing through the solution mixing chamber most of the incrustant trouble is eliminated. For dry feeding of sodium silicofluoride it is necessary that a,larger mixing chamber be provided to off -set the lower solubility of the compound. The second type of dry feed equipment, gravimetric, operates on the loss -in -weight principle which continuously "Veighs out" material from a hopper that is carried on the scales. Depending upon application point the feeder nay or may not be supplied with a dissolving tank. Generally speaking, the graviMetriC feeder being used for both sodium fluoride and sodium silicofluoride feeding is considered the ultimate in equipment, for medium and large size installations. Cravimetric units installed include a number of features not found in the less expensive volumetric installations. These include: dust tight, all enclosed cabinet, large hopper capacity equippc4 with vibrators to. control arching of the chemical, dust collector at filling chute, chart recorder and totalizer which mechanically reports operating characteristics, and alarm to indicate faulty operation. 161 • 461SEDDLETION APPROVING Tut lwroommicm cr rumps so Ino qttorsO minx or Imo •• ISTUI DEPARTMENT OF TIM CITE OF ARKANSAS, WHEREAS, the application of fluoride ion to * meter supply to reduce thie incidence of dental caries hae been approved by the U. S. Public Health s, Slivice, the Arkansas State Board of Health., the American Dental Association, kb* Aterican Association of Public Health Dentists, the American Water Works Association and many others, and; WHEREAS, it is the concensus of opinion among health authorities that a maximum concentration cf one and onembalf (1.5) parte per million of fluoride ion Is safe and desirous; NOW, THEREVORE, BE IT RESOLVED, by the City Council of tht City of , Arkansas, that thi introduction et fluorids Aig • icin cf approximately ono (1) part per million concentration to the Water Simply, be apiroved. BE IT ruRTHL1 RESOLVED, that a copy of this Resolution be spread on the minutes of the City Council and copies sent to the Water Department and the Arkansas State Board of Health. ADOPTED; at' To feed SOdium Silicofluoride **W 6 T A 690 Dry Feeder Platform Scales **Lightening mixer Test Kit igiao Current Price Deliveredr04.23/1b. F $.38/1b.F To feed Hydrofluorosilicic acid* **W& T A 747 Solution Feeder ru800 Platform Scales ni375 Test Kit r.#100 $1275 Current Price DeliVered00$0.24/111.* V23.75% F $1.01/1b.F At a dosage Of 1 mg/1, 1 lb: F will trent 1200 people for 1 day. For Sodium Silicofluoride, $0.38 X 365/1200 Illc For Hydrofluorosilicic Acid $1.01 X 365/1200 0 31c N °A 4. A ,4 1giCii *available from Pioneer Salt CoMpany, Philadelphia Pe.: *Includes freight to i Hamburg, Manua ? “ 1,1,__i .». T • 9 • 4 ' 120400 gallons oUwiter, which will ...,: the annual per person cost would be ; theihnual per Person cost would boo 4: • A ** ftanufaCturers mews are used only to identify types Of 4401pment tejUliOd. ak (from survey of 120 physicians and dentinteln Pilyetteville) 00 1.14 NWMautely yes" ',feel fluoridation is important -as you know I routinely prescribe fluoride to newborns but a survey would show 50% or less compliance." ‘flitim a medical viewpoint, there is no evidence of harmful effects of fluoridation but mUch Iiiidence of benefits as regard to teeth." • )ic for it -good luck!" 1) need to prevent dental caries 2) good evidence now that fluoridation.prevents post- m,opausal osteoporosis (and compression fractures) in elderly women," It is a shame that our community -which should be a leader in these affairs is so primitive and backward in denying this to the people." toed going! Evidence shows it would be of tremendous benefit to the children of our community." "Good luck on this." "Without question, it is needed." I believe fluoridation would be an asset to the City of Fayetteville." "We do need it." "Yes, I am in favor. Feel very strongly -appreciate your poll." "Beljeve it is an effective agent to reduce dental caries -likely will raise all kinds of orPOPition from naturalists, John Birchers, and others viewing this as an invasion of their rights of choice.( Some of us feel that way about Social Security, etc.)" "Strongly believe this is important. It's hard to believe we ban things of unproven harm and neglect things of proven value." "Reports in literature confirm it's a safe procedure and effective in decay prevention." "Recommended by pediatric and dental icademies-no harmful effects known- this IS PREVENTIVE MEDICINE." "Should have been done years ago." "Badly needed." "Long overdue." "I hope we can get it through." "Many people who move here from areas that do have fluoride in their water supplies find it hard to understand how a city like Fayetteville does not already have this health adjunct. The cost of installation and service cr such an addition is infinitely small when you consider the amount of pain and suffering reduced and/or eliminated." "Fluoridation of Fayetteville water would help reduce tooth decay." "Yes, I an in favor. I can understand why some people oppose this, though. Mass medication for all when some do not benefit." "Hope to see all incorporated city water supplies fluoridated by federal law." 4. '4 1.• 1413). it;r11..r" 4 tit)) 1.0b.„`.).k, tr. v4rmlits' noes City have the right to "treat" its citizens with fluiride? Otn• City Witer needs' to be kept pure and unadulterated." •41. J 4 4, f 144( tA 4 t .A: 4' a •04•1 • 'I will be glad to get you aB the anti -material You might want." A * * 4Lt 6 4 V ers g 4t44 ..iot 4 • • ,e ax ye - SUPSTIL A PUBLICA CONSUMERS U NO ADVERTISIN ONE DOLLAR . JULY 1978 . ••• $ PART ONE OF A TWO-PART REPORT 1,47A MICLIZIZOLATEU[i\AL The CE12tC27 Sccre On the evening of February 10, 1976, millions of Dutch television viewers were watching their sets with more than customary attention. News of a bribery scandal in the United States had just reached Europe, along with rumors that Prince Bernard of Holland was imPlicated. Those who tuned in were unaware, however, that an unrelated inter- view later in the newscast would soon affect many of them more directly than the scandal. The interview involved Dean Burk, Ph.D., an American biochemist formerly with the National Cancer Institute, the Federal agency that conducts or sponsors much of the cancer research in the U.S. Dr. Burk's message was a troubling one. Adding fluoride to drinking water as a dental health mea- sure, he .asserted, was causing thousands of cancer deaths annually in the U.S. He claimed that statistical studies done by himself and another biochemist, John Yiamouyiannis, Ph.D., showed a link between fluoridation and cancer. Dr. Burk expressed no reservations , about his conclusion. "Fluoridation," be told the audience, "is a form of public 111813 murder." Copies of the Burk-Yiamouyiannis report had been cir- culated to memlxrs of the Dutch Parliament before the TV appearance. Soon after, a proposal by the Minister of Health to fluoridate all drinking -water supplies in Holland dicd in Parliament. By September 1976. a Royal Decree ended fluoridation in Rotterdam and other Dutch cities that had been treating their water for years. A GROWING SENSE OF ALARM What happened in Holland is not an isolated incident. Despite widespread endorsement of fluoridation by medical, dental, and public health officials, the practice has come under increasing attack both in the United States and abroad as a potential cause of cancer and other diseases. Three years ago, after a publicity campaign linking fluoride to cancer. Los Angeles voters defeated an ordinance to fluoridate the city's water supply. Since 1973, voters in hundreds of smaller U.S. cities and towns have taken simi- lar action, often out of fear of cancer or ocher disorders attributed to fluoridation. How valid are those fears? Is there a genuine scientific 392 st.corst-srr(1:.s.v.— r. controversy surrounding the safety of fluoridation? Accord- ing to Representative lames 1. Delaney (D., N.Y.), chair- man of the powerful House Rules Committee, the answer is an emphatic "yes." A long-time opponent of fluoridation, Delaney has urged Congress to halt the practice, pending further investigation of its safety. Last fall, a subcommittee of the Houses Committee on Government Operations held hearings on the issue. Drs. Burk and Yiamouyiannis testified, as did representatives of the American Dental Association, the National Cancer Institute, and authorities on fluoride research. An extensive array of scientific studies and expert commentaries on fluoridation was also presented: What emerged from the testimony, in CU's opinion, we. an unmistakable sense that millions of Americans are being grossly misled about an issue important to both their health and the cost of their dental bills. Water fluoridation is the .only public-health measure that many Americans vote on directly. Yet last fall's hearings received only scant coverage by the press, except in publications that commonly run and - fluoridation stories. Accordingly, in this two-part report we will tell you the facts about fluoridation—what it is, how it developed, and what it does. This month we will also ex- amine the claims about fluoridation and cancer and consider the people behind those claims. Next month we'll take a look at other charges frequently leveled at fluoridation. includ- ing claims about allergies, birth defects, and hcan disease. ON THE TRAIL OF COLORADO STAIN Fluorides are compounds containing the element fluorine. In its various forms, fluoride is found in practically all soils, plants. and animals. as well as in human blood. bones, and teeth. les also present in at least trace amounts in all natural water supplies. Thc concentration in water varies widely, however. In the U.S.. natural fluoride levels range fmni a high of about 8 parts per million (ppm) in areas of the South. west to as little as 0.05 ppm in the Northeast. Fluoridation is simply an adjustment of the natural fluor ide content to about I ppin—a level of intake that strengthens tooth enamel and sharply reduces dental decay. especially among those exposed to fluoridated water from early chilit• hood., The nominal 1.pons teve! (acittally 0.7 lo 1,2 nim, A 4 • page i.17 itemeffing to load conditions) isn't an arbitrary one. Its selection Involved a scientific detective story complete with e hvist ending. The initial clue was uncovered early In the century by two scientists investigating a eminent defect F.S. McKay and G.V. Black were trying to find out what caused a mol- ding of tht tooth enamel, a discoloration variously known n "Colorado brown stain" and "Texas teeth." By 1916 they had narrowed the search to something in domestic water BIPPiiett. The next step was to identify the substance and get it out et the water. It took until 1931, however, before the sobstame was identified as fluoride. Meanwhile, McKay bad noticed something else. A prac- ticing dentist, he observed that patients with mottled teeth also had remarkable resistance to tooth decay. The concern of Public health officials at the time was still how to get fluoride out of the water. But McKay's observation also ironed further research by the Public Health Service to learn more about fluoride's effect on teeth. Over the next ten years, research teams led by Dr. WT. Dean of the Public Health Service studied the dental status of 7257 children in 21 cities having various levels of natural fluoride in their water. The results were unequivocal. The Un fluoride in the