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Michael W. Easley, DDS, MPH
[Scientific Review of Alt Med 5(1):24-31, 2001. c 2001 Prometheus Books,
Inc.]
Since Grand Rapids, Michigan, began fluoridating its public
water supply in January 1945, there has been a relentless effort by individuals
and small groups (including antifluoridation groups, "alternative medicine"
organizations, environmental advocacy groups, and fringe antigovernment groups)
to undermine the efforts of health professionals and civic leaders to implement
fluoridation, a safe, effective, efficient, and economical community-based
public health measure to prevent dental caries. This paper discusses some of the
strategies, techniques, and extremist measures employed by those opposed to
fluoridation in order to undermine its adoption and implementation: neutralizing
politicians, the big lie, half-truths, innuendo, quoting of inaccurate
statements and the use of statements taken out of context, quoting of experts,
conspiracy gambit, scare words, debate ploy, use of contrived organizations,
subversion of the media, commandeering established organizations, misuse of
electronic publishing, and commandeering meetings.
Community water fluoridation serves as an example of a perfect public health intervention. Because the benefits can be readily provided to everyone served by a fluoridated public water system, large groups of people can be protected in a manner that does not discriminate against any group, regardless of race, socioeconomic status, gender, or any other demographic categorization. People are protected continuously in a way that requires no conscious effort on their part to participate.
Community water fluoridation has been widely practiced since 1945 in this country and it is the 20th-century adaptation of a naturally occurring process. It does not involve adding anything to the water that is not already there. Virtually all sources of drinking water in the United States contain some fluoride.[1] Fluoridation is the adjustment of the amount of the essential trace element fluoride in water to provide for the proper protection of teeth and bones. It is a form of nutritional supplementation that is not unlike the addition of vitamins to milk, breads, and fruit drinks; iodine to table salt; and both vitamins and minerals to breakfast cereals, grains, and pastas.
Ten states, the District of Columbia, and Puerto Rico currently mandate fluoridation for designated communities through legislation. Other state legislatures (Washington and Hawaii) are currently considering mandatory fluoridation bills. In addition, several other states and many cities have required fluoridation by administrative regulation.
The total US population receiving the benefits of fluoridated water now stands officially at 145 million, or 62.2% of those on community water systems.[2] Over 14300 water systems serving more than 10500 American communities provide this public health benefit to their citizens.[2] Official reports substantially underestimate the number of persons receiving the benefits of fluoridation. Many communities, including Los Angeles and Las Vegas, have implemented fluoridation since 1992, when the last National Fluoridation Census was published.
The dental benefits resulting from continued exposure of children and adults to optimal levels of water-borne fluoride have been documented for more than three-quarters of a century in thousands of studies on fluorides and fluoridation. More than 3700 studies have been done on fluorides since 1970 alone.[3] The prevailing scientific literature from reputable peer-reviewed journals provides adequate documentation of the effectiveness, efficiency, economy, and safety of community water fluoridation for both children and adults. Community water fluoridation has been validated as a primary public health intervention.
Bernhardt and Sprague
compiled a list of techniques frequently used by the opposition in attempting to
stop the process of fluoridation.[4] Several
additional techniques have been categorized and listed in this paper.
Once fluoridation legislation has been introduced, fluorophobic extremists attempt to convince state and local elected officials to remain neutral, rather than make the appropriate health policy decision to fluoridate the water supply. Opponents often attempt to give the impression that there is "scientific" legitimacy for their positions by quoting "alternative" medicine Web sites or using naturopaths, chiropractors, "holistic" dentists, "environmental" physicians, or "health food" promoters as chief spokespersons in hearings, correspondence, and distributed propaganda.
Antifluoridationists try to convince the elected officials to refer the issue to public vote rather than to decide the issue through the legislative process. Fluorophobics attempt this because they are much more adept at running a scare campaign focused on the public than they are at convincing skeptical legislators to agree with their views. In those rare instances where fluoridation has been subjected to referendum, only a small percentage of the elections have been lost in recent years.[5] Moreover, they are lost not because of issues of science, but because of low voter turnout and because of ruthless scare campaigns directed at the most emotionally vulnerable citizens.
