by Paul Connett
Groth concludes that “the two clashing perspectives generally have not received balanced attention in the dispute, ” preference being given to the public dental health perspective for “largely historical and political” reasons. 3
The Problem of Promotion
The problem arises when a public health authority sets out to promote a practice. Effective promotion does not mesh well with cautious notes or caveats. Any expressed doubts are seen as a setback for the program. Thus, from the U. S. surgeon general down to local health officials, the practice of fluoridation is promoted with the utmost confidence. It has to be that way. To question the program is to invite its demise. Almost by definition then, promotion of the program requires statements that there are absolutely no dangers, that the practice is extremely effective, and that there is no debate on the science of the matter. Dissent must be stifled.
Bill Osmunson, DDS, MPH, provided a snapshot of the formation of those attitudes when he related an experience while taking his master’s degree in public health. He said that he got into an argument with his professor about an issue, and the professor admonished him, “Your job is not to question the science. Your job is to promote the policy. ”4
A Belief System
Most of the rank-and-file supporters of fluoridation programs doubtless believe fluoridation to be safe and effective and hold that position in good faith. Many are genuinely proud of what they see as a great contribution to public health. However, the problem is that for many of those people it has become a “belief system, ” and not one that can be well argued on the basis of the primary scientific literature.
The late Dr. John Colquhoun, who investigated this issue as part of his PhD thesis, 5 wrote in 1997, “Enthusiasts for a theory can fool themselves very often, and persuade themselves and others that their activities are genuinely scientific. ”6 To support his thesis on this, Colquhoun used the well-known text by Thomas Kuhn, The Structure of Scientific Revolutions. 7
The Fear of Losing Prestige
Over fifty years ago, a prominent water engineer had this to say on the matter of “losing prestige” if proponents of fluoridation abandoned the promotion of this practice:
The continued promotion of water supply fluoridation in [the] face of mounting adverse evidence and criticism requires some evaluation. It seems that the proponents hit upon an idea years ago, which appealed to them, and which they felt was sound. As their claims of safety were progressively discredited, rather than acknowledge this, they persisted in condoning such evidence. At the same time they were lending their prestige to such equivocation. Certainly the proponents of fluoridation are not intent upon poisoning or harming anyone, however, the dilemma of prestige is a very difficult matter to resolve. 8
If we run the clock forward to the present, it is very clear that over the last fifty years many leading public health dentists and dental researchers have built their careers and reputations on promotion of this program. Huge reputations are at stake. It takes a person of strong character to change his or her position in public.
The Fear of Losing Credibility
To the reluctance of scientists and others to give up a pet theory, we have to add the concern that bureaucracies have over losing credibility. Abandoning or modifying advocacy becomes harder to do the more vociferously officials have proclaimed the benefits. In the case of the United States, every surgeon general in office since 1950 has championed fluoridation and issued statements of glowing support. The declaration by the CDC in 1999 that fluoridation is one of “the top ten great public health achievements” of the twentieth century9, 10 is repeated nearly every day somewhere in the world. It is very hard to back down from such lofty rhetoric without losing face and credibility. As Dr. William Hirzy said in a videotaped interview with Michael Connett in 2001:
Putting this stuff in the drinking water is in essence just a hazardous waste management tool. It has nothing to do with dental health whatsoever. It has to do with defending the reputations of people who have been promoting fluoridation for years and years and years and now find themselves way out on a limb and have nothing more to say except safe and effective, safe and effective, safe and effective, when in fact it is neither safe nor effective. But they can’t change. They’re riding a tiger and they can’t get off. 11
Also, one has to wonder what other public health practices might be threatened if the CDC or other U. S. Department of Health and Human Services agencies admitted the dangers of water fluoridation, with the sudden loss in credibility—or public trust—that might entail.
The Fear of Liability
Another major reason promoters of fluoridation may be reluctant to stop supporting this practice is fear of liability. If it is admitted that fluoridation causes any harm, there are lawyers waiting in the wings to sue somebody. Many players might be subject to legal action, such as the fluoridated dental-product manufacturers, dental organizations that have endorsed those products, the water utilities that add the fluoride to water, the local councils who are practicing medicine without a license, or the government health agencies that assure everyone that it is safe to ingest fluoride. At the moment, all of these entities are “hanging tough” and presenting a common front; when they sense the battle has been lost, then the finger-pointing will begin over who should shoulder the ultimate blame.
There are ways that governments could abandon fluoridation and avoid or minimize liability. Without admitting any harm, they could halt fluoridation in the name of the precautionary principle, discussed in chapter 21. They could also end it on the perfectly reasonable grounds of the program’s declining efficacy and increasing public opposition. But it will only get more difficult as time goes on.
