If anyone wants to read more about Stephen and LGBTQIA youth, here is the NYT article.

The New York Time's

Generation LGBTQIA

By MICHAEL SCHULMAN

Published: January 10, 2013

STEPHEN IRA, a junior at Sarah Lawrence College, uploaded a video last March on We Happy Trans, a site that shares "positive perspectives" on being transgender.

In the breakneck six-and-a-half-minute monologue - hair tousled, sitting in a wood-paneled dorm room - Stephen exuberantly declared himself "a queer, a nerd fighter, a writer, an artist and a guy who needs a haircut," and held forth on everything from his style icons (Truman Capote and "any male-identified person who wears thigh-highs or garters") to his toy zebra.

Because Stephen, who was born Kathlyn, is the 21-year-old child of Warren Beatty and Annette Bening, the video went viral, garnering nearly half a million views. But that was not the only reason for its appeal. With its adrenalized, freewheeling eloquence, the video seemed like a battle cry for a new generation of post-gay gender activists, for whom Stephen represents a rare public face.

Armed with the millennial generation's defining traits - Web savvy, boundless confidence and social networks that extend online and off - Stephen and his peers are forging a political identity all their own, often at odds with mainstream gay culture.

If the gay-rights movement today seems to revolve around same-sex marriage, this generation is seeking something more radical: an upending of gender roles beyond the binary of male/female. The core question isn't whom they love, but who they are - that is, identity as distinct from sexual orientation.

But what to call this movement? Whereas "gay and lesbian" was once used to lump together various sexual minorities - and more recently "L.G.B.T." to include bisexual and transgender - the new vanguard wants a broader, more inclusive abbreviation. "Youth today do not define themselves on the spectrum of L.G.B.T.," said Shane Windmeyer, a founder of Campus Pride, a national student advocacy group based in Charlotte, N.C.

Part of the solution has been to add more letters, and in recent years the post-post-post-gay-rights banner has gotten significantly longer, some might say unwieldy. The emerging rubric is "L.G.B.T.Q.I.A.," which stands for different things, depending on whom you ask.

"Q" can mean "questioning" or "queer," an umbrella term itself, formerly derogatory before it was appropriated by gay activists in the 1990s. "I" is for "intersex," someone whose anatomy is not exclusively male or female. And "A" stands for "ally" (a friend of the cause) or "asexual," characterized by the absence of sexual attraction.

It may be a mouthful, but it's catching on, especially on liberal-arts campuses.

The University of Missouri, Kansas City, for example, has an L.G.B.T.Q.I.A. Resource Center that, among other things, helps student locate "gender-neutral" restrooms on campus. Vassar College offers an L.G.B.T.Q.I.A. Discussion Group on Thursday afternoons. Lehigh University will be hosting its second annual L.G.B.T.Q.I.A. Intercollegiate Conference next month, followed by a Queer Prom. Amherst College even has an L.G.B.T.Q.Q.I.A.A. center, where every group gets its own letter.

The term is also gaining traction on social media sites like Twitter and Tumblr, where posts tagged with "lgbtqia" suggest a younger, more progressive outlook than posts that are merely labeled "lgbt."

"There's a very different generation of people coming of age, with completely different conceptions of gender and sexuality," said Jack Halberstam (formerly Judith), a transgender professor at the University of Southern California and the author, most recently, of "Gaga Feminism: Sex, Gender, and the End of Normal."

"When you see terms like L.G.B.T.Q.I.A.," Professor Halberstam added, "it's because people are seeing all the things that fall out of the binary, and demanding that a name come into being."

And with a plethora of ever-expanding categories like "genderqueer" and "androgyne" to choose from, each with an online subculture, piecing together a gender identity can be as D.I.Y. as making a Pinterest board.

BUT sometimes L.G.B.T.Q.I.A. is not enough. At the University of Pennsylvania last fall, eight freshmen united in the frustration that no campus group represented them.

Sure, Penn already had some two dozen gay student groups, including Queer People of Color, Lambda Alliance and J-Bagel, which bills itself as the university's "Jewish L.G.B.T.Q.I.A. Community." But none focused on gender identity (the closest, Trans Penn, mostly catered to faculty members and graduate students).

Richard Parsons, an 18-year-old transgender male, discovered that when he attended a student mixer called the Gay Affair, sponsored by Penn's L.G.B.T. Center. "I left thoroughly disappointed," said Richard, a garrulous freshman with close-cropped hair, wire-framed glasses and preppy clothes, who added, "This is the L.G.B.T. Center, and it's all gay guys."

Through Facebook, Richard and others started a group called Penn Non-Cis, which is short for "non-cisgender." For those not fluent in gender-studies speak, "cis" means "on the same side as" and "cisgender" denotes someone whose gender identity matches his or her biology, which describes most of the student body. The group seeks to represent everyone else. "This is a freshman uprising," Richard said.

On a brisk Tuesday night in November, about 40 students crowded into the L.G.B.T. Center, a converted 19th-century carriage house, for the group's inaugural open mike. The organizers had lured students by handing out fliers on campus while barking: "Free condoms! Free ChapStick!"

"There's a really vibrant L.G.B.T. scene," Kate Campbell, one of the M.C.'s, began. "However, that mostly encompasses the L.G.B. and not too much of the T. So we're aiming to change that."

Students read poems and diary entries, and sang guitar ballads. Then Britt Gilbert - a punky-looking freshman with a blond bob, chunky glasses and a rock band T-shirt - took the stage. She wanted to talk about the concept of "bi-gender."

"Does anyone want to share what they think it is?"

Silence.

She explained that being bi-gender is like manifesting both masculine and feminine personas, almost as if one had a "detachable penis." "Some days I wake up and think, 'Why am I in this body?' " she said. "Most days I wake up and think, 'What was I thinking yesterday?' 

"Britt's grunginess belies a warm matter-of-factness, at least when describing her journey. As she elaborated afterward, she first heard the term "bi-gender" from Kate, who found it on Tumblr. The two met at freshman orientation and bonded. In high school, Kate identified as "agender" and used the singular pronoun "they"; she now sees her gender as an "amorphous blob."

By contrast, Britt's evolution was more linear. She grew up in suburban Pennsylvania and never took to gender norms. As a child, she worshiped Cher and thought boy bands were icky. Playing video games, she dreaded having to choose male or female avatars.

In middle school, she started calling herself bisexual and dated boys. By 10th grade, she had come out as a lesbian. Her parents thought it was a phase - until she brought home a girlfriend, Ash. But she still wasn't settled.

"While I definitely knew that I liked girls, I didn't know that I was one," Britt said. Sometimes she would leave the house in a dress and feel uncomfortable, as if she were wearing a Halloween costume. Other days, she felt fine. She wasn't "trapped in the wrong body," as the cliché has it - she just didn't know which body she wanted.

When Kate told her about the term "bi-gender," it clicked instantly. "I knew what it was, before I knew what it was," Britt said, adding that it is more fluid than "transgender" but less vague than "genderqueer" - a catchall term for nontraditional gender identities.

At first, the only person she told was Ash, who responded, "It took you this long to figure it out?" For others, the concept was not so easy to grasp. Coming out as a lesbian had been relatively simple, Britt said, "since people know what that is." But when she got to Penn, she was relieved to find a small community of freshmen who had gone through similar awakenings.

Among them was Richard Parsons, the group's most politically lucid member. Raised female, Richard grew up in Orlando, Fla., and realized he was transgender in high school. One summer, he wanted to room with a transgender friend at camp, but his mother objected. "She's like, 'Well, if you say that he's a guy, then I don't want you rooming with a guy,' " he recalled. "We were in a car and I basically blurted out, 'I think I might be a guy, too!' "

After much door-slamming and tears, Richard and his mother reconciled. But when she asked what to call him, he had no idea. He chose "Richard" on a whim, and later added a middle name, Matthew, because it means "gift of God."

By the time he got to Penn, he had been binding his breasts for more than two years and had developed back pain. At the open mike, he told a harrowing story about visiting the university health center for numbness and having a panic attack when he was escorted into a women's changing room.

Nevertheless, he praised the university for offering gender-neutral housing. The college's medical program also covers sexual reassignment surgery, which, he added, "has heavily influenced my decision to probably go under the Penn insurance plan next year."

PENN has not always been so forward-thinking; a decade ago, the L.G.B.T. Center (nestled amid fraternity houses) was barely used. But in 2010, the university began reaching out to applicants whose essays raised gay themes. Last year, the gay newsmagazine The Advocate ranked Penn among the top 10 trans-friendly universities, alongside liberal standbys like New York University.

More and more colleges, mostly in the Northeast, are catering to gender-nonconforming students. According to a survey by Campus Pride, at least 203 campuses now allow transgender students to room with their preferred gender; 49 have a process to change one's name and gender in university records; and 57 cover hormone therapy. In December, the University of Iowa became the first to add a "transgender" checkbox to its college application.

"I wrote about an experience I had with a drag queen as my application essay for all the Ivy Leagues I applied to," said Santiago Cortes, one of the Penn students. "And I got into a few of the Ivy Leagues - Dartmouth, Columbia and Penn. Strangely not Brown.

"But even these measures cannot keep pace with the demands of incoming students, who are challenging the curriculum much as gay activists did in the '80s and '90s. Rather than protest the lack of gay studies classes, they are critiquing existing ones for being too narrow.

Several members of Penn Non-Cis had been complaining among themselves about a writing seminar they were taking called "Beyond 'Will & Grace,' " which examined gay characters on shows like "Ellen," "Glee" and "Modern Family." The professor, Gail Shister, who is a lesbian, had criticized several students for using "L.G.B.T.Q." in their essays, saying it was clunky, and proposed using "queer" instead. Some students found the suggestion offensive, including Britt Gilbert, who described Ms. Shister as "unaccepting of things that she doesn't understand."

Ms. Shister, reached by phone, said the criticism was strictly grammatical. "I am all about economy of expression," she said. "L.G.B.T.Q. doesn't exactly flow off the tongue. So I tell the students, 'Don't put in an acronym with five or six letters.' "

One thing is clear. Ms. Shister, who is 60 and in 1979 became The Philadelphia Inquirer's first female sportswriter, is of a different generation, a fact she acknowledges freely, even gratefully. "Frankly, I'm both proud and envious that these young people are growing up in an age where they're free to love who they want," she said.