water, the fewer dental cavities the chil- • dren experienced. When the water contained approximately 1 ppra or more of fluoride, the children developed about 60 pereat fewer cavities than did those who drank water with negligible fluoride content. Furthermore, at thc 1 -ppm level, the unattractive mottling did not occur. It was asso- ciated with levels above 2 ppm. Thus, I ppm of fluoride beanie the benchmark level. Tooth decay was no minor health problem. During the war year of 1942 some 2,000,000 men were examined as potential members of the armed forces. Almost 10 percent of them were rejected because they didn't have 12 sound teeth in proper position out of • possible 32. $ Although the potential dental advantages of fluoridation *ere obvious, there was a natural reluctance to add a chemi- cal to community water supplies. In the early 1940's. there was no background of scientific data about possible side effects. There were some practical reassurances, though. People Md been ingesting nuoride in food and water since the 'dawn of the human race. Many Southwesterners had ken drinking water containing several times the 1 -ppm level • of fluoride for a lifetime without arty discernible side effects except mottled teeth. Eventually, a few cities decided to take the chance. THE NEWBURGH-KINGSTON EXPERIMENT Among the pioneers was the New York Slate Department of Health. Before attempting any widespread introduction 01 fluorldation, the department proposed a long-term. c -m - trolled study of a limited group of children who would be • Carefully monitored by physicians. Aker considering vari- ant communities, the department chose the cities of NOV.. burgh and Kingston as ideal candidates for the study. • Located some 35 miles apart near the Hudson R ker. bOth a cities had populations of about 30.000 and were similar in racial, economic, and othcr demographic characte r i %% ics. Each also used reservoirs with water deficient in fluoride. CONSUMER REPORTS • 91 • One airs water supply was to be fluoridated, the other not. Meanwhile, matched groups of children from the two cities were to he followed from infancy onward by means of comprehensive pediatric checkups to detect any side effects from fluoride. Special attention was to be given to growth rates, hone development, blood chemistry, the skin, the thyroid gland, vision, and hearing. Each child would also receive meticulous, regular dental exams. In March 1944, the City Council of Newburgh agreed to participate in the study and approved the fluoridation of its water to 1 ppm. Kingston agreed to serve as the con- trol city and use its fluoride -deficient water without change. A total of 817 children were enrolled in the Newburgh group and 711 in Kingston. Although most entered at the start of the study, several infants were added during each of the first three years to ensure having some children whose mothers were exposed to fluoridated water throughout pregnancy. The study went on for 10 yean, and a majority of the children in both groups participated through the final ex- amination. The findings can be summarized briefly: The examinations disclosed no differences of medical signifi- cance between the two groups that could even remotely be attributed to fluoride. There was one difference of dental significance, however. The Newburgh children experienced nearly 60 percent fewer cavities Man the Kingston children. Numerous studies have since confirmed the benefits of fluoridation. "Fewer cavities" means fewer costly fillings, fewer lost teeth, and, eventually, fewer dentures or partial dentures. The cost of fluoridation to a community, according to • report last year in the New England Journal of Medi - eine, is only about 10 to 40 cents a year per capita. THE EVIDENCE FOR SAFETY Since the early days of the Newburgh -Kingston project, literaIly thousands of scientific studies have examined the effectiveness and safety of fluoride. Virtually every doubt or question that has been raised, however scanty the evidence, has been studied in depth by one or more groups of re- searchers. As ‚dentist representing the American Dental Association noted in the House subcommittee hearings last Water fluoridation is the only public- health measure that many Americans vote on directly. And since 1973, hun- dreds of towns and cities have voted against fluoridating the water supply. v"vt:is tafl.'fluoridation may well be the most thoroughly storied community health measure of recent history.** In the late 1960s. the World Health Organization accom- plished the Herculean task M pulling much of the known information together. The objective Was to provkk an int- i! partial review of the scientific Intimate en fluotidaticat— a Va‘i international aggregation of population studies, n- periinental research, animal studies, and clinical invemiga- Page 1. l8 i lions, including human autopsy studies, clinical trials, and X-ray research. The report, "Fluorides and Human Health." came out In 1970. It addressed numerous questions raised up to that time about the possible effects of fluoride on different organs and Its alleged association to various diseases. Again, the conclusions can be summarized briefly: The study found no reliable evidence that any ill effects or symptoms resulted from drinking water fluoridated at recommended levels. Since the report's publication, the Word Health Organi- zation has uncovered no evidence to alter its judgment. In a statement issued in 1975, the organization noted: "The only sign of physiological or pathological change in life-long seen of optimally fluoridated water supplies ... is that they suffer less front tooth decay." THE LOYAL OPPOSITION No amount of study, however, has managed to quiet the criticism of fluoride that has been present from the begin- ning. Writing in the Journal of the American Dental Asso- ciation in March 1956, the commissioner of New York State's Department of Health, Dr. Herman E. Hilleboe, told of some of the troubles his agency had encountered In the early days of the Newburgh -Kingston project. Soon after the project's approval in March 1944, the local health r'The only sign of physiological or pathological change in life-long users of optimally fluoridated water supplies ... is that they suffer less from tooth decay." [from a World Health Organi- zation report] officer in Newburgh began. receiving complaints from tome of the towns citizens. Some protested that the fluoridated water was discoloring their saucepans. Others complained that it was giving them digestive troubles. One woman complained to her dentist that the "fluoride water' • had caused her denture to crack. 'These incidents all occurred before fluoride was added to the water supply," notes Dr. Hilletsoe. The complaints stopped abruptly after a Newburgh newspaper erilicized the town's imaginary ills. Despite fluoridation's success in Newburgh, protests against it elsewhere weren't collapsing so rea..ily a decade later. The rise of "a vociferous minority." said Dr. Hilleboe, had succeeded in delaying, or even reversing, the start-up of fluoridation in several areas. The opposition, he reported, came chiefly from food faddists, cultists, chiropractors, and people who misunderstood what fluoridation was. But the efforts of antifluoridationkts have also been aided by the caution of various physicians, dentists, and scientists of good standing who initially questioned the safety of flunri- daiion, Opposition has also come from other professionals 394 and lay people who view fluoridation as a government in fringement of individual freedom. Various groups have been formed for the sole purpose t fighting fluoridation, but none has had much impact outs1 of its local community. Generally, the real steam behind : antifluoridation movement has come from well -funded. i tional, multi -issue organizations that have been able disseminate large amounts of scare propaganda around I country, One such group is the John Birch Society. Anoth. up until the early 1970's, was the Rodale Press, publisher . Prevention magazine and a frequent proponent of unprov. nutrition concept'. The most active and effective group ti. day, however. is the National Health Federation, whos roots run deep into the soil of medical quackery. Those root are worth a brief examination. WHEN ROOSTERS HAD BAD TEETH In the early 1950's, an organization called the Electronic Medical Foundation ran a lucrative diagnosis -by -mail Ser- vice and also sold electronic treatment devices for "curing" numerous disorder. An estimated 3000 practitioners, mainly chiropractors, would send dried blood specimens from their patients to the foundation. There, the blood spot would be checked by an electronic gadget and a "diagnosis" mailed back by postcard. This eventually aroused a certain skepticism at the US. Food and Drug Administration. Accordingly. the FDA ar- ranged to send a few blood spots of its own. The Ant, from a man who had lost his right leg, elicited a diagnosis of arthritis In the right foot and ankle. The blood of a dead man brought back a diagnosis of colitis, and that of a rooster resulted in a report of sinus infection and bad teeth The FDA inspectors also investigated the treatment de- vices. They found that the gadgets simply contained circuits resembling those of an electric doorbell or a small radio transmitter. None could cure anything, reports FDA his. torian Wallace Janssen. , In 1954 a U.S. District Court ordered the president of the firm. Fred J. Hart, to stop distributing the treatment devices. Shortly thereafter, Hart founded the National Health Fed - nation. Hart continued to distribute the devices. however, and was subsequently prosecuted for criminal contempt and fined $500 in 1962. Between 1957 and 1963, several other officials of the NHF were convicted of misbranding dietary products wish false medical claims and received lines or prison sentenm. In 1963, the FDA released a report on the NHF that said in part: The stated purpose of the federation is b promote 'Tree• dote of choice" in health mailers. The record shows that what this frequently means is freedom to promote medical nostrums and devices which violate the law. From its incep- tion, she federation has been a front for promottn of on - proved remedies. acentric theories and quackery. In on updated report on the NHF issued in 1973. the FDA reiterated virtually she same judgment. TTroughout its history. the NHF has crusaded against any Government interference wish unproven remedies or treatments. At the same time, it has also opposed proven puhlie-health mea• sures—smallpox vaccination. pacteuriration of milk, polio JULY 1971 • . .].+'3Yl .