Suppression by medical journals of a warning about overdosing formula-fed infants with Fluoride

Article (PDF Available)inAccountability in Research 5(1-3):225-37 · February 1997with 114 Reads 
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DOI: 10.1080/08989629708573911 · Source: PubMed
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Abstract
In January 1990, a short letter was sent to the editor of the international medical journal, Pediatrics, to alert its readers that the standard, highly quoted paper by Singer and Ophaug on fluoride intake by infants, published in 1979 in the same journal, required revision/correction in order to protect one group of infants from receiving substantial overdoses of fluoride. This group comprises infants who are fed almost entirely on powdered formula which is reconstituted with fluoridated water.The letter was based on the well‐established pediatric guidelines of water intake by infants and the fundamental toxicological principle of protecting groups at highest risk. It did not question the fluoridation of public water supplies. Nevertheless, the letter, together with a response to it by Ophaug, was rejected by the editor of Pediatrics, “due to a large backlog of articles.”; Following a protest, the letter was reviewed by three referees, two of whom conceded its main point, but was still not published.In the present paper, the original, previously unpublished letter on fluoride intake by infants is first reproduced verbatim, and then the comments of the referees and editors are reported and examined. It is concluded that the most plausible explanation for the rejection of the letter is that it might assist the anti‐fluoridation movement. Another possible contributing explanation is that publication of the letter might reduce the status of the scholars who had defended the previous position and might be perceived to diminish the status of the journal.