If history is any guide, the age gap won't be so easy to overcome. As liberated gay men in the 1970s once baffled their pre-Stonewall forebears, the new gender outlaws, to borrow a phrase from the transgender writer Kate Bornstein, may soon be running ideological circles around their elders.

Still, the alphabet soup of L.G.B.T.Q.I.A. may be difficult to sustain. "In the next 10 or 20 years, the various categories heaped under the umbrella of L.G.B.T. will become quite quotidian," Professor Halberstam said.

Even at the open mike, as students picked at potato chips and pineapple slices, the bounds of identity politics were spilling over and becoming blurry.

At one point, Santiago, a curly-haired freshman from Colombia, stood before the crowd. He and a friend had been pondering the limits of what he calls "L.G.B.T.Q. plus."

"Why do only certain letters get to be in the full acronym?" he asked.

Then he rattled off a list of gender identities, many culled from Wikipedia. "We have our lesbians, our gays," he said, before adding, "bisexual, transsexual, queer, homosexual, asexual." He took a breath and continued. "Pansexual. Omnisexual. Trisexual. Agender. Bi-gender. Third gender. Transgender. Transvestite. Intersexual. Two-spirit. Hijra. Polyamorous."

By now, the list had turned into free verse. He ended: "Undecided. Questioning. Other. Human."

The room burst into applause.

Correction: January 10, 2013, Thursday

This article has been revised to reflect the following correction: An earlier version of this article and a picture caption referred incorrectly to a Sarah Lawrence College student who uploaded a video online about being transgender. He says he is Stephen Ira, not Stephen Ira Beatty.

Source NYT

Fair Use

That (1:05) certainly wasn't the first problem I saw in calculus! In fact, I don't actually remember it from either maths or physics.

Interesting talk. Eugene Wigner made a somewhat similar observation in 1959/1960 (obviously not about string theory though, just about the relationship between mathematics and the real world).

http://www.nytimes.com/2010/06/20/magazine/20pacemaker-t.html?pagewanted=all

One October afternoon three years ago while I was visiting my parents, my mother made a request I dreaded and longed to fulfill. She had just poured me a cup of Earl Grey from her Japanese iron teapot, shaped like a little pumpkin; outside, two cardinals splashed in the birdbath in the weak Connecticut sunlight. Her white hair was gathered at the nape of her neck, and her voice was low. “Please help me get Jeff’s pacemaker turned off,” she said, using my father’s first name. I nodded, and my heart knocked.
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Upstairs, my 85-year-old father, Jeffrey, a retired Wesleyan University professor who suffered from dementia, lay napping in what was once their shared bedroom. Sewn into a hump of skin and muscle below his right clavicle was the pacemaker that helped his heart outlive his brain. The size of a pocket watch, it had kept his heart beating rhythmically for nearly five years. Its battery was expected to last five more.

After tea, I knew, my mother would help him from his narrow bed with its mattress encased in waterproof plastic. She would take him to the toilet, change his diaper and lead him tottering to the couch, where he would sit mutely for hours, pretending to read Joyce Carol Oates, the book falling in his lap as he stared out the window.

I don’t like describing what dementia did to my father — and indirectly to my mother — without telling you first that my parents loved each other, and I loved them. That my mother, Valerie, could stain a deck and sew an evening dress from a photo in Vogue and thought of my father as her best friend. That my father had never given up easily on anything.

Born in South Africa, he lost his left arm in World War II, but built floor-to-ceiling bookcases for our living room; earned a Ph.D. from Oxford; coached rugby; and with my two brothers as crew, sailed his beloved Rhodes 19 on Long Island Sound. When I was a child, he woke me, chortling, with his gloss on a verse from “The Rubaiyat of Omar Khayyam”: “Awake, my little one! Before life’s liquor in its cup be dry!” At bedtime he tucked me in, quoting “Hamlet” : “May flights of angels sing thee to thy rest!”

Now I would look at him and think of Anton Chekhov, who died of tuberculosis in 1904. “Whenever there is someone in a family who has long been ill, and hopelessly ill,” he wrote, “there come painful moments when all timidly, secretly, at the bottom of their hearts long for his death.” A century later, my mother and I had come to long for the machine in my father’s chest to fail.

Until 2001, my two brothers and I — all living in California — assumed that our parents would enjoy long, robust old ages capped by some brief, undefined final illness. Thanks to their own healthful habits and a panoply of medical advances — vaccines, antibiotics, airport defibrillators, 911 networks and the like — they weren’t likely to die prematurely of the pneumonias, influenzas and heart attacks that decimated previous generations. They walked every day. My mother practiced yoga. My father was writing a history of his birthplace, a small South African town.

In short, they were seemingly among the lucky ones for whom the American medical system, despite its fragmentation, inequity and waste, works quite well. Medicare and supplemental insurance paid for their specialists and their trusted Middletown internist, the lean, bespectacled Robert Fales, who, like them, was skeptical of medical overdoing. “I bonded with your parents, and you don’t bond with everybody,” he once told me. “It’s easier to understand someone if they just tell it like it is from their heart and their soul.”

They were also stoics and religious agnostics. They signed living wills and durable power-of-attorney documents for health care. My mother, who watched friends die slowly of cancer, had an underlined copy of the Hemlock Society’s “Final Exit” in her bookcase. Even so, I watched them lose control of their lives to a set of perverse financial incentives — for cardiologists, hospitals and especially the manufacturers of advanced medical devices — skewed to promote maximum treatment. At a point hard to precisely define, they stopped being beneficiaries of the war on sudden death and became its victims.

Things took their first unexpected turn on Nov. 13, 2001, when my father — then 79, pacemakerless and seemingly healthy — collapsed on my parents’ kitchen floor in Middletown, making burbling sounds. He had suffered a stroke.

He came home six weeks later permanently incapable of completing a sentence. But as I’ve said, he didn’t give up easily, and he doggedly learned again how to fasten his belt; to peck out sentences on his computer; to walk alone, one foot dragging, to the university pool for water aerobics. He never again put on a shirt without help or looked at the book he had been writing. One day he haltingly told my mother, “I don’t know who I am anymore.”

His stroke devastated two lives. The day before, my mother was an upper-middle-class housewife who practiced calligraphy in her spare time. Afterward, she was one of tens of millions of people in America, most of them women, who help care for an older family member.

Their numbers grow each day. Thanks to advanced medical technologies, elderly people now survive repeated health crises that once killed them, and so the “oldest old” have become the nation’s most rapidly growing age group. Nearly a third of Americans over 85 have dementia (a condition whose prevalence rises in direct relationship to longevity). Half need help with at least one practical, life-sustaining activity, like getting dressed or making breakfast. Even though a capable woman was hired to give my dad showers, my 77-year-old mother found herself on duty more than 80 hours a week. Her blood pressure rose and her weight fell. On a routine visit to Dr. Fales, she burst into tears. She was put on sleeping pills and antidepressants.

My father said he came to believe that she would have been better off if he had died. “She’d have weeped the weep of a widow,” he told me in his garbled, poststroke speech, on a walk we took together in the fall of 2002. “And then she would have been all right.” It was hard to tell which of them was suffering more.

As we shuffled through the fallen leaves that day, I thought of my father’s father, Ernest Butler. He was 79 when he died in 1965, before pacemakers, implanted cardiac defibrillators, stents and replacement heart valves routinely staved off death among the very old. After completing some long-unfinished chairs, he cleaned his woodshop, had a heart attack and died two days later in a plain hospital bed. As I held my dad’s soft, mottled hand, I vainly wished him a similar merciful death.

A few days before Christmas that year, after a vigorous session of water exercises, my father developed a painful inguinal (intestinal) hernia. My mother took him to Fales, who sent them to a local surgeon, who sent them to a cardiologist for a preoperative clearance. After an electrocardiogram recorded my father’s slow heartbeat — a longstanding and symptomless condition not uncommon in the very old — the cardiologist, John Rogan, refused to clear my dad for surgery unless he received a pacemaker.

Without the device, Dr. Rogan told me later, my father could have died from cardiac arrest during surgery or perhaps within a few months. It was the second time Rogan had seen my father. The first time, about a year before, he recommended the device for the same slow heartbeat. That time, my then-competent and prestroke father expressed extreme reluctance, on the advice of Fales, who considered it overtreatment.

My father’s medical conservatism, I have since learned, is not unusual. According to an analysis by the Dartmouth Atlas medical-research group, patients are far more likely than their doctors to reject aggressive treatments when fully informed of pros, cons and alternatives — information, one study suggests, that nearly half of patients say they don’t get. And although many doctors assume that people want to extend their lives, many do not. In a 1997 study in The Journal of the American Geriatrics Society, 30 percent of seriously ill people surveyed in a hospital said they would “rather die” than live permanently in a nursing home. In a 2008 study in The Journal of the American College of Cardiology, 28 percent of patients with advanced heart failure said they would trade one day of excellent health for another two years in their current state.

When Rogan suggested the pacemaker for the second time, my father was too stroke-damaged to discuss, and perhaps even to weigh, his trade­offs. The decision fell to my mother — anxious to relieve my father’s pain, exhausted with caregiving, deferential to doctors and no expert on high-tech medicine. She said yes. One of the most important medical decisions of my father’s life was over in minutes. Dr. Fales was notified by fax.

Fales loved my parents, knew their suffering close at hand, continued to oppose a pacemaker and wasn’t alarmed by death. If he had had the chance to sit down with my parents, he could have explained that the pacemaker’s battery would last 10 years and asked whether my father wanted to live to be 89 in his nearly mute and dependent state. He could have discussed the option of using a temporary external pacemaker that, I later learned, could have seen my dad safely through surgery. But my mother never consulted Fales. And the system would have effectively penalized him if she had. Medicare would have paid him a standard office-visit rate of $54 for what would undoubtedly have been a long meeting — and nothing for phone calls to work out a plan with Rogan and the surgeon.

Medicare has made minor improvements since then, and in the House version of the health care reform bill debated last year, much better payments for such conversations were included. But after the provision was distorted as reimbursement for “death panels,” it was dropped. In my father’s case, there was only a brief informed-consent process, covering the boilerplate risks of minor surgery, handled by the general surgeon.

