AWRA Water Blog

Book Review: ‘The Fluoride Wars: How a Modest Public Health Measure Became America’s Longest Running Political Melodrama’


Introduction and ‘The Book’
It is funny to be writing about fluoridation of public water supplies and a book on that topic at this late date; I thought that battle had been settled years ago. Apparently not.

A few years ago, I encountered a book, The Fluoride Wars: How a Modest Public Health Measure Became America’s Longest Running Political Melodrama, that piqued my curiosity. It was written in 2009, authored by R. Allan Freeze and Jay H. 0470448334Lehr, two people with whom I’m familiar, and their authorship was the main reason for my initial interest. More on that later.

I have finally read the book (twice) and thoroughly enjoyed it. I will give my impresssions of it and provide some of my own views on the issue. So this won’t be a ‘standard’ book review.

I should note that I have it on good authority that the bulk of the book – 90% or so – is Freeze’s work. I wondered about that because sometimes the first person pronoun ‘I’ is used, sometimes ‘We’. Sloppy editing.

My ‘review’ starts down below at My Ten Cents.

Why Discuss Fluoridation Now?
Old hat, right?

Some local communities have been going through gyrations about whether to begin/end drinking water fluoridation. In two weeks, residents of Portland, Oregon, just about 80 miles north of my home of Corvallis (fluoridated), will vote to decide the ‘fluoride fate’ of the city’s water supply, ably distributed by the Portland Water Bureau (PWB). The City Commission had voted to fluoridate the water, but opponents produced enough votes to force a vote. Oddly enough, about one-third of PWB’s 900,000 customers cannot vote on this issue because they live outside the city. The PWB’s supply is currently fluoride-free; Portland is the largest such municipal supply in the USA. I was surprised when I learned that a few years ago.

For those who oppose fluoride in their drinking water because it is a hazardous chemical (which it is, but recall the toxicology adage,the dose makes the poison) they might be surprised to learn that the PWB already adds toxic chemicals (chlorine, ammonia, and sodium hydroxide) to the water supply. The PWB does not do so out of some nefarious government-industry conspiracy, but because of health (chlorine and ammonia) and pipe corrosion (sodium hydroxide). Listen to this OPB news report.

The Authors
I can vouch for the authors. R. Allan Freeze is one of the world’s outstanding environmental scientists. He is the lead author on the world’s best hydrogeology textbook, Groundwater, still a big seller after 34 years. Thirteen years ago he wrote a wonderful little book, The Environmental Pendulum: A Quest for Truth About Toxic Chemicals Human Health, and Environmental Protection.  I used this book for about five years in an environmental studies class. Everyone who is involved in enviromental work or just concerned about the environment should read it. Freeze wrote a well-reasoned, amazing little treatise. I figured that he would treat ‘the fluroide wars’ with the same objectivity and I was right.

Jay Lehr is no slouch, either. He’s a hydrology PhD, the nation’s first, from the University of Arizona.  He is a friend and I have great respect for him although I parted ways with him over the concept of megawatersheds. Lehr served as Executive Director of the National Water Well Association (now the National Ground Water Association) and really put that organization on the map. More recently he’s been associated with The Heartland Institute (Jay is not a pro-big government type).

Back To ‘The Book’
But how about the book? Here is the accurate blurb from the book’s WWW site:

A lively account of fluoridation and its discontents.

Since its first implementation in Grand Rapids, Michigan, in 1945, public drinking water fluoridation and its attendant conflicts, controversies, and conspiracy theories serve as an object lesson in American science, public health, and policymaking. In addition to the arguments on the issue still raging today, the tale of fluoridation and its discontents also resonates with such present concerns as genetically modified foods, global warming response, nuclear power, and environmental regulation.

Offering the best current thinking on the issue, The Fluoride Wars presents a witty and detailed social history of the fluoridation debate in America, illuminating the intersection of science and politics in our recent past. This reader-friendly assessment explores the pro- and anti-fluoridation movements, key players, and important events. Full of amusing and vivid anecdotes and examples, this accessible recounting includes:

  • A careful and non-condescending look at the hard science, popular science, pseudo-science, and junk science involved
  • A look at fluoride issues including dosage, cost, financial and funding interests, fluorosis, and problems of risk-cost-benefit analysis
  • The back-and-forth drama between pro- and anti-fluoridation factions, with all its claims, counterclaims, insults, acrimony, and lawsuits
  • Case studies of various cities and their experiences with municipal water fluoridation initiatives
  • Fluorophobia and popular conspiracy theories involving fluoride
  • The colorful characters in the debate including activists, scientists, magicians, and politicians

A richly and considerately told tale of American science and public life, The Fluoride Wars offers an engrossing history to both interested general readers and specialists in public health, dentistry, policymaking, and related fields.

I was not disappointed by the book; it is well-written and comprehensive (is it ever!) and the authors leave no stone unturned.

My Ten Cents
One thing bears clarification: fluoride is the ionic form of the element fluorine, which, at standard (room) temperature and pressure, is a diatomic, pale yellow, highly reactive gas that is extremely dangerous to handle. For most uses, fluorine is gnerally converted to the strong acid, hydrofluoric acid HF (think ‘glass etching’) or some similar chemical.

Items that struck me:

1) The conspiracy theories. For example: one involves ALCOA, the alumninum company, which has been foisting its toxic waste (containing fluoride) upon the public, selling it to those utilities who need fluoride for their water supplies. Why? Maybe so we won’t mind inhaling hydrogen fluoride gas at some of its facilities. The phosphate fertilizer companies also fall into this group, since their fluoride-containing wastes can be used as a source of fluoride.

