The Fluoride Debate

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TABLE OF CONTENTS

INTRODUCTION

HISTORY/
ENVIRONMENT

CENSORSHIP

THE FLUORIDE
DEBATE

BENEFITS
Question 1
Question 2
Question 3
Question 4
Question 5
Question 6
Question 7
Question 8

ALTERNATIVES
Question 9
Question 10
Question 11
Question 12


SAFETY
Question 13
Question 14

OVERDOSE
Question 15
Question 16
Question 17

DISEASES
Question 18
Question 19
Question 20
Question 21
Question 22
Question 23
Question 24
Question 25
Question 26
Question 27
Question 28
Question 29
Question 30
Question 31
Question 32
Question 33

PUBLIC
POLICY

Question 34
Question 35
Question 36
Question 37
Question 38
Question 39
Question 40

COST
EFFECTIVENESS
Question 41
Question 42
Question 43

CONCLUSION

PUBLIC POLICY

Question 36.
Why does opposition to community water fluoridation continue?

ADA's Fluoridation Facts Short Answer
Fluoridation is considered beneficial by the overwhelming majority of the health and scientific communities as well as the general public. However, a vocal minority continues to speak out against fluoridation of municipal water supplies. Some individuals may view fluoridation of public water as limiting their freedom of choice; other opposition can stem from misinterpretations or inappropriate extrapolations of the science behind the fluoridation issue.

ADA's Fluoridation Facts Long Answer
A vast body of scientific literature endorses water fluoridation as a safe means of reducing the incidence of tooth decay. Support for fluoridation among scientists and health professionals, including physicians and dentists, is nearly universal. Recognition of the benefits of fluoridation by the American Dental Association, the American Medical Association, governmental agencies and other national health and civic organizations (see Compendium) continues as a result of published, peer-reviewed research.

The majority of Americans also approves of water fluoridation. In June 1998, the Gallup Organization conducted a national survey of just over 1,000 adults on their attitudes toward community water fluoridation. When asked, "Do you believe community water should be fluoridated?," 70% answered "Yes", 18% answered "No," and 12% responded "I Don't Know." (See Figure 3). Results characterized by U.S. Census Region showed the level of support for community water fluoridation to be relatively constant throughout the United States, with 73% in the Northeast, 72% in the Midwest, 68% in the South and 70% in the West favoring community water fluoridation.2 These results are consistent with a December 1991 Gallup survey that asked 1,200 parents, "Whether or not you presently have fluoridated water, do you approve or disapprove of fluoridating drinking water?" More than three-quarters (78%) of the responding parents approved, 10% disapproved and 12% answered don't know or refused to answer the question (See Figure 4). Disapproval ranged from 4% in communities where water was fluoridated to 16% in communities where it was not.213, 214

Opposition to fluoridation has existed since the initiation of the first community programs in 1945. An article that appeared in the local newspaper shortly after the first fluoridation program was implemented in Grand Rapids, Michigan, noted that the fluoridation program was slated to commence January 1 but did not actually begin until January 15. Interestingly, health officials in Grand Rapids began receiving complaints of physical ailments attributed to fluoridation from citizens weeks before fluoride was actually added to the water.7

Of the small faction that opposes water fluoridation for philosophical reasons, freedom of choice probably stands out as the most important single issue.213 Some individuals are opposed to community action on any health issue, others because of environmental or economic arguments and some because they are misinformed. Some opponents may knowingly or unknowingly use half-truths and innuendoes to support their opinions, either misquoting or applying statements out of context. The sometimes alarming statements used by some antifluoridationists, however, are not substantiated by general accepted scientific knowledge.213, 215, 216

"Junk science," a term coined by the press and used over the past decade to characterize data derived from atypical or questionable scientific techniques, also can play a role in provoking opposition to water fluoridation. In fact, decision makers have been persuaded to postpone action on several cost-effective public health measures after hypothetical risks have made their way into the public media.217 Junk science impacts public policy and costs society in immeasurable ways. More people, especially those involved in policy decisions, need to be able to distinguish junk science from legitimate scientific research. Reputable science is based on the scientific method of testing hypotheses in ways that can be reproduced and verified by others; junk science, which often provides too-simple answers to complex questions, often cannot be substantiated.

In 1993 the U.S. Supreme Court issued a landmark decision that many view as likely to restrict the use of junk science in the courts. The Court determined that while "general acceptance" is not needed for scientific evidence to be admissible, federal trial judges have the task of ensuring that an expert's testimony rests on a reasonable foundation and is relevant to the issue in question. According to the Supreme Court, many considerations will bear on whether the expert's underlying reasoning or methodology is scientifically valid and applicable in a given case. The Court set out four criteria judges could use when evaluating scientific testimony: (1) whether the expert's theory or technique can be (and has been) tested, using the scientific method, (2) whether it has been subject to peer review and publication (although failing this criteria alone is not necessarily grounds for disallowing the testimony), (3) its known or potential error rate and the existence and maintenance of standards in controlling its operation, and (4) whether it has attracted widespread acceptance within a relevant scientific community, since a known technique that has been able to attract only minimal support may properly be viewed with skepticism. The scientific validity and relevance of claims made by opponents of fluoridation might be best viewed when measured against these criteria.218

Opinions are seldom unanimous on any scientific subject. In fact, there may be no such thing as "final knowledge," since new information is continuously emerging and being disseminated. As such, the benefit evidence must be continually weighed against risk evidence. Health professionals, decision makers and the public should be cooperating partners in the quest for that accountability.219

Additional discussion on this topic may be found in the Introduction - Scientific Information on Fluoridation.

Repeat of Question 36.
Why does opposition to community water fluoridation continue?

Opposition's Response

Today there is so much proof against fluoridation (so much more than could be included here) that it is amazing how the proponents can keep saying that "only a small minority oppose this public health measure." When people are given the chance to vote on this issue, the majority of them vote "No." Many scientists, doctors and dentists are very much against fluoridation; their voices just aren't allowed to be heard. (See Censorship section).

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First Edition
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