In an op-ed this weekend, Dr. Michael Wilkes asks whether “a few (can) still block a benefit for the many?” At first, it seems like an odd question.
Dr. Wilkes, after all, is an expert in public health. He is a researcher, a professor of medicine and public health at UC Davis, and he chairs the Yolo County Heath Council.
His question caused me to pause and think for a second. In many ways, we have an odd government. We have a judicial system where guilt and innocence, just by way of one example, is not determined by the professionals who practice law, but by the layman who are supposed to take the evidence, the meager instruction on the law contained in jury instructions, and render what is often life-altering decisions on guilt and innocence.
This becomes more awkward when you have a true expert – a doctor, a forensic pathologist – attempting to explain complex scientific and medical theories to a judge who acknowledges that chemistry is a weakness – and yet at the end of the day, the person who fails to understand chemistry is expected somehow to direct others to fairly apply the law to a given set of facts.
As it turns out, as strange as this sounds to someone really thinking about the implications of such a systemic structure and its consequences for guilt and innocence, it is even more strange to think that this is, in fact, how public policy is made everywhere.
Even more strange, however, is the fact that most people at the end of the day prefer this arrangement because, while doctors and public health officials may be experts on the issue of public health, public policy is necessarily the weighing of competing interests and considerations.
Most levels of government from the county on up have health department, or advisory positions that do research and make recommendations to elected bodies, who then make the law. However, these health agencies, whether it is the County Health Department or the CDC, do not make laws. That is left to the politicians.
That is, in fact, how most of us, most of the time, want it. Elected officials are charged with creating laws and public policy and they have to take into account costs, budgets, and of course politics. But in a way it’s strange.
That is still strange. After all and with all due respect, if my tooth hurts, I am not going to go to Joe Krovoza or Brett Lee to have it treated. I’m going to my local dentist. And yet, when it comes to public health, it is Joe Krovoza and Brett Lee who get to make the final call on fluoridation.
In part, that may be due to the populist roots of the foundation of this nation – the idea that we actually have a fair amount of distrust for experts and science itself. If we want to argue that the science on fluoridation is unsettled, do we really want a body of elected officials to be the ones to arbitrate between competing scholarly papers on concepts ranging from statistical analysis to complex medical findings that most do not understand?
And yet, that is exactly what we are asking our council to do, and not just in this area, but in this area the disconnect is greatest.
Michael Wilkes puts forward a powerful argument. He starts with the history of public health and makes a remarkable argument, that the success story of public health has been less about doctors curing diseases, and more about public health remedies.
He writes, “Although the skills of surgeons and cardiologists are amazing, and have helped a few people enormously, they have contributed relatively little to the overall life expectancy in America.”
Instead, he argues, “increases in life expectancy have been primarily attributed to sanitation, diet improvement, water purification, transportation improvements and, of course, immunizations. Americans live more than twice as long as our colonial forbears.”
These changes have not come without struggle. He notes, “Unfortunately, not all Americans have benefited equally from public health or medicine, including women, people of color, the poor and those in rural areas.”
He recounts a smallpox epidemic in 1900 Milwaukee and argued, “Smallpox was a preventable disease but no one was willing to take the steps to prevent its spread.”
The efforts of Walter Kempster, a public health physician, stand out as he took on smallpox with gusto, and also created Milwaukee on the verge of a “civil war” with the community divided between those who wished to stop the disease and those who he wrote, werer “not wanting to be inconvenienced.”
Dr. Wilkes writes, “Kempster hired extra physicians to launch a required immunization program, he forcibly isolated infected persons by placing them in an isolation hospital, and he imposed strict quarantines for those allowed to remain in their own homes.”
That is a lot of power to put into the hands of a non-elected official. The wealthy and politically connected did not take kindly to the intrusion, “claiming these steps were against their liberties and their rights as Americans. Stone-throwing crowds protested and homes were barricaded so people could not be removed. Thugs threw scalding water at horses pulling ambulances so the infected could not be moved. Many attempts were made to both close the health department and fire Kempster.”
