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  ¼öµ¾¹° ºÒ¼ÒÈ­ ¹®Á¦, ¿å º¸°í¼­(York Review) µî °è¼Ó
  ±Û¾´ÀÌ : kopsa     ³¯Â¥ : 04-04-25 22:02     Á¶È¸ : 4710    
¼öµ¾¹° ºÒ¼ÒÈ­ ¹®Á¦, ¿å º¸°í¼­(York Review) µî °è¼Ó

ÀÌ°÷ °Ô½ÃÆÇ¿¡´Â ¹Ì±¹°ú ¿µ±¹ÀÇ ¼öµ¾¹° ºÒ¼ÒÈ­¿Í °ü·ÃµÈ ±ÛÀÌ °Ô½ÃµÅ ÀÖ½À
´Ï´Ù. ¹Ì±¹ÀÇ °æ¿ì 2001³â 1¿ù 1ÀÏ ÃÖÃÊ ±ÛÀ» °Ô½ÃÇß°í 2003³â 9¿ù 7ÀÏ Ãß
°¡ ±ÛÀ» ³Ö¾ú½À´Ï´Ù. ¹Ì °úÇÐÇмú¿ø »êÇÏ NRC¿¡¼­ »õ·Î¿î ¿¬±¸ ÀڷḦ °Ë
ÅäÇÏ°í ÀÖÀ¸¸ç ¾Æ¸¶µµ 2004³â ¸»±îÁö´Â º¸°í¼­°¡ ³ª¿Ã °ÍÀ̶ó°í Çß½À´Ï´Ù.
¿µ±¹°ú °ü·ÃÇÏ¿© 2003³â 11¿ù 5ÀÏ ÃÖÃÊ ±ÛÀ», 2004³â 2¿ù 15ÀÏ Ãß°¡ ±ÛÀ»
°Ô½ÃÇß½À´Ï´Ù.     

1. ¿å º¸°í¼­¶õ? 

¿µ±¹ ¼öµ¾¹° ºÒ¼ÒÈ­ °ü·Ã ³í¶õÀº ÀÌÀü °Ô½Ã ±ÛÀ» Àо½Ã±â ¹Ù¶ø´Ï´Ù. ÀÌ
¹ø ±ÛÀº 2003³â 11¿ù ±Û¿¡ ¾ð±ÞÇÑ "¿å º¸°í¼­"(York Review)¸¦ ´Ù·ì´Ï´Ù.
ÀÌ º¸°í¼­´Â ¿µ±¹ º¸°Ç ´ç±¹ÀÇ À§Å¹À¸·Î 2000³â 10¿ù ¿å ´ëÇÐÀÇ Æò°¡ ±â°ü
ÀÎ CRD(The Centre for Reviews and Dissemination)¿¡¼­ ÀÛ¼ºÇß½À´Ï´Ù.

2003³â 11¿ù °Ô½Ã ±Û¿¡ ¼öµ¾¹° ºÒ¼ÒÈ­¿¡ ÀÇÇØ 15% Á¤µµ ¾î¸°ÀÌ ÃæÄ¡ ¿¹¹æ
¿¡ È¿°ú°¡ ÀÖ¾î º¸À̳ª ºÒ¼ÒÈ­¿¡ ÀÇÇÑ ÀáÀçÀû ÇØ°¡ ¾ø´ÂÁö, ºÒ¼ÒÈ­¿¡ ÀÇÇØ
»çȸÀû ºÒÆòµîÀ» ½ÃÁ¤ÇÒ ¼ö ÀÖ´ÂÁö ½Å·ÚÇÒ ¼ö ÀÖ´Â ½ÇÇè °á°ú°¡ ¾ø´Ù°í Çß
½À´Ï´Ù. ÀüüÀûÀ¸·Î ÇöÀçÀÇ ÀÚ·á·Î´Â ºÒ¼ÒÈ­ ¿©ºÎ¸¦ °áÁ¤ÇϱⰡ ¾î·Æ°í ÀÌ
º¸°í¼­°¡ ¾ÕÀ¸·ÎÀÇ ¿¬±¸ ¹æÇâÀ» Á¦½ÃÇÑ´Ù°í Çß½À´Ï´Ù. ÀÌ ºÎºÐÀº ¾ð·Ð ±â
»çÀÇ ³»¿ëÀ» ÀûÀº °ÍÀÔ´Ï´Ù. 

