The research continues to accumulate: Fluoride exposure harms the brain and reduces IQ.
The U.S. Centers for Disease Control and Prevention considers community water fluoridation
one of the ten greatest public health achievements of the 20th century.
The view of US regulatory agencies has also been the dominate view of
the medical community. Have these long-held beliefs stood the test of
It has already been established that fluoride crosses the placenta, and laboratory studies show
that it accumulates in brain regions involved in learning and memory
and alters proteins and neurotransmitters in the central nervous system.
Now, a recent study is the first
to estimate fluoride exposure in a large birth cohort receiving
optimally fluoridated water. Published in the journal JAMA Pediatrics,the study
has forced many to re-examine the practice of water fluoridation.
Funded by the Canadian government and the U.S. National Institute of
Environmental Health Science, the the new study titled Association Between Maternal Fluoride Exposure During Pregnancy and IQ Scores in Offspring in Canada examined
the association between fluoride exposure during pregnancy and the IQ
scores of the children at ages 3 and 4 years of age.
The scientists assessed fluoride
exposure in two separate ways. They measured fluoride in women’s urine
samples during pregnancy while also calculating fluoride consumption
based on how much is in a city’s water supply and how much women
The study found that of the 512
mother-child pairs, a 1-mg/L increase in maternal urinary fluoride was
associated with a 4.49-point lower IQ score in boys.
The study’s authors concluded:
exposure to higher levels of fluoride during pregnancy was associated
with lower IQ scores in children aged 3 to 4 years. These findings
indicate the possible need to reduce fluoride intake during pregnancy.“
Perhaps sensing the potential blowback from publishing the recent Canadian study in JAMA Pediatrics, the journal’s Editor-In-Chief Dimitri Christakis provide an editor’s note to accompany the study stating impart, “This
decision to publish this article was not easy. Given the nature of the
findings and their potential implications, we subjected it to additional
scrutiny for its methods and the presentation of its findings.“
Christakis said during in recent JAMA Pediatrics Editors Summary podcast, “For me, before there were ‘anti-vaxers’ there were sort of ‘anti-fluoriders.‘” He shared that while he was going through residency, the traditional teaching he received was that “fluoride is completely safe. All these people that are tying to take it out of the water are nuts.”
He commented about the recent study’s findings saying they were
“sizable” and “on par’ with the IQ drops seen in children exposed to
lead. When Christakis was asked what he would recommend as a
pediatrician if a pregnant mother came into his office he replied “I would advise them to drink bottled water.“
Outlets like NPR
and others cautioned readers not to read too much into a single study.
Yet for those who have followed the hard science placing in question the
practice of water fluoridation, the recent JAMA Pediatrics study is just another data point along an increasingly clear trajectory.
The recent study findings are consistent with that of a 2017 Mexican birth cohort study published in the journal Environmental Health Perspectives. The 2017 study, sponsored by the U.S. National Institutes of Health, spanned 12 years and found a 6.3 point reduction in IQ in preschool-aged children.
suggest that routine imaging for low back pain is a waste of time and
money that sometimes harms patients. Why does it persist?
Like all primary care physicians, Danielle Ofri sees a lot of aching backs. Low back pain is one of the top five reasons
people visit the doctor, and based on extensive experience, Ofri knows
how the conversations will go. Patients want relief from miserable pain,
so they want an imaging study. “I want to see what’s going on — that’s
what they say,” says Ofri, who treats patients at Bellevue Hospital in
F. Todd Wetzel identifies the problem as “the technological tail wagging the medical dog.”
The easy thing to do is order a scan and send them home to wait for
the results. The right thing to do, in the vast majority of cases, is
to deliver the bad news: They need to wait for the pain to subside on
its own, which may mean a few weeks of agony. In the meantime, if
possible, it’s best to stay active and limit bed rest. An over-the-counter pain reliever might help. Unless certain symptoms point to a more serious problem, the physician shouldn’t order any imaging within the first six weeks of pain. On this last point, medical guidelines
are remarkably clear and backed by studies demonstrating that routine
imaging for low back pain does not improve one’s pain, function, or
quality of life. The exams are not just a waste of time and money,
physician groups say; unnecessary imaging may lead to problems that are
much more serious than back pain.
And yet, between 1995 and 2015, magnetic resonance imaging (MRI) and
other high-tech scans for low back pain increased by 50 percent,
according to a new systematic review published in the British Journal of Sports Medicine. According to a related analysis, up to 35 percent of the scans were inappropriate. Medical societies have launched campaigns to convince physicians and patients to forgo the unnecessary images, but to little avail.
Love Undark? Sign up for our newsletter!
