Fluoride - Friend or Foe?

Among the controversies around public health, fluoridation of the public water supply ranks second behind vaccination. The nominee for Secretary for Health and Human Services wants to remove it. Is that a good idea?

The major benefit of fluoride is that it dramatically reduces dental cavities in children and to a lesser extent in adults also. In 1945 Grand Rapids, MI, became the first city in the world to add fluoride to its water. Dental cavities in children living there have dropped by more than 60% since that was done. Calgary, Alberta, stopped fluoridation and the rate of cavities in children doubled.

Canadian, Australian and U.S. dental societies support fluoridation, though most European countries have stopped mandating fluoridation. Most dentists also recommend topical fluoride, including fluoride in toothpaste, which fights plaque but does not reduce cavities.

What are the hazards? Very high levels of fluoride can lead to bone disease and staining of teeth.

(I must note that very high levels of almost anything can be harmful. Marathon runners and others have died from drinking too much water.)

The biggest concern is that studies have suggested that when mothers drink fluoridated water, their children have lower IQs. These studies were done in regions of Asia and Mexico where naturally occurring levels of fluoride in water are very high. None were done in U.S. communities that had fluoridation programs.

Good studies show that there is no harm to animals or humans from levels up to 10 times the usual consumption of fluoride.

The FDA has recommended a very conservative level of 0.7 mg/liter in the public water supply, a level that maximizes benefit while minimizing risk. In the U.S., about 85% of communities fell in that range.

How can you know? In most of the U.S. and Canada, fluoridation is a local decision. Call your town’s Department of Public Works. If your town adds fluoride they should know, and indeed should publish that data annually. Not every state requires fluoride be added, and if it is not added testing will probably not be done.

If you use well water, you can arrange for private testing.

What about fluoride in toothpaste? If it is not swallowed, very little gets into the body. If you have children too young to follow the advice not to swallow, put a very small amount (less than 1/8 inch) on the toothbrush yourself.

If you are pregnant and worried, you can buy deionized water to drink during your pregnancy.

So, proven benefit for children’s teeth or very unlikely effect on their IQ? You decide.



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What shots does an adult need?

Much of the discussion around vaccines focuses on children, who get a large number in their early years, but adults also benefit from appropriate vaccination.

Which shots should you be discussing with your doctor?

People of any age should get an annual flu shot. Influenza is a serious illness, not just a bad cold, and older adults may be hospitalized or die from influenza. The efficacy of the shot varies year to year, as the CDC must make an educated guess as to which strains will circulate, but even partial immunity is better than none.

A bonus is that those who get their flu shot are less likely to suffer heart attacks.

COVID – yes, that old virus is still around. It has mutated enough that the vaccine you got a year or two ago is no longer that protective. The only vaccine available is the newer one, and you should get it.

Shingles is a very unpleasant illness that you do not catch from others; it is the virus that caused your chicken pox when you were a child and remained dormant in your body ever since. As we age and our immune system weakens, the virus can flare up. It causes a very painful rash which can go on to a persisting nerve pain for months or years after the rash clears. The 2-shot series is highly protective and is given once if you are 50 or over.

The shingles vaccine is associated with a decreased risk of dementia, an added inducement to get it.

The pneumococcus is a bacterium that causes pneumonia in many and meningitis in some. There have been many different vaccines and the subject of which vaccine(s) to get deserves its own column – discuss it with your doctor. Bring the record of any you have received.

RSV causes severe disease in infants. In adults it is usually just a cold, but if you have weak lungs or heart failure or are elderly, it can cause more severe illness. The new vaccine seems to be a one-time only shot that is worth considering.

Tetanus boosters are recommended every 10 years and are usually combined with either diphtheria or diphtheria and whooping cough. If you have new grandchildren, getting the DPT will protect them as well if you will be close to them.

A stitch in time saves nine, and the right shots can save you from serious illness.



If you enjoy these posts, you might want to also receive those done by my medical school classmate, Dr. Steven Kanner. Check out https://drkanner.com



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Killing Brian Thompson will not solve America's health care problems

The fatal shooting of UnitedHealthcare CEO Brian Thompson as he headed to a shareholder meeting should not have come as a surprise. The U.S. is a gun-obsessed culture and leads the world in gun fatalities. What was more shocking was the outpouring of “he had it coming” posts on social media.

Whether or not the killer was motivated by a personal experience with United, the numerous posts referenced people’s rage at the health insurance industry.

Should we be surprised?

Recent years have seen health insurance rates soar and out-of-pocket costs skyrocket. Even those with employer-provided health insurance are often unable to pay for needed care as deductibles and copays keep rising.

