By Tia Will
I was deeply disappointed with the actions of he Davis City Council on October 1, 2013. But perhaps not for the reason one might think based on my past posts. I was a strong and vocal proponent of water fluoridation.
However, it was not the “no ” vote that I found disappointing. It was what I see as a devaluation of the importance of public health by three of our council members.
I have stated in public and on the Vanguard on a number of occasions that I view fluoridation as one proven effective and safe strategy for cavity prevention. I am aware that there are other potential strategies. Because of our lack of a comprehensive, integrated, preventive health care system, our generally poor dietary habits despite the efforts of individual and public health care providers to educate and motivate improvements, and despite other attempted programs which have not proven successful in the past, I felt that fluoridation was the best option for our community at this time.
Had our leaders on the City Council chosen to look at the alternatives, truly assess the scientific claims on both sides, and made a decision based on best evidence, scientific considerations, and concern for the public well being and voted “no” I would have disagreed, but I would have fully respected their choice. By their own words and actions, this is not what occurred.
Prior to the issue coming before the Council for consideration, all five of the council members were well aware that this was an issue. As leaders, all five had the opportunity to reach out to whomever they chose to discuss the issue. So what actually happened ? Dan Wolk made the decision to support fluoridation based on his perception that this was indeed an effective public health care preventive strategy. Brett Lee made efforts to find an alternative solution, but apparently did not thoroughly vet his idea with the folks who have experience with the shortcomings of this approach and was relying on voluntarily donated funds for what would likely be a very expensive proposition aimed at a much narrower constituency. Both reached out, considered this public health issue to be worthy of their attention and advocacy and I am grateful to them for their efforts. Three of our council members did not.
Each of the remaining three made their decision on other considerations. In their own words during discussion, each made it clear that public health was not the major consideration for them. Lucas Frerichs spent much of his commentary on his own personal experiences with tooth decay in a classic example of anecdotal bias in which personal experience is valued over what is demonstrated to occur over a population and demonstrates a lack of appreciation for evidence. By this standard, if Mr. Frerichs caught the flu after having received a flu shot, we should stop offering flu shots to anyone as they are obviously ineffective.
Rochelle Swanson made much of the fact that she had received many more letters against than for fluoridation and felt that it would not be “democratic” to not balance the two sides. However, she appears to have made little effort to attempt any problem solving, assess alternatives, or weight evidence in a proactive manner. Instead she made her decision based primarily on a letter writing campaign. By the reasoning employed here, if adding chlorine to the drinking water were the issue and enough people had written to her stating that they would rather boil their water and take their chances with cholera than be “poisoned” with chlorine, we would all be drinking “pure” un-chlorinated water.
And finally, Joe Krovoza made what I thought was probably the most telling comment of all. He commented that if fluoridation of the water had been included previously, the surface water project would not have passed. I was a strong proponent of the surface water project. Now, Mayor Krovoza may have been right. But with strong leadership from the council, he might also have been wrong. This decision was not about democracy. This was about the fate of the water project being held hostage by a group who would stop at nothing to achieve their goal. Alan Pryor, the leader of the opponents, stated that had the council voted in favor of fluoridation, he would have immediately started the drive for a referendum.
So essentially, this decision was made not on the basis of any consideration of public health with careful weighting of the evidence on both sides, but rather, in their own words, on the basis of personal bias, a well orchestrated letter writing campaign, and a political threat. I believe in science. I believe in evidence. I believe in our responsibility to promote the well being of our community including public health. It is a deep disappointment to me that three of our city council as witnessed by their own actions and explanations, do not appear to share those values.
Perhaps I am wrong. Perhaps Mayor Krovoza’s instruction to the city staff to begin assessing alternatives will prove productive. Perhaps there are opponents who will do what they said at public comment and work with public and private health care providers to achieve an alternative solution. However, based on my past disappointing experience in attempting to engage in cooperative educational health projects through the schools and in other public venues with my efforts at public education blocked by some of these very same fluoridation opponents, I am not optimistic.
As a friend who was not a supporter of fluoridation expressed it to me, “You and the public health community are going to be left to pick up the pieces.”
I fear he is right. This is what we do. We treat individual patients. We educate.
We advocate for healthier individual and community practices. David Greenwald is right. We are not politically savvy. We are not conversant in political agitation and letter writing campaigns and we have limited time to spend refuting every unsubstantiated potential association, fear, and speculation about what might occur to someone drinking fluoridated water some day. But we are the ones who have devoted our careers to the health of our patients and our community. The opponents have no such responsibility.
What I had hoped was whether with a “yes” vote or with a “no” vote based on their interpretation of the evidence and putting public health as the primary priority, our leaders would have each committed actively and publicly to personally addressing this very important public health issue. They chose not to.
I had hoped for better.
Well said, Tia. Although I only saw bits and pieces of the mtg on tape and not the CC members’ comments, it was disheartening to hear their reasons given as you have presented.
From the YES/NO presentations it seemed Alan and the NOs had more ‘data’ and anticipated more rebuttals, but interestingly according to you none of the CC members cited the presentations as reasons. I believe the whole issue should have been decided WITH the surface water project and feel it was kind of sneaky that it was not discussed and delayed until now.
Anyone know what Woodland’s position is?
SODA
To be fair to the members of the CC, it would be worthwhile to listen to the entirety of their comments. Each of them did make comments, in which I believe they are sincere, about caring about public well being. My point was that for none of them did this appear to be their most important consideration, thus my title
“Devaluing Public Health”. I am well aware that the council members have many other obligations to our community. However, it is rare that there is an opportunity such as this at the local level to make a real impact on the health of the community and I feel this was an opportunity needlessly squandered.
I do not know how the decision making was made regarding timing of the fluoridation issue and
I do not know where Woodland stands on this issue currently.