I believe that my father’s doctors did their best within a compartmentalized and time-pressured medical system. But in the absence of any other guiding hand, there is no doubt that economics helped shape the wider context in which doctors made decisions. Had we been at the Mayo Clinic — where doctors are salaried, medical records are electronically organized and care is coordinated by a single doctor — things might have turned out differently. But Middletown is part of the fee-for-service medical economy. Doctors peddle their wares on a piecework basis; communication among them is haphazard; thinking is often short term; nobody makes money when medical interventions are declined; and nobody is in charge except the marketplace.

And so on Jan. 2, 2003, at Middlesex Hospital, the surgeon implanted my father’s pacemaker using local anesthetic. Medicare paid him $461 and the hospital a flat fee of about $12,000, of which an estimated $7,500 went to St. Jude Medical, the maker of the device. The hernia was fixed a few days later.

It was a case study in what primary-care doctors have long bemoaned: that Medicare rewards doctors far better for doing procedures than for assessing whether they should be done at all. The incentives for overtreatment continue, said Dr. Ted Epperly, the board chairman of the American Academy of Family Physicians, because those who profit from them — specialists, hospitals, drug companies and the medical-device manufacturers — spend money lobbying Congress and the public to keep it that way.

Last year, doctors, hospitals, drug companies, medical-equipment manufacturers and other medical professionals spent $545 million on lobbying, according to the Center for Responsive Politics. This may help explain why researchers estimate that 20 to 30 percent of Medicare’s $510 billion budget goes for unnecessary tests and treatment. Why cost-containment received short shrift in health care reform. Why physicians like Fales net an average of $173,000 a year, while noninvasive cardiologists like Rogan net about $419,000.

The system rewarded nobody for saying “no” or even “wait” — not even my frugal, intelligent, Consumer-Reports-reading mother. Medicare and supplemental insurance covered almost every penny of my father’s pacemaker. My mother was given more government-mandated consumer information when she bought a new Camry a year later.

And so my father’s electronically managed heart — now requiring frequent monitoring, paid by Medicare — became part of the $24 billion worldwide cardiac-device industry and an indirect subsidizer of the fiscal health of American hospitals. The profit margins that manufacturers earn on cardiac devices is close to 30 percent. Cardiac procedures and diagnostics generate about 20 percent of hospital revenues and 30 percent of profits.

Shortly after New Year’s 2003, my mother belatedly called and told me about the operations, which went off without a hitch. She didn’t call earlier, she said, because she didn’t want to worry me. My heart sank, but I said nothing. It is one thing to silently hope that your beloved father’s heart might fail. It is another to actively abet his death.

The pacemaker bought my parents two years of limbo, two of purgatory and two of hell. At first they soldiered on, with my father no better and no worse. My mother reread Jon Kabat-Zinn’s “Full Catastrophe Living,” bought a self-help book on patience and rose each morning to meditate.

In 2005, the age-related degeneration that had slowed my father’s heart attacked his eyes, lungs, bladder and bowels. Clots as narrow as a single human hair lodged in tiny blood vessels in his brain, killing clusters of neurons by depriving them of oxygen. Long partly deaf, he began losing his sight to wet macular degeneration, requiring ocular injections that cost nearly $2,000 each. A few months later, he forgot his way home from the university pool. He grew incontinent. He was collapsing physically, like an ancient, shored-up house.

In the summer of 2006, he fell in the driveway and suffered a brain hemorrhage. Not long afterward, he spent a full weekend compulsively brushing and rebrushing his teeth. “The Jeff I married . . . is no longer the same person,” my mother wrote in the journal a social worker had suggested she keep. “My life is in ruins. This is horrible, and I have lasted for five years.” His pacemaker kept on ticking.

When bioethicists debate life-extending technologies, the effects on people like my mother rarely enter the calculus. But a 2007 Ohio State University study of the DNA of family caregivers of people with Alzheimer’s disease showed that the ends of their chromosomes, called telomeres, had degraded enough to reflect a four-to-eight-year shortening of lifespan. By that reckoning, every year that the pacemaker gave my irreparably damaged father took from my then-vigorous mother an equal year.

When my mother was upset, she meditated or cleaned house. When I was upset, I Googled. In 2006, I discovered that pacemakers could be deactivated without surgery. Nurses, doctors and even device salesmen had done so, usually at deathbeds. A white ceramic device, like a TV remote and shaped like the wands that children use to blow bubbles, could be placed around the hump on my father’s chest. Press a few buttons and the electrical pulses that ran down the leads to his heart would slow until they were no longer effective. My father’s heart, I learned, would probably not stop. It would just return to its old, slow rhythm. If he was lucky, he might suffer cardiac arrest and die within weeks, perhaps in his sleep. If he was unlucky, he might linger painfully for months while his lagging heart failed to suffuse his vital organs with sufficient oxygenated blood.

If we did nothing, his pacemaker would not stop for years. Like the tireless charmed brooms in Disney’s “Fantasia,” it would prompt my father’s heart to beat after he became too demented to speak, sit up or eat. It would keep his heart pulsing after he drew his last breath. If he was buried, it would send signals to his dead heart in the coffin. If he was cremated, it would have to be cut from his chest first, to prevent it from exploding and damaging the walls or hurting an attendant.

On the Internet, I discovered that the pacemaker — somewhat like the ventilator, defibrillator and feeding tube — was first an exotic, stopgap device, used to carry a handful of patients through a brief medical crisis. Then it morphed into a battery-powered, implantable and routine treatment. When Medicare approved the pacemaker for reimbursement in 1966, the market exploded. Today pacemakers are implanted annually in more than 400,000 Americans, about 80 percent of whom are over 65. According to calculations by the Dartmouth Atlas research group using Medicare data, nearly a fifth of new recipients who receive pacemakers annually — 76,000 — are over 80. The typical patient with a cardiac device today is an elderly person suffering from at least one other severe chronic illness.

Over the years, as technology has improved, the battery life of these devices lengthened. The list of heart conditions for which they are recommended has grown. In 1984, the treatment guidelines from the American College of Cardiology declared that pacemakers were strongly recommended as “indicated” or mildly approved as “reasonable” for 56 heart conditions and “not indicated” for 31 more. By 2008, the list for which they were strongly or mildly recommended expanded to 88, with most of the increase in the lukewarm “reasonable” category.

The research backing the expansion of diagnoses was weak. Over all, only 5 percent of the positive recommendations were supported by research from multiple double-blind randomized studies, the gold standard of evidence-based medicine. And 58 percent were based on no studies at all, only a “consensus of expert opinion.” Of the 17 cardiologists who wrote the 2008 guidelines, 11 received financing from cardiac-device makers or worked at institutions receiving it. Seven, due to the extent of their financial connections, were recused from voting on the guidelines they helped write.

This pattern — a paucity of scientific support and a plethora of industry connections — holds across almost all cardiac treatments, according to the cardiologist Pierluigi Tricoci of Duke University’s Clinical Research Institute. Last year in The Journal of the American Medical Association, Tricoci and his co-authors wrote that only 11 percent of 2,700 widely used cardiac-treatment guidelines were based on that gold standard. Most were based only on expert opinion.

Experts are as vulnerable to conflicts of interest as researchers are, the authors warned, because “expert clinicians are also those who are likely to receive honoraria, speakers bureau [fees], consulting fees or research support from industry.” They called the current cardiac-research agenda “strongly influenced by industry’s natural desire to introduce new products.”

Perhaps it’s no surprise that I also discovered others puzzling over cardiologists who recommended pacemakers for relatives with advanced dementia. “78-year-old mother-in-law has dementia; severe short-term memory issues,” read an Internet post by “soninlaw” on Elderhope.com, a caregivers’ site, in 2007. “On a routine trip to her cardiologist, doctor decides she needs a pacemaker. . . . Anyone have a similar encounter?”

By the summer of 2007, my dad had forgotten the purpose of a dinner napkin and had to be coached to remove his slippers before he tried to put on his shoes. After a lifetime of promoting my father’s health, my mother reversed course. On a routine visit, she asked Rogan to deactivate the pacemaker. “It was hard,” she later told me. “I was doing for Jeff what I would have wanted Jeff to do for me.” Rogan soon made it clear he was morally opposed. “It would have been like putting a pillow over your father’s head,” he later told me.

Not long afterward, my mother declined additional medical tests and refused to put my father on a new anti-dementia drug and a blood thinner with troublesome side effects. “I take responsibility for whatever,” she wrote in her journal that summer. “Enough of all this overkill! It’s killing me! Talk about quality of life — what about mine?”

Then came the autumn day when she asked for my help, and I said yes. I told myself that we were simply trying to undo a terrible medical mistake. I reminded myself that my dad had rejected a pacemaker when his faculties were intact. I imagined, as a bioethicist had suggested, having a 15-minute conversation with my independent, predementia father in which I saw him shaking his head in horror over any further extension of what was not a “life,” but a prolonged and attenuated dying. None of it helped. I knew that once he died, I would dream of him and miss his mute, loving smiles. I wanted to melt into the arms of the father I once had and ask him to handle this. Instead, I felt as if I were signing on as his executioner and that I had no choice.

Over the next five months, my mother and I learned many things. We were told, by the Hemlock Society’s successor, Compassion and Choices, that as my father’s medical proxy, my mother had the legal right to ask for the withdrawal of any treatment and that the pacemaker was, in theory at least, a form of medical treatment. We learned that although my father’s living will requested no life support if he were comatose or dying, it said nothing about dementia and did not define a pacemaker as life support. We learned that if we called 911, emergency medical technicians would not honor my father’s do-not-resuscitate order unless he wore a state-issued orange hospital bracelet. We also learned that no cardiology association had given its members clear guidance on when, or whether, deactivating pacemakers was ethical.

(Last month that changed. The Heart Rhythm Society and the American Heart Association issued guidelines declaring that patients or their legal surrogates have the moral and legal right to request the withdrawal of any medical treatment, including an implanted cardiac device. It said that deactivating a pacemaker was neither euthanasia nor assisted suicide, and that a doctor could not be compelled to do so in violation of his moral values. In such cases, it continued, doctors “cannot abandon the patient but should involve a colleague who is willing to carry out the procedure.” This came, of course, too late for us.)

