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AN OPEN LETTER TO CNN REGARDING YOUR FLUORIDE COVERAGE
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Please see signatures at the bottom of letter
January 8, 2025
Unbiased Science
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_ When you ignore context, public health suffers. _
Structure of sodium fluoride, Public Domain
Dear CNN Editorial Team,
We are writing in response to your recent article "Children exposed to
higher fluoride levels have lower IQs, a government study finds
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(January 6, 2025). While we appreciate your coverage of this important
public health topic, we must express serious concerns about the
article's framing and significant omissions that could mislead your
readers about water fluoridation – one of public health's most
successful interventions.
YOUR HEADLINE REQUIRES CRITICAL CONTEXT
Your headline and opening paragraphs lack essential context
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the National Toxicology Program (NTP)
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actual implications. Specifically, the research examined fluoride
levels of ≥1.5 mg/L – more than double the amount (0.7 mg/L) used
in U.S. community water fluoridation programs. This distinction is
paramount
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appears only deep within the article. The NTP highlights
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the current amount of fluoride recommended in U.S. community water
supplies has not been demonstrated to have a negative effect on
children’s IQ.
Moreover, when you report that "every 1 part per million increase in
fluoride in urine... was associated with a roughly 1 point drop in a
child's IQ score," you don't emphasize that this finding pertains to
exposure levels far above what the vast majority of Americans
encounter. Only about 0.6% of the U.S. population (approximately 1.9
million people) are exposed to these naturally high fluoride levels
that were the focus of the study. And even this small subgroup of
Americans has protections in place from the Safe Drinking Water Act,
which ensures that anyone with fluoride concentration greater than 2.0
mg/mL be notified
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their public water system.
Your article accepts without question that IQ scores provide a
reliable measure of cognitive ability. However, the scientific
community has long debated the validity and reliability of IQ testing,
particularly in children. IQ scores can be influenced by numerous
factors including testing conditions, cultural context, socioeconomic
status, and even the time of day. Moreover, a one-point difference in
IQ score - the magnitude of change your article highlights - falls
well within the standard error of measurement for most IQ tests and is
highly unlikely to translate to any meaningful difference in
real-world cognitive function or life outcomes.
When discussing potential cognitive impacts, it's essential to
distinguish between statistical significance and clinical
significance. While researchers may detect small statistical
differences in large population studies, this doesn't necessarily
indicate meaningful impacts on individual children's cognitive
development or functioning. Your article's emphasis on a one-point IQ
difference risks causing unnecessary alarm about an effect that may
have no practical significance.
Your article would benefit from acknowledging the significant scrutiny
the NTP report has faced. The American Dental Association (ADA)
has highlighted
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methodological concerns, including:
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Inconsistent application of risk of bias criteria
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Inadequate statistical rigor
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Selective reporting of non-significant study results
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Most studies were conducted outside the U.S. in areas with naturally
high fluoride levels
Earlier drafts of this report required major revision after peer
review by the National Academies of Sciences, Engineering and Medicine
found they "would not survive scientific scrutiny." While the final
version has been improved, many of these fundamental concerns persist.
The authors of the JAMA paper themselves even note as a limitation
that “many of the studies (included in the meta-analysis) were
classified as having a high risk of bias.”
THE OVERLOOKED HEALTH IMPACTS OF POOR DENTAL CARE
Your article focuses exclusively on theoretical risks while ignoring
the well-documented cognitive and health impacts of poor dental
hygiene. Research has demonstrated clear links between oral health and
overall well-being, including cognitive function. Untreated dental
problems can lead to chronic inflammation, which is associated with
cognitive decline. Moreover, children with poor dental health often
face challenges in school due to pain, difficulty eating, sleep
disruption, and decreased self-esteem - all factors that can impact
learning and cognitive development.
The historical record is clear
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before widespread fluoridation, dental infections were a leading cause
of death. While such severe outcomes are rare today thanks to modern
dental care and fluoridation, we still see significant impacts of poor
dental health, including:
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Chronic pain affecting concentration and learning
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Systemic inflammation linked to cognitive impairment
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Nutritional deficiencies from difficulty eating
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Sleep disruption affecting memory and attention
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Social and psychological impacts affecting academic performance
These documented impacts on cognition and health deserve consideration
alongside any discussion of fluoride safety.
THE MISSING HEALTH EQUITY STORY
Perhaps most concerning is your article's near-complete omission of
the significant health equity implications
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water fluoridation. As public health scientists and practitioners, we
believe your readers deserve to understand that:
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Water fluoridation prevents at least 25% of tooth decay in children
and adults
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Every $1 spent on fluoridation saves approximately $20 in dental
procedures
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The impact is most pronounced in lower-income communities where access
to regular dental care may be limited
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Fluoridation provides universal protection regardless of socioeconomic
status or access to dental care
The experience of cities that have ceased fluoridation is instructive.