Probably not surprisingly, I came away from the discussion with a completely different take. I thought the public health community as a group devalued the intelligence of the public and the Council.
The opponents of fluoridation presented their data, and were prepared to talk about the science of fluoridation, whereas almost to a person the proponents presented their credentials and basically said ‘trust me, I know what is good for you.’
“[i]I believe in science. I believe in evidence.[/i]”
So do I, and I really wish the proponents had deigned to present some as the outcome may well have been completely different.
“I believe the whole issue should have been decided WITH the surface water project and feel it was kind of sneaky that it was not discussed and delayed until now. “
Did they not include it purposely or was it just an oversight?
Or did they think it would be better to decide on the fluoride issue separately?
Mark West
[quote]whereas almost to a person the proponents presented their credentials and basically said ‘trust me, I know what is good for you.’
[/quote]
Bingo! Some took so long presenting their credentials that they hardly had anytime left to actually speak on the issue. My wife and I were at home watching and saying get to the point instead of trying to impress everyone with your qualifications.
If measure I had included water fluoridation that topic would have dominated much of the conversation. Those against fluoridation would have demanded no fluoridation as a condition of voting yes. Those against the surface water project would have had another wedge to use to defeat the measure.
I don’t see how this result could have been any different unless we were stuck with crappy well water still.
Hopefully the Medical community turns to helping with the alternative approaches. Lets get that dental care van rolling! I will offer to drive.
To blame three Councilmembers for “devaluing public health” because they honestly voted “no” to fund a public health policy that has been proven to be not only a failure but actually harmful grossly misrepresents the facts. In fact, it is the complete failure of the public health community in general and the dental community in particular that is primarily responsible for the horrific state of dental health among disadvantaged communities. Only about 4% of all the dentists in Yolo Co accept new Denti-Cal patients because they do not make as much money as from private insurers. Perhaps the public health community itself should accept at least some measure of responsibilities for this sorry state of dental health among the poor. Instead of doing so, however, they simply push the blame onto our leaders who made an accurate assessment that fluoride is not the magic pill that the public health community promised.
And contrary to Ms. Wills assertions, there were numerous other efforts on the part of the anti-fluoride advocates to discuss alternative dental health care strategies. I was personally told by one of the strongest proponents that they wanted to wait until after the Council made their decision about fluoride before having any discussions. Then, I personally approached the author of this article immediately after the Council vote and offered to immediately begin discussions on how additional funding for low-income dental care might be ramped up while the item is still fresh in everyone’s mind. Instead of embracing my honest offer, the author spent the whole time telling me I misrepresented the facts about fluoridation and was dishonest in our campaign. And then she said she did not want to enter any of the proposed discussions I offered as an olive branch because there was a lot of ill will and distrust on the proponents part which needed time to dissipate before productive talks could be held.
I am disappointed that the author of this article did not honestly report these other outreach efforts on the part of fluoridation opponents before laying all the blame at the feet of the Council and the fluoridation opponents themselves.
If the council members had all voted based upon the evidence for and against fluoridation, Dan Wolk would have been a NO vote as well.
Alan
[quote]To blame three Councilmembers for “devaluing public health” because they honestly voted “no” to fund a public health policy[/quote]
Did you even read my article ? I stated twice quite clearly that I was not criticizing the “no” vote. I was quite critical of the means by which they explained they had arrived at their decisions. Are you really asserting that you cannot discern a difference in those two points of view ?
As we have discussed previously, at every presentation I gave with any factual material, I stated quite clearly that I was speaking only for myself. I have stated many times that I was not a member of the Fluoridation Sub Committee and you were present in the room at each time I announced this. I was not involved in any of the decision making of this group. As you know, I was not amongst the people that you “reached out to ” about any of these suggestions and you stated as much to me stating quite accurately that ” I could not be expected to reach out to every one”. Then why are you criticizing me for not taking you up on the offer you never made unless you consider it an obligation to respond in person to every casual comment that is made on the Vanguard ? And if you do consider that an obligation, I would point out that as of this morning, you had not taken me up on my invitation to email me which we agreed I would let you know when I would be ready to talk ? I can honestly say that with the exception of Brett Lee, no one else opposing fluoridation attempted to contact or interact with me in any way except on the pages of the Vanguard. Are you denying this? I really consider it quite offensive to accuse me of dishonesty when you know quite well that your invitations did not include me. If you are sincere about working together, it is probably not productive to call me a liar.
I felt it was necessary to present my side of this issue since instead of sending me an email, you chose to make statements that you know to be untrue in a public venue. I think having both had a chance to present our version of events, we should take any further discussion off the pages of the Vanguard.
Once again, my email is tia.will52@gmail.com and I am happy to work with you or anyone else. Of course, if you feel that going on the attack is more productive, I’ll read those emails too.
To medwoman
[quote]…you chose to make statements that you know to be untrue in a public venue[/quote]
[quote]If you are sincere about working together, it is probably not productive to call me a liar.[/quote]
It would seem that it you who are calling me the liar in your post. And I don’t recall you asking me to email during our conversation after the Council meeting. However, I will certainly take you up on that offer now.
[quote] I thought the public health community as a group devalued the intelligence of the public and the Council.
The opponents of fluoridation presented their data, and were prepared to talk about the science of fluoridation, whereas almost to a person the proponents presented their credentials and basically said ‘trust me, I know what is good for you.’ [/quote]
mark west is absolutely spot on here.
” David Greenwald is right. We are not politically savvy. We are not conversant in political agitation and letter writing campaigns”
no you have it wrong. david wasn’t complaining that you were not politically savvy, he was complaining that the health community did not engage on this issue with the public and alan pryor did. his efforts swayed people like me who were leaning yes in the beginning. the health community never won people like me back.