In the spring of 2008, things got even worse. My father took to roaring like a lion at his caregivers. At home in California, I searched the Internet for a sympathetic cardiologist and a caregiver to put my Dad to bed at night. My frayed mother began to shout at him, and their nighttime scenes were heartbreaking and frightening. An Alzheimer’s Association support-group leader suggested that my brothers and I fly out together and institutionalize my father. This leader did not know my mother’s formidable will and had never heard her speak about her wedding vows or her love.

Meanwhile my father drifted into what nurses call “the dwindles”: not sick enough to qualify for hospice care, but sick enough to never get better. He fell repeatedly at night and my mother could not pick him up. Finally, he was weak enough to qualify for palliative care, and a team of nurses and social workers visited the house. His chest grew wheezy. My mother did not request antibiotics. In mid-April 2008, he was taken by ambulance to Middlesex Hospital’s hospice wing, suffering from pneumonia.

Pneumonia was once called “the old man’s friend” for its promise of an easy death. That’s not what I saw when I flew in. On morphine, unreachable, his eyes shut, my beloved father was breathing as hard and regularly as a machine.

My mother sat holding his hand, weeping and begging for forgiveness for her impatience. She sat by him in agony. She beseeched his doctors and nurses to increase his morphine dose and to turn off the pacemaker. It was a weekend, and the doctor on call at Rogan’s cardiology practice refused authorization, saying that my father “might die immediately.” And so came five days of hard labor. My mother and I stayed by him in shifts, while his breathing became increasingly ragged and his feet slowly started to turn blue. I began drafting an appeal to the hospital ethics committee. My brothers flew in.

On a Tuesday afternoon, with my mother at his side, my father stopped breathing. A hospice nurse hung a blue light on the outside of his hospital door. Inside his chest, his pacemaker was still quietly pulsing.

After his memorial service in the Wesleyan University chapel, I carried a box from the crematory into the woods of an old convent where he and I often walked. It was late April, overcast and cold. By the side of a stream, I opened the box, scooped out a handful of ashes and threw them into the swirling water. There were some curious spiraled metal wires, perhaps the leads of his pacemaker, mixed with the white dust and pieces of bone.

A year later, I took my mother to meet a heart surgeon in a windowless treatment room at Brigham and Women’s Hospital in Boston. She was 84, with two leaking heart valves. Her cardiologist had recommended open-heart surgery, and I was hoping to find a less invasive approach. When the surgeon asked us why we were there, my mother said, “To ask questions.” She was no longer a trusting and deferential patient. Like me, she no longer saw doctors — perhaps with the exception of Fales — as healers or her fiduciaries. They were now skilled technicians with their own agendas. But I couldn’t help feeling that something precious — our old faith in a doctor’s calling, perhaps, or in a healing that is more than a financial transaction or a reflexive fixing of broken parts — had been lost.

The surgeon was forthright: without open-heart surgery, there was a 50-50 chance my mother would die within two years. If she survived the operation, she would probably live to be 90. And the risks? He shrugged. Months of recovery. A 5 percent chance of stroke. Some possibility, he acknowledged at my prompting, of postoperative cognitive decline. (More than half of heart-bypass patients suffer at least a 20 percent reduction in mental function.) My mother lifted her trouser leg to reveal an anklet of orange plastic: her do-not-resuscitate bracelet. The doctor recoiled. No, he would not operate with that bracelet in place. It would not be fair to his team. She would be revived if she collapsed. “If I have a stroke,” my mother said, nearly in tears, “I want you to let me go.” What about a minor stroke, he said — a little weakness on one side?

I kept my mouth shut. I was there to get her the information she needed and to support whatever decision she made. If she emerged from surgery intellectually damaged, I would bring her to a nursing home in California and try to care for her the way she had cared for my father at such cost to her own health. The thought terrified me.

The doctor sent her up a floor for an echocardiogram. A half-hour later, my mother came back to the waiting room and put on her black coat. “No,” she said brightly, with the clarity of purpose she had shown when she asked me to have the pacemaker deactivated. “I will not do it.”

She spent the spring and summer arranging house repairs, thinning out my father’s bookcases and throwing out the files he collected so lovingly for the book he never finished writing. She told someone that she didn’t want to leave a mess for her kids. Her chest pain worsened, and her breathlessness grew severe. “I’m aching to garden,” she wrote in her journal. “But so it goes. ACCEPT ACCEPT ACCEPT.”

Last August, she had a heart attack and returned home under hospice care. One evening a month later, another heart attack. One of my brothers followed her ambulance to the hospice wing where we had sat for days by my father’s bed. The next morning, she took off her silver earrings and told the nurses she wanted to stop eating and drinking, that she wanted to die and never go home. Death came to her an hour later, while my brother was on the phone to me in California — almost as mercifully as it had come to my paternal grandfather. She was continent and lucid to her end.

A week later, at the same crematory near Long Island Sound, my brothers and I watched through a plate-glass window as a cardboard box containing her body, dressed in a scarlet silk ao dai she had sewn herself, slid into the flames. The next day, the undertaker delivered a plastic box to the house where, for 45 of their 61 years together, my parents had loved and looked after each other, humanly and imperfectly. There were no bits of metal mixed with the fine white powder and the small pieces of her bones.

Katy Butler lives in Mill Valley, Calif., and teaches memoir writing at the Esalen Institute in Big Sur.

From a fellow Halifax / Dartmouth native who also recently visited Vancouver and Vancouver Island, I feel your pain. Although, I'm now in North Carolina rather than China, even this relatively small geographic hop makes me feel out of place at times.

I hope all goes well with your move and you can continue to contribute to the sift. Good luck!

what u think of this (its a long read)
http://gonzalolira.blogspot.com/2011/09/what-i-learned-at-dartmouth.html#more

i don't know if you share my opinion of unprincipled people, but I will know if you read it.

*promote *money
I wrote a tongue-in-cheek column about corporate personhood earlier this year.

http://www.dailynebraskan.com/opinion/hale-let-the-corporations-have-their-rights-role-in-government-1.2531819

It would be interesting if corporations weren't people. But they are.

The aftermath of a few slapdash U.S. Supreme Court decisions means that today's companies resemble citizens more and more. And, much like the pigs and men sitting at the table in "Animal Farm," it is already impossible to determine which is which.

A few key court decisions sowed the seeds for corporate personhood. In Trustees of Dartmouth College v. Woodward (1819), it was ruled that a private business was exempt from state laws seeking to interfere with established contracts. In other words, the court ruled, states can't pass laws that impair business contracts.

In 1886, in Santa Clara County v. Southern Pacific Railroad Company, the Supreme Court ruled that corporations were entitled to protection under the Fourteenth Amendment. This decision — and its implications were huge — granted corporations the rights of citizenship.

Just last year the Supreme Court ruled, in Citizens United v. Federal Election Commission, that First Amendment rights should be extended to corporations. The floodgate of contributions — mostly anonymous — helped sweep the Tea Party to power and shake up the status quo in Washington, D.C.

It won't be long until corporations are extended Constitutional protections enjoyed by U.S. citizens. Rather than stall sharing our rights with big business, perhaps we should endorse it.

Surely, the National Rifle Association would have no qualm extending Second Amendment rights to big businesses. They may argue corporations should enjoy the same protections our forefathers had. After all, they'll say, why should corporations have to only rely on banks and lobbyists to protect their interests? They're guaranteed to blanket their members with pro-corporate paraphernalia backing whichever businesses packs the most heat. And nothing short of San Francisco can stop the NRA.

As soon as Constitutional rights are extended to corporations, they should be able to run for president. Foreign companies — much like Arnold Schwarzenegger — need not apply.

Rather than spending money for voters to elect whichever presidential candidates get the most campaign contributions and airtimes, corporations could cut out the middle man and invest in their own campaigns.

Congress is guaranteed to be friendly to a corporation in the Oval Office. Two corporations — a president and a vice president — could help put an end to wasteful government spending by working closely with legislation. Most legislators already nip at the bit for corporate donations; it's essential to winning. Corporations would bridge the aisle between Democrats and Republicans better than George Washington.

Boeing Co., the world's largest plane manufacturer, would never land billions of dollars' worth of imprudent government contracts to build impractical engines if the money were coming out of their own pockets, so to speak. And Congress would never again have to pursue worthless pet projects to keep jobs in their state, because worthless pet projects would cost corporate White House money.

Every "bridge to nowhere" must have a strip mall at the end.

As is, a majority of the Supreme Court already defers status to big business over citizens, and it wouldn't take too long until the minority could be replaced. The awesome powers of a corporate-backed executive branch, marching in lockstep with the legislative and judicial, would outrival any nation. Even China would eventually owe us money.

Of course, a business oligarchy is probably not what the framers of the U.S. Constitution originally intended for us. But lesser nations have endured far more with far less. And who among us doesn't want what's best for us?

Critics of corporate personhood want to amend the U.S Constitution to limit the rights of corporations. They argue that corporations, because their sole purpose is to make a profit, shouldn't have the same rights as you or I.

These critics are especially alarmed that corporations can make significantly larger political contributions than individual citizens. Some critics say that this is just one example where the rights of corporations actually exceed the rights of citizens. It does seem lopsided. But with such a global competitive market, how else can we compete with other countries?

Maybe corporate personhood isn't such a bad idea after all. What else could unite Americans more than having Coke and Pepsi run on the same ticket?

If a corporation were president it just might invest more time and more money at home. Then, maybe, we could all sit at the table.

This video has been declared a duplicate by the original submitter; transferring votes to the original video and killing this dupe - dupeof declared by moodonia.

Yeah its a dupe, how that didnt show up when I was searching for it is beyond me...

*dupeof=http://videosift.com/video/Conan-O-Brien-s-2011-Dartmouth-College-Commencement-Address

might be dupe: http://videosift.com/video/Conan-O-Brien-s-2011-Dartmouth-College-Commencement-Address

By the way, I won't argue with you, rougy because you're absolutely right. But don't forget that CBS, ABC, and NBC, cable channels CNN and MSNBC, as well as major newspapers, news-wires, and radio outlets, especially CBS News, Newsweek, and the New York Times are the Democratic Party's propaganda outlets.

There, I said the obvious again.