The unprincipled opposition institutes massive letter-writing and phone-calling campaigns designed to fool the legislators into thinking that "everyone is against fluoridation," when in fact the vast majority of citizens desire, accept, and approve of fluoridation.[5-7] The fluorophobics also bombard the print media with many letters to the editor in an attempt to enlist unsuspecting citizens in their cause.
The antifluoridationists burden legislators with reams of propaganda falsely claiming "evidence of harm," or inappropriately claiming that fluoridation interferes with their "freedom of choice," even though legitimate research results universally refute claims of harm and the courts have repeatedly held that fluoridation interferes with no one's constitutional freedoms. Actually, there are several functional freedoms with which fluoridation interferes: the freedoms to endure infection, pain, poor nutrition, lost work days, missed school days, higher taxes, higher health-care premiums, and uncomfortable dentures.
Legislators will sometimes let themselves be neutralized because they overestimate the extent of the opposition, incorrectly concluding that it might be better to let the electorate make the decision.
By arousing serious doubts about safety, antifluoride extremists give local
elected officials an easy excuse to delay favorable action. Thus, not only has
the legislative official been neutralized, but also the antifluoridationists
have gained more time to bombard the public with propaganda designed to turn
public opinion against fluoridation.
Fluorophobics repeatedly allege that fluoride causes things like cancer, kidney disease, heart disease, genetic damage, osteoporosis, Down syndrome, AIDS, Alzheimer's disease, nymphomania, and practically every other malady known to man -- a veritable laundry list of unproven allegations.
These laundry lists are repeated so often in antifluoride pamphlets, letters to the editor, and phone calls to talk-radio shows that the public may actually begin to believe the unsubstantiated claims. In order to lend some aura of legitimacy to the unproved claims, naturopaths and other purveyors of "alternative medicine" modalities frequently appear as the authors of such letters.
The appearance of an allegation in print (such as in the letters to the
editor section of local newspapers) is often believed by the public to be
evidence of the allegation's validity. The public incorrectly assumes that the
"authorities" (in this case print media editors) would not allow allegations to
be printed if they were untrue. Thus, the media often become unwitting pawns of
the antifluoridationists, unless the newspapers are large enough and
sophisticated enough to have employed qualified and responsible science editors
to eliminate from publication those letters that are scientifically unsound and
that constitute a potential for harm to the public.
In this technique, an out-of-context statement is used to imply a cause-and-effect relationship between fluoridation and some evil outcome. For example, fluorophobics claim that "fluoride is poison, so don't let them put it in our water." This statement ignores the principle that toxicity is related to the dose of a substance and not to mere exposure to the substance. Chlorine, vitamin D, table salt, iodine, antibiotics, and even water serve as excellent examples of substances that are harmful in the wrong amounts but beneficial in the correct amounts.
Another example of this is: "Fluoride causes dental fluorosis or mottling." By itself, this claim fails to take into account the source of the fluoride, the amount of fluoride, the mechanism of fluoride exposure, or the time of exposure as related to the dental age of the person exposed. Community water fluoridation is not responsible for causing dental fluorosis. Limited numbers of the population have a mild to moderate form of fluorosis that has been primarily attributed to improper supplementation of fluoride through careless prescriptive practices and the inappropriate ingestion of large amounts of fluoride-containing dentifrice by young children not properly supervised during tooth brushing.
Moreover, the extremely mild form of fluorosis occasionally related to fluoridation is no more a pathological condition than is having blond hair or blue eyes. Furthermore, adults cannot acquire dental fluorosis. Antifluoridationists frequently adopt the intellectually dishonest practice of showing photographs of teeth with tetracycline staining or of extremely rare cases of severe dental fluorosis that have occurred in other countries due to extensive industrial pollution or long-term ingestion of extremely high naturally occurring fluoride levels from noncommunal water sources. They then falsely claim that this will be the result for anyone, adults included, who drinks fluoridated water.
"The majority of AIDS victims come from fluoridated cities." Believe it or not, this half-truth was frequently made in the mid-1980s by the most notorious of the antifluoride health alarmists in his misguided attempts to scare San Francisco's public into stopping fluoridation in that city. He continued to make this claim even after the discovery of the virus that causes AIDS.
