In Portland we are currently being treated to a three-ring circus of anti-fluoridation woo. In the first full week of May we will be voting on whether or not to fluoridate the public water supply. The debate about it seems to have been plucked almost directly from the John Birch Society circa 1961. There are shadowy conspiracies of doctors, dentists, corporations, the government and people like me who are unwittingly shilling for the aforementioned legions of Darkness (aka modernity). It’s like a greatest hits of anti-science. It’s a Cirque de Soleil of anti-science with only slightly less colorful costuming. There’s a lot of fast and fancy footwork. Off in the second ring there is a lot of jugglers with flaming torches and flying chain saws all the better to distract the rubes. Yet, just like at the circus, it’s the center ring where the real action is happening.
In the center ring, under the hot spotlight we see hapless researchers, from Harvard, the CDC or the NRC (National Research Counsel), with whitewash poured all over their heads to the delight of the kiddies. The typical caution that scientists couch their findings in is read not as good science communication but something along the line of a surreptitious note tied to an arrow by a young man who just wants to sing but is being held by his gruff father in the tall tower of Swamp Castle. There he waits until a knight of the Round Table can come rescue him in his own particular idiom. The scientists know that ‘They’ would never let them publish their findings if they just came out and flat-out stated that fluoridation was poisoning the public for absolutely no good reason. So instead they have to use subtle code words like ‘inconclusive’, etc. But those in the know, can see through the necessary dodge and know that the scientists are really saying that water fluoridation is bad for the public no matter how much it appears they are saying just the opposite.
We are told to pay no attention to the words behind the curtain like the following from the Institute of Science in Medicine:
The anti-fluoridation movement’s allegations of harm from CWF are not scientifically substantiated. In particular, toxicity and carcinogenicity of fluoridation at the levels used in CWF have been ruled out by reliable scientific studies. The National Cancer Institute (NCI) states that CWF poses no increased risks for cancer. The CDC has also concluded that there is “no credible evidence” for such a link. Fluoride’s only identified side-effect has been mild dental fluorosis — an almost unnoticeable cosmetic concern — and one where CWF makes only a small contribution.
Courts have repeatedly ruled that CWF neither interferes with constitutional freedoms nor is “mass medication” of a population. Since it already occurs in water naturally, CWF is an adjustment of that level. Water treatment should be determined by what is best for the community as a whole. The primary source of fluoride (hydrofluorosilicic acid) is irrelevant; when added to water, this chemical breaks down into fluoride ions, sand and water. Water-treatment engineers have an excellent record of ensuring safe drinking water. (Institute for Science in Medicine)
Preparing to write this post, my wife and I got into it with a former classmate of hers on Facebook. A number of things struck me:
- The science of the issue is entirely beside the point. Just as with the unsinkable rubber ducks of the anti-vaccination movement, the anti-fluoridation partisans are only interested in science insofar as it bolsters their ideological predilections. In the back and forth there was never any engagement with how fluoride actually behaves. One prominent anti-fluoridation website even claimed that fluorine (the gas that reacts to make various fluoride silicates) doesn’t occur in nature even though fluoride is in any natural water supply.
- The argumentative tactics between the two movements are identical. There’s the ‘Gish gallop’, an argumentative tactic borrowed from creationism where so many objections are thrown out that it’s impossible to counter them all.
- Then there’s the appeal to a kind of pseudo-egalitarianism. This appeal takes the form of both excoriating anyone trying to argue the scientific merits on their own strength as elitist while at the same time reserving for themselves to engage in ad hominem attacks. I noticed this particularly in the debate on Facebook where my wife had a number of aspersions cast on both our intellect and our motivations (all behind a cheeky smile).
