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fluoridation of water

The fluoridation of water supplies to municipalities in the U.S. is done to prevent tooth decay. There is little debate among scientists over the effectiveness and safety of fluoridation to fight cavities, but a small but vocal contrarian community has effectively blocked several cities from fluoridating by creating fear that the practice is unsafe and unnecessary. By 1950, enough scientific evidence existed to make the case that fluoridation at 1.0 ppm reduced children's cavities by 50%. In 1950, the United States Public Health Service recommended that communities without naturally occurring fluoride add it to their public water supplies at a concentration of 1.0 ppm. Despite the fact that doing so would mean a reduction in business for those dentists who filled the cavities of youngsters, the American Dental Association supported the policy.

The safety of fluoridation has been challenged many times. In the small amounts that people are likely to be exposed to from public drinking water, the main health concern that has not been exaggerated and distorted over the years is the fear of dental fluorosis. (The staining and pitting of teeth from too much fluoride does not affect adults, so concerns about fluorosis focus on the amount of fluoride children are likely to be exposed to.) In January 2011, the U.S. Department of Health and Human Services proposed to change its recommended limit for fluoride to 0.7 mg/L, replacing the current recommended range of 0.7 to 1.2 mg/L. (Parts per million, ppm, and milligrams per liter, mg/L, are nearly equivalent. E.g., 1.2 mg/L = 1.201370764 ppm.*) The U.S. Environmental Protection Agency simultaneously announced that it will take a fresh look at the maximum allowable level, currently set at 4 mg/L, for fluoride that occurs naturally in drinking water. U.S. children are getting fluoride not only from drinking water but from toothpastes, mouth rinses, and processed foods.

The federal government is revising its recommendations to water utilities on how much fluoride should be added to drinking water because of concerns that children may be exposed to too much of the tooth-protecting chemical.* According to the United States Environmental Protection Agency (EPA): "Children aged 8 years and younger exposed to excessive amounts of fluoride have an increased chance of developing pits in the tooth enamel, along with a range of cosmetic effects to teeth." Also, adults who ingest excessive amounts of fluoride over a lifetime may be at greater risk for bone fracture. Like many things in our water supply--chlorine, for example--the amount determines whether it is safe or harmful. For that reason, the EPA recommends that the amount of fluoride in a water supply not rise above certain levels. The Centers for Disease Control and Prevention (CDC) provides recommendations for the optimal levels of fluoride in drinking water in order to prevent tooth decay.

Most people do not oppose chlorinating public water supplies for public safety. But many people oppose fluoridation because it is seen as an infringement of personal liberty that is not justified for public safety reasons. Conservative columnist James Kilpatrick considered fluoridation to be forced medication:

Whatever may be said for fluoridation as a matter of public health, the program is a patent invasion of private rights—specifically, the right of each individual to control the medicine he takes.

If the choice is between losing a bicuspid or losing a freedom, let the bicuspid go. (cited in Toumey, p. 75)

Others have opposed fluoridation out of fear that it was part of a government conspiracy to "snatch our souls," i.e., destroy our individuality and turn us into compliant sheep, obedient to the whims of a faceless, anonymous bureaucracy (Toumey).

The fluoridation wars have some parallels in U.S. history. See if this doesn't sound familiar. Something good for people is discovered and recommended to them by their government. Local governments join with state and federal agencies to bring this good to the people. Just about the time the local elected officials begin to implement the delivery of the goods, voices are heard crying in the wilderness about the good being forced on us by faceless bureaucrats who want to steal our freedom. Maybe our government wants to poison us, control our minds, cause us to get sick. Maybe the government agents are in cahoots with the ADA, the AMA, Big Pharma, the makers of vaccines, the Power Companies, the cell phone companies, the Communists, or ? Anyway, it should not be surprising that the opposition to fluoridation has many red herrings.

If freedom were really the issue, then municipalities should be free to have or not have fluoride added to their water supplies. If safety were really the issue, then accurate information and consensus science should be in the forefront. Instead, we find the usual crank or two put forth as authorities on equal footing with the rest of the scientific community. We also find the demand for absolute certainty that fluoridation is safe and couldn't possibly harm anyone under any circumstances in any amount. The precautionary principle and pseudosymmetry become the standards. False alarms and scare tactics abound.

the fluoridation wars

The following brief history of fluoridation in America is based on chapter five, "Soul-Snatching," of Conjuring Science by Christopher P. Toumey.