While most AIDS patients coincidentally reside in major metropolitan areas and most major metropolitan areas are fluoridated (45 of the 50 largest cities in the United States),[8] the antifluoridationists' logic never did explain the high incidence of AIDS in Los Angeles, San Diego, or Newark, New Jersey, all nonfluoridated. This same health alarmist apparently changed his mind and claimed during his unsuccessful 1992 campaign for the US presidency that AIDS is caused by the AIDS drug AZT, implying a plot by medical professionals, drug companies, and the government to infect certain groups with AIDS.[9]
A frequently used fluorophobic tome is that "while one glass of fluoridated water will not kill anyone, it is the glass after glass of fluoridated water, as with cigarette after cigarette, that takes its toll in human health and life."[10] This technique uses a guilt-by-association ploy, attempting to link the known health risks of cigarette smoking (for which there is substantial scientific evidence) to alleged risks from drinking fluoridated water (of which there is no scientific evidence).
Another oft-used claim by fluorophobics is that "insufficient research has
been carried out to prove absolute safety, and therefore consumers and
government officials are urged to wait until all doubt about safety of
fluoridation has been 'scientifically' resolved." This ludicrous argument could
be used indefinitely in that it is impossible to ever prove absolute safety for
all time for anything. Unqualified acceptance of this argument would mean that
literally all technological advancements achieved in the age of science would
have to be eliminated. Thousands of studies and untold risk-benefit analyses
have shown that fluoridation is safe and effective for the entire population.
The best way to illustrate this common fluorophobic technique is to refer to two frequently used antifluoridation publications, The Lifesavers [sic] Guide to Fluoridation[10] (a pamphlet) and Fluoride: the Aging Factor[11] (a monograph). Both use essentially the same "scientific references," both are distributed frequently in campaigns opposing fluoridation, and both documents were marketed by their author as "scientific documents." The one-sheet pamphlet claims over 250 references.
A group of 20 scientists and public health officials from around the United
States decided to actually track down the original references in order to
evaluate their validity as used by the author. It took two years and the
production of a 184-page monograph to adequately document that this pamphlet was
a piece of scientific nonsense. The refutation was appropriately entitled Abuse
of the Scientific Literature in an Antifluoridation Pamphlet.[12] What the group found through its Herculean effort was
astonishing:
Many of the "experts" to whom antifluoride statements are attributed are self-proclaimed experts. For example, John Yiamouyiannis frequently introduces himself as the "world's leading expert on fluorides and the biological effects of fluoridation." Only he and a handful of fluorophobics accept his self-proclaimed world leadership in fluoride research.
Some of the quoted experts have legitimate academic or professional credentials, although not necessarily in disciplines qualified to serve as experts in health research specific to fluorides.
Antifluoridationists occasionally find a credentialed individual to speak against mainstream science. The statements by these marginalized individuals, while of questionable authority, are often exploited by the fluorophobics. Unfortunately, a most flagrant abuse of the public trust occasionally occurs when physicians or dentists, for whatever personal reasons, use their professional standing in the community to argue against fluoridation. Such behavior clearly violates professional ethics, the principles of science, and community standards of practice.
Some nationally known figures who may have opposed fluoridation early in their professional lives (prior to the accumulation of overwhelming scientific evidence in its favor) often have their earlier statements quoted by fluorophobics despite having changed their position to one of support for fluoridation. For example, the fluorophobics repeatedly claim that Nobel Laureate and physician Hugo Theorell "condemns" fluoridation when, in fact, he publicly changed his position to one of support as far back as 1967.
The public is further misled when antifluoride zealots utilize the services
of "alternative medicine" spokespersons to "prove" that the medical community is
divided in its position on fluoridation. Unable to discriminate between
legitimate scientists and purveyors of unproven therapies, some in the public
see the dispute as a conflict between competing health-care philosophies and
ideologies.
Because alleged conspiracies are difficult to disprove, they are a favorite of the health alarmists.
