Sue Lani Madsen: Following the science where it leads

Proposals to fluoridate Spokane’s water supply have simmered for decades, but the debate may have finally cooled permanently. Not because of likelihood of a fourth public vote failing just like the first three rejections. Not because of the high cost to install, operate and maintain a system to inject fluorosilicic acid into Spokane’s eight well stations.

Science has been doing its job, asking questions, and following the data where it leads even if it debunks a heretofore mainstream narrative.

The headline on the press release from the Keck School of Medicine at USC makes the conclusion as clear as fresh spring water. “Fluoride exposure during pregnancy linked to increased risk of childhood neurobehavioral problems, study finds.”

The USC study published in the Journal of the American Medical Association on May 20 quotes a National Toxicology Program report, saying that after a systematic review of the current scientific literature there is “moderate confidence that higher fluoride exposure … is consistently associated with lower IQ in children.” Researchers at USC followed up on the studies done in Canda and Mexico with “the first, US-based study to examine associations of prenatal fluoride exposure with child neurobehavioral outcomes.”

The study found children at age 3 to 5 years were 1.83 times more likely to have clinically significant behavioral problems if their mothers had exposure to drinking water fluoridated at 0.7 mg/L while pregnant. City of Spokane water is naturally contains fluoride at levels of 0.1 milligrams per liter of water. According to the CDC, optimal fluoridation is 0.7 mg/L.

It’s useful information, but science alone cannot dictate actions. Policy decisions are about tradeoffs, in this case the tradeoff of negative impacts on vulnerable prenatal humans’ developing brains for potential positive impacts on postnatal humans’ teeth.

When fluoridating water first became a public health prescription in 1945, there weren’t many options to protect children’s teeth. A common substitute for expensive store-bought concoctions was a mixture of salt and baking soda. Toothpaste with fluoride wasn’t on the market until the mid 1950s.

Now we have protective dental sealants for children and young adults. The CDC calls it an underused solution, 80% effective in reducing cavities, and has programs to fund school-based clinics to make it available to anyone regardless of income or any other demographic characteristics. The CDC also says fluoridated water systems are only 25% effective.

Twenty-five percent effective was a good solution when the alternative was zero, but a poor policy choice when there’s an 80% effective option.

So why do we still read stories like the one republished last month in The Spokesman-Review from the left-of-center KFF Health News full of positive spin about fluoridating whole water supplies and downplaying questions where the answers don’t match the narrative?

Because actually following “the science” is hard. Science requires a willingness to question assumptions, and in a polarized political atmosphere it is extremely difficult to go against the popular narrative at risk of being labeled a heretic.

In the case of mass fluoridation, some of the early objectors were painted as tin-foil hat conspiracists who saw a communist behind every bush. While there wasn’t a Soviet plot to poison America, the well-meaning effort to solve the very real problem of poor dental health by fluoridating entire water supplies became entrenched as the consensus point of view.

Once “the science” has solidified into a consensus it becomes ideology. Municipal fluoridation has become an article of faith on most of the political left in a reaction to the original objections coming primarily from mostly the political right. Now anyone who denies the benefits or raises questions about the unintended consequences may be accused of having no compassion for marginalized people or being a science-denier.

The Spokane City Council received a report in June 2023 identifying the economic costs of fluoridation. With a price tag of $11 million in 2023 dollars just for the capital costs, the council said no thanks in a letter to Marlene Feist, director of public works, on Oct. 16. Then City Council President Lori Kinnear and Councilmember Michael Cathcart advised “it is the intent of the undersigned City Council members to table indefinitely any plans for financing and implementing a citywide water fluoridation system … without approval of the voters of the City of Spokane.”

Given the current state of the city budget, that’s not likely to happen soon. Given the increasingly negative results of scientific inquiry into the safety and effectiveness of municipal fluoridation, it’s unlikely to happen ever.

Advocacy groups opposed to municipal fluoridation petitioned the EPA for a science-based approach, appealing under the Toxic Substances Control Act. The process ended up in U.S. District Court in northern California where a judge heard ten-days of testimony in February 2024 on the negative effects of fluoride on human populations. Judge Edward Chen’s decision is still pending.

The science from the Keck School of Medicine says “These population level findings add to existing evidence from animal studies showing that fluoride can harm neurodevelopment” and USC scientists plan to continue studying the impacts on human populations. Following the data where it leads is what science does best.

Contact Sue Lani Madsen at rulingpen@gmail.com.