Thursday, April 24, 2014

Fluoride: Can a few still block a benefit for the many?

By Michael Wilkes, M.D.

The history of public health in America is an impressive success story that includes efforts to cure and prevent diseases and injuries.  Although the skills of surgeons and cardiologists are amazing, and have helped a few people enormously, they have contributed relatively little to the overall life expectancy in America.

Instead, increases in life expectancy have been primarily attributed to sanitation, diet improvement, water purification, transportation improvements and, of course, immunizations. Americans live more than twice as long as our colonial forbears.

Unfortunately, these changes have not always come without struggle. Unfortunately, not all Americans have benefited equally from public health or medicine, including women, people of color, the poor and those in rural areas.

Increasing urbanization of America has brought fresh water, sanitation, public housing and access to trained medical providers. Killers 100 years ago included infectious diseases such as TB, smallpox and syphilis. Take, as one example, Milwaukee at the turn of the last century.  Smallpox attacked people of all ages, but particularly hard-hit were the young and those living in poor conditions that included overcrowding and poor sanitation. Thousands died each month of smallpox and those who survived lived a life with significant disability.

Remember that by 1900, smallpox was a preventable disease but no one was willing to take the steps to prevent its spread. A strong public health physician named Walter Kempster took on smallpox with gusto, but created a Milwaukee on the verge of civil war — the community was divided into those wanting to stop the plague and those not wanting to be inconvenienced. Kempster hired extra physicians to launch a required immunization program, he forcibly isolated infected persons by placing them in an isolation hospital, and he imposed strict quarantines for those allowed to remain in their own homes.

The wealthy and politically connected fought back, claiming these steps were against their liberties and their rights as Americans. Stone-throwing crowds protested and homes were barricaded so people could not be removed. Thugs threw scalding water at horses pulling ambulances so the infected could not be moved. Many attempts were made to both close the health department and fire Kempster. But Kempster held strong in a severely divided city. Eighteen months later, health came to Milwaukee and Kempster’s approach was vindicated.

Fifty years later, infections were being treated with amazing antibiotics, but the huge decline of these deadly diseases started 80 years earlier as a result of important public health interventions that required restrictions on human behaviors and limited personal liberties. As we cured acute illnesses, what emerged to take their place were chronic illness like diabetes, cancer, alcoholism and tooth decay. They also required public health interventions.

In many areas, the United States lagged, and still lags, behind most other developed nations. The reasons for this are complex, but are rooted in the disparities in our health care and our inability to place the health of the public above the personal liberties of a few. We have notable successes. We have chlorinated public water; required seat belts and motorcycle helmets; set speed limits on highways; forbade drinking and driving; pasteurized dairy products; added supplements like vitamin D, calcium, iron and iodine to foods to improve the health of the public; and limited where smokers can light up.

With each of these interventions came large fights. Those promoting the health of the public were opposed by those arguing it was their right as an American to have salt without iodine or milk without vitamin D or to smoke where they wanted. The response to each battle was the same. Eventually, those promoting the greater good, backed by strong science, won, and the supplement was added. Those who didn’t want exposure were, of course, encouraged to buy their ingredients without these supplements.

In Davis, we are now faced with a similar debate around fluoride. The issue isn’t the science, because I can think of nothing that is based on more rigorous research with large populations of people around the world. Fluoride works. And safety isn’t the issue. We know that claims of brittle bones, early cancers, lowered IQs and missed menstrual periods are all just smoke and mirrors to divert the discussion. If these were true, surely after 1 billion people were exposed to fluoride for decades we would have seen these events.

So, at its core, this fluoride discussion is about whether a few can block a benefit for the many. The opposition has made their argument and it holds no water. Like with vitamin D in milk, chlorine in public water and iodine in salt, the benefits to the public are enormous, the costs to society are tiny, and the liberties for those opposed are preserved in that if they want fluoride-free water they can go and purchase it.

— Michael Wilkes, M.D., Ph.D., is a professor of medicine and public health at UC Davis and chairs the Yolo County Health Council.