But he writes, “Kempster held strong in a severely divided city. Eighteen months later, health came to Milwaukee and Kempster’s approach was vindicated.”
Left unquestioned here is whether allowing doctors and public health officials to make calls that limit personal liberties is the best course of action.
From his perspective, it seems an easy call.
He writes, “Fifty years later, infections were being treated with amazing antibiotics, but the huge decline of these deadly diseases started 80 years earlier as a result of important public health interventions that required restrictions on human behaviors and limited personal liberties.”
He describes confining of one to one’s home an inconvenience, but as science continues to advance and evolve, it becomes clear that the issue of health versus liberty will continue to conflict.
Writes Dr. Wilkes, “As we cured acute illnesses, what emerged to take their place were chronic illness like diabetes, cancer, alcoholism and tooth decay. They also required public health interventions.”
That is one of the key questions that faces us moving into the future.
It becomes clear where Dr. Wilkes resides in this debate.
“In many areas, the United States lagged, and still lags, behind most other developed nations,” he writes. “The reasons for this are complex, but are rooted in the disparities in our health care and our inability to place the health of the public above the personal liberties of a few.”
But how far are we willing to go? New York, for instance, drew the ire of many by banning sugar-filled soda.
City attorneys in New York, for example, are attempting to get an appeals court to reinstate the mayor’s soda ban.
In a story from mid-June, the New York Daily News reported that “the Health Department released a shocking report about the deadly toll exacted by diabetes in the five boroughs. As obesity has risen in the city – driven in no small part by soda consumption – deaths linked to diabetes have soared.”
The paper goes on to note, “The disease claimed a record 5,695 New Yorkers in 2011, one death every hour and a half, or 16 a day. Equally frightening, the proportion of diabetes-related deaths nearly doubled to 11% from 1990 to 2011.”
The paper adds, “Numbers like those are the reason the Board of Health voted to bar sales of most sugared drinks bigger than 16 ounces by establishments that are regulated by the department. The limitation was also grounded in well-established findings that the more soda people consume, the higher their chances of obesity, along with the likelihood of diabetes and conditions like heart disease.”
In this case, the public health officials got the backing from the politicians, but at great political costs. Around the country, many recoiled at the idea that the government should make this call even as public health is a top priority and this is not simply a matter of health, but a budgetary matter as diseases like diabetes take a huge toll not just on health, but on public budgets.
This is clearly just one example of difficult public policy decisions that will have to be made in the next twenty years.
And so it becomes clear that, while doctors and public health officials may be the experts on public health issues, it is left to the politicians to weigh between public health and civil liberties.
Unfortunately, when we see a public strongly divided, we will see politicians struggling to find the middle course that can move us forward in a way that will not blow back on them. The politicians will invariably choose the easy way out.
The fifty-year battle on public water fluoridation in Davis bears this out. Even in a highly-educated city, it seems that there is a strong enough anti-intellectual current that distrusts public health officials to derail well-intentioned efforts to promote public health.
As I have written before, I fully expect that the council will punt on the issue of fluoridation. The only real question is whether they can find a middle ground that protects the public health, while still preserving the perception of civil liberties.
—David M. Greenwald reporting
David,
Thanks for this very thoughtful editorial, discussing the issue of legislators/non-scientists making decisions for the community on issues involving science.
And I entirely agree with Dr. Wilkes’ op-ed. We have heard from many members of our medical/public health community in support of fluoridation. As a member of this community, I would also add my voice in support of fluoridation.
Here are two additional thoughts.
1. A democracy requires well educated citizens. In the field of medicine, we need to know the basics of how to evaluate medical knowledge. After all, we have decisions to make as patients, consumers of medical products and as voters on health care related issues. There are basic concepts in evaluating medical studies; they can and really need to be taught in school. Without this basic training, the public remains vulnerable to conspiracy theories as well as to poor science. They will not recognize overwhelming medical evidence when they see it (e.g. on fluoridation).