±× ÈÄ 2004³â 2¿ù Ãß°¡ ±ÛÀ» ÀÛ¼ºÇÏ¸ç ½ÇÁ¦ÀÇ "¿å º¸°í¼­" µîÀ» È®ÀÎÇß½À
´Ï´Ù. À̹ø¿¡ °Ô½ÃÇÑ Ã·ºÎ 1Àº "¿å º¸°í¼­"ÀÇ "¿ä¾à"(executive summary)
ÀÇ "°á·Ð"(conclusion) ºÎºÐÀÔ´Ï´Ù. ±×¸®°í ÷ºÎ 2´Â 2003³â 10¿ù "¿å º¸°í
¼­"¸¦ ³½ CRDÀÇ "¾ð·Ð º¸µµ¹®"ÀÔ´Ï´Ù. ¼öµ¾¹° ºÒ¼ÒÈ­ ³íÀï¿¡¼­ º¸°í¼­¸¦
À߸ø Çؼ®ÇÏ´Â ¹®Á¦°¡ ÀÖ´Ù°í Çß½À´Ï´Ù. ´©±¸³ª º¸°í¼­¸¦ ÀÐÀ¸¸é Àǹ̸¦
¾Ð´Ï´Ù. ±×·±µ¥ º¸°í¼­¸¦ Àڽſ¡ À¯¸®ÇÏ°Ô °¡Á®´Ù ºÙÀÌ´Â ¹®Á¦¿¡ ÁÖÀǸ¦
ȯ±â½ÃŲ °ÍÀÔ´Ï´Ù.     

2. ¿å º¸°í¼­ÀÇ Á¤È®ÇÑ ³»¿ëÀº?

÷ºÎ 1Àº Àо½Ã±â ¹Ù¶ø´Ï´Ù. ´Ù¸¸ ´Ù½Ã ¾ð±ÞÇÒ °ÍÀº, 2004³â 2¿ù Ãß°¡
±ÛÀ» ÀÛ¼ºÇϸç "¿å º¸°í¼­"°¡ "À±¸®Àû, ȯ°æÀû, »ýÅÂÇÐÀû, ºñ¿ëÀû, ¹ýÀû ¹®
Á¦¸¦ Æ÷ÇÔÇÏÁö ¾Ê¾Ò´Ù"°í ¸»Çß½À´Ï´Ù. ½ÇÁ¦ ºÒ¼ÒÈ­ ¿©ºÎ¸¦ °áÁ¤Çϴµ¥´Â
ÀÌ ºÎºÐµµ Áß¿äÇÕ´Ï´Ù. "°úÇÐÀÇ »óº¸¼º ¿ø¸®"¿¡ ·¹ÀÌÿ Ä«½¼°ú °ü·ÃÇÏ¿©
¼³¸íÇÑ ÀûÀÌ ÀÖÁö¸¸ ȯ°æ ¹®Á¦´Â ÇýÅðú À§ÇèÀÇ ¾ö°ÝÇÑ °úÇÐÀû ÀÚ·áÀÇ È®
º¸¸¦ ¶°³ª ÀÚ·á°¡ ¾øÀ̵µ Ã߸®ÇÒ ¼ö ÀÖ´Â À§Çè °¡´É¼º¸¸À¸·Îµµ ¹Ì·¡¿¡ ´ë
ºñÇØ¾ß ÇÒ ÇÊ¿ä°¡ ÀÖ½À´Ï´Ù. ȯ°æ ¹®Á¦ÀÇ Á¡¿¡¼­ ¼öµ¾¹° ºÒ¼ÒÈ­´Â ÇÇÇؾß
ÇÒ °ÍÀÓÀº ºÐ¸íÇÕ´Ï´Ù. 

÷ºÎ 2, CRDÀÇ "¾ð·Ð º¸µµ¹®" ³»¿ëÀº ÷ºÎ 1°ú Áߺ¹µÇ´Â ºÎºÐÀÌ ÀÖ½À´Ï´Ù.
ù ¸»ÀÌ "¼¼°èÀÇ ºÒ¼ÒÈ­ ¹®Çå¿¡¼­ ½Å·ÚÇÒ ¼ö ÀÖ´Â ¾çÁúÀÇ Áõ°Å¸¦ ¹ß°ßÇÒ
¼ö ¾ø´Ù" ÀÔ´Ï´Ù. ÇÑ ¸¶µð·Î ¼öµ¾¹° ºÒ¼ÒÈ­¸¦ ÆÇ´ÜÇϱâ À§ÇØ ÁøÁ¤À¸·Î ½Å
·ÚÇÒ ÀÚ·á°¡ ¾ø´Ù°í ÇÑ °ÍÀÔ´Ï´Ù. 