Protecting Economic Interests
Chris Bryson, a former producer and correspondent for the British Broadcasting Corporation, spent ten years writing his book The Fluoride Deception, 12 which meticulously documents the collusion between the U. S. Public Health Service, the Fluorine Lawyers Committee, and fluoride-polluting industries in the early promotion of this practice. Bryson stated in a 2004 video interview, “Fluoride science is corporate science, fluoride science is DDT science, it’s asbestos science, it’s tobacco science, it’s a racket. ”13
Bryson’s thesis is that fluoridation was a way of changing the image of fluoride from one of the worst air pollutants—responsible for many lawsuits from farmers and others claiming damage from fluoride pollution—in the 1940s to something safe enough to give to children in their drinking water.
Readers of Bryson’s fascinating book will have a pretty good notion of why the practice started, but we need another book of that caliber to explain why it continues today. One piece of evidence that industrial interests are still involved is the continued aggressive promotion of fluoridation by the American Council on Science and Health (ACSH).
According to SourceWatch (a Web site produced by the Center for Media and Democracy that describes itself as a “collaborative, specialized encyclopedia of the people, organizations and issues shaping the public agenda”), the ACSH describes itself as “a consumer education consortium concerned with issues related to food, nutrition, chemicals, pharmaceuticals, lifestyle, the environment and health. ACSH is an independent, nonprofit, tax-exempt organization. ”14 But SourceWatch indicates that ACSH accepts funding from Coca-Cola, Kellogg, General Mills, Pepsico, and the American Beverage Association, among others. One of the companies also named as supporting ACSH is Alcoa. 15 According to veteran journalist Bill Moyers, host of Bill Moyers Journal, broadcast on the Public Broadcasting Service (PBS-TV) in the United States:
ACSH has been supported in large part by contributions from companies such as American Cyanamid, Chevron, Dow Chemical, DuPont, Exxon, Monsanto and Union Carbide. The organization sends out a continual stream of press releases and reports anchored by one primary theme—that environmental risks, especially the risks of toxic chemicals, are not so great as the public is being led to believe. 16
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nbsp; Many prominent fluoridation promoters of the past and present have served as ACSH advisers or directors (e. g. , Frederick Stare, Michael Easley, and Stephen Barrett). In 1990, the ACSH threatened legal action if any federal agency attempted “to reclassify fluoride from a non-carcinogen to a probable carcinogen. ”17 We return to this discussion below when we review the role of the sugar lobby in the promotion of fluoridation.
Industry and Agency Gains
There are certainly a number of powerful entities that gain financially from the continued practice of water fluoridation. However, simply because they gain financially does not mean that they are the driving force behind the continued push for fluoridation, either today or in the past. It is a good place to start, though, if we are to understand fully why, despite the poor evidence of benefit and growing evidence of harm, proponents continue to promote this practice so zealously.
The Sugar Industry
The one economic interest that Bryson did not investigate is the sugar industry. Other commentators have, however. Notably, Fred Exner and George Waldbott, 18 Gladys Caldwell and Philip Zanfagna, 19 and Wendy Varney20 have pointed fingers in that direction.
In 1949, one year before the U. S. Public Health Service endorsed fluoridation, the director of the Sugar Research Foundation, a lobby representing about 130 sugar interests, said that its research mission was “to find out how tooth decay may be controlled effectively without restriction of sugar intake. ”21 For the sugar lobby, fluoride—delivered through the water supply— quickly became the magic bullet to achieve that goal. From the earliest days of fluoridation, considerable sums of money were paid to prominent fluoride researchers at leading American universities. 22
One researcher at Harvard who gave the sugar lobby what it wanted was Dr. Frederick Stare. According to his obituary in the Boston Globe in 2002, Dr. Stare was the founder of the Harvard University Department of Nutrition. “During a nearly six-decade career, Dr. Stare attacked health food advocates as charlatans on national television and in his syndicated newspaper column, and led boisterous campaigns to fluoridate public drinking water and defend food additives like Alar” [emphasis added]. 23
According to Caldwell and Zanfagna in the book Fluoridation and Truth Decay, Dr. Stare held a position with the Sugar Research Foundation, for which he was “required to testify before congressional committees and to lecture to various groups on behalf of the cereal and sugar interests. ”24 According to Wendy Varney, in a 1970 Senate hearing on consumer affairs “Stare was listed as a witness for at least six major trade organizations and food processing companies. These included National Biscuit Company, Kellogg Company and the Sugar Association. ”25
As far as those sugar interests were concerned, Stare provided good returns for their investment. According to Varney, he was quoted as saying, “There is no convincing evidence that in the average American diet decreasing the intake of sweets will lessen tooth decay” and describing ice cream, potato chips, cookies, and soft drinks as “nutritious snacks. ” Varney added that he even recommended “Coke as an after school teenage snack. ”26 Caldwell reported that Stare called opponents of fluoridation “compulsive critics characterized as neurotics, driven by mystic, primitive, subconscious fears. ”27
According to Zanfagna, Stare was able to convince the Food and Nutrition Board to list fluoride as “essential” in 1958 and was quoted in the media in 1967 as saying that “fluoride deficiency, lack of fluoride, is probably the most prevalent nutritional deficiency in the country. ”28
Not only did Dr. Stare promote the notion that fluoride benefited the teeth, but he was also one of the early promoters of the idea that fluoride would strengthen bones. He was a coauthor of a study published in 1966 that purported to find a reduction in hip fractures in areas with high natural fluoride levels. 29 The methodology of this study was heavily criticized at the time, 30 but Stare was undaunted by the criticism, and the results of the study led him to state before the Senate’s Select Committee on Nutrition and Health on September 8, 1969, “The fluoridation of water is more important for the health of the future elderly than the teeth of the children now. ”31
Stare was also one of the seven members of the board of directors of the industry-funded group ACSH, discussed above. In 1990, he was part of the effort by that group to restrain any federal agency from banning or seeking to reclassify fluoride from a non-carcinogen to a probable carcinogen. According to an article in Food Chemical News, 32 the ACSH threatened legal action if the EPA classified fluoride as a carcinogen in the wake of the publication of the National Toxicology Program’s 1990 animal study reporting that there was “equivocal evidence” that fluoride caused osteosarcoma in rats (see chapter 18).