-.p y1--'rv!4... , . a. 4 page 1.19 vaccination, and fluoridation of drinking -water supplies. Fez the meat part, the NHFs opposition to puhlic•heallh has been a losing cause, Until recent years, even uuod elation was slowly gaining acceptance in more com- munitla. About 105 million Americans now have fluori• dated water. But in 1974 the NHF decided to mount a new u0ooal campaign to "break the back" of fluoridation ef• forts. It hired Dr. Yientouyiannis to do the job. RAISINOTNT SPECTER Of CANCER The flat big target was Los Angeles, whose City Council had voted in September 1974 to fluoridate the water supply. The NHFa ammunition was a study by Dr. Yiamouyiennis that purported to link fluoridation to an increase in cancer. deaths. The study and a couple of publicity handouts that accompanied it were eventually reviewed b+ various public - health officials, including Thomas Mack. M.D., of Los An- geles, an associate professor of community medicine and an expert in cancer epidemiology. (Epidemiology is a branch of medicine that studies the incidence, causes, and control of a disease in specific populations.) The nature of the Yia- mouyianeis study is apparent in an excerpt from Dr. Mack$ review: "I cannot begin without commenting on the form of the documents you sent me," Dr. Mack stated. "Despite the gravity of the question addressed, the form of these sheets Is that of a propaganda flyer rather than a serious scientific effort Specifically, there is no indication that any of the ma- terial was ever prepared for submission to a reputable scien- tific journal.... AB over the documents one finds . , . condu- emblazoned essentially in the form of slogans, without utious interpretation or restrictions. For these reasons, the reader must immediately presume that objectivity has never been considered.... At the same time this bin is so pervasive and obvious, the mistaken logic so gross and naive, that the Generally, the real steam behind the antifluoridation movement has come from well -funded, national, multi -issue organizations that have been able to disseminate large amounts of scare propaganda around the country. reader assumes the author to be, however competent in his Ph.D. field, totally unaware of the principles of epidemi- otogy." Most people are unfamiliar with the principles of epid- emiology, however, and a Ph.D. degree can sometimes lad credibility even to claptrap. In Los Angeles it evidently did. The scare tactics of the NHF and other antifu ridationists scored a stunning victory over dental health. Around the beginning of 1975. Dr. Yiamouyiannis also joined forces with Dr. Burk. Like the National Health Fed - nation. Dr. Burk is a leading advocate or the worthless CONSUMER REPORTS cancer Jrug Laetrile (CONSUMER REPORTS. August 1977), and be thirds the NH P's aversion to fluoridation. The collaboration produced a study claiming that 15,000 or more excess cancer deaths occur annually in U.S. cities that fluoridate their water. The assertion was based on ■ comparison of death rates for specific cancers in some coun- ties that were fluoridated compared with some that were not. In July 1975, Representative Delaney entered the study into the Congressional Record and_ called for "an immediate suspension of all artificial fluoridation." Thc National Cancer Institute reviewed the study and was unimpressed. Unlike a proper epidemiological study, It had failed to take into account widely recognized risk fac- tors known to effect the death rate from specific types of cancers. Using the same data, the NCI reanalyzed the study, taking into account such influences as ethnic composition "There is no evidence that fluoride increases the incidence or mortality of cancer in any organ." [from a study by the Royal College of Physicians] of the population, geographic location, socioeconomic status, and other fundamental risk facton. The purported differ- ences in the cancer death rates promptly disappeared. Undaunted. Dn. Burk and Yiamouyiannis bounced back with another study. This time they compared overall cancer death rates for 10 large cities that were fluoridated venus 10 large cities that were not. Again, the fluoridated cities came out second but. Over the 20 -year period studied, cancer death nits in the fluoridated cities purportedly Increased 10 percent more than in the unfluoridated ones. In Decem- ber 1975, Representative Delaney entered the Study Into the Congressional Record and demanded that an fluoridation be stopped. If anything, the new study was even more amatedM sb than the July entry. In the judgment of one NCI of icial at the House subcommittee hearings, it represented "the worst piece of work that has been done to date on 'fluoride." Dn. Burk and Yiamouyiannis had somehow managed to Ignore the most fundamental factors involved in cancer mmiatlty raes—age, sex, and race. Old people die from cancer mote often than young people: men have a higher cancer death rate than women; and blacks a higher one than whites. Un- less those factors are taken into consideration, the results of a canca.mortality comparison would be meaningless. When NCI scientists reanalyzed the Burk-Yiamouyiannit data, they found that the difference in the cancer death tale was due entirely to the age and racial makeup of the rnpet- tive populations. Fluoridation was irrelevant. ONWARD TO EUROPE Rebuffed by NCI scientists, Dr. Burk look the National Health Federation Nudity to Holland and England. At noted earlier, the Dutch trip was a smashing wcnt But the in R .F. A N page 1.20 British refused to panic. Both the Royal College of Phy- sicians and Oxford University had recently completed studies of fluoridation and cancer. The Royal. College of Physicians in January 1976 concluded: "There is no evi- dence that fluoride increases the incidence or mortality of cancer in any organ." The Oxford study reached a similar conclusion. Moreover, British scientists had learned of the NCI's re- futation of the Burk-Yiamouyiannis studies. They also were aware that an independent study condoned for the National Academy of Sciences at the Univcrsit' of Rochester, N.Y., had confirmed the NCI's findings.. "In the normal course of events," reported an Oxford research group, "that would have been the end of the mat- ter. Unfortunately, however, it has not been." What the British scienIi is hadn't realized was that the (acts were incidental. . The real goal of antifluoridation groups, explains an American Denial Association official. "is to create the il- lusion of a scientific controversy." The "studies" are merely the ploy. The accuracy of that judgment was evidenced by what happened next. According to an account in The Lancet, a British medical journal, Drs. Burk and Yiamouyiannis be- gan publicizing their cancer claims in Britain. Through the assistance of the National Anti -Fluoridation Campaign, their misleading data,were circulated to members of Parliament, health authorities, and water boards as evidence that fluori- dation was causing many cancer deaths. Meanwhile, the National Health Federation began claim- ing in the US. that NCI officials were concealing data, a charge that eventually had an impact in Britain. In Parlia- ment, one member accused British health officials of mis- leading the public about fluoridation and of denying people the truth "because of the Official Secrets Act." THE NCI 'COVER -Up' According to testimony at the House subcommittee hear• logs, the NO refused to disclose certain information to the National Health Federation. That refusal, however, was for The real goal of the antifluoridation groups, explains an American Dental Association official, "is to create the illusion of a scientific controversy." less sinister than some members of the Di fish. Parliament were later led to believe. The NCl initially gave Dr. Burk a copy of the publication "U.S. Cancer Mortality by County: 1950-1969." which he later used in preparing the fist Burk-Yiasnouvunnis report. After the NCI reviewed that report. Dr. Yismouyiannis asked for a copy of the NCI's analyses. Those were also dis- patched. Then, according to NCI testimony. Dr. Yianmuyi- annis used that information to.allack the NCI's review. Con. ssquently, when he requested their analyses of his subsequent: 396 study, NCI ol&ials denied the request. They pointed .� that the basic sources were routine publications of i Bureau of the Census and the National Center for Hea Statistics, and they told him, in effect, -to do the calculate.- himself. "The data,' said NCI's Dr. Robert N. Hoover the hearings, "are generally available to anyone with a P. lic library card." To check that claim, a CU stan member visited the I. public library. All but two of the volumes needed, both it In short, independent investigations by seven of the leading medical and scientific organizations in the English speaking world have unanimously refuted the National Health Federa- tion's cancer claims. 1950, were on the shelves of a suburban library within walk' ing distance of our of5"es. A phone call by one of the li- brarians located the two remaining volumes at another nearby braneb. - As a result of the charges and the wide publicity the Na- tional.Health Federation gained in Britain, Drs.. Richard Doll and Leo Kiolen of the Department of Regius Professor of Medicine at Oxford decided to undertake still soother study. Their reason, they explained, was "to be sure about the truth of the matter, and because we feared that Burk and Yiamouyiannis's abuse of statistics might be detrimental to the future health of British children." At the nose time, the Royal College of Physicians requested a formal opinion of the cancer data from the Council of the Royal Statistical Society in Britain. The resulting studies appeared respectively in The Lancet and in the Journal of Applied Statistics in 1977. In The Lancet.. Drs. Doll and Kinlen-reported that none of the evidence "provides any reason to suppose that fluoridation is associated with an increase in cancer mortality, let alone causes it." The study conducted for the Royal Statistical Society, which undertook an even more comprehensive sta- tislical analysis than the NCI or Oxford. came to the sane conclusion. Furthermore, additional studies by the NCI in 1976. the US. Center for Disease Control in 1977. and the National Heart, Lung; and Blood Institute in 1977 each found no evidence linking fluoridation and cancer. In short. rode. pendent investigations .by seven of the leading medical and scientific organizations in the English-speaking world have unanimously refuted the National Health Federations can- cer claims. Meanwhile, other allegations against fluoride are in wide circulation. Fluoride is said to cause allergic reactions, hirtb• defects, mutations, heart disease, and cancer in animal,. We'll examine those allegations next month, in the second part of this report. Ally 197' ' , 1♦• ! \• _ • )�i ♦rl 1•V (Y • ♦ sex ♦/1 alt �♦•l.{„ -j'♦r, •. 41311 t�YS ' i' ' �t•, '�. .1 A pUBLfCAT10 `oi `�� page 1, 21 ;,CANSUMFRS 41NIU� a r. . y .; 'N0♦ADVERTISII9G !