À̾î ÇýÅðú À§Çè ¸é¿¡¼­ "ÇýÅà ¿©ºÎÀÇ ¹üÀ§°¡ »ó´çÇÑ ÇýÅÿ¡¼­ ¾à°£ÀÇ ºñ
ÇýÅÿ¡ À̸£¸ç ÇýÅà ȿ°ú´Â ºÒ¼Ò ħÂøÁõÀÇ Áõ°¡¶ó´Â ¼ÕÇØ¿¡ ÀÇÇÑ °ÍÀÌ´Ù"
¶ó°í Çϸç "Áõ°ÅÀÇ ÁúÀÌ ºó¾àÇÏ´Ù"´Â ¸»À» ´Þ¾Ò½À´Ï´Ù. ´Ù¸¥ ºÎÀÛ¿ë¿¡ °ü
ÇØ "¾Ï, °ñÀý, ´Ù¿î ÁõÈıº°ú °°Àº ´Ù¸¥ ºÎÀÛ¿ë È¿°ú´Â ¹ß°ßµÇÁö ¾Ê¾ÒÀ¸³ª
ÀÌ Áõ°ÅÀÇ ÁúÀÌ ºó¾àÇϱ⠶§¹®¿¡ ÃæºÐÈ÷ ¾ËÁö ¸øÇÑ´Ù"°í Çß½À´Ï´Ù. Á» ´õ
¿¬±¸°¡ ÇÊ¿äÇÏ´Ù´Â ÀǹÌÀÔ´Ï´Ù.

±×¸®°í "Ä¡¾Æ º¸°Ç¿¡¼­ÀÇ ºÒÆòµîÀÇ °¨¼Ò¿¡ °üÇÑ Áõ°Å´Â ÁúÀÌ ³·À¸¸ç ¼­·Î
»ó¹ÝµÇ¸ç ½Å·ÚÇϱ⠾î·Æ´Ù"°í Çß½À´Ï´Ù. ¼öµ¾¹° ºÒ¼ÒÈ­¿¡ ÀÇÇØ »çȸ ºÒÆò
µîÀ» ½ÃÁ¤ÇÒ ¼ö ÀÖ´Â ±Ù°Å°¡ ¾ø´Ù´Â ÀǹÌÀÔ´Ï´Ù.

3. °á·Ð

2003³â 10¿ù "CRDÀÇ ¾ð·Ð º¸µµ¹®"Àº 2000³â 10¿ù º¸°í¼­°¡ ³ª¿ÂÁö Á¤È®È÷
3³âÀÌ Áö³­ ½ÃÁ¡ÀÔ´Ï´Ù. º¸µµ¹®¿¡´Â "¿å º¸°í¼­"¸¦ ¹ßÇ¥ÇÑ ÀÌ·¡ º¸°í¼­¸¦
º¯°æÇØ¾ß ÇÒ °úÇÐÀûÀ¸·Î ¹æ¾îÇÒ ¼ö ÀÖ´Â ´Ù¸¥ ¸®ºä´Â ¾ø´Ù°í ÇÏ¸ç º¸°í¼­
¿¡¼­ °­Á¶ÇÑ´ë·Î ¾çÁúÀÇ ¿¬±¸¸¸ÀÌ ºÒ¼ÒÈ­ Áö½ÄÀÇ °£°ÝÀ» ä¿ï ¼ö ÀÖÀ» °Í
À̶ó°í Çß½À´Ï´Ù.

½ºÄÎƽ½º´Â »ç½ÇÀÎÁö ¾Æ´ÑÁö °úÇÐÀûÀÎ Áõ°Å¿Í Æò°¡¿¡ °ü½ÉÀÌ ÀÖ½À´Ï´Ù.
CRD¿¡¼­ ÇÏ´Â ÀÏ°ú À¯»çÇÏ´Ù°í ÇÒ °ÍÀÔ´Ï´Ù. ±×·¯³ª Çй®Àû Áö½Ä°ú ºñÆÇ
ÀÇ ¼öÁØÀ» Çâ»óÇÏ°Ú´Ù´Â ¶æÀ» °¡Áö¸é µË´Ï´Ù. ±Ù°Å°¡ »ç½ÇÀÎÁö, Ã߸®¿¡ ¿À
·ù°¡ ¾ø´ÂÁöÀÇ ±âº»ÀûÀÎ ºñÆÇÀû »ç°í(°úÇÐÀû »ç°í)¸¦ °¡Áø ÀÌ´Â ´©±¸³ª ½º
ÄÎƽ½º°¡ µÉ ¼ö ÀÖ½À´Ï´Ù. 

