Fluoridation, or: How I Learned to Stop Worrying and Love the Water

General Jack D. Ripper with Captain Lionel Mandrake.

Most of us have heard the famous line by General Jack D. Ripper in Dr. Strangelove, "have you ever seen a Commie drink a glass of water?" The conversation thereafter satirically illustrated a fear that grew most prominent starting in the 1940s with the Second Red Scare -- public water fluoridation. Many conspiracy theories about water fluoridation arose during this time, but they all aimed to make the same case: that fluoride in drinking water is bad (sometimes just meaning unethical), and unhealthy, for various reasons that are being neglected by the government.

In a study published in JAMA by Oliver & Wood (2014) entitled "Medical Conspiracy Theories and Health Behaviors in the United States," it was found 49% of Americans believe in at least one of 6 medical conspiracy theories, including but not limited to concerns about "Agenda 21," the vaccine-autism link, and water fluoridation. For the latter, it was found that 12% of Americans believe that "public water fluoridation is really just a secret way for chemical companies to dump the dangerous byproducts of phosphate mines into the environment." This is just one of the many explanations for water fluoridation that conspiracy theorists provide, so the variation in the "theory" aspect of it is similar to that of "chemtrails;" but unlike the chemtrail conspiracy theories which are fairly recent (starting around the 1990s), water fluoridation has invoked fear from the public for quite some time, and remains a pervasive element of the disconnect between the scientific community relating to public health and the public itself. Nick has informed me already of two scenarios this semester where his classmates have promoted the concept. So with all the concern it raises, is the fear of public water fluoridation a legitimate concern?

Of course, it's unfair to group the concerns mentioned above with the Red Scare sentiments expressed in Dr. Strangelove, but the resentment against water fluoridation still fails to be substantive. The arguments of ethics not withstanding, water fluoridation is (if at all) not anywhere near as medically harmful as 12% of the American population believes it is. Here, we're going to examine some common arguments made by proponents of this conspiracy theory and refute them. Let's get started.

Fluoride is the only chemical added to water for the purpose of medical treatment.

It depends on how you define "medical treatment." One could argue that many processes conducted during water purification, such as disinfection to kill parasites and bacteria, can be considered medical treatment (specifically preventative treatment), but either way, this is actually a red herring. Whether or not it's the only chemical added to water is immaterial, because it doesn't lend any credibility to one side or the other; however, we can examine why it was added as "medical treatment," and start to make an informed decision.

Water fluoridation in the United States began in 1945 because a wave of dental hygienists began promoting the widespread distribution of fluoride to promote dental hygiene in the United States for individuals of all ages and income levels. It was meant to be a cost-effective, efficient way to distribute this treatment throughout the United States, and so it was. Approximately $40 billion have been saved in reduced oral health care expenditures in the United States over the past 40 years due to public water fluoridation.

To celebrate the coming of a new century, in 1999, the CDC released a statement about the top ten greatest public health achievements in America from 1900 - 1999. In this list, water fluoridation was listed. The report estimates that in 1999, fluoridated drinking water reached approximately 144 million people in the United States, effectively serving its purpose. The report also refers to the 1999 edition of a book by Burt and Eklund entitled Dentistry, Dental Practice, And the Community. In Chapter 25 of the book, the causes, effects and cost of water fluoridation in the United States are discussed. It estimates that there has been approximately a 40-70% decrease in child tooth decay and approximately a 40-60% decrease in adult tooth loss.

So not only were the intentions clear, but the results were evidential, and the effort was a success. The addition of fluoride to drinking water (in the United States anyway) was a medical treatment, but it was a justified one.

Dental health products, such as toothpaste and mouth wash, which contain fluoride, tell you not to swallow them.

This is due to the very high concentration of fluoride in them, which they acknowledge can make you sick. The fluoride in toothpaste and mouth wash, also, is meant for prolonged exposure to the teeth, for optimal usage.

The dose cannot be controlled.

This argument relies on two premises: (1) that without control, there is a risk for people to harm themselves from fluoridated water; and, (2) that a lack of individual dosage control is an argument against water fluoridation. For premise one, the toxic level of fluoride is around 5-10 grams for a typical 150 pound or 70 kilogram adult, using estimates provided in Clinical Toxicology of Commercial Products, a book produced by Gosselin, Smith and Hodge in 1984. The recommended number of glasses of water to drink is 8, so if there is 1 part fluoride for every million parts water, in 8 glasses of water, there is about 0.002 grams of fluoride -- this is about 1 tenth of a grain of sand. So, the toxic amount of fluoride (5-10 grams for a 70 kilogram adult) is 2500-5000 times greater than what is found in 8 glasses of water (0.002 grams of fluoride). That means that, with the strictest estimates, if all fluoride content received in water were to be retained in the body (it's not), it would take almost 7 years to reach the toxic level.

It should be noted, then, that 1 ppm was the optimal fluoridation amount at the beginning of the project, but is now around 0.7 ppm, and thus the amount of fluoride an individual receives is about 30% less than what we estimated above. The point being, however, is that the current levels of fluoride in drinking water are not enough to be of concern to people who drink a lot of it.

But going beyond premise one and onto premise two, the argument is again irrelevant. There are many chemicals introduced to public drinking water that, if ingested in excessive quantities, could pose health risks. This doesn't mean, however, that these chemicals should automatically be taken out, because this is the case for many different things we ingest, like tuna, apples or coffee. The issue is not in whether or not they could threaten their health by drinking too much, it's a question of if they will. This requires individual responsibility to an extent; however, given what we know from the content above, we can say that there isn't too much reason to start tallying your water intake and calculating the amount of fluoride you consumed therein.

The fluoride goes to everyone regardless of age, health or vulnerability.

This part of the article talks about the progression in pharmacotherapy from stereotyped medication to individualized therapy. What the quote cited failed to note is that individualized therapy is applied when there is reason to believe that patients can be divided into medically relevant subgroups that respond differently to specific treatment, and thus they need to examine an individual's characteristics (gender, age, ancestry, etc.) to make a determination of what treatment to use. What he also failed to mention is that, aside from individualized treatment, there is also evidence-based medicine (EBM), which essentially means the treatment of individuals based on the current best evidence available. Considering that water fluoridation only began after it was found in Grand Falls, Michigan that fluoride levels of 1.0 ppm in the water were optimal for preventing tooth decay, water fluoridation would be considered a public health initiative based in EBM.

Fluoride is used as a chemical in rat poison.

This is like arguing that because chlorine is used to chemically decontaminate pool water (but is toxic), and chlorine is also used in common table salt (a.k.a. sodium chloride), then chlorination of table salt should end. Chemicals used in one way do not have the same effects as chemicals used in another way.

No health agency in fluoridated countries is monitoring fluoride exposure or side effects.

Water fluoridation, in the United States, is monitored at the state level, and not by federal agencies. This should be considered a good thing, because different states have different cities and different states have different levels of naturally occurring fluoride in the water -- if this amount is too much, some is actually removed from the water supply. Aside from this, the claim that no health agency in any fluoridated countries monitors this is just unfounded. For example, here's England's 2014 report on fluoridation.

At this point, we should be able to acknowledge that water fluoridation is not a particularly harmful practice. I'm not denying here that there are some arguments to be made against water fluoridation as a governmental practice, but we can see that as a medical effort, it's not bad. For further information, I recommend reading the World Health Organization (WHO) report on water fluoridation across the world.

Thank you all very much for reading.



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References:  

Oliver, J., & Wood, T. (2014). Medical Conspiracy Theories and Health Behaviors in the United States. JAMA Internal Medicine, 174 (5) DOI: 10.1001/jamainternmed.2014.190