- There’s the appeal to shadowy forces taking actions that they, allegedly, know to be harmful for no well-defined reason. Why, for instance, would the NAS, NSF, CDC, ADA, AMA and EPA all participate in a gigantic cover-up that is now going on its sixth decade? No reason. There may be some vague hand waving in the direction of ‘corporate overlords’ but other than that no real explanation for such malevolent behavior. Some of that might simply be hiding the cards, in as much as people who are not actually insane realize that talking about ‘Them’ trying to harm people gets a little too much into the land of paranoia for credibility.
- There’s the hyperbolic rhetoric. Fluoride isn’t just a mineral but a poison. It’s a component of sarin. Good lord, they’re putting nerve gas in the water supply God’s sake! Well, yes, so are oxygen and carbon. Oxygen at high concentrations is a firestorm waiting to happen.
- There’s also the inability to do cost-benefit thinking. If fluoride has any potential downside then it doesn’t matter how unlikely or unsupported the downside is, no possible benefit could be worth the risk. This is a recipe for fantastically bad policy–the anti-GMO movement and the anti-vaccination movement being two shining examples along with the anti-fluoridation movement.
- There’s also audacious level of misunderstanding–deliberately or incidentally–the science. It is ignored that in most cases, CWF programs are merely boosting fluoride levels found in ground water to a level where its benefits are seen. Likewise, when citing studies that show a high correlation between fluoridation and some negative health outcome it is never mentioned that these studies are observing areas with endemically high levels of fluoride in the ground water.
“The addition of fluorine to the water supply, termed water fluoridation, is carried out as a public health measure to improve oral health. One of the ways fluorine confers its benefit is by changing the crystalline structure of teeth. Fluorine ions replace hydroxide ions in calcium hydroxyapatite, Ca5{(PO4)3OH} , in teeth, forming calcium fluoroapatite, Ca5{(PO4)3F} , which is more chemically stable and more resistant to acid attack than calcium hydroxyapatite. However, as well as making the enamel more resistant to acid attack by altering the chemical structure of the enamel, fluoride helps to protect teeth by promoting the remineralisation of early decayed lesions and by reducing the ability of the bacteria on the teeth to produce acid.
Water fluoridation is a population-level caries preventive strategy. Therefore, the appropriate method of measuring effectiveness is to look at the population level effect rather than look at the effect on any given individual. (Armfield)
The first thing I noticed is that the press got the headline absolutely wrong. The headline was ‘Physicians voice opposition to fluoride in Portland’. The physicians they got were a physical therapist (not a physician) and a dentist (also not a physician but at least with some relevant subject matter knowledge). What was most interesting was that the dentist misquoted the CDC claiming that the that governmental body had declared “The CDC has stated its benefit comes from brushing it on the teeth or rinsing it, not swallowing.” This was enough of a howler that a former director of the division or oral health at the CDC, Dr. William Maas was moved to issue a correction stating, “I can assure you the CDC has not stated what Dr. Levy said it stated. CDC takes great pains to put clear information on its website and anybody that wants to know can go on it,” Maas said. “There’s plenty of evidence children and adults benefit from fluoridated water.” (KGW.com staff)
During my research I consistently came across anti-fluoridation literature skipping over the issue of concentration. In fact, the anti-fluoridation literature makes no distinction between a level of .7 to 1.2 ppm (the recommended level for prevention of caries) and a level of > 3 ppm which is the level at which adverse health effects start to show up. It is at above 4 ppm that the kinds of health concerns the anti-fluoridation partisans invoke as scare tactics start to show up. (National Research Council of the National Academies)
The anti-fluoridationists make a habit of hijacking scientific studies and flying them to some kind of rhetorical Cuba there to trot the poor studies out in front of the news cameras where they then make statements about how they have seen the light and now join their fraternal anti-fluoridationists allies in opposing the schemes of the imperialist pro-fluoridation running dogs. They do the same thing with other facts. For instance, it is a shibboleth of the anti-fluoridation movement that European nations have rejected public water fluoridation and, therefore, no one in Europe is consuming fluoride. This is simply not the case. Firstly, it ignores that the UK and Ireland fluoridate their water. It also studiously ignores that the solution in continental Europe is to get fluoride either through milk or through salt. (Institute for Science in Medicine)
There’s a point where you have to recognize that mendacity is just that, plain old dishonesty.