It’s a symptom of a well-diagnosed problem: the overuse of medical services. Unnecessary imaging isn’t confined to just low back pain. Americans spend more than $100 billion on various types of diagnostic imaging each year, much of which is unnecessary and potentially even harmful. F. Todd Wetzel,
past president of the North American Spine Society, identifies the
problem as “the technological tail wagging the medical dog.” After MRI
and computed tomography (CT) emerged in the 1970s, many physicians
started routinely using scans to make a diagnosis for low back pain,
rather than using them the way they’re intended to be used: to confirm or refute an uncertain diagnosis.
of diagnostic imaging was crystal clear a decade ago, but medical
practice changes slowly. Conventional wisdom suggests that, on average,
it takes 17 years for new medical knowledge to be incorporated into practice. Arthur Hong, an economist and primary care physician at UT Southwestern Medical Center in Dallas, has studied
inappropriate imaging for low back pain. He says public health
campaigns — think about smoking cessation, for example — move slowly.
“It’s taking a long time and we’re not there yet, but it’s a worthy
effort,” he says. “We’ve got to keep trying.”
Low back pain is a major health care headache in part because it’s so common. At least 60 percent of U.S. adults will experience it during their life and more than 30 percent report experiencing low back pain the preceding three months. In the U.S., an estimated 264 million work days are lost every year because of back pain.
The majority of adults over 60 have a disc protrusion — but it may not be the cause of low back pain.
Cheryl Clay, a recently retired office worker in Springfield,
Missouri, hurt herself when she picked up a case of soda 40 years ago
and she has suffered low back pain on and off ever since. “It’s a
throbbing, aching pain and when it flares up, it’s a consistent ache,”
she says. “It’s like it is locked — like my back is trying to bend but
it is locked halfway.”
Clay is hardly alone; recurring back pain episodes are common. Not surprisingly, many sufferers end up in a doctor’s
office. According to medical guidelines, the physician should examine
them for red flags that suggest infection, fracture, or another urgent
problem. If none are seen, the cause of the patient’s pain is most
likely muscle strain, herniated disc, or degenerative disc disease, a
term that describes the signs of wear and tear on the spinal discs as
they age, says Wetzel, who is chief of orthopedics at Bassett Medical
Center in Cooperstown, New York.
“Ninety percent of patients with low back pain will respond to things
like medication and goal-directed physical therapy, and they do not need
imaging at all,” Wetzel says.
MRIs often find lower back abnormalities that have nothing to do with
the patient’s pain —as well as abnormalities on nearby organs.
Visual: HadelProductions / Getty Images
Physicians say there are good reasons to avoid imaging. Though X-rays
are inexpensive, they zap a patient with radiation, which may raise
one’s risk of cancer. (High doses of X-rays are known to cause cancer in
humans, but the carcinogenic effect of exposure to radiation at the low
doses associated with medical imaging is not well supported; still, the
average radiation from a spinal X-ray is 75 times higher than that from a chest X-ray, leading medical guidelines to caution against unnecessary exposure.) CT scans also use radiation and are more expensive.
But the biggest problem, say physician groups, is the MRI. While this technology doesn’t use radiation, it is expensive and can actually provide too much information. David C. Levin, a radiologist at Thomas Jefferson University Hospital in Philadelphia, explains: “If
you took a whole bunch of people who had no symptoms and did MRIs of
their low back, you’d find all kinds of disc herniations and protrusions
and all sorts of other things that really aren’t causing symptoms.” The
majority of adults over 60, for example, have some disc degeneration — but it may not be the cause of low back pain.
MRIs frequently lead to surgery
for benign abnormalities, says Wetzel, who has researched why back
surgeries so often fail to alleviate symptoms. “The MRI provides so much
information that oftentimes it’s difficult to realize that much of it
may be irrelevant to the problem that brought the patient to your
doorstep,” he says.
MRIs of the lower spine also detect abnormalities on nearby organs.
Adrenal glands, Levin says, are notorious for having cysts that, in the
end, won’t cause any problems. But once a radiologist spots even a small
mass on the adrenal gland, it has to be reported to the primary care
doctor because it could be cancer.
That will likely lead to more tests
which, in turn, may find more potential problems that may or may not be
something that actually needs attention. And anything that leads to
surgery puts the patient at additional risk. A recent study of so-called
low-value hospital procedures
found that spine surgeries for uncomplicated low back pain were
associated with high rates of hospital-acquired complications,
infections being the most common.
The researchers’ conclusion: use of low-value procedures “in patients
who probably should not receive them is harming some of those patients.”
The idea that
patients receive medical procedures that physicians consider
unnecessary, wasteful or “low-value” may seem strange — unless you work
in health care.
In one survey, more than half the clinicians feared that a hypothetical patient would be upset if she did not receive imaging.
Nearly a decade ago, the Institute of Medicine (now the National Academy of Medicine) estimated that 30 percent of health care spending is wasted. Other estimates have ranged from 27 percent to more than 50 percent; an analysis published last year in Health Affairs said that “wasted spending now comfortably exceeds $1 trillion annually.”
MRI machines, like the state-of the-art model at
Tri-Service General Hospital in Taiwan shown here, often provide too
much information that may not be relevant to people suffering from low
That waste includes excessive administrative expenses (for medical
documentation and billing, for example) and fraud, but every calculation
includes a healthy dose of “unnecessary services.” The Health Affairs
researchers estimated that roughly $241 billion in 2016 was wasted on overtreatment.
