The Bottom Line

If you are reading this page you probably have heard or read claims from Fluoridation Opponents (FOs) that the fluoride ion is a deadly poison that causes a wide range of adverse health effects, and it is ineffective at preventing dental decay (caries).  You may have been convinced that Community Water Fluoridation (CWF) is irresponsible, ineffective, harmful to health and should be discontinued immediately, or preferably never implemented in the first place.  These opinions can be extremely passionate, the evidence can seem persuasive, and you might be wondering how those individuals responsible for recommending and implementing fluoridation programs can be so uncaring, ignorant, uninformed and incompetent to even consider fluoridation - if the allegations of fluoridation opponents are true.

You have no doubt also heard or read claims from Fluoridation Proponents (FPs) that exposure to the fluoride ion at optimal levels (around 0.7 parts per million) in drinking water is a safe and effective method of protecting a community against dental caries (decay) and associated health problems.

What is the truth in this confusing web of claims, counter claims and accusations, and how can you decide which position to believe? 

As a scientist and an educator, my primary goal is to help you understand the complexities of the fluoridation controversy and explain why I continue to support CWF after fifteen years studying the subject.

Investigating this topic will be an educational journey to: explore the available evidence and appreciate how science works;  learn how emotions and biases can hijack the process; understand why scientists can never guarantee complete freedom from all risk; and discover how to accurately, unemotionally and fairly evaluate the available evidence on the safety and effectiveness of drinking water fluoridation - and hopefully learn how to evaluate different positions in other controversial scientific topics as well.

Critical Thinking is a process of evaluating information and evidence about any topic so you can determine whether or not it is valid and accurate and make informed decisions about what choices to make.  A summary of Critical Thinking (no Java)

If the evidence actually demonstrated that exposure to the fluoride ion in drinking water at 0.7 ppm was, in fact, a deadly poison that has a significant risk of ruining teeth, lowering IQ and causing a range of other adverse health effects including hypothyroidism, weakened bones, arthritis, osteosarcoma, bladder and lung cancer, dementia, diabetes, kidney disease, reduced fertility, skin eruptions, gastrointestinal problems, hyperactivity and/or lethargy, headaches, kidney issues, chronic fatigue, disrupted immune system and weakness, then it would indeed be unconscionable to support fluoridation. 

So, on that note, let the journey begin to understand why I and many thousands of others continue to support CWF.  If you have been persuaded that fluoridation is a dangerous, unethical practice, I request that you suspend your current beliefs while you read my commentary - you can always pick them up again when you leave.

Fluoridation of drinking water at approximately 0.7 to 1.0 part per million is believed by most members of the scientific, dental, governmental, medical and water treatment communities to be effective at reducing the rate of dental caries (decay) in a treated population and safe for the general public.  Fluoridation References - I admit I have selected resources specifically to counter the claim that there is no reliable evidence to support the scientific consensus that fluoridation is a process that is both safe and effective.  The risks that have been identified are not ignored by the scientific, dental and medical communities, but overall, most individuals who are responsible for public health believe the majority of evidence demonstrates the benefits of fluoridating water are far greater than the risks.
There is a relatively small, but passionate, group of individuals who hold the opposite belief, that drinking water fluoridation at any level is neither safe nor effective; instead, it contributes to a significant number of severe health problems.  Many in this camp also consider fluoridation to be a form of unethical mass medication.
There are two ways to decide which viewpoint to believe (this applies to other science-based controversial topics besides fluoridation). You can either:
  Carefully examine and evaluate all the primary research and available evidence that supports each side for yourself and draw your own evidence-based conclusion -- this is a complicated and time consuming process and requires a significant level of scientific training and expertise in the topic to analyze the quality and relevance of the evidence that is available and determine its validity.
or you must
  Accept the beliefs and conclusions of one side or the other as true and authoritative based on what representatives of the position tell you is true.  Implicit is your belief that all available evidence (pro and con) has been fairly, impartially and accurately evaluated and presented to you and that the majority of available evidence actually supports the position you choose to accept.
Read Einstein's quote at the top of this page.  Consider the ideas below if you are not a subject matter expert and must rely on the interpretation and presentation of evidence by others (who you accept as experts and authorities) to form or justify a position in which you believe.
- You are, by default, accepting the expertise, beliefs, biases and interpretation of evidence by others as True and Authoritative.  Carefully consider these questions:
- Are they legitimate Authorities? 
- How do you know they are legitimate?
- Is the evidence presented and interpreted in a fair and impartial manner - how do you know?
- Is your acceptance of their Authority based on your biases?
- Is the Authority's position dictated by their biases?
- Be skeptical of any position where only 'scientific' evidence that supports one viewpoint as the Truth is presented.  Science almost never provides black and white conclusions and answers, particularly for a complex topic like fluoridation.  If evidence for only one perspective (black or white) is presented and the 'grey' tones are missing, you are almost certainly not getting the entire picture.  An example would be, "Fluoride is a dangerous poison and should never be put in our drinking water", vs. "The fluoride ion can cause health problems at high levels, but the benefits to dental health of optimally fluoridating water outweigh the small, known risks of low-level fluoride exposure."
- Be skeptical of any position that supporters claim is validated by scientific evidence yet they rely on popular media to promote and justify their agenda. Scientific progress and the acceptance of theories are not determined by media coverage or popular opinion. Groups that are unable to convince the majority of scientists that their theories are valid often try to take their message directly to the public by soliciting media coverage. A group that must depend on sensational headlines and fear to grab media attention and promote their position may not have good science to back up their beliefs.
- When nearly all experts in a particular scientific discipline accept a particular theory as true why believe a small minority of individuals that has come to a completely different conclusion?
- Keep Einstein's quote about the consequences uncritical acceptance of authority in mind as you review this information.  "Unthinking respect for authority is the greatest enemy of truth."
Description of the tab content:
  • Introduction - What is the most effective way to understand the fluoridation controversy.
  • Battle Lines - A comparison of the mutually exclusive claims of fluoridation supporters and opponents.
  • Bias & Evidence - How do a person's political, spiritual and moral beliefs influence the interpretation of evidence?
  • Science & Ethics - It is my contention that there are really two independent issues in the fluoridation controversy that should be discussed and resolved independently - but they seldom are.
  • My Conclusions - Six primary reasons why, after more than fifteen years of study, I continue to support drinking water fluoridation programs.
  • Tactics - Antifluoridation tactics that I do not agree with.

Introduction

First, read the three seemingly unrelated questions below and ponder them as you continue through the rest of this discussion:
1 Which political party has the best, most accurate understanding of economics and the best, most effective plan for economic stimulation, Republicans or Democrats? 
How do you know?
2 Which religious denomination has the best, most accurate understanding of God and the scriptures, Catholics or Baptists? 
How do you know?
3 Are water boarding and other forms of 'aggressive questioning' immoral, ineffective and never justified or are the techniques ethical, effective enough and justified in certain situations in which one life (or thousands of innocent lives) may depend on gaining critical information quickly? 
How do you know?

Think about your answers to the questions above (I'll get back to them later) as you consider these basic, mutually exclusive claims of supporters and opponents of drinking water fluoridation:
- Drinking water fluoridation is moral, safe, cost effective and beneficial and should be continued.
versus
- Drinking water fluoridation is unethical, dangerous, not cost effective and ineffective and should be discontinued.

If you already believe one of these positions is true, reflect on your beliefs as you continue to read this discussion, and consider the following questions:

There is not a more contentious issue in the discussion of drinking water contaminants and treatment methods than municipal water fluoridation.

The "contention" however, comes from a relatively small contingent of anti-fluoridation activists who are able to rally support to prevent or discontinue drinking water fluoridation programs by convincing community leaders and citizens that water fluoridation is not only ineffective and expensive, but it will significantly increases the risk of contracting a variety of severe health problems.

Books have been published that condemn drinking water fluoridation and implicate corporate greed and government conspiracy (or at least complacency) in the process.  Anti-fluoride websites: list published papers that "prove" fluoridation is ineffective and harmful; print testimonials of important individuals who are against fluoridation; and post grotesque pictures of teeth ruined by dental fluorosis and bodies contorted by skeletal fluorosis to drive the point home.  The sites are often impressive - and alarming to those who visit them looking for information about fluoridation.

This discussion is a follow-up to the extensive list of fluoridation references I researched and published in 2011 in response to claims by some website visitors that there was NO evidence to support the effectiveness or safety of water fluoridation.

My discussion below will probably have no effect on those who already hold strong beliefs on the subject - besides angering some.  I hope it will help others who are still trying to understand the controversy and formulating their own beliefs.  Fluoridation is one of the better examples of how difficult it is to examine, evaluate and discuss the scientific evidence for a controversial scientific topic - particularly when a specific belief is influenced by strong moral biases.

There have been two antagonistic, mutually exclusive camps, the Fluoridation Proponents ((FPs) and Fluoridation Opponents (FOs), since the initiation of community fluoridation in the United States in 1945.

Anyone uninitiated in the details of the fluoridation debate who begins to examine arguments of the opposing sides will quickly feel as though they have followed Alice down the rabbit hole into a universe where the antagonists each depict a completely different view of 'reality'.

All is Vanity by Allan GilbertIt is important to understand when reading the beliefs in the Battle Lines section that both groups have access to exactly the same body of evidence described in thousands of published studies on the health benefits, risks and costs of fluoridation (as well as basic experiments on the effects of exposure to the fluoride ion) from over seventy years of research and observations on humans and other animals.