2. The soft drink/obesity issue is not government vs our free will. That dichotomy is what industry would have us believe. The issue is whether our government can and will protect us from aggressive advertising of noxious but profitable products. The over consumption of sugary drinks is nothing but manipulation of our free wills by an industry bent only on profit. In return, the public bears the brunt of poor health and the costs of caring for chronic diseases. Just recall the tobacco wars which, incidentally, are still being waged.
I echo the above; provocative article….As a health care professional I am for fluoridation, but I will say the anti group has brought up a couple points that have caused me pause….the fact that the amt of water we ingest is such a small amt of the total which will be fluoridated…and the cost.
It will be interesting to see what the CC does..and especially the rhetoric they use. When is the vote?
There is a big difference between public policies regarding infectious diseases, and public policy about fluoridation. If your kid isn’t fluoridated, she doesn’t infect the child next to her with dental caries. If your kid isn’t vaccinated (or isolated in the case of small pox) she is a threat to the whole population. So unfortunately, Dr. Wilkes’ analogy, and in effect his entire essay, is based on a false premise.
[quote]The politicians will invariably choose the easy way out.[/quote]
I certainly hope that this is not the case. It is not often that our city council has the ability to weigh in significantly on public health issues since these usually fall to the county level and above. Here we have a clear opportunity for the city council to make a difference in the area of preventive medicine and public health.
I personally support fluoridation. However, what I would truly hope is that the members of the city council will weigh the scientific evidence and all the other factors such as cost, feasibility, alternatives and vote their own convictions even if it may cost them politically. This for me is what leadership is all about. What good is being elected if one is unwilling to lead based on the best available evidence and available choices ?
[quote]what I would truly hope is that the members of the city council will weigh the scientific evidence and all the other factors such as cost, feasibility, [b]alternatives[/b][/quote]
I don’t know if California’s fluoridated drinking water act (AB733 — 1995) allows for alternatives if there is funding available for direct fluoridation of the water.
Soda
[quote]the fact that the amt of water we ingest is such a small amt of the total which will be fluoridated…and the cost.
[/quote]
With regard to the cost, I think a comparison of cost of prevention with cost of treatment is worth considering.
As presented at the WAC, the cost of fluoridating was estimated as less than $3.00 per month per connection.
As listed in several sites through a Google search, the cost of a repairing a single cavity varies from $50-350.00
depending on the composition of substance used for the repair.
Personally, I would rather not be fluoridating the water. My personal preference would be a single party payer health care system in which preventive healthy care including dental is provided for all through our taxes.
However, we are far, far from my preferred alternative. I appreciate Alan Pryor’s suggestion of a tax to support care through Communicare. However, does any one believe that this will pass. Does anyone believe that the same people who are now arguing that this is forced medication and that people are currently overtaxed will support this. If fluoridation is defeated at the level of the city council,or by a vote, what I believe that you can count on is that the opponents of fluoridation will celebrate their victory, and then withdraw from any discussion of alternatives. Why ? Because they do not care about the public health. It is simply not a priority for them as it is for many of us in the health professions. One has only to read their own comments to know this is true. Over and over you hear ” I do not want [u]my[/u] water fluoridated. I don’t want [u]my[/u] children drinking fluoridated water. Conveniently ignoring that no one is making them consuming city water and that fluoride free water is readily available. I don’t want to have to [u]pay[/u] to support public health. I don’t want the taxpayer’s ( read [u]my[/u] money spent this way. Alan and a few others have paid lip service to providing care for the less economically advantaged in our community, and I truly respect this position but where will the support be for their proposals ? The city council ? They cannot make it happen . The community as a whole ?
I strongly suspect that without this proposal, we will simply do what we have done for the past 50 years.
Namely forget about it.
Water fluoridation is not my preferred choice. However, I see it as the only currently viable alternative to achieve a major public health goal and I hope our council will see it that way too.
@Don Shor,
I think you might have read the article too quickly, Don. Dr. Wilkes laid out the premises of the article very clearly right in the first two paragraphs, which shows there are several things to keep in mind. His piece is not centered solely on the issue of immunizations:
“Instead, increases in life expectancy have been primarily attributed to sanitation, diet improvement, water purification, transportation improvements and, of course, immunizations.”