Supplementary resource

  • ... Most studies of fluoride exposure from infant formula consumption have focused on risk for later development of dental enamel fluorosis (Brothwell and Limeback, 2003;Hong et al., 2006;Berg et al., 2011). Beyond fluorosis, the safety of fluoride exposure from infant formula has not been rigorously tested, despite warnings of overexposure (Diesendorf and Diesendorf, 1979). A recent study showed that up to 59% of infants younger than four months exceed the upper limit (0.1 mg/kg/day) (Institutes of Medicine, 1997) when optimally fluoridated water is used to reconstitute infant formula (Harriehausen et al., 2019); 33% and 14.3% of six-and nine-month old infants exceeded the upper limit threshold, respectively. ...
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    Background: Infant consumption of formula reconstituted with fluoridated water can lead to excessive fluoride intake. We examined the association between fluoride exposure in infancy and intellectual ability in children who lived in fluoridated or non-fluoridated cities in Canada. Methods: We examined 398 mother-child dyads in the Maternal-Infant Research on Environmental Chemicals cohort who reported drinking tap water. We estimated water fluoride concentration using municipal water reports. We used linear regression to analyze the association between fluoride exposure and IQ scores, measured by the Wechsler Primary and Preschool Scale of Intelligence-III at 3-4 years. We examined whether feeding status (breast-fed versus formula-fed) modified the impact of water fluoride and if fluoride exposure during fetal development attenuated this effect. A second model estimated the association between fluoride intake from formula and child IQ. Results: Thirty-eight percent of mother-child dyads lived in fluoridated communities. An increase of 0.5 mg/L in water fluoride concentration (approximately equaling the difference between fluoridated and non-fluoridated regions) corresponded to a 9.3- and 6.2-point decrement in Performance IQ among formula-fed (95% CI: -13.77, -4.76) and breast-fed children (95% CI: -10.45, -1.94). The association between water fluoride concentration and Performance IQ remained significant after controlling for fetal fluoride exposure among formula-fed (B = -7.93, 95% CI: -12.84, -3.01) and breastfed children (B = -6.30, 95% CI: -10.92, -1.68). A 0.5 mg increase in fluoride intake from infant formula corresponded to an 8.8-point decrement in Performance IQ (95% CI: -14.18, -3.34) and this association remained significant after controlling for fetal fluoride exposure (B = -7.62, 95% CI: -13.64, -1.60). Conclusions: Exposure to increasing levels of fluoride in tap water was associated with diminished non-verbal intellectual abilities; the effect was more pronounced among formula-fed children.
  • ... Since its inception, this pattern of bias has been de rigeur in the handful of the primarily English speaking countries that practice fluoridation. Emphasis on poor quality science is part of this pattern, a pattern that is continuing in the 21st century [1,10,46,[49][50][51][52]. ...
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    Municipal fluoridation was a mid-twentieth century innovation based on the medical hypothesis that consuming low doses of fluoride when young provided protection against cavities with only a small risk of mild dental fluorosis, a cosmetic effect. In the 21st century, more than half of American teens are afflicted by dental fluorosis with approximately one in five having moderate to severe dental fluorosis in at least two teeth. Scientific literature since the 1990s has found that even low doses of fluoride adversely affect cognitive-behavioral development and that deficits are correlated with the severity of dental fluorosis in afflicted individuals. Evidence of neurotoxic impact from low dose systemic exposure to fluoride prompted an investigation by a branch of the governmental agency that has promoted fluoridation policy since its 1940′s inception. This review identifies ten significant flaws in the design of an animal experiment conducted by the U.S. National Toxicology Program as part of that investigation into the neurotoxic impact of systemic prenatal and postnatal fluoride exposure. The authors hypothesize that organizational bias can and does compromise the integrity of fluoride research.
  • ... Incidentally, these infants receive 100 times the daily fluoride dose of breast-fed babies and at least 4-6 times that recommended by medical authorities for fluoride supplementation in unfluoridated areas. 5 In practice, the top fluoride consumers in places with 1 ppm of fluoride in drinking water ingest about the same amount of fluoride daily as the average fluoride consumers in places with 4 ppm. ...
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    Fluoridation was first introduced as a public health measure in the USA in the 1950s, after cross-sectional studies of naturally fluoridated regions of that country suggested that levels of tooth decay declined as the fluoride concentration in drinking water increased. An intense lobbying campaign was organised by a group of dentists and dental officials. Several 'controlled fluoridation trials' were conducted in the USA and Canada and, even before they were complete, the US Public Health Service reversed its previous cautious stance and endorsed fluoridation. Then, in Australia, the National Health & Medical Research Council, Australian Dental Association and Australian Medical Association all endorsed fluoridation in the 1950s, despite considerable opposition from doctors in the letters columns of the Medical Journal of Australia. At that time there was almost no knowledge of the mechanisms of action of fluoride in the human body. The promoters of fluoridation, rewriting existing scientific knowledge, claimed that there were no adverse effects, apart from a slight increase in the prevalence of dental fluorosis (fluoride-induced mottling of teeth). In 1960, a book published by Dr Philip R.N. Sutton, a dental researcher at the University of Melbourne, showed that the early North American fluoridation trials were riddled with fundamental errors of experimental design and were therefore unreliable. More recently, Dr John Colquhoun, former head of the New Zealand Fluoridation Promotion Committee, called into question the early research of naturally fluoridated communities of the USA, by showing that the key published paper derived its results by selecting a few communities from hundreds actually studied. However, by then fluoridation had become institutionalized in several countries, including Australia and New Zealand.
  • ... For infants of typical mass 8.1 kg at age 6 months, this gives total fluoride intakes of 1.0-1.5 mg/day, which are adult doses. 61 Li et al. 134 suggested a no-observed-adverse-effect level (NOAEL) of 0.15 mg fluoride/kg/day and a lowest observed-adverse-effect level (LOAEL) of 0.25 mg fluoride/kg/day of fluoride in human, 8 though these levels are currently subject to scientific debate. ...
    Article
    ‘Water is life,’ so central to human life, yet over one billion people across the world have no access to safe drinking water. Of late, there has been increasing global attention focused on resolving water quality problems especially in developing countries, as the lack of access to clean water denies the most essential of all rights, the right to life. The latest estimates suggest that around 200 million people, from among 25 nations the world over, are under the dreadful fate of fluorosis. India and China, the two most populous countries of the world, are the worst affected. India is plagued with numerous water quality problems due to prolific contaminants mainly of geogenic origin and fluoride stands first among them. The weathering of primary rocks and leaching of fluoride-containing minerals in soils yield fluoride rich groundwater in India which is generally associated with low calcium content and high bicarbonate ions. The unfettered ground water tapping exacerbates the failure of drinking water sources and accelerates the entry of fluoride into groundwater. Most of the scientific literature substantiates the benefits of low fluoride concentrations in preventing dental decay. However, as a surprising paradox, incidence of dental, skeletal and crippling skeletal fluorosis was reported in India with average fluoride concentrations as low as 0.5, 0.7 and 2.8 ppm respectively. Fluorosis, turns out to be the most widespread geochemical disease in India, affecting more than 66 million people including 6 million children under 14 years age. Though fluoride has spread its tentacles in 36,988 habitations and the number of people falling prey to fluoride poisoning have been steadily increasing, an exact exposure-health relationship is yet to be properly elucidated. There is an essential relation between poverty and fluorosis as malnutrition is found to play an aggressive role in its severity.
  • ... Dissemination of data can be blocked by hostile editors or referees. Many rejections can be justified on the grounds of quality control, of course, but some rejections may be forms of censorship, for example when profluoridationists reject articles they perceive as threatening to fluoridation (see Diesendorf and Diesendorf, 1997) or when Luis Garcia, recipient of awards for his pioneering work on pseudoconditioning, was blocked from core psychology journals for nearly two decades (Lubek and Apfelbaum, 1987;Revusky, 1977). More generally, there is considerable evidence that many editors and referees are hostile to papers that challenge prevailing beliefs (Armstrong, 1996(Armstrong, , 1997Campanario, 1995;Epstein, 1990;Horrobin, 1990;Lang, 1998;Mahoney, 1976Mahoney, ,1979Thompson, 1999). ...
    Article
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    Research data can be suppressed in various ways, including organizational secrecy, defamation law and refusal to reply to queries. In a broader sense, methods of suppression include pressures not to do research in the first place and attacks on scientists who produce unwelcome data. The context of this sort of suppression includes individual self‐interest, vested interests, and paradigms. Suppressing research data can be either compatible with or contrary to accountability, depending on the constituencies involved. Ways to challenge suppression of research data include individual requests, exposés, refusal to suppress, publicity, creating new data, and social movements.
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