At the same time, the industry has had one black eye after another, with multiple insurers in the news.

Private health insurance companies offering Medicare Advantage plans routinely overstate the health problems of their enrollees to get unjustified extra payments from the government.

A former Aetna medical director admitted under oath that he never looked at patients’ records when deciding whether to approve or deny care but simply rubber-stamped the nurse reviewers’ decisions.

United was castigated by a Senate committee for using algorithms to deny care and it was noted that the denial rate for rehab care after hospitalization rose from 10.9% in 2020 to 22.7% in 2022.

Denying care is good for insurers’ profits, and these profits flow into executive salaries. The CEOs of America’s six largest health insurers took home a total of $122,970,614 in total compensation in 2023.

Taking money from employers and individuals and paying medical bills is not rocket science and does not warrant sky-high profits. Medicare operates with an overhead of about 3% while private insurers charge 15% or more.

As I document in my book, some 25% of U.S. “health care” expenditure does not go to health care but to administrative overhead.

We need to get the excess profits out of health insurance companies and put that money towards patient care.

Shooting one CEO will not change the culture. We must hold our legislators’ feet to the fire and get the excess profits out of health insurance, whether at the state or the federal level.



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When is it time to take away the car keys?

Our ability to safely drive varies enormously. Even though 75% of surveyed drivers felt that their skill behind the wheel was in the top 25%, statistics do apply, and 25% of us are in the bottom 25%.

Many factors determine whether someone should still be driving a car. Teens and young adults tend to take more risks than older drivers while older drivers have poorer vision, slower reaction time, are likely to be taking medication that may compromise driving safety and are at greater risk of cognitive decline.

The latest survey available showed that in 2020, 59% of people 85 and older in the U.S. still had their driving license.

Older drivers are not necessarily bad drivers; that distinction clearly goes to teenage drivers, who have by far the greatest number of accidents and fatalities. Accidents are relatively low for drivers 30 to 69 and then start going up.

What is of concern is that fatal accidents rise dramatically in drivers 80 and older.

So, what do you do if your parent or spouse should not be driving? Many states require older drivers to have their vision checked at license renewal, but none require a driving test.

You cannot rely on your doctor to be proactive; only six U.S. states require doctors to report people whose medical condition makes it unsafe to drive.

If you have witnessed unsafe practices such as running lights or stop signs, drifting across lanes or driving way below the speed limit on highways, you should bring the subject up. If this is met with denial, you could contact their doctor and ask the doctor to broach the subject.

If someone is clearly a risk to themselves and others, you may need to contact the registry of motor vehicles or local police department in a smaller community. In the extreme, you can make the car undriveable by disconnecting the battery.

The corollary is figuring out how to let them get places without a car – often a major issue for those who do not live in a densely populated area with shops and services within walking distance.

Sign them up for Uber or Lyft, contact the local Council on Aging about community resources and/or offer to drive them to medical appointments and shopping or arrange for others to do so. In much of the country, to be unable to drive dramatically shrinks a person’s world.

Just maybe, if you make good alternatives available, they will give up driving and save a life.



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Robert Kennedy Jr is a danger to our health

I will leave it to others to comment on the Caligula’s horse nature of other Trump nominations, but must try to convince you that Robert Kennedy, Jr is uniquely unfit to be the head of the Department of Health and Human Services (HHS).

Not all his ideas are bad. His campaign against ultra-processed foods and food additives could benefit the U.S. population if they withstood the onslaught of opposition from the food industry. It would also be better if the revolving door between industry and regulatory agencies could be shut, as he has proposed.

Unfortunately, his rabid anti-vaccination stand by itself should disqualify him from a position overseeing the nation’s health.

Vaccines, along with clean water supplies, have done more to save lives than almost any advance in history.

I am old enough to remember the scourge of polio. Almost every summer the City of Montreal would shut public swimming pools because of polio outbreaks. In the mid-20th century, over half a million people world-wide died or were left paralyzed by polio. The best care available was the iron-lung, which took over for paralyzed respiratory muscles.

The Salk inactivated polio vaccine was released in 1955, and in 2 years, U.S. cases of polio fell from 58,000/year to 5600. By 1961 that number was 161.

The Sabin oral polio vaccine soon followed, and the ease of giving an oral rather than an injected vaccine led to mass administration around the world. By 2021, only two cases of polio were reported world-wide.

Measles, too, sickened and killed millions before the 1963 introduction of an effective vaccine. Prior to vaccination, there were over 100 million cases and 6,000,000 deaths world-wide. In the U.S. there some 4,000,000 cases and 450 deaths annually, along with over 1000 left brain-damaged.