A 2002 study by Jim A. Kuypers of Dartmouth College, Press Bias and Politics, investigated the issue of media bias. In this study of 116 mainstream US papers, including The New York Times, the Washington Post, Los Angeles Times, and the San Francisco Chronicle, Kuypers found that the mainstream press in America tends to favor liberal viewpoints. They found that reporters expressing moderate or conservative points of view were often labeled as holding a minority point of view. Kuypers said he found liberal bias in reporting a variety of issues including race, welfare reform, environmental protection, and gun control.

http://web.archive.org/web/20080205062048/http://www.cnsnews.com/ViewCulture.asp?Page=/Culture/archive/200209/CUL20020917b.html


In a survey conducted by the American Society of Newspaper Editors in 1997, 61% of reporters stated that they were members of or shared the beliefs of the Democratic Party. Only 15% say their beliefs were best represented by the Republican Party. This leaves 24% undecided or Independent.

http://www.asne.org/kiosk/reports/97reports/journalists90s/journalists.html

Here's Lynn's biography:

"Lynn previously served as the director for Program Analysis and Evaluation in the office of the secretary of Defense, a position he had held since April 1993, and earlier as assistant to the secretary of Defense for Budget.

From 1987 until 1993, Lynn served on the staff of Senator Edward Kennedy as the legislative counsel for defense and arms control matters and his staff representative on the Senate Armed Services Committee. Prior to 1987, he was a senior fellow in the Strategic Concepts Development Center at National Defense University, where he specialized in strategic nuclear forces and arms control issues. He was also on the professional staff of the Institute of Defense Analyses. From 1982 to 1985, he served as the executive director of the Defense Organization Project at the Center for Strategic and International Studies (CSIS).

Lynn is a graduate of Dartmouth College (1976). He has a juris doctorate from Cornell Law School and a master's in Public Affairs from the Woodrow Wilson School at Princeton University (1982). His publications include "Toward a More Effective Defense" (1985) as well as articles in various newspapers and professional journals."


Given this guy's CV, especially with nuclear proliferation on the verge of spinning out of control, I'd give this guy a big fucking waiver, too.

Short answer - Canadian universities are WAY younger than those in the States, so we adopted the 'classic' European terminology. I mean, U of T was founded in 1827 (yeah, guess where I graduated from), and there may be some older universities in Canada (I don't know which), but probably not as old as, say, Harvard.

>> ^Sarzy:
I've got a question which is semi-related to the topic at hand: what's the deal with the terms college and university being seemingly interchangeable in the states? In Canada, college and university are two different things (college is generally a one or two year program in which you learn a trade, whereas university is a three or four year deal in which you learn something a bit more abstract (ie. political science, english, physics, etc.). Is this not the case in the U.S.?


Yeah, American terminology like that bothers me - where's the UNIVERSITY GRAD option???

Anyway, enough people were annoyed by this like us to make a small essay on the topic - the Canadian system:
http://en.wikipedia.org/wiki/College#Canada

And here's the bit about Amerika
http://en.wikipedia.org/wiki/College#The_origin_of_the_U.S._usage

The founders of the first institutions of higher education in the United States were graduates of the University of Oxford and the University of Cambridge. The small institutions they founded would not have seemed to them like universities — they were tiny and did not offer the higher degrees in medicine and theology. Furthermore, they were not composed of several small colleges. Instead, the new institutions felt like the Oxford and Cambridge colleges they were used to — small communities, housing and feeding their students, with instruction from residential tutors (as in the United Kingdom, described above). When the first students came to be graduated, these "colleges" assumed the right to confer degrees upon them, usually with authority -- for example, the College of William and Mary has a Royal Charter from the British monarchy allowing it to confer degrees while Dartmouth College has a charter permitting it to award degrees "as are usually granted in either of the universities, or any other college in our realm of Great Britain."

Contrast this with Europe, where only universities could grant degrees. The leaders of Harvard College (which granted America's first degrees in 1642) might have thought of their college as the first of many residential colleges which would grow up into a New Cambridge university. However, over time, few new colleges were founded there, and Harvard grew and added higher faculties. Eventually, it changed its title to university, but the term "college" had stuck and "colleges" have arisen across the United States.

Eventually, several prominent colleges/universities were started to train Christian ministers. Harvard, Yale, Princeton, and Brown all started to train preachers in the subjects of Bible and theology. However, now these universities teach theology as a more academic than ministerial discipline.

With the rise of Christian education, renowned seminaries and Bible colleges have continued the original purpose of these universities. Criswell College and Dallas Theological Seminary in Dallas; Southern Seminary in Louisville; Trinity Evangelical Divinity School in Deerfield, Illinois; and Wheaton College and Graduate School in Wheaton, Illinois are just a few of the institutions that have influenced higher education in Theology in Philosophy to this day.

In U.S. usage, the word "college" embodies not only a particular type of school, but has historically been used to refer to the general concept of higher education when it is not necessary to specify a school, as in "going to college" or "college savings accounts" offered by banks. "University" is sometimes used in such contexts by Americans who wish to avoid ambiguity, for example in the context of Internet message boards where the reader hail from a different English speaking country.

you are 100% correct about the collusion of science, industry and government. The book does a wonderful job of documenting the collusion.

My problem with rembars stance is that he states that there is no scientific evidence supporting the adverse health affects of fluoride use. He goes so far as to call it a conspiracy and equates it with intelligent design. Even when I present him numerous scientific studies he does not acknowledge them, apparently because they do not coincide with his opinions. I should not have to prove anything other than there is REAL scientific work bring done by scientists (not just some crazy conspiracy theorist). Very frustrating to present evidence and have it discounted soley on the basis that he doesn't agree. That is to say, he can not agree with the outcome of the studies, but to classify them as conspiritorial and scientifically baseless is inexcusable.

Hundreds of scientist have been studying the affects of fluoride, here is the top ten of 2006

Fluoride: Top 10 Scientific Developments of the Year (only 2006)

Fluoride Action Network
January 23, 2007
Over the past year, many important papers on fluoride toxicity were published in the peer-reviewed scientific literature. To give an indication of this recent research, the Fluoride Action Network (FAN) has selected the “Top 10” scientific developments of the year, from 2006 through to the early weeks of 2007.

1) National Research Council: EPA’s fluoride standards are unsafe

The National Research Council’s long-awaited review of fluoride, released in March of 2006, was a watershed moment in the fluoride debate. The 500 page review, which took 12 scientists over three years to produce, describes in great detail why EPA’s purportedly “safe” drinking water standard (4 ppm) needs to be reduced in order to protect human health (1). The report documents myriad potential hazards from fluoride exposure, including damage to the bones, brain, and various glands of the endocrine system. According to Dr. Bob Carton, a former risk-assessment scientist at EPA, this report “should be the centerpiece of every discussion on fluoridation. It changes everything.”

1) National Research Council. (2006). Fluoride in Drinking Water: A Scientific Review of EPA's Standards. National Academies Press, Washington D.C. (Reviewed in: Fluoride 2006; 39(3):163-172.)

2) Harvard Study: Fluoridation associated with bone cancer in boys

In the wake of media scrutiny and an NIH ethics investigation, the first paper from Harvard University’s ongoing study of fluoride and bone cancer was finally published (2). The paper -- published 14 years after the study began -- reported that boys exposed to fluoridated water had a significantly higher rate of an often fatal form of bone cancer called osteosarcoma. According to the study, the boys with the highest rate of osteosarcoma were those that were exposed to fluoridated water during the ages of 6 to 8, although other years of life were also associated with increased risk – including the first year of life. These findings, which are consistent with a 1990 government study that reported the same form of bone cancer in fluoride-treated rats, have resulted in a similar degree of controversy. For example, in 1992, the top toxicologist in EPA’s Office of Drinking Water was fired after publicly expressing concern that the government was downplaying the study’s findings, while, in 2005, the principal investigator of the Harvard study (a dental professor with ties to Colgate) sparked a public outcry after it was revealed he had withheld the study’s findings from federal authorities while claiming it showed no relationship between fluoridation and bone cancer. Together, the government and Harvard studies reveal a disturbing pattern: when it comes to fluoride and cancer, politics can become a malignant force.

2) Bassin EB, Wypij D, Davis RB, Mittleman MA. (2006). Age-specific fluoride exposure in drinking water and osteosarcoma (United States). Cancer Causes and Control 17: 421-8.

3) Too much fluoride can damage the developing brain

In March, the National Research Council broke important ground by dedicating an entire chapter of its report to the growing body of evidence indicating that fluoride can damage the brain. According to the NRC, “it is apparent that fluorides have the ability to interfere with the functions of the brain and the body by direct and indirect means.” However, since we’ve already selected the NRC report as our #1 pick, our #3 pick goes to two recent papers that add further support to the NRC’s conclusions on fluoride’s potential to damage the brain.

The first paper was a review, published in the esteemed medical journal The Lancet, examining the various chemicals in today’s world that may damage a child’s developing brain (3A). The review classified fluoride, along with the rocket fuel additive perchlorate, as an “emerging neurotoxic substance” due to studies linking it to brain damage in animals and lower IQs in children.

The Lancet’s review was officially published on December 16, 2006, less than a month before an environmental health journal in the US published a new study demonstrating -- once again -- that high fluoride exposure can reduce children’s IQ (3B). The study, published in Environmental Health Perspectives, reports that groups of children exposed to 8 ppm fluoride in water have lower average IQ’s, less children attaining high IQ, and more children affected by low IQ. While 8 ppm is higher than the fluoride level added to water in fluoridation programs (0.7-1.2 ppm), previous studies from China indicate that fluoride may affect IQ at lower levels (Xiang 2003), including as low as 0.9 ppm among children with iodine-deficiencies (Lin Fa Fu 1991).

Together, the publication of the Lancet review & the Environmental Health Perspectives study suggest that the mainstream medical literature is finally beginning to recognize this critically important, but previously ignored, issue.

3A) Grandjean P, Landrigan P. (2006). Developmental neurotoxicity of industrial chemicals. The Lancet 368: 2167-2178

3B) Wang SX, et al. (2007). Water arsenic and fluoride exposure and children’s intelligence quotient and growth in Shanyin County, Shanxi, China. Environmental Health Perspectives [Epub Jan 9].

4) Infant fluoride exposure linked to permanent tooth discoloration

The upper front two teeth are the most visible teeth when a person smiles. If a baby is exposed to fluoride during the first year of their life, these two teeth are at risk of being permanently discolored – according to a new study from the University of Iowa (4). And the risk is not just for “baby teeth”, but for permanent teeth as well.

