Until 1981 I knew nothing more of fluoride´s biological implications than that it was good for bones and teeth because it is a part of the apatite mineral that is responsible for the hardness of those tissues. At least I was told so in school many years ago. Frankly, I was not so much interested in that topic then, for a simple mineral which hardens teeth and bones I found not really exciting.

Does fluoride cause cancer?

It was a letter from a famous physician of Hannover, Dr. Hans Nieper (a friend of Dr. Dean Burk), to the editor of a medical journal that drew my and my wife´s attention to the problem late in 1981. In response to an article on possible immuno-suppressive effects of tetracyclines, Dr. Nieper suggested that fluorides used in water fluoridation might have contributed to the observed occurrence of Non-Hodgkin lymphoma in American and Canadian patients consulting him. They had been treated - three months to three years before the diagnosis- with tetracyclines. As no such association existed in his German patients with lymphoma or myeloma, Dr. Nieper thought that an additional factor, typical for the U.S.A. and Canada, might be synergistic with tetracycline leading to cancer. Besides the possiblity of viruses and nitrites, he mentioned fluoridation and referred to evidence of carcinogenic fluoride effects presented at a court trial in Pittsburgh, Pa.  I called Dr. Nieper, asked him for his sources and at the same time started searching medical journals for that topic and followed every related reference.

One of Dr. Nieper´s references was a paper by Drs. Yiamouyiannis and Burk. Dr. Burk is known to most physicians from his early studies on enzyme kinetics ("Lineweaver - Burk"), and he worked for many years in the National Cancer Institute (as head of the cytochemistry section). Dr. Nieper was kind enough to give me the address of Dr. Burk in Washington to whom I sent a letter asking for more information. In his reply Dr. Burk wrote on Dec. 5, 1981: "All our evidence is against any use of fluoride in drinking water, a tablet form etc." Of course, if fluoride is carcinogenic it would not only be so if used for water fluoridation, but also in toothpaste, tablets, mouth washes ... as well as in an industrial setup.

One of the references that I found led me to a study on increased lung cancer incidence due to fluoride emissions in people living in the environment of a steel smelter. As I live in a steel city, this story was another surprise.

But mainly Dr. Nieper´s letter found my and my wife´s interest because our daughter had just shown us a form which we parents were asked to sign, saying that our child would be given fluoride tablets in the kindergarten. Needless to say we didn´t sign, I rather contacted the kindergarten people and told them of the issue which they too hadn´t heard of. They contacted the local health department and the struggle went on.

"If certain people knew ..."

When, after some time, I called our Health Department to ask them about their point of view, I was told that there´s no evidence for a fluoride cancer link and that I should consider what fluoride does for the teeth. The lady on the other end of the phone told me that she herself had introduced fluoride tablets in our federal state in 1969. No, the fluoride emission of our local steel industry is not controlled, for "they do not emit any fluoride". No, fluoride in food is not checked (even in the face of the fact that fluoride was used for some time illegally as a preservative and was still used as a pesticide), they have "no reliable methods" and as yet there was no need felt to develop any.

Concluding the talk, after touching a few more points where I heard alike unprofessional answers, I was told: "If certain people knew how much fluoride they ingest daily, they would certainly ignore the few tenths of a milligramm contained in a fluoride tablet."

What did that mean? Why then give fluoride tablets? "Give fluoride to the people lest they discover they already have it", as a journalist once put it?

A few months later the Health Department had organized what they called an "educational" meeting for the kindergarten leaders and interested parents, after which a major fluoride tablet manufacturer invited for a snack as announced already on the invitation cards. At the meeting they featured two of our best-known German fluoride "experts", one of them working for the Federal Health Office (the German FDA analogue). No one to represent the anti-fluoride position. It was really hair-raising what I got to hear there. The worst twisting of facts that I´ve ever seen [e.g. a slide showing ugly brown stained mottled teeth was presented as showing "beautiful caries-free teeth" - the discoloration, which in our country is occasionally seen in people from Sicily, and surely should have attracted the attention of the audience, was in no way addressed; the Yiamouyiannis-Burk graph was interpreted to show that the fluoridated cities did not actually show a change in trend, but the non-fluoridated ones simply developed better prevention (maybe they did just by not introducing fluoridation)].

Why there is not much interest, generally

I started writing letters to a famous weekly medical journal, which the editor published under the "Letters to the editor" section. Reactions from interested physicians made me aware that most of them had no knowledge of the issue. Their major problem was that most of the research is published in English which many of them are not able to understand. In addition to that, some had not been interested before (like me) because a "simple mineral" didn´t make stuff for a thriller (a pro-fluoride nutritionist explained: "For my book on nutrition I had to slave away at putting together one or two pages on fluoridation"). Some physicians wrote me that after they stopped prescribing fluoride they were threatened by their Medical Association to get their license withdrawn, or by colleagues who indicated they would rethink their referral practice. Others were threatened for putting anti-fluoride posters (printed by a German consumer protection organization) in their waiting rooms.

Dr. Nieper, then president of the German Society for Oncology, invited me to present a paper on fluoride and cancer at a congress of that Society. I did, and thereby I realized that there was indeed much interest in the issue (the "Verlag für Medizin" printed an enlarged version of that paper as a book in 1984).

Medical press silenced

A review of my presentation was published in the medical journal that previously had printed my letters. This article, written at the time when the introduction of water fluoridation in Berlin was considered by a health senator (it was later defeated by a public vote), brought a new experience, both to me and the editor, as now the editor came under pressure. Sure, in the course of my research I had found claims that the press is not free to report on fluoride, and that people even lost their jobs over the issue. Yet, naively, I rather thought that such claims were somewhat exaggerated. Now it became a key experience to me: the fluoride tablet manufacturer, the same who was involved in the Health Department´s "educational efforts" mentioned above, "intervened loudly" and threatened the editor that he would withdraw every advertising order if the editor once again would write something against fluoride. Well, the next issue contained a whole-page fluoride tablet ad and a review of a presentation given by the Federal Health Officer already referred to above. The latter even had learned from one of my arguments (that mineral waters sold here contain high amounts of fluoride): he demonstrated his faith in the mineral by publicly drinking a glass of a mineral water containing 1 ppm of fluoride (How courageous - I never said he would fall dead then, yet his show did not address the possible long-term effects of low-level fluoride intake in the course of years).

"How could us dentists have ever gotten involved in this fluoride matter?"

Once I was invited to participate in a TV discussion on "Fluoride for Babies?". My counterpart representing the pro-fluoride side was the representative of the Dental Association of a German federal state. He vehemently defended the application of fluoride tablets to babies for caries prevention, but as soon as the cameras went off he told me: "Mr. Meiers, in a few years us dentists will ask ´how could we have ever gotten involved in this fluoride matter´".

In order to see how the issue is handled by U. S. Public Health Dentists, I subscribed to a listserv of the American Association of Public Health Dentistry (AAPHD) and I quickly learned there that the issue is no issue at all. This group of apparently sworn-in pro-fluoridation dentists immediately unsubscribes everyone who dares to ask the "wrong" questions about the measure. Impressive examples are given here.

This way my attention was drawn more and more to the history of fluoride and fluoridation. How, actually, could they "have gotten involved in this fluoride matter"?

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