In a tad over a week, we’ll find out if ordinary Portlanders will be hoodwinked by the pseudo-scientific fear-mongering of the anti-fluoridationists or if scientific literacy will prevail.
Sources
Armfield, Jason M. “When public action undermines public health: a critical examination of antifluoridationist literature.” 9 December 2007. Australia and New Zealand Health Policy. 25 April 2013 <http://www.anzhealthpolicy.com/content/4/1/25>.
Dodes, John E. and Michael W. Easley. “The Anti-Fluoridationist Threat to Public Health.” April 2012. Institute for Science in Medicine. 25 April 2013 <http://www.scienceinmedicine.org/policy/papers/AntiFluoridationist.pdf>.
Institute for Science in Medicine. “COMMUNITY WATER FLUORIDATION.” 22 January 2012. Institute for Science in Medicine Web site. 25 April 2013 <http://www.scienceinmedicine.org/policy/statements/fluoridation.pdf>.
KGW.com staff. KGW News. 18 April 2013. 25 April 2013 <http://www.kgw.com/news/Physicians-voice-opposition-to-fluoride-in-Portland-203684431.html>.
National Research Council of the National Academies. Fluoride in Drinking Water: A SCIENTIFIC REVIEW OF EPA‘S STANDARDS. Washington DC: National Academies Press, 2006.
I’ve seen quite a lot of people who seem much more invested in the idea of preventing the water rates going up than they are in either the science or the anti-science. It’s possible that _they_ will prevail.
Whereas I find the fact that the water rates may/will go up to be the best argument in favor of flouridation. Money coming mostly from huge corporations that use tons of water, with a bit from really rich people who like to water their huge lawns, going to help mostly poor children? Sounds good to me.
Happy, if the anti-fluoridation camp triumphs using an economic argument, however much I might think that it is short-sighted, I would be disappointed but I my concern in the article was about how the anti-fluoridation side is abusing the science. I get—but don’t agree with–the argument that the money could be put to other use dealing with, say, the potholes that make driving and biking in Portland such an adventure at times. :)
I didn’t mean to go off-topic! I seem to have left off the sentence where I said I thought that anti-science, anti-government, and anti-taxes so often go hand-in-hand.
More recently (just in the last few days) the anti-flouride groups have been sending out a graphic showing that the rates of tooth decay in children in Portland have gone down dramatically since 2009, usually with wording that suggests that they are going down “naturally” and therefore will continue to go down without flouridation. Which seems quite disingenuous, since that’s when the state of Oregon started giving free health insurance (including dental!) to all poor unisured kids, (plus very discounted insurance to uninsured kids who are well above the poverty level.) But few of the people forwarding around that graphic would ever say that the goverment was responsible for something good, so they imply that the decrease happened all by itself. :(
Off-topic is fine! I do think you are pretty spot-on about anti-science, anti-government and anti-taxes. These aren’t identical, of course, but they share a lot of memetic DNA.
I’m in complete agreement with you that US anti-fluoride campaigns are almost entirely about alarmist nonsense, but this statement “It also studiously ignores that the solution in continental Europe is to get fluoride either through milk or through salt.” is unfortunately false. Looking at what I assume is the original source (http://www.scienceinmedicine.org/policy/papers/AntiFluoridationist.pdf) fluoridation of salt reaches just 10% of Europeans, and the numbers for fluoridated milk, just given as “millions”, are likely even lower. This does mean that significant parts, if not a majority, of Europe does not practice fluoridation of water, salt or milk.