► 1 v ; »,.. AUGUST 1978 J LjJ ...11'. ONE DOLLAR . { t,'.J41ILt gr81or AI I lglugr.. •..... ,:+:.u•..:IzFir �J..JjAIT0RKS0hslMF.11! /� , F: - .,. • .., ' . JAxrl7mLu. n,c ifs,ts'. • • / _. __ .. The Attack on Fluoridation -Part 2 ten are three kinds of lies," remarked 19th -century British statesman Benjamin Disraeli, "lies, damned lies. and statistics." Probably every type of misrepresentation known to Disraeli, and some be may have overlooked. have been used to attack fluoridation. Misleading information about it appears regularly in a paper called the National Fluoridation News, and the entire gamut of hokum has recently been published in a 176 -page issue of the Cancer Control Journal, a pro -Laetrile magazine based in Los Angeles. In last month's issue of CONSUMER REPORTS, we examined the most prominent charge —that fluoridated water causes cancer —and reported it to be baseless. But fluoride is also accused of causing numerous other ills, ranging from brittle nails to birth defects. Since such claims am resurrected whenever fluoridation comes up for a vote, well discuss the most persistent ones and the evidence behind them. CLAIM: FLUORIDE IS A POISON Like iron, zinc, and several other minerals, fluorine (in the form of fluoride) is classified by the National Academy of Sciences as an essential trace element in human nutrition. And like many substances essential to life or good health — iron, vitamins A and D, oxygen, end even water itself — fluoride can be toxic in excessive quantities. At high con- centrations, fluoride has been used as a poison for insects and rodents. However, at the.level in fluoridated water —one pan per million (ppm)—you'd have to drink at least sevenl hundred gallons at one sitting to get a lethal dose. The water alone would kill you first. But what about the possibility of slow poisoning —a little bit at a time over long periods? According to the National Academy of Sciences, the daily intake required to product symptoms of chronic toxicity after years of consumption is 20 to 80 milligrams or more —fu in excess of the average intake in the U.S. Such heavy doses are associated with water supplies that contain at least 10 r^m of natural fluoride, as in some parts of India. There is absolutely no danger of poisoning from imbibing water numssusw prevent dental cavities. An occasional tactic in antifuoridstioo tracts is to sun pictures of cattle or other animals harmed by fluoride pot- soning: The photographs we authentic. but the Impression conveyed is false. Vein ago, steel mills and clay factories in England and Wass sometimes polluted nearby vegeta- tion with tons of fluoride emissions. Similar incidents have also occurred in the U.S. Cattle and other animals that grazed on the vegetation would ingest enormous amounts of fluoride and develop bone fractures and lameness. Their pictures are the ones antifluoridationists use. In contrast, a controlled experiment with cattle produced far different results. The cattle were fed various amounts of fluoride in their diets for nearly 745 years. Even at fluor- ide levels as high as 27 ppm, the cattle did not experience fractures. lameness, or any adverse effects on soft tissues, fertility, or milk production. Nor were there any abnormal effects on their offspring through successive generations. CLAIM: FLUORIDE CAUSES BIRTH DEFECTS In the late 1950's, a French physician named Rapaport reported that mongolism occurred more frequently in some cities with fluoridated wales than in same cities with little' or no fluoride in their water. Experts who reviewed the study found it seriously flawed, however, especially in its mclhod of locating cases. According to Dr. Kapaporis figures, the incidence of mongoloid births in both the floori- dated and unfluoridated cities was less than half the usual rate —a highly questionable finding in itself. Thus, there was a stronr. likelihood that Dr. Rapaport had failed to uncover the majority of mongoloid births in the cities he chose to study. That -conclusion was soon cone -.mad by a more earrfully controlled -turfy in lEnglanii. Using more exacting methods sop. - .t+..a —. a+. ! w'b • ,I possibly the most absurd evidence marshalled against fluori- duion is material purporting to show that fluoride induces cancer in animals. One series of studies frequently quoted by antifluoridationists was conducted by researchers in Texas in the 1950'x. The firs) xludy involved a strain of nice that ordinarily gets cancer. Supposedly, the mice given fluori- dated water developed tumors slightly earlier than similar mice on fluoride -fret water. There were a few minor hicbcs in the experiment. however. All the mice were also Fed a dog chow that, unknown to the investigalor, contained a2 page t.22 t et :t.e tks,Ant, the Britivh rncarcters repurtaf no difference m Nt m:tdes.ce of matguvlivm whether the water wax high n♦ et Aw in ttav,Jc. Stet then. two extensive studies have substantiated the 11th findings. one surveyed virtually all mongoloid births S \la.u:hsseus from 1950 through 1966. The results, "fished in the New England Journal of Medicine in 1970, !j. shifted no link between fluoridation and mongolism. An even larger .tudy published in 1976 covered approximately IA million births In six major US. cities. Researchers St the Center for i)iscase Control investigated not only ton. golism, but also cleft palate. heart abnormalities. clubfoot, and other common birth defecls. Again, there was no ass0- clation between fluoride and any of the defects. In short, the antifluoridatlonists' claim it based solely on the dn- credited Rapoport study. CLAIM: FLUORIDE IS MUTAGENIC A variation on the birth -defects theme is the charge that Laboratory of Cellular and Comparative Physiology at the fluoride it a genttie hazard. Until recently. this claim was National Institute on Aging. The scientists conducted four based on irrelevant or questionable experiments with fruit separate experiments, including tests on mice receiving acute flies and plants. Then, in 1976. two researchers in Kansas doses of fluoride and mice raised for several generations On City, Mo, reported that various levels of fluoride damaged water containing 50 ppm of fluoride. None of the studies ehsomosomes in the bone -marrow cells and sperm cells of produced any evidence that fluoride damages chromosomes, miae. Although experts who reviewea the experiment noted even at levels 100 times that in fluoridated water supplies. several ioronsisteneies in the results, the question it raised In Germany. meanwhile, an independent group of re - Vu judged important enough to warrant further research. searchers reported similar results with human white blood Accordingly. joint studies were undertaken by the Lab- cells, which are especially sensitive to mutagenic agents. entory of Developmental Biology and Anomalies at the Not only did fluoride fail to produce damage, it also evi- National Institute of Dental Research, the Department of dented in antimutsgenic effect by proftcNng ehromosoalca lbehanntty at the University of Minnesota. and the against a known mutageo. CLAIM: FLUORIDE CAUSES ALLERGIC REACTIONS The charge that people can suffer allergic reactions or "9n- Setanot" to fluoride gained prominence from anecdotal accounts by George L. Waldbotk M.D. so early Opponent of fluoridation who founded the National F7uoridalion News. Between 1955 and 1965, Dr. Waldbott reported numerous instance of patients experiencing nausea, head- aches, "spastic colitis;" or various other symptoms that he attributed to fluoride ingestion. In the World Health Organization study described last month, a review of the Waldbott reports found no reliable evidence to support his contentions. The cases were judged to represent "a variety of unrelated conditions." Follow- ing the WHO study, the Public Health Service asked the American Academy of Allergy to evaluate the issue. After 3. s a review of the existing clinical reports, the executive coin-, mitten of the academy concluded unanimously: 'There is a . i. no evidence of allergy or intoleraoa to fluorides as used " Y , in the fluoridation of community water supplies:' 1 CLAIM: FLUORIDE CAUSES CANCER IN ANIMALS ppm of fluoride --at 10 to 100 limes the amourn any of the mice got in their water, thus making any comparison be- tween the two groups invalid. A further botching Occurred when the investigator miscalculated the amounts of fluoride in the water. Two seientias from the National Instituld of Health reviewed the study in 1951 and dismissed it. Other experiments by the same investigator and a cu.worker have long been discredited by subsequent research- Neren deft. opponents of fluoridation still cite the Texas expeimhM. as signifwanl evidence that fluoride is arcinegenic. Cwnfanred ► 491 3 p. { • t. U R 1 Y S L4e .I) y, s� m •""V q.a , v 1 %1 Y W �, a '� b M i, n -•� J/ij , YY i�.w�,[y` ! S4d ?��y'j,'�� .L�4^4 `.hS3j�' •]' ._:.bi T A.F+' _FS4'C. .i w•� '�F.-� C yr '%Y Sri vite - , .Yr i �.an .�ilih♦ u4lf,r?t*J yN K'.l 'wf - '}std y' page 1.23 a AM Another study currently getting star billing in anlifluorl- dation tracts is an experiment conducted with fruit flies In 1963. This lime, legitimate findings arc being substantially distorted. In that study, two strains of fruit flies exposed to 20 to 50 ppm of fluoride in their food experienced an in- creased incidence of melanotie tumors. Opponents of fluori- dation interpret that to mean that fluoride can cause cancer. T hat's not so, according to scientists working st the National Cancer Institute. While humans may be physir logical cousins to the mouse and other mammals, their kit hip to the fruit fly is somewhat more distant. Specifically, a metanorle tumor in s (tuft fly Is not the same as a cancerous tumor in a human or mammal. It is more akin to scar tissue, and, unlike a cancerous tumor. It's not malignant or harmful. It can be induced by a wide range of substances, including some vitamins and even lysine and tryptophan, two amino acids essential for human growth and health. Fruit flies can also get malignant tumors. but there's no evidence that fluoride has ever caused any. Indeed, fluoride has never proved to be carcinogenic in tests on a variety of animals, including rats, mice, guinea pigs, rabbits, hamsters. dop, and sheep. CLAIM: FLUORIDE CONTRIBUTES TO HEART DISEASE In Wisconsin, opponents of fluoridation have often charged that it increases the number of deaths from heart disease. They base their claim on statistics that show a rise in heart deaths in the town of Antigo. Wis., since the introduction of fluoridation there. The National Heart and Lung Institute has called the data a "misrepresentation of statistics." As one scientist points out, "The well-known fact that deaths from heart disease become more frequent as people grow older was overlooked." Sin" fluoridation was introduced in Antigo in 1949, the percentage of elderly people there has doubled. Between 1950 and 1970, for example, the segment of the Of all the numerous ills that have been attributed to fluoridation —from cancer in humans to constipation in data —none has ever been shown to be valid. In fact, the only known hazard of fluoridated water has nothing to do with drinking it. Patients undergoing kidney dialysis can be ex- posed to about 50 to 100 times the amount of fluid con- sumed by the avenge person. Accordingly, the National Institute of Arthritis and Metabolic Disease recommend, That fluoride —as well as calcium, ma6aesium. and copper — be removed from the tap water be/ore it is erred in an orri- ficfal aidney machine. Aside from that prcceuti n, there is no genuine reason to worry about fluoridation. In 1960, however, the residents of Amigo. Wis., didn't realize that scare stories being circulated by local opponents of fluoridation were false. Antigo voted to discontinue its 1i -year practice of fluoridating the water supply. The deci- iion eventually led to a study by public health officials, who wanted to learn what effects the end of fluoridation would have on the dental health of Antigo youngsters. During 1960, dental personnel from the Wisconsin Divi- sion of Health examined nearly all children in the kinder- population 75 years old or older increased 106 percent. When that factor is taken into account, the alleged effect of fluoride vanishes. According to a 1972 study by the National Heart and Lung Institute, comparisons of fluoridated and unfluoridated communities reveal no difference in the rate of heart deaths. Furthermore, reported the institute, evidence from autopsy studies, from examinations of people exposed to acute doses of fluoride in industrial accidens, and from medical data on people who have drunk water naturally high in fluoride for a lifetime "all consistently indicate no advent effect on car- diovascular health." garten. second, fourth, and sixth grades of Antigo's school►. The examiners recorded the number of decayed. missing, of 6:led teeth for each child. Four years later, they repeated the examination among children in all of the same grades except the sixth. The kindergarteners in 1964 had a rate of dental prob- lems 92 percent higher than their counterparts four yearn earlier. Among second -graders, the decay rate in permanent teeth was up 183 percent. Among fourth -graders, it was up 41 percent. A subsequent -examination of sixth -graders showed a 91 percent increase in decay rates. In 1965. Amigo voted to rcirntate fluoridation. Despite persisting claims about heart deaths by local anti- fluondationists. the people of Antigo today still drink flueti- dated water. Meanwhile, about 100 million Americans do not, largely because of the fears raised by opponents of fluoridation. The simple truth Is that there's no "scientific controversy" over the safety of fluoridation. The practice Is safe, economical, and beneficial. The survival of this fate controversy represents, in CU's opinion, out of the major triumphs of quackery over science in our generation. AUGUST 1978 ♦≥/'≥a w / Pag8 �• `1•)"CF la „PAWMl1770►q.eanwLLnWnic.w� I m EngM.ulno IU I 1e01161S406$ / fqe WO690 AAWlW 17701 {! .:tb . i EI ,Y .tom . J _j Y' ' b r • C 1{.