The article quotes Stare as saying, “Fluoridation is not dangerous and not expensive. It is absolutely safe for anyone of any age, either sex, and in any state of health. ” He also said, “It is one of the greatest advances of public health of all times. Those lucky enough to have access to fluoridated water from infancy through life will have 60 to 70 percent less tooth decay. ” He cited studies of other apparent benefits derived from fluoride use as a factor in preventing osteoporosis and as a possible deterrent to arteriosclerosis. 33
As late as 1990, this renowned nutritionist and lobbyist for the sugar and food industries was still claiming that fluoride was a nutrient—and that its ingestion was beneficial to both teeth and bones.
The Aluminum Industry
Bryson documents the very prominent role that the aluminum industry (especially Alcoa) played in the early promotion of fluoridation. 34 Whether this support was generated by concerns about liabilities associated with fluoride pollution of the environment near its plants or fluoride poisoning of the workers inside the plants or whether the industry was eager to find ways to get rid of the huge quantities of fluoride waste generated by its operations is open to question. The latter issue has faded from the picture; as the availability of the mineral cryolite has been dramatically reduced, the aluminum industry today uses much of its waste fluoride to make synthetic cryolite. Regarding the former issue, however, aluminum industry executives may still be concerned about protecting the industry from lawsuits brought by workers whose health may have been damaged by fluoride. As long as fluoride is perceived as being safe enough to put into toothpaste and drinking water, it is difficult to convince juries that it is dangerous. See the cross-examination of Dr. Phyllis Mullenix by lawyers for the Reynolds Metals Company, as reported by Chris Bryson. 35
The Phosphate Fertilizer Industry
In Florida, Cargill is among several giant companies that mine phosphate rock for the production of super-phosphate fertilizers and phosphoric acid. In the process, huge quantities of hexafluorosilicic acid are produced (see chapter 3). The willingness of communities to use this industrial-grade waste product in water fluoridation is a substantial financial benefit to the phosphate fertilizer industry. It turns what would otherwise be a costly disposal problem into a profitable business.
The Dental Products Industry
Nearly every dental product, from toothpicks to mouthwash to toothpaste to dental fillings, contains the “magic ingredient” fluoride. Were water fluoridation to cease, this industry would also take a hit. While sales of products that involve topical application might increase if fluoridation was stopped, the larger financial concern of dental product producers might be legal liability. If, or when, fluoride is proved to cause harm to a point that class-action lawyers are prepared to take the matter to court, there could be very large settlements. It should not be forgotten that the American Dental Association has its seal of approval on nearly all of those products and might also be found liable.
Summary
In short, fluoridation makes a lot of money and provides a lot of prestige and power for a relatively small number of people. Whether that makes them “true believers” in this matter despite the weak evidence of the practice’s effectiveness and the growing evidence about health conc
erns is open to question. We like to think that for the vast majority of fluoridation promoters, it is more a matter of firm belief than a cause tainted with economic interest. However, it might take only a few people to be persuaded by larger economic considerations to influence the whole fluoridation-promoting apparatus. That is the danger and the power of the two chains of command, administered by the CDC and the ADA concurrently, discussed in chapter 23.
For those like ourselves who have studied water fluoridation it remains puzzling that rational people support this practice so vehemently. We will give the final word to Columbia University historian Jacques Barzun, who wrote this on the matter in 1964:
In England, the Minister of Health has called the opponents of fluoridation cranks and fanatics; in this country, physicians who write on the subject to the newspapers fulminate against the unbelievers as if the Inquisition were back in our midst. To object to the plan is to be against science, that is to say a heretic. Scientific fact is of course irrelevant to the issue, which is purely civic, and which should be settled with the aid of simple questions, such as:
Is it common sense to treat by universal dosing a small anonymous part of the population, without knowing how much or little of the treatment the intended beneficiaries will take?