According to the study, exposure to fluoride during the child’s first year of life can cause a tooth defect, known as dental fluorosis, that won’t become apparent until the teeth erupt 7 or 8 years later. Dental fluorosis can result in white and/or brown staining of the teeth and sometimes corrosion of the enamel – effects which will last the child’s entire life if cosmetic treatment cannot be afforded.

The Iowa researchers’ findings may help explain why the American Dental Association later warned, on November 9th, that infants should not receive fluoridated water. The ADA’s warning did not, however, go far enough. According to the Iowa study, the risk of developing fluorosis on the permanent teeth is greatest for those children exposed to fluoride for each of their first four years of life. The take home message: To avoid fluorosis on the permanent front two teeth, keep fluoride away from children until they are at least 5 years old.

4) Hong L, Levy SM, et al. (2006). Timing of fluoride intake in relation to development of fluorosis on maxillary central incisors. Community Dentistry and Oral Epidemiology 34:299-309.

5) Kidney patients at risk of chronic fluoride poisoning

It’s not just infants that should avoid fluoridated water. New research provides yet further reason why people with kidney disease – particularly advanced kidney disease – should be advised to avoid fluoride as well.

Because kidney patients have a reduced ability to clear fluoride from their body, they have long been recognized to be at heightened risk of fluoride poisoning. In 2006, new research helped to further highlight this risk. Research from India confirmed that fluoride can cause a painful bone disease in kidney patients (5A), while research from Poland indicated that the health risks may extend well beyond the bones (5B). According to the Polish researchers, the heightened body burden of fluoride that kidney patients face (as measured by high levels of fluoride in their blood) may increase the rate of cell damage (oxidative stress) throughout the body – making them more vulnerable to a host of illnesses.

So, should people with kidney disease be concerned about drinking fluoridated water? According to two new reviews, the answer is yes (5C,D). According to one review, "Individuals with kidney disease have decreased ability to excrete fluoride in urine and are at risk of developing fluorosis even at normal recommended limit of 0.7 to 1.2 mg/l” (5C).

It’s time, therefore, for dental and medical organizations to start warning kidney patients to avoid water with added fluoride. As noted by Dr. Kathleen Thiessen, a scientist who helped author the National Research Council’s review on fluoride: “People with kidney disease should be very concerned about drinking fluoridated water because it does put them at a higher risk for a number of problems.”

5A) Harinarayan CV, et al. (2006). Fluorotoxic metabolic bone disease: an osteo-renal syndrome caused by excess fluoride ingestion in the tropics. Bone 39: 907-14.

5B) Bober J, et al. (2006). Fluoride aggravation of oxidative stress in patients with chronic renal failure. Fluoride 39:302-309. [See paper]

5C) Bansal R, Tiwari SC. (2006). Back pain in chronic renal failure. Nephrology Dialysis Transplantation 21:2331-2332.

5D) Ayoob S, Gupta AK. (2006). Fluoride in Drinking Water: A Review on the Status and Stress Effects. Critical Reviews in Environmental Science and Technology 36:433–487

6) Cornell scientist diagnoses fluoride poisoning in horses drinking fluoridated water

When fluoride is added to drinking water, it’s not just humans who will consume it. Millions of dogs, cats, and other animals will consume it as well. As we await the publication of a national study investigating the relationship between fluoridated water and bone cancer in dogs, a study published in 2006 provides compelling evidence that some animals may indeed be silent victims of the national water fluoridation program (6A,B).

For years, Cathy Justus’ horses in Pagosa Springs, Colorado, were experiencing symptoms that, no matter what medical treatment she tried, would not go away. The symptoms included colic (i.e. gastrointestinal pain), arthritis-like stiffness of the bones, and skin allergies. Cathy brought her horses to multiple veterinarians in the area, but none were able to find a cure for the horses’ problems -- that is, until she met Dr. Lennart Krook, a retired veterinary researcher from Cornell University. Upon examining the horses, Dr Krook quickly discovered that Cathy’s horses had dental fluorosis – a fluoride-induced condition that created large brown stains and pits on the horses’ teeth. (None of the previous veterinarians Cathy went to had ever bothered to examine the horses’ teeth, and had therefore missed this important warning sign.)

Following the discovery of dental fluorosis, Dr. Krook conducted microscopic analyses of some of the deceased horses’ bones, and found changes in the bone structure that were consistent with skeletal fluorosis. While the horses’ bone fluoride levels (between 600 and 900 ppm) were well below the levels typically associated with skeletal fluorosis (in cattle), Dr. Krook concluded that the horses were, in fact, suffering from “chronic fluoride intoxication.”

Although some have questioned Dr. Krook’s diagnosis (based on the low fluoride levels in the horses’ bones), the owner of the horses swears by it. After her town council voted (in March 2005) to end its water fluoridation program, the symptoms that had plagued Cathy’s horses for nearly 20 years, began to subside – and have not returned since. Coincidence? According to Cathy Justus, the proof is in the pudding.

So, how many other horses are being affected in a similar manner? Dr Krook and Cathy think this is a question horse owners would do well to consider. We agree.

6A) Krook LP, Justus CJ. (2006). Fluoride poisoning of horses from artificially fluoridated drinking water. Fluoride 39:3-10. [See paper]

6B) Justus CJ, Krook LP. (2006). Allergy in horses from artificially fluoridated water. Fluoride 39:89-94. [See paper]

7) Fluoride exposure linked to kidney damage in children

The kidney has long been recognized as a potential target of fluoride toxicity. This is because, as noted by the National Research Council, “Human kidneys... concentrate fluoride as much as 50-fold from plasma to urine. Portions of the renal system may therefore be at higher risk of fluoride toxicity than most soft tissues.”

It was of great interest, therefore, to read the results of a new study investigating the relationship between water fluoride exposure and kidney damage in children (7). According to the study: “our results suggest that drinking water fluoride levels over 2.0 mg/L (ppm) can cause damage to liver and kidney function in children.”

The authors reached this conclusion after studying a group of 210 children living in areas of China with varying levels of fluoride in water (from 0.61 to 5.69 ppm). Among this group, the children drinking water with more than 2 ppm fluoride – particularly those with dental fluorosis - were found to have increased levels of NAG and y-GT in their urine, both of which are markers of kidney damage. The children’s urine also contain increased levels of lactic dehydrogenase – a possible indicator of liver damage.

While definitive conclusions can not be drawn from this single study, it’s findings are consistent with previous animal studies which reported kidney damage from fluoride exposure at levels as low as 1 ppm in rats, and 5 ppm in monkeys. Taken together, the studies suggest that minimizing fluoride intake could well have a positive effect on kidney health.

7) Xiong X, et al. (2007). Dose-effect relationship between drinking water fluoride levels and damage to liver and kidney functions in children. Environmental Research 103:112-116. (Reviewed in: American Academy of Pediatrics (AAP) Grand Rounds; 2007; 17:7).

Water fluoridation linked to higher blood lead levels in children from old homes

Can water fluoridation increase the levels of lead circulating in a child’s blood? This is the question that has been asked ever since Dartmouth scientist, Dr Roger Masters, and chemical engineer, Myron Coplan, published studies in 1999 and 2000 reporting that exposure to fluoridated water was associated with increased blood lead levels in children surveyed from Massachusetts and New York State. According to Masters and Coplan, this association was not observed for all fluoride chemicals, but only those water supplies treated with “silicofluorides” (e.g. fluorosilicic acid and sodium silicofluoride).

Prompted by Masters’ & Coplan’s research, a team of scientists from the University of Maryland and Centers for Disease Control (CDC) examined the blood lead levels of children from a recent national survey to assess if there is any association with water fluoridation (8). In January 2006, the authors published the results of their study in Environmental Health Perspectives. While their findings do not neatly agree with Master’s and Coplan’s earlier studies, they also do not rule out a relationship between fluoridation and blood lead. Indeed, the authors report that water fluoridation is associated with significantly higher blood lead levels among children living in houses built prior to 1946. This is quite a striking finding as there is no shortage of houses built prior to 1946!

Thus, while the study may add a few important nuances to Masters’ & Coplan’s research, it is consistent with the theory that water fluoridation can increase the level of lead in children’s blood. Considering that lead exposure during childhood can result in permanent learning and behavioral disorders, this paper easily deserves recognition as one of the top 10 most important papers on fluoride of the past year.

Macek M, et al. (2006). Blood lead concentrations in children and method of water fluoridation in the United States, 1988-1994. Environmental Health Perspectives 114:130-134.

9) Dental fluorosis linked to tooth decay & psychological stress

One of the myths that has long been perpetuated about fluoride is that dental fluorosis – no matter how severe - is simply a “cosmetic effect.” Based, however, on the research of the past year, it appears this myth is finally on its way out. In March, the National Research Council kicked things off by stating that severe dental fluorosis (marked by extensive staining and pitting of enamel) is an adverse health effect due to its ability to make teeth weaker and prone to decay.

NRC’s conclusion was further reinforced by a study published in December in the journal Community Dental Health (9A). The study, a national survey of children’s teeth in Puerto Rico, found that both severe fluorosis and moderate fluorosis are associated with increased tooth decay and/or restorations.

The physical damage that fluorosis may cause to teeth is not, however, the only concern. Another concern, as detailed over 20 years ago by the National Institute of Mental Health (NIMH), is the psychological impact that dental fluorosis may have on a child. The NIMH’s warning gained renewed support this past year from a study published in Community Dentistry & Oral Epidemiology (9B). According to the study, children with severe dental fluorosis are more likely to be perceived by their peers as less intelligent, less attractive, less social, less happy, less careful, less hygienic, and less reliable – characteristics which could have major effects on a child’s self-esteem. (The latest surveys of dental fluorosis in the US indicate that about 1% of American children now have severe fluorosis, while about 1-3% have moderate fluorosis.)

9A) Elias-Boneta AR, et al. (2006). Relationship between dental caries experience (DMFS) and dental fluorosis in 12-year-old Puerto Ricans. Community Dental Health 23:244-50.

9B) Williams DM, et al. (2006). Attitudes to fluorosis and dental caries by a response latency method. Community Dentistry and Oral Epidemiology 34:153-9.