[quote]Hopefully the Medical community turns to helping with the alternative approaches. Lets get that dental care van rolling! I will offer to drive.[/quote]
I call shot gun.
I hope the medical community and the general public can work together to find alternative approaches and that a reliable long-term funding source can be established to keep something like a mobil dental van running . I liked Brett’s idea about a voluntary donation added to the water bill, is that still being considered?
i think that alan and tia have done a great service to the community.
tia, you are really an exception to the criticism of the health community. you have gotten into the trenches, engaged, educated and enlightened. in the end, though i agree with your goals, i think fluoridation was not politically practical.
alan, your work on this and other issues is amazing and needs recognition.
i’d really like to see you guys bridge your small gap and work together for the better of the community, especially low income kids.
[quote]i’d really like to see you guys bridge your small gap and work together for the better of the community, especially low income kids.[/quote]
“Ditto”.
[quote]However, it was not the “no ” vote that I found disappointing. It was what I see as a devaluation of the importance of public health by three of our council members.[/quote]
No, three of our council members did not “devalue the importance of public health.” They made a wise decision, and I applaud and thank them. Fluoridation does not prevent dental caries, but it does pose health risks. I continue to be disappointed by our continued dismissal of the hundreds of research articles that demonstrate this fact.
[quote]Had our leaders on the City Council chosen to look at the alternatives, truly assess the scientific claims on both sides, and made a decision based on best evidence, scientific considerations, and concern for the public well being and voted “no” I would have disagreed, but I would have fully respected their choice. By their own words and actions, this is not what occurred.[/quote]
On the contrary, it is the fluoride proponents that need to look at the alternatives, truly assess the scientific claims on both sides, and make a decision based on best evidence, scientific considerations, and concern for the public well being, rather than relying on the authority of endorsements. We saw the long list of endorsements again during the pro-fluoridation presentation at the City Council hearing. Fluoridation is promoted today just as it was 60 years ago: with endorsements, not with scientific evidence of safety and efficacy.
You state that our council demonstrates a lack of appreciation for evidence. What would that evidence be? Please supply us with the studies that you find so convincing. I haven’t seen you reference any studies in any of the many comments you have made on the Vanguard, or in either of your Vanguard articles. You have stated that you have done your own research on the fluoridation issue. Seriously, what research articles convinced you of the safety and efficacy of fluoridation? Can you supply the citations?
[quote] We are not politically savvy. We are not conversant in political agitation and letter writing campaigns and we have limited time to spend refuting every unsubstantiated potential association, fear, and speculation about what might occur to someone drinking fluoridated water some day. [/quote]
On the contrary, it is the fluoride promoters who have money and time, not the anti-fluoridation crowd. First Five has lots of time and money, public health bureaucrats have time and money. Barbara King, Alan Pryor, and Pam Nieberg were not paid for their time as they sat, weekend after weekend, month after month, at the Davis Citizens Against Fluoridation table at the farmer’s market, trying to educate Davis citizens about fluoridation. They had to dig into their own pockets to pay for all of their supplies, and to pay for every piece of literature that they passed out. You say that the pro-fluoridation side is not politically savvy and conversant in politics, and you imply that it was, in fact, the pro-fluoridation side which was disadvantaged in this campaign. Quite the opposite is true.
[quote]I believe in science. I believe in evidence.[/quote]
So do the fluoridation opponents.
I need to correct a typo in my last post:
No, three of our council members did not “devalue the importance of public health.” They made a wise decision, and I applaud and thank them. Fluoridation does not prevent dental caries, but it does pose health risks. I continue to be disappointed by [u][i][b]your[/b][/i][/u] continued dismissal of the hundreds of research articles that demonstrate this fact.
tleonard
I believe that I had made it very clear that I considered it my role to investigate the claims being made about the harmful effects of fluoride since I do have expertise in the areas of fetal development, breast cancer, and osteoporosis and readily access to articles which would either support or refute the articles you and others suggested. I never said I was an expert on tooth decay. I am not a dentist nor do I have any special expertise in this area. There were members on the Fluoride Sub Committee who had been working on this issue for years. I made no specific claims and have actually answered you on why there are no large, prospective double blinded studies on fluoridation.
I read every separate article that any of the opponents brought to my attention. Fluorosis is the only potential harm that has any basis in scientific fact at the level proposed. Alan Pryor has been frank in discussing that all of the others except “hypersensitivity” are associations only, there is no proof and frankly no strong evidence to support any of the rest of the claims. He and I disagree about what the evidence shows and does not show with regard to hypersensitivity, but we are in agreement about the lack of evidence to support the rest beyond the level of association ( or synonymous in my mind, speculation).
I think the Council voted in the context of wanting to make sure the water project succeeds. Under different circumstances it might have turned out differently.
I think the public health community does not “do grassroots” very well and they (we) were out ‘grassrooted” by the opponents of fluoridation. The public health forces did not do a good enough job of framing the issue and the politicians took the opportunity to preserve the water project.
The notion by one poster that “hundreds of articles” science makes suggests she may not understand much about how science works. It’s not the hundreds of articles – there are probably just as many on the pro side as on the con side. One article can change the course of science – for instance h. pylori and gastric ulcers. As someone who reads a lot of articles in a field far from fluoridation, there are lots of articles that don’t add much to the discussion and consensus. It’s the quality of the articles. And in the case of fluoride, there are a lot of poorly written and thought out articles, but when put all together and presented well, and with the right context, they continue to convince voters and policy makers that fluoride in the water is not the way to go. This isn’t science this is public policy sausage. And the Yolo County public health establishment are not as good sausage makers as Alan Prior, Barbara King, and a bunch of others.
