Water Fluoridation - Ethics and Politics

Ethics and Politics

Further information: Water fluoridation controversy

Like vaccination and food fortification, fluoridation presents a conflict between benefiting the common good and infringing on individual rights. Fluoridation can be viewed as a violation of ethical or legal rules that prohibit medical treatment without medical supervision or informed consent, and that prohibit administration of unlicensed medical substances. It can also be viewed as a public intervention to replicate the benefits of naturally fluoridated water in order to free people from the misery of toothache and dental work, with greatest benefit to those least able to help themselves, and where it would be unethical to withhold such treatment.

National and international health agencies and dental associations throughout the world have endorsed water fluoridation's safety and effectiveness. The Centers for Disease Control and Prevention listed water fluoridation as one of the ten great public health achievements of the 20th century, alongside vaccination, family planning, recognition of the dangers of smoking, and other achievements. Other organizations endorsing fluoridation include the World Health Organization, the U.S. Surgeon General, the American Public Health Association, the European Academy of Paediatric Dentistry, and the national dental associations of Australia, Canada, and the U.S.

Despite support by public health organizations and authorities, efforts to introduce water fluoridation have met considerable opposition, opposition that is "often based on Internet resources or published books that present a highly misleading picture of water fluoridation". Since fluoridation's inception, proponents have argued for scientific optimism and faith in experts, while opponents have drawn on distrust of experts and unease about medicine and science. Controversies include disputes over fluoridation's benefits and the strength of the evidence basis for these benefits, the difficulty of identifying harms, legal issues over whether water fluoridation is a medicine, and the ethics of mass intervention. U.S. opponents of fluoridation were heartened by a 2006 National Research Council report about hazards of water naturally fluoridated to high levels; the report recommended lowering the U.S. maximum limit of 4 mg/L for fluoride in drinking water. Opposition campaigns involve newspaper articles, talk radio, and public forums. Media reporters are often poorly equipped to explain the scientific issues, and are motivated to present controversy regardless of the underlying scientific merits. Internet websites, which are increasingly used by the public for health information, contain a wide range of material about fluoridation ranging from factual to fraudulent, with a disproportionate percentage opposed to fluoridation. Antifluoridationist literature links fluoride exposure to a wide variety of effects, including AIDS, allergy, Alzheimer's, arthritis, cancer, and low IQ, along with diseases of the gastrointestinal tract, kidney, pineal gland, and thyroid.

Conspiracy theories involving fluoridation are common, and include claims that fluoridation was motivated by protecting the U.S. atomic bomb program from litigation, that (as famously parodied in the film Dr. Strangelove) it is part of a Communist or New World Order plot to take over the world, that it was pioneered by a German chemical company to make people submissive to those in power, that behind the scenes it is promoted by the sugary food or phosphate fertilizer or aluminum industries, or that it is a smokescreen to cover failure to provide dental care to the poor. One such theory is that fluoridation was a public-relations ruse sponsored by fluoride polluters such as the aluminum maker Alcoa and the Manhattan Project, with conspirators that included industrialist Andrew Mellon and the Mellon Institute's researcher Gerald J. Cox, the Kettering Laboratory of the University of Cincinnati, the Federal Security Agency's administrator Oscar R. Ewing, and public-relations strategist Edward Bernays. Specific antifluoridation arguments change to match the spirit of the time.

Opponents of fluoridation include Arvid_Carlsson, Dr. Marcus Williams,, Dr. Charles Gordon Heyd, researchers, dental and medical, alternative medical practitioners such as chiropractors, and health food enthusiasts; a few religious objectors, mostly Christian Scientists in the U.S.; and occasionally consumer groups and environmentalists. Organized political opposition has come from right-wing groups such as the John Birch Society, libertarians, and from left-wing groups like Green parties in the UK and New Zealand. Many people do not know that fluoridation is meant to prevent tooth decay, or that natural or bottled water can contain fluoride; as the general public does not have a particular view on fluoridation, the debate may reflect an argument between two relatively small lobbies for and against fluoridation. A 2009 survey of Australians found that 70% supported and 15% opposed fluoridation; those opposed were much more likely to score higher on outrage factors such as "unclear benefits". A 2003 study of focus groups from 16 European countries found that fluoridation was opposed by a majority of focus group members in most of the countries, including France, Germany, and the UK. A 1999 survey in Sheffield, UK found that while a 62% majority favored water fluoridation in the city, the 31% that were opposed expressed their preference with greater intensity than supporters. A 2007 Scottish bioethics council report concluded that good evidence for or against water fluoridation is lacking, therefore local and regional democratic procedures are the most appropriate way to decide whether to fluoridate. Every year in the U.S., pro- and anti-fluoridationists face off in referenda or other public decision-making processes: in most of them, fluoridation is rejected. In the U.S., rejection is more likely when the decision is made by a public referendum; in Europe, most decisions against fluoridation have been made administratively. Neither side of the dispute appears to be weakening or willing to concede.