Anti-fluoride groups like to point out that the fluoride used in drinking water is someone else’s waste. The authors quickly point out that harvesting soemone else’s waste to obtain a useful material is good practice (p. 150). Can you spell r-e-c-y-c-l-i-n-g? Then of course, there are those who believe that fluoridation is some government plot to control minds or medicate us against our will. Freeze and Lehr devote an entire chapter devoted to such theories and flurophobia (the title of the chapter). It’s good.

2) The journal Fluoride, the ‘standard bearer’ for the International Society for Fluoride Research (IFSR). According to the authors,Fluoride has never published an article supportive of fluoride in drinking water. On the other hand, manistream scientists who oppose fluoridation for scientific reasons (teeth mottling, skeletal fluorosis, etc.) have had trouble getting their papers published in reputable journals or have suffered humiliation at the hands of the mainstream science/health community.

3) Great detail on the teeth mottling issue, which is a concern. It may not be a life-and-death health issue, but some believe it could be psychologically damaging.

4) The best chapter is Chapter 11 – ‘Science and Not Science’ – all about ‘junk science’, a term bandied about a lot these days. My colleague Todd Jarvis thinks this is the best description of the issue – I agree – and although it pertains to the fluoride issue, anyone concerned with junk science should read it.

5) What about the decline in dental caries in nonfluoridated communities? The authors mention that this is likely due to thehalo effect, the exposure of the populace to fluoride toothpaste and foods and beverages processed with fluoridated water. So even if you are in a nonfluoridated community you are probably getting a dose of fluoride, and your teeth are happy!

6) Very good discussion on why fluoride is good for your teeth. More than enough to whet your apatite (Ha ha!).

7) Lots of personalities: Dr. Y, H. Trendley Dean, H.V. Churchill, Kaj Roholm, William Marcus, Frederick McKay, et al. Also case studies. And references!!

8) Risk assessment and economics are covered in Chapter 12. Some people are concerned about the chance of a fluoride ‘accident’ – an overfeed that dumps too much fluoride into the drinking water. The authors judge that risk at 1 in 10,000 in a given year. Furthermore, they estimate the risk of death from such a mishap to be 1 in 1,000,000. I should note that Freeze used a similar discussion on risk and acceptable risk in his earlier book. It was very enlightening.

9) In the excellent summary chapter, ‘The Light At The End Of The Tunnel’, Freeze and Lehr acknowledge that at high concentrations – much greater than the 1.0 ppm normally found in drinking water – fluoride can do harm. As they say, it is the most bone-seeking element there is and that can lead to problems (crippling skeletal fluorosis). But they give fluoride the bulk of the credit for the near elimination of dental caries. They are skeptical about claims of fluoride and cancer. The problem with many such anti-fluoride claims is that they rely on ‘unpublished, unreplicated, or repudiated’ work.

The authors also show their hand, and it’s safe to say they come down on the side of fluoridation (p. 363):

Overall, the pro-fluoridation movement is the clear winner on the credibility front. Those to whom we usually turn for expertise on scientific, medical, and technical matters speak pretty much with one voice in favor of the fluoridation paradigm.

But then they add:

Unfortunately, they have not always worn the victor’s mantle with grace. There are many documented cases of the suppression of anti-fluoridation articles in establishment journals and the shunning of reputable scientists who developed an anti-fluoride viewpoint. These actions represent an embarrassing stain on the record of the dental research establishment.

The authors conclude with a plea for civil discourse, and urge the two sides to sit down together and discuss their differences. It does not appear that this has been done. Both sides are entrenched. I’m not surprised.

I can’t say that The Fluoride Wars is the best book I’ve read on the subject only because it’s the only book I’ve read on the issue. But it is, for the most part, an even-handed treatment of the topic. It isextremely comprehensive – well-referenced and indexed. It is a great source book for for pro and con factions alike. And the writing is exceptional. Read it. You will be educated and entertained.

Final Say
I have to say I was surprised at the extreme opposition of some to fluoridation. I understand that there are legitimate concenrs about the saftety of fluoride in drinking water. Afer all, it is a poison. But so is chlorine, and I hear little fuss about chlorination, perhaps because we have had about 40 more years doing chlorination. With respect to to chloriantion I might add that more are becoming concerned with disinfection by-products – perhaps another post may be in order. In the meantime, there is Mike McGuire’s book, The Chlorine Revolution (read my review here).

I do not consider myself naive; I do trust the water purveyors to ‘get it right’ – just like they have with the addition of chlorine. I don’t expect to see fluoride concentrations at toxic levels in drinking water any time soon. And I am not prone to conspiracy theories about fluoride or anyting else, so that issue does not resonate with me. And it may be forced medication, but you can argue that so is chlorination. To me, both are public health issues.

Do I believe in fluoridation? All I know is that I grew up with a water supply that was not fluoridated until I was in my early teens. I have the proverbial ‘mouthful of silver’ and ‘fond’ memories of those heinous belt-driven drills. My former sister-in-law, ten years my junior, grew up entirely on fluoridated water and has nary a cavity. I know – crappy sample size (although The Lancet might accept a paper on the topic).

Read more from the Water Matters blog. Here’s an excellent C&EN review.

“All substances are poisons; there is none which is not a poison. The right dose differentiates a poison….” – Paracelsus (1493-1541)

One thought on “Book Review: ‘The Fluoride Wars: How a Modest Public Health Measure Became America’s Longest Running Political Melodrama’

  1. ChemistryOrg

    You could certainly see your expertise in the work you write. The world hopes for more passionate writers like you who aren’t afraid to say how they believe. Always follow your heart.

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