AB733 1995:
Directs the DHS to adopt regulations that require the fluoridation of all
public water systems that have at least 10,000 service connections.
…but the requirement to comply may not be enforced until
sufficient funding to pay the capital costs for the system is available
from any source.
Requires the DHS to seek all sources of funding for enforcement of the
standards and capital cost requirements and permits a public water system
to collect a fee from its customers to recover the costs incurred in
complying with the requirement to fluoridate.
Permits the Attorney General, upon request of DHS, to institute mandamus
proceedings, or other appropriate proceedings, in order to compel
compliance with these provisions upon reticent owners or operators of
public water systems.
[url] ftp://www.lhc.ca.gov/pub/95-96/bill/asm/ab_0701-0750/ab_733_cfa_960507_134806_asm_comm.html%5B/url%5D
I’m not sure why we’re even having this discussion, or why the city council is even going to vote on it. State law seems pretty clear. Perhaps somebody can explain how the City of Davis could decide not to fluoridate, given the language of the law. Or how the city could use funds for any alternative program.
Don
[quote]I don’t know if California’s fluoridated drinking water act (AB733 — 1995) allows for alternatives if there is funding available for direct fluoridation of the water.[/quote]
I have no expertise in this area, but my impression from speaking with several lawyers knowledgeable in this area is that the answer is “no”. And even if it did, what alternative can you see that would cost less than
$3.00 per connection per month. Dental visits cost far more than this. One might foresee an opt out school based program for direct fluoride application however, providing the support services as well as the materials for application would doubtless cost far more than water fluoridation.
As I have stated, I am not strongly wedded to water fluoridation as the best possible alternative. I do see it as the only available alternative. If someone has a better alternative available to implement rather than to simply close our eyes to the fact that this is a major public health issue and ignore it as we have so far chosen to do, I would gratefully consider and support it.
Don
[quote]There is a big difference between public policies regarding infectious diseases, and public policy about fluoridation.[/quote]
I agree with this portion of your statement, and largely disagree with the rest.
Just because dental caries, like diabetes, is not contagious does not mean that it does not have tremendous adverse consequences for individual and for our society as a whole. Dental caries is a preventable debilitating disease.
Most of us who write letters to the editor or post comments do not really realize the impact because we have access to dental care. For us, a tooth ache caused by a cavity means the inconvenience of taking a 1/2 day off work to go to or take our kid to the dentist. Most of the cost will be covered by our insurance. Not so for many of the indigent and working poor. For them, that tooth ache may mean days of pain, inability to concentrate in school or on the job, increased cost of ER care if an abscess forms ( we don’t think of that because it doesn’t happen to us), and eventually loss of the tooth affecting our dental health for the rest of our lives. This I know having lost two teeth to a climbing accident.
So while the effects of dental caries are not dramatic and immediately visible as are the effects of small pox, they are none the less a major detriment to the health of our society and thus I support the other aspects of Dr. Wilkes essay as well as his conclusion.
Here is the text of the 1995 law that Don mentioned above:
[url]http://www.leginfo.ca.gov/pub/95-96/bill/asm/ab_0701-0750/ab_733_bill_951010_chaptered.html[/url]
medwoman:
I’ve tried to think of other policies where we treat everyone in order to benefit a few, where it doesn’t involve infectious diseases that are harmful to the whole population. The closest I could think of is West Nile Virus, where municipalities sprayed entire cities by air or ground with malathion or pyrethroids in order to protect the relatively small percentage of people who have life-threatening infections. My recollection is that about 80% of us don’t even know when we’ve been infected, most of the remaining 20% get flu-like symptoms of varying severity, and a very small percentage get very ill with occasional mortality. So we ‘treat’ everyone to protect those few.
Don
All analogies have flaws. The flaw with the Nile virus analogy is that “we ‘treat’ everyone to protect those few”.
