Maybe it’s the fear talking, but I’d rather talk 9/11 conspiracy theories with Richard Gage than get into the mess and muddle that is water fluoridation. Why? Because whilst the dueling theories of 9/11 are a straight forward case of “Did they or didn’t they?” the debates about whether fluoride is the best thing in health innovation in re the 20th Century or a poison sent by Communist gods to kill us all get rather convoluted.
The gist of the debate is this: either fluoride has been put into water to help stop dental decay or it has been put into our water supply for some other reason. Those “other reasons” range from “It’s an industrial waster/by-product that needs to be disposed of [and handy old Capitalism saw a way to do it where the government shoulders the cost!]” to “It’s a mind control agent [that calcifies the pineal gland!]” Whilst I am sceptical of the various conspiracy theories about the presence of fluoride in our water supply, I can see why people are sceptical of the claims that mandatory dosing of a population with fluoride to prevent dental is necessary (even though I also think such people don’t really understand why such mandatory dosing is a good idea).
So, if we are to deflect some of the conspiracy theories about fluoride we need to ask “Does fluoride cause a reduction in dental decay across a population?”
Well, yes, it does, but it’s a contributory cause rather than the cause of such a reduction.
Opponents of fluoridation (which aren’t necessarily people who think there is a conspiracy behind fluoride in water; they might just think it’s just not ethical to forcefully dose a population with fluoride) will point to countries which don’t fluoridate their water supply and yet still have the same rate of dental decay (or, to put it another way, the same lack of widespread dental decay) as countries which do. They will go “Aha! Fluoride isn’t the salve you claim it is!” They might even laugh mockingly and twirl a mustache (if they have one to hand).
They have a point; it seems that, at this point in time, fluoride, if it is a substance which strengthens teeth, is not making our smiles superior to some other countries which do not put fluoride in their water supplies.
Now, note that I said “some.” Most of the countries people will point at when it comes to healthy-smiles-without-fluoride are developed Western nations like, say, those we find in Europe (which, by-and-large, does not fluoridate). However, there’s probably a good reason why dental health outcomes in both Europe and in places like the USA, the UK, Aotearoa me Te Wai Pounamu (which do fluoridate) are similar, which is a heavy emphasis on dental hygiene. These are all nations which train their children to brush at least twice a day (often with fluoridated toothpaste). No, a better comparison would be with countries where dental hygiene standards (for a multitude of reasons) are not so high. In those cases, you find that our (fluoridated) dental health outcomes look so much better.
An obvious objection to this comparison, of course, is that of course, in countries where dental hygiene standards are low, dental health outcomes are worse; this doesn’t show that fluoride is doing any work because we can point towards more significant contributory cases (general attitudes towards dental hygiene) as being the important difference. Indeed, it does look as if maybe, in a country like ours, fluoride in the water might not be all that necessary because of our generally high dental hygiene. However, the argument goes, countries where dental hygiene is low, adding fluoride to the water supply will, generally, prevent a lot of otherwise unnecessary dental decay.
Of course, even if what I have said is true, it might still be the case that fluoride is an evil mind-control drug. What better vehicle for population control than a drug which also makes teeth whiter and smiles brighter? Or fluoride might be god for teeth and yet bad for the rest of the body, a drug to weaken a population before invasion by, say, Communists.
Both of these theories have been asserted by some opponents of fluoridation.
So, is fluoride poisonous. Yes, in large quantities, it is toxic and will cause problems. This is why we regulate the amount of fluoride in the water supply to a level which is not harmful to humans (you would have to drink so much water in a day to suffer the ill-effects of fluoride that, actually, you’d have other problems to contend with well before hand). It is true that, in some sense, fluoride is a waste-product; most of the additional fluoride we have in water (most water contains a naturally-occurring amount of fluoride) comes from the fertiliser industry, where it’s a by-product of the production of phosphate. Note that: “by-product.” We get fluoride and phosphate from the process. As someone once pointed out, molasses is technically a waste-product in the production of sugar, but we call it a by-product. The way we label things decides, by-and-large, whether we think they are good or bad.
Is fluoride a mind-control agent? No. No no no no no.