In 1901 Dr. Frederick McKay, a dentist in Colorado, began his search for the cause of dental fluorosis, then known as "Colorado Brown Teeth." By 1916 he had identified excessive amounts of fluoride occurring naturally in water supplies as the cause of the dental staining. He also found that there was an association between less mottling and stronger, healthier teeth. In 1931, epidemiologists had confirmed the connection between fluoride and both mottling and stronger, healthier teeth. Soon, scientific data from thirteen countries confirmed these findings.

In 1945, the U.S. Public Health Service began four case-control studies, testing the hypothesis that artificial fluoridation to 1.0 ppm would produce healthier teeth without causing mottling. By 1950, the experiment was declared a success. The communities with fluoridated water supplies had 50% fewer cavities. The recommendation was made that communities without naturally occurring fluoride add it to their water supplies at a concentration of 1.0 ppm. The American Dental Association, the American Medical Association, the American Association of Public Health Dentists, and the National Research Council concurred with the recommendation. Notice that we are talking about a recommendation, not a forced government program.

Clearly, there are other ways to deliver fluoride to children besides putting it in the water supply. One reason for putting it in the water supply, of course, is so you can poison your citizens or turn them into mindless zombies. Another reason for putting the fluoride in the water supply rather than in tablets, toothpaste, foods, etc., is that it would reach almost everyone. It would be especially beneficial to children living in poverty, whose parents could not afford adequate dental care. Furthermore, it's relatively easy and inexpensive to accomplish. For many people, the fact that fluoridation would benefit millions and the potential for harm seemed negligible, was sufficient to justify adding it to the water supply. For others, the fact that it would benefit millions was irrelevant to whether it should be added to the water supply. And the fact that nobody could guarantee that nobody would ever be harmed in any way by fluoridation justified holding off taking any action until more evidence was in that supported the safety of the process.

The "defenders of personal freedom" appear to be at least partly wrong in this case. If the majority of the people in a municipality want fluoridation, then I think they have the right to have it added to their water supply. I don't believe, however, that if the majority of citizens in a town don't want fluoride added to their water supply, that the government has a right to add it "for their own good."

In any case, the freedom issue has become muddled because freedom to choose is pointless if people can't get truthful, straightforward information about what it is they are making a choice. Getting truthful information about fluoridation is about as straightforward as getting truthful information about vaccinations and electromagnetic radiation. The forces of confusion, the merchants of doubt, the propagandists for righteous indignation, have shouted loudly and broadly and filled the marketplace with their notions, making it very difficult for the average citizen to understand the issues, much less form an educated opinion of the issues.

The anti-fluoridation movement began as soon as the government and health associations made their recommendation. In community after community, before implementation could take place the anti-fluoride folks called for a vote on the issue. There were 952 referenda between 1950 and 1966. Opponents of fluoridation won in 566 of them (about 60%).

There wasn't much of a case one could make against the effectiveness of fluoridation, but it was a simple matter to make unsubstantiated claims about the safety of fluoridation. On the one hand, you couldn't miss with the old standby argument that nobody can know with absolute certainty that fluoridation won't have adverse effects on somebody somewhere down the line. But another tactic was to claim that the evidence was in and fluoride causes headaches, fatigue, fainting, arthritis, cancer, Down's syndrome, cardiovascular disease, and a host of other ailments including AIDS. Also useful was the fact that sodium fluoride is a rat poison and fluorine was used in nerve gas. It doesn't matter that these facts are irrelevant to the issue. Bringing them up scares people into thinking you want to poison them.

Once the wild-eyed accusations had been made, the path of little resistance was paved and it was now a simple matter for people like Bette Hileman of Chemical and Engineering News to argue that until we are sure that none of these terrible things that had been linked to fluoridation were cleared up, we should play it safe and hold off. She "subverted support for fluoridation by creating an ominous tone of uncertainty and suspicion" (Toumey p. 68).