The alleged "conspirators" often include the American Medical Association,
the American Dental Association, the American Council on Science and Health, the
equipment and chemical supply companies, the Communist Party, both the aluminum
and phosphate fertilizer industries, toothpaste manufacturers, and any other
organization appearing to be threatening to the antifluoridationists. Highest on
their list of conspirators is "the government," including the Public Health
Service, the Environmental Protection Agency, the prestigious National
Institutes of Health, the world-renowned Centers for Disease Control, and the
Food and Drug Administration.
Antifluoridationists frequently play on the current phobias and concerns of the public by describing fluoridation in ecologically linked or environmentally loaded terms or phrases such as, "pollutant," "toxic waste product," "chemical by-product," "dumped in the water," or "forced down our throats."
Fluoride is frequently linked by fluorophobics with words like "poison,"
"genetic damage," "cancer," "AIDS," or "artificial." Such words conjure up fear
when linked to something to which people think they will be unwittingly exposed.
The opponents of fluoridation often try to entice unsuspecting media commentators, government officials, or program planners into holding a debate on the "pros and cons" of fluoridation, even though there are no "cons" to fluoridation. A favorite tactic of the fluorophobics is to argue for a debate so that "the people can decide who is right."
Proponents of fluoride are then often trapped into consenting to public debates. Jarvis has published an excellent list of a number of reasons for not debating health quacks, a list that is also applicable to that class of health quacks known as antifluoridationists.[13] Jarvis's 5-item list follows:
(1) The purpose of the debate is to win the audience, not to discover truth. Science is not decided by debating in a public forum, but by careful experimentation, confirmation of findings through independently conducted experiments, submission of all findings to qualified colleagues and peers for critical analysis, and publication of findings in reputable peer-reviewed journals. In a debate, even though the proponents are likely to win the debate, they are just as likely to lose the audience.
(2) In media circles, there is a saying that "everyone is the same size on TV." In other words, debates give the illusion that a scientific controversy exists when no credible people support the fluorophobics' view. Public debates also promote the illusion that there are equal numbers of "scientists" on each side of the issue. The vision of "dueling PhDs" or "dueling doctors" encourages the public to reject fluoridation until the "experts on both sides can agree."
(3) An opponent of fluoridation, utilizing the laundry list approach, can present more misinformation in five minutes than can be refuted in five hours, thus fostering confusion on the part of the public. Proponents are never provided enough time to adequately refute the fluorophobics' charges, because complete refutations, by their nature, take much longer than the sound-bite-length antifluoridation charges. As previously discussed, an extensive two-year effort was required to develop a 184-page textbook to refute allegations made in a one-sheet antifluoridation pamphlet.
(4) Public exposure favors the opponents, enabling them to gain name recognition for the materials, services, or viewpoints they are promoting. Like parasites, opponents steal undeserved credibility just by sharing the stage with respected scientists who are there to defend fluoridation.
(5) It is impossible to compete against opponents without appearing to discredit them personally. When a proponent is arguing against a health alarmist who is spreading misinformation, the proponent cannot separate the antiscience message from the antiscience messenger. Moreover, the debate format often results in the public's sympathy vote for the obvious underdog, the fluorophobics. Since fluorophobics are quick to threaten to file lawsuits even when they have no case, their detractors are exposed to legal harassment by the opponents' attorneys. One can be assured, though, that while threats to sue honest scientists are frequently made, few suits have actually been filed, and none have been successfully pursued by antifluoridationists.
Five additional techniques of health alarmists not listed by Bernhardt and
Sprague include the use of contrived organizations, subversion of the media,
commandeering established organizations, misuse of electronic publishing, and
commandeering meetings.
After repeatedly being embarrassed for
not being able to identify legitimate scientific studies that confirmed any of
their many allegations and after having their own poorly researched propaganda
pieces continually rejected by peer-reviewed journals because the articles were
unable to meet rigorous scientific standards, opponents often form their own
pseudoscientific organizations. Organizations with names like the International
Society for Fluoride Research, the International Academy of Oral Medicine and
Toxicology, the Preventive Dental Health Association, the National Health Action
Committee, and the Safe Water Foundation sound impressive to the uninformed.