��ht •i lir ,' 1 e: r (JJ�-- nY lLi,f ) p.•`.r ; _ f!!)q u,i A4ify' J'G. ;„t,NPUNWERNW H' /L�•�yy�...,��--QQ�•�-.J�-,p OF' ARMF • / ^^'� / b Y♦rvR) F' `. �^4.ni � ry +� • '1 • 1 Y , ♦ t SI♦dyy� i ♦If�l ��� � F p t_.(A t.nr kk1' .y. ;,a L .R, rl++ .w Y< A I ' ! .+T �l' ti]Yiyli 'y a^,f •y{��R�1 S yx/ i Y�i I k7 y�,[N I id I it ), L L I i JyTi . M�(!{' A" tk WWW 3 �Y��1"la"a'yRt!}yX'� • JLr k I.'!L ♦. .(• n / y it _ <ry r .,I. , . . ri �± • F ' c " r , . Jnaa 2a 197A.y y, str„� ve r Ate' !✓'t • f. ar .rn "N}. )f,: ' I �4�' FEN'1Ta.t•Y '1* I' . ,. '•�M `.,, Marl ., Mr. Phil Colwell, Director t e h`� ;� k i ar.+."?I+.d'r*."'`•`'$Y f,)�='i3.s>r City of Fayetteville a Q ♦ •I' i AR 72701 I. • 5' T/ .. w r i Y.�� j S F A i.� A :e layetteville, } J? / s ) a r n ..>ibIkt4.f..d�YY". t'•1 r!4 'v7'4' �'41 ri'{Fx r Dear Mr. Colwell: % w • —x. Iy rs' is f I have reviewed the attached article relating to fluoridation and +A)4 r L♦�.. wR Tom' • , 4_ -f t..'•Yt lA mortality, and I have sought some outside opinions as 'veil. Rtl The writer appears to be quite correct and has done an excellent job of statistical analysis. There is little doubt, as far as I'm concerned, that his conclusion is valid, end does follow as a logical .,,� result of the study. d ,. T • w.� l,} rf The study shows that the increased mortality rate in cities with ;'�.y. l ,, fluoridated water is attributcble to conditions other than fluoridation, and that fluoridation is not found to have say effect on mortality rats., F• h P'�.. %f''44v t opportunity to be of service, and I hope that this ;'t I appreciate the oppo y apologist for taking so long to 4 .. "''' information may be of use to you. I `< reply. ! .,• a Chartr II Jl r .2 !rrMI + ST 1J h7i' ri ! £ IfS •1 biy .I 21! 5 , )� , A 4 . 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YI E 1S A $ C Jp Ac SC 1• wC' tq rC'=m {Jw0c-U�Ny Ayy U 4ry1^ LQ d CaL 3N C9m DdD d:tn L u_L° n. i -. c A c`n '"�.�'.Otz=mm �Ay1�1n�Q Wa'�x �°i�'NPiz .2E'1c- alb c__ry •i� A N Q C N Ep N� J= = LL {PJf• Y' 3 O O¢ •> `D N A A N-!'g2GD OQtiEo 3�-'�9Q�L e ��f•�?o �'=Eop� D.s�—�'—`3',g '7'ii3� —='T5 � ¢ N L C< c0 {^� C p udox m Oai 'Bo ' Ow ❑ �p l°} o 'p° A C N C 01 ¢° 9 C^ A c- = o c Cp l7 O E ^ do !c, OV A U U FO - <cayC.CLi �D d .E C cm U ca yq� �Lp�cQ I W> o g .A E c n C x U U B U flOU N C C. x"= O C O d J fp !Cy flb'3 A •. u- R1 _ pi r 12 J Ea °ELi � 3 vf°i b r`� .� Q a C a m e w< n s c3 3S U r> 10 C') A f` C- E 1 f L d3 o=<E cgs N�€bo CCpE2 WJILD,E`P•f VNLL.- �c 00 bpd= a -+ oc E'o-p�}� v° -V) df a ry �jm n C._�'?•�YA La1}�.r ' a u C C �+ E F- C Npp =5 Uy}j S' 3 JS �r F O N V r ll A n G O O= N n u U 2 c LLC S Cc E4 _• b1 Jy 'a 4 C W Eco�¢_°3�$�gC7oQ"'E��QiL �iSaFSLi ¢ a, 1p ry p _ (� yU� (CJ (JUOf i tN Q G aJ O D L C `@ f T Q Y V O N Q^ Q in e in in 1D it p o5 2- Abrd2 ba a� V O ti 5 G U n 4 C N O �, ° J i c,9 E'm �"is mef Te Ef'LG4� Td y • Z Cc x C O3n Cf S 8 f Q tf ^ C , i S L^ Cf Ll 1O TL j 'n LL C(tl O �, GGG.c f5JQ = c CN ay 'f: 3Z yi9rr. c S 1t L. Ci D O C U c r S. =" S '] C L c ✓N J �j U � _, 0 ,- c e ?- E ': u u m L j y JT c o '� Q. _ ..: ->: rm c C: c ` n oO i L tx `. Da: 2 „o`-' CJC C N .. �, in 4) in ID F - f O N N f N h ti p O 'T (\ e a r, . Abatrsot Mortality rate! (for blacks and whites only) In 24 citics with fluorid sled Rnrt p2 with non-Iluor{• dated water supplies In the Unitdd Slates were com- pared for the years 1969.1971. During these three years 570.671 deaths occurred in the cities with fluo- ridated water: the 1970 reference population In those dcities was 15.972.817. The figures for the cities with non -fluoridated water were 351.053 and 11,106,746 respectively. so that the crude death rates for all causes were 1190.9 (fluoridated) and 1053.6 (non -flu - RECENTLY, there has been a good deal of inter- est in a purported relation between community water fluoridation and cancer mortality. Burk and Yiamouy'iannis''' reported on cancer mortality trends in 20 United States cities, half of which had fluori- dated their water supplies during 1952-1956. In 1950 the Crude mortality rates for cities with fluoridated water supplies were very nearly equal to the rates in the cities with non -fluoridated supplies. In 1970 there was a differential of some 20 deaths per 100,000 persons, the higher rates being in the cities with fluo- ridated water. These findings stimulated a reanalysis of the data pertaining to these cities"' and a detailed analysis of cancer mortality in selected counties in the United States with fluoridated and non -fluoridated water systems.' The conclusions of Burk and Yiamouy'iannis'-' were not supported by these later reports?'' in a further analysis,' Yiamouyiannis and Burk attempted to allow for differences in the age, race and sex compositions of their cities with fluori- dated and non -fluoridated water. In conclusion, they stated that "the increase in cancer death rates in fluo- ridated cities is significantly higher...than in non -flu' oridated cities." However, their control of the age. race and sex effects was only rudimentary. Because of these reports and because there has not been any large-scale general investigation of mortality statistics in the United States vis-a-vis community water fluoridation since the 19i0's,' it seemed ap- propriate to make such a review using recent data. METHODS Computer tapes containing information abstracted from all United States death certificates for the years 19t,9.1971 were made available by the United States National Center (or Health Statistics. For each death a number of demographic characteristics were recorded on these tapes. including state, county and — for cities with a population )250.000 at the time of the 19, 0 renws —city of residence plate of residence at death was used as an indication of exposure to fluoridated water. The local political unit chosen was the cm n tiro a the a4minictrauno of water systems is usually a city function. Information on fluoridation was provided by the person - horn the Chronic Dnues Divivon, tlurtau of Ep,demiolcq>. Custer for D"ue Contol. Atlanta. GA 3033. whctc epnnl rNunu should be sd• dewed ,o Ur Erickson. it ai_ ..__. .. ,..f p >•i.4r q:.3.p.' w. .. ry .. page 1.37 May IS. tv7g 1112 THE NEW u.tLAND JOURNAL OF MEDICINE MORTALITY IN SELECTED CITIES WITH FLUORIDATED AND NON -FLUORIDATED l WATER SUPPLIES 1 J. DAVID ERICKSON, D.D.S., PH.D. orldaled) per 100,000 person -years. Adjustments for age. sex and race reduced differences for some causes and removed them for others. Ftjrther cofrec lion. using analyses of covariance for city character- istics that influence mortality, gave adjusted death rates for all causes of 1123.9 and 1137.1, and for malignant neoplasms 195.3 and 196.9, in the cities with fluoridated and non -fluoridated water respeC ly. I found no evidence of a harmful effect of fluorida- tion. (N Ell J Med 298:1112.1116, 1978) r. Disease Prevention Activity of nd and publications' or the Dental to have a nu- the Center for Disease Control. A city was considered was maintained oridated water supply if the fluoride concentration dental caries or the natural- at a level optimum for the prevention of ly occurring level of fluoride was >0.7 path per million. of ?250,000 persons. There were 57 cities with 1970 populations for the or this study: Eleven were considered unsuitable purposes had supplies that had two had a mixed fluoridation status, and nine in 1965 later.' Of the 46 remaining. 22 been fluoridated starting or had non -fluoridated water supplies during and before the study period, and 24 had water supplies that had been fluoridated since before 1960 (see Appendix for cities with fluoridated and non-fluo- F ridated water). Because of the bias known tv occur in the recording of race other ti.. than for blacks and whites,' only deaths of persons of there racial groups were used. Denominator for rompuiing mortality roles the city were taken from the 1970 Census publications'; populs- in 1970. Lions in 1969 and 1971 were assumed to be the same as Deaths were categorized by cause according to a modified version of .' r .t the "34 Selected Cause," classification or the National Center for i Health Statistics." This classification includes all leading causes of adult deaths in the United States (Table. 1). 1 mortality rates and two types of adjusted rates ' I computed crude for of the cause -of -death categories. The crude rates ate useful each for evaluating the effects of fluoridation on mortality only it the cities with fluoridated and non -fluoridated water supplies weer the level of mortality. f a comparable in other factors that might affect The two of cities populations ' e Unfortunately, they were not. groups these variables s had different age, rare and sex compositions, and with she magnitude of death rates. Thus. the fins ad- ;, are associated procedure was to remove the effects of these variables. The ,. jussment done with the indirect method (age was classified ., adjustment was by five-year intervals). The standard ram required by this method c „y obtained by pooling of the deaths and populations of the cities were with fluoridated and non -fluoridated water. A potential defect of the indirect method is that even if two comparison groups have - identical specific rates, it is possible for the adjusted rates to s of. Yp_ then'" This property of the method is a function of a set j be by' use of standard rates used, and this problem may avoided standards derived from the composite of the twat groups," as was }:c. done here. The evaluation o(ihe effects of fluoridation on morality is further complicated by the far that the cities with fluoridated and non-flu- oridaed water supplies are different in several other characteristics ! an that may plausibly be associated with mortality. The Cavity dCrty Data Nand" provides a ready source of demographic, social and economic information about the cities studied. Before tompuung any mortality rates. I chose, from among a large number of poen-' -K tially confuundme variables, the following: population density, rte- -x dian education, median income and the p reentagr, d the work force employed in manufacturing (as a measure of indoslialita- t'. lion). Table 2 shows that the cities in the two groups were, on the avenge, d,flerens in these cha.an•-ristes. These four factors weft subequrntl sbuwa to be correlated with the level of the cities' death rates Thus, just as an adjustment for ape. sea and rare was e .. tom: ,, 151 ie YY "I • YILYn,. i:7 • t. .r' page 1.38 tau x f�, h �.1hl M Nam UMTAUTV A,Yp iLl WJIOATl0.Y - LR(CKi0Y ;~if'�- } ,x t�e1D 1. caDm R6M M a11tOtOe t1(lelld6lfe (�) Ine 6k �•i Jane cnon•q c+nf/, VYhN1131(00 a6ew. pnp, uAu6e eua6, I 'la 4 _•�{ f. " "'It"141t. A3KO9A• � Y ' w u CN11p1a Dm1 cum .4444116 4o1s1n1 _ . DYmtmf D91m Ram DYmtunt • .