The problem is that dental caries affects the many. Just in ways that are not readily seen by those who have access to dental care and thus are not perceived as important. So now, what we have is a matter of line drawing about how many would actually be benefitted. I suspect from speaking with my pediatric colleagues who write the prescriptions for fluoride supplements and who have seen first hand the lack of compliance with recommendations, that when we count only the “underserved” population, we are significantly under counting those who would stand to benefit.
The fallacy of Dr. Wilkes argument is the underlying premise that fluoridation works in reducing community dental caries rates and that is simply not proven. Indeed, in my opinion it has been disproven. Regarding his other accusations, actually it is the pro-fluoridationlists who still rely on psuedo-science performed decades ago with the sole purpose of proving the effectiveness of fluoridation.
If the science were so compelling that fluoridation was cheap and effective, how come 97% of Western Europe has rejected fluoridation and still gets their drinking water uncontaminated by this toxic byproduct of the fertilizer manufacturing industry? How come Israel and the the provinces of Queensland Australia and Ontario Canada have recently rejected mandatory fluoridation? How come the EPA Union of Scientists have called on Congress to end fluoridation? How come the oldest and largest Latino organization in the US, the League of United Latin American Citizens, have called for an end to fluoridation because of the disproportionate adverse effects that fluoridation has on the Latino population? How come Portland voters just last month rejected fluoridation of the drinking water by a 61% – 39% margin?
In fact, it is the pro-fluoidation faction that uses alarmists, non-scientific techniques such as in Dr. Wilkes article comparing a non-infectious disease like tooth decay with the mandatory immunization of smallpox. What’s next? Will Dr. Wilkes also suggest we quarantine all people with tooth decay?
The problem with tooth decay in our disadvantaged population is that NONE of the public supporters of fluoridation who are dentists accept Denti-Cal patients! They simply turn them away because they are not profitable enough compared to private-insurance paying patients. The public shame of excessive tooth decays in minority patients is squarely on the shoulders of those who refuse to provide them with basic dental services and then prevent independent dental hygienists from practicing in the disadvantaged community without dentists taking a cut of their fees.
Alan,
Look at the info in the link that Don posted at 09:12 a.m.
Can we please refrain from shooting from the hip and get our facts straight please. This is Davis, California, home of UC Davis — not the home of Podunk U.
Thank you.
Subsequent litigation and many expert opinions by municipal counsels surrounding AB733 — 1995 have clearly showed that “outside” funding must be made available for all capital and operating costs for fluoridation. A city is NOT required to spend its own money to do this
To Brian Riley re:
[quote]Can we please refrain from shooting from the hip and get our facts straight please. [/quote]
Can you please explain what facts I have not gotten straight in my post?
Alan,
I’m talking about item 5 on page 4 of that link that proves your statement wrong. It *is* proven.
You’re wasting our time with this anti-intellectual stuff, OK? I have better things to do!
Thanks.
-Brian
To Brian Riley re:
[quote]I’m talking about item 5 on page 4 of that link that proves your statement wrong. It *is* proven. [/quote]
So you are saying that because one reference by the state legislation say it is proven, that it is “proven” enough for you. I obviously have far less confidence in politicians’ evaluating what is best for our public health than you. I have actually read all of those studies myself (have you?) and suggest your bar for establishing scientific “proof” is perhaps way too low.
[quote]You’re wasting our time with this anti-intellectual stuff, OK? I have better things to do![/quote]
…and yet here you are posting away!
Alan: [quote]have clearly showed that “outside” funding must be made available for all capital and operating costs for fluoridation.[/quote]
Can you explain how Davis can show that it is not available? How have communities made the decision not to fluoridate in the face of the language in the state law? Isn’t funding usually available from the CDA or ADA? So if they offer it, wouldn’t Davis be in violation?
I have only looked into this part of the issue briefly, as with the Watsonville case. But the language of the state law seems pretty unambiguous. Perhaps you can give more detail on this.