I’ve said it before and I’ll say it again:
Proponents and opponents of fluoridation carry different burdens of proof. Proponents need to have conclusive proof of substantial benefit and very strong evidence for an extraordinarily low risk of harm. They have neither. For opponents, it should suffice to show that there is an identifiable risk of serious harm. Even small risks are indefensible when deliberately imposed on a large population. This is common sense, but it eludes the proponents of fluoridation, who continue to talk about small risks as if they are acceptable. The onus is on proponents to demonstrate that there is an adequate margin of safety between the doses that cause harm and the huge range of doses that may be experienced by those drinking uncontrolled amounts of fluoridated water and at the same time receiving unknown amounts of fluoride from other sources. And, such a margin of safety should be large enough to protect everyone in society, not just the average person. The very young, the very old, those with poor nutrition, and those with impaired kidney function are more susceptible to fluoride’s harmful effects.
The 2006 National Research Council report was the first U.S. report to look at low-level fluoride toxicity in a balanced way. The report concluded that the maximum contaminant level goal (MCLG) of 4 ppm in drinking water was too high and should be reduced. Since 4 ppm is too high (by an unspecified amount) to be acceptable as a contaminant, it is not sensible to deliberately add fluoride to our drinking water to bring the level of fluoride in our water up to .7 ppm. That implies a margin of safety of less than 5.7 times, and possibly much less, which is absurdly low by toxicological standards. Acceptance of such a small margin of safety indicates a disregard for public health. It is irresponsible to continue promoting fluoridation when studies indicate thyroid function may be lowered at 2.3 ppm, IQ in children may be lowered at levels as low as 1.9 ppm (or at 0.9 ppm if there is borderline iodine deficiency), and hip fractures in the elderly may be increased at levels as low as 1.5 ppm. Unless all of the relevant studies have been shown to be fatally flawed, there is clearly no adequate margin of safety to protect the whole population from these effects. Fifty percent of the daily intake of fluoride is absorbed by and accumulates in bone. An important study from China (Li et al.,2001) indicates practically no margin of safety sufficient to protect a whole population with a lifelong consumption of water at 1 ppm from hip fracture. It is important to remember that we are talking about mass medication, not a drug that is prescribed after due consultation with an individual patient. A risk of harm estimated at, say, 1 in 10,000 may be entirely acceptable in the case of an individual patient. In fact, we accept far higher risks of undesirable side effects if we are seriously ill. But if we are giving a drug to nearly 400 million people worldwide, that risk translates into 40,000 cases of harm from one cause. The risks for some harms due to fluoridation are probably much higher.
And yes, rdcanning, I do understand how science works.
Terry, definitions of risk and exposure can vary quite a lot and often are not agreed upon.
The NRC report from 2006 expressly stated that their job was not to make judgments about fluoridation of water at the levels most municipal systems use. And they didn’t. This report has been trotted out numerous times as some anti-fluoridation study and it’s not worth arguing about. If you can’t read the study and see what it’s limitations are, you don’t know what science is.
Mark West
[quote]So do I, and I really wish the proponents had deigned to present some as the outcome may well have been completely different.[/quote]
I do not believe that a different strategy would have led to a different outcome. The scientific arguments had all been made extensively before the WAC over a three evening process. This was available to be viewed by the city council members ahead of time. I knew the votes of all but one of the CC members when we walked in to the chamber. Nothing that was said there was going to change the vote. What was presented on October 1st was political theater and granted the theatrics from the opponents definitely were superior to those of the proponents.
[quote]I read every separate article that any of the opponents brought to my attention. Fluorosis is the only potential harm that has any basis in scientific fact at the level proposed.[/quote]
I brought several articles to your attention in a prior Vanguard comments section, when I asked you “How do you propose that a child with renal impairment will avoid drinking Davis tap water, particularly if it is a child in the less advantaged group that you are attempting to target with the water fluoridation program?” I asked this question in response to your statement, “It is the responsibility of health care professionals to advise those who might be at some theoretical risk ( though I am not sure of what condition ) if they have known renal compromise to avoid drinking tap water. It is then up to the citizen to decide whether or not to drink or cook with the water and at what levels.”
Here are the articles that I brought to your attention. Did you read them?
“[A] fairly substantial body of research indicates that patients with chronic renal insufficiency are at an increased risk of chronic fluoride toxicity. Patients with reduced glomerular filtration rates have a decreased ability to excrete fluoride in the urine. These patients may develop skeletal fluorosis even at 1 ppm fluoride in the drinking water.”
SOURCE: Schiffl H. (2008). Fluoridation of drinking water and chronic kidney disease: absence of evidence is not evidence of absence. Nephrology Dialysis Transplantation 23:411.
“Individuals with kidney disease have decreased ability to excrete fluoride in urine and are at risk of developing fluorosis even at normal recommended limit of 0.7 to 1.2 mg/l.”
SOURCE: Bansal R, Tiwari SC. (2006). Back pain in chronic renal failure. Nephrology Dialysis Transplantation 21:2331-2332.
“Persons with renal failure can have a four fold increase in skeletal fluoride content, are at more risk of spontaneous bone fractures, and akin to skeletal fluorosis even at 1.0 ppm fluoride in drinking water.”
SOURCE: Ayoob S, Gupta AK. (2006). Fluoride in Drinking Water: A Review on the Status and Stress Effects. Critical Reviews in Environmental Science and Technology 36:433–487
“In patients with reduced renal function, the potential for fluoride accumulation in the skeleton is increased. It has been known for many years that people with renal insufficiency have elevated plasma fluoride concentrations compared with normal healthy persons and are at a higher risk of developing skeletal fluorosis.”
SOURCE: National Research Council. (2006). Fluoride in Drinking Water: A Scientific Review of EPA’s Standards. National Academies Press, Washington D.C. p140 .
