On April 17, 2023, I posted a reel I called "Fluoride Dumbing Down Your Kids?" It drew an immediate warning from Instagram that the information could mislead people. My reel presented evidence that fluoridated water is consistently associated with lower IQs in children. Well, just last week a federal judge agreed with me in a ruling that could very possibly end the fluoridation of water in the US. Specifically, the Court found that fluoridation of water at 0.7 mg/L – the level presently considered “optimal” in the United States – poses an unreasonable risk of reduced IQ in children. The court did not go so far as to definitively say fluoride causes lower IQ in children. Federal Judge Edward Chen took seven years to issue his ruling largely because he wanted to wait for the results of a six-year systematic review by the National Toxicology Program on the State of the Science Concerning Fluoride Exposure and Neurodevelopment and Cognition. In the end, the judge found that the EPA did not follow it's own default margin of error policy requiring a difference of a factor of 10 between the lowest level that shows harm and the level we expose people to. 4mg/L has been the accepted lowest level of exposure that the factor of 10 is calculated from. According to their own policy, that would put the exposure at 0.4mg/L, which is significantly lower than the current CDC recommendation of 0.7mg/L. And the court ordered the EPA to initiate rule-making to that effect. How they will implement that order remains to be seen. Although these findings are authoritative, they are not binding on water companies and municipalities. Local communities make the final decisions on fluoridation of water. So watch and see what actions your water supplier takes in light of these findings. In the meantime, if you don't want fluoride in your drinking water, you have to filter it out using reverse osmosis, distillation, or ion exchange. I would do that if you're pregnant or have young kids based on this information. I am not opposed to supplementing fluoride. That is a personal choice. But I do remain opposed to the mass drugging of a population. It's hard to give personal consent to something added to the community water supply. For more detail and excerpts from the ruling, see my show notes.

Description:

On September 24, 2024, a federal judge issued the most important ruling ever on the fluoridation of drinking water in the US. This reel summarizes the landmark case. Regardless of how you may feel about fluoridation of community drinking water, I urge you to consider the wisdom of such mass undertakings in public health. If we get it wrong, the wrongness is mass distributed over decades. Whatever the virtues of a policy, the science can reveal problems that only surface years later. If you wish to supplement fluoride for your children, you can get a prescription for that. That is a personal choice. But its pretty hard to opt out of a drug that is in drinking water nationwide. I take no position on fluoride supplementation in this piece. Let's just step back and look at possible harm and personal rights of consent.

Additional detail:

The case was brought against the Environmental Protection Agency in federal court by environmental groups and concerned citizens after the EPA denied their petition in 2016 to end the practice of adding fluoride to public drinking water, which they submitted in response to emerging research suggesting it could cause neurological damage.

Publication of The six-year systematic review by the National Toxicology Program on the State of the Science Concerning Fluoride Exposure and Neurodevelopment and Cognition was suppressed for nearly a year by the government delaying the conclusion of this case.

Exposure level endpoint for fluorosis (changes in color/texture of tooth enamel) is lower than for IQ changes

Footnote on pg 25 of Final Ruling

"Unlike the NTP Monograph, Taher (2024) considered evidence relating to multiple endpoints (i.e., a particular adverse effect, see Dkt. No. 434-15, Trial Ex. 535 at 43) aside from reduced IQ to decide which endpoints need be accounted for by regulators; endpoints considered included kidney dysfunction, sex hormone disruptions, and dental fluorosis, see Dkt. No. 433-4, Trial Ex. 129 at 21-23. Taher (2024) concluded that dental fluorosis and reduced IQ are critical endpoints; evidence supported the association between fluoride and those two adverse effects. See id. at 27. Taher (2024) did find that dental fluorosis should be the primary endpoint used by regulators because data regarding the association between dental fluorosis and fluoride was more certain than evidence regarding the association between IQ reduction and fluoride. Id. However, Taher (2024) explained that both dental fluorosis, and separately, IQ reduction in children should be considered by regulatory bodies, including the United States EPA, when assessing regulation of fluoride.

"To this end, the review recommended that fluoride at 1.56 mg/L be deemed hazardous, explaining that this level should be utilized by regulators in its calculations to protect the public against both dental fluorosis and IQ reduction. See id. Thus, the findings of Taher (2024) are consistent with the NTP Monograph’s finding that fluoride is associated with reduced IQ, particularly at exposure levels above 1.5 mg/L."

[That would take the exposure rate from the current 0.7mg/L to 0.16mg/L]

Although hazard is not conclusive at lower exposure levels, it has to meet a margin of safety

Pg 4 of Final Ruling

"Notwithstanding recognition by EPA’s expert that fluoride is hazardous, the EPA points to technicalities at various steps of the risk evaluation to conclude that fluoride does not present an unreasonable risk. Primarily, the EPA argues the hazard level and the precise relationship between dosage and response at lower exposure levels are not entirely clear. These arguments are not persuasive.

