On Wednesday, the National Toxicology Program (NTP) published a long-delayed report establishing a connection between elevated fluoride levels in drinking water and reduced IQ scores in children. This report marks the first time the government has acknowledged this risk, reigniting discussions about the safety of fluoride, a substance widely used in public health for decades.
Key Findings
The report by the NTP, an interagency program within the U.S. Department of Health and Human Services (HHS), represents a comprehensive review of existing research on fluoride’s potential neurotoxic effects. It evaluated studies from diverse geographical areas, including both regions with naturally high fluoride levels in groundwater and countries like the United States, Canada, and Mexico, where fluoride is intentionally added to drinking water.
Here are the main findings:
Moderate Confidence in Fluoride’s Neurotoxicity: The report concluded with “moderate confidence” that fluoride concentrations exceeding 1.5 milligrams per liter (mg/L) in drinking water are consistently associated with lower IQ scores in children.
Consistent Evidence Across Studies: The report found that 18 out of 19 high-quality studies reviewed showed a significant correlation between fluoride exposure and diminished IQ levels in children. Additionally, the majority of studies examining other neurodevelopmental outcomes supported these findings.
Multiple Fluoride Sources: The report pointed out that drinking water is not the only source of fluoride exposure. Products such as toothpaste and tea also contribute to overall fluoride intake, indicating that even in areas with optimal fluoridation, total exposure may be higher than recommended.
The NTP also mentioned “some evidence” suggesting that fluoride exposure may be linked to various other neurodevelopmental and cognitive effects in children, and, to a lesser degree, in adults.
The report did not evaluate the exact number of IQ points lost due to fluoride exposure.
Methodology
While the mainstream media, such as The Associated Press, stresses that the report discusses a concentration that is twice the recommended level of 0.7 milligrams per liter, suggesting the findings are irrelevant, the government scientists say the opposite.
Per the report,
However, because people receive fluoride from multiple sources (not just drinking water), individuals living in areas with optimally fluoridated water can have total fluoride exposures higher than the concentration of their drinking water. In addition, there are people living in the United States who live in areas with naturally occurring fluoride in drinking water that is higher than 1.5 mg/L.
The methodology behind the report was rigorous, involving several rounds of peer review to ensure accuracy. However, the report has faced criticism for allegedly softening some conclusions, which some believe was done to protect existing public health policies. This criticism was expressed, among others, by experts speaking with Children’s Health Defense.
Water Fluoridation in the United States
Water fluoridation has been a mainstay of public health policy in the United States since the 1940s. The practice, which involves adding fluoride, a naturally occurring mineral, to public water supplies, was adopted as a way to prevent dental cavities on a large scale. Over the years, it has been celebrated as one of the top public health achievements of the 20th century, along with vaccinations and family planning.
The principle behind water fluoridation is straightforward: when small amounts of fluoride are introduced into community water supplies, people are exposed to fluoride throughout the day, which helps in preventing tooth decay. The practice has led to significant reductions in dental caries, especially in children, and has garnered support from organizations like the American Dental Association (ADA) and the World Health Organization (WHO). The latter considers a concentration of 1.5 milligrams per liter safe.
The U.S. Environmental Protection Agency (EPA) has a drinking-water standard of fluoride concentration of 2.0 mg/L.
According to research published in 2023, a large portion of American population is exposed to elevated levels of fluoride.
Despite its success in oral health, water fluoridation has not been without controversy. Critics argue that it constitutes mass medication without informed consent, and that the potential risks, particularly to children’s neurological development, have been underreported.
Fluoride on Trial
The debate over fluoride’s safety has also made its way into the courts, most notably in the ongoing lawsuit between the EPA and the Fluoride Action Network (FAN).
In 2017, FAN, alongside other advocacy groups, filed a lawsuit challenging the EPA’s 2016 decision to deny a petition that sought to regulate or ban fluoride under the Toxic Substances Control Act (TSCA). The plaintiffs argued that fluoride is a neurotoxin and should be treated similarly to other toxic substances, either by being strictly regulated or removed from public water supplies altogether.
The case has seen multiple delays, largely due to the awaited publication of the NTP report. The presiding judge, Edward Chen, paused the trial until the report was made public. Now that the report has been released, the trial is expected to continue, and its outcome could significantly impact fluoridation practices in the United States.
The EPA maintains that fluoride levels in U.S. drinking water are safe and that the benefits of fluoride in preventing dental decay far outweigh any potential risks. However, with the findings in the new NTP report, the plaintiffs’ case may gain additional support, potentially leading to significant changes in water treatment practices and public health policies across the nation.
Delays in the Report’s Publication
Notably, the publication of the report appears to have been significantly delayed due to interventions from various levels of the government. According to emails revealed in early 2023 as part of the aforementioned trial, several attempts were made to block or postpone the release of the NTP’s findings.
According to a report at website The Last American Vagabond, internal communications indicate that NTP scientists believed their work was complete in early 2022 and planned to publish the report in May of that year. However, leadership within the HHS intervened, expressing concerns about releasing the report without further review by the National Institutes of Health (NIH) and other government bodies. This led to a series of delays, with emails indicating that high-level officials, including the director of the NIH and the assistant secretary of Health, were involved in halting the report’s release.
The emails also show that despite NTP’s readiness to publish, CDC leadership pushed for additional reviews, effectively blocking the report. The delays were compounded by disagreements over the inclusion of certain statements in the report, with peer reviewers and government scientists debating the necessity of highlighting that most studies reviewed involved fluoride exposure levels above the recommended levels for water fluoridation
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