Special to The Enterprise


Discussion | 7 comments

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  • BobJuly 05, 2013 - 1:08 pm

    Thank you for being a voice of reason. It's funny what a google search can turn up: the type of conspiracy theorist pseudo-science that begets ignorance on matters of public health, from vaccines to fluoride; but amidst the ridiculous amounts of misinformation is the scientific research, based on YEARS of use and study, that show that ignorance for what it is. When you look at the pseudo-science, it all comes from a handful of the same sources, and they all just parrot each other, each claiming an "authoritative" source that another claimed from another until it's claimed from the initial source again...a giant feedback look of ignorance. The actual science is based on independent studies: some government, some universities, some public health groups--and they all come away with the same conclusion: it is safe and effective. Fluoridate Davis, it's about time! Thanks, again!

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  • Alan PryorJuly 07, 2013 - 10:37 am

    Actually it is the pro-fluoridationlists who still rely on psuedo-science performed decades ago with the sole purpose of proving the effectiveness of fluoridation. If the science were so compelling that fluoridation was cheap and effective, how come 97% of Western Europe has rejected fluoridation and still gets their drinking water uncontaminated by this toxic byproduct of the fertilizer manufacturing industry? How come Israel and the the provinces of Queensland Australia and Ontario Canada have recently rejected mandatory fluoridation? How come the EPA Union of Scientists have called on Congress to end fluoridation? How come the oldest and largest Latino organization in the US, the League of United Latin American Citizens, have called for an end to fluoridation because of the disproportionate adverse effects that fluoridation has on the Latino population? How come Portland voters just last month rejected fluoridation of the drinking water by a 61% - 39% margin? In fact, it is the pro-fluoidation faction that uses alarmists, non-scientific techniques such as in this article comparing a non-infectious disease like tooth decay with the mandatory immunization of smallpox. What's next? Will Dr. Wilkes also suggest we quarantine all people with tooth decay? The problem with tooth decay in our disadvantaged population is that NONE of the public supporters of fluoridation who are dentists accept Denti-Cal patients! They simply turn them away because they are not profitable enough compared to private-insurance paying patients. The public shame of excessive tooth decays in minority patients is squarely on the shoulders of those who refuse to provide them with basic dental services and then prevent independent dental hygienists from practicing in the disadvantaged community without dentists taking a cut of their fees.

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  • Rich RifkinJuly 07, 2013 - 5:42 pm

    ".... the pro-fluoridationlists who still rely on psuedo-science performed decades ago with the sole purpose of proving the effectiveness of fluoridation." ....... We are supposed to believe the quacks who Alan Pryor says are on the cutting edge of science; but we should ignore every single public health scientific body like the CDC and the AMA? The Centers for Disease Control is promoting pseudo-science, Alan? ....... LOLOLOLOL! ........ Alan, you should become a comic. Be sure to wear your duck hat. You might find one on Road 28H where there are no plastic shopping bags to be seen, despite your pseudo-claim to the contrary.

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  • ScottJuly 07, 2013 - 8:40 pm

    It doesn't matter what science says, the job of the city council (regardless what of what THEY or WAC thinks is best) is to do what the MAJORITY of the Davis homeowners want them to do (not just the people who are in their ear all of the time). Right or wrong! This applies to ALL of their decisions. Let's put this to a formal vote.

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  • sasshaJuly 07, 2013 - 10:23 pm

    Dr. Wilkes last sentence in his promotion of stuffing fluoride down everyones throat, ends with "if they want fluoride free H20 let them buy, right back at you doc. If you want fluoride you can buy your toothpaste, at your dentist....oops forgot to say if you can afford to buy it. Well, let's look at how much one individual can afford in uncontaminated H20 in order to say, water ones garden and veges., or bath or shower. All myriad circumstances which require H20 would have to be bought by the individual wishing to remain fluoride free. It would appear cheaper to just have fluoride treatment administered to those wishing it rather than spending tax-dollars to force it onto individuals who oppose it. Is that to rational for most thinking individuals?

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  • GrantJuly 07, 2013 - 10:31 pm

    The Great Fluoride Debate seems to me like an answer in search of a problem. Do we not currently exist just fine without supplementing our fluoride intake? Instead of forcing it on everyone, if you want more fluoride in your diet, why not pick up a tube of Aim for $0.99? Dr. Wilkes asserts that a "few" people (how many, he really has no idea), can block the benefit of the many, but ironically, it is the few people on the WAC and city council who will ultimately speak for an entire city!

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  • Claudia KrichJuly 12, 2013 - 2:39 pm

    Thank you, Dr. Wilkes, for this LOGICAL and intelligent information about fluoride, and about similar public health efforts throughout history.

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