"Importantly, the chemical at issue need not be found hazardous at the exposure level to establish that a risk is present under Amended Toxic Substances Control Act ("TSCA"). Instead, the EPA requires a margin exist between the hazard level and exposure level to ensure safety; if there is an insufficient margin then the chemical poses a risk. The trial evidence in this case establishes that even if there is some uncertainty as to the precise level at which fluoride becomes hazardous (hazard level), under even the most conservative estimates of this level, there is not enough of a margin between the accepted hazard level and the actual human exposure levels to find that fluoride is safe. Simply put, the risk to health at exposure levels in United States drinking water is sufficiently high to trigger regulatory response by the EPA under Amended TSCA."

Additional data provided by benchmark dose analysis of pregnant mothers' urine

Pg 4-5 of Final Ruling

"Subsequently, toxicology experts endeavored to put a finer point on the impact of fluoride on children’s IQ at “lower” exposure levels, i.e., those below 1.5 mg/L, and conducted a pooled benchmark dose analysis to define the precise hazard level of fluoride. For reasons described below, this pooled benchmark dose analysis benefited from increased statistical power relative to the NTP’s assessment due to its methodology (i.e., the benchmark dose analysis used individualized, continuous data, while the NTP assessment did not, due to quantity and variety of studies the NTP reviewed in that assessment). The pooled benchmark dose analysis concluded that a 1-point drop in IQ of a child is to be expected for each 0.28 mg/L of fluoride in a pregnant mother’s urine. This is highly concerning, because maternal urinary fluoride levels for pregnant mothers in the United States range from 0.8 mg/L at the median and 1.89 mg/L depending upon the degree of exposure. Not only is there an insufficient margin between the hazard level and these exposure levels, for many, the exposure levels exceed the hazard level of 0.28 mg/L.

"The EPA challenges, for a variety of reasons, whether this 0.28 mg/L hazard level (measured in maternal urinary fluoride) is appropriate for this risk evaluation. The EPA argues, among other things, that the hazard and exposure levels should not be expressed in maternal urinary fluoride because that metric reflects total fluoride exposure – not just exposure resulting from drinking fluoridated water from one’s community. Fluoride may also be ingested through, e.g., tea, fish, toothpaste, and commercial food and beverage made with fluoridated water. Nonetheless, the risk analysis should consider the additive effect of the chemical under the subjected condition of use (here, fluoridated community drinking water), especially where, as here,the fluoridated drinking water is a significant (and likely primary) contributor to aggregate exposure to fluoride. Indeed, the Amended TSCA, expressly contemplates that the aggregate exposure to a chemical will be considered when conducting a risk assessment. See 15 U.S.C. §2605(b)(4)(F). In this sense, maternal urinary fluoride is not just an acceptable metric, it is highly useful in assessing the real-world end result of exposure from drinking fluoridated water along with other sources."

Safety margin is a factor of 10

Pg 6 of Final Ruling

"The EPA’s default margin of error requires a factor of 10 between the hazard level and exposure level due to variability in human sensitivities. Put differently, only an exposure that is below 1/10th of the hazard level would be deemed safe under Amended TSCA, given the margin of error required. Here, an even greater margin (100x) is owed because the methodology (which yields the 4 mg/L hazard level) uses the lowest observed adverse effect level (“LOAEL”); this methodology adds an additional level of uncertainty (and hence the application of a 100x rather than 10x margin). But even if only the default 10x margin is required, the safe level of fluoride exposure would be 0.4 mg/L (4 mg/L (hazard level) divided by 10). The “optimal” water fluoridation level in the United States of 0.7 mg/L is nearly double that safe level of 0.4 mg/L for pregnant women and their offspring."

Conclusions

Pg 3 of Final Ruling:

"There is little dispute in this suit as to whether fluoride poses a hazard to human health. Indeed, EPA’s own expert agrees that fluoride is hazardous at some level of exposure. And ample evidence establishes that a mother’s exposure to fluoride during pregnancy is associated with IQ decrements in her offspring."

Pg 4 of Final Ruling

"The NTP concluded that fluoride is indeed associated with reduced IQ in children, at least at exposure levels at or above 1.5mg/L."

Conclusions of Law

Pg 79 of Final Ruling

• "Plaintiffs have proven, by a preponderance of the evidence, that water fluoridation at the level of 0.7 mg/L – the prescribed optimal level of fluoridation in the United States – presents an “unreasonable risk of injury to health or the environment, without consideration of costs or other non-risk factors, including an unreasonable risk to a potentially exposed or susceptible subpopulation under the conditions of use.” 15 U.S.C. § 2620(b)(4)(B)(ii)."

• "The Court thus orders the Administrator to initiate rulemaking pursuant to Subsection 6(a) of TSCA. See id. §§ 2605(a), 2620(a)."

• "The Court defers ruling as to whether Plaintiffs are entitled to recovery of their costs of suit and attorneys and expert witness fees. Parties are ordered to submit a proposed supplemental briefing schedule regarding costs and fees within two weeks of the date of this order. Defendant shall respond two weeks thereafter. The Court will take the matter under submission unless it orders a hearing."

• "The Clerk of Court is directed to enter judgment in Plaintiffs’ favor."