In Calgary, which ended fluoridation in 2011, researchers documented
increased social inequities in dental health. Similarly, after Juneau,
Alaska removed fluoride in 2007, there were significant increases in
dental procedures related to cavities, with the impact falling
disproportionately on children from socioeconomically disadvantaged
families.
HISTORICAL CONTEXT MATTERS
Your readers would benefit from understanding why water fluoridation
was implemented in the first place. In the early 1900s, dental
infections were a major cause of mortality. The discovery that
fluoride could prevent tooth decay led to one of public health's
greatest achievements. In Grand Rapids, Michigan – the first city to
fluoridate its water – researchers documented a 60-65% reduction in
dental caries among children who consumed fluoridated water from
birth.
RECOMMENDATIONS FOR FUTURE COVERAGE
As a trusted news source, CNN has a responsibility to provide
comprehensive, contextualized coverage of public health issues. Future
reporting on this topic should:
1. Clearly distinguish between exposure levels in research studies and
those used in U.S. water fluoridation programs
2. Include context about the proportion of the population affected by
high natural fluoride levels
3. Address the health equity implications of water fluoridation
4. Consider the comprehensive body of evidence supporting
fluoridation's safety and effectiveness
5. Consult a broader range of experts, including public health
practitioners and health equity researchers
CONSENSUS MATTERS
The scientific consensus remains clear: community water fluoridation
at recommended levels (0.7 mg/L) is safe and effective
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Major health organizations worldwide, including the World Health
Organization, American Dental Association, and Centers for Disease
Control and Prevention, continue to endorse this practice.
While ongoing scientific inquiry into fluoride's effects is important,
it's essential that media coverage provides proper context and avoids
sensationalism that could undermine public health. This one new review
does not actually add much to our understanding of fluoride. The real
story here isn't about the dangers of water fluoridation – it's
about the importance of maintaining appropriate safety margins while
preserving one of public health's most successful and equitable
interventions.
WE URGE YOU TO CONSIDER PUBLISHING A FOLLOW-UP PIECE THAT ADDRESSES
THESE ESSENTIAL MISSING ELEMENTS AND PROVIDES YOUR READERS WITH THE
FULL CONTEXT THEY NEED TO UNDERSTAND THIS IMPORTANT PUBLIC HEALTH
ISSUE.
Sincerely,
Dr. Jess Steier, DrPH, Public Health Scientist, Founder of Unbiased
Science [[link removed]]
Dr. Joe Schwarcz, PhD, CM, Chemist, Director of McGill
University’s Office for Science & Society
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Dr. Katrine Wallace, PhD, Epidemiologist, University of Illinois
Chicago School of Public Health
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Dr. Ashley Lerman, DDS, Diplomate, American Board of Pediatric
Dentistry, Columbia University College of Dental Medicine
Dr. Norbert Kaminski, PhD, Immunotoxicologist, Director of the
Institute for Integrative Toxicology, Michigan State University.
Dr. Ryan Marino, MD, Medical Toxicologist & Associate Professor Case
Western Reserve University School of Medicine
Michelle Bridenbaker, RN, BSN, MS, MBA, Critical Care Nurse and
Toxicologist
Dr. Sarah Scheinman, PhD, Neurobiologist, Northwestern University
Feinberg School of Medicine
Dr. Nicole Lippman, Ph.D., Licensed Clinical Psychologist
Dr. Leigh Baxt, PhD, Drug Discovery Biologist
Dr. David Robert Grimes (PhD CStat), Trinity College Dublin School of
Medicine
Dr. Shoshana Ungerleider, MD, Internal Medicine, Host/Producer TED
Health
Whitney DiFoggio, MA, RDH, Registered Dental Hygienist and Doctoral
Candidate at Eastern Virginia Medical School
Dr. Kevin C. Klatt, PhD, RD, Research Scientist, University of
California Berkeley, Department of Nutritional Sciences & Toxicology
________________________________________________________________________
_As a diverse team of public health scientists, toxicologists,
clinicians, chemists, epidemiologists, biologists, statisticians, and
psychologists, we felt compelled to respond to CNN's recent coverage
of fluoride safety. While we appreciate CNN's attention to public
health topics, their January 6th article about fluoride exposure and
IQ scores requires important scientific context and clarification.
Though we note that CNN's accompanying video provides some additional
context, research shows that many readers do not engage with
supplementary content and primarily absorb information from headlines
and article text alone. Our collective expertise across toxicology,
neuroscience, epidemiology, clinical practice, and public health
policy positions us to address several critical omissions in the
reporting that could unnecessarily alarm the public about one of our
most successful public health interventions._
_Unbiased Science combats health & science mis- and dis-information.
Contact us at
[email protected]._
_Subscribe to Unbiased Science
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