Norway for instance has no fluoridation of water and natural levels high enough to have effect are relatively rare. Norway chose to instead invest heavily in informing the population about proper dental care and the use of fluoride toothpaste, lozenges and mouthwash, an approach that has drastically reduced the prevalence of dental caries. This graph from the BMJ doesn’t include Norway, but it shows how the reduction is comparable between European nations using fluoridation and those not doing so: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2001050/figure/fig1/
Bjornar,
Thank you for the feedback. Yes, the paper you referenced was one of the sources I used in the article. I will be doing a follow-up post on this issue at some later date and will address what you said. Thank you for bringing it to my attention!
The question of discontinuing fluoridation came up in my city… And anti-science won :( it was a city council decision though, not a plebiscite. Boo.
http://www.cbc.ca/news/canada/calgary/story/2011/02/08/calgary-fluoride-city-water-supply-removal.html
No idea how/why, we’re over a million people, highly educated population, and yet people went with the fear mongers. There was almost no outcry or response to the decision.
I feel your pain. My city also recently went through this and lost: http://kitchener.ctvnews.ca/city-officials-to-support-no-vote-on-fluoridation-1.567307
The anti-fluoride group were flashy and spent lots of money on advertising, while the dentists I spoke with sat back and believed that people would go online and find good information. The naivety was tragic. This is what they would find: http://www.waterloowatch.com/
I hate to say this but I think that in almost *any* discussion dealing with public science, the scientists are outgunned. Not that they don’t have the facts on their side but that there are cultural issues that almost force scientists or science boosters to fight these arguments with a hand and a leg tied behind their backs. I’ll post more on this at a later date.
I have one minor nit: You use the term “CWF” without defining it. I’m guessing the “C” stands for “Community”, based on the Institute for Science in Medicine reference. Is this a standard term for water fluoridation? (“Fluoridation” doesn’t appear in the 1st 5 pages of Google results for “CWF”, though the very first hit when searching for “CWF fluoridation” is the CDC’s page.) Sometimes I get grumpy about unnecessary or undefined jargon :-)
Otherwise an excellent post.
Anecdata time: I grew up in a town that was an early adopter of fluoridation, but due to geography our neighborhood received its water from an adjacent town that didn’t fluoridate. (A lot of influential right-wingers in that town, they’re lack of CWF (see, I used it!) was due to Birchian scare tactics.) Until I was 13 or 14, when our street was connected to our town’s fluoridated water system, my siblings and I had tons of cavities. After that, I had no new cavities for at least 10 or 15 years. Same for my brothers and sisters. I don’t know what the cavity rates for the other kids in the neighborhood were.
Good catch on not defining CWF! I’ll chalk that up to a reminder not to stare too long at a post before hitting ‘publish’ because that’s a recipe for reading what you thought you put there and not what is actually there.
To your other point; I also grew up with fluoridated water and I had exactly one cavity until I was 33 and moved to Portland 13 years ago. I’ve now had three cavities.
This who situation has really depressed me. So many of my friends and acquaintances who should know better who’ve become ravening anti-fluoride activists in recent months. A strong woo streak runs through Portland. There’s a lot to love about this town, but sometimes this shit can be hard to take.
This “whole” situation has also depressed me.
I went to college in Portland, so I still have a lot of friends there, and I’ve been surprised by how many of them have posted against fluoridation on Facebook. I’ll be sure to share this article with ’em!
Over the weekend we received mailers from the pro- and anti-flouridation groups, and they really seem to be not even trying to talk to the same groups of people. There’s no debate going on, they are just talking past each other, with one side saying “toxic chemical medications in our water” and the other saying “tooth decay is bad for children”. I can’t imagine how people who are undecided are supposed to decide based on the information coming from either campaign.
[Also, I am _not_ impressed by the pro-flouridation group claiming the only difference between Portland and Seattle is the flouride in the water – Portland also has a dramatically higher level of child poverty than Seattle, which is directly correlated with rates of untreated tooth decay.]
Flouride is a whole separate issue! Down with flour!