+' y . old' / j•J _ / 1 'I • ISUA I,In.1 :'., 1190.1 IA11 LH6.0 I.IO43 4.1 4J z • AL.— 43 13 .. 1„ •y}'" ;;el.,s"k: )r 101D01v1 7.0 7.2 7A 74 ., Y...; •�'-' O9het fateniee .5 "^ 1917 196.9'. r ♦ (000009.0.0176) 206,6 1tl.0 199.9 IfJ.3 {'r a 34]94Nmlmtgbmf 613 31.7 39.) 94.3 $6.7 Slt �. izt. .3 }ti a ) •!fit, y/ (13001591 40 44.2 42.6 /IJ OA II•..)._ �„• ',< ':,' 13.9 103 i. let10163) Ill 11.1 ' . Y•: 20601631 177 173 [ A ,t'•: '`.. 8 tYm1 It.J 17.0 .. ) ,...` �UJ 23.9 ISA 22.5 21A 23.9 Genital • ($tfl 9.1 IA 8.8 1.7 t.7 U . Unary (IU-U9) 1,3 73 7.4 7.4 lA 7.1 1 -r•,1 (Y$ 204207) 3➢.4 36.0 N.1 373 37.1 37.9 �' 3 ?;... (rsa3dado1110.209) 333 22.0 21.7 ' 21.1 ,:❑ . .�, Di.Eern me0ilm' M.) 20 .6 fU0) 611.4 Sri.7 $93.1 $SOJ 375.4 $76.5 r+;� ;nre v Cudsou4r 425A 4)11 ()9O19tk 661.4 3941 44.9 ]99.9 .t ..• �(` 94tH `' it (3X.390.102. ' .� • y 409.110-429) 91 /1 fA 9.1 i.t 9.1 R6eumatie f1 10.5 (190396) ,t 9.2 9.3 100 . e :3' { . . Hypettenuee •'1 `.. (102.10q603.1 762.6 N2J 391.4 ar 41$3 349.2 4ehem413) 76.7 IlA U.3 ItJ MA 20.5 (' is . Other l3 S3 4.5 s, ;, •. (420 29) 33 6.1 5.2 Hype Umion 112.7 1112 s• C: 401,103) 1111 109.9 116A 't ° i Cerebroeaseular 113.1 .�, ' . (430-438) 173 164 17.3 16.7 III .16A ^ r Antrosderotif 141 117 e�. •'! 11e01 11.6 1.3 .y ,l Otherenetiat N1 117 e'rA4 ii 1441411) 11.0 MS 44.7 36.2 44.6 37A a InA ra. pn^ ^ onia 16.9 17.1 .y I. (470471.480486) 15.9 18.3 ' 1 1-•I Ironahitis. emphysema. 16.4 17.6 51 SS il "hma(49049)1 33 41 5.4 SA ( ]colic ulcer UA 21.4 : I (531.513) nl NJ 44.•9 U.7 Cur 71)6.er t ( ,.i. (571) 6A 4j 3.7 $3 A9 3.6 . - - ,..;. 1'496ritif,rmhmsit 20,3 OA q (5103111 OA 0.4 0.6 0.5 Y•f pre6Nn6678) intiaas 20.7 214 r (6 74) 19.4 U.I 19.4 U2 N Wor.eh-0 undent1111 31.7 ' T 1 ` (ESIOE1U1 346 370 33.6 38.1 r. -i � Otmt aendnits . 12 16A 12. 9 16.0 U,1 (41 ,,$ �eg0OE80t, Ee25E9191 .7 1 1 f :(E93OE959) 19.7 14.1 I8A 16.4 16.1 173 I4067E97H 33 1.1 1.3 3.9 3.7 r t •41 .........a Dtle/Cal(INI 1a (E91OE999) .. ' r, y w• Yn L L ' iF �Rrpp)tWA09 Rt�'r• .-41(4,(.0( .N ref. . WIrYI N nN1Yr:i 16NC0Y61 {Cr. eN7 P/Oeta MNy / M6r 6 . t xr (i a tDrn6 nN bl'nt'1 i i. �Y. j11 e l \ 1 7F3� m MnntMn Crc ret19.<f numUm a ISO tit916 Rest Iew.eatweL CWvfwtWl W Pr..n. Al.9�C Ib5. ^W x� G fill: �}'j5• �94F1, r •t' ♦-,/ _ _ y, 3 •v' +i','yfe�a yV'' ✓Z f5 jy. _ y.a� i .^�l ?i __�+Rf^Y�l vtiYN�is- �•i."'I';' ':t. �P�4.�Z/ o<{xf..'4 1- ")i.. .. ;--1.°y90:}.[='a• �ynS M Y '{n` I•h.1Ji 'l.- f n h"'i�3i. T ..••.i ♦.' •.a' A o � �J..�'w !i �.. _a1C •_— Tim a c.n� I•^ m __ _ b.. page 1.39 i 1114 THE NEW ENGLAND JOURNAL OF MEDICINE TabM 1. flsluelad CharaNarlattea of Study Cities by fWorkas tion Status's bum Anasu Maata •w .Annaba cell CmMaasa cirls"a (m 9owluae Now twU Mint belittle Yaw t.no,n lases (Psinus1/ 91Yrattal, MMYryrK. /9M,) tuanro Fluoridated 16.107 11.4 13.5 $9,513 NosMoridated 3.343 IL0 707 39.548 rot .gand tnorby M Mlo.kwA bunk paaula„a required to mate the cities more comparable, an adjustment was ". quired io remove the clouding effects of the variables listed in Table 7. In the interests of parsimony of analyiis, I explored the possibility of discarding one or more of these variables from further considera. tion. The key to the rationale for this exploration lies in the fact that these faun variables are correlated with each other in addition to being correlated with mortality. For example. population density is correlated with median income, and both these variables are cor- related with mortality. The question, then, is, once account is made of the correlation between population density and mortality, whether there is any correlation left between median income and mortality. If nor. one could proceed using only population density in further anal sic and ignore median income. To decide which (if any) of these variables could be discarded, weighted partial correla- tion analyses" were done for each cause-obdeath category with use of the age-rare.sex-adjusted rates. The data from each city were weighted according to its 1970 white and black populations. This weighting takes account of the fact that the estimates of the mor- tality rates from large cities will be more precise than these from smaller cities. For most causes the partial correlationcocfficients for population density or median education (or both) were the most important whereas those for median income and the manufacturing work force were quite small. It was therefore decided to retain only the former two variables for (other analysis. The final adjustments of the age -race -sex -standardized mortality rates were made by weighted analyses of covariance (weighting was by the cities' 1970 white and black populations). Analysis of covariance is a standard statistical tool"'' that combines regression analyse and analysis of variance. In the application here, linear regressions between the death rates and popular ion density and me- dian education (the covariates") were computed. With these regression lines as guides. the mortality rates of ciries with fluori- dated and non -fluoridated water supplies were adjusted to the values that they would have taken if the average values of their covariates had been the same. Tests of the significance of the dif- ferences in the respective adjusted mean rates were then made. For an analysis of covariance lobe valid, the slope of the regression line fitted to the fluoridated citiesdata alone should be equal to the slope of the line filled to the data of the non -fluoridated cities. Therefore, a rest for significant differences in slopes was also made for each category of death. The ago -sex -race -adjusted rat" are in a sense averages and are useful as summary measures. To ensure that this summarization did not obscure some point of importance, the ace-s•s-race-specific ram for each category of death in the respective groups of cities were also computed. These rates were also adjusted by weighted analyses of covariance for city population density and nedian education. The data were weighted by the cities' age -race -sex - specific populations.• entrails of the analysis of ake....,sci-sticalke (and adjusted) dealh rain an available on request to the author or through the National Autiliary pubbeauons Semite. Order NAI'S O•eumtnr 03.•10 from ASIS'NAPS c/o MM, oft he publrtm alro, P 0. Nov 3513. Grand Central Station. New York, Remit, In ad va nee..511or. ell ch n',n.h.hc ynP) reprodu.foa Of 4SSmfor a phoww'•,p' or SI for a miaolche.. Stake checks pa. pahlKal,unS. - _ -T a ! a J1 .-ot• ff a May 16. 1978 I11JUL7a During the three-year study period 570,671 blacks and whites died In the cities with fluoridated, and 351,053 in the cities with non.fluoridated water sup- plies. The 1970 reference populations were 15,972,617 and 11,106,746. Thus, the crude death rates enenl causes were 1190.9 and 1053.6 per 100,000 p years in the cities with fluoridated and non -fluori- dated water respectively (Table 1). In passing, it may be noted that these crude rates were considerably higher than the crude rate for whites and blacks in the total United States in 1970 (950.7). This pattern of a higher crude death rate in the cities with fluoridated water supplies was apparent for all categories of death except for those by accidental means and suicide (Table 1). Adjustment of the monality experience for age, sex and race reduced the differential for most causes, indicating that some of the differences in the crude rates were due simply to differences in the age, sex, and race compositions of the two groups of cities. However, even though the standardization process completely removed the differences for some causes, for others the rates of the cities with fluoridated still exceeded those of the cities with non -fluoridated water supplies. For all causes, the standardized rate of the former was 1156.0, and that of the latter 1102.4. The analyses of covariance removed the mortality excess in the cities with fluoridated water supplies (Table 1) — indeed, giving cities with non -fluori- dated water supplies slightly higher rates for many causes. The rate for all causes of the cities with fluori- dated water was now 1123.9, slightly lower than the rate of 1137.1 of those with non -fluoridated water. The rates adjusted by analysis of covariance were significantly different for only two causes: the rate for "Other Arterial" diseases was higher in the cities with fluoridated, and that for "Other Accidents" higher in the cities with non -fluoridated water. For two causes, "Tuberculosis" and "Nephritis and Nephrosis." the associations between the covariates and the death rates were significantly different in the respective cities. This difference invalidated the analysis -of - covariance procedure for tbese two causes, but only the most trivial differences in the respective rates remained after adjustment for age, sex and race. The analysis of the age -race -sex -specific rates yielded a pattern similar to that noted above for the adjusted rates. It was found, however, that the covariates (population density and median education) - were more strongly related to while mortality than to black mortality. The reductions in the rate diffcren- tials between the cities in the two groups were therefore much more striking among whites than among blacks. DlscusstoN This study shows that the marked differences in the crude mortality experience of the rides with fluori- dated and non -fluoridated waver supplies were not It � O. .• aR ..ri -„ :a c• •1 �.. _'1f... j., IA •' 4 „ - _ xY .\'e�,� tT. v.. ,•y )nv, 77 : 'rye p Ft'fl- ��}bb!�S5S. T. .W-' yr rte' ,.