So far, our exchange has only covered some arguments against fluoridation and responses to those arguments. Some readers feel we should have started with me advancing the arguments for fluoridation. For example one commenter, Alison, said
“readers haven’t had the opportunity to see the basic arguments favoring fluoridation as you see them. . . . we are genuinely perplexed about why this practice has continued and honestly and sincerely trying to further or understanding.”
Paul Connett made a similar remark in his last article:
“promoters of fluoridation should not be surprised that some people are trying to come up with a rational explanation for why certain governments are behaving so irrationally promoting this practice.”
I can’t understand why anyone should be perplexed or think fluoridation is irrational. But I am happy to give my reasons for supporting fluoridation – but remember it is a personal perspective as I can’t speak for everyone who supports it. My perspective derives from several issues that are important to me – the science, defence of science against anti-science elements, social concerns and the provisional nature of knowledge.
Scientific acceptance of fluoridation
We have many advantages in New Zealand, despite our social, economic and political problems. The climate, our scenery, our people (who are generally open-minded, liberal and accepting), agriculture and food. But our agriculture and food, and the rest that depends on these, has only really been possible because of the application of science to solve problems with the land we inherited.
New Zealanders accept the need to correct nutrient and micro-element deficiencies because we realise their importance to our place in the world. The correction of cobalt deficiencies in our central volcanic region of the North Island/Te Ika-a-Māui had huge economic returns. We also took steps to correct other important deficiencies like molybdenum, copper and selenium. Discovery of the role of fluoride in oral health, and that we had a deficiency which needed correction, was hardly a surprise to us. Nor did most of us find the solution unusual.
In the mid 1960s I worked at Soil Bureau, DSIR, outside Wellington, and remember some of the early discussions around fluoridation – there was some debate then about the possible role of the micro-element molybdenum, rather that fluoride, in limiting tooth decay. Later my research developed further into the nature of phosphate and it’s reactions in soil and the fluoride story really made sense. I became aware that the primary minerals of phosphate in soils were apatites which had fluoride as a natural constituent. This small amount of fluoride imparted important properties to the apatites – lowering their solubility and increasing their hardness which helped prevent weathering losses.
So it is understandable I could see how fluoride improved oral health (bones and teeth are bioapatites). In my research reading I also found many dental research papers were very useful. Looking back I can, for example, remember the discovery like of the role of fluoride in inhibiting dissolution of apatites by a surface reaction in partly acidulated rock phosphate fertilisers. This parallels similar discoveries about the role of surface reactions of fluoride in saliva inhibiting tooth mineralisation and reducing tooth decay.
So the efficacy of fluoridation as a social health measure was a no-brainer as far as I was concerned. But about 10 years ago I had a sort of road to Damascus moment about the political issues when working on a research project involving fluorosilicic acid. My analysis of this material (the same used in New Zealand for water fluoridation) revealed the concentrations of contaminants like arsenic were very low – contrasting sharply with the claims of activists campaigning against fluoridation (whose story I had sort of accepted till then). That left me with a healthy respect for evidence, and a corresponding suspicion of ideologically motivated activists, in these sort of public debates involving scientific issues.
Defence of science
I guess most scientific researchers have, at some stage, to meet the activity of anti-science sympathisers and activists. Evolutionary biologists have a permanent battle defending their science against creationists. There has been huge political pressure imposed on climate scientists. Surprisingly, even scientific researchers in agriculture periodically face this problem. Quacks selling snake oil seem to be able to find a market with farmers selling alternative fertilisers, etc., just as they can on health issues. Ideology also intrudes, with debates over organic farming and use of chemicals in agriculture.
Often these conflicts are not simply black and white. The last two examples are complex. There is a role for organic farming and there is certainly need to lower chemical inputs into agriculture. These issues get sensibly debated and have there own scientific support. But agricultural scientists have often had to face the problem of more highly motivated and ideologically driven detractors with more extreme views.