There is no cache of secret documents that provides different or better evidence to one group or the other - yet the beliefs and conclusions based on the this evidence are completely different and, for the most part, mutually exclusive. The best symbol of this conundrum was suggested by my wife, Carol, who mentioned that Allan Gilbert's 1892 painting, All is Vanity, (shown to the right) perfectly illustrates how the same evidence can be used to support opposing beliefs. Which of the image interpretations depicts your view of drinking water fluoridation?

Battle Lines

  Fluoridation Proponents (FPs) Believe Fluoridation Opponents (FOs) Believe
1 Effectiveness: Most scientific evidence demonstrates that fluoridation is effective in reducing tooth decay.  Originally it was believed that ingestion of ¤fluoride ions (F-) protected teeth, but more recent studies suggest that most (though not all) of the protection is from external exposure - killing cavity-causing bacteria in the mouth and aiding the remineralization of eroded enamel.  Recent studies show the decreased difference in dental caries rates between fluoridated and non-fluoridated regions is due to better dental care in the last 60 years and wider availability of the fluoride ion from sources other than municipal drinking water - use of fluoridated toothpaste, food, other beverages and dental treatments. Effectiveness: Scientific evidence actually demonstrates that fluoridation is much less effective in reducing tooth decay than FPs claim.  Early estimates of a 60% reduction in dental caries were wildly exaggerated.  Differences in dental caries rates between fluoridated and non-fluoridated regions today are modest, at best.
2 Safety: Nearly all available scientific evidence demonstrates that fluoridation is safe at recommended levels of about 1 part per million (ppm).  Some individuals will develop mild dental fluorosis with regular exposure to drinking water containing 2 ppm of the fluoride ion, and more extensive and severe dental fluorosis can be expected as levels increase.  People with kidney disease or who regularly drink a gallon or more of water a day may need to limit their intake of fluoride.  Evidence compiled over 60 years that other health problems are caused by long term exposure to the fluoride ion at recommended levels is still not compelling to most individuals in the scientific, dental, medical, government regulatory and public water treatment communities.  Much of the evidence presented by fluoride opponents is either irrelevant to the topic or is low quality research that can't survive the peer review process required for publication.   Safety: Evidence that fluoridation is dangerous to health, even at low doses over years of exposure, has been systematically ignored and suppressed by the dental, scientific and medical communities.  In fact, long term exposure to water fluoridated at 1 ppm is liable to cause: adverse effects on the male reproductive system, IQ deficits, behavioral problems, cancer, impairment of learning and memory, allergic/hypersensitive reactions,  impaired pineal gland function (causing early onset puberty, postmenopausal osteoporosis, psychiatric disease and negatively impacting calcium metabolism and parathyroid function), impaired thyroid gland function (causing obesity, lethargy, depression, and heart disease),  interference with many important biological processes and vital cellular constituents (including enzymes and G-proteins), skeletal fluorosis, renal osteodystrophy (in those with kidney disease), bone fracture in children, increased hip fracture in the elderly, bone cancer (osteosarcoma), bladder cancer, and damage to gastric mucosa. http://www.fluoridealert.org/health/
3 Proponents: Most dentists, scientists, medical practitioners, government regulators and water treatment professionals who are involved in the practice of (or research into) drinking water fluoridation, support the practice. Opponents: Professionals Statement - as of June, 2011 over 3,700 science and medical professionals had signed FAN's petition to end fluoridation. November 2012 update -- 4,293 signatures.  That includes 538 MDs (~ 0.08% of total), 343 dentists (~ 0.18% of total) and 502 PhDs (perhaps 0.008% - 0.02% of total).  April 2014 update -- 4,642 signatures.  March 2015 update -- 4,693 signatures.
4 Ethics: The fluoride ion occurs naturally in water supplies around the world, and adding it to municipal water at optimal levels is a reasonable, inexpensive way to ensure that all members of the community have some protection from dental caries (cavities) and health issues that result from chronic dental problems.  Fluoride levels are adjusted so most people in a community will receive an optimal dose.  The underprivileged benefit the most because they may not have the resources or education to take advantage of voluntary fluoride treatments. Ethics: Artificially adding the fluoride ion to municipal water without the consent of all those who drink the water is an ethically unjustified form of medical treatment.  The dose individuals receive is completely unregulated and there is no way to opt out of the treatment.  Since fluoridation causes health risks, people should be allowed to make their own decisions about fluoride treatment the same way they make decisions about taking a pain killer for a sore back.  The underprivileged suffer the most because they can't afford home treatment methods to reduce fluoride ions.
5 Risk/Benefit: The benefits of municipal water fluoridation for community health outweigh the small risks of significant dental fluorosis in communities with optimally fluoridated water and the yet unproven (after 60+ years) risks of other possible health problems. Risk/Benefit: The health risks of municipal water fluoridation for community health far outweigh the miniscule (if any) benefits of reduced tooth decay.  Since there are now many sources of the fluoride ion besides drinking water, more people are exposed to higher than recommended levels with accompanying greater health risk.
6 Cost Effectiveness: All residents of a community can enjoy community water fluoridation's protective benefits simply either by drinking fluoridated water or by consuming foods and beverages prepared with fluoridated water.  A person's income level or ability to receive routine dental care is not a barrier to receiving its health benefits.  The average cost for a community to fluoridate its water is estimated to range from approximately $0.50 a year per person in large communities to approximately $3.00 a year per person in small communities.  For most cities, every $1 invested in water fluoridation saves $38 in dental treatment costs. Cost Effectiveness: Fluoridation cannot be cost-effective since it does not prevent tooth decay.  Fluoridation is also a financial hazard to the electronics industry who rely on pure water.  Lucent Microelectronics states it will probably cost them $5,000,000 to remove fluoride from the water they buy from the city.
7 Source of Fluoride Ions: The fluoride ion has the same action in the water distribution system and the human body regardless of whether the fluoride ion is naturally occurring or sodium fluoride, fluosilicic acid or sodium fluorosilicate is added to the water.  The fact that fluoridation chemicals can be byproducts of another industry does not automatically disqualify them as safe and useful products.  Contaminant levels in the fluoridation chemicals are closely monitored and regulated. Source of Fluoride Ions: Chemicals used for fluoridation are often unnatural, toxic waste products from the fertilizer industry that can't be easily disposed of on land or sea.  Instead, Industry conveniently gets rid of these hazardous waste products by selling them to municipalities for addition to drinking water.  These noxious waste products are not pharmaceutical grade, not approved by the FDA, contain other harmful contaminants, increase the ability of water to dissolve lead from pipes and react differently in the body from natural forms like sodium fluoride.   
8 Evidence: As noted elsewhere, the scientific evidence available on the health effects, effectiveness, safety, costs and risks of drinking water fluoridation that's available to both parties in the fluoridation controversy is identical.  However, when you study literature from individuals and organizations representing the FPs and the FOs you will quickly notice that the available evidence is not selected nor used in the same manner by the opposing sides. 

The traditional use of scientific literature to support a position or to explain opposing hypotheses is to present ONLY the relevant studies, and where there are differences, discuss specifically why one set of evidence is more reliable than the other for a specific topic.  That practice makes it relatively straight forward to evaluate the evidence (although it still requires expertise in a subject to actually evaluate the quality and relevance of any given study).  As I discuss elsewhere on this page, the FOs tend to provide a subset of the available evidence that shows the harm of fluoride exposure at any level as an argument to stop fluoridation all together.

This is a list of References I compiled that summarize the evidence that water fluoridation is a safe and effective method of community water treatment.  Several FO sites with plenty of references:
   Fluoride Action Network - http://fluoridealert.org/
   The Fluoride Debate - http://fluoridedebate.com/
¤ Fluoride (F) is the name of the negative ion of the element fluorine.  The fluoride ion does not exist by itself in nature; it is always combined with other elements.  Fluoride is typically added to water in the form of a fluoride compound in which fluorine is bonded to one or more inorganic positive ions, typically sodium (sodium fluoride - NaF), hydrogen and silicon (fluorosilicic acid - H2SiF6) or sodium and silicon (sodium fluorosilicate - Na2SiF6).  When any of these compounds are added to water, the atoms separate and are dispersed in the water.  As the fluorine atom separate, however, they grab an extra electron from the other atom(s) leaving them with a negative charge.  Fluoride is frequently used as shorthand descriptor for the fluoride ion.

The Bias & Evidence section will explore how the same body of available evidence can be used to support such contradictory and mutually exclusive positions.

Political, Spiritual & Moral Biases: Science and the Interpretation of Evidence

So, how can such contradictory positions described in the Battle Lines section be supported by exactly the same body of evidence?  I direct your attention to my questions at the beginning of this discussion:

  1. Political:  Which political party has the most accurate understanding of economics and the best, most effective plan for economic stimulation - how do you know?  If you happen to be a Republican you will answer, Republican - if a Democrat, the answer will obviously be Democratic.  If you are of another political persuasion the answer would likely be 'neither - my way is correct', or perhaps, 'both parties have some valid points'.  The evidence for the current economic situation and the effects of past efforts to stimulate the economy that's available to people of all political persuasions is essentially identical - with some dedicated digging.