“We hypothesize that elevated serum F levels might contribute to the disturbances in mineral ion homeostasis that are observed in patients with CRI [Chronic Renal Insufficiency]. This is of particular concern since the incidence of dental fluorosis has increased due to increased F– uptake from multiple fluoridated sources. The ubiquitous presence of F in food and beverage products regardless of the degree of water fluoridation suggests that the overall F exposure in individuals with CRI may need to be more closely monitored.”
SOURCE: Mathias RS, et al. (2000). Increased fluoride content in the femur growth plate and cortical bone of uremic rats. Pediatric Nephrology 14:935–939
[quote]The NRC report from 2006 expressly stated that their job was not to make judgments about fluoridation of water at the levels most municipal systems use. And they didn’t. This report has been trotted out numerous times as some anti-fluoridation study and it’s not worth arguing about. If you can’t read the study and see what it’s limitations are, you don’t know what science is.[/quote]
Here we go again. I’ve said it before and I’ll say it again:
I continue to be surprised at fluoride proponents disregard for the concept of margin of safety. In conventional risk assessment, the U.S. EPA uses a default margin of safety of ten. This means the EPA seeks to limit exposure to chemicals to levels that are ten times less than the levels that cause adverse effects. Margin of safety is a deeply rooted cornerstone in all modern risk assessments, yet fluoride proponents will state that they are not concerned about studies that show adverse health effects at fluoride levels of, say, 2 ppm or 4 ppm, because Davis water will be fluoridated at a level of .7 ppm. The 2006 National Research Council report was the first U.S. report to look at low-level fluoride toxicity in a balanced way. The report concluded that the maximum contaminant level goal (MCLG) of 4 ppm in drinking water was too high and should be reduced. Since 4 ppm is too high (by an unspecified amount) to be acceptable as a contaminant, it is not sensible to deliberately add fluoride to our drinking water to bring the level of fluoride in our water up to .7 ppm. That implies a margin of safety of less than 5.7 times, and possibly much less, which is absurdly low by toxicological standards. Acceptance of such a small margin of safety indicates a disregard for public health.
[quote]This isn’t science this is public policy sausage.[/quote]
This is exactly what I would say about water fluoridation.
Medwoman:
My issue was never about safety, as I think that naturally occurring fluoride in the water is perfectly safe. What I wanted to see was evidence of ‘efficacy’ for this method of preventing dental caries, which unfortunately has been lacking.
There is evidence in favor of both the topical application directly on teeth, and for the ingestion a known doses of pharmaceutical grade fluoride, but there is a paucity of data supporting the efficacy of mass medication of the entire population through adding industrial grade fluoride to the water.
Now we choose to mass medicate the population with iodine in our salt, and vitamin D in our milk for example, but in both of those cases the vast majority of the population receives direct, measurable benefit from the treatment (and in both cases those additions are made with food-grade chemicals). With water fluoridation however, the vast majority of the population are expected to receive at best no benefit from the treatment, which in my mind changes the justification entirely.
There is no doubt that fluoride applied directly to the teeth, or ingested in known amounts, can reduce the incidence of dental decay. To date however, I have not seen a single citation for a study that shows that industrial grade fluoride added to the water, and ingested at an unknown dose, has any benefit at all to the population who needs additional fluoride. In short, I have seen no evidence that this method of drug delivery is in any way efficacious.
So my question to you is why do you support this mass medication when there is so little apparent need within the population, and even less (if any) measurable benefit?
medwoman: had to leave the council meeting early. Listened to your comments and I thought you did a good job at the podium.
I would be great if you get behind the dental care van concept… or some compelling alternative to fluoridated water.
I was thinking about this topic and how it crossed ideological lines. So did the surface water project. There have been some posts lamenting a consideration that Davis has fewer liberals than some might think. I think Davis has a high percentage of residents – liberal or not – that put environmental concerns high on the list. I see the demand that we preserve ag land and open space, ban plastic bags, ban man-made wood smoke, and ban fluoride in the water… all a function of this strong environmentalist bent in our population.
Conservatives hate all the social justice stuff that sets the personal responsibility bar low and trains the population to be more expectant and dependent on help.
Libertarians hate being told by their government what they can and cannot do. Having fluoride in their drinking water really really feels like forced medication.
Environmentalists dislike the adding of chemicals to our water. Putting fluoride in the water really, really feels like a form of pollution.
I am all three.
But it was the last group that was the deal-breaker for your side. These were the people that would otherwise tend to support social justice causes… just not those with dubious benefits and environmental impacts.
[quote] I made no specific claims and have actually answered you on why there are no large, prospective double blinded studies on fluoridation. [/quote]
Not really. You have not given any explanation for why there are no prospective, double blinded studies of the effect of consumption of hydrofluorosilicic acid (an unpurified industrial by-product that is collected in the air pollution control systems of certain industries and which is used in water fluoridation programs)on dental decay. You have said a couple of times that one can not blind municipal water customers to the components of their water supply. This does not, however, address the question as to why there have not been any double blind randomized clinical trials on any volunteer population whatsoever.
My question remains. What research have you read that convinces you of the safety and efficacy of water fluoridation?
medwoman, my questions to you are not meant to me snarky. My questions stem from a belief that one has an obligation to present one’s evidence for the safety and efficacy of water fluoridation if one is going to write an article entitled “Devaluing Public Health.” You state that Lucas Frerichs demonstrates a lack of appreciation for evidence. What evidence?
You state, “So essentially, this decision was made not on the basis of any consideration of public health with careful weighting of the evidence on both sides…” Again, what evidence?
You state, “I believe in science. I believe in evidence.” What evidence?
You state, “We educate.” Please do. Tell us your evidence for the safety and efficacy of water fluoridation.