A different tactic was used by Geoffrey Smith. He simply noted that some people might get too much fluoride because they could get it not only from their water supply but from other sources. Smith is an anti-fluoridationist, however. More sensible, from the perspective of one concerned about getting too much fluoride, is the tactic of the EPA. Look at the data and if it warrants lowering the amount of fluoride, then do so, and warn people whose water supplies contain naturally occurring fluoride in excessive amounts.

Another tactic that recurs in this kind of culture war is the post-modern, anti-science approach that paints a picture of science as a tool of government propagandists. There is no scientific truth; there is only the "truth" of those in power. The battle was not over health, safety, or freedom. The battle was over control. Those endorsing fluoridation weren't really concerned about the dental health of children. They were only concerned about establishing their own positions of control and power. Brian Martin exemplifies this approach. Toumey wryly comments: "Although it is hard to gauge the effect of an approach that denies a place for science in a scientific controversy, the effect, if any, of Martin's work must have been to discredit the advocates of fluoridation."

These bogus issues fed and continue to feed the main opposition to fluoridation, which is the belief that the government is conspiring to turn us into zombies of some sort. Putting medicine in our water is just a ploy to get us to be compliant. When stripped of its paranoiac elements, the argument against fluoridation on the grounds that it is an act of invasion on our liberty has some merit. Tooth decay isn't contagious and it isn't fatal. Health is a personal matter. The government has done its job when it assures the safety of the water supply. It goes beyond its charge when it assumes responsibility for our dental care. One might well ask, why is the government so concerned about my teeth? On the other hand, if the citizens want to fluoridate their water supply, I don't see why they shouldn't be free to do so within reasonable limits. There are municipalities that have excessive amounts of fluoride occurring naturally. To add more fluoride to these systems would be harmful to the people.

Children exposed to drinking water containing 4 milligrams of fluoride per liter -- the Environmental Protection Agency's maximum allowable concentration -- risk developing severe tooth enamel fluorosis, says a new National Research Council report. About 200,000 Americans have drinking water with that much fluoride, which comes from both naturally occurring sources and pollution....people who consume water containing that much fluoride over a lifetime are likely at increased risk for bone fractures.*

The recommendation to lower the amount of fluoride in water supplies may be the first step toward recommending that the practice be stopped if it is determined that most people are getting an adequate amount of fluoride from other sources or that a significant number of people are being harmed by fluoridating the water supplies of our cities.

parallel lines

As noted above, there are parallels to the fluoridation wars. While it may be useful to compare the battles over vaccination, tobacco, and electromagnetic radiation, climate change, and the current battle over health care in general, there are significant differences that should be noted.

The overarching issue is what role, if any, government should play. There are some who argue government has no business interfering with our liberty in health matters. This view has as much merit as the view that any act by government to restrict liberty is wrong. Every law restricts liberty. You and I don't have the right to rob banks or murder our annoying neighbors. So what? Our liberty regarding such actions is justifiably restricted. Anyone who thinks they have made a rational argument against some government proposal by simply pointing out that the government proposal would restrict liberty either hasn't thought the issue out or isn't capable of thinking clearly. The issue is never simply a matter of liberty or not; the issue is always is the government justified in intervening in this particular case?

Regardless of what the arguments were more than half a century ago regarding fluoridation of water supplies, the fact is that we have had six decades of government involvement in our dental health without any evidence that the government is poisoning us or adding other substances to our water to control our thoughts and actions. It is also a fact that the benefits of fluoridation have been proven. But, because of the widespread availability of fluoride from other sources, it is legitimate to ask whether the program is now harming people or whether it is even necessary. It is also legitimate to ask, even though the cost of fluoridation remains relatively low, whether it is worth it. Are significant numbers of poor children benefiting from the program? Where fluoride naturally occurs in harmful amounts in water supplies, should government act to force some communities to remove some fluoride, if possible, from their water supplies?

As noted above, the fluoride wars have not been the only cultural battleground where we have seen fear mongering, deception, misleading reports about health hazards, outlier experts being given equal credibility with consensus science, reliance on the precautionary principle and the demand for absolute certainty from opponents of intervention, etc. We have seen similar tactics in the battles over vaccination, tobacco use, climate change, health insurance, and the safety of cell phones, for example.