They are, in reality, front organizations for the antifluoridationists with few
members. Moreover, most of the members are untrained, uncredentialed
nonprofessionals who lack scientific qualifications. Antifluoridationists
frequently try to pass off propaganda pieces as "research" in Fluoride, the
journal of the International Society for Fluoride Research. While authors of
articles appearing in Fluoride claim that the journal is peer-reviewed, it is
not. The journal does not meet any of the standard requirements of a scientific
journal nor is it indexed in Index Medicus.
Throughout some antifluoridation campaigns,
fluorophobics have been able to recruit the media to support their views for the
following reasons:
There have been several
instances in which antifluoridationists have commandeered established
organizations in an attempt to hijack the organizations' credibility for the
antifluoride cause. Two recent examples involve the Pennsylvania Sierra Club and
one of the collective bargaining units for the US Environmental Protection
Agency.
Moreover, within a few months of the issuance of the "press release," Local
2050 of the NFFE ceased operations, with its membership being absorbed by Local
280 of the National Treasury Employees' Union (NTEU).[17] While Local 280 of the NTEU has never published an
official position on fluoridation, several former officers of NFFE Local 2050
imply that the NTEU supports the NFFE action. The activists have printed
articles and letters for antifluoride Web sites under the NTEU banner.
Numerous antifluoridation Web sites have been established in order to promote the antifluoride political agenda and to recruit converts to the movement. In addition, many "alternative" medicine Web sites have included antifluoridation sections as part of their marketing efforts, along with information that opposes traditional scientific medical practice; attacks immunization programs; promotes herbalism and other dubious therapies; and solicits patients for naturopaths, chiropractors, environmental physicians, holistic dentists, and other purveyors of unproven remedies and practices.
Some examples of antifluoridation Web sites are listed in Table 1. Many of
these contain "articles," letters, endorsements, or references to purveyors of
"alternative" or "complementary" medicine. Some also contain links to Web sites
operated by practitioners and marketers of nonscientific therapies.
Unable to establish professional credibility with civic organizations or the media, antifluoridation spokespersons must often attempt to hijack scheduled meetings or hearings in order to gain a forum from which to market their propaganda. It is not uncommon for antifluoridationists to attempt to utilize question-and-answer periods in public meetings to lecture the audience on the "pitfalls" of fluoridation rather than to ask questions of scheduled speakers. Town meetings, allegedly scheduled to provide opportunities for proponents and opponents to present their cases, often serve as a convenient forum in which antifluoridation spokespersons try to dominate the available time. Print and broadcast media, often as a result of incessant baiting by the opponents, will attempt to lure proponents into a debate-type interview opposite fluorophobes.
Antifluoridation activism provides opportunities for "alternative" medicine zealots and purveyors of unproven health modalities to publicize their "philosophical" differences with science-based health care. But fluoridation remains a safe, effective, efficient, economical, environmentally sound, and socially equitable public health measure to prevent dental disease. It also fulfills all the requirements of an excellent public policy. Despite some minor opposition that sporadically delayed fluoridation's implementation in some locales, substantial progress has been made toward achieving the long-term goal of universal fluoridation in the United States.
Leading Edge Antifluoridation Web site www.trufax.org/menu/chem.html Fluoride Issues www.sonic.net/~kryptox/fluoride.htm International Center for Nutritional Research www.icnr.com/FluoridePres.html Zero Waste America www.zerowasteamerica.com/Fluoride.htm Stop Fluoridation USA -- Information Index www.rvi.net/~fluoride/index.htm Fluorosis Prevention Program www.ia4u.net/~sherrell/ Preventive Dental Health Association emporium.turnpike.net/p/pdha/health.htm Calgary (Alberta) Antifluoride Web site www.cadvision.com/fluoride/index.htm Mountain View (CA) Citizens for Safe Drinking Water www.nofluoride.com/ Holistic Healing Web site www.holisticmed.com/ California Citizens for Health www.citizenshealth.org/ Citizens for Mercury Relief -- The Toxicity Newsletter www.talkinternational.com/fluoride1.htm Fircrest Atlas Orthogonal Chiropractic Clinic www.atlaschiro.com/
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