Correcting another typo:
medwoman, my questions to you are not meant to [u][i][b]be [/b][/i][/u]snarky.
Frankly
‘I would be great if you get behind the dental care van concept… or some compelling alternative to fluoridated water. “
My hesitancy to back this concept is based on experience with this concept within Kaiser in the form of “pap mobiles” with out reach to undeserved women. These efforts tend to be a prohibitively expensive and fall short in terms of meeting their goals of patients reached. Likewise mammogram outreach vans did not have the benefits that had been hoped. As with all things medical outfitting them tends to be to be extremely expensive in start up operation and maintenance .During a breast cancer
outreach screening in Sacramento about 20 years ago I had a conversation with Koman volunteers who were very honest about the inefficiency of this screening method and stated that that without the good publicity, they would not be using the vans.
Now I am aware that this could be different for dentistry but I would definitely want to see the breakdown of costs and anticipated patients served before I could endorse this and would think as a businessman you also would be interested in seeing the numbers before back king the idea.
Frankly
I also consider myself an environmentalist. I am for instance much more concerned than you seem to be about increased automobile emissions inevitably associated with increasing population especially in areas with low connectivity and walkability indexes due to the actual clearly known risks to air quality than you seem be. You on the other hand seem to be much more bothered about fluoride in the water than air quality. So we seem to have similar concerns but about different substances.
“Frankly: I was thinking about this topic and how it crossed ideological lines.”
Yeah, I doubt you have much more in common, then your stance on this issue, with two guys that spoke right before you during public comment. The thought did provoke a little chuckle from me when I watched the meeting the next day. Strange bed fellows indeed.
“Now I am aware that this could be different for dentistry but I would definitely want to see the breakdown of costs and anticipated patients served before I could endorse this and would think as a businessman you also would be interested in seeing the numbers before back king the idea.”
I may be overly optimistic but even getting dental screening done at schools, head start programs, migrant camps, could be helpful. Parent of kids who don’t regularly get to the dentist might not realize kids have cavities until they have abyssed and the kids are in pain. This step could be very low tech. I have many friends who refuse x-rays and dentist detect cavities via oral exam. At least the parents know about the cavity at an earlier stage when it’s easier to remedy. It’s not a perfect solution, but it’s a step.
“You on the other hand seem to be much more bothered about fluoride in the water than air quality. So we seem to have similar concerns but about different substances.”
I’m going with medwomen on this one. Smoke, from wood burning fires, causes more health problems then fluoridated water.
Medwoman
[quote]My hesitancy to back this concept is based on experience with this concept within Kaiser in the form of “pap mobiles” with out reach to undeserved women. [/quote] Similarly my hesitancy to back single payer universal, socialist-type health care models is based on experience with this concept in the form of treating cash patients from Canada who didn’t want to wait 8 months for an MRI (as one example). Seems we have both learned from experience what not to trust.
[i]I’m going with medwomen on this one. Smoke, from wood burning fires, causes more health problems then fluoridated water[/i]
Here is my problem with this argument.
People have been burning wood for heat for all of the history of people. It is only recently that we hear all the cries of health problems. I think these cries are overblown and largely artificial just like they are for most of the cries about second hand cigarette smoke. Neither are very prevalent. But people have worked themselves into a frenzy responding as if it was nerve gas from a Syrian dictator.
I see people burning wood for heat as natural, and people complaining about it and wanting to ban it as unnatural.
Conversely, I see pure clear water as natural, and putting fluoride in it as unnatural.
[I]I also consider myself an environmentalist. I am for instance much more concerned than you seem to be about increased automobile emissions inevitably associated with increasing population.[/I]
I am concerned about that too, but you cause more car exhaust in the core area forcing everyone in town to have to travel into the core area to shop. You cause more car exhaust having to stop every 200 foot for another stoplight or “special” crosswalk for those pedestrians and bicyclists that cannot use the regular crosswalk. You will cause more car exhaust with the Fifth Street road diet. My point is that you too support public policy that is responsible for higher levels of auto exhaust in the air. You just accept it for your values. I do so for my values.
[i]Yeah, I doubt you have much more in common, then your stance on this issue, with two guys that spoke right before you during public comment. The thought did provoke a little chuckle from me when I watched the meeting the next day. Strange bed fellows indeed. [/i]
You mean Larry and my other brother Larry?
I do not believe being a tin-hat carrying antifluoridationist “crosses” ‘idealogical’ boundaries. It may cross partisan boundaries. Antifluoridationism is a perspective of those who do not want large entities controlling their lives. In the case of libertarians, it may be government putting an element in drinking water. In the case of those who value organic farming and more natural foodstuffs (a large portion of those who spoke), the medical lobby and the corporate lobby endorsing adding an element to the drinking water. These ideological lines may attract more Elephants on the former and Donkeys on the latter, but in fact they are both forms of “large faceless entity stay out of my life”-ism.
What was clear from the council meeting is there is a great deal of distrust of the medical/dental establishment (m.d.e.) in this community. Those who present a public face of the m.d.e. utterly failed to gain any trust from those who distrust them by taking a ‘we know better’ attitude. (Scary thing is, that attitude works in most places.) As each side dug in, and “proved” their points with “science”, they more deeply alienated each other.
A large number of Davis residents (relative to other communities) have this distrust of standard medical/dental ways, yet when I asked in this forum, apparently only one dentist in town openly takes a stand against fluoride in water and mercury in fillings (please correct if there are others as I’m only going by the response here and a some online followup). There is a worldwide movement of ‘holistic dentistry’ (for lack of a better term). If, say, half of Davis residents have these values, and if dentists were meeting the market, should not half of Davis dentists be ‘holistic’ dentists?
Some professionals are missing out on a huge market opportunity here. If you can’t fight ’em, clean their teeth.