Governments not only have a right to protect the public health, they have a duty to do so. Quarantining individuals suffering from highly contagious and life-threatening diseases is an infringement on liberty, but it is justified to protect the health of the general public. The common good in such cases overrides the individual's right to liberty. Governments have a right to restrict liberty for national security reasons or public safety reasons. Our right to travel, turn our lights on at night, etc., may be justifiably restricted during times of war or natural disaster.

Vaccination programs infringe on personal liberty, but allowing unvaccinated people to threaten the health of the public is unacceptable. People with bad teeth may suffer, but they aren't a threat to the public. You can't catch cavities from another person. There must be some other justification for fluoridation. As noted above, the issue is different from chlorination. Even if some individuals oppose chlorination for whatever reason, we have a right to chlorinate our water supplies to prevent such things as cholera, which is deadly and contagious. What right do we have to force people to fluoridate their water? Traditionally, the argument has been that it benefits millions at little cost and it harms no one. Those who object aren't being harmed, so what's their beef? While I don't accept the argument that we shouldn't fluoridate until we can prove with absolute certainty that nobody anywhere could ever be harmed by it, there is evidence that there are some health risks from excessive fluoride. As a utilitarian, I would argue that more good than harm is done by fluoridation and that those who fear ingesting an excessive amount of fluoride use non-fluoridated tooth paste and other products. If it can be shown that very little good is done by fluoridating the water (because of availability of fluoride from other sources), then I would say that there is very little justification for continuing the program.

The tobacco industry has set the standard for obfuscating a public health issue. Their model has been followed by climate change deniers, cell phone and Wi-Fi radiation alarmists, the anti-vaccination movement, and the current opponents of health-care reform in the U.S. Outside of the general issue of the common good versus individual liberty and the issue of obfuscating alarmists opposing government intervention in principle, there seems to be very little that is analogous to the fluoridation debate and these other issues. The consequences of ignoring the science of climate change in favor of ideological beliefs could be global and catastrophic. The electromagnetic radiation concerns come from those who want the government to interfere with industry and our liberty. The loud voices crying tyranny every time a proposal is made that involves the government may lead some people to think that fluoridation must be a good thing since so many idiots oppose it. Fluoridation was certainly a good thing when it was introduced. It may still be a good thing, but the chances of a rational debate on the issue are diminished by the cacophony of irrational voices that obscure nearly every issue involving government intervention with cries of socialism, tyranny, anti-American, etc. In any case, those who think that these issues are purely scientific and can be resolved by science alone should think again.

Even so, opponents of fluoridation have criticized defenders of fluoridation for relying on "outdated science" and have supported their opposition by claiming that recent science is on their side. In particular, they cite a 2006 report from the National Academy of Sciences. That report involved a committee of scientists reviewing toxicologic, epidemiologic, and clinical data on fluoride published since 1993 (the year of their last previous report). This committee did not evaluate studies on the health benefits of fluoridation but restricted itself to studies on the potential harmful effects of fluoride from all sources. The report clearly states several times that they did not find good scientific evidence that there is significant harm being done by ingesting fluoride at levels found in municipalities that artificially add fluoride to their water supplies. The committee "concluded unanimously that the present MCLG [maximum contaminant level goal set by the EPA] of 4 mg/L for fluoride should be lowered." Municipalities that artificially fluoridate use from .75-1/mg/L.

See also 9/11 conspiracy, AIDS denial movement, the anti-vaccination movement, climate change deniers, contrarian, electrosensitives, manufactroversy, and pseudosymmetry. I also addressed fluoridation studies in a Newsletter: Fluoride water 'causes cancer'- Boys at risk from bone tumours, shock research reveals.

further reading

Hoofnagle, Chris Jay. (2007). The Denialists' Deck of Cards: An Illustrated Taxonomy of Rhetoric Used to Frustrate Consumer Protection Efforts. SSRN.

Michaels, David. 2008. Doubt is Their Product: How Industry's Assault on Science Threatens Your Health. Oxford University Press.

Mooney, Chris. (2005). The Republican War on Science. Basic Books.

Offit, Paul A. (2008). Autism's False Prophets: Bad Science, Risky Medicine, and the Search for a Cure. Columbia University Press.