People like David Icke claim it is, and books have been written on fluoride as a cause of docility in, say, the American population, but there’s no actual good evidence for the claim that fluoride affects humans pyschologically. That being said, the proponents of views like this will claim that this is precisely what the Establishment, and their pet scientists, want us to think; it is, after all, a grand conspiracy. People like me either are under the control of fluoride (given that I don’t try to avoid it) or know what fluoride does but are engaged in a disinformation campaign to stop people like you finding out its real purpose.
Pretty dastardly if true. Then again, if its true, you’re not likely to ever bother to try and find that out…
Now, it is true that there is plenty of quality scientific debate as to whether rich Western nations like our own need to put fluoride in the water and whether it’s ethical sound to do so even if it is beneficial. There are also debates, once again good debates, as to what the right concentration of fluoride is safest for human consumption, and I can see how the existence of these debates might make average epistemic agents worried that maybe they should be concerned about fluoride. However, the fact that there is a debate doesn’t mean we should be concerned that there is a conspiracy, or that fluoride is a grave threat; for such a controversial claim to hold we need good evidence, which, as far as I can see, there really isn’t any.
Or so I would have you believe.
‘The way we label things decides, by-and-large, whether we think they are good or bad.’ Wow, this is some pretty Whorfian stuff. Might switching the direction of causation be more plausible in these two cases? I.e. becuase people make good use of molasses in cooking, and flouride in water treatment (toothpaste?), they give it a label which is at least evaluatively neutral.
OK nitpicking over. Firstly, the toxicity or otherwise of flouridated water is a red herring becuase people ingest significantly more flouride from using toothpaste than they do from drinking tap water. I suppose you can say that one can choose not to use toothpaste; but one can choose to drink flouride-free bottled water if they wish, too.
Secondly, aggregate national rates of tooth decay are the wrong places to look for the efficacy of flouridation, becuase the main value of the health programme is for populations which have suboptimal dental hygene and access to dental services. In NZ these are typically found in poorer parts of Auckland and Northland, and in children more often than adults. The sorts of studies which would be able to detect the effect of flouridation on these populations would measure the difference between comparable regions and age-groups with and without flouridation inside NZ. These studies are typically unequivocal about the benefits of flouridation on the relevant groups, e.g: Treasure ET, Dever JG. 1992. ‘The prevalence of caries in 5-year-old children living in
fluoridated and non-fluoridated communities in New Zealand.’ NZ Dent J 88: 9-13.
Brute international comparisons have too many possible confounding variables to be informative (for instance, Europeans typically drink bottled water over tap water; diet has significant effects on dental health, as does climate to a lesser extent); controlling for all of these will be near-impossible.
These things are all true, although I think the nitpicking point still stands. Yes, talk of causation can also explain what’s going on here, but labeling fluoride as a “waste product” rather than a “by-product” makes fluoride seem pretty nasty when, maybe, it isn’t. Sometimes these things are done for quite rhetorical reasons, just like calling someone who was previously called a “freedom fighter” a “terrorist” makes something which sounds noble something that seems very ignoble indeed.
On the toothpaste point, lots of varieties of toothpaste doesn’t contain fluoride, so the water/toothpaste connection is actually quite a tricky one. Some people avoid high concentrations of fluoride in both (given that water contains a naturally-occuring amount of fluoride anyway). Even more confounding, some areas of the world (like parts of France) have an untreated water supply that is high in fluoride anyway, so even if people aren’t using treated municipal water and avoiding fluoridated toothpaste, they might be drinking spring water high in fluoride anyway (the whole bottled water thing is really very awkward as well; lots of bottled water is water from municipal water supplies and is, thus, fluoridated). So, as a friend says, tricksy.
I agree with the tooth decay rates, although you can still compare, say, New Zealand with Nigeria and get some idea of the efficacy of fluoridation. Indeed, the conspiracy theorists about fluoride are less happy with those kinds of comparisons than they are with local comparisons. They’ll point at studies within a developed country like Aotearoa me Te Wai Pounamu (New Zealand) and say “Well, of course, publicly funded research will say it’s a benefit and say it causes no harm; that’s what they want us (in Aotearoa me Te Wai Pounamu) to believe!”
But, overall, other than the first point, I don’t disagree with you.