    It is possible to collect new evidence (experimental and observational) on how different economic approaches and policies have impacted the economy.  Unfortunately though, each step of the process; The choice to ask specific questions, the decision to collect specific evidence (and ignore other data), the methods of evidence collection, analysis of the evidence and any conclusions about what the evidence actually demonstrates all can be biased and the results interpreted completely differently by people with different pre-existing political beliefs.  It is ultimately impossible, though, to use the methods of science to answer the question "which political system is BEST" because there is no universal agreement on what would constitute the BEST (and most effective) political system.  The bottom line: You know what is political truth based on your beliefs.
  2. Spiritual:  Which religious denomination has the best, most accurate understanding of God and the scriptures, Catholics or Baptists - how do you know?  Consider the evidence Catholics and Baptists (or any other religious group) have available to support their positions.  All first-hand evidence for the Christian faith is at least 2,000 years old.  There is, of course, considerable debate on how that evidence is to be evaluated, but ultimately, interpretation is based entirely on a person's underlying belief system and biases.  And, of course, there are a substantial number of other religious/spiritual/non-spiritual beliefs in which potential 'supporting evidence' is evaluated according to those beliefs.  It is fundamentally impossible to use the methods of science to answer the spiritual question, "which religious denomination (or belief system) has the best, most accurate understanding of God?" - or, for that matter, "does a god or spiritual realm even exist?".  The bottom line: You know what is spiritual truth based on your beliefs.

  3. Moral:  Is 'aggressive questioning' (a.k.a. torture) justified in any circumstance (to potentially save a single innocent life - or perhaps to stop a plot intended detonate a nuclear bomb in a large city where your family lives) - how do you know?  This is ultimately a moral question for which no scientific evidence can be provided to prove either position is ethically justified.  Evidence can be (and has been) collected and presented to suggest that the practice is/isn't effective in various situations.  Like politically driven evidence, however, the questions that are asked and all phases of data collection, analysis, presentation and interpretation are judgment calls and will be influenced by (possibly entirely controlled by) underlying moral and ethical beliefs for which science can't provide answers.

    There are many other human issues; abortion, contraception, capital punishment, gay rights, euthanasia, slavery, etc., where scientific observation and evidence can be collected to demonstrate consequences of actions based on a particular moral belief, however, it is impossible to use the methods of science to define or prove what constitutes a moral absolute.  The bottom line: You know what is moral truth based on your beliefs.

In the above scenarios the complete body of evidence obtained by observation or experiment could be presented to everyone on all sides of an issue, and most individuals would pick, choose, and interpret the information in a way that would support their beliefs and biases.

Think about your answers to the three questions above and consider some of your own beliefs.  What new observational or experimental evidence would cause you to change your fundamental political, spiritual, or moral beliefs? 

More importantly, because your political, spiritual and moral persuasions are based entirely on your beliefs and convictions, there is no scientific experiment or set of observations that can be designed to prove that your political persuasion, your spiritual faith or your particular moral compass are true or false - they are not even positions that can be classified as true or false, they are your beliefs.  The processes of science can be used to collect reliable evidence about a subject, but the interpretation of that evidence can be a judgment call based on powerful beliefs.

The point is, that in some circumstances, the available scientific evidence has very little influence on someone who already holds strong, specific beliefs. They will seek out (and believe as true) evidence that confirms their beliefs and not pursue evidence that opposes their beliefs (Confirmation Bias). If they encounter contrary evidence, the tendency will be to ignore it or dismiss it as false - unless, of course, some completely unavoidable 'reality-shifting' event or new, incontrovertible evidence forces a change of belief.

Please note, the examples above are only illustrations of how strongly held beliefs and agendas can trump any available scientific evidence. I do not mean to imply that I believe the fluoridation controversy is equivalent to political debates, where there is a more or less equal distribution of evidence and supporters on each side, or to religious beliefs, where it is not possible to obtain scientific supporting evidence, or that fluoridation is as serious a moral/ethical issue as torture, abortion, contraception and the other situations noted above.

From what I have experienced, though, aspects of the fluoridation controversy do seem to have their roots in the moral/ethical - even political - categories described above, where evidence can be of secondary importance to a strongly held belief, as I will discuss below.

I know that I find it difficult to even consider the possibility that a new idea is valid if it conflicts with one of my strong pre-existing beliefs.  I try to be aware of my biases, however, and I try to evaluate new ideas and evidence fairly and as impartially as I can.

Michael Shermer states, in a 2011 Scientific American article: (http://www.michaelshermer.com/2011/07/the-believing-brain/), "We form our beliefs for a variety of subjective, emotional and psychological reasons in the context of environments created by family, friends, colleagues, culture and society at large. After forming our beliefs, we then defend, justify and rationalize them with a host of intellectual reasons, cogent arguments and rational explanations. Beliefs come first; explanations for beliefs follow. In my new book, The Believing Brain (Holt, 2011), I call this process, wherein our perceptions about reality are dependent on the beliefs that we hold about it, belief-dependent realism. Reality exists independent of human minds, but our understanding of it depends on the beliefs we hold at any given time.  Once we form beliefs and make commitments to them, we maintain and reinforce them through a number of powerful cognitive biases that distort our percepts to fit belief concepts."

Shermer then describes five types of bias he believes everyone uses to filter and evaluate any new information: Anchoring Biases (relying too heavily on one reference anchor or piece of information when making decisions); Authority Bias (valuing the opinions of an authority, especially in the evaluation of something we know little about); Belief Bias (evaluating the strength of an argument based on the believability of its conclusion); Confirmation Bias (seeking and finding confirming evidence in support of already existing beliefs and ignoring or reinterpreting disconfirming evidence); In-group Bias (in which we place more value on the beliefs of those whom we perceive to be fellow members of our group and less on the beliefs of those from different groups).

Science and Ethics: Two Primary Issues in the Fluoridation Controversy

It is my contention that there are really two independent issues in the fluoridation controversy that should be discussed and resolved independently - but they seldom are:

  1. The safety, effectiveness, costs and risks of drinking water fluoridation programs - and any proposed alternatives.
  2. The rights of the individual vs. the obligation of the government to provide rules and/or services that affect the entire population, regardless of what an individual in the community might choose, based on the prevailing interpretation of risks, benefits and costs.

When these two components of the controversy are untangled, an important difference should be apparent.

The first issue is scientific and evidence-based.  Scientists can design (and have designed for decades) experimental and observational studies to measure and analyze the safety, effectiveness, costs and objective risks of fluoridation.  Not everyone might agree on the quality or published results of those studies, but at least real data (available to everyone) can be accumulated and debated to support a position.

The second issue is ethical.  Our individual beliefs about what is right and wrong are based entirely on our political, spiritual & moral values.  These fundamental beliefs in rights of the individual vs. governmental obligations cannot be tested or resolved by any form of scientific study.  There is no possible experimental, scientific study that can provide evidence about whether or not (or how aggressively) government should be involved (some would say interfere) with any human activity.

The basic situation, it seems to me as I have studied pro/anti fluoridation materials for the last decade, is as follows:

I believe the seemingly irreconcilable differences between the FOs and FPs is actually caused by those beliefs that have little to do with any hard evidence specifically related to drinking water fluoridation. I also believe that the only way that any discussion of the actual evidence regarding the safety, effectiveness, costs and risks of fluoridation can be accomplished is if the moral outrage of the FOs is disconnected from the science - and, of course, that the FPs fairly evaluate all valid evidence without letting their 70+ year investment in fluoridation bias their views.

So, if the fluoridation dispute actually does have its roots in an ideological conflict that is unlikely to be resolved by examination and interpretation of the available evidence (or the results of additional studies), how can those who don't already have strong views on the topic of fluoridation, or who are new to the dispute, figure out what to believe?

Is there anything to help decide whether one of these positions is more 'true' or valid than the other?

I am quite aware that there is a very small difference between fluoride levels in drinking water, historically around 1.0 part per million (ppm), that are presumed to be safe and effective and levels that have been demonstrated to produce significant levels of dental fluorosis in the population (greater than about 4.0 ppm).  That's not much 'wiggle room'. Fluoridation also seems to be a victim of its success - there are far more sources of the fluoride ion available today than in the 1940s (fluoride toothpaste, fluoride in the food, fluoride washes and varnishes, etc. were not available then), so people's exposure is often greater today.  And what about the alleged harm to systems throughout the body from drinking fluoridated water for a lifetime - am I not understanding some critical piece of evidence?  I don't think so...

Before I explain the reasons I have not embraced the anti-fluoridation position I will provide some background on normal exposure to the fluoride ion (F-).  As noted elsewhere, for most substances we eat, drink, breathe, or absorb through the skin, it is the dose (the amount actually absorbed into the body over time) that determines whether it is beneficial, harmful or neutral to our short or long term health.

How much of the fluoride ion might an average person be expected to receive from drinking water fluoridated at current optimal levels of 0.7 ppm - that is equal to 0.7 milligram (mg) of the fluoride ion per liter of water? If a person were to drink a gallon and a half of water per day they would consume about 4 mg of the fluoride ion - and perhaps another milligram or two from other sources.

Age and size also influences how a person will respond to a given dose - and will determine how much water they will probably drink - a 200 pound adult will drink more than a 10 - 50 pound child.  So in studies you will frequently see exposure to a substance described as the amount per kilogram (Kg) of body weight. A 100 pound (45.5 Kg) individual who drinks 1.5 gallons of optimally fluoridated water every day (and received another 2 mg elsewhere) would receive a dose of 0.169 mg of F- per Kg of weight per day. A person weighing 200 pounds (91 KG) would receive a dose of 0.084 mg of F- per Kg of weight per day drinking 1.5 gallons.  A 50 pound child, for example, might be expected to drink half a gallon of water per day (and perhaps absorb another milligram of F- from other sources) and thus receive a dose of 0.127 mg F- per KG body weight per day.  A range of from about 0.08 to 0.17 mg F- per KG body weight, then, would probably cover most people's exposure who drink optimally fluoridated water.

