by Paul Connett
Power at the Top of the Chain of Command
The second experience came when Dr. Connett met Dr. Robert Hall, chief health officer for Victoria, Australia. When Connett asked if Hall had read the “50 Reasons to Oppose Fluoridation” statement1 he had sent ahead of the meeting, Hall responded that he had but it had not changed his opinion on fluoridation. When Connett asked him if he would provide a written response to the “50 Reasons, ” Hall replied, “Neither I, nor my staff, have any intention of doing that. ” Adding irony to Dr. Hall’s refusal was the fact that the Victoria government had hired a public relations company to produce a booklet providing answers to “frequently asked questions on fluoridation. ” Clearly, the health department was better at answering its own “selected” questions than real questions from opponents.
The Tactics Examined
Various tactics have been used regularly by the two chains of command to keep doctors, dentists, scientists, the media, and decision makers away from the science that shows that fluoridation is neither safe nor effective. Moreover, even when local officials are skeptical about fluoridation, they are easily intimidated when professionals from the community turn out in force. We discuss some of these tactics in the sections that follow.
Promoters use the authority of endorsements.
Fluoridation is promoted today just as it was nearly sixty years ago: with endorsements. These endorsements, however, are highly suspect. As shown in chapter 9, when the U. S. Public Health Service (PHS) endorsed fluoridation in 1950, it was mainly reacting to political pressure. Even though the supporting science was weak, many professional associations, including the American Dental Association (ADA), the American Public Health Association (APHA), and the American Medical Association (AMA), quickly followed suit, still without solid scientific evidence that the practice was safe or effective (see chapter 10). Between 1950 and 1960 the endorsements kept rolling in, and today the ADA boasts a list of nearly one hundred organizations that endorse fluoridation. 2
While it is clear that these organizations have mobilized very little science of any substance to support their endorsements, for many people, who do not have the time to study the details of this issue for themselves, the strategy of using endorsements is very effective.
Emblematic of the subservience to authority is the use made of the statement by the Centers for Disease Control and Prevention (CDC), mentioned previously, that fluoridation is one of the “ten great public health achievements” of the twentieth century. 3 Hardly a day goes by without this being cited somewhere in the world by a journalist, editor, or government official. The statement provides a very convenient shield behind which proponents, including those who have not read a word of the primary literature, can conveniently hide.
However, if those who so casually bandy this statement around spent a little time reading the supporting document, 4 they would be surprised to find how little substance there is behind that lofty declaration. 5 For example, the CDC document ignored all published studies from 1993–1999 that reported adverse effects, citing a single review that was already six years old when the CDC statement was issued in 1999. 6 Moreover, the evidence offered for effectiveness would have made an undergraduate blush (compare figures 6. 1 and 6. 2). But the CDC gets away with it because the agency has authority. Whether it deserves to be considered an authority on fluoridation is a different matter. Most people are unaware of how biased the CDC is on this matter.
The media are easily taken in by proponents’ authority.
What makes this situation dangerous is that, while they may not be well informed on the matter, dentists and doctors are highly influential in their local communities. Their opinions are usually taken as gospel by the local media, decision makers, and members of the public. In a 1979 white paper produced by its Council on Dental Health and Health Planning, 7 the ADA illustrated the powerful influence that the authority of local dentists and other health professionals has on the media when it quoted the editor-in-chief of the Winona [Minnesota] Daily News, which published features and editorials favorable to fluoridation:
Historically on the area scene, the dental society has been the pioneer and leader among the professional groups in communicating to the public helpful information in its professional area of responsibility. We have always tried to cooperate. . . The decade-ago campaign for fluoridation had our support not so much because we favored it, but because the dental society had established credibility with us and with the community. 8
Even when local officials are skeptical about fluoridation, they are easily intimidated when local media support it and disparage those who oppose it.
The vast majority of people innocently believe that their doctor, their dentist, and the CDC, ADA, and AMA would not promote this practice unless they had studied the issue long and hard and were certain it was safe and effective. However, “certainty” in the absence of knowledge should carry no weight.
The unsatisfactory situation in which authority trumps rational argument is made even worse when local journalists are prepared to do little more than quote one sentence from each side, especially if one of those sentences is the infamous CDC quote above.
The promoters’ interests are served in two ways by the media. First, few journalists go deeper than a superficial treatment, frequently giving deference to the proponents’ presumed authority. Second, proponents make a special effort to get one-on-one sessions with editors. The resulting editorials can be so one-sided and derogatory of opponents of fluoridation that they can be truly disheartening to those who have worked hard to make a more balanced and objective assessment of the science available to the public. Of course, the opponents’ case is not helped by a handful of people who talk about fluoridation as a “plot to limit world population. ” Their unsubstantiated passion serves to make the white-coated supporters of fluoridation look very reasonable indeed. It also makes it more difficult for the scientific case against fluoridation to get a hearing.
