"No sub-segment of the fluoride problem, whether it is fluoridation of the water supply or fluoride pollution can be scientifically analyzed until we analyze the total fluoride intake. This focuses the need for a complete re-evaluation of our policy for fluorides. The urgent consideration is total fluoride ingestion -- how much fluoride are people taking into their bodies from fluoride air pollution, from soil, from water, from products processed in fluoridated water, from pharmaceuticals, pesticides, herbicides and so forth? " -- Ralph Nader, Almeda Times Star, April 14, 1970)

Ralph Nader Discusses Fluoridation

Printed in Let's LIVE magazine

June 1971

Fluoride in water supplies! All right. I came in about 15 years ago with an open mind on fluoridation. I was part of the Jaycees -- the Jaycees like to fluoridate water supplies -- so I decided not to be, you know, stampeded. I wanted to get the facts. So here are the questions I wanted answered:

1. What is the purpose of fluoridation?

2. How efficient is fluoridating water supplies to achieve the purpose?

3. What are the costs - quite apart from the purposes or benefits? Cost to various age groups, to various people who happen to be sensitive, artificial kidneys, the whole population range. What kind of research has been done?

4. Is there another way to achieve the objective of reducing cavities without any of these costs or with less cost - a more efficient way?

5. Does the government agency that is promoting fluoridation also have an open mind and encourage research to determine if it's wrong? That's the scientific approach. You always have to keep the doors open for what Alfred North Whitehead once called "options for revision."

6. If fluoridation is going to be decided, who decides - the legislature; popular referendum; or, as in Connecticut, an administrative agency; or what?

7. What kind of options are out there? That is, suppose the person doesn't want it? What is the cost of him avoiding this?

Now, I once talked to some people about cigarette smoking. I said, "Are you against the tobacco industry for what they are doing to the American people?"

"Absolutely."

"Would you favor a compulsory ban on the consumption and sale of cigarettes - you know, would you, say, put it on the level of marijuana? Thirty years in jail for possessing Pall Malls?"

And they said, "Absolutely not."

I said, "Why not?"

They said, "Because what we want to do is have full disclosure of the hazards but we don't want another prohibition situation. If people want to smoke, knowing the hazards, they should be allowed to smoke. They should have their choice."

Then I moved over into the fluoridation area and somehow the principles got reversed. The same type principles - just got reversed.

Now, the U.S. Public Health Service has a totally paranoiac mind on this subject. And it's very serious because if it's paranoid on this issue, what is it going to be on other issues? The paranoia comes from the following: Just like the old days, all those who were against fluoridation thought it was a Communist plot. Now all of those who are for fluoridation think that those who are against fluoridation are kooks, psychotics, and deservative of inclusion in a personal file that the U.S. Public Health Service maintains.

Now, in Science magazine (which is not addicted to sensational reporting) about two years ago, there was a report that the U.S. Public Health Service had a file on all the major critics of fluoridation with all kinds of extraneous personal information which it then released strategically to various sources and media throughout the country.

The Public Health Service, unfortunately, has locked itself into a position where it has made this statement on the record that there is absolutely no hazard to fluoridating public water supplies and the matter is closed. Now, that, of course, is immediately an unscientific approach. The matter must never be closed.

In the early '20s, some people thought that for thyroid deficiencies, iodine would be good in the public water supply and they put it in around the Rochester, N.Y. area. At what point is there going to be a process here where we realize that to reach a small segment of the population, you don't expose an entire segment of the population to these kinds of ingredients?

Now, an individual may want to take the risk. He might say, "O.K., get rid of cavities (although that's been a bit over-exaggerated). Reducing children's cavities is worth the risks -- worth the risks to the small, say, number of people who are particularly susceptible, worth the risks to parts of the country where total fluoride intake is serious, and the like."

Now, at the least, they should be given the facts. It shouldn't have the kind of hierarchical endorsement - the A.M.A., the A.D.A., look at all those people who endorse it, it's got to be good.