Remember these exposure ranges when examining research papers that are used to support conclusions about safety, effectiveness and risk of exposure to the fluoride ion. 

Personal Choice

The intent of this argument is not to cause any fear or get people worried about the safety of chlorination, but I believe it is important to clearly illustrate the fact that every decision comes with risks, benefits and costs that must be carefully evaluated by those who make the decisions for the community wellbeing.  It is up to those in charge of making the decisions to completely, carefully and accurately examine all relevant evidence and to not be swayed by unsubstantiated fear-mongering.

Why are fluoridation opponents only concerned about personal choice when it comes to fluoridation?  Their arguments apply equally well to the well-established practice of chlorination or other disinfectant processes.  If their arguments against fluoridation are legitimate, then for exactly the same reasons described below, chlorination should be halted and everyone should be given the personal choice to chlorinate (or otherwise disinfect) their own water.  Fortunately, the fear-evoking claims against fluoridation are not legitimate and are not supported by the vast majority of scientific evidence or endorsed by the medical, dental or scientific communities.

Facts: 

  1. Chlorination vs. fluoridation
    1. There is no water treatment process that will have no risks to anyone, anywhere under any circumstances.  Just delivering treated water through miles of pipes introduces risks.  The purpose of water treatment and distribution is to use processes that are demonstrated to provide the most benefits to the most people while minimizing risks to anyone. 
    2. The only way all risks of community water treatment could be eliminated would be to stop it entirely and make everyone responsible for their own water purification – which, of course, would introduce another set of risks to the community. 
    3. Fluoridation opponents are too focused on their passionate mission of demonizing the fluoride ion to realize that all their arguments against fluoridation are equally valid against chlorination and other disinfection processes.
      The same arguments below that show the similarity of chlorination for fluoridation can be used for other disinfection treatments.
  2. Toxicity of water treatment additive
    1. Chlorination involves the addition of chlorine gas or the hypochlorite ion to water – both additives are toxic at sufficiently high levels.
    2. Fluoridation involved the addition of the fluoride ion, typically as fluorosilicic acid, sodium fluorosilicate or sodium fluoride.  All compounds used quickly dissociate into free fluoride ions.  All additives are toxic at sufficiently high levels.
  3. Benefits
    1. Chlorine is added to drinking water at appropriate levels to provide proven health benefits to the majority of community members.
    2. Fluoride ions are added to drinking water at appropriate levels to provide proven health benefits to the majority of community members.
  4. Choice
    1. Chlorination of community drinking water is not a personal choice – if regulators decide disinfection is needed, the entire community that drinks the water is affected unless individuals choose to treat their own water or find other sources.
    2. When experts examine the evidence and decide fluoridation of community drinking water is beneficial, it is not a personal choice – the entire community will drink fluoridated water unless they choose to treat their own water or find other sources.
  5. Naturally found in water
    1. Chlorination and other disinfection processes involve the addition of chemicals to treat water that are not normally present in source water.
    2. fluoridation adds a small amount of the fluoride ion, a naturally occurring element in source water, to treat water.
  6. Disinfection Byproducts
    1. Chlorination and other disinfection processes usually create a ‘witches brew’ of toxic disinfection byproducts – to use terminology of fluoridation opponents.  Regulations ensure that levels of disinfection byproducts are below harmful (to most people) levels.
    2. Fluoridation does not create additional contaminants in the treated water, although trace amounts of other contaminants may be present in fluoride additives.  Regulations ensure that any other contaminants are far below allowable or harmful levels.
  7. Risks
    1. Disinfection byproducts (at levels below maximum contaminant levels permitted in drinking water) may potentially cause health problems for a very small percentage of community members, but the benefits to the community far outweigh the known risks.
    2. Fluoridation at optimal levels may potentially cause health problems for a very small percentage of community members, but the benefits to the community far outweigh the known risks.  After more than 70 years of research the only established risk of continual exposure to more than five times the optimal levels of fluoride (~2ppm) is mild dental fluorosis in some individuals.
  8. Medicine
    1. The attempt to classify the fluoride ion as a medicine that is forced on an unwilling population is a ‘smoke and mirror’ strategy to create an artificial distinction in the public’s mind between the water treatment chemicals chlorine and fluorine, and such an arbitrary classification is meaningless.  Attempts by fluoridation opponents to have the fluoride ion legally classified as a medicine have failed, so they make up their own definitions.
    2. Chlorination does not involve adding a medicine to the drinking water.  Regardless of whether or not chlorine is classified as a medicine, a water treatment chemical,  or a chemical weapon used during WW1, chlorine and the byproducts produced by chlorination, are ingested into the body and absorbed.  Since benefits are shown by scientific evidence to be significantly greater than risks, an arbitrary classification does not matter. Chlorine and some of the disinfection byproducts are also released into the air when using chlorinated water, and they are inhaled and absorbed into the body.
    3. Fluoridation does not involve adding a medicine to the drinking water.  Regardless of whether or not the fluoride ion is classified as a medicine, a water treatment chemical,  or a rat poison, fluoride ions are ingested into the body and absorbed.  Since benefits are shown by scientific evidence to be significantly greater than risks, an arbitrary classification does not matter. The fluoride ion is not released into the air from fluoridated water. 
    4. The Facts:
      1) Bottled water is regulated by the US Food and Drug Administration.
      2) Bottled water can contain fluoride ions at or above the level found in optimally fluoridated water.
      3) Anyone, even a child, can walk into a store and purchase as many bottles of fluoridated water as they wish - without a prescription.
      4) There are no warnings about possible health effects from drinking too much fluoridated water - no warnings to call poison control and report fluoride poisoning if 15 bottles of water are consumed.
      5) Chlorine and disinfection products in bottled water are also regulated by the FDA.
      6) Fluoridated bottled water is not a drug - Fluoridated tap water is not a drug
  9. Options
    1. If a water customer does not like to ingest any chlorine or disinfection byproducts they are free to use a filter or distillation to remove the contaminants or choose another source.  They are not free to insist on removing the benefits to other members of the community.
    2. If a water customer does not like to ingest any the fluoride ion they are free to use a filter or distillation to remove the contaminant or choose another source.  They are not free to insist on removing the benefits to other members of the community.
  10.  Dose
    1.  Fluoridation opponents make it a point to emphasize that, because people drink different amounts of water, people can be exposed to different amounts of fluoride.  Obviously, the same argument means that those who drink more water are exposed to more disinfectants and their byproducts and other contaminants that might be in their water.  Fluoridation opponents don’t seem to understand that when setting the Maximum Contaminant Levels (MCL) for disinfectants, disinfection byproducts, the fluoride ion and other contaminants, they took into account the fact that people drink different amounts of water. From the EPA site, the MCL is defined as, “The highest level of a contaminant that EPA allows in drinking water. MCLs ensure that drinking water does not pose either a short-term or long-term health risk. EPA sets MCLs at levels that are economically and technologically feasible.”  For individuals to exceed established safe levels of fluoride, disinfection byproducts, or other contaminants that are harmful at high levels, they would need to continually drink so much water they would be more at risk of water intoxication than of experiencing significant risk of harm from contaminants.  If people are not comfortable with the EPA standards or if they drink significantly more water than normal, they are free to make other choices.
    2. The Maximum Residual Disinfectant Level (MRDL) for chlorine and chloramine = 4.0 mg/l.  The MCLs for the disinfection byproducts, bromate = 0.01 mg/l, chlorite = 1.0 mg/l, HAAS = 0.06 mg/l, TTHMs = 0.08 mg/l
    3. The MCL for the fluoride ion is 4.0 mg/l – over five times the optimal level.
    4. http://water.epa.gov/drink/contaminants/ http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?fr=165.110

Six primary reasons why, after more than a decade of study, I continue to support drinking water fluoridation programs

  1. Scientific beliefs and theories are based on the Hierarchy of Evidence, the Strength & Weight of Evidence and Scientific Consensus Not on Public Opinion:  Despite claims to the contrary by Fluoridation Opponents (FOs), nearly all the evidence and the scientific consensus support drinking water fluoridation as a safe, effective and economical process for helping to reduce the incidence of dental caries in the community and the secondary health problems that can be caused by tooth decay.  More...

  2. I trust the processes of science despite the annoying tendency of periodic theory modifications and reversals caused by the evolution of scientific knowledge and the fact that all research is conducted by foible-prone humans.  As new knowledge is gained, evaluated, and integrated it is inevitable that change in theories and resulting beliefs will occur.  As inconvenient as the process is, there are no alternatives to well conducted scientific observations and experimentation for gaining an accurate understanding of the world we inhabit.  The basic theories that support drinking water fluoridation have evolved, but they have not changed significantly in over 70 years of intense study and scrutiny.  More...

  3. I trust the integrity, education and competence of those involved with fluoridation studies, promotion, regulation and implementation who support the process:  I believe the scientific, medical, dental, governmental and water treatment professionals who are charged with studying water treatment processes, caring for patients, regulating water quality and providing safe and affordable drinking water to our homes are overwhelmingly competent, intelligent, informed, well intentioned and trustworthy - and are not part of conspiracies to dispose of toxic waste products in our drinking water or deliberately increase the number of children with dental fluorosis to provide more business for the dental profession as alleged by FOs.  If bias, mistakes or fraud do occur in scientific endeavors it is the processes of science and the integrity of the majority or scientists that eventually expose the problems.  More...

  4. Discussions about the political, moral, economic and ethical issues of fluoridation are separate from evaluation of scientific evidence for the effectiveness and safety of fluoridation:  FOs frequently define fluoridation as an unethical medical practice and then evaluate the evidence in that context rather than impartially assessing safety and effectiveness and then using that information to evaluate the benefits, risks and costs to the population of fluoridation.  More...