½ºÄÎƽ½ºÀÇ ¿ªÇÒÀº ÀÌ »çȸ¿¡ °úÇаú À̼ºÀÇ °¡Ä¡¸¦ ³ôÀÌ´Â °ÍÀÔ´Ï´Ù. ÀÌ
±Ã±ØÀû ¸ñÀûÀ» À§ÇØ Àڱ⠼ºÂûÀÌ ¿ì¼±ÀÔ´Ï´Ù. ºñÆÇÀû »ç°í¿¡ Ãæ½ÇÇÑ ¹Ýµí
ÇÑ Åµµ¸¦ °®Áö ¾Ê°í´Â »çȸÀÇ ÀÎÁ¤À» ¹ÞÀ» ¼ö ¾ø½À´Ï´Ù. ºñ°úÇп¡ ´ëÀûÇÒ
¼ö ¾ø°í, ºñ°úÇÐÀ» ¹Ï´Â À̵éÀ» ¼³µæÇÒ ¼ö ¾ø½À´Ï´Ù. ¿ì¸® ÁÖÀ§¿¡´Â ºÒÇàÈ÷
µµ ½ºÄÎƽ½º¶ó´Â À̹ÌÁö¸¦ ÈѼÕÇÏ´Â À߸øµÈ À̵éÀÌ ÀÖÀ¸¸ç ÀÌ ¹®Á¦´Â °è¼Ó
"Åä·Ð »ç·Ê" µî¿¡ °Ô½ÃÇÏ·Á°í ÇÕ´Ï´Ù.
 
..............
*÷ºÎ 1

executive summary
conclusion

This review presents a summary of the best available and most reliable
evidence on the safety and efficacy of water fluoridation.

Given the level of interest surrounding the issue of public water
fluoridation, it is surprising to find that little high quality research has
been undertaken. As such, this review should provide both researchers
and commissioners of research with an overview of the methodological
limitations of previous research conducted in this area.

The evidence of a benefit of a reduction in caries should be considered
together with the increased prevalence of dental fluorosis. The research
evidence is of insufficient quality to allow confident statements about
other potential harms or whether there is an impact on social
inequalities. This evidence on benefits and harms needs to be
considered along with the ethical, environmental, ecological, costs and
legal issues that surround any decisions about water fluoridation. All of
these issues fell outside the scope of this review.

Any future research into the safety and efficacy of water fluoridation
should be carried out with appropriate methodology to improve the
quality of the existing evidence base.

...................
*÷ºÎ 2

What the 'York Review' on the fluoridation of drinking water really
found

28 October 2003

For immediate release

A statement from the Centre for Reviews and Dissemination (CRD)

In 1999, the Department of Health commissioned CRD to conduct a
systematic review into the efficacy and safety of the fluoridation of
drinking water. The review specifically looked at the effects on dental
caries/decay, social inequalities and any harmful effects. The review
was published on the web and in the BMJ in October 2000.

We are concerned about the continuing misinterpretations of the
evidence and think it is important that decision makers are aware of
what the review really found. As such, we urge interested parties to
read the review conclusions in full at
http://www.york.ac.uk/inst/crd/summary.pdf.

We were unable to discover any reliable good-quality evidence in the
fluoridation literature world-wide.

What evidence we found suggested that water fluoridation was likely to
have a beneficial effect, but that the range could be anywhere from a
substantial benefit to a slight disbenefit to children's teeth.

This beneficial effect comes at the expense of an increase in the
prevalence of fluorosis (mottled teeth). The quality of this evidence was
poor.

An association with water fluoride and other adverse effects such as
cancer, bone fracture and Down's syndrome was not found. However,
we felt that not enough was known because the quality of the evidence
was poor.

The evidence about reducing inequalities in dental health was of poor
quality, contradictory and unreliable.

Since the report was published in October 2000 there has been no other
scientifically defensible review that would alter the findings of the York
review. As emphasised in the report, only high-quality studies can fill
in the gaps in knowledge about these and other aspects of fluoridation.
Recourse to other evidence of a similar or lower level than that
included in the York review, no matter how copious, cannot do this.

The full report is available via the CRD Fluoridation Review web site
(http://www.york.ac.uk/inst/crd/fluorid.htm). For more
information, please contact Paul Wilson (01904 434571).
----
Centre for Reviews and Dissemination, University of York, York, UK,
YO10 5DD
email: crd@york.ac.uk. Tel: +44 (0)1904 321040 Fax: +44 (0)1904 321041
....................................