Andrew Wakefield, in Britain, published two studies in 1998 and 2002 claiming that the MMR vaccine caused autism. Both studies have been withdrawn by the publishers, citing fraud, and numerous studies since then have shown no association of vaccination and autism.

Celebrities with no scientific knowledge have continued to push this discredited idea, leaving some parents hesitant to vaccinate their children. The result has been a series of measles outbreaks across the U.S.

Even though most decisions about mandatory childhood vaccination are made at the state level, having a vaccine skeptic as head of the nation’s health agencies will only lead to more parents opting out and more children needlessly sick or dead.

Kennedy has also jumped to support therapies such as ivermectin for COVID despite very solid studies showing that no dose of the drug did any good and, in some cases, did harm.

If you live in a state with Republican senators, please write to them immediately and beg them to reject this flawed candidate as Secretary of HHS.



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Will a Sudoku a day keep dementia away?

As the population ages, dementia has become an increasing problem. World-wide, some 55 million people are living with dementia; in the U.S. about 7 million people suffer some form of dementia. The condition not only affects the sufferers but lowers the quality of life of their care-givers, who are usually family, and costs the health system an enormous sum.

To date, treatment has not proven to be the answer. Neither the older drugs nor the very expensive and dangerous new drugs do more than delay the decline by a few months.

For dementia, as for many health conditions, prevention is much better than treatment.

Good general health hibits: regular exercise, not smoking and treating high blood pressure are known to lower dementia risk. What about training the brain?

We strengthen our muscles by lifting weights and improve our heart and lung capacity by aerobic exercise, so it makes intuitive sense that exercising our brain should ward off dementia. There are many on-line sites and apps that promise to do just that. Do they work?

We have known for a long time that those with higher education levels have less dementia and get it later, but this may be an artifact: those with better brain capacity may gravitate to fields requiring more education. What about mentally challenging activities such as word games, crossword puzzles, Sudoku, chess and bridge?

A survey of many studies in different groups of people living in different parts of the world suggests that these activities do indeed lower the risk of dementia and delay its onset. Many activities were studied, both those listed above and reading and taking adult education classes.

The effect was not dramatic, but the risk of developing dementia was reduced by anywhere from 10 to 30% depending on the study, and those who did develop dementia did so about 2-3 years later. These numbers compare very favorably with existing treatments and have no side effects!

None of the commercial “brain boosters” as yet have any similar data available.

So, take out your pencils and get puzzling. Play mahjong or bridge. Read a challenging book. Not only will you get the social benefits, but you will stay sharp longer.

By the way, another intervention has pretty good data behind it: getting the shingles vaccine seems to also be associated with reduced risk of dementia. As if avoiding the nasty disease was not motivation enough!



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Lonely? You are not alone!

Last year, the U.S. Surgeon General declared loneliness a major public health problem. While it was made worse by the pandemic, both before and after the pandemic loneliness was common and troublesome to many.

A survey from Harvard’s School of Education found that 21% of U.S. adults described loneliness as a major problem; surprisingly, the age group that expressed the greatest problem (29%) were those 30-44, and adults over 65 had the lowest (10%) reported frequency.

If you have children or grandchildren, remember that they can also suffer profoundly from loneliness.

You do not have to be socially isolated to feel lonely; those with intact families and/or with many co-workers can feel lonely. Loneliness is a disconnection from others, even when they surround you. If you feel lonely in such a setting, you blame yourself but should not.

Our ubiquitous technology, which is supposed to help, often worsens the problem. Dealing with others through social media rather than in person does not create deep bonds.

Those who spend too much time at work may end up spending less time with family and friends with resulting feelings of loneliness.

Loneliness has been found to correlate strongly with both poor mental and physical health. We are social animals and do better in all spheres when we feel connected to others.

If you feel lonely, there are many ways to lessen this feeling.

Reach out to friends and family. Maintaining friendship requires work but need not be burdensome. A quick email with some news or a birthday or holiday card with some personal lines added takes little time and strengthens bonds. Pick up the phone.

Volunteer. Helping others gives you a sense of community connection and may lead to new friendships with those alongside whom you are working.

Join groups with whom you share interests. Alongside fellow photographers, quilters, singers or stamp collectors you will create new bonds.

There are many groups at churches, Councils on Aging and community centers where you can meet new friends.

Adopt a pet if you can deal with the time demands. The unconditional love of a dog is its own reward, and walking your dog is a great way to meet new people.

Limit your use of social media. Taking longer breaks from Facebook and the like and interacting in the flesh will usually make you feel better.

Have a single older friend or neighbor? Call them!

Finally, remember that feeling lonely is not something to feel ashamed of and that there are many people out there who would love to connect



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