  5. My own observations and experiences do not support the claim that water fluoridation is harmful at levels typically experienced in drinking water:  The primary, immediate consequence (recognized by proponents and opponents of fluoridation alike) of children who ingest too much of the fluoride ion (the equivalent of continually drinking water containing more than about 2 - 4 mg/liter fluoride) is the development of noticeable dental fluorosis - mottling and staining of the teeth.  Look around you in any of the cities that practice responsible water fluoridation (0.7 - 1.0 ppm) or that have naturally, optimally fluoridated water - how many children and adults have noticeable dental fluorosis?  How likely is it then they have overdosed on fluoride?  More...

  6. I do not agree with the anti-science tactics used by FOs to promote their message:  Carefully examine the evidence presented by both sides.  Positions that are arrived at based on a scientific assessment of the evidence are not usually emotionally driven, and their proponents present an evaluation of all the evidence available, not just that which supports their beliefs.  On the other hand, FOs (possibly because they have been unsuccessful convincing the scientific, medical and dental communities of their strongly held beliefs) often resort to direct manipulation of the media and public opinion by deploying alarming and sensational headlines, providing emotional arguments and only disclosing 'evidence' that can be made to support their position (regardless of how irrelevant or poor quality) while ignoring or dismissing all contrary evidence. If the methods used to promote a message are not scientific or used fairly, how can one trust the message to be accurate?  It is my contention that FO propaganda and the way it is presented completely buries any legitimate concerns within the mass of irrelevant and misleading fear-mongering. 
    More...  (This topic is discussed in a separate tab.)

A detailed explanation of the reasons I maintain pro-fluoridation beliefs includes the following chains of reasoning:

  1. Scientific beliefs and theories are based on the Hierarchy of Evidence, the Strength & Weight of Evidence and Scientific Consensus Not Public Opinion:  It is important to realize that legitimate scientific theories almost never have unanimous support from all experiments that have ever been conducted in the field.  There will inevitably be some studies that produce evidence contrary to an accepted theory.  Consequently, there are processes within the scientific community to help determine which evidence is most believable and will contribute to the formulation of a consistent theory. 

    Ideally all available evidence on a given subject (effectiveness or safety of fluoridation, for example) is evaluated by others in the field for quality, the appropriate methodology, analysis and conclusions before publication in a recognized scientific or medical journal - this process is called Peer Review.  It is not a perfect process, and FOs will quickly describe all of its shortcomings (real and imagined), but it is the only process I am aware of that provides at least some quality control for helping evaluate the results of many thousands of research projects each year.  2015 update - over the last few years the number of journals has exploded.  Some of them provide some peer review, others publish any article an author (with or without credentials) pays for.  It is becoming more and more difficult and time consuming to evaluate the quality of studies and resulting evidence.  See inset below.

    There are three fundamental concepts to consider when evaluating whether a claim is scientifically valid or which of two competing theories (or conclusions) is judged more valid than the other.  These concepts apply regardless of whether the theories under consideration are completely outside the realm of traditional science (energized water, alien abductions, existence of telekinesis or other psychic powers, astrology etc.) or within the boundaries of mainstream science (gradual vs. punctuated evolution, benefits and risks of fluoridation, an expanding or contracting universe, etc.)

    • Interpreting & Evaluating Evidence:

      There are two related complications that someone who is not an expert in a given scientific field will encounter if they try to locate and interpret the actual research papers (and other primary information sources) that support or oppose a given scientific theory - for example, fluoridation is effective and beneficial vs. fluoridation is ineffective and harmful.

      First: How do you know whether a published research paper you read in a journal was well designed, conducted in a manner that minimized bias, analyzed accurately and is consequently a source of reliable evidence, or whether the experiment was deliberately and unscientifically manipulated to 'prove' a desired theory? 

      Probably a more important issue, however is, how can someone who don't have the experience and expertise to read and evaluate the actual research papers themselves know that the evidence they are presented to 'prove' a position is accurate, complete, unbiased and interpreted fairly.

      Second: How do you know the scientific journal (or other source) in which a research paper is published (on which you are relying on to provide accurate information) is reliable and maintains effective processes to review submitted papers and publish only those that have a high quality of design, methodology, analysis and interpretation?

      Again, the more important issue is probably how can someone without scientific experience and expertise know the published evidence they have been presented came from a legitimate scientific journal?
                              ---------------------------------
      1) Unfortunately, scientists are not immune to sloppiness, bias, greed, or self promotion.  Consequently, experiments have been designed, implemented, interpreted and even manipulated (consciously or unconsciously) to ensure results that confirm the theory the scientist wishes to prove. 

      This is not acceptable science, and it is unlikely to produce reliable or useful knowledge. These practices also provide fodder for those with anti-science agendas to argue that knowledge gained through the process of science is unreliable and mostly useless at best and dangerous at worst.  

      This type of rigged 'science' is also often embraced by those who wish to produce 'evidence' that only supports their beliefs or products. These individuals just pretend to be scientists so they can coat their beliefs and products with a veneer of legitimacy. So-called experiments can be designed very easily to produce any desired results - all with an imposing facade of science. 

      The bottom line is that science can be hijacked to produce evidence that appears legitimate on the surface but which, at the core, is flawed and self-serving. This reality seriously complicates the process of evaluating evidence in support of (or opposition to) a so-called evidence-based  theory, idea or process.

      So, how does a non-expert evaluate the validity of claims that are made based on alleged experimental evidence that may or may not be valid? 

      Historically, results of many poor quality, biased, deceptive experiments were very seldom published.  There were relatively few high-quality scientific journals, and they employed a strict peer review process to identify and reject research papers that were poor quality, biased &/or deceptive.

      Peer review is a process where a proposed paper is first submitted to several independent experts on the subject who review all aspects of the research - the basic premise, the study design, the methods of implementation, the data analysis, etc.

      They then determine whether the submission is reliable and should be published, revised before publication or rejected. Publication in a respected, peer reviewed (or refereed) journal has traditionally been a reasonable indication of reliable research and trustworthy conclusions.

      That is still true, but it is becoming increasingly difficult to identify journals that can be trusted to publish high quality, unbiased research that's actually and reliably peer reviewed.
                              ---------------------------------
      2) The rapid proliferation of new scientific journals (printed and online) is a fairly recent phenomenon that has significantly complicated the process of finding legitimate evidence in support of (or opposition to) so-called evidence-based  theories, ideas or processes.

      The problem is not so much the number of new journals but the varying quality of the journals.  In the largely unregulated world of the Internet, anyone can create an online journal to publish anything they wish - see the references below.

      Not too many years ago, experimental results published in a journal were likely to be peer reviewed and reasonably reliable. Today, however, someone who is interested in examining original research must have the experience and expertise to actually judge the trustworthiness of the journal in which the results are published as well as the quality of the individual experimental study used to generate the evidence.

      Anyone with an agenda to promote can easily find (or create and present) published 'proof' that supports their position, refutes their opponents' evidence and appears perfectly legitimate.
                              ---------------------------------
      Because of these complications evaluating evidence, most people who do not have the requisite scientific expertise or time to dig through and evaluate all the literature will probably believe the evidence presented by the group with a position that is most closely aligned with their beliefs.

      It is important to understand, though, that if you have not evaluated the evidence for yourself, you are trusting that those you have chosen to believe in are, in fact, experts who have honestly, accurately and fairly evaluated all the available evidence to reach their conclusions.

      References - Predatory and Open Source Journals:
      Anarchy and Commercialism, 2012: "Ulrichsweb Global Serials Directory lists over 141,000 academic and scholarly journals, of which 64,000 are peer-reviewed." "Though many of these periodicals are supposedly peer-reviewed, the standard is frequently low, and much weak research is accepted for publication."  "...a large number of "bottom feeders" are now starting "journals" with the sole goal of earning a quick profit and enriching their owners."

      The rate of growth in scientific publication..., 2011: "There are no indications that the growth rate [of publication in peer-reviewed journals] has decreased in the last 50 years. At the same time, publication using new channels, for example conference proceedings, open archives and home pages, is growing fast."

      Growth dynamics of scholarly and scientific journals: This article discusses the growth in un-refereed journals as early as 2001.

      We Must Stop the Avalanche of Low-Quality Research, 2010: "The amount of material one must read to conduct a reasonable review of a topic keeps growing. Younger scholars can't ignore any of it - they never know when a reviewer or an interviewer might have written something disregarded - and so they waste precious months reviewing a pool of articles that may lead nowhere."

      Then there was the Sasquatch Genome Project's five year DNA study that concluded in 2012.  According to rather amusing commentary on the web, the study was not accepted by any journal at that time, so allegedly author Dr. Ketchum purchased a journal, renamed it Denovo and proceeded to publish the paper.  As of March 2015 the journal contains one published paper.  A search will bring up links to more entertaining details.

      How to Identify a "Good" Scientific Journal

      Scientific Articles Accepted (Personal Checks, Too) - a 2013 New York Times article that stated, "But some researchers are now raising the alarm about what they see as the proliferation of online journals that will print seemingly anything for a fee. They warn that nonexperts doing online research will have trouble distinguishing credible research from junk. 'Most people don't know the journal universe,' Dr. Goodman said. 'They will not know from a journal's title if it is for real or not.'"

      Who's Afraid of Peer Review? by John Bohannon. A spoof paper concocted by Science reveals little or no scrutiny at many open-access journals (2013).

