Eighty Years Of Conflicting Data: What The Fluoride-IQ Debate Tells Us About Public Health
By Nicole Fisher
Since the 1700s the scientific method has been the primary process for experimentation used to explore observations and answer questions. But whether we’re talking about significant breakthroughs in public health like John Snow’s discovery of public drinking water as the source in London’s 1854 cholera outbreak or never-ending contradictory publications claiming which diet is healthiest, it is clear controversy is an inherent part of public health.
At the time of John Snow’s cholera breakthrough, miasma theory (or belief that disease is spread through foul-smelling, dirty air) was the norm. Thus, Snow was ignored by many and even mocked for believing that bacteria in water could be the real source of disease. And sadly, it wasn’t until after his death that his theory was scientifically validated and broadly accepted.
Fast forward more than a hundred years, and new research controversy and confusion make the news every day. Scientific publications are met immediately with contradictory theories and widespread debate. Someone claims they can cure cancer. Someone else claims that solution actually causes cancer. Eggs are healthy. Eggs are unhealthy. Red wine is good for your heart. Alcohol should be avoided at all costs. With all the conflicting data and oversaturation of information online and in print, one can conclude just about anything they want and find some literature that supports their preconceived conclusion.
Moreover, competing information and political divides have led to shifts in how much Americans say they trust research. According to new Pew Research Center data, “Americans have broadly positive views of scientists and their work. But Americans are more tepid when it comes to trusting scientists’ competence, credibility and concern for the public interest – and they are largely skeptical of scientists’ transparency and accountability.”
And last week was no different. A JAMA Pediatrics publication looked at a more than 80-year old question about the potential impact that fluoride can have on human development and health. In the decades-long debate on whether fluoride is good or bad for us, this particular research concluded that fluoride consumed by woman during pregnancy can decrease the intelligence (IQ scores) of their babies. But what made this finding exceptionally provocative is that fluoride is in public drinking water. Meaning, more than 200,000 million Americans currently ingest fluoride without having a choice – or even knowing they are consuming it.
How Did We Get Here?
There has been a lot of coverage in the past week on the newest fluoride study findings, as well as the pros and cons of the study design, methods, participant selection, and conclusions. With few people on either side of the debate changing their minds. Because, as we know, anyone who searches enough can find results supporting what they already believe, validly or not, on both sides of the issue. But before parents get too worked up about the results of this one study, there is a lot to know about fluoride and its essential, but scandalous role in public health. Particularly in the United States, Canada and Europe, where it is intentionally placed in public drinking water.
Fluoride was first introduced into the American water supply in 1945, when municipal workers in Michigan were instructed to dump powdered sodium fluoride into the waterworks tanks. From that moment on one of the greatest public health experiments ever undertaken was introduced in the city of Grand Rapids, Michigan.
At that time, trust in the federal government was high, with children and adults alike volunteering for dental appointments the year leading up to the experiment. The goal was to help prove the cavity-fighting power of fluoride once it was introduced into the system. And it did.
U.S. Public Health Services researchers found significant decreases in tooth decay among children within just a few years of its inception. The results were so positive, that the work was sped up and within a few years cities all over the country were following suit. By 1960 (just 15 years later) there were 41 million Americans drinking fluoridated water.
However, despite the rapid buy-in and medical community consensus, very few people actually knew what fluorides were, or what the negative effects could be from ingestion. Sadly, more than 70 years later, the same is still true. Therefore, every few years medical research asserts we should be for or against the use of fluoride – specifically in our public drinking water – and the debate begins all over again.
Fluorides are compounds that are usually combined with a metal. In most cases, sodium in metallic form. Fluoride exists naturally in soil, air and water, as well as almost all food eaten and common substances like toothpaste and mouth rinse. Fluoridated water is also the norm for American public water. Because it is natural and proven to make teeth stronger and more resistant to decay caused by acid and bacteria, there were – and are – many reasons to embrace the introduction of it to the masses. Further, since it exists naturally in most fresh and salt water sources, ingesting low concentrations are a natural part of our human interaction with water and food.
However, in areas where the fluoride content in water is greater than 0.6 parts per million, it is not recommended for use. Throughout medical literature there are (conflicting) results indicating too much can lead to a variety of cancers, diminished IQ, birth defects, lower birth rates and heart disease. For example, in Tanzania water contains dangerously high levels of fluoride and poses a great public health risk. Further, despite experts determining an “optimal” amount of fluoride to be digested via water, variation exists across the entire world – both in water supplies and in regularly consumed foods and beverages.
This is what makes fluoride, like so many public health issues, difficult to understand and impossible to test in a randomized clinical control trial. So while the results of this newest study were shocking to those unfamiliar with the issue, they are not groundbreaking in the larger body of literature studying fluoride in our overall diets. And, the results – just like every other public health issue – are highly sensitive to numerous confounding factors.
What the publication itself means for the ongoing debate however, is important. It’s entry into the public arena ultimately indicates that there is still a great need to understand the impact that fluoride has on the human body – particularly during development no matter where it comes from. It also signals that the science community sees the importance of transparency and public debate. And this is good news. Open and honest discussion not only holds researchers more accountable for the quality of their work, but also helps keep the public informed of ever-changing information.
What this publication does not signal is that parents have a strong reason to panic. There is ample motivation to get informed, be more aware, and to seek additional information with an open mind – as well as a healthy bit of skepticism. Just because we have a new data point in the public health arena doesn’t mean the way things are is wrong. But it does suggest that we don’t have it 100% right. The best thing we can all do is be sure that we’re seeking out quality information, and that we’re doing everything in our power – including, perhaps, consuming less fluoride – until we know more.