-•ter.,... -Page 1.40' Ills I1 Vol. 298 No. 20 \IURTALIII' AND FLUORIDATION — ERICKSON ` b fl oridation Pan of the differences were puter tapes that it releases for external use. Thus, number of 11 cause y u shown to be attributable to the simple fact that the age, sex and race compositions of the cities were not the same. In addition to age -race -sex differences, the cities were different in a number of important characteristics other than the concentration of fluo- ride in their water supplies. Adjust.nent of the mor- tality rates for two such variables, Iopulation density and median education, removed the differences remaining after age -sex -race standardization for all except two cause -of -death categories. After adjust - although this study Involved a very large deaths, they were derived from only 46 cities. Despite these limitations, it is appropriate to note in conclusion that this study was based on a large number of dcaths and that contrasts were made for a wide variety of causesrof death. There was no evidence of a harmful effect, including cancer, attributable to fluoridation. I am indebted to Susan Baron, Mimi Doreen and Sara Wtngo •. for statistical assistance and to Faye Williams for assurarcs•>` •5 a menu by analysis of covariance the rate for "Other Arterial" diseases was higher in the cities with fluori- dated, and that for "Other Accidents" was signifi- cantly higher in the cities with non -fluoridated water supplies. But this number of residual significant dif- ferences is not surprising. There were 29 "inde- pendent tests made (i.e., excluding those made for such categories as "All Causes" or "Malignant Neoplasms" — Table 1) and at the 0.05 probability level, one would expect -1.5 to be significant by chance alone. , A similar pattern was noted for the age -sex -race- specific comparisons adjusted by analysis of covariance. There were 2088 "independent" tests made (29 causes X 18 age groups X 2 sexes X 2 races) and one would expect 104.4 to be significant by chance alone at the 0.05 level of significance. One hundred and six were observed, 58 with higher rates in the cities with non. fluoridated and 48 with higher rates in those with fluoridated water supplies. Even so, a certain non -randomness of these differences was apparent. The number of significant differences was roughly equal for whites and blacks. But a ma- jority of the significant differences among whites were due to higher rates in the cities with non -fluori- dated water supplies whereas a majority of the significant differences among blacks were due to higher rates in the cities with fluoridated water sup- plies. Mortality was chosen as the outcome measure for this study because of the availability of death - certificate information. Deaths that occurred during the years 1969-1971• were used since the 1970 census provides a useful estimate of the city populations for 1969 and 1971. Study of morbidity wis not possible because of the unsuitability of available data. For ex- ample, the National Cancer Survey" provides data on cancer incidence. However, the size of some survey areas (two were entire states) used did not make it possible to determine fluoride exposure. The use of place of residence on a death certificate as an indication of exposure to fluoridation entails the limitation that there will have been exposure miselas- si0cation because of migration. Such misclassification would be particularly important (or diseases with long latent periods or long exposure before manifestation. There is another disadvantage inherent in the use of city of residence: the National Center Fur health Statistics records only cities of >2250,000 on the corn- M APPENDIX: STUDY CITIt3 Cu I1W Putttmv taw ,na Wc.sOast Cilia with water supplies fuoridated before 1960: San Francisco 01.264 303,191 Drover Wasbin$ton. DC 146.994 3achanvitk $20,133 Miami 11LS)) Map 3,110.311 Indianapola 742222 Looisvillt 560,131 tlahimor9 t00P45 Mixaespalts 42SA19 st. hvl 306671 St lone 09.311 av1410 413,606 Rshnter 191.761 745.921 OsnUee 311.ri1 Toledo O6unoora Oh y 357,906 TS a tS32.30U9 317.194 F)ha 116.102 Notion 1.310 Rkhm"d 7s9A23 944otal 710 0 Total 13.972,117 CLb with apn•Ilao!idatd wa r applim sirmin66a. 570nA06 J0a Roaril 131475 Tonto" Lane Ramat 169P73 Los Argeln IA77,SD6 wsund 131.222 2)4.55 Sacanetno 673,44 Sin D:ecoa 429.301 Son left 276002 Tampa 112.411 Nonow" 135.794 Wichita $10.129 New Oha.t 625416 Ran" Kansa City. 1401 103.f0I le..a City ri3 Newar9 50.1.S 64 470.40 171)01 A.ot. 269421 T"a 07764 11 w 546 1 V. Ravam.Tmx too'" 1932 Iris 1932 1932 1936 I9SI "'I1932 1937 9432 *9"Iris. 132 a 1%) still Iris trio $9"$3Its'aria .-,r .Yi. .0:. -� - 3: ..trw.n. rtr.i4,w4..m t.tetd. e w" .M a ep r.a ... n,ww : r wren It Ia 4.".a Mw A aa 1.r.' n lot! a.a. 4tc .s.cd-Nil. 11aMi4tr 9r4.. w r t"., a ." dntdsid r 1544 a rn x - • t 1116 page 1.41 •. . THE NEW ENGLAND JOURNAL OF MEDICINE REFERENCES 1. Bulk D. Yiamouyiannh 1: Fluoridation and ante?. 9e1h Congrw. Fint $anion. Conrrenlonal Record 121:7172-7176. July 21. 1975 2. Yiamou)iannis J, Burk D. Cancer horn out drinking 1.11a! 94th Coons, Fine session. Conttnsional Record 121:12131-12734. Dettmber 16. 197$ 3. Doll K. ktnkn L. Flutaidaliofl of watt::: d caner mnnalitr in the U.S.A. t.ancct I:I30a1302. 1977 4. 'raves OR: Fluoridation and cancer m.nality. Origins of Hum. cancer(Cold $pring Harbor Confererrcet on Cell ProliferH ation, ), Edited by 1111 1liatt. JO Watson. JA Winston. New York. Cold Spring Harbor Laboratory. 1977, pp 357-366 S. Hoover RN. McKay 1W. Fnumcni IF It: Fluoridated drinking weer and the occurrence of cancer. I Natl Cancer lust 57:157.768. 1Q76 6. Yam: u'; i= °r J. P' ^k It fluoridation and cancer: age.dependence of cancer molbJny related to anifcial Buoridalion. Fluoride 10:102-123. 1977 7. Hagan TL, PiWernatk M, Scholl GC: W'aerboror Ouoridn and root. tality. Public Health Rep 69ASWS4. 1954 1. Fluoridation Census, 1975. Bethesda. Maryland. National Institutes of Health, 1971 9. National Center for Health Sutntia: Comparability of marital status. Max IC, 1978 raa, nativity and count? of origin an the deklb eerifkste and W tc n1 cen us record. flo(Pment Panting Office. 1969 $truce 2. No. M. 10. ti 1970 CentralSPopul BureiOli chuacun taau the �uWaehm6 on S Census r DC. Oocernnitnt Printing Office. 1972 11. Nuinnal Center for Ileallh Statietia:9 J1"W'ao rig ten of t eGucern• iied $taus. Vol. 2. Mortality. 1969. 1910, mein Printing Olfrtc pion. New YOA, 12. Fkiss IL: Statistical Methods (or Rata and PrOPo Wiley. 1973 I). United Stain Bureau of the Census: County and CityOat. Boot. 1972. w.shintlnn, DC. Governmentnt hinting analysis.ottit. 1971 1973athCmatical Methods 14. Erroymsan MA: Multiple rege for Dirital Computers. Vol. I. Edited by A Ralston. NS Wilt. New York, Wiley. 19W Pont York, IS. Armingt r. Statistical Methods in Medial Re,eattL. W'iley. 1971 16. Du on 555, Massey Fl: Initoduceron to Statistical Analysik ThiM tali. • tion. New York. McGra+-Hill. 1969 tnddarce date 17. National Cancer lmtit ute: Third national N cancer" so". (DHEW' Publication No. INLHI 75.167). gton• DC. OOwro• men' Printing office. 1975 MYASTHENIC ANTIBODIES CROSS-LINK ACETYLCHOLINE RECEPTORS TO ACCELERATE DEGRADATION DANIEL B. DRACHMAN, M.D., C. �ti'IWAM ANGUSj M.Sc., ROBERT N. ADAMS, M.Sc., JAMES D. AIICHELSON, A.B.. AND GARY J. HOFMAN, B.M-, PH.D. k" antibody Abstract The decrease of acetylcholine receptors at neuromuscular junctions of myasthenic patients has been attributed to an antibody- mediated autoimmune process that accelerates receptor degradation. We studied the mechanism of this process in skeletal - muscle cultures, using intact antibodies and antibody fragments. Addition of myasthenic IgG or its divalent fragment. F(ab')1. to cultures accelerated the rate of acetylcholine -receptor degradation threefold. By con- trast, the monovalent fragment. Fab, from myasthe- nic serum had no effect on degradation. although It bound to acetylcholine receptors. Addition of MYASTHENIA gravis is wa eakness neuromuscular uar diilor- der characterized by' of muscles. It is now well established that there is a decrease of acetylcholine receptors at neuromuscular junctions of myasthenic patients." sufficient to ac- count for the typical clinical and cicclrophysiologic manifestations of the disorder.' Abundant evidence indicates that the pathogenesis of .31y'asthenia gravis involves an autoimmune attack directed against ace- tylcholint receptors (reviewed by Drachman' and Lennon'). A Immoral immune mechanism has been implicated in myasthenia by the finding of circulating antibodies against acetylcholine receptor''" capable of reproducing the basic features of the disease on pas- sive transfer to mice. One potentially important action of the antibody has been suggested by re cnt observations that it In - IY,nn the derartmenl% of %turnl.yt and PathaI••R. Johns 11'pk my I1nn.rV"Sth.Y%I 0r Sie,l. ,cat tad ire„ repum trque•b to lie I'.chma err the 11, Ivnn.rr.t or \condor,. h'n''' Il..rt.m 1 nnrrm) Sm.l of hledn:ne, 11:1 I. hLdnnn S: h.lnmr:t. kil :11056 SoplontJ M I, ant, 15 3401 111) W,l r md'5 T11: NS nH)01Iron' the ?.al u..Oil ln,nl inn of lleabh. er second, "DCeptorc to cross- link the Fab:receptor complexes resulted in e threefold increase of the degradation rate. Similar- ly. when acetylcholine receptors with addition und tl-bungarotoxin were cross -linked by of specific antibody against a-bunQBt0t0t f t the degradation rate increased apD threefold. The effect of :myasthenic patients' anti' bodies in accelerating degradation of acetylcho- line ss- link the receptors. ceptorstors is .tr(Nuted EngioJt eir Medability to 298:1116.1122, 1978) creases the rate of degradation of acetylcholine recep- tors, both in cultured skeletal muscle, and at intact neuromuscular junctions." Furthermore, we have found that direct exposure of the receptor' to myas- thenic antibody is required for the accelerated degradation process to be initiated." In the present study we examined the nature of the Pnt ibodrrcceplor interaction that accelerates degra- dation of acetylcholine receptor'. For this purpose, we used fragments of antibodies prepared by enzymatic cleavaee of IgG. as well as specially raised rabbit an- tibodies. Our results suggest that cross -linking of the receptors by antibodies is the factor that leads to ac- cclerated degradation by muscle cells. MATEPIALS AND METHODS Sk.Itl$.Muscle Cullum/ Culture. o4 art drleul movie %ere p:rpared hy' ",rnrmu.tul •'•'I hr' writ sear ul,awd a• undre an nmu,rirrr d 111 Ire rent ta•4m An•a,dr m "eanAa/d rwelum' r+n:ua:na of 1 avl• s nulunmm rtarntial nrd,un, %dh 1yL.vb,.)up1dem-nerd will, Ire Ire rentI.,r.r en,riladlI Irl eenr .I:,,t-ennn.. r.,aart, wah Iln 1 (i1 mdldiur ,.11ama it hut. .11 t• -1 •.d p Reprinted from end copyrighted as part of Journal American Water works Association so1.42 Vol. 62 No. 4 April page printed in L. S. A. FLUORIDATION CI�EMICALS-THE THE YEAR 1970 marks the 25th anniversary of the institution of the po to municipal adding ater uppl es forthepuns pore of reducing the prevalence of tooth decay. During the past quarter-cen- tary, the practice has grown to such an extent that by the end of 1969 over 86 million people in the United States, Cr more than 55 per cent of those on public water supplies, were receiving fluoridated water.' With the enact- ment of state laws requiring fluorida- tion of all supplies of over a specified minimum size, and with the proposal for similar legislation at the federal level, there seems to be little doubt that the trend will continue at an even higher rate in the future. This growth trend has brought about a problem which was entirely unfore- seen when fluoridation began 25 Years ago. The problem concerns the appar- ent shortage of some of the chemicals used to supply the fluoride ion to be .added in the treatment process. Sources of Fluoride Chemicals The three most important chemicals used in fluoridation are sodium fluoride, sodium silicofluoride and hy- drofluosilicic (or fluosilicic) acid. Sodium fluoride is usually made by re- acting hydrofluoric acid with soda ash, while sodium silicofluoride and hydro- fluoslicie acid reach the market largely as by-products of the phosphate ferti- lizer industry. In the manufacture of super -phosphate fertilizer. phosphate rock is acidulated with sulfuric acid, and the fluoride content of the rock evolves as volatile silicofluorides. In the past, much of this volatile material was vented to the atmosphere. contrib- sting heavily to pollution of the air an4 land surrounding the manufacturing site. As awareness of the pollution problem increased. scrubbers were added to strip particulate and gaseous components front the waste gas. but in many uses the water from the scntb- bets was merely disposed of in the �earest stream, thus contributing to rater pollution. .lure recently, pro. cess