I am having some difficulty understandng the way this conversation has evolved. I did not write this piece with the intent of rehashing the pros and cons of fluoridation. The opponents won and I fully accept that. I honestly do not see the point of revisiting that on the basis of an article written specifically about priorities and process.
It seems that some of you cannot leave behind your preconceived notions of what I must believe and actually focus on what I said. For those of you who state that the CC members prioritized the public health aspect of this debate, I do not feel that you were listening closely to their comments about why they voted the way they did. I understand that many of you would like to feel that this was an objective, scientific, public spirited decision. But if that is true, why did each, other than Dan Wolk and Brett Leen focus on other aspects such as the quantity of letters received and the safety of the water project ? Not one of them stated “I have carefully weighed as my first priority the public health benefit and do not believe that fluoridation is safe or effective.”
The conversation was primarily about the points that I raised in the initial article. Since my passion is health both individual and public, it was a major disappointment to hear this take second place in our leaders priorities. I think based on their own comments that this was clearly the case.
If anyone has thoughts about that aspect of the article, I will be very happy to address them. I will also be very happy to consider anyone’s proposal for alternative preventive ( not reparative ) measures. I have absolutely no interest in going back and explaining to anyone why a large, prospective, double blind study cannot be devised to provide gold standard proof of the statistical efficacy of water fluoridation.
B.Nice
[quote]I may be overly optimistic but even getting dental screening done at schools, head start programs, migrant camps, could be helpful. Parent of kids who don’t regularly get to the dentist might not realize kids have cavities until they have abyssed and the kids are in pain. This step could be very low tech. I have many friends who refuse x-rays and dentist detect cavities via oral exam. At least the parents know about the cavity at an earlier stage when it’s easier to remedy. It’s not a perfect solution, but it’s a step.[/quote]
First I agree that I think that you are being overly optimistic. My experience with these kinds of outreach programs has not been reassurring, however I am fully aware that I have no experience with dental outreach.
However, these vans are primarily addressing a different issue. That is the issue of early detection and treatment. My hope with fluoridation was to address the issue of primary prevention which is always more cost effective.
I will use an example from another area of medicine. I now devote half of my career to breast cancer prevention and early detection and treatment. Two days a week, I do breast screening exams, order diagnostics, perform breast biopsies and deal with miscellaneous problems such as infections and abscesses. The screening part of my job is however all about early detection. However, equally important in my mind is helping the woman who does not have cancer improve her lifestyle in order to lessen her lifetime risk of getting breast cancer. At this point in time the two available modalities are maintaining a normal height / weight ratio into the menopausal years, and exercising a minimum of 150 minutes weekly both of which have been shown to decrease breast cancer risk. Primary prevention will always trump early detection and treatment.
So these “alternative” strategies that are being presented are not actually the same as a preventative approach.
My other concern about these vans is that this approach is not designed to provide a preventive benefit to the entire population but would focus on a much smaller group for probably close to the same amount of money if not more.
[quote]What was clear from the council meeting is there is a great deal of distrust of the medical/dental establishment (m.d.e.) in this community.[quote]
I would agree with this. And I am in a position to appreciate a great irony . Some of the same folks who demonstrate this distrust, are very quick to expect and sometimes even demand that I provide knowledgeable, competent and cost effective care when they have a problem. And with regard to the “we know better” attitude, do you really want to be seen by a doctor who does not know their area of expertise better than you do ?
Is it not even conceivable that those who do something for a living might actually know more about that field than the lay person does ?
This is precisely the reason that I limited my comments to those areas in which I have enough expertise to discuss the issues based on an understanding of the subject matter. I didn’t try to pretend that I knew more than I did about the effectiveness or environmental factors. I was also very specific about when I used information provided by consultants or when I had someone else do the numeric analysis of statistical data for me. Yet it seems that some of you would like to have it both ways. You want me to reach into areas of which I have stated repeatedly that I have no special knowledge, and also want to criticize when I demonstrate confidence in the information I am presenting from a strong knowledge base.
Oops. Sorry for quote placement error. I think we can all agree that I have one of the weakest knowledge bases here with regard to appropriate quotation designation ; )
Frankly
[quote]I see people burning wood for heat as natural, and people complaining about it and wanting to ban it as unnatural.
Conversely, I see pure clear water as natural, and putting fluoride in it as unnatural.
[/quote]
Your first line is an erroneous conclusion. I do not want to ban wood burning “because it is unnatural”. I want to minimize ( not ban) it because it has adverse consequences to the health of neighbors in our urban setting.
On a different thread, one commenter said that he felt he should be able to burn whenever he wanted since he was doing it inside his own house. When he finds the way to confine the smoke also within his own house, I will agree with him.
Your second statement also in my opinion is in error since it ignores the fact that there is already fluoride in the water. This is not putting in a foreign substance. Fluoride is a natural component of the water supply.
[quote] This is not putting in a foreign substance. Fluoride is a natural component of the water supply. [/quote]
This is a rather misleading claim. The naturally occurring substance in the water is calcium fluoride. We are not talking about adding calcium fluoride, or even pharmaceutical grade sodium fluoride to the drinking water as Rochelle clarified with staff during the council meeting. We are talking about adding industrial grade hydofluorosilicic acid which is most certainly not a naturally occurring substance and which does not act like either calcium or sodium fluoride when ingested.
“People have been burning wood for heat for all of the history of people.”
Fluoride has been present in water for all of history.
It is only recently that we hear all the cries of health problems. I think these cries are overblown and largely artificial just like they are for most of the cries about second hand cigarette smoke. Neither are very prevalent. But people have worked themselves into a frenzy responding as if it was nerve gas from a Syrian dictator. “
Just take out references to smoke and replace the with references to fluoride, and you sum up my feelings perfectly.