10) Water fluoridation & the “Precautionary Principle”

Based on the studies from 2006 and early 2007, it is clear that fluoride exposure – at relatively low levels – can harm human health. It has the potential to cause bone cancer, damage the brain, damage the kidney, damage the thyroid, damage the bones (particularly in kidney patients), increase the uptake of lead, and damage the teeth. However, in order to fully prove and understand the nature of these risks (including the range of doses that can cause the effects, and how these doses vary based on environmental, genetic, and dietary factors) more research would need to be conducted. Is it ethical, however, to continue exposing entire populations to fluoride in their water or salt (often against people’s will), while additional long-term studies are carried out to clarify the risks?

That is the crux of the question posed by an insightful analysis published in the March 2006 issue of the Journal of Evidence Based Dental Practice. The analysis, written by Joel Tickner and Melissa Coffin, examines the water fluoridation controversy in the context of the “precautionary principle.” The precautionary principle has become a core guiding principle of environmental health regulations in Europe and reflects the position that:

“if there is uncertainty, yet credible scientific evidence or concern of threats to health, precautionary measures should be taken. In other words, preventive action should be taken on early warnings even though the nature and magnitude of the risk are not fully understood.”

As noted by Tickner & Coffin “The need for precaution arises because the costs of inaction in the face of uncertainty can be high, and paid at the expense of sound public health.”

In determining whether the precautionary principle should be applied to fluoridation, the authors note that:

there are other ways of delivering fluoride besides the water supply;
fluoride does not need to be swallowed to prevent tooth decay;
tooth decay has dropped at the same rate in countries with, and without, water fluoridation;
people are now receiving fluoride from many other sources besides the water supply;
studies indicate fluoride’s potential to cause a range of adverse, systemic effects;
since fluoridation affects so many people, “one might accept a lower level of proof before taking preventive actions.”

While the authors never state their personal opinion on water fluoridation, the issues and questions they’ve raised certainly help to put the debate about fluoridation on the right track.

10) Tickner J, Coffin M. (2006). What does the precautionary principle mean for evidence-based dentistry? Journal of Evidence Based Dental Practice 6:6-15.

http://fluoridealert.org/top-10.htm


In reply to this comment by dag:
I get the impression after watching this- that the whole background of flouridation is tainted by corrupt corporate fucktards and bought scientists.

It's no wonder that people are suspicious - given its provenance - and regardless of its efficacy.

OK - let's move on to taking iodine from salt. Vitamin D from milk? 13 vitamins and minerals from Captain Crunch?

Rembar wanted PEER REVIEWED scientific literature to prove that the issue of Fluoridation (fluoride use) is NOT some consipiracy theory by people with NO scientific knowledge.
HERE IT IS. Hundreds of scientist have been studying the affects of fluoride, here is the top ten of 2006

Fluoride: Top 10 Scientific Developments of the Year (2006)

Fluoride Action Network
January 23, 2007
Over the past year, many important papers on fluoride toxicity were published in the peer-reviewed scientific literature. To give an indication of this recent research, the Fluoride Action Network (FAN) has selected the “Top 10” scientific developments of the year, from 2006 through to the early weeks of 2007.

1) National Research Council: EPA’s fluoride standards are unsafe

The National Research Council’s long-awaited review of fluoride, released in March of 2006, was a watershed moment in the fluoride debate. The 500 page review, which took 12 scientists over three years to produce, describes in great detail why EPA’s purportedly “safe” drinking water standard (4 ppm) needs to be reduced in order to protect human health (1). The report documents myriad potential hazards from fluoride exposure, including damage to the bones, brain, and various glands of the endocrine system. According to Dr. Bob Carton, a former risk-assessment scientist at EPA, this report “should be the centerpiece of every discussion on fluoridation. It changes everything.”

1) National Research Council. (2006). Fluoride in Drinking Water: A Scientific Review of EPA's Standards. National Academies Press, Washington D.C. (Reviewed in: Fluoride 2006; 39(3):163-172.)

2) Harvard Study: Fluoridation associated with bone cancer in boys

In the wake of media scrutiny and an NIH ethics investigation, the first paper from Harvard University’s ongoing study of fluoride and bone cancer was finally published (2). The paper -- published 14 years after the study began -- reported that boys exposed to fluoridated water had a significantly higher rate of an often fatal form of bone cancer called osteosarcoma. According to the study, the boys with the highest rate of osteosarcoma were those that were exposed to fluoridated water during the ages of 6 to 8, although other years of life were also associated with increased risk – including the first year of life. These findings, which are consistent with a 1990 government study that reported the same form of bone cancer in fluoride-treated rats, have resulted in a similar degree of controversy. For example, in 1992, the top toxicologist in EPA’s Office of Drinking Water was fired after publicly expressing concern that the government was downplaying the study’s findings, while, in 2005, the principal investigator of the Harvard study (a dental professor with ties to Colgate) sparked a public outcry after it was revealed he had withheld the study’s findings from federal authorities while claiming it showed no relationship between fluoridation and bone cancer. Together, the government and Harvard studies reveal a disturbing pattern: when it comes to fluoride and cancer, politics can become a malignant force.

2) Bassin EB, Wypij D, Davis RB, Mittleman MA. (2006). Age-specific fluoride exposure in drinking water and osteosarcoma (United States). Cancer Causes and Control 17: 421-8.

3) Too much fluoride can damage the developing brain

In March, the National Research Council broke important ground by dedicating an entire chapter of its report to the growing body of evidence indicating that fluoride can damage the brain. According to the NRC, “it is apparent that fluorides have the ability to interfere with the functions of the brain and the body by direct and indirect means.” However, since we’ve already selected the NRC report as our #1 pick, our #3 pick goes to two recent papers that add further support to the NRC’s conclusions on fluoride’s potential to damage the brain.

The first paper was a review, published in the esteemed medical journal The Lancet, examining the various chemicals in today’s world that may damage a child’s developing brain (3A). The review classified fluoride, along with the rocket fuel additive perchlorate, as an “emerging neurotoxic substance” due to studies linking it to brain damage in animals and lower IQs in children.

The Lancet’s review was officially published on December 16, 2006, less than a month before an environmental health journal in the US published a new study demonstrating -- once again -- that high fluoride exposure can reduce children’s IQ (3B). The study, published in Environmental Health Perspectives, reports that groups of children exposed to 8 ppm fluoride in water have lower average IQ’s, less children attaining high IQ, and more children affected by low IQ. While 8 ppm is higher than the fluoride level added to water in fluoridation programs (0.7-1.2 ppm), previous studies from China indicate that fluoride may affect IQ at lower levels (Xiang 2003), including as low as 0.9 ppm among children with iodine-deficiencies (Lin Fa Fu 1991).

Together, the publication of the Lancet review & the Environmental Health Perspectives study suggest that the mainstream medical literature is finally beginning to recognize this critically important, but previously ignored, issue.

3A) Grandjean P, Landrigan P. (2006). Developmental neurotoxicity of industrial chemicals. The Lancet 368: 2167-2178

3B) Wang SX, et al. (2007). Water arsenic and fluoride exposure and children’s intelligence quotient and growth in Shanyin County, Shanxi, China. Environmental Health Perspectives [Epub Jan 9].

4) Infant fluoride exposure linked to permanent tooth discoloration

The upper front two teeth are the most visible teeth when a person smiles. If a baby is exposed to fluoride during the first year of their life, these two teeth are at risk of being permanently discolored – according to a new study from the University of Iowa (4). And the risk is not just for “baby teeth”, but for permanent teeth as well.

According to the study, exposure to fluoride during the child’s first year of life can cause a tooth defect, known as dental fluorosis, that won’t become apparent until the teeth erupt 7 or 8 years later. Dental fluorosis can result in white and/or brown staining of the teeth and sometimes corrosion of the enamel – effects which will last the child’s entire life if cosmetic treatment cannot be afforded.

The Iowa researchers’ findings may help explain why the American Dental Association later warned, on November 9th, that infants should not receive fluoridated water. The ADA’s warning did not, however, go far enough. According to the Iowa study, the risk of developing fluorosis on the permanent teeth is greatest for those children exposed to fluoride for each of their first four years of life. The take home message: To avoid fluorosis on the permanent front two teeth, keep fluoride away from children until they are at least 5 years old.

4) Hong L, Levy SM, et al. (2006). Timing of fluoride intake in relation to development of fluorosis on maxillary central incisors. Community Dentistry and Oral Epidemiology 34:299-309.

5) Kidney patients at risk of chronic fluoride poisoning

It’s not just infants that should avoid fluoridated water. New research provides yet further reason why people with kidney disease – particularly advanced kidney disease – should be advised to avoid fluoride as well.

Because kidney patients have a reduced ability to clear fluoride from their body, they have long been recognized to be at heightened risk of fluoride poisoning. In 2006, new research helped to further highlight this risk. Research from India confirmed that fluoride can cause a painful bone disease in kidney patients (5A), while research from Poland indicated that the health risks may extend well beyond the bones (5B). According to the Polish researchers, the heightened body burden of fluoride that kidney patients face (as measured by high levels of fluoride in their blood) may increase the rate of cell damage (oxidative stress) throughout the body – making them more vulnerable to a host of illnesses.

So, should people with kidney disease be concerned about drinking fluoridated water? According to two new reviews, the answer is yes (5C,D). According to one review, "Individuals with kidney disease have decreased ability to excrete fluoride in urine and are at risk of developing fluorosis even at normal recommended limit of 0.7 to 1.2 mg/l” (5C).

It’s time, therefore, for dental and medical organizations to start warning kidney patients to avoid water with added fluoride. As noted by Dr. Kathleen Thiessen, a scientist who helped author the National Research Council’s review on fluoride: “People with kidney disease should be very concerned about drinking fluoridated water because it does put them at a higher risk for a number of problems.”

5A) Harinarayan CV, et al. (2006). Fluorotoxic metabolic bone disease: an osteo-renal syndrome caused by excess fluoride ingestion in the tropics. Bone 39: 907-14.

5B) Bober J, et al. (2006). Fluoride aggravation of oxidative stress in patients with chronic renal failure. Fluoride 39:302-309. [See paper]

5C) Bansal R, Tiwari SC. (2006). Back pain in chronic renal failure. Nephrology Dialysis Transplantation 21:2331-2332.