Promoters denigrate and intimidate opponents.
Hand in hand with elevation of the authority of the promoters goes the denigration of opponents. Denigrating fluoridation opponents is not hard to do if the unscrupulous proponents focus on the hysterical fringe of the anti-fluoridation movement and ignore the rational majority. In 1976 Dr. Stephen Barrett, the director of DentalWatch and Quackwatch, described opponents of fluoridation as “poison-mongers. ”9 The label is ironic when one considers that opponents are largely unpaid—indeed, many have to dig deep into their own pockets to oppose this practice—have nothing to “monger” (sell), and are trying to take a poison out of the water, not put it in!
DentalWatch Online posts a paper dated 1999 by Michael Easley, DDS, MPH, a member of the advisory board of the American Council of Science and Health (see chapter 26), in which he variously describes opponents as “health terrorists, ” “fluorophobics, ” and “antiscience messengers” and accuses them of using “innuendo, ” “half-truths, ” “scare words, ” and “The Big Lie. ” He declares, “Like parasites, opponents steal undeserved credibility just by sharing the stage with respected scientists who are there to defend fluoridation. ”10
Easley takes the argument one step further and aims an intimidating warning to dentists and doctors not to step out of line on this matter when he adds: “Unfortunately, a most flagrant abuse of the public trust occasionally occurs when a physician or a dentist, for whatever personal reason, uses their professional standing in the community to argue against fluoridation, a clear violation of professional ethics, the principles of science and community standards of practice. ”11
Abusive and intimidating language is the last refuge of those who are unable to argue credibly, and it was such language that made Paul Connett realize, quite early in his efforts to examine both sides of the issue, that there must be something wrong with the proponents’ case. 12
Promoters claim there is no debate.
In October 2009, Colleen Wulf of the Ohio Department
of Health explained to a councilor in Athens, Ohio, why she would not debate Dr. Paul Connett:
Our reasoning for not participating in debates on fluoridation is simple. Debates give the illusion that a scientific controversy exists. All major dental and public health associations. . . support the practice of fluoridation. Community water fluoridation has been recognized as one of the ten great public health achievements of the 20th century. Debates and public hearings give the vocal minority a forum to spread misinformation and fear. 13
But no scientific subject is ever beyond debate. There is always the possibility that an ugly fact will destroy a beautiful theory. As the French writer Joseph Joubert (1754–1824) wrote, “It is better to debate an issue without resolving it, than to resolve an issue without debating it. ”
In Australia, the Victoria government has posted on its Web site the following explanation as to why it will not debate the issue:
The Department of Human Services, along with key partners, including the Australian Dental Association and Dental Health Services Victoria, are unanimously of the view that public debates about water fluoridation, including debates about the relative scientific merits of particular pieces of research, provide little or no value to members of the public with a genuine interest in learning more about water fluoridation. 14
The alternative it offers consists of professionally produced leaflets that give only one side of the issue. When asked to respond to specific questions from opponents, the department refuses to do so. For example, after over nine months, Dr. John Carnie, chief health officer of the Victoria Department of Human Services, has failed to respond to eight specific questions posed to him by nineteen professionals, that were published in an open letter in the newspaper of a community threatened with forced fluoridation. 15
Promoters discourage professionals from investigating this matter for themselves, even while actively encouraging them to promote the practice.
The American Dental Association gave some extraordinary advice to its members in the same 1979 white paper cited above. The ADA Council on Dental Health and Health Planning wrote, “Individual dentists must be convinced that they need not be familiar with scientific reports and field investigations on fluoridation to be effective participants and that non-participation is overt neglect of professional responsibility. ”16
We are sure that many readers are shocked to learn that the ADA believes that professionals need not be on top of their subject to promote a practice that has the potential to affect the health of millions. Such an upside-down definition of professionalism would be more appropriate in Alice in Wonderland than in a communication to members of a professional organization.
Promoters make declarative statements about the “safety” and “effectiveness” of fluoridation without citing the primary literature.
One of the key features of propaganda is repetition. It is very noticeable in their public statements on fluoridation how frequently promoters use the phrase “safe and effective, ” as if saying this enough times would make it so. Normally, a listener might anticipate that such declarations would be accompanied by scientific evidence, but it is one of the beauties of “authority” that as long as a proponent is wearing a white coat or holds a high office, and he makes his assertions with confidence, many people will believe him.