Toumey, Christopher P. (1996). Conjuring Science: Scientific Symbols and Cultural Meanings in American Life. Rutgers University Press. (Review by Douglas Allchin)

Wallace, Amy. (2009). An Epidemic of Fear: How Panicked Parents Skipping Shots Endangers Us All, Wired.

websites

Classification and Appraisal of Objections to Fluoridation

Fluoride Science (endorsed by the American Association of Public Health Dentistry) What does the science say about the relationship of fluoridation of public water supplies and bone cancer, enamel fluorosis, infant formula, IQ), kidney health, tooth decay, and fluoride toothpaste? Find out here.

Basic Information about Fluoride in Drinking Water

The American Dental Association on Fluoride and Fluoridation

One in a Million on Water Fluoridation

Water Fluoridation - Wikipedia

Ten Great Public Health Achievements -- United States, 1900-1999 from the CDC
In addition to vaccination and identifying tobacco as a health hazard, fluoridation of water is listed.

A toothless argument by Peter Preston
The success of Britain's anti-fluoride brigade is a dismal commentary on a rigid, embattled nation

A Critical Response to Yolanda Whyte by Stephen Barrett, M.D.

news

2012 Water Fluoridation Statistics

The Campaign for Dental Health, a network of organizations, scientists, and health professionals, has begun its educational efforts to promote fluoridation. Check out http://www.ilikemyteeth.org/

Arkansas success State passes fluoridation law; coalition credited with victory A statewide fluoridation measure and two other bills aimed at improving oral health in Arkansas were passed and signed into law after a grassroots campaign by a coalition that included Arkansas State Dental Association leaders and membership; public health officials; legislators; advocates; and other stakeholders....A survey of Arkansas citizens conducted in January by the Pew Center on the States showed strong support for community water fluoridation....

Calgary City Council vote in favour of removing fluoride in water “We as a council have to show some leadership here. We have no right to force this right on all Calgarians. I would really question our right to put it in, but … I don't question at all our right to remove it,” said Alderman Jim Stevenson....The city will save money as it costs $750,000 per year to add fluoride to the water and Calgary was facing a $6 million upgrade to a local water treatment plants that are needed for fluoridation.

Fluoride in drinking water: Will the EPA get tougher? Environmental health groups are now looking to the U.S. Environmental Protection Agency to impose tougher standards on fluoride in drinking water, building on a decision by the federal Department of Health and Human Services to lower the recommended level for the first time in nearly 50 years. The HHS move came in the wake of a government study showing that about 2 out of 5 adolescents have tooth streaking or spottiness because of excessive fluoride....The EPA released two new reviews of research on fluoride. One study found that prolonged, high intake of fluoride can increase the risk of brittle bones, fractures, and crippling bone abnormalities.

blogs

Anti-fluoridation crankery? How quaintly 1960s! I only wish it weren’t on ScienceBlogs Respectful Insolence "....I hate it when a fellow ScienceBlogger goes astray!....That’s why I take no pleasure in what I’m about to do, but two days ago Coby laid down a heapin’ helpin’ of anti-fluoridation fear mongering, chock full of dubious arguments (at best) that don’t belong on ScienceBlogs. Because Coby has been so good for so long in other areas, I’m willing to give him somewhat of a pass, but not so much that I will ignore or decline to rebut what he’s posted. Actually, it’s what his father, Dr. James S. Beck, who wrote the post and who has co-authored a book with well-known anti-fluoridation crank Paul Connett, the driving force behind the Fluoride Action Network entitled The Case Against Fluoride: How Hazardous Waste Ended Up in Our Drinking Water and the Bad Science and Powerful Politics That Keep It There, posted on Coby’s blog at Coby’s invitation, namely a post entitled The Case Against Fluoride." [Read the comments....please.]

related culture wars topics

"Keeping a cool head about global warming" by R. T. Carroll

SD Newsletter 11 Jan 2010: Global warming, climate changes, science, and politics by R. T. Carroll

Cell phones, brain cancer, and other cheery thoughts by R. T. Carroll

Warning: Your Magazine May Be Hazardous to Your Health by R. T. Carroll

The Disconnect in Disconnect by R. T. Carroll

"Junk Science and Environmental Policy: Obscuring Public Debate with Misleading Discourse," by Charles N. Herrick and Dale Jamieson

Denialism Blog

Last updated 25-Jan-2014

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