To Don Shor re:
[quote]Isn’t funding usually available from the CDA or ADA? So if they offer it, wouldn’t Davis be in violation?[/quote]
CDA/First 5 funding has not been available to completely fund all the projects they want to for the past several years. They lately require cities receiving monies to execute a contract saying they want fluoridation and that they will continue to fluoridate after monies to fund the operating costs are exhausted several years down stream. Some bigger cities, however, (San Diego among them) have run out of CDA/First 5 money after 2 years and their legal counsel has advised that they do not need to continue to fund fluoridation themselves. So the battle to fluoridate or not fluoridate rages on in those communities once the initial pot of money has been completely exhausted.
But as long as outside monies are available to COMPLETELY fund capital AND operating costs, Davis would be required to fluoridate and continue fluoridating as long as operating costs are provided. West Sac only received about $200,000 in funding of their greater than $1,000,000 in total capital and operating costs. Thus, West Sac would NOT have been required to fluoridate if they had chosen not to do so.
It seems to me that capital costs are probably included in the surface water project. So the question really would be operating costs. Are outside monies available to fund operating costs?
Are you, in effect, asking the city council to specifically decline to approve the process of fluoridation on the grounds that funding is not available?
Alan
[quote]If the science were so compelling that fluoridation was cheap and effective, how come 97% of Western Europe has rejected fluoridation and still gets their drinking water uncontaminated by this toxic byproduct of the fertilizer manufacturing industry?[/quote]
Because Alan, as I have pointed out in your presence and in posts that I know you have read, this is because most of Western Europe has chosen to approach public dental health in a more comprehensive way than we have chosen here in the US with free, universal dental care. There are essentially no developed countries that do not provide fluoride for dental caries prevention in some fashion. Before one is too quick to point the finger at any one group of professionals as entirely responsible for any aspect of public health, perhaps what we should all be looking at is how much of our professional services and expertise do we give away for free or provide pro bono ? If we expect our dentists to provide their services for less than what the market will bear ( sorry for the paraphrase Jeff) then should we not all be willing to do the same? Or if we do not provide such a service, should we not all be willing to pay more in taxes so that all can have adequate health care ?
If you are saying that as a society we have a responsibility to provide health care for all, I agree whole heartedly.
But please, when our entire health care system is structured as it is, let’s not demonize one particular group for their supposed “greed”.
Alan
[quote]If the science were so compelling that fluoridation was cheap and effective, how come 97% of Western Europe has rejected fluoridation and still gets their drinking water uncontaminated by this toxic byproduct of the fertilizer manufacturing industry?[/quote]
Because Alan, as I have pointed out in your presence and in posts that I know you have read, this is because most of Western Europe has chosen to approach public dental health in a more comprehensive way than we have chosen here in the US with free, universal dental care. There are essentially no developed countries that do not provide fluoride for dental caries prevention in some fashion. Before one is too quick to point the finger at any one group of professionals as entirely responsible for any aspect of public health, perhaps what we should all be looking at is how much of our professional services and expertise do we give away for free or provide pro bono ? If we expect our dentists to provide their services for less than what the market will bear ( sorry for the paraphrase Jeff) then should we not all be willing to do the same? Or if we do not provide such a service, should we not all be willing to pay more in taxes so that all can have adequate health care ?
If you are saying that as a society we have a responsibility to provide health care for all, I agree whole heartedly.
But please, when our entire health care system is structured as it is, let’s not demonize one particular group for their supposed “greed”.
The pro-fluoridation arguments are based on many of the same studies the anti- folks use. As in most scientific arguments, we disagree about the outcomes and the methods. For instance, the IQ issue cites articles that are not generalizable to our situation. The osteosarcoma literature is pretty clear that there is no risk of osteosarcoma from fluoride at the levels found in water systems in the U.S. A recent study from Australia found that those with lifetime exposure to fluoridated drinking water had lower levels of dental caries than those that had only partial exposure.
Dr. Wilkes speaks to the principles of public health that population-based therapies can reduce risk and disease better than individual treatments. Simply because the research was done decades ago doesn’t make the longterm outcomes false. If there was such a menace from fluoride, why haven’t the locales that have backtracked supported replications of the older studies. And it is nonsense to suggest that the newer research says that fluoride is bad for us. The Iowa studies and the research from Australia (as well as the equivocal metaanalysis done by York University) all point in a different direction. And has been pointed out elsewhere in this blog, most of the countries in Europe that do not fluoridate also have universal dental coverage.