      Publishers withdraw more than 120 gibberish papers Conference proceedings removed from subscription databases after scientist reveals that they were computer-generated. There is a long history of journalists and researchers getting spoof papers accepted in conferences or by journals to reveal weaknesses in academic quality controls - from a fake paper published by physicist Alan Sokal of New York University in the journal Social Text in 1996, to a sting operation by US reporter John Bohannon published in Science in 2013, in which he got more than 150 open-access journals to accept a deliberately flawed study for publication.

      You can search on 'predatory scientific journals' to find lists of current journals to avoid.

    • Hierarchy of Evidence:  Not all scientific research designs and experimental or observational studies are created equal. Excellent quality, peer reviewed research that controls for bias and other possible sources of error contributes more to the Strength & Weight of Evidence and the Scientific Consensus than poor quality research distributed with no review process.  As noted in the sidebar, it is becoming more and more difficult for experts (never mind non-experts) to identify legitimate scientific journals - which makes the process of evaluation far more difficult, because one can't be sure anyone has actually reviewed a published paper in a low-quality journal.

    • Strength & Weight of Evidence:  According to Thomas F. Schrager, Ph.D., "Weight of Evidence is somewhat of a misnomer; more accurately it's the fit of evidence that is key rather than its weight. It is how pieces of evidence fit together, complement one another, create a picture larger than themselves that is the determinant, rather than the weight. Weight goes more to a proper interpretation of the quality of each piece of evidence. A high quality piece of evidence has the potential to add to a fit with other high quality data and/or to put into better context lower quality data."  More Information.  Schrager's definition also includes elements of the concept of Strength of Evidence, which can be defined as a subset of the totality of evidence  that includes only positive and statistically relevant &/or only unbiased evidence.

    • Scientific Consensus:  To paraphrase Schrager, the scientific community as a whole supports a specific theory and the body of supporting evidence, not as the result of a vote, but due to a long process of testing, retesting, considering, hypothesizing and observing results of experiments.

    Unlike mathematics where 1+1 will always = 2, the study of cause and effect relationships in nature is often messy.  Many components of a scientific observation or experiment can influence the outcome and conclusions drawn.  Depending on how a scientific experiment is designed, executed, and analyzed, even studies that examine the same phenomenon can come to very different conclusions. 

    That's why it's usually necessary for scientists in a given field to carefully examine all aspects of many experiments, determine the quality of each one, establish the validity of the conclusions, and figure out how each piece fits into the overall puzzle to establish a Consensus. 

    It is extremely easy to find research papers with conclusions that differ from the Scientific Consensus.  What is not easy, particularly for those who are not experts in a given field, is to examine individual papers and evaluate the reliability of the journal, the quality of the experimental design, bias controls, methodology, data collection processes, analysis, and interpretation of the results (read the discussion on the right). 

    Problems can (and do) occur at every step of the experimental process that can compromise the results and conclusions of a given study, and it seems to be easier and easier to publish studies of questionable scientific validity. 

    That is why it is crucial never to place too much faith in theories and positions supported by relatively few published papers, and why it is important not to simply dismiss the consensus of experts in the various fields because they have been denounced as mainstream, conformist scientists by those who hold passionate beliefs that are different from the mainstream consensus.

    Despite vigorous claims to the contrary by FOs, both the Strength & Weight of Evidence and the Consensus of the scientific, medical, dental, governmental, and water treatment communities are currently pro-fluoridation and have been since the 1940s. 

    One can evaluate fluoridation research against the hierarchy of evidence, count the papers that conclude fluoridation is safe and/or effective, follow the process by which a significant majority of evidence has been shown to support fluoridation, read pro-fluoride position and opinion papers from nearly all mainstream scientific, medical and dental organizations, and survey the medical and dental practitioners. 

    Among most who study fluoridation issues there is no 'Scientific Controversy or Debate' surrounding municipal water fluoridation - the process is safe and effective enough to support and promote. 

    Over 70 years of fluoride research has, however, produced some observational and experimental evidence that fluoridation might be ineffective or might pose health risks at low concentrations.  This evidence has been carefully evaluated by the scientific, medical, dental, governmental and water treatment professionals and weighed against the evidence that fluoridation is effective and safe. 

    No other water treatment processes has generated as much research.  So far, however, the contrary evidence has been insufficient to change the Consensus that drinking water fluoridation is safe and effective.

    Of course it is possible new evidence will be discovered to demonstrate convincingly that the current Consensus beliefs about fluoridation are wrong, but that has not yet happened.  The claims and evidence of the FOs have not changed much from those used in the 1950s. 

    As mentioned in the Placebo Based Health Merchandise discussion, it is always the responsibility of those who propose new or different claims (theories) about how the natural world behaves to provide convincing evidence that supports those claims.  Until the FOs provide sufficient quality evidence to support their claims, neither the Strength & Weight of Evidence nor the Consensus will change.

    Evidence has, in fact, demonstrated that people are exposed to more sources of the fluoride ion today than when fluoridation began.  Overall exposure has increased even in non-fluoridated communities resulting in a rise in the incidence of mild to moderate dental fluorosis.  This has prompted a recent recommendation by the US Department of Health and Human Services (HSS) to lower the optimal level of drinking water fluoridation to 0.7 ppm for most communities.
     

  2. I trust the Processes of Science:  Unfortunately the pronouncements of scientists and those who use the methods of science (medical doctors, dentists, governmental agencies, etc.) can seem arbitrary, confusing, complicated and contradictory at times.  Science is a process, not a fixed belief system with dogmatic proclamations - the fact that scientific theories can be presented as dogma by overzealous scientists does not help the cause. 

    As noted elsewhere, one of the most essential strengths of the scientific process is the ability to modify or reverse theories in response to new evidence.  That fundamental strength, however, is frequently portrayed as a fundamental flaw by FOs and others who have agendas contrary to the scientific process.

    A useful, though fairly trivial, example of changing scientific beliefs is whether eggs are healthy or whether they contribute to a higher risk of cardiovascular problems.  Eggs were a dietary staple until the 1960s when research began to link high cholesterol levels with heart disease.  Egg yolks contain significant amounts of cholesterol, and the medical community advised people to avoid eggs and egg products (or to not eat the yolks). 

    After thirty years of egg-cholesterol-fear, research in the late 1990s seemed to indicate that dietary (as in eggs) cholesterol did not contribute to either heart disease or stroke, except perhaps for diabetics, and eggs were in favor again.  After another twenty years of so of guilt free egg indulgences, a 2010 review article in the Canadian Journal of Cardiology concluded that, "The evidence presented in the current review suggests that the widespread perception among the public and health care professionals that dietary cholesterol is benign is misplaced, and that improved education is needed to correct this misconception."  Aaaaaarrrrrrg - What's a person to believe - how on earth can science be trusted?

    Worse than flipping positions, there have been instances where science initially got something horribly wrong.  Sometimes the problems included lack of proper trials and/or inaccurate evaluation of available evidence to determine risk.  This was the case with Thalidomide, an apparently safe and effective sedative prescribed to pregnant women in the late 1950s.  The drug eventually caused over 10,000 birth defects in 46 countries before the danger was widely recognized in 1961 and the product was recalled.  The refusal of FDA reviewer, Dr. Kelsey, in 1960 to approve the sale of Thalidomide without additional studies limited the number of birth defects in the US.

    A recent example of science-gone-wrong is Vioxx, a nonsteroidal anti-inflammatory drug developed by the pharmaceutical company, Merck, to treat osteoarthritis and acute pain.  The drug was given FDA approval in 1999 based on clinical trial results and withdrawn in September, 2004 amid allegations that the drug was linked to an increased risk of heart attacks and strokes and a possible cover-up of evidence that Vioxx use caused cardiovascular problems.  Depending on the source, there is still considerable disagreement on the extent of fault that can be assigned to Merck and the groups responsible for investigating its safety.

    These examples underscore six important truths about science based theories and practices.

    1. Science is constantly evolving:

      • Science is not a collection of static disciplines where physical laws are discovered, written in stone, then believed and taught as Gospel Truth forevermore.

      • Scientific knowledge builds on knowledge gained previously.  New experiments are designed by different individuals with different training, perspectives, ideas and tools - nature is approached differently and may provide different answers to the questions that are asked.

      • Science can only provide provisional truth and theories with no guarantee of their stability.  You can only count on theories to provide answers as long as most evidence continues to support them.

    2. Even high quality scientific experiments and observations on a given subject frequently produce evidence that can be interpreted several ways by experts, and that can lead to controversy within the scientific community.

    3. Research done in the name of (and using the processes of) science can produce incorrect and harmful results and interpretations.  This can be caused by anything from good research that investigates the wrong questions to poor experimental design, to incorrect interpretation of results to sloppy, incomplete or biased scientific studies to outright fraud.

    4. It is, however, the tools and processes of science that eventually identify and correct the errors and resolve controversies.  So, science is self correcting and has created our modern world with benefits undreamed of just several centuries ago.  As with any human endeavor, though, these benefits of modern civilization come with costs and risks.

    5. The greater the impact of new scientific theories, discoveries or products on society the greater is the scrutiny by others in the field and the greater the chance that self-correction processes will kick in if there are problems.  In the examples above, Thalidomide and Vioxx had severe negative impacts that triggered scientific review and recall of the products.

      There are many theories, discoveries and products, however, with relatively minimal impacts on society (or supporting evidence is difficult to obtain or interpret), where there is no clear scientific consensus, and popular beliefs drift back and forth over time - the egg-cholesterol debate seems to illustrates that situation.