These anti-science people and groups can often be very effective politically and will skilfully use the mass media and the new social media – blogs, Twitter and Facebook. Very few scientists have experience with, or a liking for, this form of public relations and easily lose such media debates. Scientists don’t willingly get their hands dirty in such public relations battles. It is interesting to speculate why – but that is a subject for another time. One barrier I was aware of during my career was the limits and control placed on individual researchers by their institution. Institutional politics often over-ride the freedom of researchers to defend their work and take part in social debates about it. institutions encourage scientists to keep their heads down when attacked and not retaliate. The institutional fear of such social engagement possibly results form fears of legal action.
I am now retired and this has at least one advantage – freedom from institutional constraints. Mind you, if a retired scientist is involved with paid consulting, advocacy or lobbying, then they have another form of constraint which is probably more direct and rigid than that imposed by a research institute. Because consulting, advocacy and lobbying usually need prior committment to an idea, product or policy - payment is made for endorsement or justification and not research.
In my case I have not had to rely on such extra income so have had the freedom to explore my interests, and express my opinion without censorship or control. I have enjoyed the freedom to read and research ideas and to follow my nose in a way intensive paid research does not allow because it is so focused.
Inevitably I have been attracted to some of the more controversial areas – controversial politically, not necessarily scientifically. Such as the religion-science conflict, evolution, climate change and, more recently, fluoridation. I have participated in on-line debates on these issues, and about 7 years ago started this blog. None of this would have been possible while I was employed, or if I had got into paid consulting or advocacy during my retirement.
Despite my interest in the chemistry around the fluoridation issue I did not get involved in any public discussion until earlier this year. My city, Hamilton, held a referendum in 2006 which overwhelmingly supported fluoridation. I was aware the issue was coming up again and assumed we would have another referendum this year. That was OK by me – but, like many Hamiltonians, I was shocked to hear in June that the local council had decided to stop fluoridation without a referendum. Yes, they held hearings beforehand and had last year reversed their decision to send the issue to referendum again – but most citizens were just not aware of this going on. Many of us felt it was done behind our backs.
In New Zealand decisions on fluoridation are left to local councils – because they are the ones managing the treatment plants. Most councils really don’t feel they should be making those decisions – that this should be the responsibility of central government and health ministries. However, that is the way it is.
While other decisions on water treatment don’t go to referendum, or get decided by councils, fluoridation attracts controversy – there have been regular campaigns by activists opposing fluoridation. I don’t think citizens think councils should make decisions about health and science – that is not their job. Councils should instead reflect the views of the community on such issues. Personally, I think if a community opposes fluoridation that should be enough. While I accept that the person in the street does not understand the science (why should they) and may be prone to chemophobia or misinformation, if they are so inclined it should not be imposed.
In the end sensible citizens will take advice on such issues from scientific and health experts – not local council politicians.
So I guess my interest in the political issue was sparked off by what I saw as a violation of democratic rights. As I reacted and started to comment on line and write to councillors about the injustice I became more and more aware of just how badly the science around this issue was being distorted by anti-fluoride campaigners. So, we had a repeat of the evolution and climate change debates. There was a battle about the science behind fluoridation and I had to get involved.
As with these other issues a strong motivation for me is the integrity of science. The need to challenge and expose distortions about the science. But fluoridation is also an ethical and social health issue which raises a human rights motivation for me. In particular I find some of the hostility towards fluoridation repugnant because it demonstrates a complete lack of understanding of what life is like for the economically and socially disadvantaged in our society. In fact, it often demonstrates a complete lack of empathy for their situation.
This not the place for discussing the details (and that is very difficult anyway) but I come from a socially deprived background and have some understanding of what it is like for people caught in such social and economic traps. I believe more people are actually in that situation than political activists, or politicians in general, realise. Partly because socially and economically disadvantaged people are usually incapable of advocating for their interests, and partly because the rest of society prefers to turn a blind eye, or to otherwise deny the problem.