The science behind fluoridation of domestic drinking water, on balance, is in favor and does not reveal any longterm downside for the public. The politicians ought to listen to the many citizens (some of whom have expertise) who are in favor, rather than the detractors.
At 3:39 pm Don wrote: “It seems to me that capital costs are probably included in the surface water project. So the question really would be operating costs.”
My impression from the staff report and presentation was that the capital costs for fluoridation were not included in the water project.
You can see the staff report, etc. here: http://city-council.cityofdavis.org/on-going-committees/water-advisory-committee/agenda—june-27-2013
It isn’t clear to me reading that if Davis would have to fluoridate both the surface water and the deep wells. It would be quite a cost difference.
Also, there is this about funding:
[quote]Davis is priority #136 out of 167.[/quote]
So, setting aside the issues of toxicity and efficacy and personal choice for a moment.
State law requires the city fluoridate if funds are available.
It is expensive to install the fluoridation system(s). Ongoing costs are pretty low.
A source of funds has been identified, but Davis is far down on the list.
Are proponents of fluoridation advocating that rates be raised to pay for fluoridation before some other source of funds is available?
Don: I am not sure if a source of funds has been identified. I just searched the staff report for “fund” and did not find an identified source of funds for fluoridating Davis.
That aside, I think that the proponents of fluoridation might logically prefer to persuade a city to fluoridate, and therefore use all or mostly city funds to do so, so that the proponents’ finite supply of funds can be used to force some other, unpersuaded, city to fluoridate.
And, yes, the proponents and funders are often one and the same, or very closely linked. One of the main proponents of fluoridation (and the group behind the mandatory fluoridation law) is the California Dental Association. And the CDA Foundation is one of the main sources of funding used to force fluoridation on a city.
Don:
If Davis were to fluoridate only the surface water, assuming that is even allowed, then the city would have a fine mess to deal with in letting people know when their water is or is not fluoridated–information critical for anyone giving fluoride tablets to their children.
But the number of children getting those tablets should be low, given that, in Dec 2010, a JADA article announced the new recommendations to give fluoride supplements only to children at very high risk of caries, and only after carefully assessing their total intake of fluoride from all other sources.
And, yes, Dr. Pollick–who did not mention this new, more limited recommendation when he talked of the number of children in the age range for tablets and the cost per child per year–is well aware of it as he is listed as a co-author on the article.
I didn’t see a source of funds either. So I’m curious as to what list Davis is “#136 out of 167” on. The link provided just after that item in the staff report didn’t work.
@Alan Pryor,
If you think you can parry my comments with some lightweight tit-for-tat stuff, then you are sadly mistaken my friend.
If I have arthritis, I don’t go to the dentist because he or she has never been trained to diagnose how fluoride can affect my bones. There is no dispute between those for and against fluoridation that too much fluoride will damage bones and teeth. The same goes for the thyroid, kidney and brain which studies show can be adversely affected by fluoride.
The human body doesn’t need fluoride and neither do waters supplies.
Besides, are you saying that people who work for Public Health Departments are infallible and shouldn’t be doubted?
nyscof
[quote]There is no dispute between those for and against fluoridation that too much fluoride will damage bones and teeth. The same goes for the thyroid, kidney and brain which studies show can be adversely affected by fluoride. [/quote]
It is true that very high levels of fluoride can damage teeth and bones. It is also true that appropriate levels of fluoride can strengthen both teeth and bones. One demonstration of this is that in a number of European countries elderly women are prescribed fluoride patches to improve bone strength. This is one of the many, many instances in medicine in which the optimal amount if beneficial….and too much, toxic. No one is proposing putting toxic levels of fluoride in the water supple.
Your comment that “the same goes for the thyroid, kidney and brain” is not accurate. None of these have ever been demonstrated to be harmed by fluoride if you go to the original articles rather than just relying on the FAN
web site for your information. A minimal change in blood level ( as in the thyroid studies) or the mere presene of fluoride ( which is found in high calcium areas of the body naturally) does not imply let alone prove harm.