Yes, that too! But “down with flour” is a whole separate woo-topic. [I would love to see a series of posts about the “paleo diet” on Skepchick!]
As far as I know, I can’t edit typos on comments on here, though. :)
It’s on my radar, Happyapple.
Both have a poverty rate of just over 14%, so I’m not sure what you are basing “dramatically higher” about poverty on.
Maybe instead of using the people campaigning to tell you what to think, you research the science?
“One prominent anti-fluoridation website even claimed that fluorine (the gas that reacts to make various fluoride silicates) doesn’t occur in nature even though fluoride is in any natural water supply.”
Unfortunately, that claim is ENTIRELY correct, and you are quite wrong, and you’re trying to correct a correct statement! You didn’t think it mattered when you conflated ‘fluorine’ with ‘fluoride’! That spelling difference is significant, as spelling differences so very often are in science. Fluorine is the name of the element, it is a diatomic gas at room temp. that does *not* occur in the elemental form on earth because it is very highly reactive. Meanwhile, any compound of fluorine, eg. with hydrogen, is called a fluoride. To state “fluorine does not occur in nature” is correct, at least on earth. Fluorine is chemically unstable, fluorides are correspondingly highly stable – and exist in nature all over the darn place because fluorine is the 13th most abundant element on this planet.
The point I was making is that to say that fluorine does not occur in nature ignores that it fluorine is a component of *fluoride*. If fluorine is a component of fluoride (and we both agree that it is) and fluoride occurs in nature (and we both agree that it does) then fluorine, in the form of fluoride, occurs in nature.
The fluorine that is contained in the fluoride silicates that are injected into the water supply is the *same element*. The anti-fluoridation web site was trying to make fluorine seem somehow ‘unnatural’ when it *does* occur in nature, in the form of fluorides.
If you’re going to write about science, remember that in science, there are no “little” details, only “crucial” details. I get what you’re saying, but I’m worried that you’re still NOT getting what I’m saying. It is absolutely necessary that “What you say” be exactly equal to “what you mean”. Otherwise your readers might not know what you mean. Fluorine and fluoride are different words because they represent different things. All is well with that. All is is far from well in the field known as “science writing”. Adults with Masters Degrees forget what they were taught in grade 4: that it not only MATTERS A GREAT DEAL which words you use, but also which order you use them in.
And YES: I am pedantic. Do you believe that pedanticism has any place here? I do. If you don’t, can I just point out that one slight difference between the -ine and the -ide is that exposure to the “-ine” will kill you very, very quickly, while the “-ide” probably won’t even be noticeable.
WE GET THAT YOU THINK IT MATTERS A GREAT DEAL THAT WORDS MATTER, but you’re the only one who fucking cares.
“If you’re going to write about science, remember that in science, there are no “little” details, only “crucial” details.”
Nice mansplaining, dude. JFC.
marilove: I don’t think you’ve added anything useful to the exchange. Just some shouting, and some profanity, and some “presuming to speak for others” – unless you were using the antiquated “Royal We” – were you?.
I added a 2nd comment because I had an “afterthought” – a thought that occurred to me “after” I posted. Since editing comments isn’t a feature here, I had to add another comment. I thought it was a worthwhile one. You accusation of “meaning to go on and on” is thus responded to. I hope you comprehend.
I honestly don’t mean to keep on and on, but I should add that the 1st instance of “you” in the 2nd para (immediately above) should be “your”. So, marilove, please now point out to everyone that I am imperfect – and therefore I MUST be a hypocrite, and wrong about everything, unless you’re above that kind of total speciousness.
Because you think you’ve added to the conversation? Half of what you said doesn’t even make sense.
Pleaaaassseee. *waves hand*
And tone trolling, already! That was quick. Good job, man. Keep going. I’m adding to my Obnoxious, Pedantic, Boring Troll Bingo card as we speak.