5D) Ayoob S, Gupta AK. (2006). Fluoride in Drinking Water: A Review on the Status and Stress Effects. Critical Reviews in Environmental Science and Technology 36:433–487

6) Cornell scientist diagnoses fluoride poisoning in horses drinking fluoridated water

When fluoride is added to drinking water, it’s not just humans who will consume it. Millions of dogs, cats, and other animals will consume it as well. As we await the publication of a national study investigating the relationship between fluoridated water and bone cancer in dogs, a study published in 2006 provides compelling evidence that some animals may indeed be silent victims of the national water fluoridation program (6A,B).

For years, Cathy Justus’ horses in Pagosa Springs, Colorado, were experiencing symptoms that, no matter what medical treatment she tried, would not go away. The symptoms included colic (i.e. gastrointestinal pain), arthritis-like stiffness of the bones, and skin allergies. Cathy brought her horses to multiple veterinarians in the area, but none were able to find a cure for the horses’ problems -- that is, until she met Dr. Lennart Krook, a retired veterinary researcher from Cornell University. Upon examining the horses, Dr Krook quickly discovered that Cathy’s horses had dental fluorosis – a fluoride-induced condition that created large brown stains and pits on the horses’ teeth. (None of the previous veterinarians Cathy went to had ever bothered to examine the horses’ teeth, and had therefore missed this important warning sign.)

Following the discovery of dental fluorosis, Dr. Krook conducted microscopic analyses of some of the deceased horses’ bones, and found changes in the bone structure that were consistent with skeletal fluorosis. While the horses’ bone fluoride levels (between 600 and 900 ppm) were well below the levels typically associated with skeletal fluorosis (in cattle), Dr. Krook concluded that the horses were, in fact, suffering from “chronic fluoride intoxication.”

Although some have questioned Dr. Krook’s diagnosis (based on the low fluoride levels in the horses’ bones), the owner of the horses swears by it. After her town council voted (in March 2005) to end its water fluoridation program, the symptoms that had plagued Cathy’s horses for nearly 20 years, began to subside – and have not returned since. Coincidence? According to Cathy Justus, the proof is in the pudding.

So, how many other horses are being affected in a similar manner? Dr Krook and Cathy think this is a question horse owners would do well to consider. We agree.

6A) Krook LP, Justus CJ. (2006). Fluoride poisoning of horses from artificially fluoridated drinking water. Fluoride 39:3-10. [See paper]

6B) Justus CJ, Krook LP. (2006). Allergy in horses from artificially fluoridated water. Fluoride 39:89-94. [See paper]

7) Fluoride exposure linked to kidney damage in children

The kidney has long been recognized as a potential target of fluoride toxicity. This is because, as noted by the National Research Council, “Human kidneys... concentrate fluoride as much as 50-fold from plasma to urine. Portions of the renal system may therefore be at higher risk of fluoride toxicity than most soft tissues.”

It was of great interest, therefore, to read the results of a new study investigating the relationship between water fluoride exposure and kidney damage in children (7). According to the study: “our results suggest that drinking water fluoride levels over 2.0 mg/L (ppm) can cause damage to liver and kidney function in children.”

The authors reached this conclusion after studying a group of 210 children living in areas of China with varying levels of fluoride in water (from 0.61 to 5.69 ppm). Among this group, the children drinking water with more than 2 ppm fluoride – particularly those with dental fluorosis - were found to have increased levels of NAG and y-GT in their urine, both of which are markers of kidney damage. The children’s urine also contain increased levels of lactic dehydrogenase – a possible indicator of liver damage.

While definitive conclusions can not be drawn from this single study, it’s findings are consistent with previous animal studies which reported kidney damage from fluoride exposure at levels as low as 1 ppm in rats, and 5 ppm in monkeys. Taken together, the studies suggest that minimizing fluoride intake could well have a positive effect on kidney health.

7) Xiong X, et al. (2007). Dose-effect relationship between drinking water fluoride levels and damage to liver and kidney functions in children. Environmental Research 103:112-116. (Reviewed in: American Academy of Pediatrics (AAP) Grand Rounds; 2007; 17:7).

Water fluoridation linked to higher blood lead levels in children from old homes

Can water fluoridation increase the levels of lead circulating in a child’s blood? This is the question that has been asked ever since Dartmouth scientist, Dr Roger Masters, and chemical engineer, Myron Coplan, published studies in 1999 and 2000 reporting that exposure to fluoridated water was associated with increased blood lead levels in children surveyed from Massachusetts and New York State. According to Masters and Coplan, this association was not observed for all fluoride chemicals, but only those water supplies treated with “silicofluorides” (e.g. fluorosilicic acid and sodium silicofluoride).

Prompted by Masters’ & Coplan’s research, a team of scientists from the University of Maryland and Centers for Disease Control (CDC) examined the blood lead levels of children from a recent national survey to assess if there is any association with water fluoridation (8). In January 2006, the authors published the results of their study in Environmental Health Perspectives. While their findings do not neatly agree with Master’s and Coplan’s earlier studies, they also do not rule out a relationship between fluoridation and blood lead. Indeed, the authors report that water fluoridation is associated with significantly higher blood lead levels among children living in houses built prior to 1946. This is quite a striking finding as there is no shortage of houses built prior to 1946!

Thus, while the study may add a few important nuances to Masters’ & Coplan’s research, it is consistent with the theory that water fluoridation can increase the level of lead in children’s blood. Considering that lead exposure during childhood can result in permanent learning and behavioral disorders, this paper easily deserves recognition as one of the top 10 most important papers on fluoride of the past year.

Macek M, et al. (2006). Blood lead concentrations in children and method of water fluoridation in the United States, 1988-1994. Environmental Health Perspectives 114:130-134.

9) Dental fluorosis linked to tooth decay & psychological stress

One of the myths that has long been perpetuated about fluoride is that dental fluorosis – no matter how severe - is simply a “cosmetic effect.” Based, however, on the research of the past year, it appears this myth is finally on its way out. In March, the National Research Council kicked things off by stating that severe dental fluorosis (marked by extensive staining and pitting of enamel) is an adverse health effect due to its ability to make teeth weaker and prone to decay.

NRC’s conclusion was further reinforced by a study published in December in the journal Community Dental Health (9A). The study, a national survey of children’s teeth in Puerto Rico, found that both severe fluorosis and moderate fluorosis are associated with increased tooth decay and/or restorations.

The physical damage that fluorosis may cause to teeth is not, however, the only concern. Another concern, as detailed over 20 years ago by the National Institute of Mental Health (NIMH), is the psychological impact that dental fluorosis may have on a child. The NIMH’s warning gained renewed support this past year from a study published in Community Dentistry & Oral Epidemiology (9B). According to the study, children with severe dental fluorosis are more likely to be perceived by their peers as less intelligent, less attractive, less social, less happy, less careful, less hygienic, and less reliable – characteristics which could have major effects on a child’s self-esteem. (The latest surveys of dental fluorosis in the US indicate that about 1% of American children now have severe fluorosis, while about 1-3% have moderate fluorosis.)

9A) Elias-Boneta AR, et al. (2006). Relationship between dental caries experience (DMFS) and dental fluorosis in 12-year-old Puerto Ricans. Community Dental Health 23:244-50.

9B) Williams DM, et al. (2006). Attitudes to fluorosis and dental caries by a response latency method. Community Dentistry and Oral Epidemiology 34:153-9.

10) Water fluoridation & the “Precautionary Principle”

Based on the studies from 2006 and early 2007, it is clear that fluoride exposure – at relatively low levels – can harm human health. It has the potential to cause bone cancer, damage the brain, damage the kidney, damage the thyroid, damage the bones (particularly in kidney patients), increase the uptake of lead, and damage the teeth. However, in order to fully prove and understand the nature of these risks (including the range of doses that can cause the effects, and how these doses vary based on environmental, genetic, and dietary factors) more research would need to be conducted. Is it ethical, however, to continue exposing entire populations to fluoride in their water or salt (often against people’s will), while additional long-term studies are carried out to clarify the risks?

That is the crux of the question posed by an insightful analysis published in the March 2006 issue of the Journal of Evidence Based Dental Practice. The analysis, written by Joel Tickner and Melissa Coffin, examines the water fluoridation controversy in the context of the “precautionary principle.” The precautionary principle has become a core guiding principle of environmental health regulations in Europe and reflects the position that:

“if there is uncertainty, yet credible scientific evidence or concern of threats to health, precautionary measures should be taken. In other words, preventive action should be taken on early warnings even though the nature and magnitude of the risk are not fully understood.”

As noted by Tickner & Coffin “The need for precaution arises because the costs of inaction in the face of uncertainty can be high, and paid at the expense of sound public health.”

In determining whether the precautionary principle should be applied to fluoridation, the authors note that:

there are other ways of delivering fluoride besides the water supply;
fluoride does not need to be swallowed to prevent tooth decay;
tooth decay has dropped at the same rate in countries with, and without, water fluoridation;
people are now receiving fluoride from many other sources besides the water supply;
studies indicate fluoride’s potential to cause a range of adverse, systemic effects;
since fluoridation affects so many people, “one might accept a lower level of proof before taking preventive actions.”

While the authors never state their personal opinion on water fluoridation, the issues and questions they’ve raised certainly help to put the debate about fluoridation on the right track.

10) Tickner J, Coffin M. (2006). What does the precautionary principle mean for evidence-based dentistry? Journal of Evidence Based Dental Practice 6:6-15.

http://fluoridealert.org/top-10.htm

What does this have to do with the world being round? Stop trying to build a strawman argument or whatever hand-waving you're trying to do, and deal with the actual issue at hand. The problem does not begin with two doors, it begins with three. And since the greatest chance of choosing a wrong door begins with that initial choice, it therefore becomes to the player's advantage to rechoose, thus exchanging a lesser probability of choosing the right door for a higher probability when one wrong door is eliminated.

Also, since I know you're not going to really read the above, before you go off on your next obnoxiously self-congratulating post, please explain to me how, myself and my fellow sifters aside, mathematics, physics, and computer science professors from (and I'm taking this straight from Google as they come) the University of California San Diego, Hofstra University, the University of Southern Carolina, the University of Chicago, Rice University, the United States Naval Academy, Dartmouth College, the University of Illinois, the University of Alabama, and Stanford University have all managed to slip up and not realize how right you really are? And since of course science and math are not, as you said, democratic, perhaps you should take the time to alert them to their collective silly mistake, as well as correct each of their obviously wrong examples that they have provided on their respective websites. You could change the world of mathematics as we know it!