No abstract

A meta-analysis showed that children with higher fluoride exposure have lower IQs than similar children with lower exposures. Circulating levels of fluoride in blood and urine in children have also been linked quantitatively to significantly lower IQ. Other human and animal studies indicate that fluoride is a developmental neurotoxicant and that it operates in utero. Economic impacts of IQ loss have been quantified. The objective was to use data from the meta-analysis and other studies to estimate a daily dose of fluoride that would protect all children from lowered IQ, and to estimate economic impacts. We used two methods: traditional lowest-observed-adverse-effect (LOAEL)/no-observed-adverse-effect level (NOAEL); and benchmark dose (BMD). We used 3 mg/L in drinking water as an "adverse effect concentration," with reported fluoride intakes from food, in the LOAEL/ NOAEL method. We used the available dose-response data for the BMD analysis. Arsenic, iodine, and lead levels were controlled for in studies we used. BMD analysis shows the possible safe dose to protect against a five-point IQ loss is between 0.0014 and 0.050 mg/ day. The LOAEL/NOAEL safe dose range estimate is 0.0042-0.16 mg/day. The economic impact for IQ loss among US children is loss of tens of billions of dollars.

A review of recent scientific literature reveals a consistent pattern of evidencehip fractures, skeletal fluorosis, the effect of fluoride on bone structure, fluoride levels in bones and osteosarcomas-pointing to the existence of causal mechanisms by which fluoride damages bones. In addition, there ic elidence, accepted by some eminent dental researchers and at least one leading United States proponent of fluoridation, that there is negligible benefit from ingesting fluoride, and that any (small) benefit from fluoridation comes from the action of fluoride at the surface of the teeth before fluoridated water is swallowed. Public health authorities in Australia and New Zealand have appeared reluctant to consider openly and frankly the implications of this and earlier scientific evidence unfavourable to the continuation of the fluoridation of drinking water supplies. (Aust LV

Wernicke's encephalopathy producing an altered mental state may occur in malnourished psychiatric patients even in the absence of alcohol abuse. A case is reported of a woman, aged 61 years, with schizophrenia who refused her medication for four months, had the delusion she was dying from a tumour, and withdrew to her bed with a neglect of her nutrition. She was committed to hospital in a mute unresponsive state and after taking some food and fluids for four days lapsed into coma. She responded within three hours to the administration of thiamine. Clinicians need to remain vigilant to the possibility that an altered mental state in malnourished patients may be due to thiamine deficiency rather than to the primary psychiatric disorder. If doubt exists as to the presence of Wernicke's encephalopathy, then parenteral thiamine should be administered.

Interfering in the affairs of the gravely disabled has received attention in areas such as philosophy, theology, law, politics, and sociology. For such persons to be declared incompetent and have guardians appointed to care for them, a balancing is required of the right to personal freedom against the right to care. When consideration is given to the underlying principles of autonomy and beneficence, a case can be made for weak paternalistic interventions with persons of diminished capacity who are clearly endangered and in whom the conduct involved is substantially nonvoluntary. Examples are given of beneficial results occurring in persons with alcohol dependence or alcohol-related brain damage on whom a paternalistic intervention involving financial management was imposed with the aim of seeing that basic needs were met and that spending on alcohol was not excessive.