Fluoridation – the violation of rights argument.

Of all the arguments anti-fluoridationists advance this is the one I have the most sympathy for. The idea that such matters should be left to personal responsibility and not imposed on everyone.

Partly because I see it as the most honest argument – it is specifically appealing to values and political viewpoint and, presumably, should be argued out in that arena. People  have different reactions to the argument and, being a political question, is should properly be decided democratically.

But also because it, in effect, puts aside the controversy generated by pseudo-scientific claims. It faces up to the real underlying political problem and gets away from the use of a manufactured scientific controversy as a proxy for the political and values judgements that Sir Peter Gluckman referred to in this comment (see What is in the water? for full text):

“The misuse or inappropriate and alarmist use of science is a classic example of science being a proxy for values debates.” (See Poisoning the well with a caricature of science).

In effect the Fluoride Action Alert NZ group (FANNZ) used this argument in the last of their 7 objections to fluoridation (see 7. Fluoridation is enforced medication without your consent). Although their description of fluoridation as “medication” is aimed at getting a certain emotional reaction. In reality fluoridation corrects for a natural deficiency – fluoride is usually considered a beneficial (for bone and oral health) trace element and not a “medicine.”

The libertarian argument

Brian Edwards used this rights argument in a radio discussion on Monday afternoon (listen to the audio at The Panel with Dr Brian Edwards and Michelle Boag (part 1) ). He wasn’t interested in the scientific claims, believed he had a right to “fluoride free water” and objected to fluoridated water being imposed. If someone wanted added F they have the responsibility to fluoridate their own water or find other treatments. It is the classic libertarian argument with which some people agree, or are tempted to agree.

But libertarianism can be taken to a ridiculous extremes – most practical libertarians will resist that and take a more moderate position. Consider these points Brian:

• Do you also believe you should not have chlorinated or deflocculated water imposed on you? Do you think such treaments should be left to the individual?
• Fluoride-free water is just not a possibility – we live in a soup of chemicals and nothing is completely free of such elements. For example, the Waikato River water used in Hamilton naturally contains around 0.3 or 0.4 ppm F. Sometimes peaking around 0.6 ppm F. Fluoridation simply supplemented this to achieve levels of 0.7 – 1.0 ppm – considered the safe and beneficial level by health authorities.
• So what do you want Brian? That Hamiltonians receive the Waikato river water exactly as it comes (not F-free and, if he objects to chlorination and flocullation, with its normal load of harmful organisms and colloids)? Or does he insist that the water be treated to remove these low natural levels of F (and presumably the colloids and harmful organisms)?
• And imagine this scenario – if the local geology was such that the natural water supplies had excessive levels of F ( say above 1 – 4 ppm – it happens) would you insist that it not be treated to remove such high levels? That such treatment would be an unjustified imposition violating your rights? And if it were to be treated to remove excessive amounts of F, will you demand that the level be dropped to exactly zero (the impossible F-free level) or would you accept dropping it to say 0.7 ppm F?

Very often the libertarian ideal is just not possible, Brian. And that is only considering the factual information science provides. There is still the overriding issue for libertarians of personal vs social responsiblity. The fact that it is the socially and economically disadvantaged section of society that benefits most from fluoridation. Libertarians usually argue these people should fend for themselves – remember the discussion on school meals?

In the end, while science can inform us about the reality of fluoridation, it can’t decide our values for us. That is best done by the democratic process and quite rightly the personal vs social responsibility views will drive that debate and influence the final decision.

Genuine concern or fear

Realistically I accept that some people take up positions on these sorts of issues out of genuine concern, or even fear. Consider the opposition to cell phone towers near schools and homes. Despite the best arguments of radiation specialists and the phone companies residents are often still concerned, or even afraid. Should authorities go ahead and impose towers on these people regardless (because after all the science supports them)? Or should the issue be decided democratically?

I think the latter for two reasons.:

1. Even where the science says things are safe the fear or concern people have is real. It may arise out of ignorance or being misinformed (that’s going on a lot in the fluoridation debate). It might be concern that there are effects science is so far unaware of. Or it might just be the understandable fear of the new.
2. Whatever the source of the concern or fear we have to recognise that it is, in psychological terms, a real effect. I understood this several years ago when I was considering a surgical procedure. My surgeon dealt with all the usual concerns, showed me why each one was not valid and that the procedure was safe. But I still had some concerns about possible unknown effects. His advice was that my residual fears were really psychological, but real. I should therefore not go ahead.

So, I think that on issues like cell phone towers, WiFi and fluoridation, if a majority of the people involved have real concerns or fears they need to be listened to. Even if those fears are groundless or misinformed authorities should not go ahead with their plans just because they “know better.” They must recognise the reality of the psychological effect.

The need for good information

This approach raises questions of the responsibility of authorities, experts and scientists to communicate with the public – especially when new treatments or equipment are being planned. The reality is that we are all naturally somewhat conservative and suspicious of new things. There are also a number of politically or ideologically motivated groups who cultivate people’s fears and promote a anti-science or pseudo-science approaches.

The fluoridation issue illustrates just how widespread anti-science and pseudoscience thinking is these days. Google “fluoridation” and you find that most hits seeking to give information are from groups like Fluoride Alert – anti-fluoridation activists. Very few are reliable scientific sources. It’s just so easy for the innocent layperson to be misinformed.

Recent polling in New Zealand still show many more people support fluoridation than oppose it – which I guess says something for the common sense of New Zealanders. Perhaps we are developing the ability to recognise the snake oil salespeople on the internet.

Scientists can do a lot to encourage this sort of commonsense by participating in the public debate on these issue and helping to inform it. Despite the fact that, as Gluckman says, “The misuse or inappropriate and alarmist use of science is a . . .  proxy for values debates” that distortion and misinformation can have an effect. Where possible scientists and other experts in these areas should be helping to expose it.

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NOTE: The fluoridation issue this time around was sparked by the recent decision of the Hamilton City Council to stop fluoridating Hamilton’s water supply. Hamiltonians reacted with concern and a petition calling for a Citizen’s Initiated referendum on the issue has obtained 1000 more signatures than required. So it looks like Hamilton will get its public debate on fluoridation (again) and a democratic decision – most likely at the next local body elections (see Fluoride referendum petition gains numbers).

See also:

Fluoridation
Poisoning the well with a caricature of science
Fluoridation petition – for Hamilton citizens
Fluoridation – it does reduce tooth decay
Getting a grip on the science behind claims about fluoridation
Is fluoride an essential dietary mineral?
Fluoridation – are we dumping toxic metals into our water supplies?
Tactics and common arguments of the anti-fluoridationists
Hamilton City Council reverses referendum fluoridation decision
Scientists, political activism and the scientific ethos