waste water was collected in sror. age ponds or further treated to re• coyer the fluoride cl temicals rr•na^,^, Iherein. SUPPLY PICTURE Ervin Bellack and Robert 1. Baker With the increase in the use of fluoride compounds in public water supply, there occurs the problem of supplying chemi- cals that provide the fluoride ion. pete effectively with sodium fluoride even when transportation costs are considerable. Sodium fluoride, al- though a more expensive source of the fluoride ion, possesses some unique advantages. It can be fed either dry or in solution, and because of its almost constant solubility is particularly adapt- able for use with a saturator. For the latter purpose a coarse crystalline grade is preferable. The recovery of hydrofluosilicic acid involves essentially the recirculation of scrubbing water until the acid concen- tration reaches a marketable value, which may vary from 20 to 30 per cent, but usually is about 23 per cent. Sodium silicofluoride is manufactured by adding soda ash to dilute hydro- fluosilicic acid and filtering off the resultant precipitate. After washing and drying, the product is marketed at purities exceeding 98 per cent Be- sides its use in water fluoridation, sodium silicofluoride is used as a laun- dry sour, insecticide, bactericide and fungicide, and in many manufacturing processes as well' Comparison of fuorlds Chemicals Although the first compound to be used in water fluoridation was sodium fluoride, as soon as it was found that the fluoride ion was equally available from the silicofluorides and at a lower cost, the latter gained rapid accept- ance.' The use of hydrofluosilicic acid, particularly in the larger cities. proved especially attractive both from ,he cost standpoint and also because of the simplicity and convenience cf feed- ing a material which was already in solu ion and thus required only a pro- portioning pump in order to add the Desired amount of fluoride ion to water. The acid possesses an inherent disad- vantage, however, in that the pur- chased material contains over 70 per cent water and if any appreciable ship- ping distance is involved the cost ad- vantage soon disappears. For this reason, most large users of the acid are ,hose situated vary near to the site of ii nufact tire. On the other hand. so,liun; sill coil ruri,!r must be added with , dry feeler- Inn lrcan:.c of its lower cos, and high purity it can corn- - 223 Supply and Demand In recent years another factor, aside from the advantages and disadvantages mentioned above, has appeared as an influence on decisions regarding the choice of chemical to be used in water fluoridation. This has been the lack of availability of the fertilizer -derived compounds, particularly hydrofluosilicic acid. Not only have municipalities just starting fluoridation been affected, but some woo have been performing this practice for years have found that their source of supply has been cut off. When news of this reached the authors, a survey of the fluoride chemical sup- ply situation was undertaken. Ques- tionnaires were sent to all current or potential manufacturers asking for in- formation on the availability of hydro- fluosilicic acid, sodium silicofluoride and sodium fluoride, both - powdered and crystalline. The latter was in- cluded because of reported difficulties in obtaining the coarse -crystalline ma- terial for use in saturators. Additional data requested included costs, quantit- ies, container sizes, and future avail - abilities. Table I contains some of the results of the survey. Although the basic reasons given vary front fertiliser over -production to the influence of increased imports. the apparent sbortace of fluoridation cl ent- icals can be attributed to a nit -hack in fertiliser manufacture. Since only a limited number of fertilizer manufae- A rarer sub,niurf to the JnunrAL 00 Pet. 13. 1970. by Ervin Rellark. Chemist, Fluoridation l.nFnrarery, USPII.S, rCA, ItII Il. 14zbrs'a. Marion). and Robert 1. llabrr (Asir': .lfnnbn, AIIs1VA). Teel¢iew ?'&C 0?, Wallace R Tin non /tiririnn. l'rmr..r•,rt Corr., BeVrl,lle, .Vry 1n_^y. [31J x i5 .. . -ct'`. .4 4. st` r. page 1.43 & BELLACK & R. 1, BAKER TABLE I i' prodssnl 4 fhnfdaNna CMwkalt to PladaM Prtduna ?• Artfco Chemical Co., Division of hydrofluosilicic add, Continental Oil Co. rcdium silicoBuoride fleonide, crystal Allied Chemical Corp., Industrial Sodium Chemicals Division and powdered Arco Chemical Co., Division of Atlantic Hichiteld Co. Salium fluoride, powder J. T. Baker Chemical Ca Sodium fluoride, coarse, CEemteeh Corp. fine, extra -fine, sodium bifluoride Fkessi a Reduction Co. of H rofluosilicic add Yd Canada, Ltd. W. R. Graff, Agricultural H drofluosilidc acid >' Products Division Harahan Chemical Co., Hydrofluosilicic acid Division oil nternational (drums) H)drofluosiiide add Minerals & Chem, ical Corp. Kerr-McGee Chemical Corp. Hydrofluosilicic acid, sodium silicofluoride Sodium Fluoride, ponder Olin Chemicals & crystal, sodium silico- fluoride Smith-Di,uglas Division of Bar- Hyd oflu c acid a oride den Chemical, Borden Inc. _ potassium OStauffer Chemical Co., Fertilizer H)drofluosilicic acid Division Tennessee Corp., (Cities Service), Sodium silimfluoride Ind. Chemicals Marketing Div. Texas Gulf Sulfur Co., Inc. U.S. Industrial Chemicals Co., Hydrofluosilide acid Div. of National Distillers & Chemical Corp. t Conserva- tion Chemical Co. of Illinois USS Agri- Chemicals Division of Hydrofluosilide acid U.S. Steel Corp. /ess, AWWA processors to Install or enlarge recovery facilities and thus insure ample avail- ability of fluorides in the future. That Av.u.Wur this trend is already under way is evi- denced by the information contained Add in short supply in Table I. In general. the current pic- ture is that most communities, in par - Immediately available ticular those who have firm contracts. Recovery of hydrofluosilicic are able to get sufficient fluoride thin - acid under consideration pounds for present needs. C.oittmuni- Available ties just starling fluoridation, and rttmthose Immediately available without contract tbitments, are having a difficult time locating a reli- None available in 1970 able source of fluosilicic acid, and occasionally, sodium silicofluoride. Present production cam- Sodium fluoride users, however, should milted, additional re- have no trouble in this regard. The covert' facilities under construction future appears somewhat brighter as Production committed more phosphate rock processors put re- covery facilities on stream. Quantities Production committed of hydrofluosilicic acid are expected to Production committed, be available in 1970, hopefully sufficient some acid available in to supply the needs of communities 1970 presently experiencing shortages plus Sodium fluoride crystal bas communities just starting limited availability the needs of to fluoridate their water supplies - All acid converted to potas- Besides the information listed in slum salt, which is all corn- Table 1, the survey included importers mitted and the suppliers (jobbers) through Production committed which most manufacturers market their Available fluoride chemicals. The suppliers, Recovery of hydrofluosilicic nearly 250 located in the US hLalld acid under consideration Canada, are scattered gthe p ' Y Availability unknown in close approximation to the popula- tion density. Every effort has been made to. insure Present supply committed. completeness and accuracy of the me - Additional recovery, plus terial in Table 1. Anyone possessing manufacture of sodium additional information on producers of fluoride and sodium silica- fluoridation chemicals, or those desiring fluoride under comidera- assistance in locating a source of sup - ton• ply, are requested to contact the au- thors. References ... of Health p 1. Fluoridation Census. US Dept tuners recover fluosilicic acid for sale casts estimate 1970 ro n at about Education, Manpower. Divre,on of Den Of to municipalities, when any one of these 50 million tons.` Phosphate rock con- �elth n, and Welfare, Bureau D of halts or decreases production a major Leven about smal !fraction of t the nnd if total z Encyclopedia of Chemical Tethiafogr. source of supply is affected. ' amount available were recovered and The Interscience Encyclopedia Publish- - «?'a Brighter Outlook processed, there would be ample quan- era, Inc. (1951). m Pin s" s. This limited extent of recovery fa- titles for water fluoridation as well as 3. McLuaa, F. J. Availability of Fiuorme, cat,. Public Health Repans. 63:1175 in Sodium Fluoride aSodiu • �. cilities is the key to the problem, since for other uses. The increased demand -:w there is no real shortage of fluorides, for fluoride compounds, plus the pres- (1950). .`., Annual production of phosphate rock sure exerted by anti -pollution agencies, 4. !fining Enrinreri"P, 20:2 I2S (1969) Oexceeds 40 million tons, and most fore- should encourage more phosphate rock and other sauces.` ar p A' ti= }ref :•:. :rte r � '-k x r:a " i• YYyy ' - r• DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE PNSLIC HEALTH SERVICE OaNTra pea e1uAR CONTROL g 00-3040 page 1.44 ! • ATLANTA.OWAo,A30193 Refer, PIr90 `." TaLanHONrt (4041.Of.»I 0 February 1977 OVER 105,000.000 ON FLUORIDATED WATER SUPPLIES r , AS OF DECEMBER 31, 1975 t .t. Most recent statistics show there were more than 105,000,000 peraone having access to water supplies whose fluoride content had been adjusted to the optimum level for better dental health or whose natural fluoride content was at optimum or higher levels. 212,851,000 Total U.S. Population 177,000.000* Population on Public Water Supplies . • • . . • • . Population not served by Public Water Supplies. . 35,851,000 Population on Fluoridated Water • • • • • • • . • . 105,338,000 (Adjusted. • . • . . . . . . . • •94,627,000 Natural • . . • . • . . . • • • .10,711,000) Z of Total Population on Fluoridation . 49.4 % of Population on Public Water Supplies Using Fluoridation . . .59.3 Fluoridated Communities**. . .9,425 Adjusted. • . . . • 6,795 Natural . . . . . . 2,630 Some 24,000,000 people in over 100 cities with populations of 50,000 or more, including Washington, D.C• and Chicago, have had adjusted fluoridation for more than 20 years. 702 of all cities with populations of 100,000 or more have fluoridated water. 22 States, the District of Columbia, and Puerto Rico provide fluoridated water to over half the State's population. - School Fluoridation As of December 31, 1976 Schools 124 383 Students. . States with F•uoridated School Supplies . . . . . .13 K 'kY� Dental Disease Prevention Activity •''�: iA 1 ; Bureau of State Services *EPA Estimate of Population on Community Water Systems, Federal Register, Vol. 40, 0248, Dec. 24, 1975, p. 59582. ,arc; Tv **These arc places as designated in Natior.wiee Geographical Location Codes, '» General Services Administration, Office of Finance, Feb. 1572. �ynaY:' .ei Sg •.'sip y� a�`.yt9y>�F• .•... y� A.�.`'+ j,C�`' why ^'!' �i2 -. .{{f�.,'. .^n+ 5 i• YJ 3 4 Y'b� yv� ,�r a r :' gyp.. ir,��+`' }�.e . S,C �.. ��`,�r^. �. rt�� �.n r i F: .` . '. t' .-4 MY. .:.fi .�i4'i utae' ._J;:i._`•• '- v i /.• Y itp N y! XJ11 [ , •I .. P �p<,<... , page 1.45en 4 OIi .""Po7 R: I Y( 1 i.v I' SAi H>.rgJ J. Y w,t fyAxr G 4I I id 1 r' - 0. erg!• ,! .L Itfit .'� iI • .J N.. p „ p Y � , 1 ,a n l ♦ i ce � t i s i .r'�. Y 4 [: {y�� 15�yQ�•J, Fx. Ell L i< R• co N D O{7r W V iN 3 014`�ti -� V 0r : F -S l-' of ..f0 r f l , .y . .A E �•, 3 O o G$J 0 .r 4y5 o. 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