Promoters' style has fueled fluoridation controversy

Chemical & Engineering News, August 1, 1988

The style of promotion that fluoridation’s proponents have used from the very beginning probably made the issue more controversial than it need have been.

The idea of fluoridating water supplies first arose from studies of dental mottling in areas, such as communities in Texas, where the water supply is fluoridated naturally. In the 1930s, H. Trendley Dean, a dental surgeon at the U.S. Public Health Service, correlated the occurrence of mottling or dental fluorosis with the fluoride content of water supplies in 345 U.S. communities. Fluorosis was most common in cities that had the highest concentration of fluoride in their water. He and his colleagues also unexpectedly found a lower incidence of dental caries in areas of endemic dental fluorosis.

Dean concluded that the fluoride content of the drinking water causes a lower rate of dental caries. He also determined that the incidence of mottling was very minor when the fluoride content was 1 ppm or lower but rose linearly at higher concentrations. From this, PHS officials decided in 1943 that 1 ppm was an optimal level at which to artificially fluoridate water supplies in temperate climates. In areas where the fluoride content exceeded 2 ppm, they recommended fluoride be reduced to a level near 1 ppm.

In 1945, PHS initially planned to conduct 10-year studies of artificial fluoridation in two experimental projects, one in New York and one in Michigan. One city in each state would be fluoridated artificially and another would serve as a control. PHS officials intended to complete these projects before deciding whether to recommend fluoridation of drinking water as a general practice for all communities.

However, two public health officers in Wisconsin, Francis A. Bull and John Frisch, quickly became convinced of the effectiveness of fluoridation and launched a nationwide campaign to persuade PHS to endorse it. Also, results from the two projects that leaked out in 1950, after the trials had been going on for five years, revealed a sharp reduction in dental caries in the fluoridated cities. As a result of this disclosure and Bull’s and Frisch’s campaign, PHS officials endorsed fluoridation on June 1, 1950.

Several deficiencies in research by PHS were subsequently aired at Congressional hearings in 1952 and 1957. There had been almost no careful studies to assess the possible adverse health effects of lifelong consumption of fluoridated water. Aside from their dental health, the medical condition of residents of naturally fluoridated areas had been examined superficially, at best. In one of the fluoridation trials, research plans included a study of adverse effects of artificial fluoridation on children, but none on adults. No studies focused on malnourished children and infants, despite a warning in 1952 by Maury Massler, professor of pedodontics at the University of Illinois College of Dentistry, that "low levels of fluoride ingestion which are generally considered to be safe for the general population may not be safe for malnourished infants and children, because of disturbances in calcium metabolism."

Neither PHS nor anyone else had investigated potential carcinogenic effects, effects on pregnant women, or effects on people with chronic kidney impairment or other chronic diseases. Even in the early 1950s, enough was known of fluoride’s toxicity profile to identify these as important topics to investigate.

From the beginning, the movement to fluoridate water was conducted more like a political campaign than a scientific enterprise. At a meeting of state dental directors with PHS officials in June 1951, Bull recommended tactics for promoting fluoridation. "If it is a fact that some individuals are against fluoridation, you just have to knock their objections down. The question of toxicity is on the same order. Lay off it altogether. Just pass it over. ‘We know there is absolutely no effect other than reducing tooth decay,’ you say, and go on. If it becomes an issue, then you will have to take it over, but don’t bring it up yourself."

"The minute doubt is created in the minds of the public, any public health program is doomed to failure," Bull later wrote in the Journal of the American Dental Association.

The political role of dentists has been emphasized throughout the history of fluoridation. In 1970, even after 25 years of fluoridation, John W. Knutson, then professor at the University of California Medical Center, advised dentists that when they discussed fluoridation with the public, they must realize that "they are propagandizing, not simply educating." This attitude, widely shared by political proponents, led early advocates to treat fluoridation campaigns as debates to be won with dogmatic assertions and attacks on the credibility of the opposition. To promoters, the debate has never been seen as a scientific search for truth.

As a result, profluoridationists prepare booklets for the public that contain highly biased information. If scientific studies are cited, only those that support their side of the argument are mentioned. Those opposed to fluoridation counter with equally biased propaganda.

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