” My hope with fluoridation was to address the issue of primary prevention which is always more cost effective. “
Yeah, but that ship has sailed, so should we do nothing instead?
[quote] I have absolutely no interest in going back and explaining to anyone why a large, prospective, double blind study cannot be devised to provide gold standard proof of the statistical efficacy of water fluoridation. [/quote]
By saying that “I have absolutely no interest in [i]going back[/i]…,” you are implying that you have given such an explanation once already, which you have not, as I asserted in my earlier post.
PART I of II
[i]And with regard to the “we know better” attitude, do you really want to be seen by a doctor who does not know their area of expertise better than you do ?
Is it not even conceivable that those who do something for a living might actually know more about that field than the lay person does ? [/i]
I have found in just about every profession, from lawyers to car mechanics, about half are bozos. That is why I rely on references as much as possible. My first several doctors in Davis were terrible. Such as the one talking to me about health while his obese gut rested on my thigh (“please move your stomach, please move your stomach”). Or the one who would leave for the next patient as soon as I would ask a question. Or the one who . . . well, that one is not remotely fit for print.
The attitude I speak of does not mean I don’t believe people trained in a profession know more than the rest of us untrained in that profession do. It means I see people in many a profession have an attitude that smacks of elitism, it turns people off, and I doubt they even know they are projecting it. (In my schooling of geology, geologists in the U.S. for decades stubbornly banded together as elitist professionals and rejected plate tectonics and criticized with scientific research those who believed otherwise, despite opposing views in other countries; it is now the basis for Earth macro-geology.) I am not saying this about all medical or dental persons in Davis by any means; I am saying it about most of those who chose to be the face of the professions for this debate. Overall the vibe at the WAC “pro” meeting felt elitist to me and others I spoke to. “Right” or “wrong”, I am giving a perception.
There were non factual statements made by some on the pro side. I will also say that there were probably many more non factual statements made on the against side. Anyone on either side who presented items they found on the internet “as fact”, did no one any good. There were plenty on the against side who spoke who I wish had not, as inevitably someone on the pro side will rightly attack their point and then smear the entire against side as holding that view and then saying “see, that’s how THEY think”, as if we were all of one mind because we are on one side of one issue. That definitely goes both ways for both sides of the issue.
(Continued)
PART II of II
That is why I did not point to studies in my testimony before the council. I stated that dosage is not possible to control individual to individual with water fluoridation as the delivery method, with a huge range of what any one individual may take in. When I worked in the environmental consulting industry, I was critical of the methods of the “risk assessment” side of the office. They calculated risk as numbers, percentages. The specific harm coming to any one or number of individuals was usually not even part of the report. I found this scientific method fanciful and detached.
So it is with fluoridation. Rates of tooth decay may go down with fluoridation. Individuals may be harmed with fluoridation. I have a good friend who has severe fluorosis of the teeth. I didn’t even know why his teeth looked that way until the fluoride debate came up in Davis. Talk to him about whether fluorosis is a “minor” side effect of fluoridation. He will severely disagree with what the medical experts presented during the debate. I cannot help but wonder what someone’s bones look like on the inside when their teeth look like that on the outside.
Perhaps one would argue that it is the responsibility of parents to make sure their children drink tap water to gain maximum benefit of fluoridation. Yet, is not a primary argument for fluoridation that it is necessary because of parents who do not properly care for their children’s dental health in other ways? If they don’t practice other methods of home dental care, why would these same individual parents be likely to make sure their children got the proper “dose” of tap water . . . or any tap water at all?
The article implies that the politicians in Davis have a responsibility to act in the interest of “Public Health”, or in this case, the views of the “public health community”. That is a view, but I do not believe it is law. Perhaps they, as politicians, acted politically. Perhaps they, as humans, acted on their own beliefs. Likely, they balanced all of these.
Had this been a vote to drain a pond because of a malaria outbreak, public health would have been their primary reason for deciding to drain the pond.
I believe politicians have the responsibility to do the minimum possible to deliver clean water, nothing more; and furthermore for politicians to place an additive in the water that goes in most of our bodies (to counter the lifestyles of some), something that cannot cure everyone but only increase “rates”, that is unethical in my view. In the view of many of us who spoke.
The difference here is that these different beliefs in what are our core ethics are the heart of who each of us is. No one will convince others with equally passionate and opposite beliefs on the issue by debating in public forums armed with “scientific studies”. People tend to believe the studies that back their own beliefs*, whether the study be “right” or “wrong”. And no matter which side you are on, not recognizing that in yourself IS wrong.
*This was proven by a scientist who conducted a study that backed his beliefs on his hypothesis that people tend to believe studies that back their own beliefs.
[quote]It may cross partisan boundaries. Antifluoridationism is a perspective of those who do not want large entities controlling their lives. In the case of libertarians, it may be government putting an element in drinking water. In the case of those who value organic farming and more natural foodstuffs (a large portion of those who spoke), the medical lobby and the corporate lobby endorsing adding an element to the drinking water. These ideological lines may attract more Elephants on the former and Donkeys on the latter, but in fact they are both forms of “large faceless entity stay out of my life”-ism. [/quote] Very true, and really well put! Although I think as the years go on, we’ll see that youth who would have otherwise been inclined to be “liberal” will lean libertarian. Distrusting the Man is coming back around.
[quote]Those who present a public face of the m.d.e. utterly failed to gain any trust from those who distrust them by taking a ‘we know better’ attitude.[/quote]It’s always a balancing act for the medical community to overcome that stereotype having a God Complex while simultaneously living up to expectations infallibility when it comes to each individual patient’s heath care. The problem for me is when the medical community (or any contingency) thinks that their opinion trumps all others, and that any scenario that involves anything that falls under the umbrella of their discipline automatically makes them an authority on the entire situation.