Yes you are being pedantic, Tim. The first time you posted on this, that was pointing out a problem–I disagree with the point you’re making but I’ll take it under advisement in future posts. Everything *after* that, however, is really getting into mansplaining territory for no good reason that I can detect. You’ve made your point and, unfortunately for that point, your continuing to harp on it doesn’t really make it any more clearly. I may not have communicated this clearly in my response to you but here was the logic I was using:
A better example might be Sodium (NA). Like Fluorine it is highly reactive and doesn’t occur elementary in nature. It is only ever really found in a compound but no one would say that Sodium is ‘unnatural’ which is what the writer of the anti-fluoridation piece was driving at. My argument is that if, for example, Sodium Chloride NACl) contains sodium then sodium occurs in nature in the form of natural sodium chloride. Likewise, fluorine occurs in nature in the various fluoride compounds.
It’s clear you think that is wrong and you’ve gotten your pedantic point across. I still disagree with you but as I said above, I’ll take it under advisement.
Tim, to nail Adrienne’s point home to you in another way, elemental fluorine is not found naturally. Neither is it used to treat water supplies.
That particular argument is therefore a red herring and is now disposed of.
I don’t mean to keep on and on, but I should add that another reason accuracy and precision are so important is because of the degree of controversy, and as usually accompanies such controversy, a lot of “wrong” facts are getting thrown around. I can’t sit idly by and just spectate for then I would be remiss.
I think she totally gets it that you think ACCURACY AND PRECISION ARE SO IMPORTANT. Of course you “mean to keep going on and on.” At least don’t fucking lie about it.
I like how he is talking about critical points in a science conversation and you just keep yelling at him with no points or counter points.
and ‘mansplaining ‘ is a pretty insulting term.
Interestingly enough, the Tampa Bay Times just won the 2013 Pulitzer Prize for Editorial Writing for a their series on a very similar brouhaha in Pinellas County, Florida in 2011 and 2012. There, the anti-fluoridation zealots had actually managed to convince the county commission to take it out. The newspaper launched a concerted campaign to inform the public, and succeeded when two of the key commissioners failed to be re-elected in the November 2012 election. The commission undid their decision and the water is fluoridated once again (as of March). You might check out the articles that paper ran, how they approached the problem, and so on for ideas in your fight.
A scary study went around last October that drew comments instructive of how people react to Fluoride.
The paper showed a link between high Fluoride levels and low IQ. There may be. It was a meta study and it was reasonably well done and the association in the data was there. However, many of the samples were taken in mining areas in China and there may be a lot of effects on “IQ” in those communities other than a mineral in the water. Also, studies comparing IQ measured across samples are largely invalidated because IQ is not independent of the sampling source unless the testing is done explicitly to avoid that, which obviously can’t be done in a meta-analysis.
The thing is, the levels of Fluoride in these water sources was in fact really really high, nothing like the levels recommended.
One of the comments I saw was about the EPA’s requirements for how much fluoride you put in your water, and how the level they require is in the danger range. However, the EPA does not require that you put fluoride in your water (not their job) and they don’t even recommend how much is good for health (not their job). They do have two levels that the look at, the one where they write your town water supply a letter (or something) saying that your fluoride is a bit high, watch out (this happens in, say mining areas) and the other where they show up in their hasmat suits, surround the town with a barbed wire fence, and drop a thermal bomb on you … or whatever it is they do these days. (Oh way, that’s for Ebola …. whatever).
ooop… citation for previous comment: Choi et al. 2012. Developmental Fluoride Neurotoxicity: A Systematic Review and Meta-Analysis. Environ Health Perspect. 2012 October; 120(10): 1362–1368. http://www.ncbi.nlm.nih.gov/pmc/?term=10.1289/ehp.1104912
That ‘metastudy’ has pretty well been taken apart.
http://www.sciencebasedmedicine.org/index.php/antifluoridation-bad-science/#more-22052
Meta studies are almost always bad at proving a scientific point. This one is no exception.