      Thankfully there are many scientific theories that have a significant impact on society (and considerable evidence to support) them that do not ordinarily change over time even though they are subject to ongoing review and evaluation.

    6. It can often require time and effort to understand currently accepted theories - or the benefits, risks and costs that might be associated with them.  It is seldom sufficient to consult a single source and be assured that you can understand and fairly evaluate either the evidence or the consensus for a given theory.

    It is understandable that non-scientists might become upset, overwhelmed and impatient with theories and beliefs based on scientific inquiry.  They always want science to 'get it right'.  People want Truth, security and stability and the comfort of certainty in their beliefs.  Insecurity and complexity can be frightening.  Although many scientific theories are stable for long periods of time with minimal controversy, there is no guarantee that will always be the case. 

    It is no surprise then that those who promote non-standard health beliefs and treatments (and other beliefs contrary to traditional science) emphasize the fact that mainstream scientific theories and practices can change over time, and then highlight every mistake ever made in the name of science or any evidence that generates scientific controversy. 

    These individuals or groups then claim to be Scientific Authorities worthy of providing their own alternative theories.  Their theories are presented as TRUE, easy to understand and unchanging.  No inconvenient qualifications or messy, conflicting evidence are presented to confuse the issue.  So, if you just take the word of these 'experts', there is no need to understand or evaluate any troublesome scientific theories or processes or worry that their Truth might change based on new evidence.

    FOs exemplify this practice.  Their literature suggests that any changes in theory, any evidence of poorly conducted research or any disagreements over interpretation of evidence during 65 years of study proves fluoridation is not based on valid scientific evidence.  Evidence is then presented that the fluoride ion is a harmful medication and fluoridation is ineffective and unsafe - conveniently no conflicting evidence is offered to complicate the decision making process.  Obviously, then, according to FOs, no moral, honest, right thinking person could possibly fail to conclude that fluoridation is a worthless, dangerous, unethical process.
     

  3. I trust the integrity, education and competence of those involved with fluoridation studies, promotion, regulation and implementation who support the process:   
    Response to pro-fluoridation comments in an article describing the 2013 fluoridation debate in Brooksville, FL
    The only thing you're "experts" in, is depopulation, eugenics, trying to kill most of us off, especially our children... You go ahead and drink the water, use it in your toothpaste; it's probably why you're so dumbed down already. Keep up the good work; you'll be gone soon...And good riddance.

    Response to pro-fluoridation comments in a 2013 blog about fluoridation vote in Portland OR
    To all the people who voted "No"to fluoridation, congratulations. You have just let the government know that you are an intelligent freethinker who doesn't just follow the herd. Your name is now on a list of people who cannot be easily controlled. They know who you are, and they will be coming.

    Blog comment on the Anti-Fluoridation Association of Mildura site

    It seems if you have enough money and pay the right amount you can buy your qualifications, oh and being a brown nosed yes man to boot, will get you even more browney points and "positions of importance!"
    That's what seems to be happening here on the proponents of fluoridation side because they are playing with people's lives like they just don't count/matter and they spew out facts and figures with no science at all backing them up that would stand up in a court of law.
    The more extreme characterization of fluoridation supporters by those opposed to the process often can be seen (as shown to the right) in open comments to articles and blogs that discuss fluoridation. 

    I believe, however, that the vast majority of the scientific, medical, dental, governmental and water treatment professionals who are charged with studying water treatment processes and health effects of various substances, caring for patients, regulating water quality and providing safe and affordable drinking water to our homes are overwhelmingly competent, intelligent, informed, well intentioned and trustworthy,

    They are not part of conspiracies to dispose of toxic waste products in our drinking water or deliberately increase the number of children with dental fluorosis to provide more business for the dental profession as alleged by FOs.  If bias, mistakes or fraud do occur in scientific endeavors it is the processes of science and the integrity of the majority or scientists that eventually expose the problems. 

    On August 9, 2007, the Fluoride Action Network released the Professionals' Statement calling for an End to Water Fluoridation.  According Connett, "The Professionals' Statement is the rock on which we will build the rest of our campaign."  The petition concludes:

    • We call upon Members of Congress (and legislators in other fluoridating countries) to sponsor a new Congressional (or Parliamentary) Hearing on Fluoridation so that those in government agencies who continue to support the procedure, particularly the Oral Health Division of the CDC, be compelled to provide the scientific basis for their ongoing promotion of fluoridation. They must be cross-examined under oath if the public is ever to fully learn the truth about this outdated and harmful practice.

    • We call upon all medical and dental professionals, members of water departments, local officials, public health organizations, environmental groups and the media to examine for themselves the new documentation that fluoridated water is ineffective and poses serious health risks. It is no longer acceptable to simply rely on endorsements from agencies that continue to ignore the large body of scientific evidence on this matter -- especially the extensive citations in the NRC (2006) report discussed above.

    For me, there are two extremely troubling claims (both explicit and implicit) that FOs make in this petition and in their other literature.

    A. Every one of the scientific, medical, dental, government employees and water treatment professionals who support fluoridation (many with family members that drink fluoridated water) and who are charged with studying water treatment processes, caring for patients, testing &/or regulating water quality and providing safe and affordable drinking water to our homes blindly rely on endorsements of the safety and effectiveness of fluoridation without carefully and continually examining the fluoridation evidence for themselves

    B. The professional leadership of all the agencies and organizations (list 1 list 2) that support fluoridation, like the American Dental Association, Center for Disease Control, American Academy of Pediatrics, American Medical Association, American Water Works Association, World Health Organization, continues to ignore the scientific evidence.

    The only reasons I can think of to explain these two claims are that FOs seriously believe fluoridation supporters have one or more of the following characteristics - we are all:

    • too incompetent to design and carry out high quality research on fluoridation issues.

    • too lazy to have really examined and accurately evaluated the available evidence - just go with the flow.

    • too ignorant or stupid to understand the research and evaluate the evidence and implications correctly.

    • too biased in our fanatical support of fluoridation to evaluate the evidence impartially.

    • too arrogant to admit that we could be wrong.

    • too scared to speak out against majority beliefs even though we really believe fluoride is dangerous at recommended levels.

    • so gullible that we believe other fluoridation supporters without question.

    • part of the greedy, unscrupulous government, industry, or dental interests who stand to profit either by disposing of toxic waste products in our drinking water or deliberately increasing the number of children with dental fluorosis to provide more business for the dental profession.

    • lackeys, who are under the control of special government or greedy industry interests to save money by dumping hazardous wastes in our drinking water.

    • too apathetic to take a stand to protect society (including our friends, neighbors and families) from the evils of fluoridation even though we actually believe fluoride is dangerous at recommended levels.

      and/or

    • so cruel and deceitful we enjoy feeding false information about fluoridation to the public and relish watching the resulting pain and suffering.

    Why else would FOs would create such a sweeping petition statement?  What other reasons could explain the widespread acceptance of fluoridation as a safe and effective treatment by most experts and professionals?

    These are serious implicit accusations.  Is it reasonable to believe that the majority of scientists, medical professionals, governmental officials, water treatment professionals in the United States and World Wide have one or more of the above characteristics?

    The only alternative to the FOs petition statement claims is that they are mistaken in their beliefs, and the large body of evidence has not been ignored, but has been (and continues to be) fairly examined by competent experts and found to support fluoridation.

    Personally, I find it easier to believe that a few thousand FOs might be misinterpreting the evidence and exaggerating the risks of fluoridation because of their strongly held ethical and moral beliefs than the alternative; that most members of the scientific, dental, and medical communities who study fluoridation issues and those who regulate and treat our drinking water are ignorant, incompetent, misguided or deliberately evil.

    • If there were a real fluoridation debate in the scientific community;

    • if the weight of evidence did not strongly favor the pro-fluoridation position;

    • if there were no strong scientific consensus favoring fluoridation;

    • if the scientific, dental and medical communities were more-or-less evenly split on the benefits and risks of fluoridation (like the relatively equal division of people into the main political parties);

    • then I would be more sympathetic to the anti-fluoridation position.
       

  4. Discussions about the political, moral, economic and ethical issues of fluoridation (or any other governmental intervention) are separate from evaluation of scientific evidence for the effectiveness and safety of fluoridation: 
    There has always been controversy surrounding individual rights vs. the obligations and mandates of the government to provide laws, regulations, rules and services that affect the entire population.  Government interventions are evaluated by balancing the overall risks, benefits and costs to the impacted population, regardless of what some individuals might choose.  There are many examples of government intervention designed to benefit () the majority of citizens, sometimes at the potential inconvenience or increased risk of harm () to others: These are just a few random examples:
    • Drinking water regulations that require drinking water providers to meet safety and quality standards:  () Enables nearly all residents of countries with strict drinking water regulations the luxury of being able to drink their tap water with a reasonable expectation that it's safe.  () The more stringent the regulations and the greater the number regulated contaminants, the more difficult and expensive it is for water companies to meet the standards and the more expensive the treated water becomes.

    • Addition of chlorine, other disinfectants and other chemicals to drinking water: () Drinking water disinfection by chlorine and other disinfectant methods save countless lives by reducing water-borne illnesses.  Other treatment processes reduce other harmful contaminants, adjust pH to produce safer water.  () Treatment affects the taste, and the resulting disinfection byproducts may increase the risk of some cancers or cause other health problems.

    • Seat belt laws and air bags: () Saves many lives directly by protecting individuals in most crashes, and indirectly by possibly helping the driver maintain control after impact to prevent additional collisions.  () Seat belt use inconveniences some people and may kill or injure others in certain types of accidents.

