Mark Wiener vividly remembers the Great Portland Fluoride Battle of 2013.
It wasn’t the kind of clash that has so sadly become the nightly norm in parts of Portland these days, but it was definitely a culture war: the City Council moved to fluoridate the water, and some city residents didn’t like that one bit. Opponents gathered enough signatures to force the issue onto the ballot, and then united the anti-fluoride left and anti-fluoride right to defeat the measure at the ballot box.
Willamette Week described the pro-cavity coalition thus: “It’s as if an Occupy protest, a talk on artisanal cheesemaking, and a Tea Party rally were all accidentally booked at the same hotel ballroom.”
The anti-fluoride campaign there, like anti-fluoride campaigns everywhere, was also marked by a certain, uh, passion. As Wiener put it, people pushing to fluoridate the water “may be unprepared for the incredible vitriol that people will heap upon them.”
The issue is often distorted by this vitriol – by a disconnect in passion underlying the disconnect in facts between supporters of fluoridation and opponents. As Wiener put it, “There is a broad consensus of agreement (in favor) but it also has a passionate minority who are willing to do or say almost anything to stop it.”
The campaign Wiener helped organize went down by a 3-2 margin. Portland remains – like Spokane – one of the minority of unfluoridated American cities, where the prevalence of dental cavities has led to what dentists refer to among kids there as “Multnomah Mouth.”
Our story is different in many ways, but, like Portland, we’ve got our longstanding and so far successful opposition to fluoridation. Like Portland, we have people who will passionately go to great length to misstate the science and peddle conspiracy – and who nonetheless have controlled the outcome.
And, like Portland, the results of our fluoride failure appears mostly in the mouths of our city’s poorest, most disadvantaged children.
Call it Spokane Mouth: More than 60% of third-graders had a cavity in a 2015, and nearly 1 in 6 had rampant tooth decay in seven or more teeth, according to the Spokane Regional Health District. These figures are higher for poor children and children of color, which means the many problems associated with cavities – from infections and diseases throughout the body to social problems and even poorer school performance – affect them more as well.
“Fluoride is an equity issue,” said Dr. Bob Lutz, the county health officer. “Flouride provides a level playing field.”
Kids can’t vote
The Spokane City Council will likely vote on whether to fluoridate the city’s water, in alignment with state health guidelines, on Sept. 14. As there were in Portland, there are people here who resist the idea of the council making this decision without a vote.
The mayor has said she thinks it should be on the ballot, as have others. We’ve had three advisory votes on the issue here, though they were many years ago, and fluoride has lost each time – the most recent margin, 20 years ago, was 2 percentage points.
There is reason to think there is a pro-fluoride majority here now, based on polling earlier this year by fluoride proponents that showed 54% of respondents support fluoridation of the water, as opposed to 34% who oppose it – a gap that has grown by 7 percentage points since 2016. (This poll of 400 residents, taken in May, had a margin of error of 4.9%).
At the risk of seeming authoritarian – fluorthoritarian? – a broad coalition of health officials and organizations are arguing persuasively that it’s time to take back this public-health issue from drum-beaters of conspiracy, on behalf of those kids with seven cavities in their mouths. And we don’t need a public advisory vote to do so – not by law, not by convention or context or past practice, not by principle.
Breean Beggs, council president, supports voting in fluoridation now, and notes that we already put chemicals in the water – chlorine, for example – without a vote.
“For me, when it comes to public health issues, where the science is really clear, that’s what elected officials are supposed to do,” he said, adding that those “who are the most impacted by this are people under 18 who don’t have the ability to vote.”
Unlike the Portland scenario, Washington law does not give decision-making authority on this question to the initiative process. Citizens in Port Angeles tried to overturn water fluoridation by initiative in 2013, but a court ruled that such a decision was an administrative function, not subject to being overturned by initiative.
Public health decisions – which must constantly balance the greatest benefit for most people against possible harms, side effects and downsides – are made all the time without referenda. We didn’t vote on seat belts, or cigarette labeling, or indoor smoking bans, or motorcycle helmets, or vaccination requirements in schools, or vaping age limits, or mask mandates and pandemic closures. Elected leaders and appointed public health officials made those decisions by the lights of the best evidence, not by popular vote.
All of those issues had detractors at the time of adoption. Many were painted by a passionate minority as excessive, or undemocratic, or in contradiction to some secret evidence, understood only by the critics and hidden by the proponents. At one of my first journalism jobs, I was visited regularly by a very committed opponent of proposed seat-belt laws, who was certain that seat belts were killing people by trapping them in cars.
And yet the seat-belt bloodbath never arrived.
Dr. Luis Manriquez, a clinical assistant professor at the Elson S. Floyd School of Medcine, argues that fluoride is similar. It’s supported by large body of research and proof of effectiveness in the real world, backed by every real health organization on earth. A virtual consensus view in scientific terms.
And fluoridating the water at safe levels, so everyone benefits – and especially those with limited access to dental care – is the smartest, most effective and most affordable way to do it. That’s why three-quarters of American cities already do.
“It’s one of the top 10 public health interventions of the past century, right up there with immunization and defeating polio,” he said.
‘Oh, another cavity’
This is one of those things that fluoride proponents repeat a lot, because it’s true.
There is a massive body of evidence that supports the safety and effectiveness of community water fluoridation, when done at the right dosage and with consideration for the mostly minor issues than can result for a small number of people. The greatest seeming downside is fluorosis, a mild staining of the teeth that affects some kids.
In most parts of the country, fluoridated water is an afterthought. People have it, benefit from it, and almost never think about it. Lutz, the county health officer, grew up back east before moving to the unfluoridated West – Tucson, then Spokane – in the late 1990s.
“I had no cavities until I moved here,” he said “All of a sudden it’s like, ‘Oh, a cavity. Oh, another cavity.’ “
Fluoride opponents have long argued that a series of negative consequences from fluoridation have been proven – or, more commonly, that “emerging” evidence points to more and more problems. This evidence is always emerging, and it’s always just about to prove their preordained conclusion.
An example: Fluoride opponents often point to studies that show an association between high levels of fluoridation and lower intelligence. They cite the fact that there have been 23 studies on fluoride toxicity and the effect on developing brains, and 21 found an association between higher fluoride and lower IQs.
Disturbing, no? Not really, as it turns out.
A review of those studies published by a team of Eureopean researchers in May by the Archives of Toxicity concluded those studies were essentially irrelevant to the issue of community water fluoridation: Almost every one of the 21 studies was conducted in impoverished rural communities, ranging from China to India to the Sudan, and involved naturally occurring fluoride, most at higher levels than fluoridation programs use.
Manriquez said trying to balance the pro- and anti-fluoride scientific arguments would be absurd. Acknowledging counter-arguments “is important,” he said, “but it’s also important to note when one side of the scale has 800 pounds on it and the other side has 2 pounds on it.”
The 2-pound argument gets too much traction per pound already. We’re in peak times for 2-pound arguments, on economics, climate science, the teaching of biology, sex education – the nature of reality itself, it often seems, is subject to a debate between the 800-pound argument and the 2-pound rebuttal.
Two-pound arguments are killing us on the coronavirus pandemic – conspiracy arguments, quack cures, misreading of the CDC stats, mask hysteria – and they’ve been helping to rot the teeth of poor Spokane kids for decades now.
It’s time to listen to the wisest voices, not the loudest ones. If the council members have the courage to make the call themselves and live with the vitriol, then good for them. If they don’t, we should take another run at the ballot box.
Otherwise, Spokane Mouth wins again.