One of my legal associates once made a study of how the fluoridation issue is decided. It was printed in the George Washington Law Review, and it was decided basically by a particularly acute lobbying effort by a number of dentists who stampeded the Public Health Service into the decision. Once the Public Health Service had gone on record, it could never be proved wrong. It would lose too much face. If the Public Health Service was proved wrong, what would people think about the Public Health Service in all the other things they are doing? It's a very pathetic situation, unfortunately.

I think the way out is first to recognize that there are a great number of scientists in this country and abroad who are afraid to speak out on the subject. The H.E.W. has been known to deal with this kind of person rather harshly in the dissemination of research grants. You will get some information on this, for example, by Professor Laubengayer of Cornell, who's a very well-respected chemical scientist. And in many other areas, you just don't expect to be treated well by H.E.W. in its massive research granting if you come out against this type of thing. It's a matter of professional intimidation here.

I've been told by a number of scientists -- some of them Nobel laureates -- that they have grave doubts that this is the most efficient way to combat dental caries in children; that there are much more efficient, much more comprehensive ways, without exposing the whole population.

We would want to know, as rational human beings, what the total fluoride intake is. The statement that 1 p.p.m. of fluoride is safe isn't really expositive. You want to find out what does that 1 p.p.m. do to all the other fluorides in addition. You might break a critical mass here. You take fluorides in through consumption of foods, in the air (fluoride pollution), and through other sources. What's the total?

A year and a half ago, Professor Barry Commoner wrote to the Public Health Service and said, "Do you have data of total fluoride intake?" They never answered the letter. Then, because of constant hammering, they came out with this statement about in July, and they said that the average level of fluoride intake for adults was X p.p.m. and it was safe. The data for children is yet to come. Well, have you heard about the statement of the sheriff who said that this individual couldn't possibly have drowned in the river because the average depth was a foot? It isn't the average depth that is significant; it's what they scatter around the country. You may have -- like in Montana -- heavy fluoride pollution in the air. There may be other areas. There may be certain individual susceptibility. Is there research to answer these questions? No. The Public Health Service does not promote research to disprove it. It promotes research applications that are designed to further the proof for it. A very, very poor way of manipulating or processing a public health measure.

Perhaps the crux of the argument is the following: That there are better ways -- more comprehensive ways -- to cut down the dental caries in the subject population of attention without exposing 80 or so percent of the population to it. One of the principles of ecology is you do not intrude new elements into an ecological pattern unless you have an awfully good reason to and unless the benefits far outweigh the costs.

There are now topical applications. There are a whole host of ways whereby dental caries can be very severely reduced much more efficiently. Unfortunately, our dentists, who know there is a crisis in shortage of dentists in the country, are not very much interested in seeing a comprehensive dental treatment program developed, and that is the obvious access point that's quite efficient. There are a lot of children who don't get adequate dental care and, like children get inoculations and the like at the school level, they certainly could be treated quite well in this area.

I've often wondered why all the people who are for fluoridation never say anything about soft drinks, never say anything about bleached white flour, never say anything about diet manipulations which are leading to the production of so many dental caries in our children.

That's something I think should be severely emphasized because it's not only the production of diets, it's the malnutrition of even well-to-do children around the country. The U.S.D.A. every year makes a sample of families. Last year, half the families surveyed were deemed to have inadequate diets and they weren't all poor by any means. The diet has a great deal to do with it.

Many of these topical application improvements are coming from the U.S. Navy, strangely enough, for application to 19 - and 20-year olds. If they work for 19 - and 20-year olds, they obviously will work quite efficiently for younger children.

This is the nature of the debate. These are the kinds of facts and factors that should be considered, in addition to the compulsory process of it all. Now, if there was a raging epidemic going on, if fluoride could eliminate a raging epidemic, you say, "Well, the benefits far outweigh the costs."

But we're not dealing with a contagion; we're not dealing with an epidemic; we're not dealing with something, say, as serious as typhoid. We're dealing with dental caries, so the balance here becomes much more critical in terms of the unknowns and the costs that have been indeed documented.