To chip away at that, the American Board of Internal Medicine Foundation launched the Choosing Wisely
initiative in 2012 with the goal of reducing unnecessary medical tests
and treatments. The idea is that each medical society identifies a list
of the top five “overused” tests and treatments in its specialty and
encourages its physicians to mend their ways. Items on the list are by
no means verboten; rather, items on a society’s Choosing Wisely list
deserve careful consideration rather than a quick decision.
Some 80 medical specialty societies have since called out more than 540 low-value tests and treatments. Imaging for low back pain might be the most popular target.
Eight specialty societies — including two of the largest, the American
College of Physicians and the American Academy of Family Physicians —
have tagged imaging for low back pain as an overused service.
So far, the campaign has not been a rousing success. In the first
two-and-a-half years after Choosing Wisely started, inappropriate
imaging for back pain dropped just 4 percent,
according to Hong’s research. He looked at imaging in the U.S., where
Choosing Wisely got its start. The campaign has since spread to 20
countries around the world. Earlier this year, a research team reviewed 45 studies of low back imaging rates
in North America, Europe, Australia, and New Zealand between 1995 and
2017. During that time, one in four patients who visited a primary care
doctor complaining of back pain received imaging. For those who visited
an emergency room, the numbers were one in three.
“The rate of complex imaging appears to have increased over 21 years
despite guideline advice and education campaigns,” the researchers said.
inappropriate imaging remain so common? Research points to a number of
factors, including what is, for many physicians, a paradox. “It’s hard
to be responsible for taking care of folks and then only tell them the
things you’re not going to do for them,” says Hong.
Medical groups have tagged imaging for low back pain as an overused service and asked their members to “choose wisely.”
can prompt physicians to provide unnecessary care, and physician
ownership or investment in imaging facilities is associated with higher rates
of imaging. But physicians working in the U.S. Department of Veterans
Affairs (VA) system, which provides low- to no-cost health care to more
than 9 million enrolled veterans and their families, do not have
financial incentives for ordering wasteful images — and yet a nearly a third
of the MRIs they ordered for low back pain in a single year were
inappropriate. When that was discovered, a research team set out to
figure out why
these scans were being ordered. The researchers asked nearly 600 VA
physicians, nurse practitioners, and physician assistants what they
would do with a hypothetical 45-year-old woman — low back pain, no
red-flag symptoms — who was asking for an MRI or a CT scan.
Only 3 percent thought the scan was a good idea and 77 percent said
they would worry that imaging would lead to unnecessary tests or
procedures. But clinical judgment wasn’t the only thing on their minds.
More than half the clinicians thinking about the hypothetical patient
feared that she would be upset if she did not receive imaging and that
Choosing Wisely recommendations would not be persuasive. “Many patients
don’t feel as though they’re getting an appropriate evaluation for back
pain unless they have an MRI,” Wetzel says.
And more than a quarter worried they would be leaving themselves open
to a malpractice claim if they didn’t order the test. “It’s easier to
follow the path of least resistance,” Levin says. “Let the patient go
get an MRI and then see what happens.”
Hong was a resident physician at Mayo Clinic several years ago when
a radiologist came to see him complaining of low back pain. During the
examination, he found no red flags, and the patient volunteered that he
knew the imaging guidelines for the situation.
“But he felt so terrible, and his back was so painful, that he just
kept asking me in kind of a weird way,” Hong remembers. “I finally
picked up on it: ‘Oh, this guy is asking me for an X-ray of his back.
And it’s because he just wants something done.’”
People in pain may not be receptive to a conversation about wasted
health care spending and medical guidelines that would let them suffer
for six weeks before getting an image. Ofri often opts to discuss the
potential risks of radiation exposure, which prompt patients to back off
their requests for a scan. Sometimes she discusses a likely root cause —
too much weight in the abdomen or poor lifting technique — and urges
patients to make lifestyle changes to avoid back pain episodes in the
future. She sympathizes that it isn’t really what they want to hear.
“Patients just want to feel better,” Ofri says. “The situation is not
Unfortunately, the European mindset refuses to face the reality, as if the challenge is too severe to be addressed. ‘The conference took place under the theme ‘Penser l’Europe’ [‘Thinking of Europe’]… There, I was disturbed to hear Tariq Ramadan
We Focus On News From The Oil Rich Niger-Delta Region Of Nigeria. Southernvoicenews Online Newspaper/ Magazine... We Tell The Story About The Niger-Delta People. We Report Politics, Health, Education, Aviation, Security, Oil and Gas, Religion, Views, Interviews, Opinion, Arts & Culture, Agriculture, Energy & Power, Human Angle. We Always Strive To Balance Our Reports Through Thorough Investigative Journalism, Our News Are Accurate, Objective & Balanced. We Believe In Fairness, Equity And Justice.