As for infallibility, I would not claim that for either side. That is why it is important to go back to the original papers for reliable information and not just depend on the sound bites put out by either side.
[quote]It is true that very high levels of fluoride can damage teeth and bones. It is also true that appropriate levels of fluoride can strengthen both teeth and bones.[/quote]
Actually, there is no evidence that teeth or bones need fluoride. I feel sorry for those European women who are wearing fluoride patches because studies already show that fluoride does make bones thicker but more brittle.
When fluoridation began, it was virtually the only fluoride source, 1 milligram daily was considered “optimal” to reduce tooth decay with only 10% of children suffering with mild dental fluorosis. But 68 years later, we have fluoridated toothpaste and other dental products, our food and beverage supply is fluoride saturated because fluoridated water is used to make them and they are contaminated with fluoride-containing pesticide residues and many pharmaceuticals taken daily contain fluoride. Fluoride is also an air pollutant. Now our children are over-fluoridated with up to 60% affected with dental fluorosis – 3% moderate/severe (yellow, brown and/or pitted teeth). We don’t know what damage fluoride has cause to their bones because no one is looking. And tooth decay is a national epidemic.
The truth is that virtually all American children ingest way more than 1 milligram fluoride from all sources. The CDC says that ingested fluoride does not reduce tooth decay. Fluoride’s beneficial effects are topical only.
[quote]Your comment that “the same goes for the thyroid, kidney and brain” is not accurate. None of these have ever been demonstrated to be harmed by fluoride if you go to the original articles rather than just relying on the FAN
web site for your information[/quote]
I didn’t get the other information from FAN. According to Kathleen Thiessen, Phd, there is clear evidence that small amounts of fluoride, at or near levels added to U.S. water supplies, present potential risks to the thyroid gland
Dr. Thiessen authored the endocrine chapter in the National Research Council’s 2006 Fluoride Report. She says, “Many Americans are exposed to fluoride in the ranges associated with thyroid effects, especially for people with iodine deficiency…The recent decline in iodine intake in the U.S could contribute to increased toxicity of fluoride for some individuals.”
Robert Carton, PhD, an environmental scientist who worked for over 30 years for the U.S. government including managing risk assessments on high priority toxic chemicals, says “fluoride has detrimental effects on the thyroid gland of healthy males at 3.5 mg a day. With iodine deficiency, the effect level drops to 0.7 milligrams/day for an average male.”
Among many others, the NRC Report cites human studies which show
– fluoride concentrations in thyroids exceeding that found in other soft tissues except kidney
– an association between endemic goiter and fluoride exposure or enamel fluorosis in human populations
– fluoride adversely affects thyroid and parathyroid hormones, which affect bone health
The National Kidney Foundation withdrew its support of fluoridation and reports,and now says that “exposure from food and beverages is difficult to monitor, since FDAfood labels do not quantify fluoride content.”
and “Individuals with CKD [Chronic Kidney Disease] should be notified of the potential risk of fluoride exposure.”
nyscof
[quote]present potential risks to the thyroid gland
[/quote]
And this is the level that all of the evidence with the exception of fluorosis arrives at. “Potential risk” does not equate to actual risk. The effect on bones is also dose dependent. This controversy has gone back and forth in the osteoporosis literature for the past 30 years. It would seem that the excessive dose in the 20 to 50 mg day
range which were used in some of the early American studies did indeed lead to bone fragility. It would seem from some of the European studies ( which I admit to not having read in their entirety ) that lower doses seem to provide increased density without increased fragility. I expect that we have not heard the last of this controversy regarding osteoporosis prevention. Again, I would not accept anyone’s “infallibility” on this issue.
Medwoman, from what I’ve seen in the literature the reason the Western European nations have chosen not to fluoridate water is because of the fact that the water system does not allowed controlled dosage. By fluoridating the salt people with fluoride sensitive conditions can easily avoid exposure.
The fact that Western Europe has better healthcare coverage for low income people has nothing to do with their decision not to fluoridate the water.