    • Smoking laws and label warnings: () Save lives and medical costs if kids mature enough so their brains can make rational decisions by the time they can legally purchase cigarettes, and help protect innocent non smokers from the invasive stench and potential risks of second hand smoke.  () Smokers are inconvenienced and the profits of tobacco companies are reduced.

    • Laws against driving while drunk, texting or talking on cell phones: () Prevent inebriated and distracted individuals from attempting to drive a potentially lethal weapon.  Protects innocent citizens from death and injury.  () Drunks, texters and phone users are inconvenienced.

    • Strong encouragement or mandates for Immunization against communicable diseases: () These measures are critical to prevent or minimize outbreaks of potentially devastating epidemics.  Countless lives have been saved since immunization programs were developed and initiated.  () There may be a risk of harmful side effects for a very few individuals who receive vaccinations.

    • Requirements for FDA approval on medications that claim to treat specific diseases:  () Helps protect consumers from ineffective or harmful products.  () Inconvenience and reduced profits of those who would like to legitimize and sell products to the public for which there is no scientific evidence of effectiveness beyond the placebo effect.

    • Eminent Domain Laws give the government power to take (with compensation) private property against the owner's wishes:  () These laws provide some beneficial public use.  () This action may not be perceived as beneficial (or the compensation fair) by the land owner affected by the judgment.

    Some of the governmental interventions described above are accepted nearly unanimously as justifiable, while others are more controversial.  Public acceptance depends on how the risks, benefits and costs of regulations or interventions are defined and perceived.  In each of these cases, however, the risks, benefits and costs of the proposed government intervention must be clearly understood, defined and accurately evaluated separately from (and before) the discussion about whether or not the government should act. 

    Another consideration of a science-based evaluation of whether or not to pursue intervention is a thorough consideration of the benefits, risks and costs of not intervening.  In each of the above examples there would be real, measurable consequences if no action were taken by the government.  In the case of fluoridation, there is significant evidence that without fluoridation there would be more individuals with health problems related to an increase in dental decay.  Evidence-based decisions are often a balancing act where benefits are maximized for a greater number of people while minimizing risks for as many individuals as possible while keeping costs reasonable - there are no, no-risk options.

    However, if a person deeply believes that government has almost no business interfering with a person's life or personal decisions, it is unlikely that any evidence about risks, benefits and costs will change their mind about whether or not government should or should not act in a situation they perceived to be an individual right or government interference. 

    The political beliefs and ethical concerns that fluoride is a drug and that the government has no business 'medicating' any citizen without their consent appear to be of primary importance to many FOs and would probably be held even if there were no evidence of any risk from fluoridation.  Consequently, it seems impossible for FOs to separate the discussion of fluoridation safety and effectiveness from their moral principles.  Evidence that does not support the anti-fluoridation position must be dismissed, not on its own merits, but because it does not support a belief which must be defended at all costs by any evidence that can be found.  The normal assessment process of risks, benefits and costs to the affected population do not apply.

    FOs will counter that all the doctors, dentists, scientists, government representatives and water industry professionals who support fluoridation have an equally strong moral conviction to force medications on the public regardless of consequences, and some individuals and groups also have a financial motive to poison citizens by disposing of toxic waste in their drinking water.  FOs will also claim their anti-fluoridation evidence is dismissed, not on its own merits, but because it does not support a position which must be defended at all costs by any evidence that can be found.  I simply do not buy those arguments. 
     

  5. My own observations and experiences and studies do not support the claim that water fluoridation is harmful at levels typically experienced in drinking water: 
    Fluoride level Fluoride ion concentration Rate of dental caries* Prevalence of dental fluorosis ^ Mean DMFT
    low <0.7 ppm 60.5% 29.8% 1.18
    medium 0.7-1.2 ppm 17.6% 47.2% 0.22
    high 1.2-4 ppm 32.4% 96.6% 0.46
    very high 4-6.28 ppm 54.8% 100.0% 0.92
    * Combined rate of dental caries (12 & 15 years old, male and female)
    ^ Combined prevalence of dental fluorosis (12 & 15 years old, male and female)  This includes all levels of dental fluorosis, from very mild to severe.
    Mean DMFT: The average number of teeth or surfaces that are decayed (D), missing (M), or filled (F) in an individual
    Dental Fluorosis and Dental Caries Prevalence among 12 and 15-Year-Old School Children in Nalgonda District, Andhra Pradesh, India (Sukhabogi Jr, et. al., Ann Med Health Sci Res. 2014 Sep;4(Suppl 3))  Article Link

    I live in a large city, Denver  Colorado, and the municipal water provider (Denver Water) has been adjusting fluoride levels to average about 0.9 mg/L from 1953 until 2011 when a new standard of 0.6 - 0.7 mg/L was adopted.  I have lived in Denver since about 1948, and the period during which my permanent teeth were developing, 1948 - 1952 drinking water was not fluoridated. 

    My permanent teeth were very susceptible to decay.  The dentist scene from the 1986  movie, Little Shop of Horrors, perfectly illustrates my memories of enduring pain from tooth drilling without Novocain while hearing the high-pitched whine of the drill and smelling the associated odor of burnt tooth enamel during early childhood visits to the dentist.  Memories run deep, and dental visits are still not one of my favorite outings even though my teeth now appear to be far more resistant to decay.

    Obviously, I can't state with absolute certainty that my decay-prone teeth were a result of low levels of the fluoride ion in my drinking water or that the significantly lower decay rates I have experienced in the years after fluoridation was implemented and Crest was introduced in the mid 1950s has been a result of exposure to the fluoride ion.  I can say, however, that my personal experience confirms the published evidence which shows protection from dental carries and a very low risk of harmful health issues.

    I have not seen evidence of significant dental fluorosis in the fluoridated community in which I live.  Dental fluorosis is mottling of the teeth that can range from barely noticeable white spots to very noticeable brown staining.  This is the most obvious indication that children in a community with fluoridated water have been exposed to truly excessive and harmful levels of the fluoride ion - this risk is acknowledged by both fluoridation supporters and opponents.  It is no hidden secret - if you have too much exposure to the fluoride ion while your permanent teeth are developing your risk of dental fluorosis increases. 

    It is an extremely well established fact --- The greater the concentration of the fluoride ion you are exposed to, the greater the risk of very noticeable staining.  Studies typically describe the percentage of individuals with very mild to mild fluorosis at consistent exposure to fluoride levels of 1.0 ppm or below (natural or fluoridated) as very low. 

    Fluoridation opponents have presented no good evidence I am aware of to demonstrate a significant percentage of individuals have noticeable levels of fluorosis in communities with fluoride levels of 1.0 ppm or below.  In communities with natural fluoride levels of 2 ppm fluorosis becomes noticeable in a larger percentage of residents, and in communities with natural fluoride levels of 4.0 ppm or above a significant number of individuals will have moderate to severe fluorosis and perhaps other health issues.  Note: Community water fluoridation has never been used to raise the fluoride ion levels above 1.2 ppm, and the current recommended level is 0.7 ppm.

    If drinking water with around 1.0 ppm fluoride is as harmful as alleged by FOs, then fluoridated communities, like Denver, should be filled with far more individuals suffering from obvious dental and skeletal fluorosis, brain damage, fractures, low IQ, thyroid damage, cancer, reproductive problems, increased lead exposure, and a host of other problems attributed to fluoride exposure than residents of communities with negligible fluoride levels.

    As you read materials provided by FOs you will notice (if you dig deeply enough behind the alarming headlines) that evidence provided to support claims of the alleged serious effects of long term exposure to levels of fluoride below 1.0 ppm are generally prefaced with 'may cause', 'a possible correlation', or 'may increase'. There is a reason for those qualifications - the actual evidence really does only suggest possible relationships, and does not provide sufficient proof of cause and effect to generate fear in most people or to change the scientific consensus.

    If the fluoride ion were as dangerous at low exposure levels as claimed by FOs (or if a significant number of people were actually exposed to dangerously high levels), why is it not obvious to the casual observer, never mind researchers who are searching for both beneficial and harmful consequences of fluoridation?  At this point in time I believe careful fluoride research should continue, but I do not believe the evidence which suggests fluoridation is ineffective or dangerous that's available, more than 65 years after fluoridation began in the U.S., is significant enough to cause the anti-fluoride hysteria I observe on the Internet.

Tactics of Fluoridation Opponents

  1. I do not agree with the anti-science tactics Fluoridation Opponents (FOs) use to promote their message:  FOs claim to provide convincing scientific evidence that fluoridation is ineffective and harmful to health at recommended levels, yet their tactics are completely anti-science.  In fact, as noted above, they have failed for over 70 years to convince the mainstream scientific, dental, medical, governmental, and water treatment communities that their concerns are valid.

    FOs have, however, taken their message directly to the media and public with tactics designed to panic, confuse and misinform average citizens who do not have the time nor the background to critically evaluate the available evidence.  Even if I believed the evidence clearly demonstrated the devastating health effects claimed by FOs or believed fluoridation was unethical, I would not endorse the disinformation and fear provoking tactics employed by FOs.  Use of these tactics ultimately destroys any credibility I might otherwise find in anti-fluoridation arguments.

    This article and this one provide a more complete description of FO tactics than my list below.

    Tactics:
    "Cherry Pick" Data  |  Flawed and False Arguments  |  Accidents happen  |  Shock and Scare  |  Data Overwhelm  |  Debates  |  Misuse of Information


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    Copyright - 2005, Randy Johnson. All rights reserved.

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Updated April 2015