But these problems exist, and they affect all of us. If a section of society cannot reach its potential for social, economic and psychological reasons that affects us all. It often means more people dependent on state social and financial help. Fewer people getting the education and becoming the experts needed to make our society better. These problems increase the health costs which end up being pad by us all through our taxes.
Social health policies, like fluoridation, are actually very cost-effective. They help reduce what the whole of society must pay in their absence. Probably more important from my perspective, they are humanitarian. They help rescue children and adults from otherwise hopeless situations.
Poor oral health is a huge burden for the individual. Toothache is unbearable for children, who do not have the power to ease their situation. In later life the inevitable cosmetic consequences affect the individual socially. Destroying their confidence, inhibiting their employment and other social opportunities.
Believe me, I am just as big an advocate for personal freedom of choice as the next person. But in the real world this needs to be balanced against social good. To dogmatically stress one at the cost of the other is just political extremism. And this is rejected by most people in today’s democratic, empathetic and pluralistic society. Most people accept that social health programmes benefit the whole of society, financially and ethically.
Provisional nature of knowledge
I have not dealt here with any of the many arguments used against fluoridation. This was meant to be a positive article, dealing with the argument for this practice. I expect it will bring out many of the arguments against fluoridation in the comments and response and I can respond to them then.
I don’t wish to ignore the criticisms of fluoridation – far from it. But I do want to make my own judgements on them intelligently and critically. I think that is the correct scientific approach. And my own experience has taught me that criticisms can be wrong, ideologically motivated or just plain untrue. The example of the claimed contaminants in hydrofluoric acid illustrates this.
I also recognise that humans are not really a rational species, more a rationalising one. Confirmation bias is a natural result of the very human activity of pattern seeking. We are all prone to logical fallacies, selective viewing, and biased interpretation. Scientists are no exception, but at least the scientific ethos of demanding evidence, checking ideas against reality and submitting conclusions and theories to the critique of ones peers help to to reduce (but not eliminate the problems),
Ideology and strong convictions get in the way of intelligent and critical assessments. Personally I think this problem is rife among anti-fluoride activists. They are a socially and ideologically diverse group but philosophies of alternative health, alternative medicine and treatments, opposition to establishment ideas for its own sake, conspiracy theories of one sort or another and a long-term component of extreme right-wing politics are all present. In saying that I am not denying the many honest and sensible people who may have concerns about fluoridation for one reason or another. Hopefully it is the latter group which will engage in discussion here.
I am definitely ready to honestly assess the criticisms and arguments made by opponents of fluoridation – especially if presented in good faith and a non-hostile way. One thing that a career in scientific research teaches is that we are often wrong. Discovery is about making mistakes, discovering one has been wrong, seeking further evidence and adjusting one’s ideas and theories. I can recall situations where experimental results have proven me wrong and I felt enthused because that mistake, and my discovery of it, opened things up to new discoveries. In effect, whether we personally intend it or not, scientists do experiments with the express purpose of proving themselves wrong. After all, the best experimental evidence one can offer for a dearly loved theory is one that would test it properly and show it wrong if that is the case.
That is why I have chosen the name Open Parachute (“your mind doesn’t work if it is closed”) for the blog and adopted the slogan - “if you have not changed your mind in the last few years – check your pulse, you may not be alive.”
I am certainly open to changing my mind about fluoridation. But that change will need evidence, good evidence. And honest, intelligent interpretation of that evidence.
So criticise what I have written here. Present your arguments against fluoridation. But please do so in good faith. I am not going to be convinced by name calling or hostility. Unwarranted extrapolation from studies done at high concentration are a dime a dozen and worthless in this debate. And misrepresentation of the literature is counter-productive because I do like to check. I have seen too many examples of distorted interpretation and misinformation to take such assurances on trust any more.
Anyone wanting to follow the debate and/or check back over previous articles in the debate can find the list of articles at Fluoride Debate.