An interesting example of an “official” declarative statement is in a short video clip by Dr. Poul Erik Petersen, the oral health director for the World Health Organization’s Department of Chronic Diseases and Health Promotion. The video was released at the time of the Chicago celebration by the ADA and the CDC of the sixtieth anniversary of fluoridation in July 2005. In a nutshell, this four-minute video exemplifies the problem faced by those trying to stop fluoridation. Apparently decent, intelligent, and caring professionals who hold important positions, like Dr. Petersen, can look the camera straight in the lens and make categorical claims about the safety and effectiveness of fluoridation without blinking an eye. This video can be viewed online. 17
Maybe Petersen and others promoting fluoridation actually believe what they are saying. Whether they do or not, however, they seldom feel the need to back up their comments with references to the primary literature or express the slightest reservation about what they are recommending. They issue no caveats; they suggest no doubts. The program is promoted with absolute confidence and certainty. Such certainty simply does not exist on any scientific question. But certainty is important when a policy is being aggressively promoted. Promotion does not sit well with uncertainty (see chapter 26).
Dental journals show little interest in publishing articles that indicate any dangers from fluoridation or editorials critical of the practice.
It is rare to see an article in a mainstream dental, medical, or even scientific journal challenging or criticizing fluoridation. Articles by Mark Diesendorf, Bette Hileman, and Dan Fagin provide some notable exceptions. 18–20
Articles published in the journal Fluoride are not listed in the search engine Medline/PubMed.
Ironically, the one specialist journal, Fluoride, that deals with all aspects of fluoride research has not been readily available to mainstream readers of the medical or scientific literature. The International Society for Fluoride Research (ISFR), which publishes Fluoride, was set up in 1968 by Dr. George Waldbott (see chapter 13) as a forum for research on fluoride, particularly its biological effects. It is fair to say that both Waldbott and subsequent editors of the journal have been of an anti-fluoridation persuasion and have expressed that point of view in editorials. However, the editorial board covers a wide range of interests and includes a large representation from countries that have no interest in fluoridation but on the contrary suffer from an excess of fluoride in their groundwater.
The journal provides a platform for the publication in English of work from such countries, some of which, by documenting the harmful effects of naturally occurring fluoride, argue by implication against artificial fluoridation. (All articles published in Fluoride after 1998, and for several previous years, are available online to read or download at no cost. )21 But many articles have little or no relevance to fluoridation. This has not stopped promoters of fluoridation from labeling the journal as an “anti-fluoridation magazine” and dismissing its entire contents. Many journals take editorial positions, but the editors of Fluoride have been careful of their own opposition to fluoridation and willing to publish well-written articles and guest editorials that take a pro-fluoridation position.
The real issue is that Fluoride carries a lot of information on fluoride’s health effects that promoters prefer to keep hidden. For example, it was the first journal published in English to make available the IQ studies from China, and in two special issues it has recently published nineteen other articles on the brain, recently translated from the original Chinese versions (see chapter 15).
Several U. S. reports on fluoride published by the Agency for Toxic Substances and Disease Prevention;22 the National Research Council of the National Academies;23 and TOXNET, 24 hosted online by the U. S. Library of Medicine and the National Institutes of Health, cite papers published in Fluoride. The 2006 NRC review, the most important report on the toxicology of fluoride published in the United States, cited Fluoride more than any other journal. 25 But for whatever reason, Fluoride has been kept off the list covered by PubMed, the most popular online search engine of the medical literature (it is, however, covered by the Science Citation Index).
It is difficult to avoid the suspicion that the PubMed exclusion is an act of censorship, considering the hostility of powerful dental interests within the U. S. Department of Health and Human Services. Moreover, the exclusion smacks of a double standard when the same search engine covers dental journals such as Dentistry Today, which is considered by dentists as a trade magazine with little evidence of being a scientific journal. 26
In general, promoters oppose local referenda on fluoridation and push for mandatory fluoridation on a statewide ba
sis.
Proponents have learned that even with their huge budgets and some of the tactics identified above, it is difficult for them to win if the matter goes to referendum, especially if the press does a good job of covering both sides of the issue. Notable examples of where citizens have won victories against fluoridation, even though being vastly outspent by proponents, are Worcester, Massachusetts;27 Bellingham, Washington;28 and Juneau, Alaska. 29 Thus, over recent years, proponents in the United States have preferred to use their political and financial power to introduce mandatory fluoridation by legislation at the state level.
As indicated in chapter 1, we are conscious that local decisions by referendum are not ideal since they transfer to our neighbors a decision (consent to medication) that we should make as individuals. However, they are a large step better than mandatory statewide fluoridation, an oppressive measure that effectively bypasses any local discussion or control.
Recently, the Louisiana Dental Association (LDA) used both a high-powered PR firm and a lobbying firm to help pass a statewide mandatory fluoridation bill with very few citizens in Louisiana knowing what was happening. Only now are a small number of citizens finding out about it, a possibly ominous portent of what may occur in other states. According to the director of the LDA: