The Fluoride Wars: How a Modest Public Health Measure Became America's Longest-Running Political Melodrama

Book Review The Fluoride Wars: How a Modest Public Health Measure Became America's Longest-Running Political Melodrama by R. Allan Freeze and Jay H. Lehr (2009) is published by John Wiley and Sons (ISBN 978-0470448335).

Laura L. Sanders, Book Editor

The Fluoride Wars: How a Modest Public Health Measure Became America's Longest Running Political MelodramaThe Fluoride Wars may be one of the most relevant books ever written on how America evaluates public policies on a controversial topic, in this case, fluoridation of publicly supplied drinking water. The objective of the book is to “present a social history of the fluoridation debate in the United States.” Authors Allan Freeze and Jay Lehr address issues related to fluoridation of public water supplies and toothpastes. The element fluoride has been added to many public water supplies and toothpastes in the United States for more than 6 decades. Fluoride does not harden tooth enamel itself but, rather, at the right doses, helps lower the incidence of cavities by making the enamel more acid resistant.

Freeze and Lehr review evidence showing that with low doses of fluoride, cavities in children have been reduced in a significant and verifiable manner. For those who receive too much fluoride, side effects have been documented. For children who do not have access to dental care, public health promotion of fluoridated water is the single most important dental health improvement and shows great benefit in reducing the incidence of childhood cavities. Adults have less need for fluoridated water.

Fluoridation may seem a topic unworthy of an entire book. But Freeze and Lehr tell an offbeat tale that lesser writers might not have tackled at all. In a scientifically curious manner, they examine the arguments on both sides of the issue. Although for decades, the vast majority of dentists have supported the fluoridation of drinking water and toothpaste, a few dentists and medical doctors are not in favor of the practice.

A highly passionate anti-fluoridation faction paints portraits of those favoring fluoridation as self-serving, stubborn, sinister, and greedy. The stories of both sides are described in this interesting book on what most Americans, generally uninformed about the pros and cons of fluoridation, might have said was a generally benign public health initiative.

As hydrogeologists, not dentists, the authors clearly enjoy exploring the social history and popular science of the fluoridation debate. The Fluoride Wars is written in an easy-going readable style, describing the dramas and controversies, as well as stories of the main players on both sides of the argument. Yes, there are charts and tables, and the book references hundreds of scholarly journals and studies, but this is neither a dental school textbook nor a review of every article ever written on fluoridation of public drinking water supplies.

Rather, this is a book to be read and enjoyed for the stories it tells. The book describes the stories of the pioneering dentists and the research that led to their early public heath successes. Colorful and interesting anti-fluoridation protagonists are described, as are conspiracy theories involving fluoride.

But the real debate of fluoridation in America is a much larger issue than just good oral hygiene. It is about the public health role that the government should play in our lives. This lively story serves as a guidebook related to the scientific process, public health policy, the evaluation and dissemination of data, and the delivery of health services to the public and it forms the blueprint of almost all of the usual American conflicts, controversies and even conspiracy theories.

The Fluoride Wars provides lessons larger than just public water supplies and toothpaste improvements. Although the authors could have been writing about any one of dozens of other relevant but unusually controversial American topics, such as national health care, nuclear power, environmental regulation, or genetically modified food, the same observations about how Americans uniquely go about solving scientific and technical problems can nonetheless be made.

The authors recognize that consensus among parties in the fluoride discussion will not occur in the near term. They sum up the fluoridation issue with the following astute comment: “The greatest obstacle to progress lies in the polarity of views of the major players on both sides of the chasm. Their entrenched positions and adversarial mentality mitigate against any type of civil discourse.”

It is this civil discourse that is needed more in this country than ever before, not only in the fluoride discussion, but also in so many other controversial areas of national importance as well. That is why The Fluoride Wars is so relevant.

Source Ground Water Volume 48, Issue 1, page 8, January/February 2010.
Book Review The Fluoride Wars: How a Modest Public Health Measure Became America's Longest-Running Political Melodrama.

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